Here's the text for today:
Backstage many readers to give me a message, want me to analyze the Helicobacter pylori, said that the recent old fire, fire to a lot of information is difficult to distinguish between true and false, especially some people say that the number of People infected with Helicobacter pylori in China exceeds 800 million, do not treat Helicobacter pylori may also be stomach cancer, Helicobacter pylori is listed as a class of carcinogens.....
It's not lightly scary.
There are also readers who say that their whole family has checked Helicobacter pylori, shivering, if I do not write a rigorous, down-to-earth, popular, can solve the popular science article about Helicobacter pylori, he will fly over to kiss me, because the doctor said that kissing can spread Helicobacter pylori, I have to pull me into the water.....
I was also scared not lightly, write it, stay up late to write it.
1. What exactly is Helicobacter pylori?
About the history of the discovery of Helicobacter pylori we will not be ripped off, everyone can baidu at any time, and it is certain that some scientists have swallowed this bacterium in order to confirm the relationship between this bacterium and gastritis, and even swallowed this bacterium (showing admiration for the five bodies), and later gastritis occurred, and only then did they affirm the connection between them.
Anyway, this bacterium in the stomach is said to be the only microorganism that can survive in the stomach, because the stomach acid is particularly strong and can kill bacteria, and this bacterium can form a vajra cover on its own (the bacteria are alkaline around it) and survive. This bacterium is spiral-shaped and often causes inflammatory lesions near the gastric pylorus, so it is named "Helicobacter pylori".
2. Helicobacter pylori infection in China
The "Helicobacter pylori china according to the expert consensus opinion on the prevention and control of gastric cancer" formulated in Shanghai in 2019 said a lot of problems, included a lot of high-quality clinical studies, indicating that China is a country with a high infection rate of Helicobacter pylori, with an infection rate of 34.52%-80.55%, and the infection rate of the population in most areas is more than 50%, and the average infection rate is 58.07%. There have been many subsequent studies, and the domestic infection rate has been reported one after another, and the figures have varied, but they are generally around 50%.
In other words, it is true, not an exaggeration, that about half of Chinese infected with Helicobacter pylori. Just like half of the readers who read my article now, there may be half of them infected with Helicobacter pylori, many people don't even know if they are infected, whether I am infected, I don't know myself, because I haven't done the relevant tests.
Why are so many people infected? Because it can spread violently from person to person, especially between family members. The route of transmission is mainly oral transmission, if the infected person is rarely cured without treatment, then he will always be a communicator, family meals, shared dishes, shared food, chewing food feeding, kissing, etc. may cause infection.
Of course, not all family members will be infected, and whether they are infected or not is also related to the closeness of contact and genetic background. In order to prevent cross-infection, the state has vigorously advocated the use of public chopsticks and spoons, preferably a meal sharing system. But it is still difficult to do this from the family dinner table that our ordinary Chinese, and my family cannot do it. As a consequence, one person in the family is infected with Helicobacter pylori, and the rest are at risk.
3. Is it a disease if I am infected with Helicobacter pylori?
Don't worry, don't worry about it, just look at it first.
At present, it is certain that once the stomach is found to have Helicobacter pylori, it is an infectious disease. Because this bacterium doesn't do nothing in the stomach, it always has to do something, do something bad (for us). Many studies have shown that chronic active gastritis is present in all infected people, yes, all infected people, without exception.
But this chronic active gastritis is generally histological, that is, you do gastroscopy, you can see more or less changes in the gastric mucosa, but most infected people have no symptoms, no complications, just found during physical examination. Only 15%-20% of infected people develop peptic ulcer (e.g., gastric ulcer, duodenal ulcer), 5%-10% of infected people develop dyspepsia, and 1% of infected people develop gastric malignancy (gastric cancer, MALT lymphoma).
Oh again, once infected with Helicobacter pylori, it is considered an infectious disease. It's just that most of this infectious disease has no symptoms, so many people don't pay attention to it. Since it is a disease, should it be treated? Sell it first, and then look down.
4. If I am infected with Helicobacter pylori, will I definitely get cancer?
It can be clearly said that Helicobacter pylori infection is the main cause of stomach cancer in China. As early as 1994, the WHO defined Helicobacter pylori as a Class I carcinogen.
The vast majority of gastric cancers occur in the following patterns: normal gastric mucosal superficial gastritis atrophic gastritis enterochemical dysplasia gastric cancer, which is recognized. Helicobacter pylori infection can cause chronic active gastritis, so Helicobacter pylori infection is an important factor in the occurrence of gastric cancer.
