What are Helicobacter pylori?
Helicobacter pylori is a type of bacteria, responsible for the majority of peptic ulcers. H. pylori infection is common in the United States as well in other parts of the world. Scientists estimate that about 20 percent of people under the age of 40 and half of those over 60 have it. However, most infected people do not develop ulcers. Why H. pylori do not cause ulcers in all the infected is not clear. Most likely the course of an infection depends on the characteristics of the infected person.
It is important to know the type of H. pylori and other factors that the doctor should discover. Researchers are not certain how people contract Helicobacter pylori, but they think it may be through contained food or water. Doctors even found this bacterium in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact such as kissing.
How do Helicobacter pylori cause a peptic ulcer?
H. pylori weaken the protective mucous coating of the stomach and duodenum so that it allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer. This bacterium is able to survive in stomach acid because it secretes enzymes that neutralize the acid. This mechanism allows H. pylori to make its way to the safe area - the protective mucous lining. The bacterium’s spiral shape also helps it burrow through the lining.
What are the symptoms of an ulcer?
Abdominal discomfort is the most common symptom, appearing as a dull, gnawing ache. This symptom comes and goes for several days or weeks, usually occurring 2-3 hours after a meal. It tends to occur in the middle of the night, when the stomach is empty. It can be relieved simply by eating, or by antacid medications.
Other symptoms of ulcer include weight loss, poor appetite, bloating, burping, nausea and vomiting. Some people experience only very mild symptoms or none at all. Emergency symptoms are sharp, sudden, persistent stomach pain, bloody or black stools, bloody vomit, or vomit that looks like coffee grounds. If you notice any of these, you should contact your doctor and report these symptoms, as they could be signs of a serious problem, such as perforation, when the ulcer burrows through the stomach or duodenal wall. Bleeding could happen because the acid or the ulcer breaks a blood vessel obstruction.
How is a Helicobacter pylori-related ulcer diagnosed?
Diagnosing ulcer: To see whether symptoms are caused by an ulcer, the doctor may perform an upper gastrointestinal series or an endoscopy. An upper gastrointestinal series is an X-ray of the esophagus, stomach, and duodenum. The patient drinks chalky liquid called barium to make these organs and any ulcers show up more clearly on the X-ray. An endoscopy is a diagnostic method that uses an endoscope, a thin, lighted tube with a tiny camera on the end. Then the doctor carefully eases the endoscope into the mouth and down the throat to the stomach and duodenum. This allows the doctor to see the lining of the esophagus, stomach, and duodenum. The doctor can use the endoscope to take photos of ulcers or remove a tiny piece of tissue. This tissue is then examined under a microscope – a procedure known as biopsy. If an ulcer is bleeding, the doctor can use the endoscope to inject drugs that promote clotting. He could also guide a heat probe that cauterizes the ulcer.
Diagnosing Helicobacter pylori: If an ulcer is present, the doctor will test the patient for Helicobacter pylori. This test is important because treatment for an ulcer caused by this bacterium is different from that for an ulcer caused by NSAIDs. Blood, breath, stool, and tissue tests are the best way to look for H, pylori. Blood tests are most common, detecting antibodies to Helicobacter pylori. The doctor takes the blood in the doctor’s office through a finger stick.
Urea breath tests are an effective diagnostic method for these bacteria as well, also common after the treatment to see whether it worked. In the doctor’s office, the patient drinks a urea solution, which contains a special carbon atom. If H. pylori are present, they break down the urea, releasing the carbon. The blood carries the carbon to the lungs, where the patient exhales it, so that is why breath test is 96-98 percent accurate.
Stool tests are also valuable in helicobacter pylori diagnosis, detecting bacteria in the patient’s fecal matter. Studies have shown that this test, called the Helicobacter pylori stool antigen test, is very accurate.
Tissue tests works by using the biopsy sample from the endoscope. There are three types for tissue testing for Helicobacter pylori. The rapid urease test detects the enzyme urease, produced by H. pylori, while a histology test allows the doctor to find and examine the actual bacteria. A culture test involves allowing Helicobacter pylori to grow in the tissue sample. It is important to know that blood tests are not used to detect Helicobacter pylori following treatment, because a patient’s blood can show positive results even after these bacteria have been eliminated.
How are Helicobacter pylori peptic ulcers treated?
H. pylori peptic ulcers treatment uses drugs that kill the bacteria. These drugs are also supposed to reduce stomach acid, and protect the stomach lining. Antibiotics are also included into the treatment. Two types of acid-suppressors, such as H2 blockers and proton pump inhibitors, are common in therapy. Treatment usually involves a combination of antibiotics, acid suppressors, and stomach protectors for a complete treatment. Antibiotic regimens recommended for patients may differ across regions of the world, because certain areas have begun to show resistance to particular antibiotics.
The use of only one medication to treat Helicobacter pylori is the wrong choice, and doctors do not recommend it. At this time, the most effective treatment is a two-week course of treatment called triple therapy. This therapy involves taking two antibiotics to kill the bacteria and either an acid suppressor or stomach-lining shield. Two-week triple therapy reduces ulcer symptoms, kills the bacteria, and prevents ulcer recurrence in more than 90 percent of patients diagnosed with Helicobacter pylori. Unfortunately, most patients may find triple therapy complicated because it involves taking as many as 20 pills each day. In addition, the antibiotics used in triple therapy may cause mild side effects: nausea, vomiting, diarrhea, dark stools, metallic taste in the mouth, dizziness, headache, and yeast infections in women. Nevertheless, recent studies show that two weeks of triple therapy are the ideal treatment for H. pylori. Early results of studies in other countries suggest that one week of triple therapy may be as effective as the two-week therapy. Off course, in this case there are fewer side effects.
Another option is two weeks of dual therapy. Dual therapy involves two drugs, an antibiotic and an acid suppressor, but it is not as effective as triple therapy. Two weeks of quadruple therapy, which uses two antibiotics, an acid suppressor, and a stomach-lining shield, looks promising in research studies: it is known as the Bismuth triple therapy.
Read More: Helicobacter pylori associated diseases
Can we prevent a Helicobacter pylori infection?
No one knows for sure how H. pylori spread, so prevention is difficult, although researchers are trying to develop a vaccine. Changing medical belief and practice takes time when we remember that once most scientists and doctors thought that ulcers are caused by stress, spicy food, and alcohol. Treatment involved bed rest and a bland diet, so it is hard to change all this now. Later on, researchers added stomach acid to the list of causes and began treating ulcers with antacids, but since scientists discovered Helicobacter pylori in 1982, studies conducted around the world have shown that using antibiotics to destroy this bacterium cures peptic ulcers.
The prevalence of Helicobacter pylori ulcers is changing, the infection becoming less common in people born in developing countries. However, the medical community continues to debate Helicobacter pylori’s role in peptic ulcers. If you have a peptic ulcer and you were not tested for Helicobacter pylori, you should talk to your doctor. Just remember that the majority of peptic ulcers are caused by the Helicobacter pylori bacterium, not due to spicy food or stress. It is also important to remember that Helicobacter pylori transmits from person to person through close contact and exposure to vomit. That is why you should always wash your hands after using the bathroom and before eating.