What is Helicobacter Pylori, and how it is treated?

Helicobacter pylori (H. pylori) is a strange bacterium that was only discovered in human stomachs 20 – 25 years ago. I say “strange” because bacteria don’t usually survive in the stomach’s extremely acidic environment. H. pylori apparently does this by living deep under the protective layer of mucus that covers the inside of the stomach.

H. pylori infection is very common. It is found in about 10 percent of healthy people under the age of 30, and in greater numbers in older people. It is more commonly found in people from socioeconomically deprived backgrounds and is very common in the third world. It is probably transmitted through contaminated food or water.

Health concerns 300x244 What is Helicobacter Pylori, and how it is treated?

What is Helicobacter Pylori, and how it is treated?

H. pylori is now thought to be the cause of duodenal ulcers in 90 to 95 percent of cases. It is found in stomach ulcers and cases of gastritis (an inflammation of the stomach without ulcers) in 50 to 60 percent of cases.

When researchers in Australia first proposed that this strange bacterium was the cause of ulcers, the response of the medical community was disbelief and ridicule. For years, the medical dogma was that ulcers were caused by excessive acid production and that certain types of people were psychologically more susceptible to the effects of acid. To propose that ulcers were really an infectious disease that could be cured with antibiotics was therefore a startling discovery.

By now, I think all experts in this country have accepted the role of H. pylori, and antibiotic treatment is always given when it is present in someone with an ulcer. More and more doctors are treating H. pylori when no ulcers or gastritis are present, since the treatment is safe and relatively easy, and may bring about a cure. There is also evidence that H. pylori may contribute to stomach cancer, so treating it will hopefully prevent that very serious cancer.

There is a blood test that measures antibodies to H. Pylori. The presence of a positive blood test can be assumed to indicate infection in someone who has not been previously treated. Unfortunately, after treatment, the antibody level in the blood falls slowly, so the test cannot be used to tell if the treatment was successful or if the infection has recurred.

The gold standard test for H. pylori is to see the bacteria on a biopsy of the stomach lining. Some experts will repeat that test after treatment to see if the infection has been eradicated. There is also a radioisotope breath test that is supposed to be more accurate than the blood test in determining cure, but it is not yet widely available, and I have no personal experience with it.

There are now quite a few different combination therapies to eradicate H. pylori, many of which use Pepto-Bismol, since the active ingredient, bismuth, has been shown to inhibit the bacteria. The most effective treatments use three drugs (triple therapy) with or without Pepto-Bismol. I personally use cimetidine (Tagamet), metronidazole (Flagyl), and ampicillin, since it is the cheapest combination and is well tolerated by most people. But regimens using other drugs, such as ranitidine (Zantac), omeprazole (Prilosec), tetracyclines, Biaxin, and others are also effective.

The discovery of H. pylori and its treatment has revolutionized our care of people with ulcers. We now seldom see the painful chronic ulcers that used to be so common. Bleeding and perforation are also much less common. I can’t remember the last time I had to send someone for ulcer surgery, and most of my patients with H. pylori have had either total remissions of pain or greatly reduced pain from their ulcer or gastritis.

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