DIGESTIVE HEALTH & YOU

Keeping bacteria in check

HELICOBACTER pylori (H. pylori) is a common bacterium that resides in the stomach and causes peptic (duodenal and gastric) ulcers.

In the past, it was thought that peptic ulcers were caused by intake of spicy food and alcohol, smoking, and stress. The discovery of this bacterium in 1982 led to it being identified as the root cause of most types of peptic ulcers.

H. pylori grows in the gastrointestinal (GI) tract and, in the right conditions, attacks the stomach lining. The most dangerous thing about this bacterium is its capability to withstand high acidity levels, which lets it survive the harsh acidic environment of the stomach and duodenum.

The bacterium is spiral-shaped, hence the name “helicobacter” (helicon is Latin for “spiral”). Its shape lets it puncture the stomach’s protective lining that protects the inner wall from the strong acid secreted for digestion.

A puncture in the lining means that acid reaches the inner stomach wall. The acid can cause open sores, commonly known as ulcers.

Since H. pylori spreads easily and thrives in unsanitary conditions, it usually infects people who do not have access to clean water or live in places that are overcrowded.

It commonly spreads from person to person through contaminated saliva, vomitus or faecal matter. Another known way for the bacterium to spread is through food and water that have been in contact with H. pylori-contaminated faecal matter.

Identify the telltale signs

Normally acquired during childhood, approximately 60% of the world population have H. pylori in their systems. However, most do not develop ulcers or experience symptoms of an infection during their lifetime.

In early stages of an active H. pylori infection, symptoms include bloating, heartburn, nausea and abdominal pain, anaemia, appetite loss and unexplained weight loss.

“People aged above 70 usually take a combination of medications, including nonsteroidal anti-inflammatory drugs, which increases their risk of developing bleeding ulcers with concurrent H. pylori infections,” says Dr Saravana Kumar Karunanathy, consultant physician, gastroenterologist and hepatologist at ParkCity Medical Centre.

If you have any of these symptoms, it is imperative to consult a doctor to rule out the possibility of a H. pylori infection. If left undetected and untreated, the bacterium can cause gastritis or persistent inflammation of the stomach and, in more severe cases, stomach cancer.

“If you have a family history of gastric cancer, it is advisable to get a check-up, because your risk of developing it increases six-fold when you have a H. pylori infection,” he says.

Tests for a H. pylori infection include:

Stool test – A stool sample is tested for traces of H. pylori antigens, which indicate an

infection. Blood test – Analysis of a blood sample may reveal evidence of an active or previous H. pylori infection. However, breath and stool tests are better at detecting active H. pylori infections than a blood test. Urea breath test – Before undergoing a breath test, you swallow a pill that contains tagged carbon molecules.

If you have H. pylori infection, carbon is released when the solution is broken down in your stomach.

You will be asked to exhale into a bag and your breath analysed. If a H. pylori infection is present, the patient’s exhaled breath will contain isotopelabelled carbon dioxide. For accurate results, patients are required to fast the day before and avoid taking antibiotics or proton-pump inhibitors for at least two weeks prior to the procedure.

Endoscopy – Also known as a gastroscopy, this test is done using a thin flexible tube with a small camera fitted on one end. The tube is passed through the oesophagus of the patient and into thestomach.

The camera lets the endoscopist view the interior of the stomach and detect abnormalities such as growths or ulcers.

An endoscopy is usually performed if the patient is experiencing symptoms such as bloody stools, recurrent abdominal pain or rapid weight loss.

This procedure can help doctors determine the presence of ulcers and detect bleeding or stomach cancer. During this procedure, tissue samples are biopsied and analysed for H. pylori.

Since it is an invasive procedure, patients are normally lightly sedated for its duration.

Treating a H. pylori infection

The most common treatment offered is a course of antibiotics, taken over 10 to 14 days. Since H. pylori is rather resistant, two types of antibiotics are prescribed, along with a proton-pump inhibitor to regulate gastric acidity.

In 80% of patients, this first line of defence will be effective in eradicating their H. pylori infection.

Two weeks after treatment, the patient is tested again, usually with the urea breath test. If traces of a H. pylori infection are still present, a second course of treatment is pursued.

“Taking antibiotics can be unpleasant. Patients may experience side effects during treatment. However, the medication is necessary to get rid of the bacteria completely. For this reason, it is essential that patients complete the full course of antibiotics,” says Dr Saravana Kumar.

However, someone who has been diagnosed, treated and completely cured of a H. pylori infection can be infected again.

Stay clean, stay safe

The only way to stop H. pylori from spreading is by maintaining satisfactory hygiene. It is essential to wash your hands thoroughly and sanitise your surroundings as much as possible.

On the bright side, there has been a significant decrease in H. pylori infections in Malaysia due to increase in awareness.

Dr Saravana Kumar shares, “In the late 1980s and early 1990s, H. pylori infections were prevalent in 50% of the population. That figure has dropped by 14% to 15% over the years.”

For unknown reasons, Indians are more affected by this bacterium than other ethnic groups in Malaysia. However, H. pylori infections that develop into stomach cancer are mostly observed in people of Chinese descent.

Research is still ongoing to find out why this bacterium affects some people more than others and why some people do not display symptoms of a H. pylori infection.

For as long as these questions remain unanswered, it is best to maintain hygiene to reduce the chances of infection. For more information, call 03-5639 1212.

People aged above 70 usually take a combination of medications, including non-steroidal anti-inflammatory drugs, which increases their risk of developing bleeding ulcers with concurrent H. pylori infections. Dr Saravana Kumar Karunanathy