Helicobater Pylori – the silent cause of gastritis, gastric ulcers and gastric cancer.

Updated: Jun 16


Introduction


Helicobater Pylori (H. Pylori) is a type of bacteria that resides in the stomach.


The stomach was long considered inhabitable by bacteria until it’s discovery around the 1990’s. It was found that H.Pylori was able to secrete urease that converts urea to ammonia. Ammonia is a basic substance that neutralizes the stomach acid and allows the bacteria to live. As H. Pylori multiply, it eats into stomach tissue, which leads to gastritis and/or peptic ulcer. Over a period of time, this may even lead to gastric cancer.






How can I be infected?


H.Pylori is believed to be transmitted via oral-oral or fecal-oral route. This means that poor sanitary conditions / poor hygiene are the leading cause of H.Pylori transmission and infection. Among those infected are mainly children due to this reason.

A local study of H. Pylori prevalence in Malaysia has shown a 49% prevalence rate of H. pylori infection among west coast Malaysians exhibiting indigestion symptoms (dyspepsia), with the prevalence of 16.4% in the Malays, 48.5% in Chinese and 61.8% in Indians.




What are the symptoms of H. Pylori infection?


Most people infected with the bateria do not have any symptoms, not until complications such as peptic ulcer have developed.

However, there are a number of symptoms that are associated with the infection:-

- Bloatedness

- Nausea/ vomitting

- Heartburn

- Excessive burping

- A dull stomach pain that does not go away

- Dyspepsia

Consult your doctor immediately if you are having: -

- Loss of weight/ loss of apetite with trouble swallowing / early satiety/ feeling very full after a small meal

- Symptoms of anemia such as fainting/ reduce effort tolerance

- Blood in stool, or black/ dark tarry stools (melena)




How can I screen/ diagnose H.Pylori infection?




The mentioned above are the screening modalities for the bacteria within clinic settings. ‘Sensitivity’ represents the accuracy of a positive result whilst ‘specificity’ represents the accuracy of a negative result.


The gold standard for H.Pylori testing is the Urea Breath Test (UBT).


The Antibody detection test requires blood taking while the SAT requires stool collection.

At hospital settings where endoscopy is available, a tissue sample could be taken during endoscopy and tested for the presence of H.Pylori.



Can H.Pylori infection be treated?


Yes, it is absolutely treatable.


The treatment regime for H.Pylori infection involves a combination of three drugs, called ‘triple therapy’.


In a nutshell, triple therapy consists of 2 antibiotics and 1 proton pump inhibitor (PPI). The 2 antibiotics are for the bacteria eradication, while the PPI reduces the gastric acid, helping the gastric lining heal.


The current most widely used regime:

  1. Proton pump inhibitor (PPI) (eg, omeprazole 20 mg BID, lansoprazole 30 mg BID, esomeprazole 40 mg QD, pantoprazole 40 mg QD, rabeprazole 20 mg BID) plus

  2. Clarithromycin 500 mg BD (first-line and continues to be recommended in areas where H pylori clarithromycin resistance is less than 15% and in patients without previous macrolide exposure ​) or metronidazole 500 mg BD (when clarithromycin resistance is increasing) plus

  3. Amoxicillin 1000 mg BD or metronidazole 500 mg BD (if not already selected)


The treatment should be at an optimal period of 14 days.



There have also been recent literatures promoting the use of probiotics (such as L.Bacillus Reuteri )in adjunct with the triple therapy. It was found that the use of probiotics during triple therapy has significantly reduce gastric side effects accompanying the intensive treatment of antibiotics.


Retesting of H.Pylori infection should be performed 4 weeks after completion of antibiotics to confirm eradication.