By Daniel Lindenberg, MD, PA
If you think stress, spicy foods, or alcohol causes the majority of stomach ulcers you would be among the majority of Americans…you would also be wrong. A small spiral shaped bacterium commonly found in the stomach H. pylori is responsible of 80% of stomach ulcers and 90% of ulcers in the upper end of the small intestine. While you may not be familiar with H. pylori chances are that you or someone you love is infected with this bacterium and it could be wreaking havoc on your intestinal system. According to the National Institutes of Health approximately 20% of people under the age of 40 and 50% over the age of 60 in the US are infected with H. pylori.
H. pylori’s spiral shape allows it to penetrate the stomach’s protective mucous lining, where it produces substances that weaken the lining and make the stomach more susceptible to damage from gastric acids. The bacteria can also attach to cells of the stomach, causing stomach inflammation (gastritis), and can stimulate the production of excess stomach acid. Over time, infection with the bacteria can also increase the risk of stomach cancer.
Symptoms of H. Pylori
Having H. pylori infection doesn’t necessarily mean you’ll develop ulcers or stomach cancer. In fact, most people infected with the bacteria never have symptoms. Only a small number of people with the infection develop stomach cancer.
When H. pylori does cause symptoms, they are usually either symptoms of gastritis or peptic ulcer disease. The most common symptom of peptic ulcer disease is gnawing or burning abdominal pain, usually in the area just beneath the ribs. This pain typically gets worse when your stomach is empty and improves when you eat food, drink milk, or take an antacid.
Other symptoms may include:
• Weight loss
• Loss of appetite
• Vomiting (vomit may be bloody or look like
• Black, tarry stools
Complications associated with H. pylori infection include:
• Ulcers. H. pylori can damage the protective lining of your stomach and small intestine. This can allow stomach acid to create an open sore (ulcer). About 10 percent of people with H. pylori will develop an ulcer.
• Inflammation of the stomach lining. H. pylori infection can irritate your stomach, causing inflammation (gastritis).
• Stomach cancer. H. pylori infection is a strong risk factor for certain types of stomach cancer.
How H. pylori Is Diagnosed
Several types of tests are available to help diagnose H. pylori infection and/or ulcers. These include:
• Upper GI(gastrointestinal) series. An X-ray of the upper GI tract — the esophagus, stomach, and duodenum. Prior to the X-ray you must swallow a chalky liquid called barium, which makes ulcers show up on the X-ray.
• Endoscopy. A procedure that involves snaking a thin, flexible tube with a camera down the esophagus, through the stomach, and into the small intestine to view the upper GI tract.
• Blood test. A test that looks for antibodies in the blood that indicate exposure to H. pylori.
• Stool test. A test that uses a small sample of stool to look for evidence of infection.
• Urea breath test. A test used to check for the presence of a gas produced by the bacteria.
Treatments for H. Pylori
There a number of treatments for H. pylori infection. They include:
• Antibiotics to kill the bacteria
• Medications, including H2-blockers and proton pump inhibitors, to reduce the amount of stomach acid
• Surgery to treat ulcers
Doctors used to advise people with ulcers not to eat spicy, fatty, or acidic foods. However, it is now known that diet has little if any effect on ulcers for most people. Smoking, on the other hand, can interfere with the healing of ulcers and has been linked to their recurrence. If you smoke and have ulcers, that is another reason to stop.
The appropriate treatment for you will depend on a number of factors, including:
• Your age, health, and medical history
• The severity of infection or stomach damage
• Your ability to tolerate certain medications or treatments
• Your treatment preference
If you’re concerned about H. pylori infection or think you may have a high risk of stomach cancer, talk to your gastroenterologist. Together you can decide whether you may benefit from H. pylori screening.