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Helicobacter Pylori Screening

What is Helicobacter Pylori?

Commonly known as H. pylori, Helicobacter pylori is a type of bacteria that enters your body and lives in your digestive system. Helicobacter pylori is arguably the most common, treatable cause of peptic or stomach ulcers. Epidemiologically, a H. pylori infection may be present in more than 50% of the global population, but it usually goes underdiagnosed.

For most people, a H. pylori infection will not cause stomach ulcers or any other notable symptoms. But for individuals who end up developing symptoms, there are medications that can effectively eliminate the germs and facilitate the healing of stomach ulcers.

Most people usually get a H. pylori infection during childhood. Research has proven that risk factors for H. pylori infection are closely linked to living conditions in childhood. These risk factors may include living in crowded areas, living with an infected individual, as well as living without a reliable water supply of safe and clean water.

What is the association between H. pylori and gastric cancer?

Once a person is infected, the H. pylori bacteria will multiply in the mucus layer of the duodenum (small intestine) and stomach lining. The bacteria produces an enzyme known as urease that changes urea into ammonia. The function of ammonia is to shield the bacteria from stomach acid. As the bacteria continue to multiply, it eventually erodes into the stomach tissue, eventually resulting in gastric ulcers.

Research has shown that if you are suffering from a H. pylori infection, you have a greater chance of getting gastric cancer later in life. If there is a history of stomach cancer in your family, your doctor may recommend that you get tested for H. pylori, regardless of the presence or absence of stomach ulcers.

Besides screening and subsequent treatment, your doctor might also recommend certain lifestyle alterations, such as incorporating more fibre into your diet. Routine checkups with your doctor and adhering to their recommendations may help lower your risk of developing gastric cancer.

What does H. pylori do?

As previously mentioned, H. pylori is a type of bacteria that colonises and infects the digestive system, while thriving and living in your stomach. It can potentially damage the tissues in your stomach as well as the duodenum. This can result in inflammation in mild cases, and lead to gastric, indigestion, bloatedness, or change in bowel habits. In more severe cases, it can also result in very painful and worrisome sores known as peptic ulcers in your stomach.

How do I know if I have H. pylori?

Most people with either duodenitis or gastritis caused by H. pylori do not display any notable symptoms. But studies show that at least 10% of people infected with the bacteria develop more severe symptoms, such as stomach or duodenal ulcers and, in rare cases, stomach cancer.

Stomach ulcers can trigger a plethora of symptoms or no symptoms at all, with some of the most prevailing symptoms being:

  • Bloatedness
  • Discomfort or pain in your abdomen
  • Reduced appetite
  • Dark or black-stained stools, blood in the stool, change of bowel habit
  • Feeling full after consuming a small amount of food
  • Vomiting or nausea

Although it is uncommon, if left untreated, chronic gastric inflammation secondary to H. pylori can cause the stomach lining to undergo changes which may ultimately lead to gastric cancer.

Although it is uncommon for Helicobacter pylori to cause gastric cancer, it is regarded as a major treatable cause of stomach cancer. Interestingly, epidemiological studies reveal those who reside in regions where the H. pylori infection occurs at a relatively early age are at a higher risk of developing stomach cancer.

What can be done to diagnose a H. pylori infection?

It is highly advisable that you schedule an appointment with a doctor if you experience any unusual stomach pains or discomforts, particularly if your symptoms are either recurrent or persistent. 

There are a few diagnostic methods for a H. pylori infection. Your doctor will discuss with you during consultation on your symptoms, acquire a medical history, assess your personal risk, and perform a physical examination. They will then recommend the suitable tests for diagnosing a Helicobacter pylori infection.

Diagnostic or screening options for the Helicobacter pylori infection include:

  • Blood test: involves a doctor drawing a sample of blood from your body before looking for H. pylori antibodies in your system. It is useful and sufficient for patients who are treatment naive (never been treated) for a H. pylori infection.It can also be paired with other blood tests when you are seeing your doctor for routine medical checkup/health screening requiring blood tests. 
  • Urea-Breath test: involves swallowing a pill, liquid, or pudding that contains carbon. If you are infected with H. pylori, your doctor  will effectively detect carbon molecules when you exhale into a bag.You are advised to fast at least 8-10 hours prior to the procedure. Medications such as antibiotics, proton pump inhibitors, or bismuth subsalicylate have to be held off before undergoing this particular test. A Urea-Breath test is useful in screening and diagnosing an active H. pylori infection, or in patients who have been treated, and would like to be checked if the bacteria has been eradicated. Speak to your doctor further to understand the test.
  • Stool test: a sample of your stool may help your doctor identify proteins that are associated with H. pylori. You will need to stop using medications such as antibiotics, proton pump inhibitors, or bismuth subsalicylate before taking this particular test. 
  • Upper endoscopy test/gastroscopy: an upper endoscopy test involves your doctor offering you a light sedative before carefully inserting an elongated tube with a miniature camera at the end, down your throat and into your stomach. This allows your doctor to view your digestive tract. If necessary, your doctor may also remove small pieces of tissue from your stomach during the test. The samples of tissue can then be examined for an H. pylori infection. This endoscopic diagnostic option has a high accuracy in diagnosing a H. pylori infection, though the procedure is more invasive in nature.

