H Pylori: The Surprise Cause Of Most Ulcers
Helicobacter pylori, also known as H. pylori, is a bacteria that can cause stomach ulcers. H. pylori infect roughly two-thirds of people worldwide, according to the Centers for Disease Control and Prevention, although it doesnt always cause ulcers. Most people who have this bacteria never experience any symptoms of it. As sanitation improves, cases of H. pylori infections are decreasing. Many cases are treatable, but serious cases can lead to stomach cancer.
History of H. Pylori
H pylori were not discovered until 1982. Before that time, stress, stomach acid, and spicy foods were considered to be the main causes of stomach ulcers. Those with ulcers were treated with medications that relieved symptoms but did not cure infections, which led to recurring ulcers. After H. pylori were discovered, medical professionals began focusing on getting rid of infections with antibiotics. Researchers also understood more about how this bacteria causes stomach ulcers.
How H. Pylori Causes Ulcers
H pylori enter the body when people consume contaminated food or water or eat with contaminated utensils. The bacteria also spreads through contact with body fluids from those with an H. pylori infection. Many infections occur in areas that do not have adequate sewage systems or clean sources of water.
Treatments for H. Pylori
Preventing H. Pylori Infections
If youve been dealing with discomfort caused by ulcers, please contact a gastroenterologist with GI Alliance today.
How Can Parents Help
H. pylori infection can be cured with antibiotics. So the most important thing parents can do is to give their child the antibiotic medicine as directed for as long as the doctor prescribed.
To help soothe belly pain, follow a regular meal schedule. Plan meals so that your child’s stomach isnt empty for long periods. Eating 5 or 6 smaller meals each day may be best, and your child should take some time to rest after each meal.
Dont give your child aspirin, aspirin-containing medicines, ibuprofen, or anti-inflammatory drugs. These may irritate the stomach or cause stomach bleeding.
How Is H Pylori Treated
Your healthcare provider will create a care plan for you based on:
Your age, overall health, and past health
How serious your case is
How well you handle certain medicines, treatments, or therapies
If your condition is expected to get worse
What you would like to do
Your healthcare provider may have you take medicine that kills bacteria .
Other medicines may include:
H2-blockers. These are used to reduce the amount of acid in your stomach by blocking the hormone histamine. Histamine helps to make acid.
Proton pump inhibitors. These help to keep your stomach from making acid. They do this by stopping the stomach’s acid pump from working.
Stomach-lining protectors. These medicines protect your stomach lining from acid and help kill bacteria.
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Causes And Risk Factors Of H Pylori
Doctors arent exactly sure how H. pylori infection is passed from person to person. Research shows that you can become infected with the bacteria by consuming contaminated food or water. H. pylori may also spread through contact with an infected persons saliva, vomit, or fecal matter.
H. pyloriH. pylori
- Sharing a crowded living space
- Living in a developing country
- Not having access to clean water
- Living with someone who has H. pylori
How Are Peptic Ulcers Treated
Acid-suppressing drugs can heal ulcers, however, if H. pylori is still present, the pain and risks associated with ulcers will come back. Therefore, the best treatment must involve getting rid of the infection as well.
An effective vaccine to prevent H. pylori infection in humans is not available. Researchers are actively working on the development of such a vaccine.
In the past, the recommended treatment involved a combination of two antibiotics and an acid-suppressing drug, called a proton-pump inhibitor , to be taken for ten days. However, over the years, H. pylori infections have become increasingly difficult to treat. As a result, new recommendations for treatment have recently been introduced which involved changes to the strength and length of time medication is to be taken. The new recommendations include the addition of a third antibiotic along with the PPI and that these are to be taken for 14 days. If you have been diagnosed with a peptic ulcer, ask your doctor about the new recommendations.
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H Pylori Infection Signs Symptoms And Conditions
Most people infected with H. pylori experience no or very mild symptoms. However, if people with an H. pylori-related illness may experience the following:
- Aching or burning pain in the abdomen
- Appetite changes with weight loss
Depending on the disorder caused by H. pylori, the signs and symptoms may vary in length and severity.
It is not known why some people are more likely to develop stomach ulcers than others. However, there are several theories regarding the cause.
One theory suggests that genetic factors play a role in susceptibility to H. pylori infection. Another theory suggests that the relative degree of harm caused by different strains of H. pylori bacteria may be responsible for the development of ulcers.
Disorders related to H. pylori include:
- Gastric mucosa-associated lymphoid tissue the development of a cancerous tumor from white blood cells in the stomach lining
- Gastritis an inflamed stomach lining
- Non-ulcer dyspepsia stomach discomfort or pain not caused by an ulcer or other condition associated with pain
- Stomach or duodenal ulcers these are open sores in the stomach lining or beginning of the small intestine
- Stomach cancer when abnormal stomach cells divide uncontrollably
Once H. pylori has taken up residence in the stomach, it will be a constant presence in the hosts intestines. Over time, an H. pylori infestation can lead to:
Thats why its crucial to seek treatment if you have H. pylori.