But not all people infected with Helicobacter pylori develop stomach cancer, studies have shown that about 1% (and some studies believe that < 1%) of infected people will develop stomach cancer, and 1 in 100 infected people will eventually develop stomach cancer. Is this a big probability? Not very big but not very small, we compare the data on lung cancer from smoking: 25 cigarettes per day, the incidence of lung cancer after many years is about 12%.
In this comparison, is the probability of stomach cancer from Helicobacter pylori infection low? Also, the probability of this thing is not evenly shared, not to say that a hundred people must have 1 person with stomach cancer, if these 100 people are in other high-risk situations (such as stomach ulcers, family history of stomach cancer, drinking, older age, high mental stress), then 50 people have stomach cancer is possible. And if there are no such risk factors among the 1,000 people infected with Helicobacter pylori, there may not be a single stomach cancer in the end.
Yes, that's it, probability is just probability, specific to the individual can not talk about probability.
5. If you are infected with Helicobacter pylori, should you treat it?
It is safe to say that if no treatment is taken, the infected person will be infected for a long time, always be a transmitter, and will not say that he is fine. Over time, related problems may occur, such as stomach ulcers, and even stomach cancer.
Radical treatment of Helicobacter pylori can promote the healing of peptic ulcers, reduce the incidence of gastric cancer, and can also alleviate 80% of early gastric MALT lymphomas.
If so, should it be treated? Do you want to cure Helicobacter pylori?
In theory, yes. All infected people need treatment.
The reason is very simple, this bacterium in the stomach will cause damage to some extent, which is not the same as the colonization of the skin, the colonization of the surface of the skin does not need to be treated or can not be treated. And Helicobacter pylori is not a human symbiotic bacterium, nor is it a probiotic (for children, there may be potential benefits, it is not easy to say), on the whole is a harmful bacteria for the human body, since it is a harmful bacteria, it is always right to treat it.
However, as pointed out in the 2017 "Fifth National Consensus Report on the Treatment of Helicobacter pylori Infection": At present, the infection rate of Helicobacter pylori in China is about 50%, and it is unrealistic for such a large group of patients to actively screen all infected people and carry out treatment. What do you mean? It is unlikely that all infected people will be treated, but treatment is helpful, some people help more, some people help less, which people help more? This involves the eradication of treatment indications, and those who meet the treatment indications can benefit more, including:
People who meet the above conditions are recommended to eradicate Helicobacter pylori.
But you should see clearly that the above is the expert consensus in 2017.
When the time comes to 2019, what do experts say?
The "Helicobacter pylori pylori of China based on expert consensus opinions on the prevention and control of gastric cancer" formulated in Shanghai in 2019 emphasizes that the early eradication of Helicobacter pylori can effectively prevent gastric ulcers and stomach cancer. Moreover, Helicobacter pylori gastritis is an infectious disease, and eradication of Helicobacter pylori can effectively reduce the source of infection.
It is also emphasized that Helicobacter pylori is currently the most important controllable risk factor for the prevention of gastric cancer, and eradication of Helicobacter pylori should become a first-level preventive measure for gastric cancer. Studies from our shandong and fujian provinces have shown that the incidence of gastric cancer after eradication of Helicobacter pylori has decreased to 0.53, and eradication therapy is particularly beneficial for asymptomatic patients and patients after endoscopic early carcinectomy, with a 34% reduction in the risk of gastric cancer after eradication.
Time to last year, in 2021, the expert group issued the latest consensus "Expert Consensus on the Prevention and Control and Management of Helicobacter pylori Infection in Chinese Residents' Families (2021)", this consensus is more fierce, directly targeting the families of residents, because the eradication of Helicobacter pylori involves too many people, and education must be in place and the promotion efforts are unprecedented.
The 2021 consensus directly states that eradication therapy should be considered for all adult Helicobacter pylori infection in the family.
See no, no assumptions, no premises, anyway, if you are infected with Helicobacter pylori, and adult (children below), you should be treated, nothing to be polite. Of course, unless there are countervailing factors can not be eradicated, what is called countervailing factors, I understand that there is no way to treat, such as due to the existence of other diseases can not use these drugs, or these drugs are allergic, etc., the average person rarely has this factor.
