H. Pylori; The true stomach villian! Here's what internists should test and treat for
10 March 2019| Last updated on 11 March 2019
Have you ever heard of H. Pylori (Helicobacter Pylori), the most common pathogen of the upper gastrointestinal tract? Probably not, and in this case, the following could be of interest to you.
Identified in 1982 by Australian scientists, H. Pylori is believed to be present in the upper gastrointestinal tract of around 50% of the world’s population.
Of these, over 80% of cases are entirely without symptoms; that is, it’s not uncommon for people to have this bacteria living inside their bodies for an entire lifetime and not even knowing it!
Responsible for health conditions which were formerly believed to be caused by stress and poor diet, H. Pylori is now a recognized as a principal cause of persistent stomach inflammation and ulcers of the stomach or the first part of the small intestine (duodenum).
There is also evidence linking H. Pylori infection to iron deficiency anemia and vitamin B12 deficiency, with many scientists advocating its role in certain types of stomach cancer.
As a matter of fact, this bacteria is contagious, but how it spreads, that`s not yet wholly clear for scientists who put forward the probability of an oral-oral route (through direct or indirect exchange of saliva) or a fecal-oral route (through contact with unclean hands or surfaces, or drinking contaminated water).
Most infections are acquired in childhood and commonly within families, especially in developing countries.
The bacteria infects the protective coating that lines the stomach and this induces the release of certain enzymes and toxins, and subsequently, the alarming of the immune system.
Injury of the cellular lining of the stomach or duodenum ensues as it becomes more vulnerable to damage because of the acidic digestive secretions, and by time this leads to chronic inflammation of the stomach wall (gastritis), or duodenum (duodenitis).
What are the symptoms of H. Pylori Infection?
Most people with H. Pylori infection will not experience any symptoms. Despite uncertainty, it is widely believed that some people may be born with more resistance to the harmful impact of H. Pylori. As for those unfortunate ones who suffer its `wrath`, they tend to report some or all of the following symptoms:
- Upper abdominal pain
- Nausea or vomiting
- Lack of appetite
- Frequent burping
- Unexplained weight loss
Who should be tested for H. pylori?
The common question directed to medical professionals is: Should everyone be tested?
Well no, not everyone! Having H. Pylori is not a disease unto itself and therefore, routine screening is not recommended. If there are ongoing symptoms such as dyspepsia and discomfort / pain in the upper abdomen, a medical action should be taken to confirm the presence of the bacteria and investigate any abnormal changes in the stomach.
Under medical supervision, H. Pylori can be usually diagnosed by the following investigations:
- Urea breath test: performed by breathing into a prepared packet 20-30 minutes after swallowing a urea-containing pill (urea is a chemical comprised of nitrogen and a minimally-radioactive carbon). The bacteria generates an enzyme which breaks down urea into ammonia and carbon dioxide (CO2). High levels of carbon dioxide will trigger a positive reaction, confirming the presence of H. Pylori.
- Blood antibody tests: to detect whether specific defensive proteins; antibodies, have been produced by the body`s immune system in response to the presence of H. Pylori.
- Stool antigen tests: provide a direct evidence of H. Pylori infection in a stool sample by detecting specific proteins; antigens, which tend to exist on the surface of the bacteria.
If these tests are inconclusive and the symptoms persist, or with the presence of specific risk factors for stomach malignancy, the attending Internist may advise an upper gastrointestinal endoscopy to clearly visualize the stomach and obtain tissue samples if necessary.
How can H. Pylori be treated?
If an H. pylori infection causes symptomatic disease, the treatment would be focused, firstly, on the eradication of the present infection and, secondly, on the repair of any injury to the stomach.
Treating this bacterial infection and the irradiation of H. Pylori can be challenging, as rising rates of antibiotic resistance have rendered many traditional therapies useless.
Because of this, Internists nowadays tend to apply a more aggressive approach to treatment which involves prescribing a combination of three or four medications (which includes antibiotics) multiple times a day for at least 2 weeks.
Roughly speaking, the treatment is 80% effective in eradicating the bacterial infection, and the cure rate ultimately depends on choosing the ideal combination of medications, adhering to prescribed regimen of intake and finishing the full course of treatment.
Repeated testing four or more weeks after treatment ends is recommended to confirm the infection has been successfully cured.
One final advice
H. Pylori is a really important health topic since it’s so common all across the globe. It is often difficult to avoid the bacteria given that it is so widespread and our understanding about the routes of infection remains unconfirmed.
As a general rule, it is always wise to wash your hands regularly, to eat food that has been properly prepared, and to drink water from a safe, clean source.
If you're experiencing symptoms suggestive of gastritis that either recur or fail to go away, it is always wise to consult your trusted Internal Medicine doctor who will investigate H. pylori as a potential suspect. The testing is quick, safe and can help direct you to effective and lasting treatment.
Dr. Dragana Sarenac
Internal Medicine Specialist, MD
Dubai London Clinic