Infection with
H. pylori is the cause of most stomach and duodenal ulcers.
H. pylori also causes some cases of non-ulcer dyspepsia. Infection with
H. pylori
can be confirmed by a test done on a sample of faeces, or in a 'breath
test', or from a blood test, or from a biopsy sample taken during an
endoscopy. A one week course of two antibiotics plus an
acid-suppressing drug will usually clear the
H. pylori infection. This should prevent a recurrence of a duodenal or stomach ulcer that had been caused by this infection.
What is H. pylori infection and who does it affect?
Helicobacter pylori (commonly just called H. pylori)
is a bacterium (germ). It can infect the lining of the stomach and
duodenum. It is one of the most common infections in the UK. More than
a quarter of people in the UK become infected with H. pylori at some stage in their life. Once you are infected, unless treated, the infection usually stays for the rest of your life.
What problems does H. pylori cause?
Usually none
Most people who are infected with H. pylori
have no symptoms and do not know that they are infected. A number of
these bacteria may just live harmlessly in the lining of the stomach
and duodenum.
Stomach and duodenal ulcers
H. pylori is the most common cause of duodenal and stomach ulcers. About 3 in 20 people who are infected with H. pylori
develop an ulcer. An ulcer is where the lining of the stomach or
duodenum is damaged by the acid which is made in the stomach, and the
underlying tissue is exposed. If you could see inside your gut, an
ulcer looks like a small, red crater on the lining of the stomach or
duodenum.
The exact way H. pylori causes ulcers in some
infected people is not totally clear. Your stomach normally produces
acid to help with the digestion of food and to kill bacteria. This acid
is corrosive so some cells on the inside lining of the stomach and
duodenum produce a natural mucus barrier which protects the lining of
the stomach and duodenum. There is normally a balance between the
amount of acid that you make and the mucus defense barrier. An ulcer
may develop if there is an alteration in this balance allowing the acid
to damage the lining of the stomach or duodenum. In some people H. pylori
causes inflammation in the lining of the stomach or duodenum. This
causes the defence mucus barrier to be disrupted in some way (and in
some cases the amount of acid to be increased) which seems to allow the
acid to cause inflammation and ulcers.
Non-ulcer dyspepsia
This is a condition
where you have recurrent bouts of indigestion (dyspepsia) which are not
caused by an ulcer or inflammation. It is sometimes called functional
dyspepsia. H. pylori is sometimes found in people with non-ulcer dyspepsia. Getting rid of H. pylori cures some cases, but makes no difference in most cases. The cause of most cases of non-ulcer dyspepsia is not known.
Stomach cancer
The risk of developing stomach cancer is thought to be increased with long-term infection with H. pylori.
However, it has to be stressed that more than a quarter of people in
the UK become infected with this bacterium, and the vast majority do
not get stomach cancer. The increased risk is small. Your risk may be
greater if you have H. pylori in addition to having a first
degree relative (mother, father, brother, sister or child) who has been
diagnosed with stomach cancer.
Gastric mucosa associated lymphoid tissue lymphoma - a MALToma
This is a rare and unusual type of stomach cancer. Infection with H. pylori is thought play a role in this condition developing.
How is H. pylori diagnosed?
Various tests can detect H. pylori:
- A 'breath test' can confirm that you have a current H. pylori infection.
A sample of your breath is analysed after you take a special drink.
Note: prior to this test you should not have taken any antibiotics for
at least four weeks. Also, you should not have taken a proton pump
inhibitor or H2 blocker drug for at least two weeks. (These are acid
suppressing drugs.) Also, you should not eat anything for six hours
before the test. The reason for these rules is because they can affect
the test result.
- An alternative test is the 'stool antigen test'. In this test you
give a pea-sized sample of your faeces (stools) which is tested for H. pylori.
Note: prior to this test you should not have taken any antibiotics for
at least four weeks. Also, you should not have taken a proton pump
inhibitor or H2 blocker drug for at least two weeks. (These are acid
suppressing drugs.)
- A blood test can detect antibodies to H. pylori. This is sometimes used to confirm that you are, or have been, infected with H. pylori.
However, it takes six months or more for this test to become negative
once the infection has cleared. So, it is no use to confirm whether
treatment has cleared the infection (if this needs to be known). If
needed, the breath test or stool antigen test are usually used to check
if an infection has cleared following treatment.
