Disease: Helicobacter pylori
(H. pylori)

    Helicobacter pylori (H. pylori) facts

    • Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation in the stomach and is a common cause of ulcers worldwide
    • H. pylori causes chronic inflammation (gastritis) by invading the lining of the stomach and producing a cytotoxin termed Vacuolating cytotoxin A (Vac-A); these functions can lead to ulcer formation.
    • Although many infected individuals have no symptoms, other infected individuals may have occasional episodes of:
      • belching,
      • bloating,
      • nausea and vomiting and
      • abdominal discomfort.
    • More serious infections cause symptoms of:
      • abdominal pain,
      • nausea and vomiting that may include vomiting blood,
      • passing dark or tarry like stools,
      • fatigue,
      • low red blood cell count (anemia),
      • decreased appetite, diarrhea,
      • heartburn, and
      • bad breath.
    • H. pylori is contagious; however some individuals may be simply colonized with the bacteria and the bacteria cause no disease.
    • The diagnosis of H. pylori infection include antibody tests, urea breath tests, stool antigen tests, and endoscopic biopsies.
    • Chronic infections with H. pylori weakens the natural defenses of the stomach so most individuals with symptoms need to be treated to prevent ulceration formation.
    • H. pylori is difficult to eradicate from the stomach because of antibiotic resistance; consequently, two or more antibiotics are usually given together with a protein pump inhibitor (PPI) medication (for example, omeprazole [Prilosec, Zegerid] or esomeprazole [Nexium])
    • In general, patients should be treated if they are infected with H. pylori and have ulcers. Moreover, patients with MALT lymphoma of the stomach progresses quickly if H. pylori is not treated and eradicated.
    • Because about 50% of the world's population carries or is infected with H. pylori, prevention is difficult; however, recommendations to help prevent ulcers include:
      • Reduce or stop alcohol intake and/or quit smoking
      • Use acetaminophen instead of NSAIDs
      • Avoid caffeine
      • Check for symptoms of H. pylori infection after radiation therapy
      • Avoid or reduce stress
    • Good hand washing techniques with uncontaminated water will reduce chances of infection.
    • Currently, no vaccine is available against H. pylori to prevent either colonization or infection.
    • The prognosis for H. pylori infections is usually good to excellent, but up to 20% may have reoccurring infection. Untreated and more severe infections have a worse prognosis because of the potential for bleeding, anemia, and low blood pressure (hypotension) development.

    What is Helicobacter pylori?

    Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation of the inner lining of the stomach (gastritis) in humans. This bacterium also is considered as a common cause of ulcers worldwide; as many as 90% of people with ulcers have detectable organisms.

    H. pylori infection is most likely acquired by ingesting contaminated food and water, and through person to person contact. In the United States, about 30% of the adult population is infected (50% of infected persons are infected by the age of 60), but the prevalence of infection is decreasing because there is increasing awareness about the infection, and treatment is common. About 50% of the world population is estimated to have detectable H. pylori in their gastrointestinal tract (GI tract, but stomach, mainly).

    The infection is more common in crowded living conditions with poor sanitation. In countries with poor sanitation, approximately 90% of the adult population can be infected. Infected individuals usually carry the infection indefinitely (for life) unless they are treated with medications to eradicate the bacterium. One out of every six patients with H. pylori infection may develop ulcers of the duodenum or stomach. H. pylori also are associated with stomach cancer and a rare type of lymphocytic tumor of the stomach called MALT (mucosa-associated lymphoid tissue) lymphoma. In addition, several recent research papers have shown a link between diabetes, infections, elevated hemoglobin A1C levels, and H. pylori.

    What does H. pylori cause in humans?

