Stomach Bacteria (H.pylori)

Helicobacter pylori (H pylori) is an organism found in stomach. It is estimated that more than half the world’s population is infected with this bacteria. That includes 20 to 40 percent of Canadians.

Usually, infected individuals have no symptoms and develop no problems as a result of this. Only 15 percent of infected individuals develop clinically significant H pylori related disease in their lifetime – stomach ulcers, gastritis and cancer.

Is this bacteria a normal inhabitant of stomach since so many people seem to carry it? Or people are infected from others? The answer is not very clear.

Since the bacteria have potential to cause illness, should we screen everybody for this bug?

Here is what a review article in the Canadian Journal of Gastroenterology says:

-Consensus conference of the Canadian Helicobacter Study Group does not recommend screening in asymptomatic individuals.

-Recommendation is to screen and treat all patients with gastric or duodenal ulcer whether they are symptomatic or asymptomatic.

-There is controversy as to whether patients with dyspepsia (indigestion) benefit from H pylori eradication. It seems that a small number (up to 15 percent) of such patients benefit from treatment.

How can we test for H pylori infection?

A blood test can tell us whether one has been exposed to the infection. If this test is negative then there is 90 percent chance that there is no infection. A positive blood test does not mean that you are currently infected. Under the age of 50, this test should be good enough depending on patient’s symptoms.

Urea breath test is superior to the blood test and is another simple way to check for infection. It has less than 10 percent false negative and false positive results. But in Medicine Hat, most patients end up getting the most expensive invasive test called gastroscopy. Why? Because the other two tests are not readily available.

What to do if infection with H pylori is detected?

The review article says that testing should not be performed to detect the presence of H pylori without an intention to treat if the test result is positive. Recently published guidelines recommend treatment of asymptomatic patients whose infection becomes known. In patients with peptic ulcer disease, eradication of H pylori infection is cost effective.

Treatment is with an acid suppressant (proton pump inhibitor) and two antibiotics for seven days. This is called triple therapy. It is almost always curative, and the infection almost never recurs in Canadian adults, but research says that eradicating the bacteria in the absence of peptic ulcer rarely fixes the problem of indigestion.

Are we smarter today than 17 years ago when the bacterium was first discovered?

In many ways, yes! Now we can cure peptic ulcer without surgery. But new studies suggest that treating this bacterium may increase the risk of esophageal ulcers and cancer. If you don’t treat it then there may be a risk of getting stomach cancer! Go figure!

Who said doctors know everything? In the last 20 years, this is one of the most important discoveries in medical science. But there are many unanswered questions.

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