HELICOBACTER PYLORI (H. pylori) OVERVIEW
Helicobacter pylori, also known as H. pylori, is a bacterium that is commonly found in the stomach. The vast majority of people who have H. pylori have no symptoms and will
never develop problems. H. pylori is one of the causes of peptic ulcers (stomach and duodenal ulcers), gastritis, and rarely stomach cancer. It is not clear why some people with H. pylori get these conditions and others do not.
HOW DOES ONE GET H. PYLORI
H pylori is very common, affecting an estimated half of the world’s population. The incidence is highest in developing countries and in crowded living conditions as the bacteria is transmitted from person to person. H. pylori is probably spread by consuming food or water contaminated with fecal matter. It has been difficult to find and prevent the actual sources and routes of transmission. In the United States and other developed countries, infection with H. pylori is unusual during childhood but becomes more common during adulthood.
H. PYLORI INFECTION
Most people with H pylori have no symptoms. About 20% will develop problems such as gastritis or ulcers. H. pylori causes inflammation to the stomach and duodenum (the first part of the small intestine). The bacteria infect the protective layer that lines the stomach. This leads to the release of certain enzymes and toxins and activation of the immune system. Together, these factors may directly or indirectly injure the cells of the stomach or duodenum. This causes chronic inflammation in the walls of the stomach (gastritis) or duodenum (duodenitis) and then ulcers from chemical action of stomach acid.
H. PYLORI SYMPTOMS
Most individuals with mild chronic gastritis or duodenitis have no symptoms. Ulcers can cause a variety of symptoms or no symptoms at all. Symptoms are usually upper abdominal pain, loss of appetite, and/or nausea. Bleeding ulcers usally are painless and present with vomiting blood or passing blood in the stool (often turns the stool black).
H. PYLORI TESTING
There are several ways to diagnose H. pylori:
Endoscopy – During endoscopy, a flexible scope is used to examine the upper GI tract in a sedated patient. A specific diagnosis can be made (ulcers, gastritis, acid reflux, cancer etc) and biopsies of the stomach can be done to detect the presence or absence of H. pylori.
Blood tests – A blood tests for the specific antibodies that the body’s immune system develops in response to the H. pylori bacterium.
Breath tests — Breath tests (known as urea breath tests) require that you drink a specialized solution containing a substance with a radioisotope tracer that is broken down by the H. pylori bacterium. The breakdown products can be detected in your breath by measuring the amount of radionuclide tracer exhaled.
Stool tests — Tests are available that detect H. pylori antigen (proteins) in stool.
WHO SHOULD BE TESTED FOR H. PYLORI?
H. pylori testing is often done when considering symptoms may indicate a possible ulcer or gastritis. H. pylori infection is a common cause of ulcers. Not all patients with ulcers have H. pylori, aspirin and NSAID’s (ibuprofen, naproxen, and others) can also cause ulcers.
H. pylori testing is usually not recommended if there are no symptoms to suggest H. pylori related disease.
H. PYLORI TREATMENT
H. pylori is somewhat resistant to therapy and a single antibiotic is not sufficient treatment. Treatment involves taking several medications for 7 to 14 days. Treatment regimens include an acid blocker called proton pump inhibitors (PPI). These medications decrease the stomach’s production of acid, allowing tissues damaged by the infection to heal. Examples of proton pump inhibitors include lansoprazole (Prevacid®), omeprazole (Prilosec®), pantoprazole (Protonix®), rabeprazole (AcipHex®), dexlansoprazole (Dexilant®), and esomeprazole (Nexium®) and Zegerid.
Two and sometimes three antibiotics are also given with the PPI. The optimal H. pylori treatment regimen continues to be researched and there are several o,ptions. The antibiotics may be all given together or sometimes sequentially (one then another). Typical antibiotics currently in use are metronidazole (Flagyl), or clarithromycin (Biaxin), amoxicillin, and tetracycline among others.
Treatment failure – 5- 20 percent of patients with Helicobacter pylori are not cured after completing their first course of treatment. A second and different treatment regimen is usually recommended.
Follow-up – After completing H. pylori treatment, repeat testing can be performed to ensure that the infection has resolved. Blood tests are not recommended for follow up testing; the antibody detected by the blood test often remains in the blood for four or more months after treatment, even after the infection is eliminated.