Tens of thousands of years ago, Helicobacter pylori existed in the human body. It silently settled in the human stomach, breathing and growing together with human beings!
But people don’t know it exists because it has always been thought that bacteria cannot survive in the acid conditions of the stomach.
Image source: Zhanku Hailuo
It was discovered in the 1980s by two Australian scientists, Barry Marshall and Robin Warren, and suspected that it was involved in the development of gastric ulcers.
The duo’s scientific discoveries upended cognition for which they were awarded the Nobel Prize in Physiology or Medicine.
Just recently (December 2021), the U.S. Institute of Toxicology, a division of the U.S. Department of Health and Human Services, released the 15th Edition of the Carcinogens Report. Among them, Helicobacter pylori chronic infection is listed as a definite human carcinogen[1].
Ordinary people still have many questions about Helicobacter pylori. Today, we will answer your questions one by one.
Q1What is Helicobacter pylori?
Helicobacter pylori is a bacterium that can survive stomach acid conditions.
After it enters the human body, it will settle on the surface of gastric epithelial cells, and it is difficult for the human body to remove it spontaneously.
Q2 What harm does Helicobacter pylori do to the human body?
Helicobacter pylori produces various enzymes and cytotoxins that have damaging effects on the mucosa, and also stimulates epithelial cells to release inflammatory mediators to damage the mucosa, which is a predisposing factor for various gastric diseases.
China is a country with a high incidence of Helicobacter pylori infection. 25~30% of the infected people will develop gastrointestinal diseases of varying degrees, such as indigestion, gastritis, peptic ulcer, gastric cancer, etc.
Helicobacter pylori infection is also closely associated with extra-gastrointestinal diseases, such as iron-deficiency anemia, idiopathic thrombocytopenic purpura, autoimmune diseases, and cardiovascular and cerebrovascular diseases [2].
Although not all patients with Helicobacter pylori will develop gastric cancer, due to repeated inflammatory stimulation, especially patients with gastric antrum infection will increase the risk of gastric cancer. Helicobacter pylori is also recognized by the World Health Organization. Tissue Cancer Research Institute as a class of carcinogens [3].
Q3How do I know if I have Helicobacter pylori infection?
Many people think that having bad breath or other symptoms of stomach discomfort means that they have Helicobacter pylori infection. This method of identification is unreliable and must be tested to know whether it is infected or not. Helicobacter pylori.
How to detect:
First go to a regular hospital for examination, the first choice is C14 or C13 breath test, non-invasive and quick results.
Other detection methods include:
Non-invasive testing methods such as serum antibody testing and stool antigen testing, as well as testing methods that require endoscopy such as gastric mucosal biopsy [3].
Q4 I am infected with Helicobacter pylori, do I have to treat it?
Helicobacter pylori is indeed closely related to many diseases, but most of the time it is an asymptomatic infection. The doctor will give advice according to the specific situation.
It is generally believed that when a Helicobacter pylori infection is diagnosed, a doctor may recommend eradication of Helicobacter pylori if:
patients with peptic ulcers (including gastric and duodenal ulcers);
Patients with chronic gastritis with mucosal atrophy or erosion;
In people with a family history of gastric cancer, Helicobacter pylori may increase the risk of gastric cancer;
Patients with MALT lymphoma (gastric MALT lymphoma) [4].
Q5Is Helicobacter pylori easy to re-infect?
Helicobacter pylori eradication therapy significantly reduces the risk of reinfection, with studies showing that the reinfection rate for 12 months of eradication therapy is approximately 1.5% [5].
Q6 Will I be infected when I eat with someone who carries Helicobacter pylori?
A number of studies at home and abroad suggest that Helicobacter pylori is mainly transmitted through oral-oral and fecal-oral routes, and family members infected with Helicobacter pylori are always potential sources of infection.
Eating together may also increase the risk of H. pylori transmission without good hygiene and eating habits [6].
Q7Do children need treatment for Helicobacter pylori infection?
If a child is diagnosed with peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma (gastric MALT lymphoma), it must be cured.
