Helicobacter pylori, also known as H. pylori, is a bacterium that is normally found in the stomach. It is found in about half of the world's population.
The vast majority of people infected with H. pylori have no symptoms, and never develop complications as a result of the presence of the bacteria. However, H. pylori is capable of causing a number of digestive problems, including ulcers and, rarely, stomach cancer. It is not yet clear why some people with H. pylori suffer from these symptoms and others do not.
This article discusses the symptoms, testing, and treatment of H. pylori infection.
Risk factors - H. pylori is probably transmitted by consuming food or water contaminated with fecal content. H. pylori causes changes in the stomach and duodenum (the first part of the small intestine). The bacterium infects the protective tissue that lines the upper digestive system (stomach and duodenum). This infection leads to the release of certain enzymes and toxins which cause the activation of the immune system. Together, these factors may directly or indirectly damage the cells of the stomach or duodenum. This condition causes chronic inflammation in the walls of the stomach (gastritis) or the duodenum (duodenitis).
As a result of these changes, the stomach and duodenum are more vulnerable to damage from digestive juices, such as stomach acid.
In the United States and other developed countries such as Israel, infection with H. pylori is uncommon during childhood, but becomes more common during adulthood. However, in developing countries (third world countries), most children are infected with H. pylori before the age of 10.
The characteristics of Helicobacter pylori infection - most people with chronic gastritis or duodenitis have no symptoms. However, some people will have more serious problems, including stomach or duodenal ulcers. These ulcers may cause a variety of symptoms or be completely symptomless. The more common symptoms are:
● Pain or discomfort (usually in the upper abdomen)
● Swelling
● Feeling of abdominal fullness after eating a small amount of food
● Lack of appetite
● Nausea or vomiting
● Dark or black stools
● A bleeding ulcer can cause anemia and fatigue
Not infrequently, chronic gastritis causes abnormal changes in the stomach, which can lead to the development of certain types of cancer. It is rare to develop cancer as a result of Helicobacter pylori infection. However, because so many people in the world are infected with Helicobacter, it is considered an important cause of stomach cancer. People living in countries where H. pylori infection occurs at a young age (developing countries) are at the highest risk of stomach cancer.
Diagnosis - There are several ways to diagnose H. pylori. The most common tests include:
Breath tests - in a breath test (the so-called Uraz test) you have to drink a special solution containing a substance that is broken down by the Helicobacter bacterium, if it is present in the stomach. The decomposition products are then tested in the air exhaled from the mouth.
Stool tests - certain proteins of the Helicobacter bacterium can be detected in the stool.
Blood tests - blood tests can detect specific antibodies that the body's immune system develops in response to the H. pylori bacteria. However, due to the doubt about its level of accuracy, the use of this method is quite limited.
Who should be tested?
Presence of typical symptoms - a diagnostic test for Helicobacter pylori infection is recommended in situations where you are currently suffering from stomach or duodenal ulcers, or if you have previously suffered from ulcers in the upper digestive tract.
It should be noted - although H. pylori infection is the most common cause of ulcers, not all patients with ulcers have H. pylori. Certain medications (for example, aspirin, ibuprofen [Advil, Norofen, etc.]), naproxen [Nexin, Nerosin, etc.]) may also cause peptic ulcers, without Helicobacter bacteria.
If there are no symptoms - H. pylori testing is generally not recommended if there are no symptoms or a history of gastric or duodenal ulcer disease. However, in certain situations, it may be considered for specific populations, such as those with a family history of stomach cancer (especially people of Chinese, Korean, Japanese, or Central American descent; these groups have a higher incidence of stomach cancer)
Helicobacter pylori treatment - people with typical symptoms of infection with the bacterium, or with an active stomach and duodenal ulcer related to the bacterium should be treated. Successful treatment of H. pylori can speed up ulcer healing, prevent recurrent ulcers, and reduce the risk of complications (such as bleeding).
Medicines - There is no single medicine that treats H. pylori infection. Most treatment regimens include taking several different medications for 10-14 days.
● Most treatment regimens include drugs called proton pump inhibitors (PPIs). This drug reduces the production of acid in the stomach, thus allowing the tissues damaged by the infection to heal. Examples of proton pump inhibitors include omeprazole (Losec, Ompredex), lansoprazole (Lanton), esomeprazole (Nexium), pantoprazole (Controloc)
● At the same time it is common to take two different types of antibiotics; This combination reduces the risk of treatment failure and bacterial resistance.
• There is an increasing number of patients with antibiotic-resistant H. pylori infection, so it is important to take all medications as prescribed.
Side effects - up to half of the patients have side effects when taking treatment for H. pylori. Side effects are usually not severe, and only less than 10% of patients stop treatment due to side effects. For those who experience side effects, a certain change in medications or dosages can be considered.
Treatment failure - in about 10-20% of cases, the treatment fails and fails to eradicate the bacteria. In such situations, they usually switch to another treatment course, which is different from the first one, and sometimes includes three types of antibiotics instead of two.
Follow-up - after the completion of the treatment, a repeat test is usually carried out a month later to ensure that the bacteria has been eradicated. This is usually done with a breath test only. Blood or stool tests are not recommended for follow-up tests; The antibodies detected by these tests remain in the blood or stool for four or more months after treatment, even after the bacteria has been eradicated from the body.
The Figure was partly generated using Servier Medical Art, provided by Servier, licensed under a Creative Commons Attribution 3.0 unported license