    H. pylori infections start with a person acquiring the bacterium from another person (via either the fecal-oral or oral-oral route). Although the majority of individuals that have these bacteria in their GI tracts have few if any symptoms (see symptoms), most people develop stomach inflammation (gastritis) from the body's response to the bacterium itself and to a cytotoxin termed Vac-A, a chemical that the bacterium produces. Researchers also suggest that the stomach acid stimulates the bacterium in addition to the cytotoxin, and increases invasion of the lining of the stomach, inflammation, and ulcer formation. Other investigators have shown that these bacteria and their products are associated with alterations in the cells lining the stomach that when altered are associated with stomach and other cancers, although these are infrequently seen diseases.

    The frequency of people infected may somehow be related to race. About 60% of Hispanics and about 54% of African Americans have detectable organisms as compared to about 20% to 29% of Anglo Americans. In developing countries, children are very commonly infected.

    What are the symptoms of H. pylori infections?

    Most individuals infected with H. pylori have few or no symptoms. Some may experience a few episodes of gastritis like:

    • minor belching,
    • bloating,
    • nausea,
    • vomiting, and
    • abdominal discomfort.

    Often, these symptoms simply go away. However, those individuals who have a more serious infection exhibit symptoms of stomach and duodenal ulcers or gastritis which include the following:

    • abdominal pain and/or discomfort that usually does not wax and wane
    • nausea and vomiting sometimes with blood or coffee-ground like vomitus
    • dark or tar-like stools (black color of feces due to bleeding ulcers)
    • fatigue
    • low red blood cell count due to bleeding
    • full feeling after a small amount of food
    • decreased appetite that is more constant

    Other symptoms may include:

    • diarrhea,
    • heartburn, and
    • bad breath (halitosis).

    If a person has symptoms of black, tarry stools and fatigue they should seek medical help or go to an emergency department to be evaluated for intestinal bleeding.

    Is H. pylori contagious?

    Yes, H. pylori are contagious. However, sometimes there is a grey area between the terms contagious and colonized. Contagious usually implies a disease-causing agent is transferred from person to person, while colonization usually implies a non-disease-causing agent simply populates a body surface but does not cause disease, even when transferred from person to person. The grey area occurs when many people have the agent that causes disease in some of them, but not in many others. Some microbiologists consider such organisms as adapting to their human hosts by slowly changing from infecting humans to colonizing them. Although this is speculation, it seems to fit the ongoing situation with H. pylori. However, others think the bacteria become infecting agents when their genes and surrounding environment trigger H. pylori to produce and release enough toxic chemicals to cause the GI tract to become inflamed.

    How is H. pylori infection diagnosed?

    Accurate and simple tests for the detection of H. pylori infection are available. They include blood antibody tests, urea breath tests, stool antigen tests, and endoscopic biopsies.

    Blood tests for the presence of antibodies to H. pylori can be performed easily and rapidly. However, blood antibodies can persist for years after complete eradication of H. pylori with antibiotics. Therefore, blood antibody tests may be good for diagnosing infection, but they are not good for determining if antibiotics have successfully eradicated the bacterium.

    The urea breath test (UBT) is a safe, easy, and accurate test for the presence of H. pylori in the stomach. The breath test relies on the ability of H. pylori to break down the naturally occurring chemical, urea, into carbon dioxide which is absorbed from the stomach and eliminated from the body in the breath. Ten to 20 minutes after swallowing a capsule containing a minute amount of radioactive urea, a breath sample is collected and analyzed for radioactive carbon dioxide. The presence of radioactive carbon dioxide in the breath (a positive test) means that there is active infection. The test becomes negative (there is no radioactive carbon dioxide in the breath) shortly after eradication of the bacterium from the stomach with antibiotics. Since some individuals are concerned about even minute amounts of radioactivity the breath test has been modified so that it also may be performed with urea that is not radioactive.

    Endoscopy is an accurate test for diagnosing H. pylori as well as the inflammation and ulcers that it causes. For endoscopy, the doctor inserts a flexible viewing tube (endoscope) through the mouth, down the esophagus, and into the stomach and duodenum. During endoscopy, small tissue samples (biopsies) from the stomach lining can be removed. A biopsy specimen is placed on a special slide containing urea (for example, CLO test slides). If the urea is broken down by H. pylori in the biopsy, there is a change in color around the biopsy on the slide. This means that there is an infection with H. pylori in the stomach.

