Helicobacter pylori: stomach bacteria, symptoms, serious?

Helicobacter pylori is a bacterium which colonizes exclusively the gastric mucosa, most often during childhood. Untreated, it persists and inflames the stomach. “She has a established role in the development of peptic ulcers and stomach cancers“explain the High Authority of Health (HAS). Most of the time Helicobacter pylori infection does not cause symptoms. SO how to know ? And is it always serious ? Answers with Dr Michael Bismuthspecialist in hepato-gastroenterology at Montpellier University Hospital.

Definition: what is Helicobacter pylori bacteria?

Helicobacter pylori is a bacteria that infects the inner lining of the stomach. I’identification of this germ in Australia in the 1990s completely challenged the pathophysiology of the ulcer gastro-duodenal which became a infectious disease. “7 out of 10 stomach ulcers are directly related to Helicobacter pylori infection and 9 out of 10 duodenal ulcers“, says Dr. Michael Bismuth. THE two doctors who discovered Helicobacter pylori received the Nobel Prize in Medicine. She is not present only in humans. It resists a very acidic environment. “The incidence of Helicobacter pylori infection is different in adults and children. In France, it is lower in people under 30 (20% of people are infected by the age of 20) and more common after age 50 (about one in two people)” indicates specialist in hepato-gastroenterology.

There contamination occurs in childhood basically for the first five years of life and goes unnoticed. “Theoretically, man can be contaminating by two means: orally or through stool. The transmission of the bacterium is mainly by direct transmission from person to person oro-oral and especially gastro-oral. That is to say that the contamination is done by a direct contact with infected saliva by regurgitation or during vomiting. Transmission through the stool, following contact through the hands or through contaminated water and food, is rarer and is found more in developing countries where hygiene is deficient” indicates the French Helicobacter Study Group (GEFH) .

Is Helicobacter pylori serious?

The main danger of a Helicobacter pylori infection is the development of a stomach cancer. According to the High Authority for Health, “of those infected, 1% develop stomach cancer“. But “even if this risk is low, Helicobacter pylori is the main cause of stomach cancer (80% of cases). The earlier the treatment takes place, the more effective it is in reducing the risk of developing this cancer.

What are the symptoms of Helicobacter pylori?

“Most of the time, inflammation is silent causing no symptoms” respond Dr Michael Bismuth. It can still lead to digestive disorders with discomfort and pain. The symptoms are then those of complications if they occur: gastritis and ulcer. “Helicobacter pylori infection can be complicated by chronic gastritis (chronic inflammation of the stomach) which persists for life if the infection is not treated”says the specialist.

Diagnosis: how do you know if you have Helicobacter pylori?

There is no no screening currently organized of Helicobacter pylori infection in France. When the search for the bacteria is decided by the doctor, he can prescribe:

• serology (blood test) to detect antibodies produced by the body to fight the bacteria
• urea breath test marked (not reimbursed by health insurance)
• stool antigen testing (not reimbursed by health insurance).
• fibroscopy with sampling of the stomach wall and analysis of these samples

To know : there looking forH. pylori is not justified for relatives if one is infected with the bacterium, except in two situations :

• They themselves present symptoms linked to a disease of the stomach (discomfort, pain).
• Precancerous or cancerous lesions have been detected in your stomach.

What are the treatments for Helicobacter pylori?

“The treatment of Helicobacter pylori and its eradication are recommended in several situations such as the presence of a peptic ulcer, chronic gastritis associated with bacteria, MALT lymphoma, dyspepsia (after endoscopic exploration), long-term PPI treatment, a personal or family history of first-degree gastric cancer“, says the specialist. There are several therapeutic strategies proposed by the gastroenterologist. The treatment is based in particular on:

• taking antisecretory drugs (to reduce acidity) such as proton pump inhibitors (PPI): Omeprazole, Esomeprazole, Rabeprazole, Lansoprazole, Pantoprazole.
• taking multiple antibiotic medications such as amoxicillinMetronidazole, Clarithromycin, Levofloxacin.
• Pylera® which is a drug composed of antibiotics and a drug based on bismuth. It is taken in combination with a PPI.

The treatment “can eliminate the infection in 80 to 90% of cases” indicates the HAS. In 10 to 20% of cases, it may fail either because the bacteria are resistant to the antibiotics used, or because of the difficulties encountered by patients in following the treatment. A control test is thus prescribed by the doctor to check if the bacteria has been eliminated. The recommended test is breath test with labeled urea (to be done on an empty stomach in the laboratory). It consists of swallow a urea solution marked and then to collect the exhaled air. If the exhaled air contains carbon dioxide, which is also marked, this means that the bacteria have transformed the urea into carbon dioxide and therefore that it is present. The breath test is contraindicated in pregnant or breastfeeding women.

Thanks to Dr. Michael Bismuth, specialist in hepato-gastroenterology at Montpellier University Hospital.