Helicobacter pylori

What is it?
This is a bacteria commonly found in the stomach in about half the world’s population. Usually people have no symptoms, but it can cause problems including ulcers and rarely stomach cancer. Why only some people infected with H. pylori develop symptoms is unclear.

Who gets it?
In developed countries like the United States, people are usually infected as adults, with 50% of those older than 60 infected. In developing areas of the world, most children are infected before 10 years old and 80% of adults are infected before age 50.

Why does it happen?
H. pylori can infect the protective tissues that line the stomach and release chemicals that cause the immune system of your body to activate. With infection, the cells of the stomach and the first part of the small intestine, the duodenum, are more vulnerable to digestive liquids like acid. This sensitivity together with the activation of the immune system can cause a chronic inflammation. The bacteria are likely spread by eating food or water that is contaminated.

What are the symptoms?
Often, people with H. pylori have no symptoms. Possible symptoms include:

  • Abdominal pain or discomfort
  • Bloating
  • Feeling full after eating just a small amount of food
  • Nausea or vomiting
  • Lack of appetite
  • Dark, tarry stools
  • Low red blood count (anemia)
  • Fatigue

How is it diagnosed?
There are several ways to tell if you are infected with H. pylori, the most common tests include:

  • Blood test. This measures the level of a specific antibody (protein) that the body creates to try to fight infection with H. pylori. This test can be positive even if the infection is eliminated for months after treatment.
  • Breath test. A solution is drunk and if H. pylori is present within the stomach it will breakdown the substance; the levels of these breakdown products will be measured in your breath.
  • Stool test. This is measuring for H. pylori proteins in stool.


How is it treated?
H. pylori cannot be treated with just one medicine because it is very resistant to be killed so several medicines are taken for 7-14 days. It is important to take the medicine for the full course for successful treatment. Medicines such as those below are used:

  • Proton pump inhibitor (omeprazole-Prilosec, esomeprazole-Nexium, lansoprazole-Prevacid, dexlansoprazole-Kapidex, pantoprazole-Protonix, rabeprazole-AcipHex, dexlansoprazole-Dexilant).
  • These agents actually target the cells of the stomach that produce acid and shut down the pump that secretes acid so a new pump has to be produced.
  • Antibiotics. Typically two medicines are used to reduce the risk of failed treatment and antibiotic resistance.

Up to 20% of patients with H. pylori may not be cured after the first course of treatment. Typically, retreatment includes taking medicines for 14 days and at least one of the antibiotics will be different from the first round of treatment.

Should I confirm the bacteria are gone?
Confirmation the clearance is recommended in people such as those below:

  • Continued symptoms
  • H. pylori associated ulcer was present
  • Gastric mucosa associated lymphoid tissue (MALT) lymphoma is present
  • History of a surgery for gastric cancer

What are the complications?
Sometimes the chronic inflammation in the stomach can cause changes in the cells leading to certain forms of cancer. (This is not common, but because so many people in the world are infected it is still an important cause of stomach cancer.)

Up to 50% of people with H. pylori, when treated, experience side effects to the medicines used. Usually these side effects can be improved by changing the dose or timing. Rarely, do side effects progress to a level that treatment has to be stopped.

What can I do?
Reinfection with H. pylori once eradicated is unusual. Symptom recurrence usually means the initial treatment did not get rid of all the bacteria.

Some studies suggest that by taking a probiotic (live “good” bacteria that can be ingested to work in the gut) when treating for H. pylori eradication is more likely and there are less medication side effects.

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