H. pylori infection Epidemiology Symptoms and Treatment

What is H pylori infection?

Helicobacter pylori infection (H. pylori infection) is a common gastric infection caused by Helicobacter pylori bacteria (H. pylori), a gram negative rod shaped bacteria in the genus helicobacter. In most cases, H. pylori infection occurs during childhood. Common symptoms of helicobacter pylori infection include stomach fullness, abdominal pain, nausea, vomiting, loss of appetite, intestinal bleeding, meteorism, bloating, weight loss, right upper quadrant fullness, low grade fever, heartburn and stomach acid reflux. Without early diagnosis and prompt treatment, Helicobacter pylori colonizes the gastric mucosa and penetrates into epithelial cells of the stomach lining and causes gastritis.

Can H pylori cause gastritis?

H. pylori infection is a bacterial infection that causes gastroenteritis, an inflammation of the gastrointestinal tract involving both the stomach and the duodenum. CagA+ H. pylori strains are associated with protracted inflammation of the gastric mucosa and increased risk of gastric and duodenal ulcers, gastroesophageal reflux and reflux esophagitis (GERD), and gastric cancer due to accumulation of inflammatory cells in the lamina propria (LP) of gastric mucosa (antrum and fundus). The cytotoxin-associated gene A (cagA gene) is delivered into gastric epithelial cells via bacterial type IV secretion. Cytokine expression in the body of a living organism (in vivo) to cagA+ helicobacter pylori strains have direct effects on gastric epithelial cells that have a profound effect on gastric physiology.

H. pylori is associated with 95% of duodenal ulcers and 80% of gastric ulcers

The inflammatory response to cagA+ helicobacter pylori strains and H. pylori–induced cytokines induce profound changes in the gastric epithelial cells, resulting in an active inflammatory microenvironment that is maintained by immune cells such as T cells (including T-helper cells and Th1 cells), NK cells (natural killer cells), eosinophils, neutrophils, and macrophages.

What will happen if H pylori goes untreated?

If left untreated, H. pylori infection can cause inflammation (gastritis) and stomach ulcers. About 10% of people with H. pylori infection develop a peptic ulcer.

Long term H. pylori infection may increase your chance of developing gastric cancer, lymphoma and gastric or duodenal perforation. About 1% of individuals with H. pylori infection develop gastric cancer. About 78% of all gastric cancer cases are caused by chronic H. pylori infection

The active inflammatory microenvironment induced by H. pylori infection results in the development of mucosa-associated lymphoid tissue (MALT). Normally, the gastric mucosa does not contain MALT. B cell MALT lymphoma occurs in approximately 0.1% of infected individuals; however, early-stage gastric MALT lymphomas can be cured by eradication of H. pylori infection.

Is H pylori common?

H. pylori infection is present in 50-65% of the world population. However, in most cases, patients infected with H pylori are asymptomatic, and for most people, H. pylori infection doesn’t cause gastric ulcers.

In developing countries, H. pylori infection is present in 75-80% of adults and 10-15% of children

H. pylori adapts and colonizes the gastric mucosa overlying the gastric epithelial cells and achieves attachment to epithelial cells, these characteristics enable H. pylori to evade the immune response and establish persistent colonization in an area close to the gastric epithelium, resulting in chronic gastritis in all infected individuals

Evasion of the immune responses and persistent colonization in the stomach result in chronic atrophic gastritis. If left untreated, H. pylori induced gastritis develops into Gastric enterochromaffin-like (ECL) cell tumors and duodenal gastrinomas. The malignant transformation of gastric mucosa involves the transformation from hypertrophy, to simple ECL hyperplasia, to dysplasia, and finally to neoplasia (formation of ECL cell carcinoids).

The malignant transformation induced by H. pylori involves the mutation and downregulation of p27, an apoptosis regulator and a tumor suppressor. The downregulation and mutation of p21 WAF1/CIP1 and Cyclin D1 are associated with the malignant transformation of gastric hyperplastic polyps secondary to h-pylori infection.

Is Helicobacter pylori serious?