- Sometimes a biopsy (small sample) of the lining of the stomach is
taken if you have a gastroscopy (endoscopy). The sample can be tested
for H. pylori.
How is H. pylori cleared from the stomach and duodenum?
H. pylori
is killed by certain antibiotics. However, a combination of drugs is
needed to completely get rid of it. You need to take two antibiotics at
the same time. In addition, you need to take a drug to reduce the acid
in the stomach. This allows the antibiotics to work well in the
stomach. You need to take this 'combination therapy' for a week. It is
important to take all the drugs exactly as directed, and to take the
full course.
Combination therapy clears H. pylori in up to 9 in 10 cases if it is taken correctly for the full course.
If you do not take the full course then the chance of clearing the
infection is reduced. A second course of combination therapy, using
different antibiotics, will usually work if the first course does not
clear the infection.
Combination therapy is sometimes called
'triple therapy' as it involves three drugs - two antibiotics and an
acid-suppressing drug.
Who should be tested for H. pylori, and treated if it is found?
If you have recurring 'dyspepsia' (recurring indigestion symptoms)
If you have recurring dyspepsia, it is common practice to test for H. pylori before doing any other tests. If H. pylori
is found, then combination treatment is often given. The exact
diagnosis may not be known. For example, it might not be clear if the
dyspepsia is caused by a duodenal or stomach ulcer, or non-ulcer
dyspepsia. These can only be confirmed by having a 'look down' into the
gut with a test called gastroscopy (endoscopy). However, if symptoms go
after treatment for H. pylori, then that is the end of the
matter. You do not need further tests such as gastroscopy. You will not
know exactly what caused the symptoms, but it does not matter: if the
symptoms have gone, whatever was causing them will have gone!
Other reasons for testing
If you are in one of the following groups, you may be offered a test for H. pylori and offered treatment with combination therapy if it is found. If you:
- Have a duodenal or stomach ulcer. Combination therapy will usually cure the ulcer.
- Have non-ulcer dyspepsia. Combination therapy may work and clear symptoms, but it does not in most cases.
- Have a first degree relative (mother, father, brother, sister or
child) who has been diagnosed with stomach cancer. Treatment is advised
even if you do not have any symptoms. The aim is to reduce your future
risk of stomach cancer.
- Are taking, or are about to take, long-term anti-inflammatory drugs
such as ibuprofen, diclofenac, aspirin, etc. The combination of these
drugs and H. pylori increases the risk of developing a stomach ulcer.[
- Have a MALToma (mucosa-associated lymphoid tissue lymphoma).
- Have atrophic gastritis (inflammation of the stomach lining).
- Have had an operation to remove a stomach cancer.
- Have unexplained iron deficiency anaemia.
- Have a condition called chronic idiopathic thrombocytopenic
purpura. This is an uncommon blood condition where the number of
platelets in the blood becomes very low. Some research suggests a
possible connection between H. pylori infection and this condition.
Follow up
After 'combination therapy', a test may be advised to check that H. pylori
has gone (has been eradicated). This test will usually be a breath test
or a stool antigen test (described earlier). If a test is done, it
needs to be done at least four weeks after the course of combination
therapy has finished. In most cases, the test is 'negative' meaning
that the infection has gone. If it has not gone, then a repeat course
of combination therapy with a different set of antibiotics may be
advised.
Some doctors say that for certain situations, this
'confirmation of eradication' test is not necessary if symptoms have
gone. For example, after using combination therapy to treat a duodenal
ulcer. In this situation, the fact that symptoms have gone usually
indicates that the ulcer and the cause (H. pylori) have gone.
But, some doctors say it is needed to play safe. However, for some
conditions such as a stomach ulcer, a 'confirmation of eradication'
test is usually always advised. Your own doctor will advise if you
should have this test following treatment.
Are there any side-effects of combination therapy?
Up
to 3 in 10 people develop some side-effects when they take combination
therapy. These include: indigestion, feeling sick, diarrhoea, and
headaches. However, it is worth persevering for the full course if
side-effects are not too bad. A switch to a different set of drugs may
be advised if the first combination does not clear the H. pylori, or if it caused bad side-effects and you had to stop taking it.
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Reviewed: 25 Jul 2008
