If you don’t stop eating so much
spicy food, drinking so much coffee and driving yourself so hard at work, you’re going to give yourself stomach ulcers. Or maybe you won’t.

Everyone—including doctors—used to think that ulcers were the result of excess acid in the stomach caused by eating the wrong things and being too stressed out. But most ulcers are actually caused by a bacterial infection.

“A bug called H. pylori is the root cause of a lot of peptic ulcers,” says Michael Antil, M.D., an internal
medicine specialist with Pinehurst Medical Clinic. “It can easily spread from one family member to
another or to anyone living in close contact with someone who has that bug in their stomach.”

The lining of the stomach is made of pretty tough stuff, but when infection sets in, the acid in the stomach can start eating away the lining.

People with stomach ulcers typically have sharp, burning pain, especially right after eating. Other symptoms can include nausea, lack of appetite, bloating and belching. Endoscopy is the most effective diagnostic tool for ulcers of the stomach and upper part of the small intestine.

Fortunately, there are ulcer treatments that are very effective for most people. Doctors usually prescribe a combination of powerful antibiotics and acid suppressants. Very few people require surgery for ulcers anymore.

“Ulcers are just as prevalent as they have ever been, but now physicians are much more likely to treat them with antibiotics up front,” Dr. Antil says. “That decreases the recurrence of ulcers long term. We’re not always telling people they have to stay on acid suppression medicine for the rest of their lives.”

Part of the old belief about ulcers—that they are brought on by stress—is apparently true in many cases.

“I don’t know that a direct link has been found, but it has been proven that our immune system doesn’t function as well when we are under a lot of stress,” Dr. Antil says. “

The immune system and the anti-inflammatory chemicals that our body makes are involved in protecting the lining of the stomach.”

Good for your heart, bad for your stomach
The other major cause of peptic ulcers, second only to bacterial infection, is aspirin, according to Wayne Lucas, M.D., a gastroenterologist with Pinehurst Medical Clinic.

“Aspirin is a great medicine,” Dr. Lucas says. “It’s inexpensive, and it does wonderful things. It’s good for the joints and good for the heart, but it’s hard on the stomach. Even if you take a baby aspirin a day to protect your heart, it can result in ulcers.”

According to Dr. Lucas, it isn’t just plain aspirin that causes problems, but also anti-inflammatory
arthritis medicines that are similar to aspirin.

“Now that medicines such as Vioxx are being pulled off the shelf, people are going back to some of the older arthritis medicines, so I imagine we will be seeing more ulcers,” he says.

The beef about stomach cancer
If you eat a lot of meat and you like it well done, you are at greater risk for developing cancer of the stomach. Stomach cancer is much less common than some other cancers, but one study has found that people who eat beef well done or medium well are three times as likely to develop stomach cancer than those who eat beef rare or medium rare.

Ellen Willard, M.D.

That is because the process of cooking beef and other red meats produces cancer-causing chemicals. Researchers also found that people who eat beef at least four times a week have twice the risk of stomach cancer as those who eat beef less often.

“Many stomach cancers can be surgically removed, but there is a pretty high risk of them coming back,” says Ellen Willard, M.D., a medical oncologist with Pinehurst Medical Clinic and medical director of the Community Hospital Comprehensive Cancer Center at FirstHealth Moore Regional Hospital. “But now it has been shown that chemotherapy and radiation after surgery decrease the risk of recurrence. New studies also show that chemotherapy before surgery makes surgery easier.”

The small intestine
Doctors use scopes to diagnose problems in the throat, esophagus and stomach. They also have scopes to look for problems in the colon and rectum.

But the small intestine has always been the dark unknown, because there was no way to see what was going on in most of the 22 feet of tubing that winds through the abdomen from the stomach to the colon. There wasn’t a viewing device that could get through all those hairpin turns. Now there is.

About three years ago, physicians at Moore Regional were among the first in the state to use a wireless, scopeless diagnostic technology called capsule endoscopy. Patients swallow a capsule that contains a camera, transmitter, battery and strobe lights. Despite all that, the capsule is only about twice as large as the ones we routinely take for headaches.

As the capsule passes through the digestive system, it sends amazingly clear video pictures to a recorder that the patient wears on a belt around the waist. This technique is used most often to diagnose serious bleeding when other tests have not been able to find the cause or where it is coming from.

“Capsule endoscopy is becoming the standard of care for finding the source of bleeding that we believe is coming from the small intestine,” says Dr. Lucas.

If the bleeding is occurring at the far upper end of the small intestine near the stomach, doctors can stop it by cauterizing the leaking vessels with an instrument that is passed through an endoscope. Otherwise, the patient may need surgery or an angiography procedure to correct the problem.

Detecting Crohn’s disease
Capsule endoscopy is also useful in diagnosing other problems in the small intestine.

“We are using it increasingly for patients with diarrhea and looking for small bowel Crohn’s disease,” Dr. Lucas says.

William Hudgins, M.D.

Crohn’s disease is an inflammatory disorder of the lower end of the small intestine, which often causes severe pain and diarrhea. It also can cause so much swelling that the intestine becomes completely blocked. If Crohn’s disease is suspected, the patient typically has a radiology test.

“We have the patient drink barium, and then we take X-ray pictures every half-hour or so to see how far it has progressed through the GI system,” says William Hudgins, M.D., of Pinehurst Radiology Group. “We look very closely at the point where the small intestine connects to the colon, because that is where the problem is most likely to be.”

Crohn’s disease is sometimes hard to detect with X-rays, especially if the patient has a relatively mild case, so capsule endoscopy may be used.

“With the capsule, we can easily see the ulcers that people with Crohn’s disease often get on the lining of the intestine,” Dr. Lucas says.

The cause of Crohn’s disease isn’t clear, but it is believed to be an autoimmune disorder. One of the most effective medicines in treating it is one that is used to prevent organ rejection in kidney transplant patients. In severe cases that don’t respond to medication, the affected section of the small intestine may have to be removed.

A literal flip of the stomach
Margie Johnson felt bad all over. Her back hurt, she had trouble swallowing, and she felt bloated.

Her doctor referred her to Thomas Swantkowski, M.D., a gastroenterologist with Pinehurst Medical Clinic. He didn’t see anything wrong as he passed an endoscope down her esophagus. Then he got to her stomach.

Johnson’s stomach had flipped over and, instead of being in its normal location, part of it was up behind her heart. It’s something that happens only rarely, most often in older people.

Michael Rowland, M.D., a general surgeon with Pinehurst Surgical, performed a laparoscopic procedure to correct the problem. A day and a half later, Johnson was out of the hospital.

“I had no desire for food for a good while, and I lost about 35 pounds,” she says, “but now my appetite is back and I feel great.”