After many years, an untreated H. pylori infection can cause sores, also called ulcers. In most cases, peptic ulcers caused by H. pylori  heal after a few weeks of treatment; however, without prompt treatment, the ulcer itself can lead to more serious complications, such as perforation and internal bleeding. If you suffer from gastralgia, avoid taking NSAIDs for pain, since these drugs can damage your gastric mucosa. About 1% of individuals with H. pylori infection develop gastric cancer.

How do you know if you have H pylori?

Around 50 percent of individuals with h-pylori are asymptomatic or they will have mild symptoms. In most cases, chronic H. pylori infection results in atrophic and even metaplastic changes in the stomach; however, a peptic ulcer can alert you to a potential infection. If you have a peptic ulcer, you may have a dull pain in your stomach that usually increases two to three hours after eating.

Can Helicobacter pylori be caused by stress?

H-pylori infection an infectious bacterial disease, which is not caused to stress. However, when we’re stressed, the immune system’s ability to fight off H. pylori is reduced. Normally, the immune system defends the body from developing harmful conditions caused by H. pylori infection. Saying so, stress, anxiety, socioeconomic status, smoking, or depression usually affect the outcome of H. pylori infection

H. pylori does not cause ulcers in every infected person.

Can Helicobacter pylori cause death?

If left untreated, H. pylori Infection causes chronic inflammation and significantly increases your risk of developing peptic ulcer disease and gastric cancer. H-pylori infection is a major cause of gastric cancer, which is the 2nd leading cause of cancer-related morbidity and mortality worldwide.

Where exactly can H. pylori be found in the body?

H. pylori strains containing the toxigenic allelic s1 form of VacA colonize the gastric mucosa overlying the gastric epithelial cells where they secrete the Vacuolating cytotoxin A (VacA), which is associated with an increased risk of peptic ulceration and gastric cancer. About 90 percent of duodenal ulcers and up to 80 percent of gastric ulcers are caused by H. pylori infection.

How do you get H.pylori infection?

The source of infection:

In most cases, H.pylori infection is caught from other humans (pathogen carriers).

Mechanism of transmission:

How can H.pylori be transmitted and can you get H pylori from kissing?

Is H pylori a sexually transmitted disease?

H.pylori is usually transmitted from person to person by means of contact with contaminated saliva, vomit or fecal matter, through kissing, and by fecal contamination of food or water (untreated water). However, H.pylori can also be transmitted by means of contact with contaminated vaginal fluid, fecal matter, or saliva, through unprotected oral, vaginal, or anal sex, and can also be passed from person to person by means of contact with contaminated saliva, fecal matter, or vomit, through poor hygiene, like sharing utensils, such as spoons, forks, or knives.

When an infection is present, H.pylori can be present in the mouth, throat, vagina, and rectum of an infected individual.

Is H. pylori contagious?

Yes, H. pylori is a contagious infection that usually spreads among family members and among people living in crowded conditions, and for this reason, experts believe that a combination of socioeconomic factors (unsanitary conditions, untreated water), dietary factors (poor nutrition), and poor hygiene contribute to higher H pylori prevalence.

Causes

What is the cause of H. pylori infection?

H. pylori infection is a bacterial infectious disease caused by infection with H. pylori (Helicobacter pylori bacteria), a gram negative rod shaped bacteria in the genus helicobacter.

H. pylori infection is a bacterial infection that can be passed on from one person to another by means of contact with contaminated saliva, vomit or fecal matter, through kissing or sharing utensils, and from consumption of contaminated food or water. In most cases, H. pylori infection occurs during childhood. Contributing factors include:

1. Living with someone who already has H. pylori infection
2. Socioeconomic factors, like renting a room in a dorm or hostel or sharing a flat or a house with many people, as you won’t have a choice of who you live with
3. A lack of clean water.
4. If you are living in a developing country where unsanitary and crowded living situations are more prevalent.

If left treated, H. pylori colonization usually persists lifelong, H. pylori infects epithelial cells at mucosal surfaces, and for this reason, the bacteria are usually found in the gastric mucosa (the gastric columnar epithelium) and in extragastric sites from the squamous epithelium of the mouth, to the duodenal epithelium, to the epithelium of the urethra.

