H. pylori, also known as Helicobacter pylori, is a type of bacteria that infects the stomach. It is one of the most common infections in humans, with around 50% of the world’s population estimated to be infected. H. pylori infection can lead to peptic ulcers, gastritis, and even stomach cancer in some cases. So it is important to treat H. pylori infection properly. But is it easily treatable? Let’s take a look at some key questions around H. pylori treatment.
What is H. pylori?
H. pylori are spiral shaped bacteria that live in the mucous lining of the stomach. The bacteria can burrow into the stomach lining and attach themselves, allowing them to persist for many years or even decades if left untreated. H. pylori infection is usually acquired in childhood and often persists throughout life unless treated. Some key facts about H. pylori:
– Discovered by scientists Barry Marshall and Robin Warren in 1982. Before this, ulcers were thought to be caused solely by stress and diet.
– It is able to survive in the harsh, acidic environment of the stomach.
– Causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers.
– Infected individuals have a 2 to 6 fold increased risk of developing gastric cancer.
– Around 50% of the world’s population is infected, although infection rates are declining in developed countries.
– Infection is more common in developing countries and in areas with poor sanitation and overcrowding.
How do you get infected with H. pylori?
H. pylori infection predominantly occurs during childhood and is associated with poor hygiene practices. The bacteria can be transmitted from person to person through the following routes:
– Fecal-oral route – Ingestion of food or water contaminated with H. pylori bacteria from feces. This is particularly common in areas with poor sanitation.
– Oral-oral route – Direct transmission from person to person by vomiting, saliva or other oral contact.
– Intrafamilial transmission – H. pylori infection tends to cluster within families. Infected parents or siblings are often a source of infection.
The risk of infection increases with factors such as:
– Living in crowded housing conditions
– Lack of clean water supply
– Poor sanitation practices
– Low socioeconomic status
– Having infected family members
In developed countries, infection levels have dropped dramatically over the past few decades due to improvements in sanitation and living conditions. But in developing countries, the infection remains common.
What are the symptoms of H. pylori infection?
H. pylori infection can present with a wide range of symptoms, or none at all. Here are some of the most common signs:
– Dyspepsia – Epigastric pain, bloating, nausea
– Peptic ulcer disease – Gastric and/or duodenal ulcers
– Iron deficiency anemia from occult gastrointestinal bleeding
– Vitamin B12 deficiency
– Unintentional weight loss
– Loss of appetite
However, the majority of infected people have no obvious symptoms. It often remains a silent infection until other problems manifest.
How is H. pylori infection diagnosed?
If H. pylori infection is suspected, there are several tests that can be used to diagnose it:
Blood antibody test
This is the simplest test. A blood sample is checked for antibodies to H. pylori. A positive result indicates the person has been exposed to the bacteria and mounted an immune response. Limitation is that it cannot distinguish between past and current infection.
Urea breath test
This test requires swallowing a capsule containing urea labeled with carbon 13 or carbon 14. If H. pylori is present, it will metabolize the urea releasing labeled carbon dioxide that can be detected in the breath. High sensitivity and specificity.
Stool antigen test
A stool sample is checked for proteins from the cell wall of H. pylori using monoclonal antibodies. Relatively simple and accurate. Can also be used to confirm eradication after antibiotic treatment.
Endoscopy and biopsy
The most definitive way to detect H. pylori is by gastric biopsy taken during endoscopy. Biopsy samples are analyzed by rapid urease testing, histology, or bacterial culture. Allows direct visualization of any stomach inflammation or ulcers.
What is the conventional treatment for H. pylori infection?
The standard first-line treatment for H. pylori consists of:
– A proton pump inhibitor (PPI) such as omeprazole or lansoprazole taken twice a day. PPIs reduce stomach acid production and allow the antibiotics to work better.
– Two antibiotics – usually clarithromycin plus either amoxicillin or metronidazole for 7-14 days. The antibiotics kill the H. pylori bacteria.
This “triple therapy” has about an 80-90% eradication rate when prescribed optimally. But efficacy has been declining in recent years likely due to increasing antibiotic resistance.
Alternative second-line treatments include levofloxacin, tetracycline, rifabutin, bismuth-containing regimens and extending the treatment duration to 14 days. Sequential therapy (antibiotics followed by different antibiotics) and concomitant therapy (all antibiotics together) are other strategies.
Treatment Regimens
| First-line | Second-line |
|---|---|
| PPI + Clarithromycin + Amoxicillin or Metronidazole for 7-14 days | PPI + Levofloxacin + Amoxicillin for 10-14 days |
| 80-90% eradication rate | 70-90% eradication rate |
What factors affect treatment success?
Several factors can influence the likelihood of successful H. pylori eradication with antibiotics:
– **Antibiotic resistance** – Rising resistance to clarithromycin and metronidazole reduces treatment effectiveness. Resistance testing guides ideal antibiotic choice.
– **Patient compliance** – Taking all antibiotics for the full course as prescribed is crucial. Non-compliance increases risk of treatment failure.
– **High bacterial load** – Large numbers of H. pylori bacteria in the stomach make eradication more difficult. Ulcer disease is linked to higher bacterial loads.
– **Cigarette smoking** – Smoking appears to increase the risk of treatment failure, likely due to its detrimental effect on gastric mucosa.
– **High gastric acidity** – Higher acidity impairs antibiotic efficacy. PPIs to suppress acid significantly improve eradication rates.
