Helicobacter Pylori Infection - Causes, Symptoms and Treatment

What is Helicobacter Pylori Infection?

Manifesting as either an acute or chronic illness, Helicobacter pylori is an infectious disease responsible for more than 90% of duodenal ulcers and 80% of gastric ulcers. It is also responsible for atrophic gastritis and infected persons have a 2- to 6-fold increase in their risk of developing gastric cancer and mucosal-associated-lymphoid-type (MALT) lymphoma. H. pylori is probably the most chronic infection in human beings; approximately two-thirds of the world's population is infected with the bacterium. In the United States, it is estimated that 10% of Americans suffer from peptic ulcer disease (PUD). H. pylori is most prevalent among older adults, African Americans, Hispanics, and lower socioeconomic groups. Incidence occurs earlier and at increased rates in developing countries; how­ever, prevalence of infection is probably decreasing in developed countries.

What are the Causes of Helicobacter Pylori Infection?

H. pylori is a gram-negative, spiral microaerophilic bacterium that occurs in the gastric mucus layer or the epithelial lining of the stomach. Transmission is believed to be via an oral-oral or fecal-oral route, but the exact source remains unknown. Humans are the only known reservoirs; however, infected water sources may also be implicated. Iatrogenic infection via contaminated endoscopes has also been documented.

What are the Signs and Symptoms of Helicobacter Pylori Infection?

Although H. pylori infections are wide-spread, not all infected persons become symptomatic. Acute infection is characterized by gnawing or burning epigastric pains, which typically occur when the stomach is empty, between meals, and in the early morning hours. The pain, which may persist for minutes to hours, is often partially relieved by eating or taking antacids and H 2 blockers. Other symptoms may include nausea, vomiting, loss of appetite, and bleeding - which can manifest as hematemesis, hematochezia or melena. Severe or prolonged bleeding can cause anemia, fatigue, and weakness and hypotension. Comorbid conditions such as cardiopulmonary disease may be exacerbated by significant blood loss. Chronic infection may result in the find­ing of gastric carcinoma or MALT lymphoma.

Diagnosis for Helicobacter Pylori Infection

H. pylori can be diagnosed through serologic tests that measure H. pylori antibodies in the blood. The 13 C-urea breath test, involving the drinking of a special carbon-labeled urea formula and subsequent measuring of expired CO 2 levels, is also available. Upper endoscopy is the diagnostic test of choice; histological identification ofthe bacterium via tissue biopsy remains the gold standard. The biopsy urease test, based on the bacterium's ability to produce urease, may also be undertaken and provides for rapid identification at the time of biopsy. The 13 C-urea breath test is more reliable than serology for the detection of active H. pylori infection in children. Below 10 years of age, serology is insufficiently sensitive for clinical purposes, whereas the 13C-urea breath test remains a reliable test.

Differential diagnoses to consider include: functional gastrointestinal disorder, viral gastroenteritis, pancreatic disease, and gastric cancer.

Treatment for Helicobacter Pylori Infection

Anyone with active PUD, a documented history of PUD, early gastric cancer or MALT lymphoma should be tested for H. pylori infection and treated if found to be infected. H. pylori can be effectively eradicated with antibiotics. Currently, there are five Food and Drug Administration (FDA) approved treatment regimens consisting of 1 to 2 weeks of one or more antibiotics such as tetracycline, metronidazole or clarithromycin, plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor. (See FDA-approved treatment options for Helicobacter pylori.) Treatment regimes for children have not yet been formalized. Eradication rates range from 70% to 90%, depending upon the regimen used, antibiotic resistance patterns, and patient compliance.

Conditions resulting from substantial bleeding, such as hypotension, anemia, and cardiopulmonary complications should also be treated accordingly. Retesting after treatment may also be prudent in cases of complicated PUD.

Special Considerations and Prevention Tips for Helicobacter Pylori Infection

• Monitor for signs and symptoms of bleeding, such as hypotension, tachycardia, dyspnea, fecal occult blood, occult blood in vomitus, and decreased hemoglobin values.
• Be aware that tarry black stools may result from bismuth and iron preparations and do not indicate gastric bleeding.
• Active gastric bleeding may require insertion of a nasogastric tube; the patient may be unable to take oral nutrition during the acute episode.
• Discontinue nonsteroidal anti-inflammatory drugs.
• Utilize appropriate personal protective gear when performing patient care activities that may result in soiling with bodily discharges, such as blood, feces, or vomitus.
• Advise patients that past infection with H. pylori does not confer immunity.
• Advise people to wash hands thoroughly, before and after eating food - and should only eat food which has been properly prepared, and to drink water from a safe, clean source only.
• Since the mode of transmission of H. pylori is unknown, stress the importance of thorough hand washing after using the toilet.