    Biopsies also may be cultured in the bacteriology laboratory for the presence of H. pylori; however, this is done infrequently since other simpler tests are available.

    A recently-developed test for H. pylori is a test in which the presence of the bacterium can be diagnosed with a sample of stool. The test uses an antibody to H. pylori to determine if H. pylori is present in the stool. If it is, it means that H. pylori is infecting the stomach. Like the urea breath test, in addition to diagnosing infection with H. pylori, the stool test can be used to determine if eradication has been effective shortly after treatment.

    In 2012, the FDA gave approval for the urea breath test to be done in children aged 3 years to 17 years old.

    Why treat H. pylori?

    Chronic infection with H. pylori weakens the natural defenses of the lining of the stomach to the ulcerating action of acid. Medications that neutralize stomach acid (antacids), and medications that decrease the secretion of acid in the stomach (H2-blockers and proton pump inhibitors or PPIs) have been used effectively for many years to treat ulcers.

    H2-blockers include

    • ranitidine (Zantac),
    • famotidine (Pepcid),
    • cimetidine (Tagamet), and
    • nizatidine (Axid).

    PPIs include

    • omeprazole (Prilosec),
    • lansoprazole (Prevacid),
    • rabeprazole (Aciphex),
    • pantoprazole (Protonix), and
    • esomeprazole (Nexium).

    Antacids, H2-blockers and PPIs, however, do not eradicate H. pylori from the stomach, and ulcers frequently return promptly after these medications are discontinued. Hence, antacids, H2-blockers or PPIs have to be taken daily for many years to prevent the return of the ulcers and the complications of ulcers such as bleeding, perforation, and obstruction of the stomach. Even such long-term treatments can fail. Eradication of H. pylori, however, usually prevents the return of ulcers and ulcer complications even after appropriate medications such as PPIs are stopped. Eradication of H. pylori also is important in the treatment of the rare condition known as MALT lymphoma of the stomach. Treatment of H. pylori to prevent stomach cancer is controversial and discussed later in this article.

    What is the treatment for H. pylori?

    H. pylori is difficult to eradicate from the stomach because it is capable of developing resistance to commonly used antibiotics. Therefore, two or more antibiotics usually are given together with a PPI and/or bismuth containing compounds to eradicate the bacterium. (Bismuth and PPIs have anti-H. pylori effects.) Examples of combinations of medications that are effective are:

    • a PPI, amoxicillin (Amoxil) and clarithromycin (Biaxin)
    • a PPI, metronidazole (Flagyl), tetracycline and bismuth subsalicylate (Pepto-Bismol, Bismuth)

    These combinations of medications can be expected to cure 70% to 90% of infections. However, studies have shown that resistance of H. pylori (failure of antibiotics to eradicate the bacterium) to clarithromycin is common among patients who have prior exposure to clarithromycin or other chemically similar macrolide antibiotics (such as erythromycin). Similarly, H. pylori resistance to metronidazole is common among patients who have had prior exposure to metronidazole. In these patients, doctors have to find other combinations of antibiotics to treat the H. pylori. Antibiotic resistance is another reason why antibiotics should be used carefully and judiciously for the right reasons, and indiscriminate use of antibiotics for improper reasons should be discouraged. First-line regimens for Helicobacter pylori eradication are taken from the guidelines developed by the American College of Gastroenterology as follows:

    1. Standard dose of a *PPI (proton pump inhibitor) *b.i.d. (esomeprazole is *q.d.), clarithromycin 500 mg b.i.d., amoxicillin 1,000 mg b.i.d. for 10-14 days
    2. Standard dose PPI b.i.d., clarithromycin 500 mg b.i.d. metronidazole 500 mg b.i.d. for 10-14 days
    3. Bismuth subsalicylate 525 mg p.o. q.i.d. metronidazole 250 mg * p.o. *q.i.d., tetracycline 500 mg p.o. q.i.d., ranitidine 150 mg p.o. b.i.d. or standard dose PPI q.d. to b.i.d. for 10-14 days
    4. PPI + amoxicillin 1 g b.i.d., for 5 days, followed by PPI, clarithromycin 500 mg, tinidazole 500 mg b.i.d. for 5 days (used mainly in other countries)

    *PPI = proton pump inhibitor; pcn = penicillin; p.o. = orally; q.d. = daily; b.i.d. = twice daily; t.i.d. = three times daily; q.i.d. = four times daily.

