H. Pylori Infection Essay, Research Paper
Millions of people around the world suffer from ulcers. An ulcer is a sore or hole
in the lining of the stomach or duodenum (the first part of the small intestine).
People of any age can get an ulcer and women are affected just as often as men.
With stomach ulcers, H. pylori infection is found in 60 to 80 percent of the cases.
Again, it is still uncertain how the infection acts to cause the ulcer. It probably
weakens the protective mucous layer of the stomach. This allows acid to seep in
and injure the underlying stomach cells. However, there is still a great deal of
research to be done to unravel this relationship. In times past, physicians were
taught “no acid, no ulcer.” The medical profession felt the single most important
factor causing duodenal ulcers to form was strong stomach acid. Research has
now shown that over 90% of all patients who develop duodenal ulcers have H.
pylori infection in the stomach as well. Medical studies are under way to
determine the relationship between the two and how an infection in the stomach
can be related to a duodenal ulcer. Acid is still important; patients without acid
in the stomach never get duodenal ulcers. However, physicians now accept the
fact that the infection is directly related to the development of duodenal ulcers. It
is now rather easy to clear duodenal ulcers with the strong acid-reducing
medicines available. But, the ulcers will usually recur unless the H. pylori
infection is also cleared from the stomach.
Although we use to think that spicy food, acid, and stress were the major
causes of ulcers, we now know that nine out of ten ulcers are caused by H.
pylori. Helicobacter Pylori is a specific bacteria that can cause infection of the
stomach. This infection can contribute to the development of diseases, such as
dyspepsia (heartburn, bloating and nausea), gastritis (inflammation of the
stomach), and ulcers in the stomach and duodenum. It will be useful to know
some things about the upper digestive tract to understand how and where
Helicobacter pylori infection can occur. H. pylori is a fragile bacteria that has
found an ideal home in the protective mucous layer of the stomach. These
bacteria have long threads protruding from them that attach to the underlying
stomach cells. The mucous layer that protects the stomach cells from acid also
protects H. pylori. These bacteria do not actually invade the stomach cells as
certain other bacteria can. The infection, however, is very real and it does cause
the body to react. Infection-fighting white blood cells move into the area, and the
body even develops H. pylori antibodies in the blood. H. pylori infection
probably occurs when an individual swallows the bacteria in food, fluid, or
perhaps from contaminated utensils. The infection is likely one of the most
common worldwide. The rate of infection increases with age, so it occurs more
often in older people. It also occurs frequently in young people in the developing
countries of the world, since the infection tends to be more common where
sanitation is poor or living quarters are cramped. In many cases it does not
produce symptoms. In other words, the infection can occur without the person
knowing it. The infection remains localized to the gastric area, and probably
persists unless specific treatment is given. Medicines that reduce stomach acid
may make you feel better, but your ulcer may come back. Since most ulcers are
caused by this bacterial infection, they can be cured for good with the right
antibiotics. The main cause for ulcers in eating disorder patients is the irregular
eating habits. When there is no food in the stomach for long periods of time the
stomach acid simply starts eating away at the lining. Similarly when there is too
much food in the stomach for long periods of time it will damage the tissues.
Those irritations then develop into the open sores known as ulcers.If ulcers are
not treated complications such as serious weight lose, leading to malnutrition,
the risk of bleeding, which can eventually lead to anemia, and also complete
penetration of the stomach lining called perforation.
The most common ulcer symptom is a gnawing or burning sensation in the
abdomen between the breastbone and the belly button. The pain often occurs
when the stomach is empty, between meals and in early morning hours, but can
occur at anytime. It may last anywhere between minutes and hours and may be
relieved by either eating or taking antacids. Less common symptoms include
nausea, vomiting, or loss of appetite. Sometimes ulcers bleed. If bleeding
persists, it may lead to anemia with weakness and fatigue. If bleeding is heavy it
may appear in vomit r bowel movements. Complications from stomach ulcers
may include serious weight loss leading to malnutrition and the risk of bleeding,
which can lead to anemia, (a condition were the body does not have enough red
blood cells to carry oxygen). Another risk is that the ulcer may go through the
wall of the stomach causing what is called a perforation. People who are having
frequent pain in their stomach should see there doctor for treatment, as ulcers
can be serious. People should not attempt to treat themselves with
over-the-counter medications because delaying treatment could be dangerous.
To determine if you have an ulcer, the doctor may do several tests. An
x-ray called a barium swallow or upper GI may be done to see if there is an
There are quiet a few other ways for a physician to locate an ulcer. The
first test that may be performed is an endoscopy This is a test in which a small
tube with a camera inside is inserted through the mouth and into the stomach to
look for ulcers. During the Endoscopy, small samples of the stomach lining can
be obtained and tested for H. pylori using the chemical called PyloriTek.The
second test is called the C13 urea breath test non-invasive and non-radioactive.
