Video link: Chen Ye: 6300 words to explain the 7 major problems of Helicobacter pylori!
This video was recorded on December 2, 2017, and has not been compiled before, but we have recently made special arrangements for readers.
Ye Chen, M.D., Chief Physician, Professor, Doctoral Supervisor, Professor of Gastroenterology, Southern Hospital, Southern Medical University, Member of Gastroenterology Branch of Chinese Medical Association.
He received his Ph.D. from the First Military Medical University in 2000 and was a postdoctoral fellow at Baylor Medical University in the United States from 2002 to 2006, focusing on the pathogenesis of gastrointestinal infections and inflammation.
He has published more than 100 signed articles, including more than 20 SCI articles and 4 monographs. He is responsible for more than 10 projects at or above the provincial and ministerial levels such as the National Natural Science Foundation of China, the national "863" program sub-topic, the health and family planning commission industry research special project, etc., and has won 1 second prize of the National Science and Technology Progress Award, 3 second prizes of the provincial and ministerial scientific and technological progress award, and 4 authorized invention patents. He was selected as the "New Century Excellent Talents" Support Program of the Ministry of Education, the provincial training object of the "Thousand Hundred and Ten Project" of Guangdong Province, and the "Pearl River Scholar" Distinguished Professor of Guangdong Province.
Good evening, first of all, I would like to start with a story from 30 years ago, in 1984, a young doctor who was far away in Australia, he decided to take a risk. Because he found that many of the patients he treated were plagued by chronic gastritis and stomach ulcers, which were manifested as periodic, rhythmic epigastric pain, bloating, and even nausea, vomiting, abdominal discomfort and other symptoms.
More than two years ago, he and one of his scientific partners, a pathologist, discovered that a spiral-shaped Campylobacter often appeared in the stomachs of these people, and he wondered if this bacterium could be related to chronic gastritis and ulcers. But it has not been confirmed.
Two years have passed, and this problem has been bothering him, so he decided to try the method by himself, and he cultured the bacteria isolated from the patient's body and drank the liquid himself.
What happened next? As you can imagine, he immediately had the same abdominal pain, bloating and even vomiting as his patients, and he still insisted on letting the bacteria stay in his body for ten days.
Although the symptoms slowly improved, but there was still discomfort, at this time he bravely let his colleagues give him a gastroscope, and then found that his stomach had obvious edema, congestion, and gastritis.
He also asked his colleagues to take a biopsy of his gastric mucosa and culture it outside the body, and it was cultured to find itself in the stomach, and it also colonized the same curved, spiraling bacteria as his patients. Of course, after a month, he took the antibiotic tinidazole orally, and then completely killed the bacteria, and his symptoms also improved.
After this brave initiative, he published the report in a well-known medical journal, The Lancet, which caused a sensation in the digestive and microbial communities as soon as it was published. Everybody jumped in, trying to figure out if this was happening on a global scale.
By chance, ten years later, when I graduated as a young medical student from undergraduate, I began my graduate career and began to study Helicobacter pylori. Starting from animal models, I also did some population censuses, and of course I did a lot of laboratory work, I wanted to analyze how this bacteria caused disease from a molecular and cellular point of view.
In the process, there were also some unexpected discoveries, in addition to the discovery of Helicobacter pylori, we also found another type of Helicobacter pylori family called Helicobacter helimannia. Although it is a brother of Helicobacter pylori, its infection rate is less than 0.1%, that is, less than one in a thousand, and it can also cause a chronic inflammation of the stomach, and even in some patients with stomach cancer has been found.
My supervisor Professor Zhou Dianyuan led us to do a lot of work in this regard, and even won the second prize of the National Science and Technology Progress Award. Then another decade passed, I graduated from graduate school, I got my phD, and I started studying abroad.
In 2005, I was a postdoc in my third year at Baylor Medical School, and I happened to meet the person who discovered Helicobacter pylori at a seminar, and he was Barry Marshall, a young doctor who was no longer young.
I was very happy and excited to meet one of the originators of my field and talked to him for a short minute. I am especially grateful to him for his discovery, which allowed me to get my PhD smoothly.
Five months later, Barry Marshall and the pathologist I mentioned at the beginning, his research partner Robin Warren, won the 2005 Nobel Prize in Medical Physiology.
So why was the Nobel Prize awarded to these two at that time, that is, to reward them for discovering Helicobacter pylori and discovering the role of this bacterium in gastritis and ulcers.
Today, There is a consensus on many aspects of Helicobacter pylori, and even all of us here may know about such a bacterium.
In my clinical work, people often ask questions. Let's first look at these questions, such as the first one, what are the harms of infection with Helicobacter pylori? Here I would like to tell you that the infection of Helicobacter pylori must be 100% caused by our chronic active gastritis.
Of course, 70% of people here in chronic active gastritis do not show any symptoms, if you do not do gastroscopy may not be found all the time, only about 10% of people have symptoms of dyspepsia.
With symptoms and then go gastroscopy, it is found that it is an active gastritis, or peptic ulcer, and the peptic ulcer caused by Helicobacter pylori accounts for 15 to 20% of all these infected people, then the malignant tumors of the stomach, including gastric lymphoma, gastric cancer actually only account for less than one percent of the proportion of Helicobacter pylori.
Then we probably know such a proportion, and we can see that there are many people in the population who are widely infected with Helicobacter pylori, but the really serious consequences are not as serious as we think. So it still has harm, but its harm is hierarchical.
The second question is whether Helicobacter pylori is contagious? We are particularly concerned about this issue.
In clinical practice, I often meet a person in the family who is infected with Helicobacter pylori, and then I bring the whole family over, and then I ask the doctor: Dr. Chen, my child is only three years old, you see our husband and wife are both infected, what should the child do.
Let's say our grandmother and grandmother raised the next generation, and then they started to take their grandchildren, and they were panicked to find out that they were infected with Helicobacter pylori, and then secretly came over and said: I still have grandchildren, with grandchildren, what if I pass them on.
First of all, I would say that Helicobacter pylori is contagious, but it does not come as fast and so intensely as we know it.
It is mainly transmitted from the source of infection, transmission route and susceptible population of infectious diseases.
The source of infection is, of course, an adult who has already been infected, and the transmission route is more of a mouth-to-mouth transmission, such as a way for adults to feed children. Susceptible people mainly refer to children, not that we adults, couples kiss or eat together is so easy to contagious.
Because Helicobacter pylori is an anaerobic bacterium, it dies very quickly outside the body and is not so easy to survive. So I often tell these parents not to worry.
Sometimes between couples or couples sometimes one of them is very anxious, and even affects the feelings between each other, thinking that it is not the other party that infects themselves, in fact, I told him that it is not your spouse who infected you, it may be that you were infected when you were young, and you are not the same strain.
Then there's the question of I'm infected with Helicobacter pylori, can it be eradicated? Will it always be killed or killed, wildfires will burn endlessly, and spring winds blow and grow again, will it be like this?
I tell you, if you go to a gastroenterologist, if the doctor gives you a proton pump inhibitor according to the guidelines, plus bismuth and two selective antibiotics, then the first eradication rate can reach more than 90%, and its eradication rate is very high.
You only need to take the drug for 10 to 14 days, you can get a good eradication, of course, there are some stubborn, some refractory cases of this kind of existence, you have to find this kind of experienced doctor to deal with this problem for you.
So Helicobacter pylori can be completely eradicated, so will it recur after eradication?
I often see people around me saying that I don't want to eradicate it, there are no symptoms anyway, and after the eradication, after two days of eating, friends will be immediately passed on again. In fact, this is not the case, and the recurrence rate in adults, that is, after eradication, is extremely low.
Professor Zhou Liya of the Third Hospital of Peking University did a study and believed that the recurrence rate after the eradication of the infection was only a little more than 1.7%, that is, less than two out of a hundred people would relapse. So the recurrence rate after eradication is very low for adults, and there is no need to worry about this.
Then there is another question that I believe everyone will pay special attention to, that is, how likely it is to get stomach cancer after infection with Pylori.
First of all, I want to tell you that stomach cancer is terrible, stomach cancer is the third largest tumor in our country, and the incidence and mortality rate are the third of all tumors. But the occurrence of stomach cancer is a multi-factor, multi-stage, multi-step process, it does not happen all at once.
Then in addition to 10-15% of stomach cancers may be congenital hereditary factors, more than 85% of stomach cancers, that is, what we call intestinal gastric cancers, actually have a slow progression process. It progresses from an inflamed gastric mucosa to stomach cancer.
So what is this ratio?