    A recent investigation reported that triple therapy of either levofloxacin (Levaquin) or rifabutin in combination with amoxicillin and esomeprazole yielded cure rates of 90% and 88.6%. The treatments lasted 10 to 12 days respectively (10 days of levofloxacin 20=50 mg b.i.d. or rifabutin 150 mg q.d. for 12 days. Amoxicillin was 1 gm esomeprazole was 40 mg, both b.i.d.).

    Some doctors may want to confirm eradication of H. pylori after treatment with a urea breath test or a stool antigen test, particularly if there have been serious complications of the infection such as perforation or bleeding in the stomach or duodenum. Endoscopic biopsies to determine eradication of the bacterium are not necessary, and blood tests are not good for determining eradication since it takes many months for the antibodies to H. pylori to decrease. The best tests for determining eradication are the breath and stool tests discussed previously. Patients who fail to eradicate H. pylori with treatment are retreated, often with a different combination of medications.

    Who should receive treatment for H. pylori?

    There is a general consensus among doctors that patients should be treated if they are infected with H. pylori and have ulcers. The goal of treatment is to eradicate the bacterium, heal the ulcers, and prevent the ulcers' return. Patients with MALT lymphoma of the stomach also should be treated. MALT lymphoma is rare, but the tumor often quickly regresses upon successful eradication of H. pylori.

    There currently is no formal recommendation to treat patients infected with H. pylori without ulcer disease or MALT lymphoma. Since antibiotic combinations can have side effects, and stomach cancers are infrequent in the United States, it is felt that the risks of treatment to eradicate H. pylori in patients without symptoms or ulcers may not justify the unproven benefits of treatment for the purpose of preventing stomach cancer. On the other hand, H. pylori infection is known to cause atrophic gastritis (chronic inflammation of the stomach leading to atrophy of the inner lining of the stomach). Some physicians believe that atrophic gastritis can lead to cell changes (intestinal metaplasia) that can be precursors to stomach cancer. Studies have also shown that eradication of H. pylori may reverse atrophic gastritis. Thus, some doctors are recommending treatment of ulcer- and symptom-free patients infected with H. pylori.

    Many physicians believe that dyspepsia (non-ulcer symptoms associated with meals) may be associated with infection with H. pylori. Although it is not clear if H. pylori causes the dyspepsia, many physicians will test patients with dyspepsia for infection with H. pylori and treat them if infection is present.

    Scientists studying the genetics of H. pylori have found different strains (types) of the bacterium. Some strains of H. pylori appear to be more prone to cause ulcers and stomach cancer. Further research in this area may help doctors to intelligently select those patients who need treatment. Vaccination against H. pylori is unlikely to be available in the near future.

    Can H. pylori infections be prevented?

    With at least 50% of the world population with detectable H. pylori in their stomachs, it seems likely that with no vaccine available, it will be very difficult or impossible for people to have no exposure to these bacteria. The chance of the organisms causing symptomatic infection is low, but certainly not absent. Currently, suggestions have been made to prevent ulcers, but the effectiveness of these recommendations are unknown. The following is a list of recommendations to help prevent ulcers:

    • Reduce or stop the intake of alcohol
    • Stop smoking
    • Substitute acetaminophen (Tylenol and others) for aspirin for pain control
    • Substitute acetaminophen or other drugs for nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Avoid caffeine in coffee and many "power" drinks
    • Check for GI symptoms and treat immediately during or after radiation therapy
    • Identify and reduce or avoid stress
    • Wash hands with uncontaminated water to avoid contracting the bacterium
    • If infected with H. pylori, antimicrobial treatment may avoid ulcer formation and extension of disease

