A common infection affecting people all over the world is H. pylori infection. This infection is caused by Helicobacter pylori (Hp), a spiral shaped gram-negative bacillus commonly found in the mucous layer of the gastric or the stomach epithelial lining. The bacterium was first cultured and discovered in 1982 by Warren and Marshall who identified it as Campylobacter pylori.
H. pylori is responsible for antral gastritis, ulcers of the duodenum and gastric which affects both adults and children. The bacteria causes over 90% duodenal ulcers and approximately 80% gastric ulcers. Prior to its discovery, ulcer origin was associated with acid, stress, lifestyle and spicy foods. A larger percentage of patients were administered long term medications for instance H2 to heal the ulcer. However, these medications were not able to treat H. pylori infections as the condition reoccurred after acid suppression has been eliminated.
Today, H. pylori infection has affected about two thirds of people in the world and the infection is most prevalent in the United States where it has affected majority of older adults, Hispanics, African Americans as well as lower socioeconomic groups. Most people who become infected with H. pylori do not suffer any symptoms associated with the infection, nevertheless, H. pylori is responsible for chronic persistent, chronic active and also atrophic gastritis in children and adults. Individuals who get infected have about 2-6 times higher risk of developing MALT lymphoma and gastric cancer as compared to those who are not infected.
It has not been established how H. pylori is spread and why some people develop symptoms while others have no symptoms at all. But it is likely that the bacterium is spread from one person to another trough oral-oral or fecal-oral routes. Potential environmental reservoirs are contaminated sources of water.
The most common symptom of ulcer is burning or gnawing pain inside the epigastrium and this normally occurs when there is nothing in the stomach, early in the morning, between meals or other times and can last for some minutes or even hours. Less common symptoms of ulcers include lack of appetite, nausea and vomiting. At times, bleeding may occur and can lead to anemia, fatigue and weakness if it prolongs and in case of heavy bleeding, melena, hematochezia or hematemesis may occur.
Therefore, people with active duodenal or gastric ulcers or known ulcer history must be tested for H. pylori and if the results are positive, they must be treated. H. pylori infection testing and treatment are recommended after resection of premature gastric cancer and also for gastric MALT lymphoma of lower grades. For patients with complicated or bleeding ulcer cases, retesting after treatment can be prudent. For pediatric patients who need extensive diagnostic work-ups pertaining abdominal symptoms, they are recommended to consult a specialist for evaluation.
H. pylori infection therapies involve 10 -14 days of effective antibiotics which are administered once or twice. Such antibiotics include clarithromycin, amoxicillin, metronidazole or tetracycline plus either a bismuth subsalicylate, proton pump inhibitor or a ranitidine bismuth citrate. It is important to note that tetracycline is only given to children above the age of 12 years. Acid suppression by using proton pump inhibitor like omeprazole or H2 blocker together with antibiotics can help to ease symptoms of ulcers.
