Everyone knows that peptic ulcers are due to excess stomach acid caused by stress, spicy food and alcohol, right? And the treatment for ulcers is milk, a bland diet and stress reduction, right?

Wrong on all counts.

Peptic ulcers develop in the stomach or in the upper part of the small intestine, called the duodenum. They cause a burning pain, which is worse when the stomach is empty. Eating food and taking antacids help relieve the pain temporarily.

About one in 10 Americans will develop an ulcer at some point. Sometimes ulcers heal on their own without treatment. But, they can become severe and cause bleeding or perforation of the stomach wall. These are dangerous complications requiring immediate medical care.

There are two main causes of peptic ulcers. About 20 percent are caused by overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen. The other 80 percent of ulcers are caused by bacteria called Helicobacter pylori, which can infect the stomach or upper intestine.

In the early 1980s, two Australian scientists discovered ulcers are caused by bacteria called H. pylori, which makes the lining of the stomach and duodenum prone to damage by stomach acid. Their discovery was met with skepticism at first. It took over a decade before H. pylori was generally accepted as a cause of ulcers.

In the late 1990s, tests for H. pylori were developed and came into widespread use. Anyone suspected of having a peptic ulcer can be tested for H. pylori infection with a blood test, a breath test or a biopsy.

Blood tests for H. pylori measure antibodies against the bacteria. These tests are up to 95 percent accurate in diagnosing an H. pylori infection. However, blood tests are not useful in determining whether or not the infection is cured after treatment.

The breath test for H. pylori is up to 98 percent accurate. To prepare for the test, the patient first drinks a special solution. If H. pylori is present, the solution mixes with the bacteria and forms a carbon that can be measured when the patient exhales.

The best way to test for H. pylori is to have a biopsy taken of the ulcer itself. To do this, the patient has an endoscopy, in which a thin, flexible tube is inserted through the mouth into the stomach and upper intestine. Then, tissue samples are taken of the ulcerated areas. These samples are tested for the presence of H. pylori.

Once it is determined a peptic ulcer is caused by H. pylori, treatment is aimed at eliminating this bacteria and reducing stomach acid. There are multiple FDA-approved treatment regimens that include a combination of two or three drugs taken for 10 to 14 days.

In the past, peptic ulcers tended to recur after treatment with antacids alone. Now, peptic ulcers can be cured with the addition of antibiotics.

There are still some unsolved mysteries about H. pylori. Not everyone who is infected with H. pylori will develop an ulcer. It is not understood why some people are more susceptible to ulcers than others.

About 45 percent of Americans have these bacteria in their gastrointestinal tract, compared to 80 percent of the population worldwide. This has lead to the theory that good hygiene reduces the risk of H. pylori infection.

Scientists believe H. pylori is transmitted from person to person, but do not fully understand how it is spread. Probably, people are infected in childhood, especially in developing countries.

If you have peptic ulcer symptoms, talk to your health care provider about getting tested for H. pylori.

Kathryn B. Brown is a family nurse practitioner with a master’s degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to kbbrown@eastoregonian.com. You can find more local health news and information in the Health section at www.chinookobserver.info.