H. pylori and Peptic Ulcers

Helicobacter pylori
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What is H. pylori?

Helicobacter pylori (H. pylori) is a bacteria responsible for most ulcers and many cases of chronic gastritis (inflammation of the stomach). This organism can weaken the protective coating of the stomach and duodenum (first part of the small intestines), allowing damaging digestive juices to irritate their sensitive linings.

How Common is H. pylori?

About half of the world's population is infected with H.

pylori. However, many people who have this organism in their gastrointestinal tract don't get an ulcer or gastritis. Research suggests that other factors must also be present for the damage to take place. The factors that increase your risk for an ulcer from H. pylori include:

  • Inheritance of certain strains of the bacteria that are more dangerous than others
  • Abnormal immune response in the intestines
  • Certain lifestyle habits, like coffee drinking, smoking, and ongoing stress

Diagnosing H. pylori

If an ulcer is found, a doctor will test a patient for H. pylori. While the most common test for the presence of H. pylori is a blood test, stool and tissue samples may also be taken.

Another diagnostic test is the urea breath test (UBT). A patient swallows a capsule containing urea, a chemical made up of nitrogen and carbon that naturally occurs in and is produced by the body. If H. pylori is present, the urea will break up into nitrogen and carbon as carbon dioxide.

The carbon dioxide is absorbed through the lining of the stomach and into the blood, then travels to the lungs. Samples of exhaled breath are collected, and the carbon dioxide is measured. This test is about 94 to 98% accurate.

An upper endoscopy can also be used as a method of diagnosis. During endoscopy, biopsy specimens of the stomach and duodenum are taken.

The diagnosis of H. pylori can be made by examining them in a lab.

Stool tests may be used to detect H. pylori infection in the patient's fecal matter. Studies have shown that this test, called the Helicobacter pylori stool antigen (HpSA) test, is accurate for diagnosing H. pylori.

How are H. pylori peptic ulcers treated?

The most commonly recommended first-line treatment is a combination of a proton pump inhibitor (PPI) and the antibiotics amoxicillin and clarithromycin for two weeks. This is sometimes given in a single prescription called "Prevpac."

A drug called metronidazole is sometimes substituted for amoxicillin when treating patients who are allergic to penicillin.

Proton pump inhibitors include:

William D. Chey, M.D., F.A.C.G., A.G.A.F., F.A.C.P., Benjamin C.Y. Wong, M.D., Ph.D., F.A.C.G., F.A.C.P., "American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection." doi: 10.1111/j.1572-0241.2007.01393.x. American College of Gastroenterology. 23 Aug 2007.

"What I need to know about Peptic Ulcers." NIH Publication No. 05–5042 October 2004. National Digestive Diseases Information Clearinghouse (NDDIC). 23 Aug 2007.

"H. pylori and Peptic Ulcer." NIH Publication No. 05–4225 October 2004. National Digestive Diseases Information Clearinghouse (NDDIC). 23 Aug 2007.

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