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Helicobacter pylori. What is it?
Helicobacter pylori is a common bacterial infection that affects the stomach. Its association with disorders of the stomach was first discovered in Australia in the early 1980s, and was a major breakthrough in understanding and treating peptic ulcer. Until that time, peptic ulcer was thought to be due to too much acid in the stomach. The treatment then was to give drugs that reduced the stomach's acid production. This is still effective treatment. However, the discovery that eliminating the Helicobacter pylori bacteria cured the ulcer in most people meant that many no longer needed to keep taking drugs to reduce stomach acid. Where does it come from? Helicobacter pylori is one of the most common bacterial infections throughout the world. No one is completely sure how it spreads but it passes between individuals and the most likely route is hand to mouth. It runs in families and is more common in spouses but it is not transmitted by sexual intercourse. p>It is more common in densely populated areas, affects men and women equally, and occurs in children, especially in developing countries. How common is it? In Australia, Helicobacter pylori infection is often acquired in late childhood. By age 30, one in five people have it, and by age 60, almost half the population is affected. Symptoms The most common symptom is indigestion. However, having the Helicobacter pylori bacteria doesn't necessarily mean you will have indigestion, and having indigestion due to too much acid doesn't necessarily mean you have the bacteria. In most people, there are no symptoms. Those who do have symptoms may experience indigestion, abdominal pain, nausea, bloating and burping. Each of these can also have other causes. Diseases due to Helicobacter pylori infection nflammation of the stomach (gastritis). At the time of infection, there may be acute symptoms of nausea, vomiting and indigestion. Later, when the inflammation becomes chronic, symptoms may be mild or non-existent. The gastritis usually disappears if the infection is successfully treated.
How is it diagnosed?
There are three possible tests: a blood test, a
breath test and a biopsy test.
Carbon dioxide is produced, absorbed from the stomach,
passes through the lungs and is expired in the breath. After breathing
into a machine, the quantity of gas can be measured and confirms the
presence or absence of the Helicobacter pylori bacteria.
This test is useful to check whether treatment to eradicate
the bacteria has been successful. The breath test is done after fasting
and takes about an hour.
It is usually done 4 weeks after the end of treatment.
Blood tests are useless at this stage as they give positive results
for many months even though the bacteria have been eradicated.
Treatment
There are several ways to treat Helicobacter pylori infection.
The two common choices are with bismuth (De-Nol) or potent acid-lowering
drugs in combination with two antibiotics (usually metronidazole plus
one of several antibiotics such as tetracycline, amoxycillin or clarithromycin).
No one drug is successful in treating Helicobacter pylori
infection. Treatment is complex and involves taking all the medications
for up to two weeks. The greatest success is achieved with at least
three medications (triple therapy).
Side-effects occur in one in three people, however, these
are usually not severe. They may include some nausea, vomiting, diarrhoea
and thrush.
Rarely, a more severe diarrhoea associated with colitis
may occur. In clinical studies, less than 5 per cent of people withdrew
from treatment because they were unable to tolerate side-effects. There
are fewer side-effects with a combination of only two medications but
this therapy is less successful.
Adding a potent acid-lowering drug to bismuth triple therapy
may reduce the side-effects and increase the success. This is known
as quadruple therapy.
After treatment, you will need tests to check that the
treatment has been successful. This is usually by a breath test or another
gastroscopy.
If treatment is unsuccessful, you may need a further course,
perhaps using a different combination of drugs or for a longer period.
In Australia, the risk of reinfection with Helicobacter
pylori infection is low.
What to expect after treatment
Guideline Application Statement This document has been
prepared by The Gut Foundation and every care has been taken in its
compilation. The leaflet is intended to be used as a guide only and
not as an authoritative statement of every conceivable step or circumstance
which may or could relate to the management of Helicobacter pylori.
The Gut Foundation and the compilers of this document shall not be liable
to users of the document nor to any other person, firm, company or other
body for any loss, direct, indirect or consequential, on whatsoever
account for any omission or negligent mis-statement contained therein,
or by reason of, arising form or in relation to any such user, by any
other person, company or body relying or acting upon or purporting to
rely or act upon any matter contained therein or arising thereout.
The Gut Foundation acknowledges the generous
support of an educational grant from Pharmacia & Upjohn Pty Limited.
The Gut Foundation Research Institute Telephone: (02) 9382 2749
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