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What Is H. Pylori?

Infection with the helicobacter pylori bacteria, usually referred to as H. Pylori, is common, affecting almost half of all people in the United States at some point in their lifetime. In most cases, the infection doesn't cause symptoms; however, an H. Pylori infection can cause peptic ulcers in some people. In rare cases, it can contribute to the development of stomach cancer.

If you have any signs or symptoms of a peptic ulcer, it's important to see a healthcare provider. Since H. Pylori infections can cause peptic ulcers, treatment involves eliminating the infection with antibiotics and helping the stomach heal with antacids. Treating H. Pylori infections also reduces the risk of developing stomach cancer.

Most people with an H. Pylori infection won't have any symptoms. If the infection causes a peptic ulcer, you'll then experience typical ulcer symptoms such as: Upper abdominal pain or discomfort Bloating and belching Feeling excessively full after eating, even after only a small amount of food Nausea or vomiting Loss of appetite Weight loss There are a few ways H. Pylori can enter the gastrointestinal system. The primary ways are ingesting bacteria through contaminated food or water and having close contact with the saliva or bodily fluids of a person who has an H. Pylori infection. Bacteria can cause changes to the protective lining of the stomach, which may lead to chronic inflammation. This inflammation makes the lining less protective. Over time, the stomach's exposure to digestive acids can result in a peptic ulcer. Risk Factors H. Pylori bacteria can actually live inside you without causing symptoms. Many people have this bacteria in their bodies without it turning into an infection. Some people are more likely than others to develop an infection, including: People who smoke People with a family history of gastric cancer People with low socioeconomic status People living in undeveloped countries People who regularly take non-steroidal anti-inflammatory drugs (NSAIDs) People with well water, or who drink other sources of unfiltered water People living in crowded housing conditions If your healthcare provider thinks you have an H. Pylori infection, they will perform a physical exam, ask you about your symptoms, and take a comprehensive family or medical history. From there, H. Pylori can be fairly easily tested for and diagnosed through several different types of tests: Blood test: If you have H. Pylori, your body sends antibodies throughout your body to help fight the infection. Your blood may be tested for the presence of H. Pylori antibodies. Stool sample: Stool can be tested for H. Pylori antigens (foreign cells that trigger an immune response) or cultured to test for the presence of the H. Pylori bacteria. Breath test: This measures the level of carbon dioxide in your breath after swallowing a harmless substance known as urea; if your carbon dioxide levels are higher than normal after ingesting the urea, it indicates an H. Pylori infection. If necessary, more in-depth upper gastrointestinal testing such as endoscopy or X-ray may be required. During an endoscopy, your healthcare provider will take a biopsy (tissue sample) of your stomach lining and look at the tissue more closely under a microscope. An X-ray is a non-invasive imaging technique that can be used to detect ulcers and other complications.  If your peptic ulcer is determined to be caused by H. Pylori bacteria, you will likely be prescribed medications to eliminate the bacterial infection and heal the ulcer. This is done through a combination of antibiotics and acid-reducers. To eliminate the H. Pylori bacteria, most people require a combination of at least two antibiotics. The most commonly prescribed antibiotics for H. Pylori are clarithromycin, metronidazole, and amoxicillin. Your provider will likely also prescribe a proton pump inhibitor such as Prilosec or Nexium. Proton pump inhibitors reduce the amount of acid produced in the lining of your stomach, and may be taken for a few weeks at a time as part of your treatment plan. Sometimes, bismuth subsalicylate, an anti-diarrheal that can lower the amount of fluids and inflammation in the intestines, is also recommended. To help the ulcer heal, your provider may prescribe a histamine blocker (also called an H2 blocker) medication like Pepcid AC (famotidine). H2 blockers limit the amount of acid produced by the histamine cells in your stomach. Sometimes the H. Pylori infection doesn't go away with the first round of treatment and a second round is required. Your provider will likely test your breath or stool for H. Pylori after you complete your initial treatment to see if follow-up treatment is necessary. H. Pylori is very common and you may not be able to prevent ingesting the bacteria. But there are some simple ways you can reduce your risk, like practicing good hand hygiene (e.G. Washing your hands after using the bathroom, eating or preparing food, or caring for sick people), eating food that has been prepared and cooked properly, and drinking clean sources of water. You can also work to eliminate some of the common risk factors for H. Pylori infections, such as not smoking and limiting the use of NSAIDs. If you have inflammation from an untreated H. Pylori infection, you may develop a peptic ulcer or chronic gastritis, a progressive inflammation of the stomach lining.  Less commonly, long-term H. Pylori infections can also cause certain types of stomach cancer, like gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Researchers aren't sure, however, how much an H. Pylori infection raises your risk for stomach cancer overall. The risk for gastric adenocarcinoma is higher for people with chronic H. Pylori infections. Additionally, nearly all people with gastric MALT lymphoma (which is rare in the United States) have symptoms of an H. Pylori infection and often see tumor shrinkage after undergoing antibiotic treatment for H. Pylori. The H. Pylori bacteria is prevalent in many parts of the world, and nearly half of all Americans will contract an H. Pylori infection at some point. For many of these people, infection will be asymptomatic, but for some, the bacteria will disrupt the protective lining of the stomach and cause peptic ulcers. Treating H. Pylori infections with antibiotics and acid-reducing medications can improve symptoms and reduce the risk of other complications, like gastric cancer.

Where Did My H. Pylori Infection Come From?

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H. Pylori: Treatment Options

Helicobacter pylori (H. Pylori) bacteria infections are the primary cause of stomach ulcers, but many people with H. Pylori don't know they have it. H. Pylori infections are usually asymptomatic, but if you have ulcer symptoms, it's best to treat the infection and eliminate the bacteria. Prolonged ulcer symptoms can lead to complications, and having a chronic H. Pylori infection can increase your risk for certain types of stomach cancer.

