H Pylori: The silent killer living inside all of us

By Ritu Dokania, Friday magazine

Nov 7, 2012

It’s silent, insidious and is the cause of gastric symptoms that range from the antisocial to the downright dangerous. But why do so few people know of its existence? Ritu Dokania unveils the mysterious bacteria behind your most embarrassing symptoms...

Alisha, a 30-year-old sales manager, hated going out in public. She refused offers of evenings out with her friends, bypassed busy events and dreaded business meetings with a passion.

It wasn’t that she disliked socialising – she had always been quite gregarious at heart – but chronic gastric symptoms were making her life a misery and she preferred to hide herself away.

Although her symptoms were troublesome, ranging from bloating and mild stomach pain to flatulence and belching, they didn’t seem serious enough to seek medical advice. She did some research online and decided it could be aerophagia, which is caused by swallowing too much air, and tried to treat it by avoiding carbonated drinks and putting an end to her chewing gum and smoking habits. Yet nothing seemed to help.

Several months passed and Alisha was no longer just embarrassed by her symptoms, but was feeling uncomfortable throughout the entire day, while horrible abdominal cramps had started to keep her awake at night.She arranged an appointment with Dr Denesh Gopalan, a gastroenterologist at Welcare Hospital in Dubai. He decided to test her for the little-known bacteria, H Pylori. The diagnosis was positive.

“H Pylori is one of the most widespread infections in the world and around 60 per cent of the UAE population has it,” says Dr Gopalan. “Yet most people don’t know about this silent infection until they start suffering from gastritis or the painful effects of ulcers.”

Its presence is hard to detect, but delayed discovery can give rise to a number of problems as H Pylori is associated not only with ulcers, but also with stomach cancer and gastric malt lymphoma, which is a stomach cancer affecting the white blood cells of the immune system.

Thankfully, once the cause of Alisha’s problems had been pinpointed, her infection was easy to eradicate. “She was put on a course of antibiotics for 14 days, after which the symptoms she had been suffering from for so long subsided remarkably,” says Dr Gopalan.

H Pylori, short for Helicobacter Pylori, is a spiral-shaped bacterium that resides in the stomachs of humans and animals. Although our stomachs are lined with a protective coating to keep it safe from bacterial infections, H Pylori secretes an enzyme that neutralises stomach acid, enabling the bacteria to burrow deep into the walls of our stomachs, where it may survive undetected for decades.

The damage it causes to the mucous coating allows powerful stomach acid to get through to the sensitive lining beneath. Together, the stomach acid and H Pylori irritate the lining of the stomach or duodenum, which can cause ulcers and other complications.

The link between H Pylori and ulcers was a scientific breakthrough. Scientist Barry Marshall discovered it by deliberately ingesting broth infected with the bacteria in order to prove the connection, and in 2005 he and his colleague Robin Warren were awarded the Nobel Prize in Physiology or Medicine for their discovery, which reversed decades of doctrine that ulcers were caused by spicy food and stress.

The Centers for Disease Control and Prevention in Atlanta estimates that two-thirds of the world’s population is infected with the bacterium, making it the most widespread infection in the world.

It is most likely acquired by the ingestion of contaminated food or water, which can happen via faecal matter if food is prepared by people who do not wash their hands after using the bathroom, or in poor sanitary conditions. It can spread from person to person via saliva or by sharing food utensils and is most common in socio-economic groups characterised by crowded living conditions.

Symptoms and implications

H Pylori is often asymptomatic, meaning most people with the infection will never have any signs or symptoms. When symptoms do occur they may include burping, bloating, heartburn, oesophageal reflux, diarrhoea, constipation, flatulence and upper- and mid-abdominal pain. Difficulty losing weight may also be attributed to H Pylori, Dr Gopalan says. Having the infection causes stress and eventually cortisol.

H Pylori is also the leading cause of gastritis, an inflammation of the stomach lining. It is responsible for over 90 per cent of all duodenal ulcers and nearly 80 per cent of all gastric ulcers.

“This pernicious bacteria, which survives so easily in our stomachs, should be exterminated before it does serious harm,” says Dr Gopalan. “While it can remain in the human stomach for a long time without causing any symptoms, it may manifest into more serious diseases over time – one to two per cent of infected people are at risk of stomach cancer and the cancer gastric malt lymphoma is eight times more common in people with H Pylori than in those not infected.”

Apart from these diseases, medical researchers and doctors believe that H Pylori may be implicated in a number of non-digestive conditions including cardiovascular disorders, migraine and Raynaud’s disease (impaired circulation in the hands and feet). Surprisingly, it may also cause depression and anxiety. The happy chemical, serotonin, is largely seen in a healthy digestive system and damage to your stomach by H Pylori will lead to a shortage of this important chemical.

Detection, treatment and prevention

“When I tell my patients about this bacteria, seven out of ten of them will never have heard of it before,” says Dr Gopalan. “But I am more surprised to see that even physicians often do not think to test for this bacteria when a patient complains about the common symptoms of this infection.”

A patient’s breath can be a typical warning sign, says Dr Gopalan, as reflux directly from the stomach or higher levels of periodontal gum disease caused by the bacteria can give it a strong smell. Testing for H Pylori infection may be performed on blood, stool or breath samples or through biopsies of tissue from the lining of the gastrointestinal tract obtained during endoscopy.

H Pylori is successfully eradicated in 80 per cent of cases, but it can be a tough infection to treat, says Dr Gopalan, as it often resides in the deepest layers of the stomach. It is also important that the antibiotics are prescribed carefully.

“H Pylori quickly becomes resistant to several antibiotics when given one at a time,” says Dr Gopalan. For this reason, a ‘triple therapy’ is often employed, which consists of two types of antibiotics and a proton pump inhibitor (PPI), which is used to decrease the stomach’s acidity, allowing the inflamed stomach lining to heal. The treatment is given for ten to 14 days according to the presence and severity of the infection. After a month, the test is repeated to see if the infection has cleared.

“Some antibiotics that are recommended elsewhere in the world might not be suitable in UAE due to the bacteria’s resistance pattern here,” warns Dr Gopalan. “It is advisable to check with your doctor about whether the antibiotic prescribed is the correct one for your particular geographical area.”

Since the source of H Pylori is not yet fully known, recommendations for avoiding infection have not been made. In general, it is always wise to wash hands thoroughly, only eat food that has been hygienically prepared, and drink water from a safe, clean source.

Certain nutrients, especially vitamins A, C, and E, along with zinc, protect the stomach lining by combating free radicals, so ensure that you are not deficient in any of these. Certain probiotics (healthy bacteria) such as lactobacillus and bifidobacterium may also help protect you from H Pylori.

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