Twenty years ago, I was diagnosed with a stomach ulcer. I was told to watch my diet and take antacids. No further testing was done, and the pain went away eventually. Now I have been told that bacteria cause ulcers. Is there any reason to suspect that I might still have the bacteria even if I don't have stomach pain at this time? If so, could I be tested? Would there be any benefit in eradicating the bacteria?

Dan

There is very good evidence that the bacterium Helicobacter pylori contributes to peptic ulcer disease. A many as 85 to 90 percent of duodenal ulcers (ulcers in the first part of the small intestine) are associated with the organism, while about 70 percent of gastric (stomach) ulcers are associated with it. The majority of ulcers that are not related to H. pylori are caused by the ingestion of large amounts of nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin) and ibuprofen (Advil).

Before the association with H. pylori was discovered, patients with ulcers were treated with acid-suppressing medication alone. These standard treatments were then compared with regimens containing antibiotics designed to eradicate H. pylori. The rate of ulcer recurrence was far higher in people who did not receive antibiotics.

Your case is complex. You say you had a stomach ulcer, but I wonder how it was diagnosed. Patients with stomach ulcers typically complain of abdominal pain and burning shortly after eating. However, diagnosing ulcer disease on the basis of symptoms alone is not very accurate. The two most reliable means of establishing the diagnosis are endoscopy (in which a gastroenterologist looks into the stomach and duodenum through a flexible tube) and barium swallow. For the barium swallow, the patient swallows barium and then has an X-ray. Because barium appears white on an X-ray, a radiologist looking at the image can see how the barium clings to lining of the stomach and duodenum, and can detect ulcerations. If you did not have one of these tests, then I would not be sure that you actually had a stomach ulcer.

Assuming you did have a stomach ulcer, then your risk of having H. pylori is about 70 percent. If you were taking a lot of NSAIDs, such as ibuprofen or indomethacin, the likelihood may be somewhat lower. If you had H. pylori, then your risk of ulcer recurrence was or even still is rather high. The fact that you have not had symptoms of an ulcer does not necessarily mean that you are free of disease, as some stomach ulcers are asymptomatic.

Here are my suggestions: If you did not have a confirmatory test to prove that you had an ulcer, such as a barium swallow or endoscopy, do nothing unless you develop symptoms. If you had a confirmed ulcer, then you might want to be tested for H. pylori. If a blood test is positive, you should consider therapy with one of the many antibiotic regimens to eradicate the bacteria. This is the approach recommended by the American College of Gastroenterology.

By the way, the general population should not be tested or treated for H. pylori. This is only of proven benefit for people with ulcers. It is not clear whether treatment is beneficial for people with abdominal complaints without an ulcer (a syndrome called "nonulcer dyspepsia") who also show evidence of H. pylori infection.