What is H.pylori ?
H.pylori is a bacteria that lives only in the lining of the stomach and is one of the most common chronic infections in humans. The importance of H. pylori was unrecognised until 1982, when two Australian doctors (Barry Marshall and Robin Warren), discovered that the germ was almost always present in patients with gastritis (inflammation of the stomach) and ulcers. Doctors now believe that H.pylori is associated with most stomach ulcers and almost all duodenal ulcers. H.pylori causes inflammation of the stomach lining and weakens the natural protection against stomach acid, which may then cause an ulcer. If stomach acid is reduced with medications, an ulcer may heal, but it tends to come back once the medication is stopped. However, if H.pylori is treated successfully with antibiotics, an ulcer can be permanently cured. This means that the ulcer medication may no longer be needed.
Does H.pylori always cause ulcers?
H.pylori does not always cause ulcers to form but almost always produces inflammation of the stomach lining. Some people with H.pylori infection do not have any symptoms, but many report nausea, gas, bloating and burning stomach pain. Doctors believe that H.pylori may be responsible for many of these symptoms.
How common is H.pylori infection?
H.pylori infection occurs throughout the world, in every part of society and in every age group. About 30% of the Australian population has the infection, which is more common with advancing age and is rare in children. Once infected with H.pylori, a person usually continues to carry the germ unless certain medications are used to cure the infection.
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How did I get it and can I spread it?
Most people with H. pylori have acquired the infection during childhood, but continue to carry it throughout their life. H.pylori appears to be passed from person-to-person. It is more common in spouses of infected patients than in the general population. It is also common in places where sanitation is poor and where crowded living conditions exist. It is not clear exactly how a person gets H.pylori, but it may be through swallowing infected food or water. H.pylori is not found naturally in animals, so pets do not seem important in the spread of the infection. Careful personal hygiene (through hand washing, use of separate personal items such as eating utensils, glassware, etc.) probably is the best way to reduce person-to-person spread of H.pylori.
How is H. pylori infection diagnosed?
There are several ways to determine the presence of H.pylori:
- Blood tests can be used to determine the presence of antibodies to the bacteria. These tests tell if person has ever had the infection but do not prove that the infection is still present. A biopsy of the stomach can be used to determine the presence of H.pylori.
- A biopsy is obtained during an examination of the stomach with a flexible scope. The biopsy is examined by a pathologist under a microscope to look for the presence of H.pylori, or more easily by a Rapid Urease Test (RUT) where a sample of the stomach is mixed with a slide with a colour change indicating that H.pylori is active in the stomach.
- The urea breath test whereby a sample of the patients breath is captured and analysed for the presence of H.pylori.
How is it treated?
Treatment protocols for H.pylori will differ by region as there will be differences in strains and infection loads.
The current conventional approach is usually initiated by the physician with the regime commencing with one course of standard 7-days triple therapy with Clarithromycin, Esomeprazole and Amoxicillin as the first-line treatment. Triple therapy is a combination of medications consisting of a proton pump inhibitor (e.g. esomeprazole, rabeprazole), used to suppress the acid production (heart burn and acid reflux etc.) taken along with two other commonly available antibiotics.
The choice of antibiotics used for an infected patient has to be carefully assessed and decided by your medical professional.