Is H. Pylori the Cause of Your Tummy Troubles?

Digestive Health, Featured Article
on January 24, 2013

Got tummy problems—and your doc can’t seem to tell you why? Or, have you been treated for other conditions like irritable bowel syndrome, with little relief? You could be infected with a microscopic spiral-shaped bacterium called Heliobacter pylori, or H. pylori, for short.

Some 30 to 40 percent of Americans, most of them older, are infected with H. pylori, which can cause a stomach pain along with bloating, burping and loss of appetite; ongoing discomfort in your upper abdomen; or nausea and vomiting.

Doctors aren’t quite sure how anyone contracts it. One theory is that the bacterium gets into your body if you eat food that hasn’t been properly washed or cooked or drink contaminated water. The pathogen then spreads from person to person via contact with infected stool or vomit or possibly saliva, which could be why dental hygienists are more prone to H. pylori, says gastroenterologist Dr. Patricia Raymond, associate professor of clinical internal medicine at Eastern Virginia Medical School in Norfolk.

It’s believed most people acquire H. pylori during childhood, though symptoms don’t show up until they’re older, if at all: Plenty of individuals who carry the bacterium never have any problems. But if you think you might be infected, here’s a guide to H. pylori conditions and how they’re diagnosed and treated.

H. Pylori’s Fall-Out

Forget stress or a diet heavy in spicy foods: H. pylorihas been fingered as the leading cause of peptic ulcer—a sore in the lining of the stomach (known as a gastric ulcer)  or duodenum (a duodenal ulcer), the entrance to the small intestine. (Non-steroidal anti-inflammatory medications, or NSAIDS, are the other cause.)  H. pylori burrows into the protective mucus lining the stomach and duodenum. “It breaks up the mucus, leaving tissue vulnerable to your own acid,” explains Raymond.  The result: a dull or burning pain in your stomach between meals that may be accompanied by weight loss, bloating, burping, nausea, vomiting and loss of appetite. If the ulcer worsens, a person may develop intense stomach pain or bloody or black stools. Her vomit may be bloody or resemble coffee grounds.

H. pylori may also cause gastritis and dyspepsia, which trigger ulcer-like symptoms. More common causes of gastritis include a viral infection, excessive alcohol use, and long-term use of NSAIDs such as aspirin and ibuprofen. Symptoms include pain in the upper abdomen, nausea and vomiting and loss of appetite. Dyspepsia is described as chronic or recurrent pain or discomfort in the upper abdomen, including bloating, gas, fullness, fatigue and nausea. And people infected with H. pylori have a two- to six-fold increase in risk for gastric cancer and mucosal-associated-lymphoid-type (MALT) lymphoma, reports the CDC.

When to Test for H. Pylori

Raymond suggests testing for H. pylori“when someone is suffering from a big grab bag of symptoms we call dyspepsia.” There are four ways to detect H. Pylori: Endoscopy, which involves passing a flexible tube with a camera at the end through the esophagus to the stomach and duodenum, allows the doctor to check for ulcers and, if necessary, biopsy tissue. The procedure requires a four- to-eight-hour fast and may involve sedation. Doctors can also do a blood test to look for H. pylori antibodies; a breath test to check for urease, an enzyme secreted by the bacterium; or a fecal antigen test, which can detect H. pylori in your stool. Which test is done will depend upon several factors including its availability and cost as well as your symptoms and medical history.  For instance, while the blood test is fast and inexpensive, it’s not the best way to test someone who has been treated for the infection in the past.  The reason: The blood test can have positive results for months after treatment, according to Raymond. “If I have treated you for H. pylori, I would do the stool test, which is much more sensitive,” she says. Indeed, she performs the stool test three months after treating someone for H. pylori to determine if treatment has worked.

Treating H. Pylori

Treatment for H. pylori takes time—10 to 14 days—and commitment: A patient has to take three to four medications—adding up to anywhere from six to 16 pills per day. depending upon the regimen.  The three possible treatment include two regimens that involve taking three medications, so-called triple therapy; and a third involving four medications—quadruple therapy. All involve some combination of antibiotics and antacids. Generally, people try quadruple therapy after failing triple therapy.

Even if someone sticks to the medication regimen, treatment may not succeed. “Each therapy is about 80 percent effective,” says Raymond.  While it’s important to eradicate the bacterium, “at a certain point, you have to wonder whether it’s worth it to keep bopping someone with broad spectrum antibiotics, which can be deleterious,” says Raymond.  In these instances, she will try a new regimen if one appears. In the meantime, she puts the patient on a type of antacid called a proton pump inhibitor. “With a strong antacid drug, we can keep people from getting ulcers,” she says.