Helicobacter pylori, or H. pylori, infection occurs when H. pylori bacteria infects the lining of the stomach or the first part of the small bowel. This infection is more common in developing countries and affects about half of the people in the world. Often, this infection is asymptomatic. In some cases, however, infection with H. pylori can result in stomach pain, ulcer disease and even stomach cancer.
Cause
H. pylori is an infection that is passed from person to person through contact with bodily fluids such as saliva or fecal matter. While the stomach is typically a hostile environment for bacteria because of its acidity, H.pylori is able to thrive in this environment. According to the National Institutes of Health, or NIH, H.pylori is then able to damage the mucus lining of the stomach and the first part of the small intestine. This damage is known as gastritis. When the damage is so severe that the stomach acid gets to the sensitive lining underneath, an ulcer is formed. While the H.pylori bacteria itself does not directly cause symptoms. the resulting gastritis or ulcer disease often will.
Identification
According to the American Academy of Family Physicians, or AAFP, H.pylori infection is most commonly asymptomatic. When symptoms do occur, abdominal discomfort, bloating, nausea, flatulence and bad breath may be noted. If H.pylori infection results in ulcer disease or in gastric cancer, symptoms of rectal bleeding, weight loss, difficulty or pain with swallowing and decreased appetite may be noted. Depending on the location of the ulcer, abdominal discomfort is sometimes briefly relieved by eating food but then returns. Antacids often temporarily relieve discomfort from an ulcer.
Diagnosis
If a patient has symptoms that are consistent with H.pylori infection, testing can be performed to determine if this is likely the cause. A blood test that tests for antibodies to H.pylori bacteria is often checked. According to the NIH, antibodies are produced by the immune system to help fight against bacteria, so this test will be positive if a patient has recently had an H.pylori infection. A test that measures the amount of urea in a patient's exhaled air, or urea breath test, can also be checked. H. pylori produces a large amount of urease and so this test should be positive in infected patients. A stool test can also be performed to look for H.pylori. If a test called an endoscopy is performed to look directly at the lining of the stomach with a small camera, ulcers or inflamed areas can be biopsied and examined for evidence of H.pylori.
Treatment
Treatment of H.pylori symptoms involves eradication of the bacteria to allow the gastritis or ulcer to heal. While antacids produce temporary relief, a treatment regimen known as "triple therapy" is needed to eradicate H.pylori. According to the NIH, this regimen involves three medications. One of these medications is an antibiotic which is active against H.pylori bacteria. The second medication is an acid reducing agent, typically a proton pump inhibitor, to make the environment more hostile to H.pylori. The third agent is a bismuth compound to aid in healing of the ulcer and to help the antibiotic to kill the bacteria. These three medications are typically used for a two-week period, and most patients will have relief of symptoms with treatment.
Prevention
The best prevention for H.pylori infection is the prevention of initial transmission of the bacteria. Like most infections, transmission can be prevented by washing hands after using the bathroom and before eating, by eating food that is thoroughly cooked and by drinking water from a clean source. According to the AAFP, in patients who already have H.pylori, smoking and drinking alcohol seems to increase the likelihood of developing ulcer disease.
