Recently, the United States listed Helicobacter pylori as a clear carcinogen, and the Mainland Food and Drug Administration also approved the first Helicobacter pylori consumer self-test product certificate, which shows that Helicobacter pylori has attracted everyone's attention.
Sometimes it is lamented that if it were not for the US HHS (US Department of Health and Human Services) this time to list Helicobacter pylori in a class of carcinogens, it is estimated that many people may still ignore Helicobacter pylori, and the Mainland Food and Drug Administration has been continuously promoting this aspect. Today, let's talk about Helicobacter pylori.
01, Helicobacter pylori is listed as a class of carcinogens by the WHO
Many people may not know that in fact, Helicobacter pylori was listed as a class of carcinogens by the International Agency for Research on Cancer under the WHO in 2017, that is, it clearly has a carcinogenic effect on people. This means that Helicobacter pylori is a well-known carcinogen like alcohol, tobacco, aflatoxin, etc., and is another biological factor that is considered to be clearly carcinogenic after human papillomavirus (HPV).
This is also a very new substance that is considered to be clearly carcinogenic, after all, Helicobacter pylori was first isolated from gastric mucosal biopsy tissue in patients with chronic active gastritis in 1983, and the researcher who made this discovery at the time, Barry J. Marshall, also won the 2005 Nobel Prize in Physiology or Medicine, which is also a relatively rare situation in these years. After all, the familiar Nobel Prize is often awarded to many scientific experts who study biological mechanisms, and Marshall is only a doctor, and mainly the discovery of Helicobacter pylori, which is still rare.
However, since Helicobacter pylori was discovered and confirmed to be related to gastritis, there have been studies on the relationship between Helicobacter pylori and cancer.
In fact, as early as 1995, researchers found that people infected with Helicobacter pylori had a significantly higher proportion of stomach cancer than the general population, suggesting that Helicobacter pylori and gastric cancer showed a clear correlation [1]. A series of subsequent studies have also confirmed that Helicobacter pylori does have carcinogenic effects [2].
Its carcinogenic mechanism of action has also been elucidated, after infection with Helicobacter pylori on the one hand will increase the production of free radicals near Helicobacter pylori and increase the frequency of gene mutations in host cells, on the other hand, Helicobacter pylori will change the balance of cellular proteins such as adhesion proteins, causing local inflammation and high levels of tumor necrosis factorS NFα and interleukin 6 and other corresponding signaling pathways, eventually leading to stomach cancer.
Therefore, Helicobacter pylori is recognized by the WHO as a class of carcinogens.
02, Helicobacter pylori was listed as a definitive carcinogen in the United States
But the HHS in the United States is more special, this institution has been doing its own set, they do not agree with the WHO's view, so HHS has been in accordance with its own standards to establish a set of carcinogens list, of course, this list does not like the WHO to classify carcinogens, but to give whether it is clearly carcinogenic.
As for why Helicobacter pylori itself is only now listed as a definitive carcinogen in the United States, it may be largely because the proportion of Helicobacter pylori infection in the American population is not so high.
The figure below is from a research paper on global Helicobacter pylori infection, showing the incidence of Helicobacter pylori infection in different countries [3].
We can see that the level of Helicobacter pylori infection in the United States is low, less than 40%, so the proportion of related cancers caused by the United States is low, so the inclusion of relevant standards in the United States will naturally lag behind.
But for other countries can not be so, such as our China, the proportion of Helicobacter pylori infection is between 50-69%, which is a very high proportion, which is troublesome, as a clear carcinogenic factor of stomach cancer, we can not be vigilant.
In fact, stomach cancer is a very high incidence of cancer in the mainland. According to the largest statistics published in the top journal CA CANCER J CLIN on the incidence of cancer in mainland China, gastric cancer is the second largest cancer in mainland China [4].
It can be said that we are more worthy of attention to Helicobacter pylori, after all, this is also a relatively clear cause of cancer. Because of this, hospitals are now also basically providing tests for Helicobacter pylori.
03, How to detect Helicobacter pylori?
At present, there are two common helicobacter pylori detection methods, and we briefly introduce its principle here.
The first is called C13 urea exhalation
This principle is based on the metabolic method of Helicobacter pylori, first collecting our normal expiratory situation, and then taking the isotope-labeled C13, these components will react in the stomach, if there is Helicobacter pylori, they will metabolize these components, and then form gas. Finally, the exhalation is collected, and through the before and after comparison, see if there is C13 metabolized by Helicobacter pylori, so that it can show whether there is helicobacter pylori infection and the amount of Helicobacter pylori.