Early eradication of Helicobacter pylori, especially before gastric mucosa atrophy and intestinal metaplasia occurs, can reduce the risk of stomach cancer. This is repeatedly emphasized by the Guidelines and consensus.
Therefore, if you are infected with Helicobacter pylori, you have to be treated.
6. How is it treated? Will there be any side effects of treatment? Is the cost-benefit ratio high?
The treatment is actually very simple, mainly 10-14 days of treatment, the eradication rate > 90%. Currently, a bismuth quadruple (PPI + bismuth + 2 antibiotics) is recommended. Different regions may have different options depending on antibiotic resistance.
In general, the treatment is very simple, it is a conventional drug, and the course of treatment is not long, 10 days or 2 weeks, half a month can be, no long-term medication is required. These drugs are also generally safe and do not cause any major adverse reactions. It is not a problem that causes antibiotic misuse, spread of drug-resistant bacteria, etc.
Is the cost-effectiveness of the treatment high? Such a big move to let everyone come together to treat. Studies have shown that in areas with high risk of gastric cancer (that is, areas with high incidence of gastric cancer), eradication of Helicobacter pylori is a cost-benefit advantage, and the extensive eradication of Helicobacter pylori should be gradually promoted (almost universal eradication) to prevent gastric cancer.
But I've been thinking about a question, is it a bit excessive not to choose to cure all infected people? (Not questioning, just doubting, after all, the level is not enough, the cognition is not deep) is it overly nervous? Maybe even if I have an infection, but there are no symptoms, I will ignore him, wait for gastritis or stomach ulcers, and then treat, can I? From gastritis, stomach ulcer to stomach cancer there is still a long distance, you can also breathe, do you want to treat all infected people so urgently? This is really my doubt, I hope that people of insight can help answer.
If all infected people are to be treated, then everyone must be tested first. How do you know if there is no test, so that there will be a boom in the detection of Helicobacter pylori? Do people in this industry have huge business opportunities? (Taobao Tmall already has a lot of people selling their own test kits for Helicobacter pylori at home)
7. Should children be routinely screened for Helicobacter pylori infection?
No.
The 2017 consensus says: Routine screening for Helicobacter pylori in children under 14 years of age is not recommended, why? Because children infected with Helicobacter pylori rarely have serious problems, their risk of developing peptic ulcers, atrophic gastritis, and stomach cancer is very low and treatment is not necessary. Since there is no need for treatment, there is no need for screening.
But if you have screened your child and found to be infected with Helicobacter pylori, should he be treated? This has to be said separately. If your child doesn't have any symptoms, they don't need treatment because there are few types of antibiotics available to your child, most antibiotics are unsafe for them, and they have a low tolerance to adverse drug reactions, are prone to problems, and are afraid of self-defeating. So, again, don't screen your child for Helicobacter pylori.
However, if the child already has a stomach ulcer or duodenal ulcer (found with gastroscopy) and is found to be infected with Helicobacter pylori, eradication treatment is required in this case. It's all a decision to weigh the pros and cons. Without eradication, stomach ulcers may not be easy to get, and although antibiotics are available in fewer types and may have side effects, they can still be cured.
The 2021 consensus is vague, saying that the treatment of Children with Helicobacter pylori infection in the family needs to be based on risk-benefit assessment and related disease status, and the decision on whether to treat or not is based on the consensus opinion and consultation with the parents of the child.
8. How to avoid being infected with Helicobacter pylori?
Oral transmission of this is still difficult, eating outside can generally be done to use public chopsticks, at home to eat with public chopsticks I can not do. Anyway, everyone looks at it, the reason is such a truth, and it is another thing to do it or not. Personally, Helicobacter pylori is not so scary, don't be afraid when you see that it will cause cancer.
Cigarettes, alcohol is also a class of carcinogens, everyone is basically familiar with immunity, accustomed to it, feel not so terrible (in fact, it is still very scary, but it is impossible to ban alcohol and alcohol is impossible to drop), in comparison, Helicobacter pylori infection is more extensive, but the harm is well, there is no tobacco and alcohol high, long-term smoking and drinking, lung cancer liver cancer rate is certainly more than 1%.
I am not saying that the harm is not terrible than tobacco and alcohol, not this meaning, but that it is necessary to be vigilant, but do not fidget, do not be tricked by people with ulterior motives, so as not to buy all kinds of unreliable reagents for testing Helicobacter pylori on the Internet. To really test yourself for infection, go to the hospital to do a blow or leave a stool, or even do a gastroscope is the most reliable.