Dear Dr. B: My doctor says I have bugs in my stomach. He gave me antibiotics to kill the bugs. Can you please tell me more about these bugs? Where do they come from? How did I get them? Will I pass them to my family? What are my chances of getting them again? Yours, Mr. Bugged!
Dear Mr. Bugged: The bug (bacterium) is called Helicobacter Pylori (H. pylori). The discovery of this bacterium in 1982 has changed how we think about ulcers and non-ulcer symptoms of the stomach and duodenum. Despite significant research and advances in understanding this organism, its cause remains poorly understood.
Let us start with a short history. Once upon a time, most ulcers in the stomach and duodenum were thought to be due to acid produced by the stomach. For more than hundred years, thousands (could be millions) of people all over the world underwent surgery to reduce acid in the stomach, to get rid of the ulcers and prevent their recurrence.
The results of these surgeries (there were variety of them) were not always satisfactory. There were numerous complications and side effects. There were many unhappy patients and surgeons. Then, we saw some newer drugs come in the market to reduce the acid in the stomach. This was 25 years ago. It started with tagamet and now we have a variety of them, better and stronger like losec, pantaloc, prevacid etc.
These drugs did considerably cut down the number of surgical procedures for peptic ulcer disease. But the recurrence rate of ulcers continued to be high unless the patient stayed on the pills for a long time. This made patients unhappy, as the pills are expensive. Thus the compliance rate was poor.
So, what about H. pylori?
Peptic ulcer disease affects about 10 percent of the population at some time in their lives. There are approximately 2500 new cases each year in Alberta. Over 90 percent of duodenal ulcers and 70 percent of gastric ulcers are associated with H. pylori infection. But only about 15 percent of patients with H. pylori infection will develop peptic ulcer disease or cancer of the stomach as a consequence of their infection. Some ulcers are caused by aspirin or NSAID (non-steroidal anti-inflammatory drugs).
Where do the bugs come from?
Only proven reservoir for H. pylori is the human host. Major modes of transmission are still unclear. Oral-oral and fecal-oral routes are possibilities. There is also considerable evidence that H. pylori is transmitted between spouses. In Canada, the majority of H. pylori infections are acquired before the age of five years and that infection after that age is uncommon, less than one percent per year.
Who should be treated?
Eradication therapy for patients with H. pylori infection who do not have underlying peptic ulcer disease has generally not been advocated, says Alberta Clinical Practice Guidelines administered by the Alberta Medical Association. Two types of antibiotics and an acid suppressing drug like losec should be given for seven days to patients who have a proven peptic ulcer. Eradication rates are approximately 90 percent. Side effects of medications occur in less than five percent of patients.
Would I get it again?
True reinfection within one year is generally uncommon unless the initial management or compliance was poor. Late reoccurrence is caused by repeated exposure through contact with an infected partner.
So, Mr. Bugged, I hope this information helps to debug your stomach!
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