Helicobacter pylori infection occurs when bacteria called Helicobacter pylori have infected the stomach (in childhood). Usually, Helicobacter pylori infection is not problematic, but in acute conditions it can cause stomach ulcers and even stomach cancer.
What is a Helicobacter pylori infection?
Helicobacter pylori is a rod-shaped bacterium that can colonize the human stomach. With an incidence of approximately 50%, Helicobacter pylori infection is one of the most common chronic bacterial infections. Click to enlarge. Helicobacter pylori infection is caused by Helicobacter pylori – a tiny bacterium found in the stomach. At least half of the world’s population is infected with the bacterium, so the infection can be considered one of the most prevalent in the world. Despite this, over 80 percent of infected individuals are asymptomatic. Therefore, it is believed that Helicobacter pylori may play an important role in natural gastric ecology and protection against some diseases. The age at which this bacterium was acquired appears to influence a pathological outcome of Helicobacter pylori infection. Pathological Helicobacter pylori infection of the stomach causes permanent inflammation of the stomach (chronic gastritis). About 10-20% of patients with Helicobacter pylori infection develop gastric and duodenal ulcers. Helicobacter pylori infection is also associated with a 1-2 percent risk of stomach cancer.
Causes
Helicobacter pylori infection is contagious from person to person through direct contact with saliva, vomit, or feces, although the exact route of transmission is unknown. Studies suggest that Helicobacter pylori infection is more easily transmitted through the gastric mucosa than through saliva, so spread through contaminated food or water is also possible. The bacterium survives the acidic pH in the stomach and burrows into the gastric mucus via flagella to get close to the gastric epithelial cell layer. The injected cysteine-rich proteins trigger inflammatory processes of Helicobacter pylori infection and index an immune system response. Since most people acquire a Helicobacter pylori infection in childhood, risk factors are primarily to be sought in childhood. These include, most importantly, living in crowded conditions and inadequate sanitation, which is why the risk of Helicobacter pylori infection is higher in developing countries.
Symptoms, complaints, and signs
In many cases, Helicobacter pylori infection initially causes no symptoms. After infection, affected individuals may live for years without symptoms. As a rule, chronic inflammation of the stomach (gastritis) develops after a certain time. This is most noticeable in the form of striking burning pain in the upper abdomen. Sometimes stomach pain and severe gastric pressure also occur. Furthermore, those affected also experience a rapid feeling of satiety when eating. In addition, symptoms such as a persistent feeling of fullness, heartburn, bad breath, frequent belching, loss of appetite, nausea and, rarely, nausea are possible. In rare cases, fever occurs in the course of a Helicobacter pylori infection. As a gastric or duodenal ulcer develops in the vast majority of patients, other symptoms may occur. Depending on the location of the ulcer, symptoms may either improve or worsen in the short term after food intake. Severe pain may occur, especially at night. In addition, flatulence, diarrhea and irregular bowel movements often occur. Bleeding is common when ulcers are present. Those affected recognize these by the characteristically black-colored stool (tarry stool). Due to the disturbed intestinal flora, symptoms such as lack of energy, fatigue and sleep disturbances also occur in the longer term. A Helicobacter pylori infection can also trigger episodes of neurodermatitis and psoriasis. Those affected often experience itchy skin.
Diagnosis and course
Most people infected with Helicobacter pylori infection do not show symptoms. If there is a burning pain in the abdomen, nausea, vomiting, frequent belching, flatulence or severe weight loss, a doctor should be consulted in the medium term.An immediate visit to the doctor for evaluation of Helicobacter pylori infection is recommended if severe or persistent abdominal pain, difficulty swallowing, bloody or black tarry stools, and vomiting that looks like coffee grounds are present. Non-invasive diagnostic methods include a blood antibody test, a stool antigen test, or a C-breath test in which labeled drinks are ingested to detect Helicobacter pylori infection. The most reliable method for detecting Helicobacter pylori infection is a biopsy during an endoscopy with a rapid urease test. In addition, a urine ELISA test would also be possible, although none of the testing methods for diagnosing Helicobacter pylori infection are completely error-free.
Complications
Serious symptoms and complications occur in the patient’s stomach as a result of Helicobacter pylori infection. In the worst case, this can lead to stomach cancer, which can also be fatal for the affected person. As a rule, the affected person suffers from stomach pain and abdominal pain. These pains can occur after eating or in the form of pain at rest and reduce the quality of life of the patient enormously. Furthermore, flatulence and heartburn occur. It is not uncommon for diarrhea to occur, which is usually accompanied by vomiting and nausea. Everyday life is made considerably more difficult for the patient by the Helicobacter pylori infection. Familiar activities are no longer possible without further ado. The patient’s ability to cope with stress also decreases enormously, so that sporting activities can no longer be performed. Weight loss and possibly deficiency symptoms occur. The Helicobacter pylori infection is treated with the help of antibiotics, and usually no further complications occur. Without treatment, the symptoms do not disappear on their own and stomach cancer develops, which, if left untreated, can lead to the patient’s death.
When should you go to the doctor?
Helicobacter pylori infection should always be examined and treated by a doctor. If left untreated, this disease can, in the worst case, lead to stomach cancer and thus to the death of the affected person. A doctor should usually be consulted if the affected person suffers from severe pain in the stomach or abdominal area. This pain is permanent and is often accompanied by heartburn. Flatulence or diarrhea can also indicate a Helicobacter pylori infection if these complaints occur permanently and are not dependent on the food taken. In many cases, vomiting or nausea also occur. If these symptoms occur, a doctor must always be consulted. Often, severe and sudden weight loss also indicates the disease. In the further course, the Helicobacter pylori infection can also lead to bloody and thus black stools, which can also cause a panic attack in some patients. Medical treatment is then necessary at the latest. As a rule, Helicobacter pylori infection can be treated relatively easily with the help of antibiotics, so that it is sufficient for the affected person to consult a general practitioner. However, in severe cases or emergencies, the hospital can also be visited. In most cases, there is a positive course of the disease without complications.
