Helicobacter pylori (often shortened to H. pylori) is a type of bacteria that can infect the lining of your stomach and the first part of your small intestine (duodenum). This infection is very common worldwide, but what exactly does it do, and how is it treated?
H. pylori Symptoms: What to Watch For
Many people infected with H. pylori don’t experience any symptoms. However, in some individuals, H. pylori can lead to stomach irritation (gastritis), stomach ulcers, and duodenal ulcers. In rare cases, it can also be a risk factor for stomach cancer.
Common Signs of H. pylori Gastritis or Ulcers
- Abdominal Pain: This is often felt in the upper abdomen, below the rib cage and in the middle. It can manifest as an ache, discomfort, burning sensation, or sharp pain. Eating habits can influence the pain, sometimes worsening it, while other times, providing temporary relief.
- Nausea: A persistent feeling of sickness.
- Frequent Burping: Excessive burping than usual.
Other, more serious symptoms may suggest a bleeding ulcer or even stomach cancer. It’s crucial to consult a doctor if you experience:
- Vomiting blood
- Black, tarry stools
- Unexplained weight loss
- Severe abdominal pain
Helicobacter pylori Treatment: Eradicating the Infection
H. pylori is susceptible to specific antibiotics. However, a combination of medications is typically required for complete eradication. This combined approach is frequently called triple therapy or eradication therapy.
Antibiotics and Eradication Therapy
Eradication therapy usually involves taking three medications simultaneously for one week. This includes two different antibiotics (such as amoxicillin and clarithromycin) and an acid-reducing medication like omeprazole. Adhering strictly to the prescribed dosage and completing the entire course are crucial for successful treatment.
Success Rates and Potential Side Effects
Eradication therapy is effective in clearing H. pylori in up to 90% of cases when followed correctly. Failing to complete the entire course reduces the likelihood of eliminating the infection. If the initial treatment fails, a second course with different antibiotics is usually prescribed.
Up to 30% of individuals undergoing eradication therapy may experience side effects. Common side effects include:
- Diarrhea
- Nausea
- Taste changes
However, it’s important to persevere with the full course unless the side effects are severe. If the initial combination proves ineffective or causes intolerable side effects, an alternative set of medications may be recommended.
What Causes Helicobacter pylori Infection?
The precise mode of H. pylori transmission isn’t fully understood. It is thought that the bacteria spread from person to person. The infection is commonly acquired during childhood, likely from parents or siblings.
Possible transmission routes include:
- Saliva Contact: Through kissing or transferring infected saliva onto the hands and subsequently touching the mouth.
- Vomit Contact: Via traces of vomit on the hands followed by touching the mouth.
- Fecal Contamination: Through contact with feces (stool) from an infected person, such as by contaminating hands and then touching the mouth, or by consuming water or food contaminated by sewage.
Higher rates of H. pylori infection are frequently observed in developing countries with crowded living conditions and sanitation challenges, like unsafe drinking water.
H. pylori Test: When and How to Get Tested
Testing for H. pylori is crucial when you have symptoms or if you’re at risk.
Common Reasons for H. pylori Testing
- Persistent indigestion (dyspepsia) symptoms.
- Having a stomach or duodenal ulcer.
Other Reasons to Consider Testing
- Unexplained iron-deficiency anemia after other causes have been ruled out.
- Having a first-degree relative (parent, child, or sibling) diagnosed with stomach cancer.
- Having mucosa-associated lymphoid tissue lymphoma (MALToma).
- Having a condition called chronic idiopathic thrombocytopenic purpura.
H. pylori Screening
Routine screening for H. pylori in asymptomatic individuals is generally not recommended in many countries, including the UK. However, screening may be considered in regions with higher rates of H. pylori infection and stomach cancer, such as certain East Asian countries.
How is Helicobacter pylori Diagnosed?
Several methods are available to diagnose H. pylori infection:
- Urea Breath Test: This test detects a current H. pylori infection. You’ll drink a special liquid containing urea and then provide a breath sample for analysis. If H. pylori is present, it will break down the urea, and the breakdown products will be detected in your breath. Prior to this test, you should avoid antibiotics for at least four weeks and proton pump inhibitors (PPIs) or H2-receptor antagonists for at least two weeks. You should also fast for several hours before the test.
- Stool Antigen Test: A stool sample is tested for H. pylori traces. Similar to the breath test, avoid antibiotics for four weeks and PPIs/H2-receptor antagonists for two weeks before the test.
- Blood Test: This test detects antibodies to H. pylori, indicating a past or present infection. However, it cannot differentiate between a current and previous infection. Because of its high false-positive rate, it’s less frequently used to confirm current infections.
The breath test or stool antigen test is usually used to confirm eradication after treatment.
Follow-Up
If you have dyspepsia, you typically only need to retest for H. pylori if your symptoms return after treatment. For gastric or duodenal ulcers, testing is usually performed 6-8 weeks post-treatment. Sometimes, a repeat endoscopy is recommended to ensure the ulcer has healed.
How Common is Helicobacter pylori Infection?
H. pylori infection is remarkably common. Globally, roughly half of the world’s population is infected. It’s more prevalent in developing countries.
In the UK, about 30-40% of people have H. pylori. The infection appears to be declining over time. Untreated, H. pylori typically persists for life.
Complications of Helicobacter pylori
Although most people with H. pylori remain asymptomatic, the infection can lead to complications in some cases.
Gastritis
Gastritis, or inflammation of the stomach lining, can cause upper abdominal pain and nausea. H. pylori damages the stomach lining, triggering the body’s immune response and leading to inflammation.
Stomach and Duodenal Ulcers
H. pylori is a primary cause of stomach and duodenal ulcers (peptic ulcers). The bacteria cause inflammation and damage to the stomach or duodenal lining. Ulcer symptoms resemble gastritis, including abdominal pain and nausea. Ulcers can also bleed, leading to anemia or more severe bleeding with blood in vomit or black, tarry stools. Perforated ulcers, where the ulcer erodes through the stomach or duodenal wall, are a serious complication requiring emergency surgery.
Stomach Cancer
H. pylori increases the risk of stomach cancer, although most infected individuals will not develop the disease. The risk is higher for those with a family history of stomach cancer. H. pylori is also linked to mucosa-associated lymphoid tissue lymphoma (MALT lymphoma), a rare type of non-Hodgkin’s lymphoma. Chronic inflammation caused by H. pylori is thought to promote cancer development.
Interestingly, H. pylori infection may reduce the risk of esophageal cancer. It’s thought that H. pylori might reduce the amount of stomach acid entering the esophagus (reflux), thereby reducing the risk of damage.
How to Prevent Helicobacter pylori Infection
The exact transmission methods are still being researched, but general hygiene measures can help lower the risk of H. pylori infection:
- Thoroughly washing hands before eating, before preparing food, and after using the toilet.
- Consuming hygienically prepared food and drink.
- Drinking water only from safe, clean sources.
