About helicobacter pylori
What is helicobacter pylori?
Helicobacter pylori (H. pylori) facts
- Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation in the stomach and is a common cause of ulcers worldwide
- H. pylori causes chronic inflammation (gastritis) by invading the lining of the stomach and producing a cytotoxin termed Vacuolating cytotoxin A (Vac-A); these functions can lead to ulcer formation.
- Although many infected individuals have no symptoms, other infected individuals may have occasional episodes of:
- nausea and vomiting and
- abdominal discomfort.
- More serious infections cause symptoms of:
- abdominal pain,
- nausea and vomiting that may include vomiting blood,
- passing dark or tarry like stools,
- low red blood cell count (anemia),
- decreased appetite, diarrhea,
- heartburn, and
- bad breath.
- H. pylori is contagious; however some individuals may be simply colonized with the bacteria and the bacteria cause no disease.
- The diagnosis of H. pylori infection include antibody tests, urea breath tests, stool antigen tests, and endoscopic biopsies.
- Chronic infections with H. pylori weakens the natural defenses of the stomach so most individuals with symptoms need to be treated to prevent ulceration formation.
- H. pylori is difficult to eradicate from the stomach because of antibiotic resistance; consequently, two or more antibiotics are usually given together with a protein pump inhibitor (PPI) medication (for example, omeprazole [Prilosec, Zegerid] or esomeprazole [Nexium])
- In general, patients should be treated if they are infected with H. pylori and have ulcers. Moreover, patients with MALT lymphoma of the stomach progresses quickly if H. pylori is not treated and eradicated.
- Because about 50% of the world's population carries or is infected with H. pylori, prevention is difficult; however, recommendations to help prevent ulcers include:
- Reduce or stop alcohol intake and/or quit smoking
- Use acetaminophen instead of NSAIDs
- Avoid caffeine
- Check for symptoms of H. pylori infection after radiation therapy
- Avoid or reduce stress
- Good hand washing techniques with uncontaminated water will reduce chances of infection.
- Currently, no vaccine is available against H. pylori to prevent either colonization or infection.
- The prognosis for H. pylori infections is usually good to excellent, but up to 20% may have reoccurring infection. Untreated and more severe infections have a worse prognosis because of the potential for bleeding, anemia, and low blood pressure (hypotension) development.
What is Helicobacter pylori?
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation of the inner lining of the stomach (gastritis) in humans. This bacterium also is considered as a common cause of ulcers worldwide; as many as 90% of people with ulcers have detectable organisms.
H. pylori infection is most likely acquired by ingesting contaminated food and water, and through person to person contact. In the United States, about 30% of the adult population is infected (50% of infected persons are infected by the age of 60), but the prevalence of infection is decreasing because there is increasing awareness about the infection, and treatment is common. About 50% of the world population is estimated to have detectable H. pylori in their gastrointestinal tract (GI tract, but stomach, mainly).
The infection is more common in crowded living conditions with poor sanitation. In countries with poor sanitation, approximately 90% of the adult population can be infected. Infected individuals usually carry the infection indefinitely (for life) unless they are treated with medications to eradicate the bacterium. One out of every six patients with H. pylori infection may develop ulcers of the duodenum or stomach. H. pylori also are associated with stomach cancer and a rare type of lymphocytic tumor of the stomach called MALT (mucosa-associated lymphoid tissue) lymphoma. In addition, several recent research papers have shown a link between diabetes, infections, elevated hemoglobin A1C levels, and H. pylori.
What are the symptoms for helicobacter pylori?
Abdominal discomfort symptom was found in the helicobacter pylori condition
Most people with H. pylori infection will never have any signs or symptoms. It's not clear why this is, but some people may be born with more resistance to the harmful effects of H. pylori.
When signs or symptoms do occur with H. pylori infection, they may include:
- An ache or burning Pain in your abdomen
- Abdominal Pain that's worse when your stomach is empty
- Loss of appetite
- Frequent burping
- Unintentional weight loss
When to see a doctor
Make an appointment with your doctor if you notice any persistent signs and symptoms that worry you. Seek immediate medical help if you experience:
- Severe or persistent abdominal pain
- Difficulty swallowing
- Bloody or tarry stools
- Bloody or vomit or vomit that looks like coffee grounds
What are the causes for helicobacter pylori?
The exact way H. pylori infects someone is still unknown. H. pylori bacteria may be passed from person to person through direct contact with saliva, vomit or fecal matter. H. pylori may also be spread through contaminated food or water.
What are the treatments for helicobacter pylori?
H. pylori is difficult to eradicate from the stomach because it is capable of developing resistance to commonly used antibiotics. Therefore, two or more antibiotics usually are given together with a PPI and/or bismuth containing compounds to eradicate the bacterium. (Bismuth and PPIs have anti-H. pylori effects.) Examples of combinations of medications that are effective are:
- a PPI, amoxicillin (Amoxil) and clarithromycin (Biaxin)
- a PPI, metronidazole (Flagyl), tetracycline and bismuth subsalicylate (Pepto-Bismol, Bismuth)
These combinations of medications can be expected to cure 70% to 90% of infections. However, studies have shown that resistance of H. pylori (failure of antibiotics to eradicate the bacterium) to clarithromycin is common among patients who have prior exposure to clarithromycin or other chemically similar macrolide antibiotics (such as erythromycin). Similarly, H. pylori resistance to metronidazole is common among patients who have had prior exposure to metronidazole. In these patients, doctors have to find other combinations of antibiotics to treat the H. pylori. Antibiotic resistance is another reason why antibiotics should be used carefully and judiciously for the right reasons, and indiscriminate use of antibiotics for improper reasons should be discouraged. First-line regimens for Helicobacter pylori eradication are taken from the guidelines developed by the American College of Gastroenterology as follows:
- Standard dose of a *PPI (proton pump inhibitor) *b.i.d. (esomeprazole is *q.d.), clarithromycin 500 mg b.i.d., amoxicillin 1,000 mg b.i.d. for 10-14 days
- Standard dose PPI b.i.d., clarithromycin 500 mg b.i.d. metronidazole 500 mg b.i.d. for 10-14 days
- Bismuth subsalicylate 525 mg p.o. q.i.d. metronidazole 250 mg * p.o. *q.i.d., tetracycline 500 mg p.o. q.i.d., ranitidine 150 mg p.o. b.i.d. or standard dose PPI q.d. to b.i.d. for 10-14 days
- PPI + amoxicillin 1 g b.i.d., for 5 days, followed by PPI, clarithromycin 500 mg, tinidazole 500 mg b.i.d. for 5 days (used mainly in other countries)
*PPI = proton pump inhibitor; pcn = penicillin; p.o. = orally; q.d. = daily; b.i.d. = twice daily; t.i.d. = three times daily; q.i.d. = four times daily.
