How did you cure your ideopathic gastritis

Helicobacter pylori infection (H. pylori)

Helicobacter pylori is a bacterium that settles in the mucous membrane of the stomach and can lead to various clinical pictures there. Most often it triggers inflammation (gastritis) and ulcers (ulcers) in the stomach and upper small intestine. Australians B. Marshall and J.R. Warren discovered H. pylori as early as 1983, but their discovery went unnoticed for a long time - it was not until 2005 that they received the Nobel Prize in Medicine.

Short version:

  • Helicobacter pylori is a bacterium that mainly settles in the stomach.
  • In most cases, an infection occurs in childhood and goes unnoticed for a long time.
  • Helicobacter pylori causes diseases of the upper gastrointestinal tract.
  • Treatment is carried out with several antibiotics and other drugs at the same time.

An infection with Helicobacter pylori is the most common cause of gastric mucosal inflammation (type B gastritis) and gastric or duodenal ulcer (gastric ulcer, duodenal ulcer).

Overall, around half of the world's population is infected with Helicobacter pylori. The prevalence rate in Africa is around 70%, but it is significantly lower in the western industrialized nations. There are no exact data for Austria, but it is assumed that around 19% of the population are infected with H. pylori. In Germany, 3% of children, 48% of adults and up to 86% of adults with a migration background are infected.

What is Helicobacter pylori?

H. pylori is a bacterium that settles in the lining of the stomach and damages it.

In order to survive and multiply in the acidic environment of the stomach, the bacteria have developed various strategies: On the one hand, they have the ability to form a certain protein (urease) that converts urea into ammonia and carbon dioxide. Ammonia neutralizes the aggressive stomach acid and protects H. pylori from decomposition. On the other hand, the bacteria prefer to settle in the mucous layer of the gastric mucosa, where they are even better protected from acidic gastric juice.

How does Helicobacter pylori become infected?

The transmission route has not yet been fully clarified. A fecal-oral route or an oral-oral or gastric-oral route is adopted. The bacterium is infected directly from person to person, most often already in childhood.

+++ More on the topic: Routes of infection +++

The bacteria can be found in saliva, stool and vomit. The bacterium is absorbed through contaminated water or food or through contact with vomit, saliva or stool. The close contact between family members also explains the increased occurrence of H. pylori within the family. Direct transmission between two life partners - for example when kissing - cannot be completely ruled out, but it is rather unlikely.

Whether an infection with Helicobacter bacteria develops depends on various factors:

  • Genetics: The genetically determined gastric acid production plays a major role here. Both too high and too little production can encourage ulcer formation.
  • Immune system of the affected person
  • Environment-related factors: salty and / or preserved foods
  • Resistance factors of the pathogen

What diseases can Helicobacter pylori cause?

1. Bacterial type B gastritis:

In most (90%) cases, after colonization with Helicobacter pylori, mild inflammatory processes occur. The infection often remains symptom-free for years to decades. Symptoms usually only appear after the mucous membrane is weakened or damaged by alcohol, nicotine, drugs, stress, etc.

Typical symptoms of type B gastritis are a feeling of pressure in the stomach area, a feeling of fullness, nausea and bad breath. Experience has shown that some complaints are not caused by the gastritis itself, but by the irritable bowel syndrome that also exists.

2. stomach or intestinal ulcers:

In 10% of all people infected with H. pylori, type B gastritis develops into ulcers in the region of the stomach (gastric ulcer) or the duodenum (duodenal ulcer). In ulcers in the upper gastrointestinal tract, Helicobacter is the cause of 75% of the gastric ulcer and up to 95% of the duodenal ulcer.

The symptoms of gastrointestinal ulcers are mostly unspecific and manifest themselves as pain in the epigastric region and / or in the right upper abdomen.

In the case of a gastric ulcer, the pain worsens when the patient consumes food; in the case of an intestinal ulcer, the (fasting) pain typically occurs around 90 minutes after eating and improves again as soon as the patient has eaten.

If left untreated, both gastric and intestinal ulcers can persist for weeks to months and, in addition to the unpleasant symptoms mentioned above, also lead to serious complications (bleeding, perforations, stenosis due to scarring, etc.).

+++ More on the topic: gastric ulcer +++

3. gastric cancer: 0.05% of the cases

4. MALT lymphoma: much less often

5. Special forms of gastritis: Autoimmune gastritis, lymphocytic gastritis, giant fold gastritis

6. Manifestation outside the gastrointestinal tract: idiopathic thrombocytopenic purpura (ITP), chronic recurrent urticaria, iron deficiency anemia, Parkinson's disease

How is the diagnosis made?

The diagnosis of H. pylori infection is usually made by gastroenterologists through tissue removal during a gastroscopy or through non-invasive tests. In principle, it is sufficient to detect the pathogen using one of the following detection methods:

Tissue removal during a gastroscopy:

  • Rapid urease test: detection of ammonia (sensitivity 90–95%, specificity 90–95%)
  • Histology: HE staining, Giemsa, silver staining (sensitivity 80–98%, specificity 90–98%)
  • Culture: resistance test (sensitivity 70–90%, specificity 100%)
  • PCR (sensitivity 90–95%, specificity 90–95%)
  • Molecular Tests

Non-invasive tests:

  • C13 breath test: evidence of increased CO2-Concentration (sensitivity 85–95%, specificity 85–95%)
  • Stool antigen test (sensitivity 85–95%, specificity 85–95%)
  • Serology (sensitivity 70–90%, specificity 70–90%)

Before a (re-) examination for H. pylori no antibiotics and proton pump inhibitors (PPIs) should be taken for at least four weeks.

How is a Helicobacter pylori infection treated?

Antibiotic therapy is usually initiated after H. pylori has been detected. As standard therapy, amoxicillin, clarithromycin and metronidazole are taken together with a proton pump inhibitor and a probiotic in the morning and in the evening for 14 days. The aim of this therapy is the complete elimination (eradication) of the H. pylori germ.

Hard indications for eradication according to the Maastricht consensus are:

  • symptomatic H. pylori-associated gastritis
  • Giant fold gastritis
  • H. pylori-associated gastroduodenal ulcer disease
  • positive family history for gastric cancer
  • Condition after partial gastric resection
  • MALT lymphoma
  • after resection of an early gastric cancer
  • ASA or NSAID long-term therapy

The success of the therapy should be checked by checking the H. pylori status four weeks after the last antibiotic intake at the earliest. If the germ has survived, another antibiotic therapy for complete eradication should be carried out by the attending physician. Therapy schemes with other antibiotics or combinations with bismuth and tetracycline, among others, are used.

At the latest after the second unsuccessful eradication attempt, a culture of the germ should be created so that antibiotics can then be used in a targeted manner. Trust in the specialist knowledge of your treating specialists!

How useful are Helicobacter pylori self-tests?

A large number of self-tests are offered on the Internet that either detect antibodies in the blood against Helicobacter or components of the bacterium (antigens) in the stool. However, since antibodies (the body's own defense cells) can still be detected in the blood after the infection has already survived or has been treated, the antibody test is not conclusive for the presence of an acute infection.

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Authors:
Astrid Leitner
Medical review:
Dr. Rainer Watzak
Editorial editing:
Mag. Julia Wild

Status of medical information:

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ICD-10: A49