Helicobacter Pylori

Helicobacter pylori is a very interesting bacterium and its research has been awarded by the Nobel Prize. Helicobacter is a rod-shaped microorganism capable of withstanding very dangerous environment. Therefore it is not a surprise that we find it in stomach, where it is able to survive the actions of hydrochloric acid. Helicobacter pylori is extremely frequent and we assume its presence in about 25% people in developed countries and more than 50% of people of developing countries. People are usually asymptomatic carriers, but Helicobacter presence increases the risk of some gastrointestinal diseases.


Helicobacter pylori lives within the stomach mucosa. This is usually a totally asymptomatic process but sometimes Helicobacter causes chronic inflammation of stomach. It is not clear why some people are more sensitive to Helicobacter presence; it is probably a consequence of a certain genetic predisposition. The inflammation can cause chronic unspecific troubles including abdominal pain, nausea, loss of appetite, etc. Chronic inflammation can lead to atrophy of stomach mucosa and increases risk of peptic ulcers, stomach cancer and some types of lymphoma. Lymphoma is a cancer of lymphatic tissue and Helicobacter is linked to the so-called MALT (mucosa associated lymphatic tissue) lymphoma. Fortunately, MALT lymphoma has an overall good prognosis.


Helicobacter pylori
Schema - helicobacter pylori



We diagnose Helicobacter presence especially in people who have pathology in upper GI endoscopy (peptic ulcers, signs of mucosal inflammation). There are non-invasive and invasive ways of diagnostics. During the endoscopy we can use small forces to take a sample. Helicobacter in such sample can be diagnosed by a chemical reaction or directly under the microscope. Non-invasive methods include detection of Helicobacter antigen in patient's feces (less accurate) and the urea breath test. The test uses the bacterial ability to break down urea molecules. The patient drinks flavored urea solution (urea, not urine!). The urea molecules in the solution contain special labeled carbon. After a short time, the patient breathes into a special device. Helicobacter splits the urea into water and carbon dioxide (CO2) and the labeled carbon is detected by the device.


The fundamental question is, whether to treat a diagnosed Helicobacter or not. It is not entirely clear but we advise to treat always when Helicobacter presence is related to other pathologies (stomach inflammation, peptic ulcers, MALT lymphoma, etc.). There are many guidelines to treat the infection; we usually use combination of proton pump inhibitors and antibiotics (often aminopenicillin and clarithromycin). The therapy prevents occurrence of complications and in case of MALT lymphoma, the eradication of Helicobacter may be curative.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources