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In 1982, Dr Barry Marshall, an Australian gastroenterologist, started noticing a strange finding in some of his patients. The majority of his gastritis and ulcer patients showed the microscopic presence of a helical shaped bacteria in the fluid biopsied from their stomachs. Dr. Robin Warren, the pathologist at his hospital had picked up on these findings while examining the biopsy reports of Dr. Marshall’s patients. He alerted Dr. Marshall of this and together, they started reviewing slides of his patients with gastritis and duodenal ulcers. Again and again, they found the same results – growth of this bacteria in the tissues biopsied. They named the bacteria Helicobacter Pylori (helicobacter for the helical shape and pylori which pertains to the stomach). Drs. Marshall and Warren hypothesized that this bacteria was causing the gastritis and ulcers in their patients and presented their findings to the medical community. The theory was met with speculation and hesitancy and many of their colleagues were not convinced. To prove his theory, Dr. Marshall decided to drink the gastric juices obtained from one of his ulcer patients. Within two weeks, he became violently ill, with vomiting episodes daily. He then had a colleague scope him and the fluid was sent for pathological analysis. There on his pathology slides was evidence of the same bacteria he had seen in his sick patients.
Fast forward 40 years and H. Pylori is now proven to be the cause of over 90% of gastritis and duodenal ulcer cases and the number one infectious cause of gastric cancers. In 2005, Drs. Marshall and Warren were awarded the nobel prize for their discovery.
H. Pylori infection is most prevalent in Asia as well as some developing nations with an estimated 80% infection rate, while in the US it has an infection rate of approximately 20-30%. In the US, it is most common in Hispanic and Native American populations followed by African American and white populations.
When an individual is infected with H. Pylori, the bacteria attach to the protective mucosal lining of the stomach and small intestine, weakening them and allowing acid to penetrate the area beneath. The irritation of the membrane from the bacteria and acid causes gastritis which can then lead to the development of “sores” or ulcers. These ulcers are most common in the first part of the small intestine connected to the stomach, but ulcers can also form within the stomach. If left untreated, ulcers can lead to bleeding, perforations and gastric cancer.
H. Pylori is transmitted through food and from infected household contacts. One study showed that the greater number of household members, the higher the chance of infection. The most common transmission occurs in childhood but most childhood cases are asymptomatic and more prevalent than once believed. Since many patients with H. Pylori infections are asymptomatic, treatment is usually reserved for those who present with symptoms.
Symptoms of H. Pylori infection include:
● Burning sensation or pain in the stomach
● Stomach pain that is worse when stomach is empty
● Nausea and vomiting
● Loss of appetite
● Bloating and belching
● Unintentional weight loss
● If a bleeding ulcer is present, there may be blood in stool or black/tar colored stool
It’s important to speak to your doctor if you experience any of these symptoms so they can rule out other causes such as NSAID induced gastritis and ulcerations.
If your doctor suspects an H. Pylori infection, the most effective method of detecting it is through a stool antigen test. A breath test is also available.
The current consensus is that only symptomatic cases are to be treated. The most common treatment option is a combination of two antibiotics, clarithromycin (Biaxin) and amoxicillin (Amoxil) with a proton pump inhibitor such as Lansoprazole (Prevacid).
It is also sold as a triple regimen called a Prevpac HP Pac that contains the proton pump inhibitor and two antibiotics in one pack.
Some natural therapies which have been shown to have some efficacy in treating H. Pylori include the probiotic strain Saccharomyces boulardii Saccharomyces Boulardii in Helicobacter Pylori Eradication in Children: A Randomized Trial From Iran - PMC as well as cranberry juice. Addition of cranberry to proton pump inhibitor-based triple therapy for Helicobacter pylori eradication - PMC
If you think you may have an H.Pylori infection, it’s important to speak with your doctor to get tested and treated to prevent long term complications.
References:
https://www.cancercenter.com/community/blog/2022/03/what-is-h-pylori
https://badgut.org/information-centre/a-z-digestive-topics/nobel-prize-for-h-pylori-discovery/
https://www.discovermagazine.com/health/the-doctor-who-drank-infectious-broth-gave-himself-an-ulcer-and-solved-a-medical-mystery
https://www.nobelprize.org/prizes/medicine/2005/press-release/
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