Can I Be Re
Once you have had successful treatment of H. pylori, the chance of being re-infected is very low because most infections occur in childhood. It is very rare to get it as an adult. If you have recurrent symptoms it is most likely because the medication to get rid of the bacteria has not worked, rather than you have been re-infected with the bacteria again.
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Is There A Peptic Ulcer Diet Plan
No particular diet is helpful for people with peptic ulcers. At one time, a bland diet and avoidance of spicy or greasy foods was recommended. Milk and dairy food have been used in the past for ulcer symptoms, but have not been proven to be effective. We now know diet has little effect on ulcers. In some people, however, certain foods seem to aggravate stomach ulcer symptoms. Keep a food diary with your intake and the resulting symptoms and avoid eating any foods that aggravate symptoms.
Tests To Detect H Pylori
Simple blood, breath, and stool tests can detect H pylori with a fairly high degree of accuracy.
Experts recommend testing for H pylori in all patients with peptic ulcer, because it is such a common cause of this condition.
Smokers and those who experience regular and persistent pain on an empty stomach may also be good candidates for screening tests.
Some doctors argue that testing for H pylori may be beneficial for patients with dyspepsia who are regular NSAID users.
Given the possible risk for stomach cancer in H pylori-infected people with dyspepsia, some experts now recommend that any patient with dyspepsia lasting longer than 4 weeks should have a blood test for H pylori. However, this is a subject of considerable debate.
Tests for Diagnosing H pylori
The following tests are used to diagnose H pylori infection. Testing may also be done after treatment to ensure that the bacteria have been completely eliminated.
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What Are The Complications Of H Pylori
If you are infected with the bacteria you can get a painful sore called a peptic ulcer. These sores form in your upper digestive tract.
A very bad ulcer can wear away your stomach lining. It can also cause problems such as:
Bleeding when a blood vessel is worn away
A hole or perforation in your stomach wall
Blockage when the ulcer is in a spot that blocks food from leaving your stomach
H. pylori can also lead to stomach cancer.
How Might H Pylori Infection Decrease The Risk Of Some Cancers But Increase The Risk Of Other Cancers
Although it is not known for certain how H. pylori infection increases the risk of non-cardia gastric cancer, some researchers speculate that the long-term presence of an inflammatory response predisposes cells in the stomach lining to become cancerous. This idea is supported by the finding that increased expression of a single cytokine in the stomach of transgenic mice causes sporadic gastric inflammation and cancer . The increased cell turnover resulting from ongoing cellular damage could increase the likelihood that cells will develop harmful mutations.
One hypothesis that may explain reduced risks of gastric cardia cancer and esophageal adenocarcinoma in H. pylori-infected individuals relates to the decline in stomach acidity that is often seen after decades of H. pylori colonization. This decline would reduce acid reflux into the esophagus, a major risk factor for adenocarcinomas affecting the upper stomach and esophagus.
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Why Dont All Doctors Automatically Check For H Pylori
Changing medical belief and practice takes time. For nearly 100 years, scientists and doctors thought that ulcers were caused by stress, spicy food, and alcohol. Treatment involved bed rest and a bland diet. Later, researchers added stomach acid to the list of causes and began treating ulcers with antacids.Since H. pylori was discovered in 1982, studies conducted around the world have shown that using antibiotics to destroy H. pylori cured peptic ulcers. The National Institutes of Health released a consensus statement in 1994 confirming that H. pylori causes peptic ulcers. Despite the evidence, however, the medical community continues to debate H. pyloris role in peptic ulcers. If you have a peptic ulcer and have not been tested for H. pylori infection, talk to your doctor.
What Is The Treatment For Peptic Ulcers
The choice of treatment depends on whether or not the ulcer is caused by infection with H pylori. Correct diagnosis is key to whether a treatment works or not. If the bacteria are the cause, treatment focuses on killing the infection. Regardless of whether the bacteria are the cause, reducing acid in the stomach is another important focus of treatment.
The following treatments are recommended for ulcers:
- Lifestyle changes: Quit smoking, avoid alcohol, aspirin, and NSAIDs
- Acid-blocking medications
- Medications that protect the lining of the stomach and duodenum
- Triple-therapy or dual-therapy regimens for ulcers caused by H pylori
No single medication works to get rid of H pylori infection. Two combinations have been found that work well in most people.
These treatments are generally given for two weeks.
Once H pylori bacteria are eradicated from a persons digestive tract, usually it will not come back. The ulcers usually heal completely and do not return.
Treatment for bleeding ulcers depends on the severity of blood loss and includes:
It is important to remember that treatment may not work if the diagnosis is not correct. If the doctor diagnoses an ulcer, it is important to determine whether the ulcer is caused by infection with H pylori.
