What is H. pylori?

Helicobacter pylori (H. pylori) is a bacterium that is the main cause of ulcers occurring in the lining of the upper part of the small intestine (duodenal ulcers) and in the lining of the stomach (gastric ulcers). It is also the leading known cause of stomach cancer. Initially, the bacterium causes inflammation (gastritis or duodenitis). Many people may be unaware of this inflammation, and only experience symptoms when an ulcer develops, perhaps years later. Not all people infected with H. pylori will develop an ulcer, and very few will develop cancer.

What are the symptoms?

The most common presentation of infection with H. pylori is not symptomatic. When symptoms are present, the first symptoms are usually those of an ulcer. Ulcers cause pain, which can vary in intensity from mild discomfort to severe pain. The pain may last from minutes to hours and may come and go for several days or weeks. The pain may be severe enough to wake you during the night. Drinking milk or taking an antacid may relieve the pain and if the pain is frequent during the day, continual snacking will alleviate the pain when it occurs.

How is it diagnosed?

The test usually used to diagnose an ulcer is an endoscopy. This is a procedure in which a flexible fiber-optic tube, which relays images to a video camera, is passed through the mouth down into the stomach. This enables Dr. Treyzon to look at your esophagus, stomach, and duodenum. This procedure also allows Dr. Treyzon to perform a biopsy, which involves taking a sample of cells from the lining of the stomach or duodenum.

Dr. Treyzon also offers a quick, noninvasive breath test to check for H. pylori. This involves swallowing a fluid while breathing into a nasal cannula. Analysis of the breath samples can confirm the presence of H. pylori and may indicate the extent of the infection. This test is done in the office and takes approximately 15 minutes.

What is the treatment?

There are over ten commercially available treatment options comprised of antibiotic cocktails in conjunction with antacids. We usually choose based on your allergies, other medications you are taking, and preexisting exposure to the antibiotics in the regimen. In general, success rates are in the 80-90% range with the first round of treatment. We usually recommend one of these two options to start off with:

Regimen 1:

Amoxicillin 500 mg, 2 tablets orally twice a day for 10 days

Clarithromycin 500 mg, 1 tablet orally twice a day for 10 days

Omeprazole 20 mg, 1 tablet orally twice a day before meals for 10 days

An over-the-counter probiotic, 1 tablet twice a day for 10 days

Possible common side effects:  diarrhea, taste disturbance, stomach upset, and rash

Regimen 2:

Doxycycline 100 mg, 1 tablet orally twice a day for 10 days

Metronidazole 250 mg, 1 tablet orally four times a day for 10 days

Omeprazole 20 mg, 1 tablet orally twice a day before meals for 10 days

Pepto Bismol 262 mg, 2 tablets orally four times a day for 10 days

Possible common side effects:  taste disturbance, stomach upset, nausea, and heartburn

Even if you have no symptoms, it is important to treat and confirm eradication of the infection so that you decrease the likelihood of developing stomach cancer and stomach ulcers as a result of this chronic infection. H. pylori is the number one cause of stomach cancer worldwide. It can be easily detected and easily cured with a short course of antibiotics.  Ask Dr. Treyzon about a screening breath test at your next office visit.

Author Natalie Bransky Assistant to Dr. Treyzon

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