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Helicobacter Pylori

What is Helicobacter pylori?
Helicobacter pylori is a bacteria that lives in the stomach and duodenum of up to 50% of the world’s population. It is thought that Helicobacter pylori is transmitted through the ingestion of contaminated food or water at a young age.

What diseases are associated with Helicobacter pylori?

Peptic ulcers
(stomach and duodenal)
Helicobacter pylori is responsible for the majority of peptic ulcers. It does this by weakening the protective coating on the stomach and duodenum. However, most infected people do not develop ulcers. Eradicating the bacteria leads to ulcer healing.
“Non ulcer” dyspepsia Helicobacter pylori may be the cause of chronic dyspepsia (upset stomach / indigestion) in people who do not have an ulcer. If no other cause for these symptoms is found, treatment of Helicobacter pylori infection should be considered.
Stomach Cancer Helicobacter pylori is associated with a six fold increase in the risk of stomach cancer. However, the lifetime risk remains low at ~2%.

How can I be tested for Helicobacter pylori?

A number of tests are available. However, given that Helicobacter pylori is such a common infection, testing is recommended only if your doctor is considering treatment. The range of available tests are outlined below. It is important to note that these tests may be “falsely negative” if you are taking antibiotics or antacid medications, and so it is recommended that these medications are not taken for at least four weeks prior to testing.

Gastroscopy A small tissue sample (biopsy) of the stomach can be taken and tested for Helicobacter. Testing should always be performed if an ulcer is seen.
Breath Test This test is easy to perform and widely available. A breath test is also commonly used to confirm bacterial eradication.
Stool Test This test is available in most pathology centres
Blood Test This is not commonly performed due to concerns regarding accuracy. Additionally, the test may remain positive for a period of time after successful treatment. Since the blood test does not require stopping any current medications, it may be useful in people who cannot stop their antacid medications.

What is the treatment for Helicobacter pylori?
A combination of medications is required – including antibiotics and antacid tablets known as “proton pump inhibitors”. This is a 7-14 day treatment. Whilst initial treatment is a standard (3 tablets regimen) the bacteria may be resistant and a subsequent course of therapy may be needed in up to 20% of patients. A follow up breath test is recommended to confirm that the medication has worked.

Who shouldn’t be treated for Helicobacter pylori?
As mentioned previously, testing for Helicobacter pylori should only be performed if treatment is being considered. Treatment for people with Helicobacter pylori is not recommended for people who do not have any symptoms. The exceptions to this may include: relatives of a person with stomach cancer, presence of certain changes (intestinal metaplasia) on biopsy, and infected spouse of a person with recurrent Helicobacter infection.

Can I become reinfected with Helicobacter pylori after successful treatment?
Reinfection with Helicobacter pylori after successful treatment is uncommon, and occurs at a rate of less than 2% per year.

Is there a vaccine for Helicobacter pylori?
Researchers are trying to develop a vaccine for Helicobacter pylori, although there is currently no effective vaccine available. It is unclear if Helicobacter pylori infection can be prevented, but handwashing before eating and after using the bathroom is recommended.

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