Facts and Definition of Helicobacter Pylori (H. pylori)
- H. pylori is type of bacteria that infects about 50% of the population.
- H. pylori infection is associated with inflammation of the stomach lining (gastritis), and duodenum (part of the small intestine).
- H. pylori bacteria burrow into the cells of the stomach lining and cause gastritis.
- H. pylori is the most common cause of gastric ulcers and gastritis.
- Ten percent of those infected with H. pylori may develop an ulcer. Also, those infected have an increased risk of stomach cancer and lymphoma.
- Symptoms of H. pylori infection include
- The presence of the H pylori bacteria in the stomach may decrease the prevalence of esophagitis by decreasing the amount of stomach acid that refluxes back into the esophagus. This in turn leads to a decreased risk for esophageal cancer in those infected with H. pylori.
- H. pylori bacteria are found most frequently in underdeveloped countries; but with improved economic conditions, the rate of infection in the population decreases. The infection rate in the United States is between 20%-30%, however, it is higher in Hispanics, African Americans, and the elderly.
- H. pylori is diagnosed by blood, breath, or stool tests.
- Natural treatment and cures for H. pylori infection have not been scientifically proven to cure the infection
- The American College of Gastroenterology has developed guidelines for the treatment of H. pylori infection.
- Treatment for H. pylori involves antibiotics to eradicate the infection as well as medications to decrease the amount of stomach acid.
- Triple therapy of either Levaquin (levofloxacin) or rifabutin in combination with amoxicillin and esomeprazole has resulted in high cure rates.
- There is no special diet that can eradicate or cure H. pylori infection.
- H. pylori infection is contagious and seems to be spread from person to person by saliva.
- Personal hygiene an important preventive measure to decrease the risk of decreasing human-to human-transmission of H. pylori.
- The prognosis for H. pylori is good in most cases. Many infections are mild and produce few, if any, symptoms. Those with severe infection and ulcers have a more guarded prognosis since ulceration can lead to bleeding and other damage.
What Is H. Pylori Infection?
Helicobacter pylori (H. pylori) is a type of bacteria responsible for widespread infection with more than 50% of the world's population infected, even though most of those infected have no symptoms. H. pylori infection is associated with low grade inflammation of the stomach and duodenum (the first part of the small intestine that empties the stomach).
The bacteria has evolved to survive in the acidic environment of the stomach where enzymes digest food.
What Are Symptoms of H. Pylori Infection?
The majority of people who are infected with H. pylori are symptom and disease free.
For those who do have symptoms, gastritis and ulcers are the results of an H. pylori infection. These illnesses are characterized by:
- upper abdominal pain;
- loss of appetite;
- nausea and vomiting; and
- if severe enough, bleeding into the gastrointestinal tract.
Abdominal pain is usually described as a burning sensation in the central upper abdomen below the ribs. It may be associated with bloating, burping, and loss of appetite. Often the symptoms occur after eating, and many times patients waken in the early morning hours with abdominal pain.
If there is enough inflammation, bleeding is possible from the stomach lining or from an ulcer, a small crater-like area in which the inflammation has caused the protective lining of the stomach to wear away. Symptoms of bleeding include vomiting blood and passing black, tarry stools. The black stools are a result of blood that has been metabolized and partially digested.
Note: that iron and bismuth subsalicylate (Pepto-Bismol, Pink Bismuth) will also turn the stools black.
What Causes H. Pylori Infection?
While the exact mode of transmission H. pylori is not known, it seems to be spread from person to person by saliva, and most people who are infected become infected as children. It also has the potential to be spread by fecal contamination. This may explain why the rate of infection is so high in poorer countries and in socio-economic groups characterized by crowded living conditions, poor sanitary conditions, and lack of clean water. Personal hygiene is also very important since food preparers who may not perform adequate hand washing may be potential sources of infection.
As mentioned previously, most people who become infected do so in childhood. After being ingested, the bacteria burrow through the protective mucosa that lines the stomach to attach to deeper layers of the stomach, where they can reside for years without causing symptoms.
