Peptic Ulcers - Complications

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Infection with H. pylori promotes a precancerous condition called atrophic gastritis. The process most likely starts in childhood. It may lead to cancer through the following steps:

• The stomach becomes chronically inflamed and loses patches of glands that secrete protein and acid. (Acid protects against carcinogens, substances that cause cancerous changes in cells.)
• New cells replace destroyed cells, but the new cells do not produce enough acid to protect against carcinogens.
• Over time, cancer cells may develop and multiply in the stomach.

When H. pylori infection starts in adulthood it poses a lower risk for cancer, because it takes years for atrophic gastritis to develop, and an adult is likely to die of other causes first. Other factors, such as specific strains of H. pylori and diet, might also influence the risk for stomach cancer. For example, a diet high in salt and low in fresh fruits and vegetables has been associated with a greater risk. Some evidence suggests that the H. pylori strain that carries the cytotoxin-associated gene A (CagA) may be a particular risk factor for precancerous changes.

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Although the evidence is mixed, some research suggests that early elimination of H. pylori may reduce the risk of stomach cancer to that of the general population. It is important to follow patients after treatment for a long period of time.

People with duodenal ulcers caused by H. pylori appear to have a lower risk of stomach cancer, although scientists do not know why. It may be that different H. pylori strains affect the duodenum and the stomach. Or, the high levels of acid found in the duodenum may help prevent the spread of the bacteria to critical areas of the stomach.

Other Diseases. H. pylori also is weakly associated with other non-intestinal disorders, including migraine headache, Raynaud's disease (which causes cold hands and feet), and skin disorders such as chronic hives.

Men with gastric ulcers may face a higher risk for pancreatic cancer, although duodenal ulcers do not seem to pose the same risk.

Review Date: 07/18/2011
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).