H. Pylori is a Bacteria
Stress, spicy foods, type A personality, which of these cause most stomach ulcers? The answer is none of them! Research shows that most ulcers develop because of an infection named helicobacter pylori (H. pylori). Patients are tested for H. pylori prior to bariatric surgery to decrease the risk of developing ulcers after surgery.
H. pylori is a bacteria found in the stomach. It was identified in 1982 by Australian scientists Barry Marshall and Robin Warren. A British scientist named Stewart Goodwin found it was present in patients with chronic gastritis and gastric ulcers. It is also linked to the development of duodenal ulcers and stomach cancer. More than 80 percent of individuals infected are asymptomatic.
Understanding the bacteriology and its unique features that enable it to survive in an environment as hostile as the stomach are important in appreciating how H. pylori causes tissue injury and clinical disease. H. pylori is a spiral shaped bacteria that has two to seven flagella which enhances its mobility through viscous solution the organism’s urease, motility, and ability to adhere to gastric epithelium are factors that allow it to survive and proliferate in the gastric milieu. Bacterial urease hydrolyzes gastric luminal urea to form ammonia that helps neutralize gastric acid and form a cloud around the organism, enabling it to penetrate the gastric mucus layer. It’s a spiral shape, flagella and the mucolytic enzymes which it produces facilitate its passage through the mucus layer to the gastric surface epithelium.
H. pylori has been demonstrated in individuals of all ages. Although, the route in which infection occurs remains unknown, person to person transmission of H. pylori through either fecal or oral exposure seems most likely. The organism can be cultured from vomitus or diarrheal stools suggesting the potential for transmission among family members during periods of illness. Humans appear to be the major reservoir of infection; however, H. pylori has been isolated from primates in captivity and domestic cats. It is unclear how these animals originally acquired the H. pylori infection. The infection is more common in crowded living conditions with poor sanitation. Contaminated water supplies in developing countries may serve as an environmental source of bacteria. The organism remains viable in water for several days. Evidence of H. pylori can be found in most samples of municipal water from endemic areas of infection.
Children who regularly swim in rivers, streams, and pools that drink stream water or uncooked vegetables are most likely to be infected. Interfamilial clustering of infection further supports person to person transmission. Infected individuals are most likely to have infected spouses and children than uninfected individuals.
To help prevent infection:
- wash hands with soap and water and using bathroom and before eating
- eat food that has been washed and properly cooked
- drink from clean safe water source
Several test are available to help diagnose H. pylori infection:
Upper GI series: an x-ray of the upper GI tract-the esophagus stomach and duodenum. The x-ray contrast makes ulcers show up in the x-rays.
Endoscopy- A procedure that involves snaking a thin, flexible tube within a camera down the esophagus, through the stomach and into the small intestine to view the upper GI tract. For an endoscopy the patient is lightly sedated the scope is passed into mouth down the throat and into the stomach and duodenum the doctor uses endoscope to take photos of ulcers and take a biopsy the biopsied tissue is examined to see if pylori is present.
Blood test: a test the look for antibodies in the blood that indicates exposure to it. Pylori
Stool test: a test the uses a small sample of stool to look for evidence of infection.
Urea breath test: a test use to check for the presence of gas produced by bacteria the patient swallows a capsule, liquid or pudding that contains urea “labeled” with a special carbon atom after a few minutes, the patient breaths into a container exhaling carbon dioxide. If the carbon atom is bound in the exhaled breath, H. pylori is presents as bacterium contains large amounts of urea a chemical that breaks urea down into carbon dioxide and ammonia The Urea Breath Test is also used to determined is eradication has been effective after treatments.
H. pylori is difficult to eradicate from the stomach because it is capable of developing resistance to commonly antibiotics, therefore two or more antibiotics are given together with a proton pump inhibitor.
Combination therapy can be expected to cure 70-90% of infections. Treatment failure is common among patients who have prior exposure to these antibiotics. In these patients, a second course of treatment is given, consisting of another combination of antibiotics.
Although when H. pylori colonizes the stomach, most individuals infected will never experience symptoms despite having chronic gastritis. Approximately 10-20% of those colonized by H. pylori will eventually develop gastric and duodenal ulcers. Having H. pylori infection does not necessarily mean a person will develop ulcers or stomach cancer. It pylori infection is associate with a 1-2% life time risk of stomach cancer and a less than 1% risk of gastric MALT Lymphoma.