Cause of Gastritis and Ulcer Treatment : Treatment, Ulcer Bacterium and Cancer?

by Food and Drug Administration (FDA)

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Treatment

Quite a few helpful drugs are already on the market, though they are not approved for treating ulcers. FDA's role now is to wade through studies, old and new, to identify the best combinations of drugs, a process that was under way when this issue of FDA Consumer went to press. FDA is also considering new drugs to treat bacterial ulcers.

"We would really like to inform physicians quickly and also evaluate the data. There are many regimens proposed," says Gallo- Torres.

The consensus development conference examined several treatment plans. Its report said that there had been extensive studies of bismuth subsalicylate (better known as Pepto Bismol), an antiprotozoan drug, Flagyl (metronidazole), and either the antibiotic tetracycline (giving an overall 90 percent cure rate) or amoxicillin (with an overall 80 percent cure rate).

According to the consensus development report, there had been one study of another regimen, consisting of amoxicillin, metronidazole and ranitidine, that showed a 90 percent effective rate. However, all of these approaches require a patient to take several different pills several times a day. The committee reported that a two-drug alternative, consisting of amoxicillin, taken four times a day, and Prilosec (omeprazole), taken twice a day, offers 80 percent effectiveness. However, at press time FDA had not verified these regimens.

Clearly, doctors will have many choices. But at the time of the conference, only 1 to 2 percent of U.S. physicians were treating an ulcer as they would a bacterial infection, according to the conference report.

Concluded conference member Daniel K. Podolsky, M.D., of Massachusetts General Hospital, "These recommendations represent a sea change in how we approach this problem. From this time forward, I would consider use of these drugs to be essential."

As data confirming the bacteria-ulcer link continue to pour in, medical researchers are already asking questions that will form the basis of future studies: What factors cause bacterial gastritis to develop into an ulcer? Do children have bacterial ulcers? Can the new treatments prevent complications, such as bleeding ulcers? Does H. pylori cause stomach cancer, and, if so, can we prevent it? (See accompanying article.)

Meanwhile, the future of current ulcer sufferers looks brighter than ever. Says consensus team member Ann L.B. Williams, M.D., of George Washington University Medical College, "We now have an opportunity to cure a disease that previously we had only been able to suppress or control."

Can the Ulcer Bacterium Also Cause Cancer?

It's been known for several years that people with a form of stomach cancer called gastric carcinoma are very often infected with H. pylori, and there is evidence that the infection precedes the cancer. More recently, researchers linked the microbe to a second type of stomach cancer, called primary gastric lymphoma.

This second type of malignancy affects lymphoid tissue — antibody-producing cells in the stomach. However, such cells are not normally present in the stomach unless there is an infection.

In the May 5, 1994, issue of The New England Journal of Medicine, a multi-center team led by Julie Parsonnet, M.D., of Stanford University, reported that people with gastric lymphoma also have H. pylori infection, and that the infection precedes the cancer. In an accompanying editorial, Peter G. Isaacson, D.M., of University College London Medical School, suggests that the bacterial infection initiates a chain reaction leading to cancer. He suggests that first infection causes chronic gastritis; then, the inflammation causes stomach lining tissue to overgrow; and, ultimately, excess growth may blossom into cancer, given some as- yet unidentified environmental trigger or genetic susceptibility.

But, so far, the link between H. pylori and cancer is far more tenuous than that between the bacteria and gastritis or ulcers. Fewer than 1 percent of people infected with the microbe develop cancer, and some populations in which many people are infected have very low stomach cancer rates. These facts, researchers say, suggest that several factors are at play. Still, it will be interesting to see if antibiotic/anti-secretory treatment can reduce incidence of these already rare cancers.

The consensus development conference convened to study H. pylori in February 1994 concluded, "if there is any causal relationship between H. pylori infection and gastric cancer, clearly other facts are also important." They recommend further study into whether eradicating the infection can prevent cancer.

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