H. pylori – Chances are that you have or had it

MOST PERSONS who are infected with H. pylori experience no symptoms. H. pylori should be eradicated in anyone diagnosed with such. Exterminating H. pylori helps heal ulcers present, reduces the risk of stomach bleeds, and lowers the chances of developing stomach cancer and all the other complications listed below under “Complications linked to H. pylori”.

Approximately 66% of the world’s population is infected with H. pylori. Most are children.

H. pylori plays no role in the onset, persistence, or severity of symptoms of gastroesophageal reflux disease (GERD). Often referred to as acid reflux.

Adaptability of H. pylori to the stomach’s environment 

The stomach is a holding area for digestion. Its digestive juices consist of a strong acid- hydrochloric acid, enzymes (pepsin, gastric amylase, gastric lipase), water, intrinsic factor, and electrolytes. The stomach prevents self-digestion by way of a protective bicarbonate-rich mucus coating. H. pylori protects itself from being digested by secreting two alkaline substances, specifically urease, and ammonia, that neutralise the acid in its immediate environment. Most bacteria are devoid of this capability. Furthermore, after penetrating the mucus coating, H. pylori attaches itself to the stomach’s epithelial layer. H. pylori prefers to inhabit the lower end and least acidic area of the stomach – the antrum.

Symptoms and signs of H. pylori

Eighty percent of persons whose stomachs are infected with H. pylori have no symptoms. Those who report symptoms may experience:

• An ache or burning just below the lower end of the breast bone.

• This discomfort or pain may worsen when hungry.

• Reduced appetite.

• Nausea/ vomiting.

• Increased belching.

• Puffiness of the abdomen.

• Loss of weight.

• Melena stool (black, very foul smelling, tarry, and sticky stool).

Detecting H. pylori

Below are tests used for detecting H. pylori:

• A stomach lining biopsy.Via endoscopy, a small piece of lining is removed from the antrum and gastric corpus of the stomach. This is the most accurate way of diagnosing H. pylori. Being invasive, this method carries some risks. It is the most expensive and least practical way of testing.

• Stool test. This test is used to detect the presence or absence of traces of H. pylori in the stool. This test can be used to diagnose an active infection or determine if an infection has been eliminated.

• C-Urea breath test. This is a highly accurate test that can detect if there is a current H.pylori infection or if a treatment regime has been successful. For the test, you are given a substance containing urea to swallow, and the breath is analysed 15 minutes later. If there is an increase in the levels of carbon dioxide compared to pre-urea administration, it means H. pylori is present.

• Blood test. This test detects the presence of antibodies to H. pylori. It cannot tell if one is currently infected with H. pylori. This test can remain positive for years after the infection is eradicated. This test should not be used to determine if the treatment for H. pylori has worked. Of all the tests on offer, this gives the highest percentage of false-positive results. Most UK hospitals have abandoned this test.

Footnote: Apart from the blood test, all the other tests require the cessation of proton pump

inhibitors for two weeks before the test is performed.

Transmission of H. pylori

It’s not certain how a person contracts H. pylori, however, available evidence suggests that the following are the primary modalities of transmission:

• Contaminated uncooked food or water.

• Person-to-person transmission – saliva, exposure to vomit/ stool, oral sex (anilingus).

Complications linked to H. pylori 

About 90% of persons with H. pylori go through life without complications. The remainder may experience:

• Stomach inflammation (gastritis).

• Ulcers of the stomach and or duodenum.

• Stomach bleeds.

• Gastric (stomach) cancer – H. pylori causes 90% of gastric cancers.

• Non-Hodgkin’s Lymphoma.

• H. pylori possibly plays a role in the development of pancreatic cancer, AD dementia, urticaria, Parkinson’s, migraine, iron deficiency anaemia, pernicious anaemia, and immune thrombocytopenic purpura.

Treatment of H. pylori

H. pylori is treated with a combination of two different antibiotics and a proton pump inhibitor taken over two weeks. No treatment regime is 100% effective. Bismuth may be added to some treatment regimes.

Possible non-pharmacological treatments include probiotics, cranberry juice, broccoli, green tea, aloe vera, ginger, garlic, olive oil, licorice, honey, and curcumin (turmeric).

Studies have shown that H. pylori may be spontaneously eradicated, especially in young children.

Testing for the eradication of H. pylori

• Best performed 28 days after the completion of treatment and at least two weeks after the proton pump inhibitor was stopped.

• Tests that can be performed to confirm eradication include stool antigen test, C-urea breath test, or stomach lining biopsy.

• H.pylori antibody blood test has no role in determining if H. pylori has been eradicated.

Author: Dr. C. Malcolm Grant – Family Physician – Family Care Clinic, ArnosVale – Former Tutor, Faculty of Medical Sciences, UWI, Cave Hill, Barbados. For appointments: clinic@familycaresvg. com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp) Disclaimer:The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.