This Bacteria a Silent Killer

Bonnie - while the bacteria, C. Difficile, is presently the "bug du jour" in the media, and its devastating effects should not be taken lightly, there is another bacteria that flies under the radar because its effects are more cumulative than acute, yet can be just as devastating. Helicobacter pylori (H. pylori), a microaerophilic Gram-negative bacterium, infects the stomach of more than 50% of the human population worldwide and is a major cause of chronic gastritis, peptic ulcer, mucosa-associated lymphoid tissue (MALT) lymphoma, gastric cancer, and is also associated with coronary artery disease and its risk factors such as diabetes mellitus, atherogenic lipids and low-grade inflammation. A clinical review in the April issue of the New England Journal of Medicine provides information on how to detect, diagnose, treat, and manage Helicobacter pylori infection.

Methods of Testing
Routine testing for H pylori infection is not recommended because the vast majority of patients with this infection do not have any associated clinical disease. However, confirmed gastric or duodenal ulcers and gastric MALT lymphoma are definite indications for detecting and treating H pylori infection. After surgical removal of early gastric cancers, it may also be reasonable to test for and eradicate H pylori infection.
Bonnie - I disagree with this. While H.pylori is something I focus on after many other gastrointestinal issues are ruled out, it surely has its merits as a preventative screening tool. I have discovered and help eradicate H. pylori in many of my clients, including my own husband, well before ulcers and cancer occurred.

For younger patients with upper gastrointestinal tract symptoms but without alarm symptoms such as weight loss, persistent vomiting, or gastrointestinal tract bleeding, it is reasonable to use a noninvasive test-and-treat strategy for H pylori infection.

Options for noninvasive testing include the urea breath test, fecal antigen test, and serologic test. Patients with positive test results should undergo eradication therapy. For patients with alarm symptoms, or for older patients with new-onset dyspepsia, endoscopy is recommended.

Treatments
Antibiotics (twice per day for 7-14 days) with short-term Proton Pump Inhibitor therapy is the standard treatment to eradicate H. pylori. However, a percentage of H. pylori strains have become antibiotic-resistant.
Bonnie - while the NEJM recommends treating with two specific antibiotics, I always recommend that your physician cultures your H. pylori strain against several classes of antibiotics to discover which will be the most effective for eradication.

After Eradication Therapy: What Next?
Retesting to make sure the treatment was successful may include a urea breath test or fecal antigen test performed at least 4 weeks after treatment is completed, so that false-negative results from suppression of H pylori are avoided.

When treatment fails to eradicate H pylori infection, therapeutic options include empiric acid-inhibitory therapy, endoscopy to detect underlying ulcer or another cause of symptoms, and subsequent use of the noninvasive test-and-treat strategy. Clinicians should also consider another cause for the symptoms, such as biliary tract, pancreatic, musculoskeletal, or cardiac disease or psychosocial stress. Poor compliance with initial treatment may also be implicated and mandates adherence to the second treatment regimen.

Cardiovascular Disease and Diabetes
Many studies have revealed a close relationship between H, pylori (HP) infection and insulin resistance. The aim of this study in the April issue of Southern Medical Journal was to investigate the effects of H. pylori eradication on insulin resistance, serum lipids and low-grade inflammation. The study confirms the beneficial effects of H. pylori eradication on insulin resistance, atherogenic lipid abnormalities and low-grade inflammation, and in turn, may prevent coronary artery disease and metabolic syndrome.

H. pylori in the Elderly
Eradication of H. pylori infection improved gastric muscle atrophy (gastritis) and prevented the progression of intestinal metaplasia (the transformation of mucosa, particularly in the stomach, into glandular mucosa resembling that of the intestines, although usually lacking villi.) in the elderly population during the long-term follow-up periods. H. pylori eradication for the elderly population is effective according to this study in the April issue of Journal of Gastroenterology and Hepatology.

Bonnie - if conventional treatment is not effective, zinc carnosine is a dietary supplement with 24 research studies behind it. I have found it to be effective in limiting the effects of H. pylori in those who have it, have had it in the past, or have a family history of it and want to be proactive.

Have you had H. pylori? If so, feel free to share your experience below.