According to the National Institutes of Health, helicobacter pylori (h. pylori) is a type of bacteria that lives in the stomach and damages the mucous lining that protects the stomach and duodenum. While some patients never develop symptoms from h. pylori infection, other patients develop abdominal discomfort or peptic ulcer disease. H. pylori causes half of peptic ulcers worldwide and treatment is needed to eradicate h. pylori infection and allow the ulcers to heal.
Indications
According to the American Academy of Family Physicians (AAFP), h. pylori produces no symptoms in 90 percent of patients. Treatment of h. pylori, however, leads to ulcer healing in patients with duodenal and gastric ulcer disease related to infection. Patients who should be tested for h. pylori include patients with dyspepsia and risk factors such as bleeding, weight loss, difficulty swallowing and age older than 45; patients with dyspepsia and known peptic ulcer disease; and patients with dyspepsia and a history of treated peptic ulcer disease. Treatment for these patients is particularly important because they are at increased risk for ulcer complications or development of gastric cancer. Patients with dyspepsia and no risk factors and patients with reflux disease are also sometimes tested and if positive are typically treated, though it is unknown if this relieves symptoms in this population.
Types
According to the AAFP, a medication regimen known as "triple therapy" is typically utilized to eradicate h. pylori. This regimen consists of three different types of medications that act together to optimize the chance of successful eradication.
The first type of medication is an antibiotic such as amoxicillin or clarithromycin which is active against h. pylori and also accumulates in the lining of the stomach and duodenum.
The second type of medication is an acid reducer such as a histamine receptor antagonist or a proton pump inhibitor. Since h. pylori thrives in an acidic environment, the acid reducer makes it easier to eradicate the bacteria.
The third type of medication is a bismuth compound which assists with ulcer healing by increasing the secretion of mucus. This medication also acts with the antibiotic to kill h. pylori by causing detachment of the bacteria from the walls of the stomach and duodenum.
Non-Pharmacologic Treatments
While medication is needed to completely eradicate h. pylori, there are several lifestyle changes that can help to decrease the risk of further ulcer disease. As discussed by the AAFP, patients should not use non-steroidal anti-inflammatory agents (NSAIDs), as these medications are known to delay ulcer healing. Additionally, patients should quit smoking, as smoking is also believed to be a risk factor for developing ulcer disease in patients with h. pylori.
Benefits
In patients with ulcer disease related to h. pylori, treatment helps to heal the ulcer and also to prevent ulcer recurrence. In these patients, symptoms such as abdominal pain, weight loss and poor appetite will be relieved. According to the AAFP, the risk of ulcer perforation and gastric cancer is also reduced in these patients. In patients with non-ulcer related abdominal discomfort, it is unclear whether treatment for h. pylori will help symptoms.
Considerations
As discussed by the AAFP, some patients have persistent h. pylori infection despite treatment. This is often caused by failure to complete the treatment course or to take all of the prescribed medications. In patients who follow the regimen exactly, treatment failure can be due to resistance of a particular strain of h. pylori. In these patients, quadruple therapy with two antibiotics, an acid reducer and a bismuth compound is needed. In patients with a history of ulcer-related complications or evidence of early gastric cancer, post-treatment evaluation for complete eradication of h. pylori is necessary.
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