Helicobacter Pylori (cont.)
Who should receive treatment?
There is a general consensus among doctors that patients
should be treated if they are infected with H. pylori and have ulcers. The goal
of treatment is to eradicate the bacterium, heal the ulcers, and prevent the
ulcers' return. Patients with MALT lymphoma of the stomach also should be treated. MALT lymphoma
is rare, but the tumor often quickly regresses upon successful eradication of H.
pylori.
There currently is no formal recommendation to treat patients
infected with H. pylori without ulcer disease or MALT lymphoma. Since antibiotic
combinations can have side effects and stomach cancers are infrequent in
the United States, it is felt that the risks of treatment to eradicate H. pylori
in patients without symptoms or ulcers may not justify the unproven benefits
of treatment for the purpose of preventing stomach cancer. On the other hand,
H pylori infection is known to cause atrophic gastritis (chronic inflammation
of the stomach leading to atrophy of the inner lining of the stomach).
Some physicians believe that atrophic gastritis can lead to cell changes (intestinal
metaplasia) that can
be precursors to stomach cancer. Studies have also shown that eradication of
H pylori can reverse atrophic gastritis. Thus, some doctors are recommending treatment
of ulcer- and symptom-free patients infected with H. pylori.
Many physicians believe that dyspepsia may be associated with infection with
H. pylori. Although it is not clear if H. pylori causes the dyspepsia, many
physicians will test patients with dyspepsia for infection with H. pylori and
treat them if infection is present.
Scientists studying the genetics of H. pylori have found
different strains (types) of the bacterium. Some strains of H. pylori appear to
be more prone to cause ulcers and stomach cancer. Further research in this area
may help doctors to intelligently select those patients who need treatment.
Vaccination against
H. pylori is unlikely to be available in the near future.
Last Editorial Review: 2/28/2005
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