OHelicobacter pylori, better known asH.pylori, is a bacterium that lives in our stomach and duodenum, being responsible for the most common chronic bacterial infection in humans.
OH.pylorihas been recognized in all populations of the world and in individuals of all ages. Conservative estimates suggest that another 50% of the world's population has the stomach colonized by this bacterium.
In this text we will address the following points:
- What is theHelicobacter pylori.
- How to handle it.
- What are the diseases it causes.
- What are the symptoms.
- How the diagnosis is made.
- What is the relationship between H. pylori and stomach cancer.
- How is the treatment.
What is Helicobacter pylori?
OH.pyloriis a bacterium that has the incredible ability to survive in one of the most inhospitable environments of our body: the stomach, which has an extremely acidic medium, with a pH below 4.
The acidity of the stomach is one of the mechanisms of defense of our organism against the bacteria that are ingested next to the food. There are few living things that can survive in such an acid environment.
However, theH.pyloripresents some evolutionary "tricks" that allowed him to adapt to such a hostile environment. The bacteria produce substances that neutralize the acids, forming a kind of protective cloud around it, allowing it to move inside the stomach until it fix.
In addition to this protection,H.pylorican overcome the mucus barrier that the stomach has to protect itself from its acidity, adhering to the mucosa, an area below the mucus, where the acidity is much less intense. Therefore, in addition to producing substances against acidity,H.pylorican penetrate the stomach to places where the environment is less aggressive.
The mode of contagion of theH.pyloriis still not fully known. We know that transmission can occur from an infected person to a healthy person through contact with vomiting or feces, the latter usually in the form of contaminated water or food.
Humans appear to be the main reservoir of the bacterium, however, H. pylori has already been isolated in other primates, sheep and domestic cats, suggesting that the transmission of these to humans may to occur.
Contaminated water, especially in developing countries, often serves as a source of bacteria.H.pylorican remain viable in the water for several days. In countries without universal basic sanitation, most children are infected before the age of 10 and the prevalence in the adult population reaches more than 80%. In developed countries, such as the United States and Europe, contamination in children is uncommon, but transmission in adult life is frequent, where more than 50% of the population over the age of 60 is infected.
When a family member becomes infected withHelicobacter pylori, the risk of transmission to the children and conjunge is very high. This transmission is common even in houses with good hygienic conditions, which raises doubts whether the transmission always occurs via the fecal / oral route.
Transmission through saliva has not yet been proven. OH.pylorican be found in the mouth, especially in dental plaques, but its concentration seems to be too low for transmission. One fact that speaks against this form of transmission is the fact that dentists do not present higher rates of contamination than other professionals who do not constantly deal with saliva and plaques bacterial infections.
Diseases caused by Helicobacter pylori
As already mentioned at the beginning of this article, theH.pyloriusually lodges in the wall of the stomach, just below the protective layer of mucus. This layer is essential for protecting the stomach, preventing hydrochloric acid from attacking your mucosa.
The problem is that theH.pyloriproduces a number of enzymes, some of them directly irritating to the stomach cells, others active against the layer of mucus, making it weaker, which leaves the stomach wall unprotected against the contents acid.
These actions cause inflammation of the stomach mucosa, leading to gastritis and in some cases to the formation of peptic ulcer (also read: GASTRITE AND GASTRIC ULCERA) and even tumors
In short, the presence of theHelicobacter pyloricauses damage to the stomach and duodenum, and is therefore associated with an increased risk of:
- Duodenitis (inflammation of the duodenum).
- Duodenal ulcer.
- Ulcer of the stomach.
- Cancer of the stomach.
- Lymphoma of the stomach (MALT lymphoma).
Symptoms of H.pylori
The vast majority of patientsH.pyloridoes not present any type of symptom or complication. There are more aggressive strains of the bacterium and there are more sluggish strains, which explains, in part, the occurrence of symptoms only in a few people contaminated.
It is important to note that theHelicobacter pyloriitself causes no symptoms. Patients who areH.pyloriwho present complaints are made by the presence of gastritis (read: GASTRITE SYMPTOMS) or peptic ulcers caused by the bacteria. In these cases, the most common symptoms are:
- Pain or discomfort, usually type burning and in the upper abdomen (read: ABDOMINAL PAIN | Major Causes).
- Feeling of swelling in the belly.
- Quick quenching of hunger, usually after eating only a small amount of food.
These symptoms are called dyspepsia (read: STOMACH SYMPTOMS - DISPEPSY).
In the case of ulcers, the following signs and symptoms are also common:
- Nausea or vomiting.
- Dark stools.
- Anemia (read: ANEMIA | Symptoms and causes).
If the patient does not present gastritis or ulcers, the simple presence ofH.pylorican not be held responsible for symptoms such as stomach pains.
Just as an example, studies show that only 1 in 14 patients with burn complaints stomach, without gastritis or ulcer documented in the endoscopy, present improvement with the treatment toH.pylori.
OH.pylorialso appears to be responsible for the appearance of recurrent canker sores in some patients (see: AFTA | CAUSES AND TREATMENT), but this association has not yet been proven.
How is the Diagnosis done?
Currently there are several methods to diagnose the presence of bacteriaH.pylori. However, it is more important than diagnosing the bacteria to know who should be screened for its presence. As in some places up to 90% of the population is contaminated by the bacteria, the tests will be positive in almost everybody. Therefore, it does not make sense to requestH.pyloriin people without specific complaints.
In the past,H.pyloriwas done only with digestive endoscopy, through biopsies of the stomach. Nowadays there are non-invasive tests, through feces, blood or breathing.
However, in patients complaining of stomach pain, endoscopy is important for assessing the state of the stomach, also serving to diagnose gastrointestinal ulcers or tumors. Therefore, many of theHelicobacter pyloriare still made by digestive endoscopy, through biopsy and urease test. The non-invasive tests end up being used more after the treatment, as a way of confirming the elimination of the bacterium.
Patients less than 55 years of age, who present complaints of stomach burning, without signs that may indicate a tumor or active ulcers (bleeding, anemia, early satiety, loss of unexplained weight, recurrent vomiting, family history of gastrointestinal cancer, etc.) may undergo a noninvasive test for treatment if they are positive for H.pylori. Endoscopy is indicated only if there is no improvement of the symptoms with the treatment.
Relation to stomach cancer
We know that the majority of the population is colonized by theH.Pylori, but only a very small part develops stomach cancer. Therefore, we can conclude that theH.pyloriincreases the risk of cancer, but it is not the only factor.
Therefore, no treatment is indicated for everyone who has the bacteria. Only patients with a family history of gastric cancer should be concerned with the asymptomatic presence ofH.pylori. In these, even if the patient does not present any symptoms, the research of the bacterium and the treatment aiming to eradicate it is indicated.
OH.pyloriis related to the onset of a specific type of lymphoma of the stomach, called MALT. The relationship is so strong that the treatment of this tumor is done with antibiotics and the eradication of the bacterium leads to the cure of this neoplasia.
Treatment of H.pylori
Recently the indications for treatment ofH.pyloriwere expanded, encompassing groups that until recently were not usually treated.
Current indications for treatment ofHelicobacter pyloriare:
- Gastric and / or duodenal ulcer.
- Gastric MALT lymphoma.
- First-degree relatives of gastric cancer patients.
- Iron deficiency anemia with no apparent cause (read: ANEMIA FERROPRIVA | Iron deficiency).
- Idiopathic thrombocytopenic purpura (read: IDIOPATHIC TROMBOCYTOPENIC PURPURE (ITP)).
- Patients on long-term anti-inflammatory therapy who have gastrointestinal bleeding and / or peptic ulcer.
The treatment is usually done with 3 drugs for 7 to 14 days with:
- A proton pump inhibitor (Omeprazole, Pantoprazole or Lanzoprazol) + two antibiotics such as Clarithromycin and Amoxicillin or Clarithromycin and Metronidazole.
After 4 weeks of the end of treatment, the patient can perform the non-invasive tests to confirm the elimination of the bacteria.
Reinfection by H.pylori
Contrary to what was previously thought, reinfection withH.pyloriafter the correct and successful treatment is uncommon. In general, when the patient is treated, and some time later discovers that he still has the bacterium, it is because the treatment was not successful and did not lead to the complete eradication ofH.pylori.
The risk of reinfection is greatest in areas with poor sanitation and inadequate water for drinking or bathing.
Research for Bariatric Surgery
Although there is still no consensus, most physicians request a survey of H. pylori, and the in the case of a positive result, for obese patients who will undergo surgery bariatric.
This behavior seems to reduce the risks of stomach lesions, such as ulcers, in the postoperative period.