H. pylori can be transmitted from the mouth of an infected person to the vagina during oral-genital sex, and thus it may be possible for it to colonize the squamous epithelium of the vaginal tract, since it can survive on the squamous epithelium in the mouth, in fact, H. pylori infection could be a cause of bacterial vaginosis. Moreover, in case of gastric metaplasia, H. pylori can also inhabit metaplastic gastric epithelium in the distal esophagus (gastric-type mucus-secreting cells in the surface epithelium of the distal esophagus), in this case, transmission usually occurs from the duodenum via acid reflux or from the mouth via saliva.

What is the incubation period for Helicobacter pylori and how long does it take for a person to get h. pylori infection?

The incubation period for H. pylori ranges from 2 to 4 days. Early symptoms include: nausea, heartburn and abdominal discomfort or pain. H. pylori infection is a silent infection and clear symptoms may never develop; However, in about 50% of cases, symptoms usually do not appear until late adulthood

What are the symptoms of H. pylori infection?

Can you have h pylori infection and not know?

H. pylori infection is considered a silent disease because symptoms are not loudly expressed in nearly 50% of cases.

What are the first symptoms of H pylori?

Early signs and symptoms of H. pylori infection may include: Fatigue, reduced appetite, abdominal discomfort, heartburn, bloating, frequent burping or belching, nausea, vomiting, and epigastric pain that may improve (duodenal ulcer) or worsen (gastric ulcer) when you drink, eat, or take antacids. In severe cases, symptoms may include: bad breath, diarrhea, anemia, and peptic ulcer symptoms, like loss of appetite, dull pain in the stomach, acid reflux, feeling easily full, dark blood in stools, unintentional weight loss, vomiting blood, dark or tarry stools, shortness of breath (dyspnea), feeling faint.

Diagnosis

How to diagnose H. pylori infection and what is the best way to test for H pylori?

Blood, stool and breath tests are used to determine whether you have an H. pylori infection. However, the urea breath test (UBT) and stool antigen tests (SATs) are more accurate at detecting active H. pylori infections than is a serological blood test.

A Blood test may be used to detect an antibody to the bacteria (detection of a specific anti-H pylori IgG, IgA, and IgM), analysis of a blood sample may reveal evidence of an active or previous H. pylori infection in your body.

What is the most reliable test for H. pylori and how accurate is the H pylori breath test?

The urea breath test (UBT) is an extremely accurate (100% sensitivity and 96% specificity) and fast noninvasive diagnostic procedure used to detect the presence of active H. pylori infection (detection of 13C or 14C labelled CO2 in expired air as a result of H. pylori urease activity). A one hour fast is required prior to starting the test.

What is best test for H pylori?

Stool antigen tests (SATs) are noninvasive diagnostic procedures used to look for the H. pylori antigen in stool, these tests are as accurate as the urea breath test, submitting a faecal (stool) sample may reveal evidence of an active H. pylori infection in your body, a positive stool antigen test or a positive urea breath test after completion of eradication therapy identify individuals who are still infected (H. pylori positive), while, serology tests (antibody testing) are unable to distinguish active from previous infection, and thus are no longer recommended

A gastric biopsy and culture is an invasive procedure performed under endoscopic guidance. Gastric biopsy and resection specimens are collected to detect Helicobacter pylori (H. pylori) using PCR (polymerase chain reaction), silver impregnation, tinctorial stains and immunohistochemical (IHC) methods. Biopsy, histology, and culture require endoscopy.

A biopsy can be used to detect H. pylori.

Can H pylori infection detected by endoscopy?

The doctor uses an endoscope to inspect the inside of your throat, esophagus, stomach and duodenum. This allows your doctor to diagnose gastritis (inflammation of the stomach lining) based on a physical examination. Moreover, your doctor may collect a sample of tissue (biopsy) to determine whether you have an H. pylori infection.

What does it mean if you test positive for H pylori?

A positive breath test, stool antigen test, or biopsy indicates that you are still infected, whereas, a positive blood test for H. pylori antibody may indicate a new or past infection

When should you be retested for H pylori?

Testing once is enough, screening should be performed at least four weeks after completion of eradication therapy to avoid false-negative results.

Treatment

Can the H pylori bacteria come back?

