The Medical Procedures Center, P.C. - PATIENT EDUCATION H. PYLORI INFECTION AND TREATMENT

The Medical Procedures Center, P.C.

"We treat people, not just problems."

John L. Pfenninger, M.D.

4800 N. Saginaw Road, Midland, MI 48640

(989) 631-4545

Visit our Website at http://www.MPCenter.net

PATIENT EDUCATION
H. PYLORI INFECTION AND TREATMENT

What is Helicobacter pylori and what does it do? Helicobacter pylori or H. pylori is a bacterium that very commonly lives in the stomach and small intestine. Most people in the U.S. actually have this bacteria living in them by the time they are 40 or 50 years old. Most people who are infected with this bacterium do not develop ulcers, but recent studies have shown H. pylori to be the most common cause of duodenal and stomach ulcers. The second most common cause for ulcers is the use of medications like aspirin or ibuprofen (Advil or Motrin) called non-steroidal antiinflammatory drugs (NSAIDS). Other causes are much less common or are unknown. Because H. pylori infections that cause ulcers can be cured with specific medication combinations, the treatment of stomach ulcers has been revolutionized. Many people who had to take acid blocking medications like Tagamet for years have been freed from the expense and hassle of taking daily medications to control their ulcer problem.

How do I know if H. pylori is a problem for me? Because H. pylori is so common and many times does not cause any sort of problem, testing for and treatment of H. pylori is only needed if you have persistent symptoms. Everyone gets heartburn occasionally, for instance after over-indulging at a holiday meal. However, if dyspepsia or heartburn symptoms are persistent enough to require daily use of antacids or acid blockers, stomach discomfort wakes you from sleep, or food or milk make stomach discomfort either better or worse, an ulcer may be present. A trial of acid blockers may be prescribed by your family doctor. If the symptoms persist for 2 weeks or if the symptoms return after 6 weeks of medication, evaluation for ulcers should be performed. Tests for the presence of H. pylori can be performed in several ways and can be done at the time of upper endoscopy when the doctor looks into the stomach with a tube.

What kind of tests are available so I can know if H. pylori is a problem for me? There are a number of different tests available for evaluating if H. pylori is present or has been present. These tests vary in how they are performed, their cost and their accuracy in determining current or past infection. Your doctor can help determine which test is best for you. Some involve a blood test, others a breath test, and still others require a biopsy. For some of the tests, use of certain prescription medications within two weeks of the test will give false negative results (Proton pump inhibitors and antibiotics are the most notable of these prescription medications). Testing for H. pylori should be done if you are found to have an ulcer of the duodenum or stomach or gastritis. Detection of and treating for H. pylori if you have other diagnoses has not been found to be helpful in controlled studies.

If I have an ulcer or recurrent gastritis and a positive test for H. pylori, how is it treated? Usually, treatment involves use of the strongest type of prescription antacid (Proton pump inhibitors) and two or three antibiotics taken daily for 1 or 2 weeks. This is a pretty tough germ and studies are continuing to determine the most effective and shortest course of medications that will eradicate this germ. There are a number of different treatment regimens or "recipes". Factors that will help you and your doctor decide which medications are going to work the best for you include whether you have used antibiotics recently. Resistance to single antibiotics is a common problem with H. pylori, and if you have used one recently, there is a greater chance that the germ will be resistant and that particular medication will not work for you. Other factors include whether you are allergic or sensitive to any of the medications. It is very important to complete the medication as prescribed because the H. pylori can develop resistance to a partial course of medication. Testing for cure of the H. pylori infection can be performed after the treatment course, but two weeks free of antibiotic and Proton pump inhibitor use are needed before you can be evaluated with a special breath test. These medications suppress the amount of germs that are present, but after they are stopped, the germ can return to numbers that may allow the ulcer or gastritis to recur.

Why shouldn’t everyone be tested for H. pylori? Because 50% of the world’s population (1.5 billion people) is estimated to be infected and most of these people are not troubled by the presence of this bacterium, the cost of testing people would be much too expensive. The maxim "If it ain’t broke, don’t fix it" seems to apply to this situation. However, if ulcer disease or gastritis are found during diagnostic testing like upper endoscopy or UGI X-rays, testing and appropriate treatment should be undertaken.