Helicobacter Pylori Infection
Previously called: Campylobacter Pylori
The discovery in 1983 of the helicobacter pylori organism by Drs Warren and Marshall is one of the major advances in gastroenterology in recent decades. This discovery has revolutionised the approach to many upper gastrointestinal disorders, especially peptic ulcer disease. Helicobacter pylori causes a spectrum of disease in humans, including gastritis, ulcer disease (gastric and duodenal), and probably gastric cancer and gastric lymphoma.
The links between helicobacter pylori infection and gastric carcinoma and lymphoma are less established, but it is highly likely that helicobacter pylori is at least one cause of these stomach cancers. Thus, helicobacter pylori infection is a condition of enormous importance throughout the world.
Indigestion (dyspepsia) is a very common symptom, and a high proportion of people with dyspepsia will have helicobacter pylori infection causing gastritis. Furthermore, up to 10% of the population will develop peptic ulcer disease at some time in their lives and most duodenal ulcers and many gastric ulcers are due to helicobacter pylori infection.
Infection with helicobacter pylori can be diagnosed by biopsy with pathological examination and the urea breath test; both are accurate. A blood test can indicate previous exposure, but not necessarily active infection.
Treatment is based on a proton pump inhibitor (to reduce acid secretion in the stomach) taken simultaneously with two antibiotics for 7-10 days. Compliance, side effects and bacterial resistance to metronidazole (one of the antibiotics that can be taken) influence the success of therapy.
Second-line therapy is offered to those patients who remain infected after initial treatment, once the reasons for failure of first-line therapy (e.g. compliance) have been established. For those who are still infected after two treatments, the choice lies between a third attempt with quadruple therapy (where bismuth is added to the triple therapy) or simple maintenance therapy with acid suppression.
It can be very difficult to eradicate helicobacter pylori in a small percentage of patients, due to antibiotic resistance.