Infection by Helicobacter pylori is one of the most prevalent, affects approximately 40% of the population, and is the main cause of peptic ulcer. The infection usually occurs in childhood, and is less common in adults. The possible routes of infection can be by the fecal-oral or oral-oral route, mainly within the family, parents-children or between siblings.
«Helicobacter pylori infection, besides being the main cause of gastroduodenal ulcer and its complications, is also known for its pathogenetic role in the development of gastric cancer and gastric MALT lymphoma. Sometimes the symptoms are not as intense and only manifest as gastric discomfort and poor digestion, which is known as dyspepsia, which improves on numerous occasions by treating the infection by this bacterium. Although the infection rarely resolves spontaneously and usually persists throughout life, it only causes symptoms in a small percentage that ranges between 10 and 25% of those infected, ”explains Dr. Blas José Gómez Rodríguez, an expert from the Spanish Foundation for Digestive System (FEAD).
Chronic gastritis or chronic duodenitis caused by infection by the bacterium Helicobacter pylori is in most cases it is asymptomatic and may be associated with or worsen the symptoms of dyspepsia such as pain or discomfort in the upper-middle part of the abdomen after meals, abdominal distension and post-ingestion heaviness, nausea, etc.
Only some people develop complications such as gastric or duodenal ulcers, and not all have symptoms, but in the case of having them, the most frequent are:
– pain or discomfort in the upper and central part of the abdomen (low in the sternum)
– early satiety
– lack of appetite
– nausea and vomiting
– darkening of the stool which may become black like tar
– ulcers that bleed can cause anemia and tiredness
Less frequently, other patients may develop chronic gastritis, because changes can occur in the lining or inner layer of the stomach, or in very rare cases stomach cancer. “It is very rare to develop gastric cancer from Helicobacter pylori infection. However, as it is such a common infection, this possibility must be taken into account, and the eradication treatment for Helicobacter pylori is indicated in patients with direct relatives with gastric cancer, ”says Dr. Gómez.
There are different tests to diagnose the presence of Helicobacter pylori infection, but it must be taken into account that before performing the diagnostic test, the intake of omeprazole and derivatives should be suspended for the previous 14 days and for 4 weeks before. of the test in the case of antibiotics.
There are different effective diagnostic tests that the specialist doctor evaluates:
– Carbon 13 urea breath test. It consists of taking a urea tablet that contains carbon 13, which is broken down in the body passing into the blood and from there to the lungs, which allows analyzing the air expelled with the breath and knowing if the testo is positive in Helicobacter pylori or not.
– Determination of Helicobacter pylori antigen in stool. It consists of searching the patient’s stool for the presence of the Helicobacter pylori antigen.
– Serological test. It consists of the determination in blood of the presence of antibodies against Helicobacter pylori.
– Invasive test (biopsies during upper gastrointestinal endoscopy) it is possible to determine the presence of Helicobacter pylori by taking a small sample of gastric tissue and performing a urease test, which is a test similar to a breath test, in which the tissue sample is contacted with a medium containing labeled urea. In case of having the infection, the pylori will break down the urea and the medium will take on a certain color that indicates its presence.
It is also possible to analyze the presence of Helicobacter pylori directly under the microscope by examining biopsies of gastric tissue with histochemical stains and even with more specific techniques such as immunohistochemistry, although the latter is not frequently used.
Once the infection has been diagnosed and treated, it is necessary to confirm with another test that the infection has been eliminated. The most used in this case is the breath test.
How to treat it
There are different factors that influence it. On the one hand, compliance with the treatment regimen such as its dose and duration, together with the presence of drug allergies or antibiotic resistance. In addition to the type of antibiotic used, administration schedule and side effects.
The goal of the treatments is to resolve the infection by the bacteria, that is, eliminate it in 100% of treated cases. But this is a goal that is not always achieved in daily practice, due to the development of resistance to antibiotics by the bacteria.
The ideal would be to know the susceptibility of the germ that each patient presents, performing a culture and an antibiogram to direct the specific treatment. But this is not feasible in daily practice, since invasive studies would be required to obtain the sample and the difficulty of cultivating this germ in the laboratory. That is why some general guidelines are applied that a priori must achieve the desired objective of eliminating the germ, that is, empirical treatments.