The good news is that it's possible to treat H. Pylori, heal any ulcers the infection has caused, and reduce your risk for complications and future illness. Medications like antibiotics and acid reducers are the frontline treatments for H. Pylori. While it may take more than one round of treatment, H. Pylori infections can be cured. 

Medications are the primary treatment for H. Pylori because it's a bacterial infection of the stomach. You can't eradicate the bacteria with diet or exercise, lifestyle changes, or other therapies.  The goal of medication treatment is twofold: to eliminate the H. Pylori bacteria and to heal the parts of the stomach damaged by the bacteria, where one or more ulcers have formed. This is done through a combination of antibiotics, acid-reducers, and sometimes anti-diarrheal medications. Antibiotics Every treatment protocol for H. Pylori will include two antibiotics. Because of the prevalence of antibiotic resistance (bacteria that no longer respond to antibiotic treatment) and the difficulty in eliminating H. Pylori bacteria, taking two antibiotics gives you the best chance at clearing the infection.  The most commonly-prescribed antibiotics for treating H. Pylori are clarithromycin, amoxicillin, and metronidazole. If those antibiotics fail to eliminate the infection—or if you have used them frequently in the past or have a history of resistance to any of them—your provider may choose to use tetracycline or levofloxacin instead. You will need to complete a 10- to 14-day course of these antibiotics.  These antibiotics are generally considered safe for most people, but common side effects include gastrointestinal upset (like nausea and diarrhea) and a metallic taste in the mouth.  At the end of treatment, your provider will likely retest you for H. Pylori. About 80% of people don't require any further treatment, but about 20% will need to repeat their treatment with some changes. In most cases, your provider will prescribe a different pair of antibiotics for you to take for 10 to 14 days, and may add in additional medications, like bismuth subsalicylate.  Anti-Diarrheal Medication Bismuth subsalicylate is an anti-diarrheal medication often sold over-the-counter (OTC) as Kaopectate or Pepto-Bismol. When used as part of a treatment protocol for H. Pylori, it can have bacteria-reducing and -suppressing effects, helping to rid the stomach of the bacteria and promote further healing of the area affected by the stomach ulcer. Bismuth subsalicylate is not usually used as part of the frontline treatment for H. Pylori, but it can be an important component for people needing re-treatment. It increases their chances of clearing the infection. Acid Reducers Alongside two antibiotics, most people receiving treatment for H. Pylori will take a proton pump inhibitor (PPI), which is commonly referred to as an anti-reducer. These medications don't have any effect on the bacteria, but they do help your stomach ulcer heal. PPIs reduce the amount of acid produced by your stomach. They are often taken for 14 days at a time. Some PPIs are available by prescription and some can be bought OTC. Common PPIs include: Prilosec (Omeprazole)  Nexium (Esomeprazole)  Prevacid (Lansoprazole) Protonix (Pantoprazole) PPIs don't have many side effects, but some people may experience headaches or gastrointestinal upset. Prolonged use can increase your chance of bone fracture. Surgery is also usually not recommended to treat H. Pylori, though is sometimes necessary to remove an ulcer that isn't healing with other types of treatments. In fact, the discovery that H. Pylori is the most common cause of ulcers has actually reduced the need for surgery to treat them, according to several studies from the late 1990s; prior to that time, surgery to remove parts of the stomach suspected to have an H. Pylori infection was often performed, but only eliminated the infection about 50% of the time. For the most part, antibiotics and acid-reducing medications are the only treatment for H. Pylori. But because antibiotic resistance continues to be a pressing issue in the practice of medicine today, some experts have studied the effect that probiotics have on H. Pylori. Though no studies support the use of probiotics as a substitute for standard treatment with antibiotics and PPIs, several studies suggest that adding probiotics to your treatment regimen may improve outcomes. Not only can probiotics strengthen your immune response in the gut (priming it to better fight off bacteria like H. Pylori), they may have an antimicrobial effect on the bacteria itself, inhibiting its growth.   A 2022 review of studies finds that incorporating probiotics into standard H. Pylori treatment may lead to better eradication of the bacteria, less treatment-related side effects (like diarrhea), and better overall compliance with the treatment. If you test positive for H. Pylori, your healthcare provider will recommend receiving treatment until the infection has fully cleared. Eliminating the H. Pylori bacteria is the best way to improve your health outcomes, both in the short-term (i.E. Healing your stomach ulcer and preventing future ulcers) and the long-term (reducing your risk of stomach bleeding and stomach cancer). However, there is some debate about whether asymptomatic people who test positive for H. Pylori should undergo the usual treatment regimen to get rid of the bacteria. Some experts say asymptomatic infections should be treated, while other experts say this often isn't necessary. This is complicated by the fact that H. Pylori testing usually isn't performed unless you have stomach ulcer symptoms or a history of peptic ulcer disease, though sometimes routine testing is recommended for people with a family history or otherwise increased risk of stomach cancer. If you test positive for H. Pylori but don't have any ulcer symptoms, you should discuss the pros and cons of treating your infection with your healthcare provider. Unless you have any reason not to take the typically-prescribed medications for treating H. Pylori, your provider may recommend treatment to lower your future risk of illness and complications.  H. Pylori is a common bacterial infection that can be asymptomatic but can also cause stomach ulcers. Symptomatic people should follow the recommended treatment prescribed by their provider—usually a combination of antibiotics and acid reducers—in order to heal any existing ulcers, prevent new ones from forming, and avoid more serious complications like GI bleeding and cancer.  This treatment cures H. Pylori quickly in the vast majority of people, with a small percentage needing to repeat the treatment in order to eliminate the bacteria fully.

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