Helicobacter Pylori infection: Symptoms and complications

Did you know that 84% of stomach cancer cases are caused by a bacteria called Helicobacter pylori, and roughly 60% of the adult population worldwide has this infection? But don’t worry, most people with Helicobacter Pylori can be treated, especially if diagnosed early. In this article, I will explain what causes this infection and the signs and symptoms you should look out for.

What is a Helicobacter Pylori infection?

Helicobacter Pylori (H.pylori) is a common bacteria that grows in the digestive tract and infects your stomach lining. Its name comes from the word “Helico”, which means spiral. The spiral shape of H. pylori allows the bacteria to penetrate your stomach’s mucous lining and neutralise stomach acid, which interferes with your immune response and can lead to stomach problems in the long run.

Many people have H. pylori infection but most don’t know it. H. pylori infection is more prominent in developing countries and tends to affect children more due to their lack of proper hygiene. Numerous studies have shown those with the infection have a 10-20% risk of developing peptic ulcers and a 1-2% chance of stomach cancer. The latter significantly increases if you have a family history of stomach cancer.

What causes Helicobacter Pylori infections?

The H. pylori bacteria has been around for thousands of years, and we believe the infection stems from a lack of hygiene. In addition, H. pylori infections are contagious. While the exact route of transmission is not known, it is thought that transmission happens through oral contact like kissing or fecal-oral contact. The latter happens when you do not wash your hands properly after using the bathroom. H. pylori can also spread through contaminated water or food. In developed countries like Singapore, transmission of H. pylori is rather common within family groups. 

With that said, your risk of infection will partly depend on your environment, personal hygiene and living conditions. Factors that increase your risk include: 

  • Living in a developing country
  • Living in overcrowded housing or a household with others with H. pylori
  • No access to clean water
  • Eating food that’s not cooked or cleaned safely

Symptoms of Helicobacter Pylori infection

A large number of individuals with H. pylori do not present any symptoms. However, pain usually occurs on an empty stomach at night, between meals or early in the morning. Most patients describe this pain as a gnawing pain that comes and goes and is relieved by eating or taking antacid drugs. 

Other symptoms if present include: 

  • Excessive burping 
  • Bloating 
  • Nausea 
  • Heartburn 
  • Fever 
  • Lack of appetite 
  • Unexplained weight loss 

In more serious cases leading to an ulcer, gastrointestinal bleeding may occur, leading to: 

  • Trouble swallowing 
  • Blood in the stool or black tarry stool 
  • Vomit in blood 

If you experience any of these symptoms, please see a doctor immediately.

Complications of Helicobacter Pylori

H. pylori is unique in its ability to colonise the stomach and stay in the stomach for decades. It appears that the age of initial infection affects the potential risk of infection; those infected at an earlier age are more likely to develop gastric ulcers, cancer, gastric atrophy and inflammation. Other serious complications include: 

  • Internal bleeding; when a peptic ulcer breaks through a blood vessel
  • Obstruction; when food is blocked from leaving the stomach 
  • Perforation; when an ulcer breaks through the stomach wall 
  • Peritonitis; an infection of the peritoneum

How are Helicobacter Pylori infections diagnosed?

There are a series of tests to confirm the presence of H. pylori. At my clinic, I carry out the following:

Blood test
Blood samples are taken to look for antibodies against the bacteria.

Stool test
For a stool test, I will require a sample of your stool to check for signs of the infection in your faeces. This will be done at home; I will provide a container for you to take home.

Breath test
During this test, you will drink a solution containing urea and breathe through a nasal breath cannula. If H. pylori is present, carbon dioxide will be released and detected by the breath analyser.

Endoscopy
An endoscopy involves inserting a long and narrow instrument with a camera attached to it into your mouth and down your stomach. If necessary, I might retrieve some samples via the endoscope for testing. This is usually the most accurate way to detect H. pylori. 

In addition to either of the above, I will also examine your stomach to check for any bloating and listen for sounds within the abdomen.

Treatment for Helicobacter Pylori infections

The good news is H. pylori infection can be treated easily with gastric medication and antibiotics. For most doctors including myself, we prescribe a standard 14 days therapy of proton pump inhibitors like omeprazole and antibiotics such as clarithromycin and amoxicillin. This is often referred to as “triple therapy”. 

Usually, only one round of antibiotics is needed, but if treatment fails the first time round, more and different drugs may be prescribed. Whatever it takes, it’s crucial to clear the infection as extensive research has demonstrated the link between the continued presence of H. pylori and stomach cancer. The risk factor is about 65%.

Long term outlook

Those who receive successful treatment for H. pylori infection usually have a positive long-term outlook. However, if the infection is still present despite treatment, a peptic ulcer may develop. In this case, the outlook depends on the nature of the disease and how soon it’s diagnosed. 

If you have a family history of stomach cancer, I strongly urge you to get tested and treated for H. pylori. Above all, ensure to always wash your hands before eating and after using the bathroom and make sure your food and water are clean. Having good hygiene will protect you from developing the bacteria.

References

  1. Camilo, V., Sugiyama, T., & Touati, E. (2017). Pathogenesis of Helicobacter pylori infection. Helicobacter, 22 Suppl 1, 10.1111/hel.12405. https://doi.org/10.1111/hel.12405
  2. Wang, F., Meng, W., Wang, B., & Qiao, L. (2014). Helicobacter pylori-induced gastric inflammation and gastric cancer. Cancer letters, 345(2), 196–202. https://doi.org/10.1016/j.canlet.2013.08.016

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