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Feb 18, 2008

Getting to know H. pylori

SINCE its “discovery” in 1982 by Prof Barry Marshall and Dr Robin Warren, H. pylori has been extensively researched. Known to cause gastritis, peptic ulcer and possibly some cancers, more and more doctors are treating this infection seriously.

What is Helicobacter pylori?

It is bacteria found in the mucous layer of the stomach lining or first part of the small intestine, which causes more than 90% of ulcers1. Ulcers are sores in the lining of the stomach. Before 1982, when this bacterium was discovered, spicy food, acid, stress, and lifestyle were considered the major causes of ulcers. Since we now know that most ulcers are caused by an infection with H. pylori, they can be cured with appropriate antibiotics.

Who gets H. pylori?

About two-thirds of the world’s population is infected with H. pylori. In the United States, H. pylori is found more often in older adults, African Americans, Hispanics, and those in the lower socio economic groups.

In Malaysia, it was found that the prevalence of H. pylori infection was higher in patients more than 50 years of age compared to those below 30 years4.

It is still not known how H. pylori gets into the body or why some people with H. pylori become ill while others do not. The bacteria is most likely spread from person to person through the faecal-oral route (when infected faecal matter comes in contact with hands, food, or water) or the oral-oral route (when infected saliva or vomit comes in contact with hands, food, or water).

How does H. pylori get into the stomach?

Although much research has been devoted to determine how Helicobacter infections are acquired, the simple answer is that, with the exception of a few patients who have been infected during gastric endoscopy, we don’t know how this organism is introduced into the stomach.

An update in January 1997 suggested that food contaminated with the bacteria may be the route of infection. Adequate nutritional status, especially frequent consumption of fruits and vegetables and of vitamin C, appears to protect against infection with H. pylori.

In contrast, food prepared under less than ideal conditions or exposed to contaminated water or soil may increase the risk of infection.

What are the symptoms?

The most common symptom of ulcers are gnawing or burning pain in the stomach area, between the breastbone and the navel. Commonly, the pain occurs when the stomach is empty, between meals and in the early morning hours, but it can also occur at other times of the day.

Less common ulcer symptoms include nausea, vomiting, and loss of appetite. Bleeding can also occur and prolonged bleeding may cause anaemia leading to weakness and fatigue.

If the bleeding is heavy, vomiting of blood or passage of bloody stools may occur. Dark stools or dark vomit often indicate old bleeding.

How is H. pylori infection diagnosed?

Doctors have several methods to test for H. pylori infection. By measuring antibodies against H. pylori, blood tests can determine if a person had been infected.

A breath test (urease breath test) can determine if H. pylori is still present in the patient’s stomach. In this test, the patient is given a harmless substance to drink; some of the residue from the substance is broken down and exhaled in the breath. By collecting this breath, the healthcare provider can determine if H. pylori is present.

A doctor can also perform endoscopy, in which a small flexible instrument with a camera inside is inserted through the mouth into the throat, stomach, and intestine to look for ulcers.

During endoscopy, stomach lining tissue samples can be obtained. Several tests can be performed on these tissue samples to determine if a patient is infected with H. pylori.

What is the treatment for H. pylori?

The treatment for H. pylori infection consists of one to two weeks of one or two effective antibiotics. Successful rates range from 70% to 90% depending on the regimen used. Antibiotic resistance and patient non-compliance are the two major reasons for treatment failure1.

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