What is H.pylori and how is it spread?
Helicobacter pylori (hereafter H.pylori) is a gram-negative bacterium that inhabits the human gastric epithelium. It is one of the most common bacterial infections worldwide and it is estimated that at least 50% of the population in developed countries is infected, while in underdeveloped countries this figure can be as high as 80%. This bacterium is particularly resistant to gastric acid thanks to the production of urease, an enzyme that allows it to live for long periods of time in the stomach lining.
It is especially contagious during childhood, although it often goes unnoticed because it is asymptomatic. It usually occurs through direct contact with the fluids or stool of infected persons, as well as through contaminated food or water, a route that tends to be relatively common in underdeveloped countries.
What are the symptoms?
H.pylori infection can be symptomless and remain inactive throughout life. However, the most common symptoms in those cases that do cause clinical symptoms may be:
- Abdominal pain and bloating.
- Feeling of fullness early, one to three hours after meals.
- Lack of appetite.
- Unintentional weight loss.
- Belching, nausea and vomiting.
- Burning sensation in the stomach.
- iron-deficiency anaemia or vitamin B12 deficiency
- tarry, dark or bloody stools, if ulcers are present.
In addition, due to complications of the infection, such as an excess of gastric acid that inflames the gastric mucosa, complications such as chronic gastritis, peptic or gastroduodenal ulcer and even, although less likely, serious pathologies such as lymphoid tissue lymphoma or mucosa-associated gastric adenocarcinoma may develop.
How is H.pylori infection diagnosed?
If you have any of the symptoms described above, it is recommended to consult your doctor. You will also need to indicate which medications you are taking, as you may need to stop taking some of them for a while before the tests to avoid altering the results, such as antibiotics or proton pump inhibitors.
There are several ways to diagnose H. pylori infection. The least invasive for the patient include:
- Breath test: The patient is asked to swallow a substance containing urea; if H.pylori infection is present, this will break down the urea into ammonia and carbon dioxide. After a short period of time, the doctor will ask the patient to exhale into a special bag or device that can measure the carbon dioxide levels. If they have increased, the test result will be positive. It is often used both to detect the presence of the bacteria and to eradicate it after treatment.
- Stool test: It consists of analysing the patient’s stool to detect the bacteria. At OPERON we have the Simple/Stick H.pyl and Simple H.pyl-Tf rapid tests, capable of detecting antigens in stool in three simple steps and giving reliable results in only 5-15 minutes, which is ideal for primary care consultations. Additionally, the Simple H.pyl-Tf can detect the presence of transferrin, a very stable protein to detect, in case of ulcer, possible bleeding in the upper intestinal tract, as it does not degrade as it passes through the intestine. It is often used both to detect the presence of the bacterium and its eradication after treatment.
Other more invasive tests would be a blood test to measure antibodies against the bacteria and an upper endoscopic biopsy, although the former would not differentiate between an active infection and a past infection.
What treatments currently exist?
The doctor will determine in which cases treatment is necessary. Generally, this consists of taking a combination of antibiotics for 10 to 14 days along with medication that reduces the acidity of the stomach, so that the antibiotics can be more effective. Although sometimes the bacteria may show resistance and require several courses of treatment, eradication of the bacteria is usually successful or, at least, alleviates symptoms and possible complications.
How can H.pylori infection be prevented?
Mainly by maintaining good hygiene measures and avoiding exposure to potential sources of infection. This involves:
- Frequent hand washing with soap and water, especially before meals, after toileting and after handling raw food.
- Drinking safe, well-treated drinking water that is free of contaminants. This is one of the main routes of transmission of H.pylori in poorly developed areas.
- Avoid eating undercooked or unwashed food.
- Hygiene in community settings such as kindergartens, residences, hospitals, schools, restaurants…
- Avoid sharing utensils and personal belongings such as toothbrushes, cutlery, glasses, etc., as the bacteria can be transmitted through saliva.