How is a H. pylori infection treated?

If you tested positive for a Helicobacter pylori infection, your doctor will discuss the treatment options and related side effects with you. Your doctor will also weigh up the risks and benefits of treatment vs not treating and possible long term sequelae from the Helicobacter pylori infection.

Treatment options for Helicobacter pylori include:

  • Antibiotics: often the first line of treatment against infection with H. pylori. Your doctor  will offer at least two types of antibiotics at once to help get rid of the infection. This ensures that the bacteria do not become resistant to one drug. You are strongly advised to take antibiotics exactly as your doctor prescribes, including completing all doses of the drugs, even if your symptoms subside.
  • Acid-reducing medications: medications that minimise the amount of acid in your stomach. There are numerous types of acid-reducing medications for H. pylori infections, such as proton pump inhibitors that work by inhibiting the production of gastric acid and histamine (H2) blockers that work by targeting a substance known as histamine, which triggers the production of stomach acid.
  • Bismuth subsalicylate: also known as Pepto-Bismol, this medication works by coating the ulcers in your stomach, protecting them against acids.

Is it possible to prevent a H. pylori infection?

Currently, there is no vaccine that offers the ultimate protection against a H. pylori infection. 

However, there are lifestyle measures that you can practise to reduce your risk of Helicobacter infection or reinfection such as:

  • Wash your hands more regularly and thoroughly
  • Only drink water from a safe and trusted source
  • Don't consume contaminated food
  • Avoid sharing meals without common utensils with others 

Frequently Asked Questions

Are there any complications associated with H. pylori?

H. pylori can potentially cause a number of infections, such as:
Gastric and duodenal ulcers: nearly 10% of people infected with H. pylori will eventually develop a stomach sore or ulcer. This occurs because the bacteria damage the mucous coating that protects the lining of your small intestine and stomach. When this sensitive coating is damaged, strong stomach acid can easily pass through the lining, resulting in injury. Research shows that H. pylori infection accounts for at least 90% of intestinal ulcers and more than 80% of stomach ulcers.
Gastritis: inflammation of the stomach lining. Individuals with a H. pylori infection have a greater risk of developing this particular condition. If left untreated, gastritis can potentially result in stomach cancer.
Stomach cancer: H. pylori infection is a treatable risk factor of stomach cancer. Stomach cancer remains the second most prevalent cause of cancer-related fatalities globally.

What can a H. pylori infection result in?

An infection with H. pylori can potentially cause peptic ulcer disease, chronic gastritis, gastric cancer, as well as gastric MALT lymphoma.

Should H. pylori patients be tested to prove eradication of the bacteria?

Yes, mostly because of the increasing antibiotic resistant strains and reinfection of the bacteria. You are recommended to undergo a clearance test with urea-breath test following treatment eradication of Helicobacter pylori. Speak to your doctor to understand more on the clearance test.

What are some of the most common symptoms of gastritis?

Symptoms of gastritis vary among individuals. Some people may not exhibit any visible symptoms. If one is symptomatic, they can present with symptoms such as nausea, vomiting, indigestion, loss of appetite, vomiting blood or coffee ground-like material, hiccups, black-tarry stools, recurrent upset stomach, burning sensation in the stomach, as well as bloating.

Have H. pylori bacteria become resistant to antibiotics?

H. pylori infections can easily and effectively be treated using antibiotics. However, research shows that some H. pylori infections are becoming resistant to certain types of antibiotics. This implies that the bacteria can survive antibiotic treatment, and victims may require another type of medication to completely eradicate the bacteria.
Thankfully, H. pylori infections are still a treatable medical condition with appropriate antibiotic medication regimens. Early screening, prompt diagnosis, and right treatment are keys to preventing potential digestive system complications such as gastritis, intestinal ulcers, and cancer.

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