Helicobacter pylori

Helicobacter pylori, or H. pylori, previously known as Campylobacter pylori, is a Gram-negative, microaerophilic bacterium usually found in the stomach. It was identified in 1982 by Australian scientists Barry Marshall and Robin Warren, who found that it was present in a person with chronic gastritis and gastric ulcers, conditions not previously believed to have a microbial cause. It is also linked to the development of duodenal ulcers and stomach cancer. However, over 80% of individuals infected with the bacterium are asymptomatic, and it may play an important role in the natural stomach ecology.

More than 50% of the world's population has H. pylori in their upper gastrointestinal tracts.

It was once thought stress and diet caused peptic ulcers but is now known they are due to H. pylori. The biopsychosocial model was once applied to peptic ulcers. Davey Smith states that peptic ulcer was "the classic BPS disease" but that "cognitive behavioural therapy rather disturbingly had no effect"; only the discovery of helicobacter pylori in 1983 allowed the patients to be cured.

Testing

Urea breath test (UBT)

• During the test, you swallow a special substance that has urea. Urea is a waste product the body produces as it breaks down protein. The urea used in the test has been made harmlessly radioactive.
• If H. pylori are present, the bacteria convert the urea into carbon dioxide, which is detected and recorded in your exhaled breath after 10 minutes.
• This test can identify almost all people who have H. pylori. It can also be used to check that the infection has been fully treated.

What you cannot take prior to the Urea breath test

• FAST for at least one hour before the test. This means that you consume no food and drink only water prior to the test.
• Phenylketonuric patients should avoid the test. Active ingredient is mixed with aspartame and contains 84 mg phenylalanine per dosage unit. (For reference, 12 ounces of typical diet cola soft drinks contain approximately 80mg of phenylalanine).
• Avoid proton pump inhibitors including Prilosec, Prevacid, Nexium, Protonix, Aciphex, and Dexilant within two weeks prior to the urea breath test.
• Avoid antibiotics two weeks prior to the urea breath test.
• Avoid bismuth preparations (Pepto Bismol) within two weeks of the urea breath test.
• Do not test before four weeks after H. pylori treatment.

What you can take prior to the Urea breath test

• Prior to testing, the patient may take H2 antagonists (Tagamet, Zantac, Pepcid, Axid) or Antacids (Tums, Rolaids, Maalox).

Blood tests

You do not have to do anything prior to the blood test.

• Blood tests are used to measure antibodies to H. pylori. Antibodies are proteins made by the body's immune system when it detects harmful substances such as bacteria.
• Blood tests for H. pylori can only tell if your body has H. pylori antibodies. It cannot tell if you have a current infection or how long you have had it. This is because the test can be positive for years, even if the infection is cured. As a result, blood tests cannot be used to see if the infection has been cured after treatment.

Stool tests

• A stool test can detect traces of H. pylori in the feces.
• This test can be used to diagnose the infection and confirm that it has been cured after treatment.

What you cannot take prior to the stool test

Some medicines can change the results of the test. Inform your doctor about all your prescription and nonpresecription medications you are taking.

• Do not take antibiotics or medicines containing bismuth (such as Pepto-Bismol) for 1 month before the test.
• Do not take proton pump inhibitors (such as Nexium or Prilosec) for 2 weeks before the test.

Biopsy

• A tissue sample, called a biopsy, is taken from the stomach lining. This is the most accurate way to tell if you have an H. pylori infection.
• To remove the tissue sample, you have a procedure called endoscopy. The procedure is done in the hospital or outpatient center.
• Usually, a biopsy is done if endoscopy is needed for other reasons. Reasons include diagnosing the ulcer, treating bleeding, or making sure there is no cancer.

What you cannot take prior to a biopsy

Many medications may change the results of your test. Inform your doctor of all prescription and nonprescription medications you are taking.

• Do not take antibiotics or medicines containing bismuth (such as Pepto-Bismol) for 1 month before the test.
• Do not take proton pump inhibitors for 2 weeks before the test.
• Do not take H2 blockers, such as Pepcid, Zantac, Axid, or Tagamet, for 24 hours before the test. 

Treatment

Treatment could mean taking 14 or more pills per day for weeks. Antibiotics must be taken the right way or bacteria in your body could become resistant to them.

Antibiotics are used to kill the bacteria, usually two, as well as bismuth subsalicyate. Drugs that reduce the amount of acid in your stomach may also be taken. Medicines that block the chemical histamine, which prompts your stomach to produce more acid.

1-2 weeks after you finish your treatment, your doctor may test your breath or stool again to make sure the infection is gone.

Prevention

• Wash your hands after you use the bathroom and before you prepare or eat food. Teach your children to do the same.
• Avoid food or water that’s not clean.
• Don’t eat anything that isn’t cooked thoroughly.
• Avoid food served by people who haven’t washed their hands.

Stress, spicy food, alcohol, and smoking may prevent ulcers from healing.

See also

• Biopsychosocial model

Learn more

• Helicobacter pylori (H.pylori) Simplified (Video)