Tens of thousands of years ago, there was already the presence of Helicobacter pylori in the human body, which silently settled in the human stomach, breathed with humans, and grew together!
But people don't know about its existence, because it has always been believed that under stomach acid conditions, it is impossible for bacteria to survive.
Image source: Stand Cool Helo
It was discovered by two Australian scientists, Barry Marshall and Robin Warren, in the 1980s and suspected it was related to the onset of stomach ulcers.
Their scientific discoveries subverted cognition, and they won the Nobel Prize in Physiology or Medicine.
Just recently (December 2021), the U.S. Institute of Toxicology under the U.S. Department of Health and Human Services released the 15th edition of the Carcinogen Report. Chronic H. pylori infection is classified as a definitive human carcinogen[1].
Regarding Helicobacter pylori, ordinary people still have a lot of questions. Today, we will answer everyone's questions one by one.
Q1What is Helicobacter pylori?
Helicobacter pylori is a bacterium that can survive stomach acid conditions.
After it enters the human body, it will reside on the surface of the gastric epithelial cells, and it is difficult for the human body to remove spontaneously.
Q2What are the hazards of Helicobacter pylori to the human body?
Helicobacter pylori produces a variety of enzymes and cytotoxins that have a destructive effect on the mucous membrane, and also stimulates epithelial cells to release inflammatory mediators to damage the mucous membrane, which is a predisposing factor for a variety of stomach diseases.
China is a country with a high incidence of Helicobacter pylori infection, and 25 to 30% of infected people will have gastrointestinal diseases of different degrees, such as dyspepsia, gastritis, peptic ulcer, stomach cancer, etc.
Helicobacter pylori infection is also closely associated with extragastric diseases such as iron deficiency anemia, idiopathic thrombocytopenic purpura, autoimmune disease, and cardiovascular and cerebrovascular diseases [2].
Although not all patients with Helicobacter pylori develop stomach cancer, Helicobacter pylori is also classified as a class of carcinogens by the World Health Organization's Cancer Research Institute due to repeated inflammatory stimuli, especially in patients with analal infections that increase the risk of gastric cancer [3].
Q3How do I know if I have Helicobacter pylori infection?
Many people think that there is bad breath or other symptoms of stomach discomfort, which means that there is Helicobacter pylori infection, which is unreliable and must be tested to know whether it is infected with Helicobacter pylori.
How to detect:
First go to the regular hospital for examination, the first choice is C14 or C13 breath test, non-invasive, the results are fast.
Other test methods include:
Non-invasive tests such as serum antibody testing and stool antigen testing, as well as endoscopic tests such as gastric mucosal biopsy [3].
Q4 Infected with Helicobacter pylori, do I have to treat it?
Helicobacter pylori is indeed closely related to many diseases, but most of the time it is an asymptomatic infection, and doctors will give advice according to the specific situation.
It is generally believed that Helicobacter pylori infection has been confirmed, and doctors will recommend radical treatment of Helicobacter pylori if:
Patients with peptic ulcer (including gastric ulcer and duodenal ulcer);
Patients with chronic gastritis with atrophy or erosion of the mucous membranes;
In people with a family history of stomach cancer, Helicobacter pylori may increase the risk of stomach cancer;
Patients with MALT lymphoma (gastric MALT lymphoma)[4].
Q5Is Helicobacter pylori susceptible to re-infection?
The risk of re-infection after Helicobacter pylori eradication therapy is significantly reduced, with studies suggesting a rate of about 1.5 percent re-infection after 12 months of eradication treatment [5].
Q6 Will it be infected if I eat with people who carry Helicobacter pylori?
A number of studies at home and abroad have suggested that Helicobacter pylori is mainly transmitted through the mouth-mouth and fecal-oral routes, and family members infected with Helicobacter pylori are always potential sources of infection.
Without good hygiene and eating habits, eating together may also increase the risk of transmission of Helicobacter pylori [6].
Q7 Does a child with Helicobacter pylori infection need treatment?
If a child is diagnosed with peptic ulcer, lymphoid tissue lymphoma associated with the gastric mucosa (gastric MALT lymphoma), it must be radically cured.
