Helicobacter Pylori - The True Stomach Bug

Key takeaways

• H. pylori is a unique microbe that can grow in the stomach

• H. pylori infection can cause stomach ulcers and increase the risk of stomach cancer

• The typical symptoms of H. pylori are stomach pain or burning, nausea, and bloating

• A urea breath test is the most effective way to diagnose H. pylori

• Eradicating H. pylori can improve gut and skin issues, such as rosacea

What is it?

Helicobacter pylori (H. pylori) is a spiral-shaped species of bacteria that can be found in the human stomach, which is typically too acidic for most bacteria to grow. To be able to inhabit such a hostile environment, H. pylori has adopted an effective mechanism for survival. The bacteria produce an enzyme called urease, which buffers stomach acid by creating ammonia. Transmission of H. pylori occurs most frequently via the oral-oral route, but it is also possible to contract H. pylori by faecal-oral transmission following ingestion of contaminated water or food.

H. pylori affects an estimated 4.4 billion people worldwide. It is most prevalent in Africa, South America and Western Asia. While many individuals with the infection remain asymptomatic, H. pylori is still clinically significant. It is responsible for 70-80% of stomach ulcers and over 60% of gastritis (stomach inflammation) cases. Moreover, chronic H. pylori infection is a major risk factor for developing stomach cancer.

What are the symptoms?

The most frequently reported symptoms of H. pylori infection are stomach pain or discomfort, nausea, bloating, and loss of appetite and/or weight. H. pylori may contribute to the development of functional dyspepsia, a disorder of the gut-brain interaction that shares many of the same symptoms as H. pylori.

Whilst H. pylori can lead to gastrointestinal (GI) symptoms, some studies suggest that it is associated with extra-gastric disorders, such as cardiovascular disease, Alzheimer’s disease, dementia, high blood pressure, migraines, and rosacea. The supporting evidence for these associations remains weak, so further research is required before a direct link can be established. However, rosacea has been shown to improve markedly following the treatment eradication of H. pylori and patients with H. pylori are more likely to have food intolerances, such as histamine or lactose intolerance.

How do you test for it?

There are a wide range of tests available for H. pylori. These can be categorised into invasive and non-invasive tests. An endoscopy is an example of an invasive test for H. pylori, whilst non-invasive tests include the stool antigen test and the carbon-13 urea breath test.

An endoscopy involves the insertion of a long, thin tube into the upper GI tract via the mouth, enabling clinicians to visualise any abnormalities. This diagnostic tool is often employed for patients that are above 45 years old or in younger patients that have alarming symptoms or a family history of gastric cancer. During endoscopy, a sample of the stomach tissue is taken and tested for H. pylori. The downsides to this method are that it is uncomfortable, expensive, and is a time-consuming procedure.

The stool antigen test is a non-invasive test which involves providing a stool sample to detect any antibodies produced in response to the H. Pylori infection.

Lastly, the urea breath test is another non-invasive option which involves ingesting a sample of carbon-13 labelled urea. If H. pylori is present, the bacteria will break down the urea into ammonia and carbon dioxide, and the carbon dioxide is detected in breath.

The non-invasive nature of both the stool antigen test and urea breath test mean they are often the favoured option for diagnosis in the primary care setting. Guidelines do suggest that the urea breath test is the most effective method due to its higher sensitivity and lower cost. Additionally, the urea breath test can be done easily at home.

How do you treat it?

H. pylori is treated with a triple-therapy regimen, comprising of a proton pump inhibitor (PPI) and two different kinds of antibiotics. The PPI is used to reduce the amount of stomach acid produced, allowing the lining of the stomach to heal while the antibiotics target the H. pylori. Once the treatment regimen is completed, it is recommended that the patient re-test using the carbon-13 breath test to confirm the infection has been cleared. 

Eradication therapy for H. pylori is highly effective for the treatment of functional dyspepsia in patients that had also tested positive for H. pylori. Whilst the mechanism of action isn’t yet understood, eradication of H. pylori has been shown to improve, and even cure, functional dyspepsia symptoms. Therefore, in patients with symptoms of nausea, bloating, and epigastric pain or discomfort, testing for H. pylori, such as with the urea breath test, is highly recommended. 

Wondering if you or your patient should get tested for H. pylori? A simple, non-invasive urea breath test could provide the answers you need. Visit out website to learn more, and don’t hesitate to contact us with any questions or if you would like to arrange a test. 

References

1. Gravina, A. G., Zagari, R. M., De Musis, C., Romano, L., Loguercio, C., & Romano, M. (2018). Helicobacter pylori and extragastric diseases: A review. World journal of gastroenterology, 24(29), 3204–3221. https://doi.org/10.3748/wjg.v24.i29.3204.

2. Hooi, J., Lai, W., Ng, W., Suen, M., Underwood, F., & Tanyingoh, D. et al. (2017). Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology, 153(2), 420-429. doi: 10.1053/j.gastro.2017.04.022

3. NICE Excellence. (2022). Helicobacter pylori infection | Treatment summary | BNF content published by NICE. Retrieved 8 March 2022, from https://bnf.nice.org.uk/treatment-summary/helicobacter-pylori-infection.html

4. Gravina A, Federico A, Ruocco E, Lo Schiavo A, Masarone M, Tuccillo C, Peccerillo F, Miranda A, Romano L, de Sio C, de Sio I, Persico M, Ruocco V, Riegler G, Loguercio C, Romano M. Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United European Gastroenterol J. 2015

5. Malfertheiner, P., Megraud, F., O’morain, C. A., Gisbert, J. P., Kuipers, E. J., Axon, A. T., … & El-Omar, E. M. (2017). Management of Helicobacter pylori infection—the Maastricht V/Florence consensus report. Gut, 66(1), 6-30.

6. Schnedl, W. J., Meier-Allard, N., Schenk, M., Lackner, S., Enko, D., Mangge, H., & Holasek, S. J. (2022). Helicobacter pylori infection and lactose intolerance increase expiratory hydrogen . EXCLI Journal, 21, 426-435

7. Ford, A. C., Tsipotis, E., Yuan, Y., Leontiadis, G. I., & Moayyedi, P. (2022). Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut.