What is Helicobacter pylori ?
Helicobacter pylori (also known as H. pylori or HP) is a bacterium that is the main cause of ulcers occurring in the lining of the upper part of the small intestine (duodenal ulcers) and in the lining of the stomach (gastric ulcers). Initially, the bacterium causes inflammation (gastritis or duodenitis) - many people may be unaware of this inflammation, only experiencing symptoms when an ulcer develops, perhaps years later. Not all people infected with H. pylori will develop an ulcer.
The methods by which this bacterium is passed from one person to another are still not understood completely. However, it is thought that people infected with the bacterium are only capable of passing it to others for a short period (days or weeks). It may be passed via the fingers through contact with vomit or stools from an infected person. Therefore, good hygiene may decrease the risk of the bacterium being spread. However, it is thought that people living in the UK are unlikely to pass it on and do not need to take any special measures to avoid giving it to others.
What are the symptoms of Helicobacter pylori infection?
The first symptoms of infection with H. pylori are usually those of an ulcer. Ulcers cause pain, which can vary in intensity from mild discomfort to severe pain. The pain may last from minutes to hours and may come and go for several days or weeks. The pain may be severe enough to wake you during the night. Drinking milk or taking an antacid may relieve the pain and if the pain is frequent during the day, continual snacking will alleviate the pain when it occurs.
Are any tests needed?
The test usually used to diagnose an ulcer is an endoscopy. This is a procedure in which a flexible fibre-optic tube, which relays images to a video camera, is passed through the mouth down into the stomach. This enables the doctor to look at your oesophagus (gullet or food pipe), stomach and duodenum (upper part of the small intestine). This procedure also allows the doctor to perform a biopsy - this involves taking a sample of cells from the lining of the stomach or duodenum, which can then be grown in a special culture to test for the presence of H. pylori . If there is growth of H. pylori, different antibiotics can then be tested on this culture to establish which is the most effective at treating the bacterium. The most effective antibiotic can then be used to treat your ulcer.
Endoscopy has largely replaced other tests to diagnose ulcers but sometimes these other tests may still be used:
- A barium x-ray - this involves swallowing a harmless liquid which shows up on x-ray. This is less successful than endoscopy in diagnosing ulcers and a biopsy cannot be taken be during the procedure.
- A urea breath test - this involves swallowing a tasteless fluid and then giving breath samples into a special device. Analysis of the breath samples can confirm the presence of H. pylori and may indicate the extent of the infection.
- Blood tests to detect antibodies to H. pylori are also available. You may have a blood test prior to an endoscopy. If antibodies are not present, then you probably do not have a duodenal ulcer. If antibodies are present, this indicates that H. pylori is present and an endoscopy will be requested. It is unlikely that treatment will be given based on a diagnosis from a blood test alone and endoscopy will still be necessary.
What treatment is available?
Infection with H. pylori is usually treated with a combination of three drugs (triple therapy).
A proton pump inhibitor such as esomeprazole, lansoprazole, omeprazole, pantoprazole or rabeprazole which suppress gastric acid will be given together with two antibiotics. The antibiotics used include amoxicillin, clarithromycin and metronidazole.
Occasionally if triple therapy is unsuccessful a treament regimen involving four drugs (quadruple therapy) may be used.
Evidence shows that triple therapy can eradicate H. pylori in around 80-85 per cent of cases. The main reason why therapy to eradicate H. pylori fails is that patients do not always take their medication as prescribed. It is very important for you to take all your tablets every day as directed.
Unfortunately, many people suffer side effects from therapy. The side effects may include diarrhoea, nausea, a metallic taste and sometimes a severe inflammation of the bowel. However, if you can tolerate any side effects that you experience and persist with the course of treatment then H. pylori should be eradicated for good. If you stop half way through a course, your ulcer and all the problems that occur as a result of it will return. You may also be left with a drug-resistant strain of H. pylori that cannot easily be treated with further antibiotics. If you cannot tolerate the side effects of treatment you should check with your doctor before stopping the course.
Long-term ulcer sufferers are at risk of perforation of the lining of the stomach or duodenum and are also at risk of bleeding from the gastrointestinal tract. There is also increasing evidence that infection with H. pylori is associated with cancer of the stomach. Therefore, it is important to identify and treat H. pylori infection.
Further information available from:
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Fact sheet provided by MIMS
Date last reviewed: October 2014