Gastrointestinal Doctors and Nurses at CCDD
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Gastrointestinal Conditions

Helicobacter Pylori (Stomach Infection)

This unusual name identifies bacteria that can cause infection in the stomach. Bacteria are tiny microbes, larger than viruses, but still only seen with the aid of a microscope. To understand how and where the infection occurs, it is useful to know the anatomy of the upper digestive track. The food pipe is called the esophagus, and it enters into the larger, upper part of the stomach where food is collected. The narrower, lower part of the stomach is called the antrum. The antrum contracts frequently and vigorously, and in so doing, grinds up the food and squirts it into the small intestine. The stomach, including the antrum, is covered by a thick layer of mucous which acts to protect it from the strong acid that the stomach secretes.

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What Is It? | What Causes It? | Diagnosis | Treatment | Summary

What Is It?
Helicobacter pylori is a fragile bacteria that has found an ideal home in the protective mucous layer of the stomach antrum. The bacteria have several long threads protruding from them that attach themselves to the side of the underlying stomach cells. The germ is protected in this mucous environment. It does not infect the underlying stomach cells as certain other bacteria might. The infection, however, does generate a reaction in the body. Infection fighting white blood cells move into the area and the body even develops protein antibodies to the bacteria, so the infection is indeed very real. It is generally accepted by medical authorities that this infection occurs when an individual swallows the bacteria in food, fluid, or perhaps, from contaminated utensils. It is known that older people have a higher incidence of the infection, as do people in Third World countries where contaminated foods are more likely to occur. The infection, however, remains localized and probably persists indefinitely unless specific treatment is given.

Stomach Problems: What Causes Them?

  • Gastritis - Inflammation of the stomach is called gastritis. Gastritis can be caused by excessive alcohol and be certain drugs, such as aspirin and some arthritis drugs, such as ibuprofen. The Helicobacter pylori bacteria can also cause gastritis. The infection has been found in every part of the world, in every part of society, and in every age group. What is known is that the infection tends to be more common where sanitation is less effective, so that it occurs more quickly in younger people in Third World countries. However, the infection does increase with age in all parts of the world, indicating its wide prevalence. This infection is probably one of the most common infections in the world. It is now known that in many, perhaps most cases it does not produce symptoms. In other words, the infection can occur without the individual knowing it. The symptoms of gastritis are upper abdominal burning, bloating, and discomfort. Nausea and even vomiting may also occur.

  • Non-ulcer dyspepsia - At times a person may have symptoms that suggest ulcers, including burning or pain in the upper abdomen, often occurring an hour or so after meals or during the night. These symptoms are often temporarily relieved by antacids, milk, or medications that reduce stomach acidity. Yet, the physician does not find an ulcer when the patient is tested by x-ray or endoscopy. If Helicobacter pylori is found in the stomach, it is tempting to believe that it is the cause of the symptoms. At times, a physician will start antibiotic therapy to see if clearing the infection is associated with a decrease in symptoms.

  • Duodenal ulcers - The duodenum is the first portion of the intestine beyond the stomach. In times past, physicians were taught "no acid, no ulcer." This statement means that the medical profession felt the single most important factor in duodenal ulcer formation was strong stomach acid. Research has now demonstrated that almost all patients who develop duodenal ulcers have Helicobacter pylori infection in the stomach antrum. Medical studies are underway to determine the relationship between the two, and how an infection in the stomach can be related to a duodenal ulcer. Acid is still vitally important. Patients without acid in the stomach still never get duodenal ulcers. Increasingly, however, physicians are accepting the fact that the infection is related somehow to the development of a duodenal ulcer. It is now rather easy to clear duodenal ulcers with the strong medicines available. But the recurrence of the ulcers tends to be great unless the Helicobacter pylori infection is cleared.

  • Stomach ulcers - Ulcers can develop in the stomach as well, and in these instances, the Helicobacter pylori infection is found in 60 to 80 percent of the cases. Again, it is still uncertain how the infection acts to cause an ulcer. The infection could weaken the protective mucous layer of the stomach. This would allow acid to deep in and to injure the underlying stomach cells. There is still a good deal of research that needs to be done to unravel this relationship.

There are several ways to make the diagnosis. During endoscopy, the physician may take small snippets of tissue that can be tested either immediately or at a later date. There is also a breath test available to detect the presence of infection. In this test, a substance called urea is given by mouth. A strong enzyme in the bacteria breaks down the urea into an ammonia gas which is then exhaled through the lungs and can be measured. Ad finally, there is a blood test that can measure the protein antibodies in the blood against the bacteria.

Since the infection is so common and often does not cause symptoms, it is generally recommended that no treatment be given under these circumstances. There are times, however, when the ulcers or symptoms do not clear up under standard treatment with medicines that reduce stomach acid. Then the physician may consider treatment with antibiotics. Interestingly, one of these antibiotics is a bismuth compound which is available over the counter as Pepto-Bismol. The bismuth part of the medicine actually kills the bacteria. It must be remembered that the microbe is buried deep in the stomach mucous so it is difficult to get rid of this infection. Therefore, three antibiotics are generally used together to prevent the germ from developing resistance to any one antibiotic. The drugs must be used for up to 30 days to get the best results.

Helicobacter pylori is a very common infection of the stomach. In most cases it causes no problems or symptoms. It is becoming increasingly clear that the infection is related to the development of stomach and duodenal ulcers. However stomach acid is still a major factor in the development of most ulcers. In most cases, antibiotic treatment is not necessary. In some instances, antibiotic therapy may be required. By itself, the infection is usually not serious. The physician is able to evaluate this infection in light of other digestive problems and arrive at the appropriate treatment program.