An Overview Of H. pylori Infections - Symptoms, Diagnosis, and Treatment Options

Symptoms of Helicobacter Pylori

Inflammation and ulcers caused by H. pylori may be asymptomatic or symptomatic. For the latter, the following are the most common:

• Abdominal discomfort in the upper part
• Nausea
• Vomiting
• Loss of appetite
• Bloating
• Darkening of the stool
• Blood in the stool (bleeding from the ulcer)
• Fatigue

How is H. Pylori Detected?

There are three tests that are routinely used to detect an H. pylori infection. They are:

1. Stool Test: This consists of tests that detect the presence of certain proteins that are specific to H. pylori and are passed in the stool
2. Blood Test: This test detects the antibodies that are produced by an individual’s immune system specifically in response to H. pylori.
3. Urea Breath Test: This procedure involves drinking a special solution that contains a substance which is broken down by the bacterium. The products of the breakdown are then detected in the breath.

H. Pylori Infection - Treatment Options

Antibiotic Course

Only patients who test positive for H. pylori should be treated with antibiotics. They should also be informed about the aspect of developing drug resistance if they do not take the drugs for the prescribed amount of time. This is a serious issue and is the main hindrance in the antibiotic treatment regime. Other factors, such as potential side-effects of the drugs, are also to be considered when prescribing treatment.

Triple Therapy

The approved antibiotic treatment consists of a triple therapy. This is administered for about 10-14 days. Cure rates upto 90% have been reported in cases of peptic, gastric, and even duodenal ulcers.

Each drug has its own purpose. The most commonly used triple regimes that are being used worldwide include:

• Omeprazole, Amoxicillin, Clarithromycin (OAC) for 10 days   OR
• Bismuth subsalicylate, Metronidazole, Tetracycline (BMT) for 14 days   OR
• Lansoprazole, Amoxicillin, Clarithromycin (LAC) for either 10 or 14 days

Latest discoveries have showed that Omeprazole, Amoxicillin, and Clarithromycin (OAC) show the best results. Omeprazole is a proton pump inhibitor which blocks excess acid production in stomach whereas Amoxicillin and Clarithromycin play a role in H. Pylori eradication.

Possible Side-effects

About 50% of patients experience side-effects during the antibiotic regime. These are usually minor and can be controlled by adjusting the antibiotic dosage or timing. Some of these include:

• Metallic taste in the mouth
• Blackening of stool
• Constipation
• Diarrhea
• Abdominal cramping

Consuming alcohol during the regime can also cause many distressing side-effects, such as nausea, vomiting, headaches, rapid heart rate, etc.

In-case of H. Pylori Treatment Failure

A second regime for 14 days is then administered. This comprises of:

• A proton pump inhibitor and two antibiotics.
• At least one of the antibiotics is different from those used in the first regime.

Follow-up after Treatment

A breath or stool test is generally performed to confirm the success of treatment. Blood tests are not recommended since there are chances of a false-positive result.

See Also: New Breath Test Detects H.Pylori in 10 minutes

Alternates Methods under Investigation

Quadruple Therapy

Due to the increasing resistance to antibiotics, researchers have conducted successful trials using a quadruple antibiotic regime. This consisted of Omeprazole along with a single 3-in-1 capsule containing Bismuth subcitrate potassium, Metronidazole, and Tetracycline. The results showed a better cure rate as compared to the triple therapy, along with the same safety and tolerability.

Vaccine

Researchers are also working on the development of a vaccine against H. pylori infections. This could significantly reduce the incidence of stomach cancer among susceptible individuals.