Helicobacter pylori (H pylori)

What is Helicobacter pylori (H pylori)?

Helicobacter pylori or simply H. pylori is a spiral-shaped bacterium that can infect the stomach. It lives in the mucus layer which sticks to the stomach lining and produces chemicals that cause inflammation. Unless treated with medications, the infection tends to be lifelong.

What diseases are caused by H. pylori?

Most of the people with H. pylori do not manifest any disease or problems at all. There is no clear explanation why some infected people develop illnesses such as ulcer or cancer while other people do not. The bacteria can cause the following conditions:

• Gastric ulcers (stomach ulcers)
80% of gastric ulcers (ulcers in the stomach) are caused by the infection with H. pylori.

• Gastritis
The bacteria can also lead to gastritis (inflammation of the stomach) and can promote overproduction of gastric acid once it is attached to the gastric cells.

• Duodenal ulcers
These are ulcers in the first part of the small intestine. More than 90% of duodenal ulcers are caused by the infection with H. pylori.

• Stomach cancer
H pylori increases the risk for development of gastric (stomach) cancer and lymphoma.

How can a person acquire H. pylori?

It is not clear how H. pylori is actually transmitted. Most people acquire the bacteria during childhood, and it is rare for adults to catch the infection.

Possible modes of transmission of H. pylori are the following:
• Ingestion of contaminated water
• Contact with the infected person's stool or vomit
• Direct contact with an infected person's saliva (kissing, sharing of eating utensils or food)
• Poor hygiene

How can H. pylori be diagnosed?

There are various diagnostic tests that can be performed to rule out H. pylori infection.
1. Breath test
Breath test is useful in determining the effectiveness of the treatment. After drinking a chemical a sample of the breath is obtained and analyzed. Breath test is accurate, easy, and fast to perform.
2. Blood test
Antibodies to the bacteria indicate a current or a recent infection. It is not useful test to check for success after eradication therapy.
3. Gastroscopy and Biopsy
A small tissue sample of the stomach or duodenal lining is obtained through gastroscopy or endoscopy (a flexible tube is inserted through the mouth). This sample can be examined by several methods - using a chemical reaction, under a microscope or can be incubated to culture the bacteria.
4. Faecal Antigen tests
This is to examine the presence of H. pylori in the stool.

How can H pylroi be treated?

For people with the infection but do not manifest any signs and symptoms, no treatment is required.
Triple therapy or drug combinations is the effective treatment for H. pylori since it prevents drug resistance. The commonly combined drugs are two antibiotics (e.g. Metronidazole, Amoxicillin, Tetracycline, or Clarithromycin) and one ulcer-healing drug (e.g. Bismuth, Omeprazole, Pantoprazole, or Lansoprazole). These drugs are usually taken for seven days.
The effectiveness of treatment depends on treatment compliance. But generally, the success rate of treatment combinations is high.
These medications may have side effects such as nausea, diarrhoea, and taste disturbances. Also while you are taking Tinidazole or Metronidazole, it is suggested to avoid drinking alcohol to prevent any possible undesirable reactions.
For pain associated with ulcer, an antacid may also help for temporary pain relief. But before taking any antacid, it is important to consult first your physician since some antibiotics may interact with antacids.

How do I know if the treatment is effective?

If you religiously followed the proper treatment course, you are more likely been treated effectively from the infection. Testing for the presence of H. pylori after the treatment is not always required.
Patients who had a serious complication from ulcers, such as bleeding, perforation or recurrence, should have tests to confirm eradication of the H pylori before stopping the anti-ulcer medications. If a gastroscopy is scheduled for ulcer follow-up then a biopsy is simple to do. Otherwise, breath test is the easiest test to do.

How can H. pylori infection be prevented?

Since the source of the infection is unknown, there are no specific measures that can lead to an absolute H. pylori prevention. But generally, gastrointestinal infections are best prevented through proper hygiene. Thoroughly washing of hands before and after eating, or after using the toilet, proper handling of food, and drinking safe and clean water can help to prevent any gastrointestinal infection.