Go Away…Helicobacter Pylori – Dr. Chieng Jin Yu

helicobacterDoctor, what is Helicobacter Pylori?

H. pylori infection occurs when a type of bacteria called Helicobacter pylori infects your stomach. The H. pylori infection transmission mechanism is oral-oral or fecal-oral, as well as through contaminated water. This usually happens during childhood.

The discovery of Helicobacter pylori in 1983 by Warren and Marshall ranks as one of the most important discoveries in gastroenterology world. The award of the Nobel Prize in Medicine to Drs Warren and Marshall in 2005 is a fitting tribute to their momentous discovery. H. pylori is an important discovery as it has revolutionalized our understanding and management of peptic ulcer disease.

More than 50% of the world’s population are infected with H. pylori. However, most people don’t realize they have H. pylori infection, because they never get sick from it.

Is H. pylori infection common among Malaysians?

Malaysia is a multiracial country, with each ethnic group has their own unique lifestyle, religious and cultural practice.

The first study carried out in Malaysia by KL Goh (1997) reported a high prevalence rate of 59%, followed by Sasidharan S (2008) with a prevalence rate of 14.6%, and the most recent one reported as 14% by JY Chieng (2015). Undoubtley, the H. pylori infection is common among Malaysians, but most studies have consistently shown a marked decrease in H. pylori prevalence. In addition, most studies showed that the higher prevalence of H. pylori infection among non-Malays than in Malays.

Do we need to care about the H. pylori infection?

H. pylori infection is well recognized as a major causative organism for peptic ulcer disease and gastric cancer in human beings. H. pylori-positive patients have at least a sixfold greater risk of developing gastric cancer than do those without infection. Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is a rare but interesting condition in that eradication ofH. pyloricauses clinical regression of the lymphoma in 75% of cases. The association between H. pylori infection and gastro-oesophageal reflux disease remains controversial

How to know if I am infected with H. pylori ?

Majority of the patients with H. pylori infection are asymptomatic. Or you may have symptoms of peptic ulcer disease (dyspepsia) such as fullness, bloating and nausea.

Tests and procedures used to determine whether you have H. pylori infection includes:

Blood test. Analysis of a blood sample may reveal evidence of an active or previous H. pylori infection in your body. However, breath and stool tests are better at detecting active H. pylori infections than is a blood test. Serology is an inappropriate means of detecting cure of infection, as it can remain positive for up to one year after eradication.

Breath test. During a breath test, you swallow a pill that contains tagged carbon molecules. If you have H. pylori infection, carbon is released when the solution is broken down in your stomach. Your body absorbs the carbon and expels it when you exhale. You exhale into a bag, and your doctor uses a special device to detect the carbon molecules. You need to stop taking acid-suppressing drugs known as proton pump inhibitors (PPIs), and antibiotics for at least two weeks before you have the test.

Endoscopy exam. You need to fast for at least six hours prior. During the exam, your doctor inserts a long, flexible tube equipped with a tiny camera (oesophago-gastro-duodenoscopy, OGDS) down your throat and esophagus and into your stomach and duodenum. Your doctor can detect if any abnormalities in your upper digestive tract and remove tissue samples (biopsy) for further analysis ofH. pylori infection, such as a rapid urease test named CLO test. However, this test isn’t generally recommended solely to diagnose an H. pylori infection because it’s invasive.

Stool antigen test. A test that is extremely useful in children, to detect the presence of H. pylori antigen in the stool.

Who needs the eradication?

Eradicating Helicobacter pylori cures most ulcer disease. You need eradication if found H. pylori related peptic ulcer disease. Patients post gastric surgery resection, or the first degree relatives of patients with gastric cancer should be treated as well. Some prospective studies show little benefit to the eradication of H. pylori infection in the patient with non-ulcer dyspepsia. And the H. pylori eradication can be beneficial tothe high-risk ulcer patient who is beginning chronic NSAID use.

How to treat?

The presence of the infection should always be confirmed prior to antimicrobial treatment.

Your doctor will prescribe you a one-week course of oral medicines consisting of proton pump inhibitor (PPI), together with two types of antibiotics. Current first line eradication regime is a seven-day course of PPI and antibiotics. Eradication therapy, in general, is safe and well tolerated. Antibiotic therapy may be associated with certain drug adverse reactions, that you need to see the doctor for further advice if happens. Eradication is effective in 80-85% of patients on triple therapy.

A few studies suggest that probiotics and lactobacilli reduce the activity of H. pylori.

Do I need to follow up after the treatment?

After completing H. pylori treatment, repeat testing is usually performed to ensure that the infection has resolved. This is typically done with a breath test. Failure of treatment is usually due to poor compliance or to antibiotic resistance. And you may need a second line of eradication (e.g. Levofloxacin-based therapy) or further assessment.

Is there any vaccine available in the market?

Further workflow should be promoted and continued to produce a vaccine against the organism.

Dr. Chieng Jin Yu is a consultant Gastroenterologist & Hepatologist and  a medical lecturer at Universiti Putra Malaysia.

References

  1. Goh KL. Prevalence and risk factors for Helicobacter Pylori infection in a multi-racial dyspeptic Malaysian population undergoing endoscopy. Journal of Gastroenterology and Hepatology 1997; 12: S29-S35.
  2. Sasidharan S, UyubAM, Azlan AA. Further evidence of ethnic and gender differences for Helicobacter Pylori infection among endoscoped patients. Transactions of the Royal Society of Tropical Medicine and Hygiene 2008; 102: 1226-1232.
  3. Chieng Jin Yu, Pan Yan, Loong Yik Yee. Prevalence of Helicobacter Pylori Infection Among Patients Attending Gastroenterology Endoscopy Unit At Serdang Hospital – Malaysian Journal of Medicine and Health Science (ISSN 1675-8544); Vol. 11(1) January 2015: 11-17.
  4. Tan Huck Joo. Malaysian Society of Gastroenterology and Hepatology: The Management of Helicobacter Pylori.

 

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