Helicobacter pylori: how do you get it and how do you know you have it? Have you ever even heard of Helicobacter pylori?
Helicobacter pylori is one of the most common, if not the most common chronic human infections. H. pylori is a major cause of peptic ulcer disease: gastric and duodenal ulcers. Approximately 10% of the population of the U.S. suffer from peptic ulcer disease (500,000-850,000 cases occur each year). Higher rates are seen in developing countries and lower socioeconomic groups. Up to 90% of some populations may be infected. In Columbia and China, H. pylori infects over half the population in early childhood.
Transmission:
Although the source of transmission for H. pylori is unknown, it is most likely spread person-to-person through fecal-oral routes or oral to oral routes. H. pylori has been isolated from dental plaque and the saliva of persons infected with the organism. Contaminated water sources may also be a possible source of H. pylori transmission.
To date, humans the only known reservoir. So, how do you know if you have H. pylori…or a peptic ulcer? Symptoms are variable and may not be present.
Diagnosis:
Diagnosis of peptic ulcer disease are based on symptoms in addition to test results. There are numerous methods to confirm H. pylori as the causative agent of peptic ulcer disease. Some tests are less invasive and moss accessible than other.
Non-invasive tests:
Breath test
Patient is given a solution containing urea attached to carbon 13 (13C) or carbon 14 (14C). Urease produced by H. pylori metabolizes the urea in the carbon bond releasing labeled carbon measured as CO2 when the patient breath into a test apparatus. The presence of H. pylori can be determined based on the detection of CO2. Sensitivity and specificity range from 94% to 98%.
Helicobacter pylori Stool Antigen test (HpSA)
A test has been distributed for H. pylori antigen detection in stool samples as a diagnostic aid. The test has promise but there are relatively few studies to evaluate the diagnostic capacity of H. pylori stool antigen testing.
Invasive tests:
Blood test
Blood testing involves having one vial of blood drawn (4 mL to 10 mL). The serum (fluid portion of the blood after a blood clot has formed) is tested for the presence of H. pylori antigens (proteins) to determine if the individual has been infected. Sensitivity and specificity of testing ranges from 80% to 95% depending on the assay.
Endoscopy
Biopsy of the stomach lining collected using endoscopy (procedure in which a small tube with a camera is inserted through the mouth and esophagus into the stomach). The biopsy sample is sent to the pathology lab for microscopic examination and/or microbiology lab for culture. Rapid urease detection can also be performed to predict the presence of H. pylori.
Treatment:
H. pylori treatment consists of a combination of 2-3 antibiotics for 7-14 day. Cure rates range from 70-90% depending on the specific antibiotic regime. Combinations of antibiotics include amoxicillin, tetracycline, metronidazole or clarithromycin. Treatment usually involves two antibiotics and bismuth citrate (e.g. Zantac), bismuth subsalicylate (e.g. Pepto Bismol) or proton pump inhibitor (e.g. Losec). The bismuth salts and proton pump inhibitors suppress acid production and helps alleviate some of the gastric mucosal inflammation and discomfort caused by the ulcer(s).
Treatment failure is caused by antibiotic resistance or patient noncompliance.
Read more about peptic ulcer disease and H. pylori:
Helicobacter pylori: Its Role in Peptic Ulcer Disease
Peptic Ulcer Disease: The Role of Helicobacter pylori
Sources:
Helicobacter pylori and Peptic Ulcer Disease: The Key to Cure
