H. pylori: A small bug with severe consequences

This post was written by Reshi Kanuru, MD, PPG – Gastroenterology.

“A bacteria caused my ulcer?” he asked, looking at me with confusion. I had just explained to the patient that his stomach biopsies showed a bacteria called Helicobacter pylori, otherwise known as H. pylori.

H. pylori is a bacteria that infects the stomach. While H. pylori is more common in developing countries, it can cause abdominal symptoms in the United States. An H. pylori infection can cause significant consequences from abdominal pain to gastric ulcers and, in rare cases, types of stomach cancer. As a result of this connection, the World Health Organization (WHO) has characterized H. pylori as a carcinogen. Because of the severe consequences of H. pylori, it is important for us to understand the symptoms of H. pylori, how it’s diagnosed and how it’s treated.

Symptoms

The symptoms of H. pylori can vary, from mild to severe. Many people present with abdominal pain, nausea and even vomiting. H. pylori can cause bleeding ulcers and lead to low blood counts due to a loss of iron. If you have abdominal symptoms, you should be evaluated for H. pylori.

Transmission

We don’t know exactly how H. pylori is transmitted, but we believe it’s transmitted through poorly prepared food when someone does not wash their hands properly. We don’t typically see it pass between family members, but it is always good to practice good hand hygiene to prevent transmission. 

Diagnosis

Currently, there are three methods for diagnosing H. pylori. The first test is called the H. pylori breath test. The breath test involves swallowing a pill or solution that contains a chemical called urea. The urea has special carbon atoms, which can be detected with special equipment. H. pylori has the ability to digest urea, and produce carbon dioxide in response. The carbon dioxide contains the special carbon atoms from the urea and is released in your breath. Your breath is collected and sent for testing. If your breath contains the special carbon atoms then you have H. pylori. 

Another test is the H. pylori stool antigen test. This is a test where you collect a sample of your stool and submit it to the lab. The sample is tested for particular proteins that tell us H. pylori is present in the stomach. The stool test is nearly as good as the breath test, but it is usually less expensive than breath testing. Proton pump inhibitors (PPIs) for acid reflux, like Nexium, Prilosec or Protonix, should be avoided two weeks prior to testing for H. pylori with a stool or breath test, as these medications can cause errors in the results. H2 blockers, like Pepcid and Zantac, can be taken in that two week period to control reflux symptoms without interfering with the test results.

The last way to diagnose H. Pylori, is to obtain biopsies of the stomach during an upper endoscopy. An upper endoscopy (EGD) is when a person is sedated with medication and we use a flexible fiber optic camera to go from the mouth into the stomach. While an EGD is very accurate, the stool or breath test is a better option. We no longer recommend obtaining blood tests to diagnose H. pylori, as these tests don’t distinguish between a past infection or an active one.

If you are diagnosed with H. pylori, remember that after finishing treatment, we always want to make sure it has been successfully treated by completing an H. pylori breath or stool test. Your healthcare provider can explain when you should complete follow-up testing.

Treatment

H. pylori is typically treated with a regimen of antibiotics and acid reflux medications to decrease acid in the stomach. Treatment usually involves 3-4 medications consisting of two antibiotics, an acid reflux medication, bismuth or Pepto-BismolÔ. It is important to take the medications completely without missing dosages.

If you develop side effects from the medications, talk with your healthcare provider so they can adjust your regimen. In some cases, H. pylori can be difficult to treat and might require more than one treatment regimen. Approximately 9-31% of those treated with an initial regimen of antibiotics, depending on the regimen, will require further treatment. Prior antibiotics exposure and not following the treatment directions make H. pylori more difficult to treat. 

If you have abdominal discomfort, discuss your symptoms with your physician and consider being tested for H. pylori. A gastroenterologist can also fully evaluate your condition. Remember, if you are diagnosed with H. pylori, it is important to complete your regimen exactly as prescribed and to have repeat testing after being treated to make sure the H. pylori has been successfully treated.

 

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