H. pylori: ever heard of it?
Here’s a pleasant thought: There exists, in the stomachs of the majority of us here on Planet Earth, a bacterium called Helicobacter pylori, or H. pylori. H. pylori, explains the National Cancer Institute, grows in the mucus layer that coats the inside of our stomach. In order to survive in this harsh, acidic environment, says the NCI, H. pylori secretes an enzyme that converts the chemical urea to ammonia. The ammonia then neutralizes the acidity of the stomach, making it more hospitable for the bacterium.
Oh, and there’s more. Because of its handy little spiral shape that allows it to burrow into the mucus layer, H. pylori remains hidden, and safe, from our immune cells, which normally recognize and attack invading bacteria but which have been rendered ineffective since they’re unable to reach the stomach lining.
But what, you may ask, does H. pylori have to do with you? Maybe nothing, and maybe plenty. When was the last time you popped a few antacids? Or grabbed for your emergency supply of Pepcid or Prilosec? Ever been diagnosed with a peptic ulcer?
“H. pylori causes chronic inflammation in the stomach, with subsequent changes of the cells,” explains Henrique Fernandez, MD with Gastroenterology Associates of Colorado Springs. “It has been described that H. pylori can cause gastro-duodenal ulcers, and that it has a relationship with carcinogenesis, most frequently with gastric cancer and a type of gastric lymphoma called MALT lymphoma.”
According to the Centers for Disease Control, about two-thirds of the world’s population is infected with H. pylori, and though most people never suffer symptoms, the bacterium is responsible for more than 90% of duodenal ulcers and up to 80% of gastric ulcers. Infected folks have a 2- to 6-fold increased risk of developing gastric cancer and (MALT) lymphoma.
“It is unknown the exact route of infection,” says Dr. Fernandez, “however it has been described as person-to-person transmission - oral-oral or fecal-oral.”
People with active gastric or duodenal ulcers or documented history of ulcers should be tested for H. pylori, and if found to be infected, they should be treated, says the CDC, which adds that treating H. pylori with H2 blockers and proton pump inhibitors alone can relieve symptoms and may heal the ulcer, but they don’t treat the infection, meaning symptoms will likely return once the blockers and PPI are discontinued. “Since we now know that most ulcers are caused by H. pylori,” says the CDC, “appropriate antibiotic regimens can successfully eradicate the infection in most patients, with complete resolution of mucosal inflammation and a minimal chance for recurrence of ulcers.”
“For initial therapy,” explains Dr. Fernandez, “it has been recommended to start with triple therapy consisting of a proton pump inhibitor and two antibiotics, treating the patient for approximately 10-14 days. If there is recurrence of the disease or resistance to one of the initial antibiotics, a quadruple therapy is recommended, switching the initial antibiotics to new ones, continuing with the antacid PPI and adding Bismuth [a heavy metal toxic to H. pylori]. If the patient fails two attempts of treatment, then endoscopy with biopsy of the stomach and culture and sensitivity is indicated.”
For those infected with H. pylori, Dr. Fernandez recommends diets with increased levels of antioxidants: vitamins C, E and beta-carotene have some protective effect against developing gastric cancer.
“It is important to decrease salt consumption,” says Fernandez, “because salt increases the possibility to have recurrence of H. pylori infection.” The doctor also suggests staying away from a red-or processed-meats diet.