– **Prior antibiotic exposure** – Previous antibiotic courses targeting other infections can also induce resistance in H. pylori.
When should treatment be repeated?
If initial treatment fails to eradicate H. pylori, a second course of antibiotics is required with a different regimen based on antibiotic sensitivities and local resistance patterns. Molecular antibiotic resistance testing provides guidance on the best antibiotics to use.
Repeat endoscopy and biopsy is usually recommended after the second treatment course to confirm eradication through culture, histology or urease testing. Further treatment may use quadruple or salvage regimens if dual or triple therapy repeatedly fails.
Rarely, antibiotics permanently fail to eradicate the infection. In these cases, long-term suppression therapy with PPIs may be used to control symptoms and prevent complications. But the bacteria remain present in a dormant state.
How soon after taking antibiotics for H. pylori is it cured?
H. pylori is considered cured when antibiotics successfully eradicate it from the stomach and intestinal system. But how soon can eradication be confirmed?
– H. pylori bacteria are typically killed off within a few days of starting antibiotic treatment.
– However, confirmation of cure should only be tested 4-6 weeks after finishing antibiotics. This allows time for any remaining bacteria to become detectable.
– Testing for eradication too soon can give a false negative result.
So in summary, H. pylori is eliminated from the body quickly with antibiotics, but final cure needs to be verified at least a month after treatment through urea breath or stool antigen testing. Repeat endoscopy can also definitively confirm eradication via biopsy.
What are the risks of leaving H. pylori untreated?
Some key risks and complications associated with untreated chronic H. pylori infection include:
– **Chronic active gastritis** – Persistent inflammation of the stomach lining leading to dyspepsia, nausea and pain. Can progress to…
– **Stomach and duodenal ulcers** – Up to 90% of ulcers are linked to H. pylori. Can cause bleeding or perforation without treatment.
– **MALT lymphoma** – H. pylori is associated with a type of lymphoma arising from mucosa-associated lymphoid tissue in the stomach.
– **Atrophic gastritis and intestinal metaplasia** – Chronic inflammation induces precancerous changes to stomach cells over time. May ultimately lead to…
– **Gastric cancer** – H. pylori is the strongest risk factor for cancer of the stomach, responsible for 60-90% of cases.
– **Other issues** – Iron and vitamin B12 deficiency, unexplained weight loss and loss of appetite.
So in summary, leaving H. pylori infection untreated substantially raises the risk of peptic ulcers, vitamin deficiencies, gastric lymphoma and potentially fatal stomach cancer in the long run.
Is it possible to eradicate H. pylori naturally?
While antibiotics are the only proven way to definitively cure H. pylori infection, some natural supplements and therapies may help suppress the bacteria and reduce stomach inflammation, especially when used in conjunction with antibiotic therapy:
– **Probiotics** – Can inhibit H. pylori colonization and attenuate gastritis when taken for weeks to months. Species like Lactobacillus and Bifidobacterium are commonly studied.
– **Phytomedicine** – Certain plant extracts including broccoli sprouts, red ginseng, curcumin and honey have demonstrated anti-H. pylori effects in vitro and in vivo. But clinical evidence is limited.
– **Garlic** – In vitro garlic extract exhibits antibacterial action against H. pylori. Some small human studies found fresh garlic supplementation 3-4 times a day may have a role as adjunct therapy along with antibiotics. But more evidence is needed.
– **Green tea** – Polyphenols in green tea demonstrate inhibitory effects on H. pylori growth in laboratory experiments. Mixed results in human trials so far. May help suppress infection.
– **Vitamin C** – Studies indicate high-dose vitamin C taken with antibiotics can improve H. pylori eradication rates and gastric inflammation. Dosages of 500 – 1000 mg daily are typically used.
So in summary, natural agents show promise and may help manage H. pylori infection if taken regularly. But there is no high-quality evidence that herbal therapies alone can permanently eradicate the bacteria outside of conventional antibiotic treatment.
Should you get retested after H. pylori treatment?
Yes, retesting after completing antibiotics for H. pylori is recommended to confirm the infection has been fully cured. This is advised even when initial treatment is expected to be effective.
Here are some reasons to get retested after H. pylori therapy:
– Verify eradication was successful and no bacteria persist. Treatment can fail in 10-20% of cases.
– Detect potential antibiotic resistance requiring second-line therapy.
– Reduce risk of peptic ulcers, gastritis and cancer from untreated infection.
– Avoid unnecessary additional antibiotics if already eradicated.
– Provide assurance for both patients and clinicians that a definitive cure was achieved.
– May be required as proof of cure for insurance reimbursement.
Retesting is ideally performed using the urea breath test or stool antigen test at least 4 weeks after completing antibiotics. False negative results can occur if testing is done too soon after treatment while dead bacteria are still present.
Conclusion
In summary, H. pylori infection is an extremely common condition that can persist for life if not treated properly. While standard triple therapy antibiotics still achieve 80-90% cure rates, eradication is becoming more difficult with rising antibiotic resistance. Repeated courses of alternative antibiotics guided by susceptibility testing are often needed for refractory cases.Confirmation of cure via urea breath test or biopsy is advised at least 1 month after antibiotic therapy. With appropriate treatment and confirmation of eradication, H. pylori infection can be fully cured in most patients. But without antibiotics, natural agents alone have not been proven to reliably eliminate the bacteria.