Helicobacter Pylori

What is it?

Helicobacter Pylori (HP) is a bacteria which can infect the lining of the stomach. It generally affects the lower end of the stomach and causes chronic inflammation or gastritis. In some cases, the gastritis causes ulcers, or symptoms which suggest that an ulcer is present. These symptoms may not improve with antiulcer therapy or may improve temporarily only to recur when treatment is stopped. Chronic infection with HP may also cause severe recurrent ulcer disease. Occasionally, it causes no symptoms at all.

How Does Infection Occur?

The precise mode of transmission has not been determined, but the infection is spread from person to person. The organism has been isolated from stool and dental plaque. A fecal oral route is suspected. Poor sanitation in underdeveloped countries is associated with a higher rate of infection. The bacteria invade the mucus layer of the stomach and multiply. It produces ammonia which neutralizes the surrounding acid, thus protecting itself. Sometimes, a person will have an acute infection which is eliminated completely by the body's immune system. In many cases, the infection never completely clears, and the body's immune response actually worsens the inflammation associated with the infection. Some strains of HP produce a toxin which causes further damage. Chronic infection may also cause the stomach to produce excessive amounts of acid.

Does it Cause Cancer?

Gastric cancer seems to be associated with HP. When stomach cancers are surgically removed, HP is often found in the stomach lining surrounding the cancer. The incidence of stomach cancer in various populations also correlates strongly with the incidence of HP infection.

Diagnosis

The most reliable method of diagnosis is gastroscopy and biopsy. Gastroscopy may be necessary to diagnose other conditions which could cause similar symptoms. The characteristic appearance of the bacteria can be identified by microscopic examination in about 90% of patients with the infection. Cultures are usually not necessary.

Blood tests are available to detect antibodies to HP. Unfortunately, they cannot determine whether the patient has an active HP infection. We may request blood tests if HP infection is suspected such as in the patient with ulcers and biopsies negative for HP. We often use this information to make decisions to treat for the infection.

By age 60, over half the population in the U.S. has antibodies to HP indicating some exposure. This makes HP the most common infection afflicting the human race. The fact that the infection is so common makes it difficult to make a decision to treat solely on the basis of a blood test.

Treatment

HP is generally treated whenever it is identified. It has been clearly proven that patients with gastric or duodenal ulcers and helicobacter infection benefit from treatment. Patients with gastritis or non ulcer dyspepsia and helicobacter do not respond as consistently. It is not always clear whether HP is contributing to a person's symptoms. The simplest way to answer this question is to treat the infection and see if the patient improves. The potential to eliminate recurrent ulcer disease and the risk of gastric cancer are powerful arguments in favor of treatment. The bacteria tend to rapidly become resistant to antibiotics if a single drug is used. For this reason, multiple antibiotics are used, and most programs will cure about 95% of patients with HP infection. Research suggests that combining triple therapy with antiulcer medication speeds the healing of duodenal ulcers and dramatically reduces the risk of duodenal ulcer recurrence. It also reduces the risk of recurrent ulcer bleeding.

Can it Recur?

There are many strains of HP, and infection can recur. Fortunately, this is uncommon, and occurs in about 1% of patients per year. We do not recommend repeat testing to confirm eradication unless the symptoms do not resolve with treatment.

Treatment Programs

  • Prevpack--take for two weeks (14 days), followed by 4-6 weeks of a PPI
  • Prevacid (lansoprazole) 30 mg twice a day
  • Biaxin (clarithromycin)500 mg twice a day
  • Trimox (amoxicillin) 500 mg-2 capsules twice a day
  • Helidac--take for two weeks. Also should take a PPI twice a day while on Helidac and then once a day for an additional 4-6 weeks.
  • Bismuth Subsalicylate 262.4 mg-2 tablets four times a day
  • Metronidazole 250 mg four times a day
  • Tetracycline 500 mg four times a day

PPIs

These drugs turn off acid production by the stomach. They will speed the healing of ulcers and help relieve the symptoms of ulcers and stomach irritation associated with HP. They also improve the likelihood of curing the infection.

  • Prilosec (omeprazole)
  • Prevacid (lansoprazole)
  • Aciphex (rabeprazole)
  • Protonix (pantoprazole)

See Also: The Helicobacter Foundation