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Adaptation Of H Pylori To High Acidity Of Stomach
As mentioned above, H. pylori produce large amounts of urease to produce ammonia as one of its adaptation methods to overcome stomach acidity. Helicobacter pylori arginase, a bimetallic enzyme binuclear Mn2-metalloenzyme arginase, crucial for pathogenesis of the bacterium in human stomach, a member of the ureohydrolase family, catalyzes the conversion of L-arginine to L-ornithine and urea, where ornithine is further converted into polyamines, which are essential for various critical metabolic processes.
This provides acid resistance and is thus important for colonization of the bacterium in the gastric epithelial cells. Arginase of H. pylori also plays a role in evasion of the pathogen from the host immune system mainly by various proposed mechanisms, arginase competes with host-inducible nitric oxide synthase for the common substrate L-arginine, and thus reduces the synthesis of NO, an important component of innate immunity and an effective antimicrobial agent that is able to kill the invading pathogens directly.
Alterations in the availability of L-arginine and its metabolism into polyamines contribute significantly to the dysregulation of the host immune response to H. pylori infection.
Helicobacter Pylori Infection And Skin Diseases
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What Causes Stomach Ulcers
Stomach ulcers occur when the layer protecting the stomach lining from stomach acid breaks down. This allows the stomach lining to become damaged.
This is usually caused by:
- an infection with Helicobacter pylori bacteria
- taking non-steroidal anti-inflammatory drugs , such as ibuprofen or aspirin particularly if theyre taken for a long time or at high doses
Theres little evidence that stress or certain foods causes stomach ulcers.
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Urease And Survival Under Acidic Stomach Conditions
H. pylori has developed an acid acclimation mechanism that promotes adjustment of periplasmic pH in the harsh acidic environment of the stomach by regulating urease activity. The urease gene cluster is composed of seven genes, including catalytic subunits , an acid-gated urea channel , and accessory assembly proteins . The metal cofactor nickel has to be inserted into the apoenzyme for heterodimer urease activity through the action of the four accessory proteins, among which UreE appears to be an important metallochaperone . A recent paper describes how the other metallochaperone, HypA, interacts with UreE, and facilitates nickel transfer from HypA to UreE, and subsequently to downstream partner proteins, possibly UreG . However, the mechanism of nickel transfer and insertion into the apo-urease is currently not well understood and requires further studies.
To allow the rapid adjustment of periplasmic pH, the ArsRS two-component system, in an acid-responsive manner, controls the transcription of the urease gene cluster . Recently, a second, cytoplasmically localized acid responsive sensor kinase, FlgS, was identified in H. pylori. Although FlgS, with its cognate response regulator, HP0703, is known to regulate flagellar gene transcription, Marcus et al. indicated that a decrease in the cytoplasmic pH, exaggerated in the absence of membrane-located ArsS, may activate cytoplasmic FlgS . However, the regulatory network between the two histidine sensor kinases is still unclear.
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How H Pylori Makes You Sick
For decades, doctors thought people got ulcers from stress, spicy foods, smoking, or other lifestyle habits. But when scientists discovered H. pylori in 1982, they found that the germs were the cause of most stomach ulcers.
After H. pylori enters your body, it attacks the lining of your stomach, which usually protects you from the acid your body uses to digest food. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.
You can get H. pylori from food, water, or utensils. Itâs more common in countries or communities that lack clean water or good sewage systems. You can also pick up the bacteria through contact with the saliva or other body fluids of infected people.
Many people get H. pylori during childhood, but adults can get it, too. The germs live in the body for years before symptoms start, but most people who have it will never get ulcers. Doctors arenât sure why only some people get ulcers after an infection.
How Do H Pylori Damage The Stomach
The damage to the lining of the stomach is due to a complex interaction of the bacteria and the host’s immune response. H. pylori release several enzymes and microbial products that directly damage the lining of the stomach. The immune system reacts by mounting a floridinflammatory response in an attempt to eradicate the bacteria. As a consequence of this inflammatory response, the stomach lining is unintentionally damaged.
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How Is H Pyloridiagnosed
There are three main tests that can be used to diagnose H. pylori, and each one has some pros and cons:
The urea breath test: This involves drinking a solution that contains a compound called urea, followed by breathing into a bag. H. pylori is detected by the way it breaks down the urea. This test is the most accurate, but its also the most expensive. And it requires that you dont take any antibiotics or proton pump inhibitors for a few weeks prior to testing.
The fecal antigen test: Thisis a stool test that looks for signs of H. pylori. This test is almost as accurate as the urea breath test, and its much less expensive. It also requires that you dont take any antibiotics or PPIs for a few weeks before the test.
A serologic blood test: Thischecks for antibodies to H. pylori in the blood. This test is not usually recommended because its difficult to tell if someone has an active infection or if they were only exposed in the past. But it is the only test that does not require someone to be off all antibiotics and PPIs for several weeks prior.
Most people dont need an endoscopy to diagnose and treat H. pylori. But if there are indications that you need an endoscopy, your provider can diagnose H. pylori by taking a biopsy sample during the procedure.