.This a breath test that can determine if you are infected with H. pylori. In this
test, you drink a harmless liquid and in half an hour, a sample of your breath is
tested for H. pylori. The last test I will describe is a triple-antibiotic therapy for
peptic ulcer disease.Patients who have had two or more ulcer episodes are
candidates for antibiotic therapy. Those patients experiencing their first ulcer
episode should not be treated with antibiotics, since one third of such patients
will not have a recurrence anyway, and antibiotics are not without problems –
they are expensive and inconvenient, they have associated side effects, and they
may induce antibiotic resistance in H. pylori. The best regimen to have emerged
for eradicating H. pylori consists of a bismuth compound combined with two
other antimicrobial agents — for example, tetracycline or amoxicillin plus
metronidazole — with all three agents given for 14-16 days. Bismuth salts (e.g.,
PeptoBismol) are reasonably effective topical antimicrobial agents that penetrate
the mucous layer of the stomach and reach the gastric crypts in sufficiently high
concentrations to kill H. pylori. Bismuth also helps reduce the development of
antibiotic resistance in H. pylori. Since bismuth compounds are inexpensive and
well tolerated, there is no advantage to not using them.
Doctors treat stomach and duodenal ulcers with several types of medicines
including H2-blockers, acid pump inhibitors, and mucosal protective agents.
When treating H. pylori, these medications are used in combination with
antibiotics. Most doctors treat ulcers with acid-suppressing drugs known as
H2-blockers. These drugs reduce the amount of acid the stomach produces by
blocking histamine, a powerful stimulant of acid secretion. H2-blockers reduce
pain significantly after several weeks. For the first few days of treatment, doctors
often recommend taking an antacid to relieve pain.Initially, treatment with
H2-blockers lasts 6 to 8 weeks. However, because ulcers recur in 50 to 80 percent
of cases, many people must continue maintenance therapy for years. This may no
longer be the case if H. pylori infection is treated. Most ulcers do not recur
following successful eradication. Nizatidine (Axid) is approved for treatment of
duodenal ulcers but is not yet approved for treatment of stomach ulcers.
H2-blockers that are approved to treat both stomach and duodenal ulcers are:
Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid). Like
H2-blockers, acid pump inhibitors modify the stomach’s production of acid.
However, acid pump inhibitors more completely block stomach acid production
by stopping the stomach’s acid pump–the final step of acid secretion. The FDA
has approved use of omeprazole for short-term treatment of ulcer disease.
Similar drugs, including lansoprazole, are currently being studied. Mucosal
protective medications protect the stomach’s mucous lining from acid. Unlike
H2-blockers and acid pump inhibitors, protective agents do not inhibit the
release of acid. These medications shield the stomach’s mucous lining from the
damage of acid.
It is found that the most effective therapy, according to the NIH Panel, is a
2-week, triple therapy. This regimen eradicates the bacteria and reduces the risk
of ulcer recurrence in 90 percent of people with duodenal ulcers. People with
stomach ulcers that are not associated with NSAIDs also benefit from bacterial
eradication. While triple therapy is effective, it is sometimes difficult to follow
because the patient must take three different medications four times each day for
Typical 2-week, triple therapy: Typical 2-week, dual therapy:
Metronidazole 4 times a day Amoxicillin 2 to 4 times a day, or
clarithromycin 3 times a day
Tetracycline (or amoxicillin) 4 times a day Bismuth subsalicylate 4 times a day
Omeprazole 2 times a day
In the past, doctors advised people with ulcers to avoid spicy, fatty, or
acidic foods. However, a bland diet is now known to be ineffective for treating or
avoiding ulcers. No particular diet is helpful for most ulcer patients. People who
find that certain foods cause irritation should discuss this problem with their
doctor. Smoking has been shown to delay ulcer healing and has been linked to
ulcer recurrence; therefore, persons with ulcers should not smoke. Drinking,
smoking and caffeine intake should be in moderation. People who take aspirin
and ibuprofen may be told to avoid these medications.
Jacintha S. Cauffield, Pharm.D. of Clinical Pharmacy Fellow, University of
Florida, Gainesville, Fla. has done research that proves the stomach’s inability to
defend itself against the powerful digestive fluids, acid and pepsin, contributes
to ulcer formation. The stomach defends itself from these fluids in several ways.
One way is by producing mucus–a lubricant-like coating that shields stomach
tissues. Another way is by producing a chemical called bicarbonate. This
chemical neutralizes and breaks down digestive fluids into substances less
harmful to stomach tissue. Finally, blood circulation to the stomach lining, cell
renewal, and cell repair also help protect the stomach.
Speaking in a first hand point of view, ulcers are extremely painful and
uncomfortable. I first realize that there might be a problem approximately two
summers go when a persistent burning sensation overcame my abdomen mostly
every day in the early morning. When I first approached my pycisain with my
discomfort he asked me to retreat home and return if the problem wasn?t to
decrease. Since the pain, if anything, increased, my doctor sent me to get what I
now know as a urea breath test. At first, when I swallowed the chalk-like tasting
liquid my mouth and throat instantly got dry, leaving after only a few moments.
When the breath test appeared positive with the presence of H. Pylori, my doctor
gave me a strict set of dietary rules to follow and then I was placed upon a
two-week therapy. Though, the constant medication was bothersome, all
symptoms lessened and than demolished entirely. The only advice I would give
anyone concerning ulcers, is try to eat right, and not to get tormented about petty
things. Ulcers, ultimately feel like a burning inferno tucked below your skin.