Helicobacter Pylori and Reflux Disease

Helicobacter Pylori and Reflux Disease

Helicobacter Pylori and Reflux Disease

Helicobacter pylori, or H. pylori as it is commonly called is a bacterium which infects the stomach and first part of the intestine called the duodenum. Its identity and its relationship to ulcer disease is one of the most exciting discoveries in medicine in the era of the 1980's. Prior to this time, doctors thought that ulcer disease was simply a physiologic response to stress, stomach acid, and irritation. We now know that most ulcers are almost always caused by this infection.

We don't know exactly how the bacterium is spread. It is probably spread by fecal-oral contamination. It may be salivary spread. We know it has been isolated in dental plaque. It infects up to half the people in the world, and is most prevalent in developing countries with crowded living conditions. The bacterium has long tendrils of flagella which help it move about the stomach and attach to the cells that line the stomach. The bacteria is a corkscrew shape. It lives in the protective mucus which coats the lining cells of the patient's stomach. The bacterium produces chemicals which damage the mucus and the lining cells of the stomach and duodenum.

It is relatively rare in young children in the U.S., but increases with age so that about half of U.S. adults over the age of 60 are infected. Most people don't seem to have symptoms; however, in those who do, the illness may be quite severe. Symptoms include stomach fullness, bloating, sharp pains, and nausea which sometimes cause blood in the vomitus and stools. It can cause dark blood in the stool. People who have these bacteria are often anemic because of slow and consistent bleeding. The bacteria can block the absorption of iron. Hemoccult tests of the stool are strongly suggested. Common blood test the doctor would perform would be a CBC, serum iron blood test, and SMA 23 must be evaluated.

The infection can be diagnosed in several ways. One is a blood test which checks for antibodies to the bacterium which is formed during an infection. Another way is a breath test where a patient swallows a urea substance which the bacterium breaks down into a measurable amount of hydrogen gas. Another way is to take a small biopsy from the stomach lining during an endoscope exam and look for the bacteria under a microscope. The stool can be checked for fragments of the bacterium. Once a blood test is positive it usually is positive for life.

Once the diagnosis is made, doctors can prescribe very specific treatments to eliminate the infection from the stomach. The medicines are usually taken for two weeks. The proton pump inhibitor omperazole may be given for a month to help heal all ulcers. The cornerstone of treatment is prescribing 2-3 antibiotics to be taken together. This is necessary to penetrate the bacterium and to hopefully prevent resistance. If the first treatment doesn't work, then 2-3 different antibiotic combinations have to be given for two weeks again. The second part of the treatment is a proton pump inhibitor which turns off acid production in the stomach. This causes the H. pylori to be more vulnerable to the antibiotics, and helps heal any ulcers which have formed. The third part of the treatment is large doses of bismuth (found in products like Pepto Bismol) which coat the stomach lining and somehow inhibits the bacterium's growth.

The good news is that most H. pylori infections can be cleared with this plan of treatment. A lot of the long-term complications of peptic ulcer disease are being avoided. Once treated successfully, generally, patients do not get H. pylori infections again

John Drew Laurusonis

Doctors Medical Center

www.doctorsmedicalctr.com

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