Helicobacter pylori, or H. pylori, is a spiral-shaped bacterium that can live in the stomach and in the first part of the small intestine, or duodenum. According to the Centers for Disease Control and Prevention (CDC), infection with this type of bacteria is the cause of 90% of duodenal ulcers and 80% of gastric ulcers. Patients with H. pylori infection also have an increased risk of developing gastric cancer and mucosa-associated lymphoid tissue lymphoma (MALT) compared to patients who are not infected. However, most patients with H. pylori infection do not develop ulcer disease or stomach cancer.
History
According to the Helicobacter Foundation, H. pylori was first discovered approximately 25 years ago in the stomachs of patients with ulcer disease and gastric cancer. The bacteria is found in approximately half of the world's population, and most patients have very few symptoms related to infection. Even in patients without symptoms, however, direct visualization of the stomach during a procedure called an endoscopy will often note inflammation of the stomach lining. In some people, this inflammation leads to ulcer disease and occasionally to stomach cancer.
Pathophysiology
As discussed by the National Institutes of Health, H. pylori damages the mucous coating that lines the stomach and duodenum, resulting in inflammation. This allows the stomach acid to reach the sensitive layer underneath and can result in ulcer formation. Not every patient with stomach inflammation and H. pylori infection develops ulcers, however. While the reasons for this are unknown, it is known that smoking and drinking alcohol increase the risk of ulcer formation.
Identification
Clinicians test for H. pylori in any patient with a stomach ulcer. They can diagnose H. pylori infection by checking for a byproduct called urease in exhaled breath, by checking a blood test for signs that the body has been fighting the infection, or by checking the stool for evidence of infection. In patients who complain of abdominal pain and concerning symptoms such as weight loss, fevers, bleeding or stomach mass, an endoscopy may be performed. An endoscopy is a procedure in which a physician directly visualizes the stomach and duodenum with a camera at the end of a small tube. According to the NIH, an ulcer or a lesion suspicious for cancer can be biopsied during the endoscopy and tested for H. pylori.
Prevention/Solution
If a patient with gastritis tests positive for H. pylori, the infection can be treated to relieve symptoms and to decrease the likelihood of future ulcer disease or gastric cancer. According to the NIH, H. pylori is best treated with "triple therapy," or three different classes of medications. These medications include an antibiotic, a medication to reduce stomach acid, and a medication to increase mucus secretion. Patients usually take the medications for a two-week period. If an ulcer is present, this therapy often will allow the ulcer to resolve. Unfortunately, if gastric cancer is already present, this therapy will not cure it. According to the Helicobacter Foundation, however, about 50% of cases of gastric MALT can be cured with H. pylori treatment.
Considerations
While most patients with H. pylori infection do not have complications, it is important to get tested and treated if the patient has signs or symptoms of ulcer disease or stomach inflammation. Patients with symptoms such as dull or aching abdominal pain that improves briefly with eating or pain that improves with antacids should be tested. If positive, these patients benefit from treatment from both a symptomatic standpoint and from reduction in their risk of developing ulcer disease or gastric cancer.