Essentially, this is a relatively indirect approach, which is to reflect the infection by detecting metabolites of Helicobacter pylori.
The second is the stool test
This approach is relatively straightforward. Any kind of organism will have life and death, Helicobacter pylori is no exception, they will continue to die, and these dead components will eventually come to our excrement with the digestive tract, so we can detect the excrement, if the excrement is found to have the corresponding marker of Helicobacter pylori, then we can determine whether to infect Helicobacter pylori.
In fact, the two have their own advantages, the former is a common strategy in hospitals, but there are also some problems, such as the need for fasting testing, and to exclude antibiotics and Hp-sensitive drugs such as proton pump inhibitors. But this is not the key, the most troublesome thing is that the former due to the need for isotope testing, the need for special equipment, so must go to the hospital for special testing, which limits the detection of Helicobacter pylori.
In fact, according to the proportion of infection in the mainland, the proportion of 700 million to 800 million Helicobacter pylori infections in the mainland, and the proportion of Helicobacter pylori tested in hospitals is very low, which also leads to many people not knowing that they are infected with Helicobacter pylori.
This is also one of the reasons why the Mainland Food and Drug Administration approved the first Helicobacter pylori consumer self-test certificate, that is, to make Helicobacter pylori, a microbial test that causes stomach cancer, more close to the consumer market, so that more people can more easily detect Helicobacter pylori.
For example, the approved Helicobacter pylori consumer-grade self-test products can be tested directly at home, so that they can more easily grasp the situation of their Own Helicobacter pylori.
04, How to treat Helicobacter pylori?
So how to treat Helicobacter pylori? In fact, there are already mature Helicobacter pylori treatment strategies, the most common being quadruple therapy.
That is, one bismuth agent + one proton pump inhibitor + two antibiotics. Bismuth agents are mucosal protectors, proton pumps can inhibit gastric acid secretion, and antibiotics can kill Helicobacter pylori, in addition, the three will also interact with each other to enhance the effect.
Bismuth agents are bismuth potassium citrate granules or tablets, colloidal pectin bismuth capsules, colloidal bismuth bitartrate capsules and the like
Proton pump inhibitors such as omeprazole capsules, lansoprazole enteric-coated tablets, rabeprazole enteric-coated tablets, pantoprazole capsules and the like
Antibiotics mainly include amoxicillin, clarithromycin, furazolidone, metronidazole, levofloxacin, moxifloxacin and so on.
So if you have a high level of Helicobacter pylori, then it is best to go to the hospital to prescribe medication for treatment.
05, how to avoid infection with Helicobacter pylori?
For people who are not yet infected with Helicobacter pylori, they should also be vigilant.
In fact, Helicobacter pylori is mainly transmitted through human-to-human contact, such as parents infected with Helicobacter pylori, and the probability of infection in children is much higher. Probably a big reason for our way of eating, the main way we eat at the moment is to share tableware, and this will lead to Helicobacter pylori with saliva and other ways to conduct on different people.
Therefore, in daily life, we should advocate the use of "male chopsticks", which can reduce the spread of Helicobacter pylori due to dietary contact. If there is a Helicobacter pylori infection in the family, they should also advocate the way of meal sharing.
In addition, a common way of Helicobacter pylori is "fecal mouth" infection, which mainly refers to the fact that Helicobacter pylori in the feces in the bathroom may also spread, so it is necessary to develop the habit of washing hands frequently in the bathroom.
In daily life, we should also pay attention to avoiding raw and cold food as much as possible and disinfect accordingly, which can reduce the infection of Helicobacter pylori.
1、Forman, D. "The prevalence of Helicobacter pylori infection in gastric cancer." Alimentary Pharmacology & Therapeutics 9 (1995): 71-76.
2、Mentis, Alexios-Fotios A., et al. "Helicobacter pylori infection and gastric cancer biology: 2tempering a double-edged sword." Cellular and Molecular Life Sciences 76.13 (2019): 2477-2486.
3、Hooi, James KY, et al. "Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis." Gastroenterology 153.2 (2017): 420-429.
4、Chen, Wanqing, et al. "Cancer statistics in China, 2015." CA: a cancer journal for clinicians 66.2 (2016): 115-132.