Helicobacter pylori as an insidious enemy: How is it transmitted and manifested?

Helicobcter pylori (HP) is a rod-shaped bacterium with flagella. It infects the human gastrointestinal tract and is responsible for most inflammatory diseases of the stomach.

Its discovery dates back to 1893.
However, the greatest contribution to research on this bacterium is attributed to Marshall and Warren, who won the Nobel Prize in Medicine in 2005. They discovered that HP is involved in gastritis and gastric ulcer disease.

In the general population, up to 20-70% of people are infected with HP (prevalence), depending on geographical location.

The highest prevalence is in China, the lowest in the USA.

The source of HP and its host is the human being. Transmission of infection occurs by mouth-to-mouth and stool-to-mouth routes. In the family, it is mainly transmitted from older to younger persons.

Risk factors for HP infection:

• lower socioeconomic status
• older age
• Smoking
• meat consumption
• consumption of chilli peppers
• eating in restaurants
• drinking unfiltered and unbottled water
• family history of stomach ulcers

What are the symptoms of Helicobacter pylori infection?

Patients infected with HP are generally asymptomatic. However, nonspecific manifestations are sometimes observed.

Examples include symptoms such as:

• Nausea (feeling like vomiting).
• vomiting
• feeling of pressure in the stomach after eating
• abdominal pain
• bloating
• heartburn
• drive
• bad breath (halitosis)
• weight loss

How HP infection manifests itself in a person depends on the bacteria itself, but also on the state of the body's immunity.

The transmission of the bacterium occurs...

A patient can get HP infection from food, water or cutlery. It is more common in countries or communities with poor water quality.

Infection can also occur through contact with saliva or other fluids of the patient.

Transmission occurs by the mouth-to-mouth and stool-to-mouth (fecal-oral route).
In a family, it is passed from older to younger people.

Diagnosis

Diagnosis relies on so-called invasive and non-invasive techniques. Invasive ones involve taking a sample from the stomach during gastroscopic examination (GFS). Non-invasive ones are those that do not require taking a sample from the stomach.

Invasive techniques

During a gastroscopic examination, the doctor views the lining of the stomach. He or she may find signs of gastritis, gastric or duodenal ulcer, or in severe cases of stomach cancer.

During the examination, the doctor uses forceps to remove a piece of tissue from the stomach. The sample obtained can then be examined:

• a so-called urease test immediately after the examination
• microscopically in a histological laboratory
• by culture in the microbiology laboratory

Non-invasive techniques include

Breath tests are highly sensitive. They are carried out fasting after a two-week period without antibiotics and proton pump blockers.

The patient drinks a preparation containing urea. Helicobacter pylori enzymes then break down the urea to form carbon dioxide, which is determined in the patient's breath by a special device after about 60 minutes.

Blood is drawn for antibodies to HP. The test does not detect active HP infection. The test is more suitable for epidemiological purposes.

Stool examination for the presence of HP antigen. This is a highly sensitive test that is used for diagnosis and treatment success.

What about home tests that can be purchased, for example, in a pharmacy?

Home tests are also available to detect the presence of HP infection.

Blood tests show the presence of antibodies in a person's blood. Stool tests show the presence of HP antigen in the stool and are highly specific.

These home tests should always be followed by a doctor who will determine further investigation and treatment.

Treatment of HP

A patient with a positive finding of HP is treated with a combination of medications.

1. Antibiotics - drugs that destroy bacteria - are used:
   • Amoxicillin
   • clarithromycin
   • metronidazole
   • tetracycline
   • azithromycin
   • ciprofloxacin
2. Drugs that reduce acid production in the stomach - called proton pump inhibitors (PPIs):
   • omeprazole
   • pantoprazole
   • esomeprazole
   • lansoprazole
3. Bismuth - together with antibiotics helps to destroy bacteria
4. Histamine blocking drugs that stimulate acid production in the stomach:
   • famotidine
   • Ranitidine
   • cimetidine

Administration schedules

Standard eradication therapy consists of a triple drug combination: PPI, clarithromycin or metronidazole, amoxycillin or metronidazole.

Sequential eradication therapy: PPI plus amoxicillin for 5-7 days, followed by 7 days of PPI plus two antibiotics, most commonly clarithromycin and metronidazole.

Hybrid eradication therapy involves the administration of PPIs plus amoxicillin for 3-7 days, followed by the addition of two antibiotics, most commonly metronidazole and clarithromycin for a further 7 days.

Bismuth therapy is an alternative to first-line therapy or after failure of any of the above regimens. It consists of administration of an PPI or histamine blocker, bismuth, tetracycline and metronidazole.

The standard three-combination treatment according to the latest recommendations lasts 14 days.

It is very important to follow the treatment as directed by the doctor.

If antibiotic treatment is interrupted, HP can become resistant to antibiotics and treatment becomes more difficult to manage.

During treatment, concomitant use of probiotics is recommended. After 4 weeks of treatment, the success of treatment is most often checked by stool examination for HP antigen or breath test.

Diet in Helicobacter pylori infection

Recommended foods that may help treat the infection are...

Probiotics in the form of yoghurt, sour milk or taken in tablets. They help in the treatment of HP infection, relieve the side effects of antibiotics.

Omega-3 and omega-6 fatty acids reduce inflammation of the stomach lining and the growth of Helicobacter pylori, helping to treat the disease. They are found mainly in fish and olive oil.

Fruits and vegetables should be eaten during treatment for HP infection because they are easily digestible and improve stomach function. Broccoli, cauliflower and cabbage contain a substance called isothiocyanate, which helps in cancer prevention and fights Helicobacter pylori.

White meat and fish are low in fat and easy to digest.

What not to eat when infected with HP

• Coffee, chocolate, black tea as they contain caffeine and stimulate acid production in the stomach
• bubbly drinks - they cause pressure in the stomach, which can cause pain and acid reflux
• alcoholic drinks - aggravate stomach inflammation
• acidic fruits such as lemons, oranges, grapefruits, pineapple, which cause heartburn
• aromatic and spicy foods - garlic, mustard, ketchup, mayonnaise, worcestershire sauce, soy sauce
• fatty foods, fried foods and cheese, which are high in fat and slow digestion and empty the stomach
• convenience and canned foods that contain many preservatives and chemical additives that can irritate the stomach and aggravate inflammation