Radical treatment may be considered in the following cases:
(1) Chronic gastritis;
(2) Have a family history of gastric cancer;
(3) Unexplained refractory iron-deficiency anemia;
(4) Plan to take long-term NSAIDs (including low-dose aspirin) [6];
(5) Guardians, older children strongly demand treatment [7].
How to cure Q8? How soon to review?
There are many ways to cure Helicobacter pylori. At present, the most common ones in our country are triple therapy and quadruple therapy:
Triple Therapy
Triple therapy is two antibiotics combined with a proton pump inhibitor. However, due to the increased resistance rate of Helicobacter pylori to clarithromycin, metronidazole and levofloxacin in many areas, the current large In some areas, traditional triple therapy is not suitable, but quadruple therapy is considered.
Quadruple therapy
Add a bismuth agent to the triple therapy for 14 days. Doctors will choose appropriate antibiotics based on local drug resistance and patient conditions.
Review time:
It is not recommended to review immediately after treatment, because it may be affected by the drug, resulting in inaccurate results.
It is recommended to re-examine 4 to 8 weeks after eradication therapy [4]. Doctors usually recommend the choice of a C13 or C14 breath test when reviewing.
If you want to prevent Helicobacter pylori, you should pay more attention to dietary hygiene, wash your hands frequently, and increase the awareness of using public chopsticks and spoons to prevent repeated and cross-infection.
Even if it is really infected, don’t worry too much, make decisions under the guidance of a doctor, and if necessary, follow the doctor’s recommendations for timely eradication treatment [2].
Contributing Author: Fang Jian
Deputy Chief Pharmacist, Department of Pharmacy, Huadu District People’s Hospital, Guangzhou
Reviewer: Cheng Rui
Beijing Friendship Hospital Gastroenterology Attending Physician
References
[1]15th Report on Carcinogens.National Toxicology Program.December 21, 2021. https:https://ntp.niehs.nih.gov/go/roc15
[2] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, Chinese Medical Association Gastroenterology Branch Helicobacter pyloriAcademic Group, Editorial Committee of “Chinese Journal of General Practitioners” of the Chinese Medical Association, Expert Group for the Compilation of Guidelines for Primary Diagnosis and Treatment of Digestive System Diseases. Guidelines for Primary Diagnosis and Treatment of Helicobacter pylori Infection (2019)[J]. Chinese Journal of General Practitioners, 2020,05 :397-402.
[3] National Clinical Research Center for Digestive Diseases (Shanghai), National Alliance of Early Cancer Prevention and Treatment Centers of Digestive Tract, Helicobacter pylori and Peptic Ulcer Group of Digestive Disease Branch of Chinese Medical Association , National Helicobacter pylori Research Collaborative Group. Expert consensus on the prevention, control and management of Helicobacter pylori infection in Chinese households (2021)[J]. Chinese Journal of Digestion, 2021,04:221-233.
[4] National Clinical Research Center for Digestive Diseases (Shanghai), Health Management Branch of Chinese Medical Association, Nuclear Medicine Branch of Chinese Medical Association. Clinical application of Helicobacter pylori-urea breath test Expert consensus (2020)[J]. Chinese Journal of Digestion, 2020,12:797-802.
[5]Xie Y, Song C, Cheng H, et al. Long-term follow-up of Helicobacter pylori reinfection and its risk factors after initial eradication: a large-scale multicentre, prospective prospective open cohort, observational study[J]. Emerging microbes & infections, 2020, 9(1): 548-557.
[6] Li Chao, Zhang Zhenyu. 2017 Taiwan Helicobacter pylori consensus: consensus on clinical management, screening treatment and monitoring of Helicobacter pylori infection to improve gastric cancer control in Taiwan[J] . Journal of Gastroenterology and Hepatology, 2018, 01:1-12.
[7] Huang Ying. Expert consensus on the diagnosis and treatment of Helicobacter pylori infection in children [J]. Chinese Journal of Pediatrics, 2015, 53(07): 496-498.
Editors: Wei Luo, Zhang Xiaoyi, Zhang Liang
Typesetting: Han Ningning | Proofreading: Wu Yihe
Operation: Li Yongmin | Coordinator: Wu Wei
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