    Currently, there is no commercially available vaccine to prevent either infection or colonization of the stomach by H pylori. However, research is ongoing, and the NIH is funding vaccine studies in conjunction with vaccine makers (For example, Helicovax to prevent H. pylori colonization of human GI tracts by EpiVax, Inc.). Moreover, some nutritionists suggest a diet high in fruits and vegetables, and low in sugar may help reduce or stop H. pylori infection.

    What is Helicobacter pylori?

    Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation of the inner lining of the stomach (gastritis) in humans. This bacterium also is considered as a common cause of ulcers worldwide; as many as 90% of people with ulcers have detectable organisms.

    H. pylori infection is most likely acquired by ingesting contaminated food and water, and through person to person contact. In the United States, about 30% of the adult population is infected (50% of infected persons are infected by the age of 60), but the prevalence of infection is decreasing because there is increasing awareness about the infection, and treatment is common. About 50% of the world population is estimated to have detectable H. pylori in their gastrointestinal tract (GI tract, but stomach, mainly).

    The infection is more common in crowded living conditions with poor sanitation. In countries with poor sanitation, approximately 90% of the adult population can be infected. Infected individuals usually carry the infection indefinitely (for life) unless they are treated with medications to eradicate the bacterium. One out of every six patients with H. pylori infection may develop ulcers of the duodenum or stomach. H. pylori also are associated with stomach cancer and a rare type of lymphocytic tumor of the stomach called MALT (mucosa-associated lymphoid tissue) lymphoma. In addition, several recent research papers have shown a link between diabetes, infections, elevated hemoglobin A1C levels, and H. pylori.

    What does H. pylori cause in humans?

    H. pylori infections start with a person acquiring the bacterium from another person (via either the fecal-oral or oral-oral route). Although the majority of individuals that have these bacteria in their GI tracts have few if any symptoms (see symptoms), most people develop stomach inflammation (gastritis) from the body's response to the bacterium itself and to a cytotoxin termed Vac-A, a chemical that the bacterium produces. Researchers also suggest that the stomach acid stimulates the bacterium in addition to the cytotoxin, and increases invasion of the lining of the stomach, inflammation, and ulcer formation. Other investigators have shown that these bacteria and their products are associated with alterations in the cells lining the stomach that when altered are associated with stomach and other cancers, although these are infrequently seen diseases.

    The frequency of people infected may somehow be related to race. About 60% of Hispanics and about 54% of African Americans have detectable organisms as compared to about 20% to 29% of Anglo Americans. In developing countries, children are very commonly infected.

    What are the symptoms of H. pylori infections?

    Most individuals infected with H. pylori have few or no symptoms. Some may experience a few episodes of gastritis like:

    • minor belching,
    • bloating,
    • nausea,
    • vomiting, and
    • abdominal discomfort.

    Often, these symptoms simply go away. However, those individuals who have a more serious infection exhibit symptoms of stomach and duodenal ulcers or gastritis which include the following:

    • abdominal pain and/or discomfort that usually does not wax and wane
    • nausea and vomiting sometimes with blood or coffee-ground like vomitus
    • dark or tar-like stools (black color of feces due to bleeding ulcers)
    • fatigue
    • low red blood cell count due to bleeding
    • full feeling after a small amount of food
    • decreased appetite that is more constant

    Other symptoms may include:

    • diarrhea,
    • heartburn, and
    • bad breath (halitosis).

    If a person has symptoms of black, tarry stools and fatigue they should seek medical help or go to an emergency department to be evaluated for intestinal bleeding.

    Is H. pylori contagious?

