This week on the GI series, I will be writing about peptic ulcer and Helicobacter pylori infection. Helicobacter pylori is a bacteria that causes an infection in the stomach and is usually associated with peptic ulcer disease (PUD). I know, the name sounds scary right, let's just call it H.pylori for short. PUD is a gastric disorder where by the mucous lining of the stomach is compromised partly due to over-production of gastric acid secretion. H.pylori test is recommended for anyone that has an active PUD. About 10% of north american population will experience PUD in their lifetime. Not all cases of PUD will be positive for H.pylori but when tested positive, a combination of antibiotics and acid reducer (called triple or quadruple therapy) is recommended to be taken twice daily for 2 weeks to eradicate the bacteria.
Causes and risk factors of PUD:
-over production of acid in the stomach
-use of medications such as NSAIDs (Aspirin, ibuprofen, naproxen), anticoagulants, alendronate, risendronate, oral steroids or some antidepressants known as SSRIs
-smoking and drinking alcohol
-spicy foods
-underlying stress disorder
What are the symptoms?
Symptoms of PUD include bloating, abdominal fullness, nausea, early satiety and sometimes gastro-esophageal reflux. The most common complication of peptic ulcer disease is GI-bleeding that presents with nausea, blood in vomit, or black tarry stool. Most people with H.pylori do not have symptoms, but when they do, the symptoms will be similar to that of PUD.
How is H.pylori transmitted?
The exact way H. pylori infects someone is not fully understood. H. pylori bacteria may be passed from human to human via the fecal-oral route i.e. through direct contact with saliva, vomit or fecal matter. H. pylori may also be spread through contaminated food or water.
How is H.pylori diagnosed?
Diagnostic tests for H.pylori can be invasive or non-invasive. Invasive tests will involve a biopsy endoscopy where a tiny camera is inserted into the GI-tract to visually examine the tract and bring out some tissue (biopsy) to be tested further in the laboratory for the presence of the H.pylori bacteria. Non-invasive tests include antibody testing (testing for antibodies in the blood or urine), urea breath test (testing the patient's breath for presence of high urea levels due the activity of the bacteria) or lastly the fecal antigen test (testing for H.pylori in the stool).
After treatment, testing is also required to confirm eradication. The urea breath test is recommended for confirmation of H.pylori eradication.
H.pylori Treatment
H. pylori infections are usually treated with at least two different antibiotics at once, to help prevent the bacteria from developing resistance to a single antibiotic. Your doctor also will prescribe or recommend an acid-suppressing drug, to help your stomach lining heal.
Common antibiotics that can be used include:
Amoxicillin, clarithromycin, metronidazole, levofloxacin. Choice of antibiotics depends of a variety of factors based on the patients antibiotic use history, resistance level in the community and the patient's allergy history.
Drugs that can suppress acid include:
Proton pump inhibitors (PPIs). These drugs stop acid from being produced in the stomach. Some examples of PPIs are omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and pantoprazole (Protonix).
Histamine (H-2) blockers. These medications block a substance called histamine, which triggers acid production. One example is cimetidine (Tagamet HB).
Bismuth subsalicylate. More commonly known by the brand name Pepto-Bismol, this drug works by coating the ulcer and protecting it from stomach acid.
If you have unresolved peptic ulcer disease, you may want to talk to your doctor about getting tested for H.pylori and if positive get treated to prevent possible complications down the line.
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