That is to say, a normal gastric mucosa, it because of some factors, such as Helicobacter pylori is a major factor, making it a superficial gastritis, only 50% of superficial gastritis turns into atrophic gastritis, 40% of atrophic gastritis to intestinal metaplasia, intestinal metaplasia is less than 10% to dysplasia, and less than one percent of dysplasia will progress to gastric cancer.
So looking at this data, we don't have to be bothered by the problem of whether we are infected with Helicobacter pylori or not, we will definitely get stomach cancer. But it should be mentioned here that Helicobacter pylori infection is one of the most important and controllable risk factors for preventing stomach cancer.
Why? We know that in fact, all tumor occurrences, and even the occurrence of some diseases, are genetically susceptible. We can't do this, we have been born to decide, there are environmental factors, this is not controllable, you can't control it yourself. There are dietary factors, which may be partially controllable, but most of the time the ones that provide diet are not something you can control.
So Helicobacter pylori infection is the only factor that can be confirmed and controlled at present. So, that's why, as a first-level preventive measure, eradication of Helicobacter pylori can reduce stomach cancer, and reduce the incidence of stomach cancer in terms of the population.
So there is another question, many people may think, I am infected with Helicobacter pylori is not necessary to treat it? Because we are all worried, that is, many people think that the medicine is three points poison, and taking these drugs will not have other effects on my body, especially since I have no symptoms.
Now that our living standards have improved, there are more people examining the body, and the examination center presents us with a positive report of Helicobacter pylori, should I kill it? I would like to tell you that the benefits of H. pylori eradication vary from individual to individual.
Our medical decisions are also based on a balance of risk and benefit. For example, if you are an asymptomatic, gastroscope is a patient with superficial gastritis, your eradication of Helicobacter pylori is more likely to be a primary prevention of gastric cancer, that is, to prevent stomach cancer caused by the less than one percent probability I just said.
But if you're already a patient with atrophic gastritis, the likelihood of it progressing to stomach cancer increases a lot. Or you have a family history of stomach cancer, your own father already had stomach cancer in your grandfather's generation, you were born with this genetic susceptibility, or you come from a high incidence of stomach cancer, such as some areas, such as the Changle area of Fujian Province or some other areas with a high incidence of stomach cancer.
Even if you have an early tumor of the stomach and have done endoscopic resection, at this time you belong to a high incidence of gastric cancer, and the benefits of eradicating Helicobacter pylori at this time will certainly be considerable. Because on the one hand it eliminates this symptom in you, and secondly, it stops the progression of your early disease to stomach cancer to the greatest extent. Therefore, whether treatment is needed or not is different from person to person.
Let's take another example, let's say children, we just mentioned that children are a susceptible group, so do we have to do a test on our children, such as children under ten years old, to confirm whether he is infected? I tell you, this is not recommended at all, even if he has symptoms of indigestion, you should consider changing him from your feeding and daily living habits.
Children only need to have helicobacter pylori eradication if they have a clear peptic ulcer. Because children mature as they develop, some children can heal themselves and do not need treatment, and children's tolerance to drugs is also relatively poor, and the side effects may be greater.
There is also a category of elderly people, I just received an 82-year-old man from Macao in the outpatient clinic a while ago, she is a doctor herself, she graduated from a particularly well-known medical school in China, but she works in Macao.
She told me that she had done a dozen gastroscopes, and from the age of 70 she found herself positive for Helicobacter pylori and then eradicated, although Pylori was eradicated, but there was already a shrinkage, and she also knew that atrophy was a precancerous lesion, so she had to do a gastroscopy once a year.
I told her, the old man you are 82 years old, now there is atrophy but not severe atrophy, it progressed to stomach cancer is estimated to take more than ten years, when you are more than 90 years old, why do you have to make yourself so hard, every year to do gastroscopy. But the old lady told me that it wouldn't work, that I still wanted to live to be a hundred years old.
That is why I say that there is always such a contradiction between the people's yearning for a better life and the medical conditions we provide. For an old man who is eager to live to the age of 100, you say that we will not eradicate her, which also needs to be considered.
But in most cases, for the elderly over 80 years old, if there are many comorbidities and even diabetes, hypertension, chronic kidney disease, etc., these diseases may be the main factors restricting his life, then Helicobacter pylori infection I think can actually be put backwards, do not do this eradication treatment is actually harmless.