Treatment and Therpie
To prevent the bacteria from developing resistance to a particular antibiotic, Helicobacter pylori infection is usually treated with several antibiotics. Because acute Helicobacter pylori infection can cause damage to the protective lining of the stomach as well as the small intestine, leading to the formation of gastric ulcers, medications to reduce acid production are also prescribed to help heal the stomach lining. The standard initial treatment is “triple therapy,” consisting of proton pump inhibitors such as omeprazole and the antibiotics clarithromycin and amoxicillin. If repeat tests show that treatment of Helicobacter pylori infection has not been successful, further use of different antibiotic combinations is indicated. Increasingly widespread antibiotic resistance has now also led to the development of quadruple therapies that add a bismuth colloid such as bismuth subsalicylate. Levofloxacin is also used as part of therapy to treat clarithromycin-resistant strains of Helicobacter pylori infection.Recent studies have shown that ingestion of lactic acid bacteria exerts a suppressive effect on Helicobacter pylori infection. A supplemental diet of yogurt containing lactobacillus and bifidobacterium therefore seems indicated.
Outlook and prognosis
The prognosis of Helicobacter pylori infection is variable. Almost half of the population of Germany is infected with this bacterium. Many affected individuals show no symptoms, regardless of how long the infection has been present. Other patients develop chronic gastritis and gastric and duodenal ulcers. Long-term exposure to Helicobacter pylori can also lead to stomach cancer or what is known as MALT lymphoma in the stomach. Initially, complaints often include nonspecific symptoms such as upper abdominal pain, bloating, belching, and heartburn. However, after diagnosis, treatment should begin to reduce the risk of gastric ulcers, he said. However, simple therapy with antibiotics is not effective. The bacteria are acid-loving and thus not so easy to fight with antibiotics. Only in the context of a triple or quadruple therapy is it possible to fight the bacteria. In triple therapy, in addition to the administration of two antibiotics, a proton pump inhibitor is administered to lower the PH level. In stubborn cases, however, this therapy fails. In such cases, an additional bismuth salt is administered as part of the quadruple therapy. The success rate of this therapy is then 95 percent. The persistence of a Helicobacter pylori infection is often based on a reinfection of the stomach by bacterial populations in the dental plaque. Patients with periodontitis are particularly affected. In some cases, there are also bacterial strains with a certain antibiotic resistance. Complete reinfection is also possible in about one percent of cases.
Prevention
Rising antibiotic resistance increases the need for new therapeutic strategies to prevent Helicobacter pylori infection. Extensive vaccine trials have already shown promising results for therapies to strengthen the digestive flora. Real-world evidence suggests that various probiotics and flavonoid-containing foods such as green tea, red wine, broccoli, sprouts, and garlic prevent symptomatic progression of Helicobacter pylori infection.
Follow-up
After eradication therapy, i.e., medication to combat the Helicobacter pylori bacterium, has been performed, the success of the therapy must be monitored. For this purpose, at least four to six weeks must have elapsed between the cessation of drug administration and the monitoring of success. Stomach-protecting medications such as omeprazole should also be discontinued two weeks before the control, as this can falsify the follow-up control. In patients with a complicated course, for example, who have suffered a gastric ulcer or gastric bleeding due to chronic gastritis, the control should be performed endoscopically. Here, the patient receives a gastroscopy including biopsy removal from the gastric mucosa. Just as in the case of confirmatory diagnosis, rapid urease tests are carried out on the samples taken in order to be able to infer the burden of Helicobacter pylori by determining the pH envelope. In patients without gastric ulcer, a non-invasive therapy control is sufficient. This is sufficient in the majority of patients and is performed with a breath test or a stool antigen test. If eradication therapy has failed, alternative therapies and possible development of resistance must be considered together with the physician. If the bacterium has been successfully eliminated, patients can usually return to a completely normal diet. As support and to protect the attacked gastric mucosa, particularly spicy and acidic foods and smoking should be avoided.
This is what you can do yourself
Helicobacter pylori infection is primarily noticeable to those affected by the unpleasant symptoms of gastritis. While removal of the bacterium in many cases is accomplished by the physician’s drug therapy, the patient himself can do a lot in everyday life to quickly alleviate the symptoms. This is especially true with regard to not further stressing the irritated mucous membrane of the stomach. It is therefore crucial to consistently avoid stimulants such as nicotine, alcohol and coffee.Fatty, spicy and lavish meals also make it difficult for the stomach to regenerate and should ideally be replaced by several smaller and non-stressful meals. Caution is also advised with fruit acid. Even though a glass of orange juice is often appreciated for its vitamins, it irritates an inflamed stomach lining even more. Ideal drinks in case of Helicobacter pylori infection are still mineral water or unsweetened teas based on herbs. Mental stability is also helpful for a quick recovery in Helicobacter pylori infection, as in many other stomach diseases. In this context, it often supports healing if those affected reduce stress factors from their private and professional lives as best as possible. In addition, a sufficient amount of sleep is necessary. In case of strong mental stress, relaxation methods such as progressive muscle relaxation, a dosed endurance training or even yoga help.