Helicobacter pylori: are you infected?

If you have frequent stomach upset, you may want to check whether you are infected with Helicobacter pylori or not. Since the discovery of this bacteria in early 1980's, it has changed the belief that bacteria cannot survive in the acidic environment of the stomach.

    Helicobacter pylori

Why is H. pylori so important and why should you be treated if you are infected with it? The reasons are:

• Almost 70-90% of all peptic ulcer diseases are related to H.pylori
  • About 90% of duodenal ulcers are related to H.pylori
  • About 60% of gastric (stomach) ulcers are related to H.pylori
• If you are infected, you have 10-20% risk to get peptic ulcer disease
• If you are infected, you have a 1-2% risk of getting stomach cancer

Yes. H.pylori has been classified as class I carcinogen (cancer-causing agent) for gastric cancer, in the same class as smoking causes lung cancer.

    Gastric & duodenal ulcer

Since the bacteria stay in the digestive tract, we can get infected by taking in food/drink contaminated with the bacteria. H.pylori infection produces no symptoms in 30-35% of patients. When it does, it can cause:

• Dyspepsia (indigestion)
• Nausea/vomiting
• Abdominal pain/discomfort
• Anemia if bleeding from ulcer

It's easy to check whether you are infected or not. The screening test is usually a blood test that check your antibody level against H.pylori. If it is positive, it means that you have current or recent infection, and should be treated.

After treatment, you should check whether the bacteria are eradicated successfully by doing a urea breath test. This should be done at least 4 weeks after finishing treatment. Blood test is not recommended to be used to confirm eradication because the antibody level may remain high up to 2 years after all the bacteria died. Besides the breath test, another test that can be done to confirm eradication is stool antigen test.

If you have severe symptoms that make a doctor suspect ulcer in your stomach/duodenum, then you can straight away go for an endoscopy in which a tube with camera is inserted through your mouth into your stomach to look for the ulcer. At the same time, tissue samples (biopsy) can be taken to check for the presence of H.pylori.

Treatment for H.pylori is called triple therapy, as it is a combination of 3 types of medication (2 antibiotics and 1 anti-acid). It should be taken accordingly for at least 7 days (up to 14 days) or failure of treatment and bacteria resistance can occur easily. If treated rightly, the success rate is up to 90-95%. It is not easy to get the infection again after it has been successfully eradicated. The re-infection rate is only about 1-2%, but it is noted to be slightly higher in children and women.