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Helicobacter pylori
Active Duodenal Ulcer
   

Helicobacter pylori - "The Ulcer Bacteria"


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Helicobacter pylori (he-lick-oh-back-ter pie-lorrie) is an unusual name that refers to a tiny acid-resistant germ (bacteria) that has been found to be a major cause of peptic ulcer disease. Also known as H. pylori, this organism was first reported in the stomach of patients with ulcers in 1982 by Dr. Barry Marshall of Perth, Western Australia, but its significance was not recognized until the past several years. Actually, it is quite surprising that this germ can even survive inside your stomach because all other germs are immediately killed by the powerful stomach acids. Exactly how this happens is unclear. However, evidence is piling up that this corkscrew-shaped bacteria can burrow through and digest the layer of mucous that protects the lining of your stomach and duodenum. The infection remains localized to the stomach lining and does not spread throughout the body. If the infection is not treated, it usually lasts a lifetime.

Once Helicobacter pylori invades your stomach lining, it produces an ammonia-like chemical which neutralizes acid in the immediate vicinity, thus protecting itself from stomach acid. The bacteria do not actually invade the stomach cells as certain other bacteria can. The infection, however, is very real and does cause the body to react. Infection-fighting white blood cells move into the area, and the body even produces Helicobacter antibodies in the blood.

A Breakthrough In Ulcers

Until recently, it was felt that most ulcers were caused by lifestyle factors such as poor diet, too much stress, heavy drinking, and smoking. But amazingly, it now seems in the majority of cases the real culprit may be this tiny bacteria. As Helicobacter invades the stomach lining, it disrupts the protective mucous layer and allows the corrosive stomach acids to come in direct contact with the delicate tissues below. This can then lead to peptic ulcers and stomach inflammation called gastritis. In fact, chronic gastritis is the hallmark of Helicobacter. It is found in nearly all those infected.

The real breakthrough is the evidence that Helicobacter infection is the culprit in up to 90% of duodenal ulcers. Most of the other 10% are probably caused by too much aspirin, ibuprofen, and other anti-inflammatory drugs. Stress and diet may play a role in aggravating an ulcer, but no longer seem to be the main cause. The good news is that we now have medications to eradicate Helicobacter which speeds ulcer healing, and more importantly, greatly reduces the risk of ulcer recurrence. Soon, for many people, ulcers will be a thing of the past.

How About Cancer? There is also some evidence that two types of cancer may be increased in patients who harbor this infection - stomach cancer and lymphoma. This does not mean that every person who has Helicobacter will develop cancer; in fact, very few do in this country. However, left untreated for decades, Helicobacter may be an important risk factor and therefore is another reason why it should be treated.

How Does One Get Helicobacter ? If you have Helicobacter, you are not alone. It is quite common and may be the most common infection in the world. By age 20, over one-fourth of Americans are infected. The rate of infection increases with age, so it occurs even more often in older people. But, no one has satisfactorily explained how anyone picks up this germ in the first place, though it probably reaches the stomach by way of the mouth through contaminated food, fluids, or utensils. It is not transmitted in the blood and as far as we know Helicobacter is not transmitted through the water supply in the United States. The infection can occur in anyone, but seems more prevalent in countries where sanitation is poor. The common housefly has recently been felt to play some role. Helicobacter is quite common in our society and often affects more than one member of a household. In many cases, it does not produce symptoms. In other words, the infection can occur without the person even being aware of it.

Can Helicobacter Be Prevented? Not at the present time. However, research is being done on prevention through vaccination. Hopefully, this will be available in the future. This would probably have to be administered as part of the routine childhood immunizations to be most effective. How Is It Diagnosed? Symptoms, when they occur, may vary widely, but the most common ones are abdominal pain, nausea, indigestion, gas and bloating. This infection is most accurately diagnosed by a direct biopsy and laboratory analysis of samples taken from your stomach lining. This can be simply and painlessly done during a gastroscopy "scope" examination. The gastroscope test has the advantage of accuracy and allows a direct inspection and biopsy of the stomach and duodenal lining to best assess if ulcers or cancer are present.

Two other tests are available. A breath test is also now available. During a breath test, a substance called urea is swallowed. If the bacteria is present, the urea is broken down into carbon dioxide which is then exhaled and can be measured in the breath. A positive breath test means there is an actual active infection in the stomach with this "ulcer bacteria."

Also, there is a blood test that measures antibodies against Helicobacter. But, a positive antibody test can mean either an active infection, or that it was present in the past and now is cleared.

Who Should Be Tested? Only your doctor can diagnose Helicobacter and recommend a treatment plan. If you have symptoms of an ulcer such as a sharp gnawing abdominal pain 1 to 3 hours after eating, you should be tested. If you have ulcers or a past history of ulcers, you should be tested. Those with a first degree relative ( a parent or sibling) who had stomach cancer should also be tested.

Who Should Be Treated?

The real breakthrough is that now many ulcers can be cured. If you have a duodenal or gastric ulcer and have this infection, the chances of the ulcer returning in the future is great. However, many scientific studies have proven that eradication of Helicobacter markedly reduces the risk of ulcer recurrence. For the first time, ulcers can now be cured in most individuals.

Since this infection is so common, some doctors feel that it need not be treated if there are no symptoms. More research is needed, but most doctors now recommend treatment regardless of symptoms because of the increased risk of cancer in the untreated individual. How Is Helicobacter Treated? Treatment can be a nuisance since there currently is no one antibiotic that satisfactorily kills Helicobacter. For now we must use a combination of multiple drugs. These include multiple antibiotics as well as medications to reduce stomach acid. Unfortunately, this multi-drug treatment can cause side effects, but can clear the infection in most cases. Much research is being done on treatment. Hopefully, a simpler more effective treatment will be available in the future. Your doctor can best decide which treatment regimen is appropriate for you.

What Are The Side Effects?

As with all effective drugs, there are possible side effects. But most of these are minor and subside when the treatment is completed. These may include nausea, vomiting, diarrhea, and a metallic taste in the mouth. Women may develop a mild vaginal yeast infection for which a nonprescription cream or vaginal suppository may be used. If you develop severe diarrhea, rash, or fever, call your doctor.

How Do I Know When It Is Gone?

You won't, but the odds are good. If the organisms are not resistant to therapy, the infection can be cured in up to 90% of cases. If symptoms do return, your doctor can perform additional tests if needed after the treatment is completed to see if the infection has been successfully eradicated. Both a stomach biopsy during a repeat scope test and the breath test can determine if the infection is gone. A breath test at least four weeks after therapy is finished is the simplest non-invasive way to assess cure. The blood test is not useful to assess cure since it may still show antibodies to Helicobacter for over a year after the infection is cleared. If the blood test turns negative, however, it indicates cure.

Will It Come Back?

No one knows for sure since the source of infection may vary from individual to individual. But, in general, the return rate of Helicobacter infection is less than 1% per year. So you have less than one chance in twenty of getting the infection back in the five years that follow successful treatment.

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