Helicobacter Pylori Infection

Discovery of Helicobacter pylori infection

• HOW CAN A BACTERIUM PRODUCE AN ULCER?

  For many years it has been considered that gastroduodenal ulcers were consequence of an imbalance between the aggressive factors (the acid) and the defenses (the mucus that  covers the inner layer of the digestive tract). This “traditional” hypothesis is not incompatible with the causal Helicobacter pylori role, since the bacterium, on one hand, increases gastric acid secretion  and, also, it debilitates the gastric mucosal layer. Therefore, the traditional aphorism that says “without acid there is no ulcer”, should be updated and extended with “without Helicobacter pylori there is no ulcer” (although we must not forget that there are other causes of ulcers different from this bacterium,like anti-inflammatory drugs). Consequently, both  acid and the infection with Helicobacter pylori are important factors for the development of  ulcers.

• HOW HAVE I GET INFECTED?

  The infection is believed to be most frequently acquired at early years, being transmitted directly person to person. In worst developed countries, the contagious route is mainly the fecal-oral one, and maybe in some cases can be acquired by contamined waters. At developed countries, nevertheless, the most probable contagious route is the gastro-oral one (ex. Vomitting).

  Most of the infections are acquired during childhood, being rare, although possible, during adulthood. Domestic animals are not H. pylori hosts, and therefore they cannot be infection agents. Once acquired, the bacterium lives at human stomach along lifetime unless a suitable antibiotic treatment is given.

• IS THIS INFECTION FREQUENT?

  This bacterium is distributed worldwide, being probably one of the most frequent bacterial infection in the world. It is believed that more of 50% on Spaniards above 50 years is infected.

• WHAT CONSEQUENCES DOES THE INFECTION HAVE?

  Most infected people only develops a minimal inflammation (mild gastritis) in the stomach. This inflammation neither produces pain (maybe just mínimum disconfort) nor imply risks. Only 1 out of 10 infected people will develop ulcers or celular changes leading to metaplasia, dysplasia or even gastric cáncer if not treated (nevertheless, in Western countries this is rare). This way, it is not currently recommended to look for the infection to the general population. It is also not recommended to take antibiotics empirically in people without digestive disturbances related to H. pylori.

• HOW CAN HELICOBACTER PYLORI BE DIAGNOSED?

  The diagnosis can be performed by two types of methods, invasive ones (those who need an upper gastrointestinal endoscopy), and non-invasive ones (those performed without endoscopy). If the doctor diagnoses an ulcer during the endoscopy, he can obtain a mucosal simple to be studied under microscope (histology) or to be performed a rapid urease test. In case the doctor decides that an endoscopic study is not needed, non-invasive test cau be used. Among them we have urea breath test, determination of H. pylori antibodies by a blood simple or the determination of H. pylori antigens in fecal samples. Among the non-invasive methods, the gold standard remains the breath test. It is a simple test consisting in blowing in a small pipe after having drunk a lemon flavoured liquid. It is undoubtly the elective diagnostic tool to control the eradication after treatment. Nevertheless, the test can have false negative results if the patient have taken antibiotics or drugs for the acid secretion (like, i.e, omeprazole) close to the test. This way, antibiotics must be stopped at least 30 days before the breath test, and other drugs like omeprazole at least 15 days before.

• IS IT NECESSARY TO HAVE TREATMENT?

  Patients infected with H. pylory and ulcers must have an antibiotic course in order to eradicate infection. Long term treatment with proton pump inhibitors (i.e omeprazole) or other antisecretory drugs is only recommended in patients who cannot stop treatment with aspirin or antiinflammatory drugs. When there are no visible lesions in the stomach secondary to H. pylori infection, it is not clear whether it is necessary or not to look for H. pylori and to treat it, since the results of scientific studies are contradictory. Some experts, however, recommend “look and treat” strategy in all patients with symptoms suspected to be related to H. pylori infection. Nevertheless, the doctor will choose the best strategy to diagnose and to treat (if necessary) in each patient.

  It is not easy to treat the H. pylori infection, since the stomach is not an hospitalary place for the cells to defeat H. pylori. For this, it is necessary to associate several antiacid drugs with antibiotics to manage the infection. The first option compresses three different medicines (two antibiotics and a proton pump inhibitor) for 7 to 10 days. Before starting treatment, the doctor will make sure that the patient is not allergic to any of the drugs prescribed.

  The initial efficacy of the eradication therapy is aproximately 7-8 of every 10 patients. In patients who fail to eradicate infection at a first attemp, it is possible to give a second course of drugs (different from the previous ones).

• AS SOON AS THE INFECTION WASELIMINATED: CAN I GET INFECTED AGAIN? MUST I HAVE ANY TYPE OFCONTROL?

  If the treatment has reached the goal to eliminate the infection, it seems exceptional that a patient can get infected again. Therefore, neither any control nor precautions are justified. It is also not necessary to study asymptomatic relatives in order to rule out the presence of H. pylori.

• ¿CÓMO SE TRATA LA INFECCIÓN POR HELICOBACTER PYLORI?

  No es fácil tratar esta infección, pues el interior del estómago es un lugar inhóspito, donde no llegan bien las células que se encargan de defender al organismo ni tampoco los antibióticos. Por ello es necesario asociar varios medicamentos antiulcerosos y antibióticos para conseguir eliminar la infección. El tratamiento que se recomienda actualmente asocia tres medicamentos distintos (dos antibióticos y un fármaco que disminuye la producción de ácido por el estómago) administrados dos veces al día, durante 7 a 10 días. Antes de iniciar el tratamiento su médico se asegurará de que usted no es alérgico a ninguno de los medicamentos que deberá tomar. Con este tratamiento se logra curar la infección en aproximadamente 8 de cada 10 pacientes. En caso de que no se logre eliminar la bacteria con un primer tratamiento, puede administrarse, si su médico lo considera indicado, un segundo tratamiento erradicador (que será distinto del primero).

• UNA VEZ ELIMINADA LA INFECCIÓN ¿PUEDO VOLVER A CONTRAERLA? ¿DEBO REALIZAR ALGÚN TIPO DE CONTROL?

  Si el tratamiento ha sido efectivo para eliminar la infección, es excepcional que la vuelva a contraer. Por tanto, no se justifica ninguna medida de control ni precaución, y no es necesario estudiar a los familiares por si tienen también la infección.