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What is it?
Helicobacter Pylori (HP) is a bacteria which can
infect the lining of the stomach. It generally affects the lower
end of the stomach and causes chronic inflammation or gastritis.
In some cases, the gastritis causes ulcers, or symptoms which
suggest that an ulcer is present. These symptoms may not improve
with antiulcer therapy or may improve temporarily only to recur
when treatment is stopped. Chronic infection with HP may also
cause severe recurrent ulcer disease. Occasionally, it causes
no symptoms at all. How Does Infection Occur?
The precise mode of transmission has not been determined,
but the infection is spread from person to person. The organism
has been isolated from stool and dental plaque. A fecal oral route
is suspected. Poor sanitation in underdeveloped countries is associated
with a higher rate of infection. The bacteria invade the mucus
layer of the stomach and multiply. It produces ammonia which neutralizes
the surrounding acid, thus protecting itself. Sometimes, a person
will have an acute infection which is eliminated completely by
the body's immune system. In many cases, the infection never completely
clears, and the body's immune response actually worsens the inflammation
associated with the infection. Some strains of HP produce a toxin
which causes further damage. Chronic infection may also cause
the stomach to produce excessive amounts of acid. Does it Cause Cancer?
Gastric cancer seems to be associated with HP. When
stomach cancers are surgically removed, HP is often found in the
stomach lining surrounding the cancer. The incidence of stomach
cancer in various populations also correlates strongly with the
incidence of HP infection. Diagnosis
The most reliable method of diagnosis is gastroscopy
and biopsy. Gastroscopy may be necessary to diagnose other conditions
which could cause similar symptoms. The characteristic appearance
of the bacteria can be identified by microscopic examination in
about 90% of patients with the infection. Cultures are usually
not necessary.
Blood tests are available to detect antibodies to
HP. Unfortunately, they cannot determine whether the patient has
an active HP infection. We may request blood tests if HP infection
is suspected such as in the patient with ulcers and biopsies negative
for HP. We often use this information to make decisions to treat
for the infection.
By age 60, over half the population in the U.S. has
antibodies to HP indicating some exposure. This makes HP the most
common infection afflicting the human race. The fact that the
infection is so common makes it difficult to make a decision to
treat solely on the basis of a blood test. Treatment
HP is generally treated whenever it is
identified. It has been clearly proven that patients with gastric
or duodenal ulcers and helicobacter infection benefit from treatment.
Patients with gastritis or non ulcer dyspepsia and helicobacter
do not respond as consistently. It is not always clear whether
HP is contributing to a person's symptoms. The simplest way to
answer this question is to treat the infection and see if the
patient improves. The potential to eliminate recurrent ulcer disease
and the risk of gastric cancer are powerful arguments in favor
of treatment. The bacteria tend to rapidly become resistant to
antibiotics if a single drug is used. For this reason, multiple antibiotics are used, and
most programs will cure about 95% of patients with HP
infection. Research suggests that combining triple therapy with
antiulcer medication speeds the healing of duodenal ulcers and
dramatically reduces the risk of duodenal ulcer recurrence. It
also reduces the risk of recurrent ulcer bleeding. Can it Recur?There are many strains of HP, and infection can recur. Fortunately, this is uncommon, and occurs in about 1% of patients per year. We do not recommend repeat testing to confirm eradication unless the symptoms do not resolve with treatment.
Treatment Programs
Prevpack--take for two weeks (14 days), followed by 4-6 weeks of a PPI
Helidac--take for two weeks. Also should take a PPI twice a day while on Helidac and then once a day for an additional 4-6 weeks.
PPIs-These drugs turn off acid production by the stomach. They will speed the healing of ulcers and help relieve the symptoms of ulcers and stomach irritation associated with HP. They also improve the likelihood of curing the infection.
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See Also: The Helicobacter Foundation www.helico.com |
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