But for a person who does have extremely high expectations for the quality of life or for life expectancy, it is obviously not okay for you not to eradicate him. Therefore, whether Or not to treat Helicobacter pylori infection requires different decisions for different individuals.
There is also the question of why helicobacter pylori infection has such a different outcome.
I have a row of photos that we see with gastroscopes, some of which are a chronic gastritis, superficial gastritis, some of which have shrunken, some of which have ulcers, and some of which are already a lymphoma.
We see ulcers, mucous membrane folds are very bad, a look is not a good stomach, some have progressed to stomach cancer, why is it so different in outcome? This question was something I thought about when I started working on Helicobacter pylori.
We can't ignore the role of the host, so let's move on to one of my post-Helicobacter pylori research days, when I met Barry Marshall in 2005. The first sentence said thank you to him, the second sentence I told him, I said I am not just doing Helicobacter pylori now, I want to do the interaction between other pathogenic bacteria and the host, he said very good.
So I began to pay attention to how this pathogen works with our body at that time, why there are so many changes, and then I found that there are actually times of hostility between the various bacteria and the host in our body, there are times of symbiosis, there are times of competition, and there are times of synergy.
So in the long course of history, they also had a co-evolutionary process, so at that time I also wrote a Mini Review that mentioned the word Subversion, which is a subversive meaning.
For example, the epithelial cells of the intestine or lungs have many receptors, which are originally used to protect our bodies and feel various signals, but at this time it will be subverted by certain microorganisms and become complicit with it, resulting in a more intense infection.
So you see the interaction between this microbe and the host is a rather complex process. Sometimes it's hard for us to describe microbes in terms of white and black, or it's hard to use when I have to attack it, when I should keep it, but there needs to be a time. This also gave me a new understanding of the pathogenesis of microorganisms.
At the same time, I am also grateful to this Helicobacter pylori, which has brought me a broader and balanced microecological world.
After returning home, in addition to paying attention to the interaction between bacteria and hosts, I also began to pay attention to the role of bacteria and bacteria. For example, intestinal bacteria, there are abundant microorganisms in the intestines, how do they interact with each other, and how do they interact with the host?
Now I'm also doing a work on this, and one of the typical manifestations of this is a characteristic manifestation that I'm currently studying, Clostridium difficile infection, which I've been following for many years.
We will do colonoscopy in the clinic and find that some patients develop a pseudomembranous enteritis after using a large number of broad-spectrum antibiotics. The entire intestine will be covered by a layer of pseudo-membrane, some people defecate more than ten times a day, and even excrete the entire pseudo-membrane from the intestine, like a intestinal tube is very scary, the patient is also very nervous.
This is Clostridium difficile infection, which is a typical manifestation of the imbalance between bacteria and bacteria in our gut, and the imbalance between the microflora and the host.
In 2013, cdc of the U.S. Centers for Disease Control and Prevention identified Clostridium difficile infection at the top of the pressing level of infection caused by microbes that affect our human health. It can result in an additional cost of $100 million a year, but we don't seem to pay special attention to this now, and our domestic Clostridium difficile infection doesn't seem to be that serious either.
The first indication for fecal transplantation, which we are familiar with, is also for recurrent Clostridium difficile infections, as we know for certain diseases of our gut health. That is to say, Clostridium difficile infection is not how sinister it is, in fact, it usually exists in our intestines, but after the dysbacteriosis, it will occur some such events.
From my research experience, we can see that in fact, our understanding of microorganisms, pathogenic bacteria and diseases is like this vast starry sky that is endless.
I feel very fortunate that I started with Helicobacter pylori, and at least with the joint efforts of all epidemiologists, microbiologists and our clinicians, There is some consensus that Helicobacter pylori has been reached:
First of all, Helicobacter pylori can indeed cause stomach disease, it is a cause of our chronic gastritis, peptic ulcer, and even MALT lymphoma of the stomach, and it is also closely related to the occurrence of stomach cancer.
The second point to tell you is that we do not need to have any panic about such an infection, in fact, it has coexisted with our human body for many years, it can cause disease, but its disease spectrum is not very broad, it may not eventually lead to malignant tumors of the stomach.
The third point is to tell everyone that this infection is controllable, and it can be eradicated through standardized and reasonable treatment.
So I hope that in a populous country like China, in the case of such a high incidence of stomach diseases, everyone can pay attention to Helicobacter pylori, can give it a correct treatment, and ultimately maintain the health of our stomach.
Thank you!
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