All H. pylori-positive patients should undergo eradication therapy, especially, if they have, or ever have had, a peptic ulcer. Prompt treatment effectively prevents the development and recurrence of peptic ulcers in the future.

Treating H. pylori not only helps ulcers to heal but, more importantly, it prevents the spread of infection to others

What are the treatments for H pylori and what antibiotics are used to treat Helicobacter pylori?

H. pylori treatment usually consists of a 14-day antibiotic regimen containing two effective antibiotics that help to kill the bacteria, such as amoxicillin (Amoxil, Trimox), levofloxacin (Levaquin), tetracycline (Sumycin, not to be used for children <12 yrs.), metronidazole (Flagyl), or clarithromycin (Biaxin), plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor to lower acid levels and help the ulcer to heal, such as omeprazole (Prilosec, Prilosec OTC), pantoprazole (Protonix), rabeprazole (Aciphex, Aciphex Sprinkle), and lansoprazole (Prevacid, Prevacid IV, Prevacid 24-Hour).

Can Helicobacter pylori be cured?

In most cases, patients are usually cured after finishing one to two weeks of medicine.

What is the best treatment for H pylori?

H pylori eradication rates were higher for a 14-day regimen of triple therapy with lansoprazole (eg, Prevacid 30 mg twice daily for 14 days), amoxicillin (eg, Amoxil 1 g PO every 12 hours for 14 days), and clarithromycin (eg, Biaxin 500 mg orally every 12 hours for 14 days) compared with a 14-day regimen of triple therapy with lansoprazole (eg, Prevacid 30 mg twice daily for 14 days), amoxicillin (eg, Moxatag 1 g BID for 14 days), and levofloxacin (eg, Levaquin 500 mg or 750 mg orally every 24 hours for 14 days). Saying so, a 14-day regimen of triple therapy with LAC (lansoprazole, amoxicillin, and clarithromycin ) is superior to a 14-day regimen of triple therapy with LAL (lansoprazole, amoxicillin, and levofloxacin).

What are the side effects of H pylori treatment?

Common side effects of H. pylori treatment may include: dry mouth, increased thirst, metallic taste (unpleasant taste in your mouth), nausea, vomiting, headache, epigastric pain, constipation, and less commonly, dysbacteriosis (dysbiosis), melena (dark colored stools), vaginal itching or discharge.

How to prevent h pylori infection?

Common ways to prevent Helicobacter pylori infection include:

Stay hydrated and drink at least 3 liters of water a day, but make sure to only drink water from a clean, safe source.

Practice good hygiene: wash your hands after going to the bathroom, before you eat and before you start cooking.

Avoid sharing utensils, like glasses, forks, spoons, knifes, etc. with family members, friends or strangers because H. pylori is mainly transmitted by direct contact with infected saliva.

Eat properly prepared food: heat food items properly and make sure that they are cooked thoroughly and safely under clean conditions because food can also become contaminated with H. pylori bacteria.

Take immune boosting supplements, like Immunal® (Echinacea purpurea)

Precautions

If you suspect that you may have a Helicobacter pylori infection, you should consult with your doctor as soon as possible. The only way to know for sure whether you have H. pylori infection is to get tested.

Seek urgent medical care if you experience any of the following symptoms:

Dysphagia (Difficulty Swallowing)

Acute abdomen pain (persistent and severe abdominal pain)

Bloody, black or dark brown vomit that looks like coffee grounds (haematemesis)

Black tarry or bloody stools

Persistent epigastric pain just under your lower left ribs in the upper left side of your abdomen that improves after eating, drinking, or taking antacids

If you have symptoms of a perforated peptic ulcer, like acute sharp abdominal pain, a rigid hard abdomen that is tender to touch, fainting, profuse sweating, palpitations, confusion, vomit blood, or have blood in your stool (melena).

Check with your doctor before trying any new supplements, especially if you are currently taking any medication

Read more:

How to get rid of H. pylori infection naturally?

How to prevent dysbacteriosis after antibiotics?

Verified by: Dr.Diab (March 9, 2018)

Citation: Dr.Diab. (March 9, 2018). What is H. pylori infection? Epidemiology Symptoms and Treatment. Medcoi Journal of Medicine, 24(2). urn:medcoi:article19930.