When Should You Seek Medical Care For H. Pylori?
It is always appropriate to see your health-care professional for abdominal pain. Symptoms of diseases of many organs in the abdomen can be upper abdominal pain, nausea, and vomiting. For example, gallbladder, liver, pancreas, and kidney ailments may have abdominal pain as the presenting symptom. Upper abdominal pain and nausea may be an atypical presentation of angina, or pain from coronary artery disease.
Vomiting blood or passing black, tarry, or bloody stools are medical emergencies and should not be ignored. Accessing care at an emergency department or by activating the emergency medical system (call 911 if available) is appropriate. Sudden, severe pain is also an indication to seek urgent or emergent care.
Which Specialties of Doctors Treat H. Pylori Infections?
H. pylori infection may be treated by primary care providers including internists and family medicine specialists. Specialists in gastrointestinal diseases, known as gastroenterologists, often treat patients with H. pylori infection.
What Tests Diagnose H. Pylori?
Testing for the H. pylori infection may be performed on blood, stool, or breath samples. Also, biopsies or small bits of tissue from the lining of the gastrointestinal tract obtained during endoscopy can be tested for the presence of H. pylori.
Usually this testing is done after the diagnosis of gastritis or ulcer is made. Diagnosis depends upon the health care practitioner taking a patient history and asking specific questions. Aside from the infection, there are other, lifestyle-related causes of gastritis and ulcers including smoking, alcohol consumption, and nonsteroidal anti-inflammatory medication use, for example, aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve).
Physical examination will yield more information regarding the diagnosis of abdominal pain. In addition to examining the abdomen, a rectal examination may be performed to test for blood in the stool.
In addition to testing to testing for the presence of the H. pylori bacteria, other blood tests may be performed to screen for anemia (low red blood cell count) and other diseases. A urine sample may be taken to look for infection.
If there is a concern that an ulcer is present, arrangements may be made for a consultation with a gastroenterologist and possible endoscopy, in which the gastroenterologist uses a thin tube containing a camera to examine the lining of the esophagus, stomach, and duodenum.
Alternatively, an upper GI series may be performed to look for an ulcer. In this test, X-rays of the abdomen are taken after the patient swallows barium or another type of contrast material. If a gastric ulcer is found, endoscopy is usually recommended, since some ulcers have the potential to become cancerous. Ulcers in the duodenum typically do not have this potential.
What Medications Treat H. Pylori Infection?
The therapy for Helicobacter pylori infection involves multiple steps. In addition to antibiotics to eradicate the bacteria, another goal is to decrease the amount of acid secretion in the stomach and remove risk factors for further stomach irritation.
A two week course of combination antibiotic therapy is recommended.
Proton pump inhibitors and H2 blocker medications decrease acid secretion in the stomach and are often prescribed for a minimum of two weeks.
- Proton pump inhibitors
- H2 blocker
Bismuth therapy with Pepto- Bismol is sometimes recommended, especially if the first round of antibiotic therapy failed. Please remember that this treatment will cause stools to turn black.
- Avoid alcohol
- Take aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve) only with approval of your health-care professional
- Stop smoking
Can H. Pylori Infection be Prevented?
Personal hygiene is the first step in decreasing human to human transmission. This is especially important for those involved in food preparation, either in the home or in public places. Vaccines to prevent the infection are being developed but are still in the research phase and not available for human use.
Helicobacter pylori is a worldwide epidemic, and the bacteria have infected humans for thousands of years. It is seen more frequently in populations afflicted with poverty and lack of access to clean water and sewage removal. Increasing basic living standards and providing clean water should decrease the potential for infection.
The diagnosis of Helicobacter pylori infection usually follows the diagnosis of gastritis or ulcer disease. With adequate antibiotic therapy, the bacteria should be eradicated and the risk of future complications decreased. While the infection may be gone, it is important to continue behavioral modification to prevent stomach inflammation from non-infectious causes.