Helicobacter pylori

Helicobacter pyloriHelicobacter pylori (formerly known as Campylobacter pylori) is a gram-negative bacterium that is usually found in the stomach and is one cause of gastritis and gastric ulcers.

Description
Helicobacter pylori this infection is widely spread all over the world. It was estimated that about 50% of the population are infected. However, not all of them become symptomatic and they may even have no idea that they are infected. H. pylori infection spreads via oral-to-oral, fecal-to-oral contact, contaminated food and water.

Bacterium
H. pylori is a gram-negative bacterium that requires oxygen in low concentrations to thrive. This implies the ability of the bacterium to live and reproduce in the stomach.

Risk factors
A person is more likely to get infected in childhood in case of living in the following conditions:
– crowded homes (a lot of people live in a home together);
– water supply issues;
– lives in a developing country (crowded and unsanitary living conditions);
– lives with someone who has an H. pylori infection.
– Intake of nonsteroidal anti-inflammatory drugs (NSAIDs) for a long period of time increases the risk of developing a peptic ulcer.

Symptoms
Signs or symptoms of H. pylori infection may include:
– Aching or burning pain in the abdomen;
– Abdominal discomfort or pain that worsens when the stomach is empty;
– Heartburn;
– Nausea;
Foul breath (halitosis);
– Diarrhea;
– Loss of appetite (anorexia);
– Bloating;
– Unexplained weight loss;
– Bloody or black-colored feces (so called tar-like stools) or vomit due to the bleeding of the ulcer;

Check out the Helicobacter pylori Test

Complications
The complications include:
– internal bleeding characterized by tar-like stool or vomiting with the black vomit;
– obstruction caused by an ulcer blocking the food passage;
– perforation when an ulcer breaks through the stomach wall;
– peritonitis when the abdominal cavity or its lining is infected;

Diagnosis
To detect the presence of H. pylori several tests may be performed:
Stool test: H. pylori fecal antigen test;
Carbon 13 urea breath test – a person is drinking urea (usually with a beverage) with a carbon isotope (carbon 13 or carbon 14). Later the concentration of the carbon is measured in the breath;
H. pylori serology – detection of immunoglobulin G antibodies against H. pylori;
Antibioticogram is done to evaluate the susceptibility of the bacterium to the antibiotics;
Other tests include:
Esophagogastroduodenoscopy with biopsy of the stomach lining;
pH-metry;

Applicable medicines
There are several regimens that may be used to eradicate Helicobacter pylori infection:

Triple therapy
Triple therapy is a first-line therapy which includes the following medications:
Proton pump inhibitor (PPI) (omeprazole 20 mg twice a day (BID), lansoprazole 30 mg BID, esomeprazole 40 mg four times per day (QD) etc.) plus
Clarithromycin 500 mg BID or metronidazole 500 mg BID (in case of clarithromycin resistance) plus
Amoxicillin 1000 mg BID or metronidazole;
Nonbismuth quadruple therapy
Nonbismuth quadruple therapy may be given as a sequential or concomitant therapy.

1) Sequential therapy
Sequential therapy requires a 14-day intake of the following medications:
PPI plus amoxicillin for 5-7 days (pantoprazole 40 mg BID and amoxicillin 1 g BID for 7 days), then
PPI plus 2 other antibiotics (usually clarythromycin and metronidazole) the next 5-7 days;

2) Concomitant therapy
Concomitant therapy includes:
PPI in a standart dose
Amoxicillin
Clarithromycin (1 g QD)
Metronidazole;
The therapy requires 10-14 days intake of medications.

Bismuth-based therapy. Helicobacter pylori
Bismuth-based therapy is an option to treat those who live in areas with high clarithromycin and metronidazole resistance.  It lasts for 10-14 days and consists of:
PPI or H2 receptor antagonist (lansoprazole 30 mg BID or ranitidine 150 mg BID)
Bismuth subsalicylate 525 mg QID (or bismuth tripotassium dicitrate 300 mg QID)
Metronidazole 250 mg QID or 500 mg TID (levofloxacin may be used instead)
Tetracycline 500 mg QID

Levofloxacin-containing therapy
This regimen includes of a PPI + amoxicillin 1 g BID + levofloxacin 500 mg QD for 7-10 days.
Second-line therapy should avoid repeating previously used treatment regimen and include at least one antibiotic.

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