Radical cure may be considered in the following cases:
(1) Have chronic gastritis;
(2) Have a family history of stomach cancer;
(3) There is unexplained refractory iron deficiency anemia;
(4) Planned long-term use of NSAIDs (including low-dose aspirin)[6];
(5) Guardians and elderly children strongly request treatment [7].
Q8 How to cure it? How long does it take to review?
There are many ways to cure Helicobacter pylori, and the most common in mainland China is triple therapy and quadruple therapy:
Triple therapy
Triple therapy is two antibiotics combined with a proton pump inhibitor, but due to the increased resistance of Helicobacter pylori to clarithromycin, metronidazole and levofloxacin in many regions, most parts of the mainland are currently not suitable for traditional triple therapy and consider quadruple therapy.
Quadruple therapy
A bismuth agent is added to the triple therapy, which is recommended for 14 days. Doctors will choose the appropriate antimicrobial drugs based on local resistance and patient conditions.
Review time:
Immediate re-examination after treatment is not recommended, as it may be affected by the drug and result in inaccurate results.
It is recommended to repeat the test after 4 to 8 weeks of eradication therapy [4]. Doctors usually recommend a C13 or C14 breath test for re-examination.
If you want to prevent Helicobacter pylori, you should pay more attention to dietary hygiene, wash your hands frequently, enhance the awareness of using public chopsticks and spoons, and prevent duplicate and cross-infection.
Even if you are really infected, don't worry too much, make decisions under the guidance of a doctor, and if necessary, perform eradication treatment in a timely manner according to the doctor's recommendations [2].
Contributing Author: Fang Jian
Deputy Pharmacist of the Department of Pharmacy, Huadu District People's Hospital of Guangzhou
Review expert: Cheng Rui
Attending physician of the Department of Gastroenterology, Beijing Friendship Hospital
bibliography
[1]15th Report on Carcinogens.National Toxicology Program.December 21, 2021. https://ntp.niehs.nih.gov/go/roc15
[2] Chinese Medical Association, Journal of Chinese Medical Association, General Medicine Branch of Chinese Medical Association, Helicobacter pylori Group of Gastroenterology Branch of Chinese Medical Association, Editorial Committee of Chinese Journal of General Practitioners of Chinese Medical Association, Expert Group for The Preparation of Primary Diagnosis and Treatment Guidelines for Digestive Diseases. Guidelines for primary diagnosis and treatment of Helicobacter pylori infection (2019)[J]. Chinese Journal of General Practitioners,2020,05:397-402.
[3] National Clinical Research Center for Digestive Diseases (Shanghai), National Alliance of Early Cancer Prevention and Control Centers of the Digestive Tract, Helicobacter pylori and Peptic Ulcerology Group of Digestive Disease Branch of Chinese Medical Association, National Helicobacter pylori Research Collaboration Group. Expert consensus on the prevention, control and management of Helicobacter pylori infection in Chinese households (2021)[J]. Chinese Journal of Digestion,2021,04:221-233.
National Clinical Research Center for Digestive Diseases (Shanghai), Health Management Branch of Chinese Medical Association, Nuclear Medicine Branch of Chinese Medical Association. Expert consensus on clinical application of Helicobacter pylori-urea breath test (2020)[J]. Chinese Journal of Digestion,2020,12:797-802.
[5] Xie Y, Song C, Cheng H, et al. Long-term follow-up of Helicobacter pylori reinfection and its risk factors after initial eradication: a large-scale multicentre, prospective open cohort, observational study[J]. Emerging microbes & infections, 2020, 9(1): 548-557.
[6] LI Chao,ZHANG Zhenyu. 2017 Helicobacter pylori Taiwan Consensus: Consensus on Clinical Management, Screening Treatment and Monitoring of Helicobacter pylori Infection to Improve Gastric Cancer Control in Taiwan[J]. Journal of Gastroenterology and Hepatology,2018,01:1-12.
HUANG Ying. Expert consensus on the diagnosis and treatment of Helicobacter pylori infection in children[J].Chinese Journal of Pediatrics,2015,53(07):496-498.
Editors: Wei Luo, Zhang Xiaoyi, Zhang Liang
Typesetting: Han Ningning | Proofreader: Wu Yihe
Operations: Li Yongmin | Coordinator: Wu Wei
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