A recent investigation reported that triple therapy of either levofloxacin (Levaquin) or rifabutin in combination with amoxicillin and esomeprazole yielded cure rates of 90% and 88.6%. The treatments lasted 10 to 12 days respectively (10 days of levofloxacin 20=50 mg b.i.d. or rifabutin 150 mg q.d. for 12 days. Amoxicillin was 1 gm esomeprazole was 40 mg, both b.i.d.).
Some doctors may want to confirm eradication of H. pylori after treatment with a urea breath test or a stool antigen test, particularly if there have been serious complications of the infection such as perforation or bleeding in the stomach or duodenum. Endoscopic biopsies to determine eradication of the bacterium are not necessary, and blood tests are not good for determining eradication since it takes many months for the antibodies to H. pylori to decrease. The best tests for determining eradication are the breath and stool tests discussed previously. Patients who fail to eradicate H. pylori with treatment are retreated, often with a different combination of medications.
Who should receive treatment for H. pylori?
There is a general consensus among doctors that patients should be treated if they are infected with H. pylori and have ulcers. The goal of treatment is to eradicate the bacterium, heal the ulcers, and prevent the ulcers' return. Patients with MALT lymphoma of the stomach also should be treated. MALT lymphoma is rare, but the tumor often quickly regresses upon successful eradication of H. pylori.
There currently is no formal recommendation to treat patients infected with H. pylori without ulcer disease or MALT lymphoma. Since antibiotic combinations can have side effects, and stomach cancers are infrequent in the United States, it is felt that the risks of treatment to eradicate H. pylori in patients without symptoms or ulcers may not justify the unproven benefits of treatment for the purpose of preventing stomach cancer. On the other hand, H. pylori infection is known to cause atrophic gastritis (chronic inflammation of the stomach leading to atrophy of the inner lining of the stomach). Some physicians believe that atrophic gastritis can lead to cell changes (intestinal metaplasia) that can be precursors to stomach cancer. Studies have also shown that eradication of H. pylori may reverse atrophic gastritis. Thus, some doctors are recommending treatment of ulcer- and symptom-free patients infected with H. pylori.
Many physicians believe that dyspepsia (non-ulcer symptoms associated with meals) may be associated with infection with H. pylori. Although it is not clear if H. pylori causes the dyspepsia, many physicians will test patients with dyspepsia for infection with H. pylori and treat them if infection is present.
Scientists studying the genetics of H. pylori have found different strains (types) of the bacterium. Some strains of H. pylori appear to be more prone to cause ulcers and stomach cancer. Further research in this area may help doctors to intelligently select those patients who need treatment. Vaccination against H. pylori is unlikely to be available in the near future.
Chronic infection with H. pylori weakens the natural defenses of the lining of the stomach to the ulcerating action of acid. Medications that neutralize stomach acid (antacids), and medications that decrease the secretion of acid in the stomach (H2-blockers and proton pump inhibitors or PPIs) have been used effectively for many years to treat ulcers.
- ranitidine (Zantac),
- famotidine (Pepcid),
- cimetidine (Tagamet), and
- nizatidine (Axid).
- omeprazole (Prilosec),
- lansoprazole (Prevacid),
- rabeprazole (Aciphex),
- pantoprazole (Protonix), and
- esomeprazole (Nexium).
Antacids, H2-blockers and PPIs, however, do not eradicate H. pylori from the stomach, and ulcers frequently return promptly after these medications are discontinued. Hence, antacids, H2-blockers or PPIs have to be taken daily for many years to prevent the return of the ulcers and the complications of ulcers such as bleeding, perforation, and obstruction of the stomach. Even such long-term treatments can fail. Eradication of H. pylori, however, usually prevents the return of ulcers and ulcer complications even after appropriate medications such as PPIs are stopped. Eradication of H. pylori also is important in the treatment of the rare condition known as MALT lymphoma of the stomach. Treatment of H. pylori to prevent stomach cancer is controversial and discussed later in this article.
What are the risk factors for helicobacter pylori?
H. pylori is often contracted in childhood. Risk factors for H. pylori infection are related to living conditions in your childhood, such as:
- Living in crowded conditions. You have a greater risk of H. pylori infection if you live in a home with many other people.
- Living without a reliable supply of clean water. Having a reliable supply of clean, running water helps reduce the risk of H. pylori.
- Living in a developing country. People living in developing countries, where crowded and unsanitary living conditions may be more common, have a higher risk of H. pylori infection.
- Living with someone who has an H. pylori infection. If someone you live with has H. pylori, you're more likely to also have H. pylori.