Author: Rebecca Arenson, DNP
Overview
H. Pylori is a gram negative bacteria that affects people of all ages word-wide. It is estimated that around 50% of the world’s population is affected. Once acquired, infection persists and may or may not produce disease in the stomach or duodenum. Disease symptoms are typically those similar to dyspepsia-belching, sour-stomach, nausea, bloating. The route by which infection occurs remains unknown. Person-to-person transmission of H pylori through either fecal/oral or oral/oral exposure seems most likely. The risk of acquiring H. pylori infection is related to socioeconomic status and living conditions early in life. Factors such as density of housing, overcrowding, number of siblings, sharing a bed, and lack of running water have all been linked to a higher rate of acquiring H. Pylori. It is more prevalent in resource-limited nations, where up to 80% of adults are infected. In the US, infection becomes more common during adulthood. H. Pylori is associated with peptic ulcer disease, chronic gastritis, and stomach cancer.
How is it diagnosed?
The choice of testing used to diagnose H. pylori depends on whether a patient requires an upper endoscopy for evaluation of symptoms or surveillance. Endoscopy is not indicated solely for the purpose of establishing H. Pylori status. However, H. Pylori can be diagnosed through endoscopy with gastric biopsies. In patients who do not require an endoscopy, stool testing or urea breath testing can be completed. Proton pump inhibitors, antibiotics, and bismuth preparations can affect the accuracy of testing so it is recommended to stop these medications 2 weeks prior to testing. Blood testing to check for H. Pylori has low sensitivity and specificity. One cannot differentiate between active and past infection when positive.
How is it treated?
H. Pylori is treated with antibiotic regimens. The regimen used depends on if the patient has any previous allergies to antibiotics. A regimen includes use of a proton pump inhibitor (PPI) and an antibiotic. It sometimes includes bismuth subsalicylate as well. Eradication should be confirmed in all patients treated for H. Pylori with either a breath test, stool test or endoscopy-based testing. Tests to confirm eradication should be performed at least 4 weeks after completion of antibiotic treatment. Approximately 20% of patients fail an initial attempt at H. Pylori eradication; requiring a change in therapy. Reinfection after treatment is overall unusual.
References
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Hu, Y., Wan, J. H., Li, X. Y., et al. Systemic review with meta-analysis: the global recurrence rate of Helicobacter pylori. Aliment Pharmacol Ther 2017; 46: 773.
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