Helicobacter Pylori and Ulcers

Helicobacter Pylori (H. pylori) is a very common infection of the stomach. It is perhaps the most common infection in the world. Since the mid 1980’s, mounting evidence points to H. pylori as a major contributor to the development of digestive illnesses such as gastritis (irritation and inflammation of the lining of the stomach), peptic ulcer disease (sores that form in the stomach or upper part of the small intestine), and even stomach cancer later in life.

Experts believe that, even though the bacteria can cause these illnesses, most H. pylori infections are silent and produce no symptoms. The bacteria are found everywhere in the world, but especially in developing countries, where up to 10% of children and 80% of adults have laboratory evidence of an H. pylori infection, usually without having any symptoms.

H. pylori infection probably occurs when a person swallows the bacteria in food, fluid, or from contaminated utensils. When food is swallowed, it passes through the esophagus, entering the larger upper part of the stomach. There, a strong acid is secreted in the stomach which helps to break down the food. The antrum, (which is the lower part of the stomach), contracts, grinding up the food and pushing it into the small intestine. The entire stomach is covered by a layer of mucous that protects it from the strong stomach acid.

The fragile H. pylori bacteria find an ideal home in the protective mucous layer of the stomach which not only protects the stomach cells from acid, but also protects the bacteria. H. pylori have long threads protruding from them that attach to the underlying stomach cells. The body reacts by sending infection-fighting white blood cells into the area, and the body even develops H. pylori antibodies in the blood.

When the bacteria do cause symptoms, they are usually either symptoms of gastritis or peptic ulcer disease.
• Gastritis and dyspepsia symptoms include discomfort, bloating, nausea, and, in some cases, vomiting. The person may also experience burning or pain in the upper abdomen which would suggest ulcers, yet the doctor does not find an ulcer when the patient is tested by x-ray or endoscopy.
• With stomach ulcers, H. pylori infection is found in 60-80% of the cases. While it is uncertain how the infection acts to cause the ulcer, scientist feel that H. pylori probably weakens the protective mucous layer, allowing acid to seep in and injure the underlying stomach cells.
• Research has shown that over 90% of all patients who develop duodenal ulcers have H. pylori infection in the stomach as well. Medical studies are under way to determine the relationship between the two. With the strong acid-reducing medicines available, it is rather easy to clear duodenal ulcers. However, unless the H. pylori infection is also cleared from the stomach, the ulcers will usually reoccur.

There are also two types of cancer now known to be related to H. pylori bacteria; stomach cancer and lymphoma. This does not mean that all people with H. pylori infection will develop cancer; very few do. However, it is likely that if the infection is present for a long time, perhaps since childhood, these cancers may then develop.

Because the infection seems to run in families and is more common where people live in crowded conditions, scientists suspect that H. pylori infection may be contagious, although they are not sure how it is passed from person to person.

Doctors currently have three tests at their disposal in order to make the diagnosis of an H. pylori infection:
• During a visual exam of the stomach through a thin, flexible, lighted tube (endoscopy), the doctor can remove small bits of tissue through the tube. The tissue is then tested for the bacteria.
• There is a blood test that measures the protein antibodies against the bacteria that are present in the blood. This test can often give a false-positive result as the presence of the antibody can mean the infection is present or that it was present in the past and has since been cleared.
• A breath test is available where a substance called urea is given by mouth. A strong enzyme in the H. pylori bacteria breaks down the urea into carbon monoxide which can be measured when exhaled.

H. pylori infections are treated with antibiotics. Because a single antibiotic may not kill the bacteria, a combination of antibiotics may be given. With prolonged antibiotic therapy, H. pylori gastritis and peptic ulcer disease can often be cured.

Currently there is no vaccine against H. pylori, and since its transmission isn’t clearly understood, prevention guidelines aren’t yet available. However, there are some things that are always important for you and your family to do to guard your health and help to prevent illness:
• Wash your hands thoroughly.
• Drink water from a safe source.
• Eat food that has been properly prepared.