    Yes, H. pylori are contagious. However, sometimes there is a grey area between the terms contagious and colonized. Contagious usually implies a disease-causing agent is transferred from person to person, while colonization usually implies a non-disease-causing agent simply populates a body surface but does not cause disease, even when transferred from person to person. The grey area occurs when many people have the agent that causes disease in some of them, but not in many others. Some microbiologists consider such organisms as adapting to their human hosts by slowly changing from infecting humans to colonizing them. Although this is speculation, it seems to fit the ongoing situation with H. pylori. However, others think the bacteria become infecting agents when their genes and surrounding environment trigger H. pylori to produce and release enough toxic chemicals to cause the GI tract to become inflamed.

    How is H. pylori infection diagnosed?

    Accurate and simple tests for the detection of H. pylori infection are available. They include blood antibody tests, urea breath tests, stool antigen tests, and endoscopic biopsies.

    Blood tests for the presence of antibodies to H. pylori can be performed easily and rapidly. However, blood antibodies can persist for years after complete eradication of H. pylori with antibiotics. Therefore, blood antibody tests may be good for diagnosing infection, but they are not good for determining if antibiotics have successfully eradicated the bacterium.

    The urea breath test (UBT) is a safe, easy, and accurate test for the presence of H. pylori in the stomach. The breath test relies on the ability of H. pylori to break down the naturally occurring chemical, urea, into carbon dioxide which is absorbed from the stomach and eliminated from the body in the breath. Ten to 20 minutes after swallowing a capsule containing a minute amount of radioactive urea, a breath sample is collected and analyzed for radioactive carbon dioxide. The presence of radioactive carbon dioxide in the breath (a positive test) means that there is active infection. The test becomes negative (there is no radioactive carbon dioxide in the breath) shortly after eradication of the bacterium from the stomach with antibiotics. Since some individuals are concerned about even minute amounts of radioactivity the breath test has been modified so that it also may be performed with urea that is not radioactive.

    Endoscopy is an accurate test for diagnosing H. pylori as well as the inflammation and ulcers that it causes. For endoscopy, the doctor inserts a flexible viewing tube (endoscope) through the mouth, down the esophagus, and into the stomach and duodenum. During endoscopy, small tissue samples (biopsies) from the stomach lining can be removed. A biopsy specimen is placed on a special slide containing urea (for example, CLO test slides). If the urea is broken down by H. pylori in the biopsy, there is a change in color around the biopsy on the slide. This means that there is an infection with H. pylori in the stomach.

    Biopsies also may be cultured in the bacteriology laboratory for the presence of H. pylori; however, this is done infrequently since other simpler tests are available.

    A recently-developed test for H. pylori is a test in which the presence of the bacterium can be diagnosed with a sample of stool. The test uses an antibody to H. pylori to determine if H. pylori is present in the stool. If it is, it means that H. pylori is infecting the stomach. Like the urea breath test, in addition to diagnosing infection with H. pylori, the stool test can be used to determine if eradication has been effective shortly after treatment.

    In 2012, the FDA gave approval for the urea breath test to be done in children aged 3 years to 17 years old.

    Why treat H. pylori?

    Chronic infection with H. pylori weakens the natural defenses of the lining of the stomach to the ulcerating action of acid. Medications that neutralize stomach acid (antacids), and medications that decrease the secretion of acid in the stomach (H2-blockers and proton pump inhibitors or PPIs) have been used effectively for many years to treat ulcers.

    H2-blockers include

    • ranitidine (Zantac),
    • famotidine (Pepcid),
    • cimetidine (Tagamet), and
    • nizatidine (Axid).

    PPIs include

    • omeprazole (Prilosec),
    • lansoprazole (Prevacid),
    • rabeprazole (Aciphex),
    • pantoprazole (Protonix), and
    • esomeprazole (Nexium).

