Zakariya Waqar-Uddin column: Helicobacter pylori – a common cause of stomach upset
It has been forty years since the discovery of helicobacter pylori, a bacterial infection we now know is a common cause of abdominal pain, heart burn, and stomach ulcers.
Prior to being identified, it was assumed that gastric ulcers (this including ulcers of the stomach and the first part of the small intestine) was mainly due to stress.
One of the scientists who discovered helicobacter pylori, often abbreviated to H. pylori, famously proved the link by ingesting a broth containing the bacteria.
Within hours he was violently ill with nausea, vomiting and abdominal pain. An endoscopy of his stomach confirmed gastritis (inflammation of the lining of the stomach).
Yet after taking a simple course of two antibiotics and one proton pump inhibitor (the most prescribed in the UK is lansoprazole), he was returned to good health.
Since this time it has been agreed that helicobacter is a common cause of gastritis, and that identification and treatment often improves symptoms.
However what is less clear is whether we should screen everyone for h. pylori, in the same way bowel screening is offered, and indeed if there is a definite link between h. pylori and two forms of stomach cancer.
Current estimates advise us that anywhere between 15 – 40 % of the UK population have helicobacter in their stomach. Yet at the same time up to 90 percent will not have any symptoms.
The bacteria are transferred in saliva and faeces. Hence kissing and poor hygiene practices can allow it to be move from one person to another, also referred to as human-to-human contact.
In areas of the world with inadequate levels of sanitation, the numbers with helicobacter infection are much higher.
It is thought that constant inflammation of the stomach due to untreated infection may be one of the reasons for an increased risk of stomach ulcers and stomach cancer.
Helicobacter pylori infection is also implicated in the development of fatty liver and ischaemic (coronary artery) heart disease, though the links are less clear.
Certain areas of the world, notably the Far East, have a far greater incidence of gastric cancer. In many of these countries, helicobacter pylori is routinely screened for. However, the evidence that identification and treatment reduce risk of developing stomach and duodenal cancer is not concrete.
A recent study in Taiwan over 5 years looked at a group of 240,000 individuals aged 50-69. Those screened for bowel cancer and helicobacter had no fewer cases of gastric cancers and deaths from stomach cancer, compared to those screened for bowel cancer alone.
In the UK we do not have a screening programme for helicobacter at present. If a person complains to their GP of abdominal pain which suggests gastritis there are two equally suitable options.
Either they will be offered a trial of a proton pump inhibitor (commonly lansoprazole or omeprazole) of the test for h. pylori.
This can either be a breath test, stool sample or blood test, though the latter cannot differentiate between current and past infection. Most GPs will advise a stool test initially.
If positive, the person will be offered a week-long course of two antibiotics and a proton pump inhibitor. In many cases this will result in improvement, though some may need a PPI for longer.
With Gaviscon, PPIs and a multitude of other antacid remedies easily available over the counter, it can be tempting to self-treat, and indeed soldier on even though you do not feel any improvement.
Though gullet and stomach cancer are thankfully rare, it is important to recognise when self-management is not working, and be mindful of the red flags for more serious disease.
These include persistent abdominal pain that does not ease, or radiates to the back, and nausea and vomiting that does not improve of its own. Constant regurgitation of stomach contents, food sticking in your gullet and passing blood in your stool should never be dismissed. Fresh red blood is likely due bleeding from lower parts of the bowel. Dark red blood, which may almost be black and tarry in appearance and consistency, is usually from the stomach, which has become digested as it passes down the gastrointestinal tract.
Sometimes fatigue that does not resolve can be a sign of stomach disease.
Any of the above warrant an urgent visit to your GP with referral for further tests as appropriate.