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Helicobacter Pylori

Gastroenterology Hepatology

Helicobacter pylori is a spiral-shaped bacterium capable of surviving in the stomach's highly acidic environment. It is one of the primary causes of gastric diseases and is strongly associated with chronic gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. H. pylori infection is prevalent worldwide, including in Hong Kong, particularly among the elderly population.

Symptoms

Asymptomatic Infection

Most individuals do not exhibit noticeable symptoms, but the bacteria can cause chronic gastric mucosal inflammation, increasing the risk of ulcers or gastric cancer.

Symptomatic Infection

Upper Abdominal Discomfort or Pain Often worsens after eating.
Indigestion: Including bloating, belching, and nausea.
Heartburn or Acid Reflux.
Complications of Gastric Ulcers: Black Stools (indicating gastrointestinal bleeding), Severe Abdominal Pain (potential sign of gastric perforation)

Causes and Factors

Routes of Transmission

Fecal-Oral Route: Consuming contaminated water or food.
Oral-Oral Transmission: Close contact between family members, such as sharing utensils or kissing.
Other Routes: Exposure to contaminated medical instruments, such as endoscopes.

Risk Factors

Poor Hygiene: For example, consuming untreated water.
Close Contact with Infected Individuals: Sharing utensils or living spaces with infected persons.
Excessive Use of Acid-Suppressing Medications: Reduces gastric acid's natural antibacterial effects.

Complication

Stomach and Duodenal Ulcers

Helicobacter pylori is the primary cause of most peptic ulcers.
Untreated ulcers may lead to perforation or bleeding.

Stomach Cancer

Chronic infection can cause atrophic changes in the gastric mucosa, increasing the risk of stomach cancer.
The International Agency for Research on Cancer (IARC) has classified Helicobacter pylori as a Group I carcinogen.

Gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma

Helicobacter pylori infection is closely associated with MALT lymphoma.

Diagnosis

Non-Invasive Tests

13C Urea Breath Test (UBT)
- The patient ingests urea labelled with carbon 13 isotopes. If Helicobacter pylori is present, it breaks down urea, releasing labelled carbon dioxide that is detectable in the breath.
- High accuracy is often the first choice for non-invasive diagnosis.
Stool Antigen Test
- Detects H. pylori antigens in the stool. Useful for initial diagnosis and confirming eradication post-treatment.
Serology (Antibody Testing)
- Detects antibodies to H. pylori in the blood. However, it cannot distinguish between current and past infections.

Invasive Tests

Gastroscopy (Endoscopy)
- Direct visualization of the gastric mucosa and collection of biopsy samples for further analysis.
Rapid Urease Test (RUT)
- Detects urease enzyme produced by H. pylori in biopsy tissue.
Bacterial Culture and Antibiotic Susceptibility Testing
- Cultures H. pylori from biopsy samples to determine antibiotic sensitivity, especially in cases of antibiotic resistance.

Treatments

Helicobacter Pylori infection requires eradication therapy to reduce the risk of complications and disease recurrence.

Standard Triple Therapy Combination

Combination:
- Amoxicillin (Lysine-type antibiotic)
- Macrolide antibiotics
- Proton pump inhibitor (PPI) to reduce stomach acid and promote bacterial eradication.
The treatment course typically lasts 10–14 days.

Quadruple Therapy

Suitable for patients with antibiotic resistance or those who have failed triple therapy.

Combination:

Amoxicillin (Lysine-type antibiotic)
Macrolide antibiotics
Proton pump inhibitor (PPI)
Bismuth compounds

Supplementary Therapy

Probiotics can be used to reduce antibiotic-associated side effects, such as diarrhoea.

FAQ

Helicobacter pylori infection does not heal on its own. It typically requires medication to eradicate the Infection effectively. Without treatment, the Infection can lead to complications such as gastric ulcers or other serious issues.

After treatment, doctors recommend tests, such as the urea breath test (UBT), to confirm whether the Infection has been successfully eradicated.

Yes, Helicobacter pylori infection can recur, especially if the treatment is incomplete, if antibiotic resistance develops, or if the individual becomes reinfected. Proper and complete treatment is essential to reduce the risk of recurrence.

Preventive measures for Helicobacter pylori infection include: Practicing good hygiene, such as frequent handwashing, especially before meals or after using the restroom. Avoiding the consumption of uncooked or contaminated food and water. Refraining from sharing food or utensils with infected individuals.