    Antacids, H2-blockers and PPIs, however, do not eradicate H. pylori from the stomach, and ulcers frequently return promptly after these medications are discontinued. Hence, antacids, H2-blockers or PPIs have to be taken daily for many years to prevent the return of the ulcers and the complications of ulcers such as bleeding, perforation, and obstruction of the stomach. Even such long-term treatments can fail. Eradication of H. pylori, however, usually prevents the return of ulcers and ulcer complications even after appropriate medications such as PPIs are stopped. Eradication of H. pylori also is important in the treatment of the rare condition known as MALT lymphoma of the stomach. Treatment of H. pylori to prevent stomach cancer is controversial and discussed later in this article.

    What is the treatment for H. pylori?

    H. pylori is difficult to eradicate from the stomach because it is capable of developing resistance to commonly used antibiotics. Therefore, two or more antibiotics usually are given together with a PPI and/or bismuth containing compounds to eradicate the bacterium. (Bismuth and PPIs have anti-H. pylori effects.) Examples of combinations of medications that are effective are:

    • a PPI, amoxicillin (Amoxil) and clarithromycin (Biaxin)
    • a PPI, metronidazole (Flagyl), tetracycline and bismuth subsalicylate (Pepto-Bismol, Bismuth)

    These combinations of medications can be expected to cure 70% to 90% of infections. However, studies have shown that resistance of H. pylori (failure of antibiotics to eradicate the bacterium) to clarithromycin is common among patients who have prior exposure to clarithromycin or other chemically similar macrolide antibiotics (such as erythromycin). Similarly, H. pylori resistance to metronidazole is common among patients who have had prior exposure to metronidazole. In these patients, doctors have to find other combinations of antibiotics to treat the H. pylori. Antibiotic resistance is another reason why antibiotics should be used carefully and judiciously for the right reasons, and indiscriminate use of antibiotics for improper reasons should be discouraged. First-line regimens for Helicobacter pylori eradication are taken from the guidelines developed by the American College of Gastroenterology as follows:

    1. Standard dose of a *PPI (proton pump inhibitor) *b.i.d. (esomeprazole is *q.d.), clarithromycin 500 mg b.i.d., amoxicillin 1,000 mg b.i.d. for 10-14 days
    2. Standard dose PPI b.i.d., clarithromycin 500 mg b.i.d. metronidazole 500 mg b.i.d. for 10-14 days
    3. Bismuth subsalicylate 525 mg p.o. q.i.d. metronidazole 250 mg * p.o. *q.i.d., tetracycline 500 mg p.o. q.i.d., ranitidine 150 mg p.o. b.i.d. or standard dose PPI q.d. to b.i.d. for 10-14 days
    4. PPI + amoxicillin 1 g b.i.d., for 5 days, followed by PPI, clarithromycin 500 mg, tinidazole 500 mg b.i.d. for 5 days (used mainly in other countries)

    *PPI = proton pump inhibitor; pcn = penicillin; p.o. = orally; q.d. = daily; b.i.d. = twice daily; t.i.d. = three times daily; q.i.d. = four times daily.

    A recent investigation reported that triple therapy of either levofloxacin (Levaquin) or rifabutin in combination with amoxicillin and esomeprazole yielded cure rates of 90% and 88.6%. The treatments lasted 10 to 12 days respectively (10 days of levofloxacin 20=50 mg b.i.d. or rifabutin 150 mg q.d. for 12 days. Amoxicillin was 1 gm esomeprazole was 40 mg, both b.i.d.).

    Some doctors may want to confirm eradication of H. pylori after treatment with a urea breath test or a stool antigen test, particularly if there have been serious complications of the infection such as perforation or bleeding in the stomach or duodenum. Endoscopic biopsies to determine eradication of the bacterium are not necessary, and blood tests are not good for determining eradication since it takes many months for the antibodies to H. pylori to decrease. The best tests for determining eradication are the breath and stool tests discussed previously. Patients who fail to eradicate H. pylori with treatment are retreated, often with a different combination of medications.

    Who should receive treatment for H. pylori?

    There is a general consensus among doctors that patients should be treated if they are infected with H. pylori and have ulcers. The goal of treatment is to eradicate the bacterium, heal the ulcers, and prevent the ulcers' return. Patients with MALT lymphoma of the stomach also should be treated. MALT lymphoma is rare, but the tumor often quickly regresses upon successful eradication of H. pylori.

    There currently is no formal recommendation to treat patients infected with H. pylori without ulcer disease or MALT lymphoma. Since antibiotic combinations can have side effects, and stomach cancers are infrequent in the United States, it is felt that the risks of treatment to eradicate H. pylori in patients without symptoms or ulcers may not justify the unproven benefits of treatment for the purpose of preventing stomach cancer. On the other hand, H. pylori infection is known to cause atrophic gastritis (chronic inflammation of the stomach leading to atrophy of the inner lining of the stomach). Some physicians believe that atrophic gastritis can lead to cell changes (intestinal metaplasia) that can be precursors to stomach cancer. Studies have also shown that eradication of H. pylori may reverse atrophic gastritis. Thus, some doctors are recommending treatment of ulcer- and symptom-free patients infected with H. pylori.

    Many physicians believe that dyspepsia (non-ulcer symptoms associated with meals) may be associated with infection with H. pylori. Although it is not clear if H. pylori causes the dyspepsia, many physicians will test patients with dyspepsia for infection with H. pylori and treat them if infection is present.

    Scientists studying the genetics of H. pylori have found different strains (types) of the bacterium. Some strains of H. pylori appear to be more prone to cause ulcers and stomach cancer. Further research in this area may help doctors to intelligently select those patients who need treatment. Vaccination against H. pylori is unlikely to be available in the near future.

    Can H. pylori infections be prevented?

    With at least 50% of the world population with detectable H. pylori in their stomachs, it seems likely that with no vaccine available, it will be very difficult or impossible for people to have no exposure to these bacteria. The chance of the organisms causing symptomatic infection is low, but certainly not absent. Currently, suggestions have been made to prevent ulcers, but the effectiveness of these recommendations are unknown. The following is a list of recommendations to help prevent ulcers:

    • Reduce or stop the intake of alcohol
    • Stop smoking
    • Substitute acetaminophen (Tylenol and others) for aspirin for pain control
    • Substitute acetaminophen or other drugs for nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Avoid caffeine in coffee and many "power" drinks
    • Check for GI symptoms and treat immediately during or after radiation therapy
    • Identify and reduce or avoid stress
    • Wash hands with uncontaminated water to avoid contracting the bacterium
    • If infected with H. pylori, antimicrobial treatment may avoid ulcer formation and extension of disease

    Currently, there is no commercially available vaccine to prevent either infection or colonization of the stomach by H pylori. However, research is ongoing, and the NIH is funding vaccine studies in conjunction with vaccine makers (For example, Helicovax to prevent H. pylori colonization of human GI tracts by EpiVax, Inc.). Moreover, some nutritionists suggest a diet high in fruits and vegetables, and low in sugar may help reduce or stop H. pylori infection.

    Source: http://www.rxlist.com

    H. pylori infections start with a person acquiring the bacterium from another person (via either the fecal-oral or oral-oral route). Although the majority of individuals that have these bacteria in their GI tracts have few if any symptoms (see symptoms), most people develop stomach inflammation (gastritis) from the body's response to the bacterium itself and to a cytotoxin termed Vac-A, a chemical that the bacterium produces. Researchers also suggest that the stomach acid stimulates the bacterium in addition to the cytotoxin, and increases invasion of the lining of the stomach, inflammation, and ulcer formation. Other investigators have shown that these bacteria and their products are associated with alterations in the cells lining the stomach that when altered are associated with stomach and other cancers, although these are infrequently seen diseases.

    The frequency of people infected may somehow be related to race. About 60% of Hispanics and about 54% of African Americans have detectable organisms as compared to about 20% to 29% of Anglo Americans. In developing countries, children are very commonly infected.

    Source: http://www.rxlist.com

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    Define Common Diseases

    Senior Healthcare Matters helps you find information, definitaions and treatement options for most common diseases, sicknesses, illnesses and medical conditions. Find what diseases you have quick and now.