Helicobacter pylori (H. pylori) is a type of bacteria responsible for widespread infection with more than 50% of the world's population infected, even though most of those infected have no symptoms. H. pylori infection is associated with low grade inflammation of the stomach and duodenum (the first part of the small intestine that empties the stomach).
The bacteria has evolved to survive in the acidic environment of the stomach where enzymes digest food.
The majority of people who are infected with H. pylori are symptom and disease free.
For those who do have symptoms, gastritis and ulcers are the results of an H. pylori infection. These illnesses are characterized by:
Abdominal pain is usually described as a burning sensation in the central upper abdomen below the ribs. It may be associated with bloating, burping, and loss of appetite. Often the symptoms occur after eating, and many times patients waken in the early morning hours with abdominal pain.
If there is enough inflammation, bleeding is possible from the stomach lining or from an ulcer, a small crater-like area in which the inflammation has caused the protective lining of the stomach to wear away. Symptoms of bleeding include vomiting blood and passing black, tarry stools. The black stools are a result of blood that has been metabolized and partially digested.
Note: that iron and bismuth subsalicylate (Pepto-Bismol, Pink Bismuth) will also turn the stools black.
While the exact mode of transmission H. pylori is not known, it seems to be spread from person to person by saliva, and most people who are infected become infected as children. It also has the potential to be spread by fecal contamination. This may explain why the rate of infection is so high in poorer countries and in socio-economic groups characterized by crowded living conditions, poor sanitary conditions, and lack of clean water. Personal hygiene is also very important since food preparers who may not perform adequate hand washing may be potential sources of infection.
As mentioned previously, most people who become infected do so in childhood. After being ingested, the bacteria burrow through the protective mucosa that lines the stomach to attach to deeper layers of the stomach, where they can reside for years without causing symptoms.
It is always appropriate to see your health-care professional for abdominal pain. Symptoms of diseases of many organs in the abdomen can be upper abdominal pain, nausea, and vomiting. For example, gallbladder, liver, pancreas, and kidney ailments may have abdominal pain as the presenting symptom. Upper abdominal pain and nausea may be an atypical presentation of angina, or pain from coronary artery disease.
Vomiting blood or passing black, tarry, or bloody stools are medical emergencies and should not be ignored. Accessing care at an emergency department or by activating the emergency medical system (call 911 if available) is appropriate. Sudden, severe pain is also an indication to seek urgent or emergent care.
Testing for the H. pylori infection may be performed on blood, stool, or breath samples. Also, biopsies or small bits of tissue from the lining of the gastrointestinal tract obtained during endoscopy can be tested for the presence of H. pylori.
Usually this testing is done after the diagnosis of gastritis or ulcer is made. Diagnosis depends upon the health care practitioner taking a patient history and asking specific questions. Aside from the infection, there are other, lifestyle-related causes of gastritis and ulcers including smoking, alcohol consumption, and nonsteroidal anti-inflammatory medication use, for example, aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve).
Physical examination will yield more information regarding the diagnosis of abdominal pain. In addition to examining the abdomen, a rectal examination may be performed to test for blood in the stool.
In addition to testing to testing for the presence of the H. pylori bacteria, other blood tests may be performed to screen for anemia (low red blood cell count) and other diseases. A urine sample may be taken to look for infection.
If there is a concern that an ulcer is present, arrangements may be made for a consultation with a gastroenterologist and possible endoscopy, in which the gastroenterologist uses a thin tube containing a camera to examine the lining of the esophagus, stomach, and duodenum.
Alternatively, an upper GI series may be performed to look for an ulcer. In this test, X-rays of the abdomen are taken after the patient swallows barium or another type of contrast material. If a gastric ulcer is found, endoscopy is usually recommended, since some ulcers have the potential to become cancerous. Ulcers in the duodenum typically do not have this potential.
The therapy for Helicobacter pylori infection involves multiple steps. In addition to antibiotics to eradicate the bacteria, another goal is to decrease the amount of acid secretion in the stomach and remove risk factors for further stomach irritation.
A two week course of combination antibiotic therapy is recommended.
Proton pump inhibitors and H2 blocker medications decrease acid secretion in the stomach and are often prescribed for a minimum of two weeks.
Bismuth therapy with Pepto- Bismol is sometimes recommended, especially if the first round of antibiotic therapy failed. Please remember that this treatment will cause stools to turn black.
Personal hygiene is the first step in decreasing human to human transmission. This is especially important for those involved in food preparation, either in the home or in public places. Vaccines to prevent the infection are being developed but are still in the research phase and not available for human use.
Helicobacter pylori is a worldwide epidemic, and the bacteria have infected humans for thousands of years. It is seen more frequently in populations afflicted with poverty and lack of access to clean water and sewage removal. Increasing basic living standards and providing clean water should decrease the potential for infection.
The diagnosis of Helicobacter pylori infection usually follows the diagnosis of gastritis or ulcer disease. With adequate antibiotic therapy, the bacteria should be eradicated and the risk of future complications decreased. While the infection may be gone, it is important to continue behavioral modification to prevent stomach inflammation from non-infectious causes.
H. pylori is the most common cause of gastric ulcers and gastritis, and 10% percent of those infected with H. pylori may develop an ulcer. Also, those infected have an increased risk of stomach cancer and lymphoma. Symptoms of gastric ulcers include:
