Helicobacter Pylori (cont.)
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
Who should receive treatment for H. pylori?
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 may reverse atrophic gastritis. Thus, some doctors are recommending treatment of ulcer- and symptom-free patients infected with H. pylori.
Many physicians believe that dyspepsia (non-ulcer symptoms associated with meals) 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.
Can H. pylori infections be prevented?
With at least 50% of the world population with detectable H. pylori in their stomachs, it seems likely that with no vaccine available, it will be very difficult or impossible for people to have no exposure to these bacteria. The chance of the organisms causing symptomatic infection is low, but certainly not absent. Currently, suggestions have been made to prevent ulcers, but the effectiveness of these recommendations are unknown. The following is a list of recommendations to help prevent ulcers:
Currently, there is no commercially available vaccine to prevent either infection or colonization of the stomach by H pylori. However, research is ongoing, and the NIH is funding vaccine studies in conjunction with vaccine makers (For example, Helicovax to prevent H. pylori colonization of human GI tracts by EpiVax, Inc.). Moreover, some nutritionists suggest a diet high in fruits and vegetables, and low in sugar may help reduce or stop H. pylori infection.
Medically Reviewed by a Doctor on 2/6/2015
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