May 6, 2013

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

A couple of weekends ago, I got to hang out at the Max Bell Center at the University of Manitoba. My daughter Emily, Jessica Miner, Mallory Mathison-Eddie, Brie Toews, and Olive Jonasson from Ecole MacNeill all went to the Provincial Science Fair, the Manitoba School Science Symposium. The girls got to meet kids from all over province. They did some neat science activities like designing and flying paper rockets and making catapults out of mouse traps. I hope their experience got them excited by science.


One of my favorite stories of a real life science fair project involved Dr. Barry Marshall. Now dont try this at home, but he drank a beaker full of bacteria to prove a point. Before the early 1980s everyone assumed that no bacteria could live in the very acid human stomach. And it was assumed that stomach ulcers were caused by spicy foods and stress. As early as the late 1800s some bacteria were found in the stomach but they were assumed to be contamination, dead or due to a pre-existing hole in the stomach like an ulcer. In the late 70s and early 80s an Australian pathologist named Robin Warren became convinced that a special bacteria called Helicobacter pylori (H. pylori) did live in many peoples stomachs. When Dr. Warren eventually teamed up with the gastroenterologist Dr. Barry Warren in 1981, the two of them found lots of H. pylori in peoples stomachs during biopsies. Furthermore the H. pylori seemed to cause stomach ulcers. The scientific community was unimpressed. Dr. Marshall and Dr. Warren did a lot of work to convince the scientific community that H. pylori was a cause of stomach ulcers. However the one experiment that stands out for me is that Dr. Barry Marshall drank a beaker of H. pylori and gave himself an ulcer. Then he took a cocktail of antibiotics and cured his ulcer. Because of all the work Dr. Marshall and Dr. Warren did they got the Nobel Prize in Medicine in 2005. Their work re-wrote the medical texts on ulcers.


If you have consistent stomach problems like heart burn, hunger like pain that is relieved by food or antacids, you may have a stomach ulcer. Other symptoms can be discomfort after you eat, nausea and occasional vomiting. Not all stomach problems are ulcers, but if symptoms like these go on for more than a week or two, it is probably time to talk to your doctor to see what is going on with you.


If your doctor thinks that your stomach complaints might be an ulcer, they may test to see if you have H. pylori in your stomach. The test for H. pylori can be a breath test, a blood test, a stool test, or they may test your stomach lining directly with an endoscope. If you have H. pylori in your stomach, you will probably be given something called triple therapy.


Triple therapy is a cocktail of medication designed to kill off H. pylori in the stomach. It usually includes a PPI, amoxicillin and clarithromycin. A PPI is a proton pump inhibitor and reduces the amount of acid your stomach produces. PPIs have names like omeprazole, esomeprazole and pantoprazole. Amoxicillin and clarithromycin are antibiotics. You will probably have to take 1 pill of the PPI, 2 pills of amoxicillin and 1 pill of clarithromycin twice a day for 1 to 2 weeks. I know that is a lot of pills, but if you take all of them, there is a good chance we can kill off the H. pylori. As Dr. Marsh showed about 30 years ago, if we kill off H. pylori, we may permanently get rid of your stomach problems.


Triple therapy seems to kill off H. pylori about 80% of the time. If it fails, the doctor may consider something called quadruple therapy. The drugs change a little. They include a PPI, bismuth subsalicylate, tetracycline and metronizadole. Although quadruple therapy is very effective it is usually saved for second line because many people just dont want to take that many pills. Finally, quitting smoking is important. Smoking can stop or slow ulcers from healing, and can cause the sphincter at the top of the stomach to loosen. The sphincter is a muscular valve that lets food into the stomach. When smoking causes this sphincter to loosen, it can lead to heartburn.


Not all stomach problems are ulcers. Not all ulcers are caused by H. pylori. However, thanks in part to the Science Fair like stunt of Dr. Barry Marshall infecting himself with H. pylori, getting an ulcer and then curing the ulcer with antibiotics we now have an effective treatment for H. pylori caused stomach ulcers. So encourage your kids to enter Science Fairs. Let them discover something they didnt know before. Maybe their discovery will be something no one knew before. Your kids are where our next Nobel Prize winning breakthroughs will come from.



As always if you have any questions or concerns about these or other products, ask your pharmacist.


The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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