As you might have heard
by now, ulcers in your stomach and duodenum (peptic ulcers) are not caused by your boss or by stress but by a bacterium (bug)
living in your stomach. Ignored for centuries the rediscovery of this bacterium by two Australian doctors Warren and
Marshall has been one of the most exciting things to happen in the field of Gastroenterology (GI).
Lore has it that in
the 1980's Dr. Marshall was asked at a GI meeting "Are you proposing that H pylori causes some ulcers? (sarcasm). He replied
"No, I am proposing that H pylori causes all ulcers!". Actually, the truth lies somewhere in between. (top)
What is Helicobacter
The name says it all. It
is a wavy, spiral bacterium that lives in or near the pylorus (a part of the stomach). Man is the only known host so far.
It is transmitted from person to person by contamination of food, utensils and instruments. It is much more common in the
developing world where almost all adults are infected. In the U.S. infection is uncommon before age 30 and becomes more common
as one grows older. It is more common in lower socioeconomic groups. Its incidence seems to be declining in the western world,
mainly because of improved sanitation and hygiene. (top)
How does it survive
the stomach acid?
It lives on the surface
of the stomach beneath the alkaline mucus layer, where it is protected from the strong acid secreted by the stomach to digest
food. The body secretes antibodies (soldiers of the immune system) against it but these fail to eradicate H Pylori. .(top)
What are the diseases
linked to H Pylori?
Gastritis is an inflammation
of the lining of the stomach. H Pylori causes an acute and chronic type of gastritis. Most people do not have symptoms from
Gastritis. We do not have any evidence that treating this type of Gastritis with antibiotics helps people. Note that there
are other causes of gastritis like alcohol, aspirin and aspirin like medications (top)
and Peptic Ulcer Disease.
It is now well established
that H Pylori is an important cause of ulcers in the Duodenum (upper small bowel) and in the stomach. Treating H Pylori with
antibiotics helps heal ulcers and prevents ulcers from coming back. If you have a history of ulcers in the past, or you have
symptoms of ulcers, you would benefit from treatment. You need to contact your Borland-Groover Clinic gastroenterologist
or your primary physician about this. Note that not all ulcers are caused by H Pylori. There are several other
causes, of which aspirin and aspirin like medications are most important. (top)
and Cancer of the stomach.
H Pylori is classified as
a Group 1 carcinogen by the World Health Organization. It is a cause of some types of cancer of the stomach, especially in
the developing world. There is still no evidence that eradicating H Pylori results in a decreased incidence of stomach cancer.
While H Pylori infection is common, stomach cancer is quite rare, hence other factors may be involved. (top)
H Pylori has been
strongly implicated as a cause of an uncommon type of stomach lymphoma (MALT). What is fascinating is that treatment
of H Pylori with antibiotics helps in shrinking the tumor! (top)
There are a few studies
linking H Pylon in some instances to Heart disease, Rosacea of the face and growth retardation in children. Note that these
are mere associations and no causal relationship has been established. (top)
How does one detect
There are several ways of
detecting the presence of H Pylori. These include Upper Endoscopy with biopsy, blood tests to detect antibodies against
the bacterium and breath inhalation tests. The last is not widely available. Each method has its advantages and disadvantages.
For example Endoscopy not only finds the bug with great certainty but also finds ulcers, tumors and gastritis. On the other
hand it is an invasive test and is expensive. Your Borland-Groover Clinic physician would be able to advise you about
the best test for you. (top)
How is H Pylori treated?
Most often, a combination
of different antibiotics is used for 7-14 days to eradicate the infection. There are more than half a dozen regimens which
eradicate the infection with high certainty, at a reasonable cost and with minimal side effects. The best regimen for you
is based on your allergies, recent use of antibiotics, presence of an active ulcer, physician's familiarity with the drugs
etc. Your Borland Groover Clinic physician would be able to decide the best regimen for you.
It is very
important for you to take the antibiotics as directed for the duration specified or H Pylori develops resistance to them.
This makes subsequent treatment very difficult. Because the antibiotics are very effective it is not necessary to check for
cure except in cases of ulcer complications or if you are having an Endoscopy for another reason.
The above is a synopsis
of a exciting and rapidly evolving field of study in Gastroenterology. At every GI meeting research papers on H Pylori exceed
any other subject. (top)
If you have any questions
contact a Borland-Groover Clinic physician near you or e-mail us at our web page address.
With your help we hope
to defeat H Pylori