A common bacterial infection that can live in the stomach for years without causing noticeable symptoms can eventually lead to gastritis, stomach ulcers and, in some cases, an increased risk of stomach cancer.
Nikki Sommer, a nurse practitioner with Key West Surgical Group Incorporated and Med Spa, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Helicobacter pylori, commonly known as H. pylori, is more widespread than many people realize, with an estimated half of the world’s population carrying the bacteria. In North America, estimates generally range from 30 to 40 percent.
“Some people may never develop symptoms. Others can develop chronic gastritis, stomach ulcers, serious complications,” Sommer explained.
The bacteria can survive in the stomach despite its highly acidic environment. Sommer said H. pylori produces an enzyme called urease, which helps neutralize some of the acid immediately surrounding the bacteria.
“It gives itself its own little protective bubble when it’s wreaking havoc in your stomach,” she said.
H. pylori is believed to spread primarily through close person-to-person contact involving contaminated food or water. It can also spread through saliva, vomit or fecal contamination.
Sommer said the infection can be acquired during childhood, when hygiene habits may not be as well established.
Symptoms can include burning or aching pain in the upper abdomen, bloating, excessive burping, nausea, indigestion and feeling unusually full after eating only a small amount.
Some people may also experience vomiting or a decreased appetite. Sommer said discomfort can occur when the stomach is empty, between meals or during the night.
She cautioned that not every episode of heartburn or indigestion indicates an H. pylori infection. However, persistent symptoms that do not respond to typical treatments may warrant further evaluation.
H. pylori is one of the major causes of peptic ulcer disease. Sommer explained that an ulcer develops when the protective lining of the stomach or the upper portion of the small intestine becomes damaged, exposing the underlying tissue to irritation.
“An ulcer is when the protective lining in your stomach that shields it from acid erodes away,” she said. “It becomes damaged, and then the tissue underneath becomes very, very irritated.”
She also noted that prolonged use of certain pain medications, including ibuprofen, Motrin, Aleve and naproxen, can contribute to stomach ulcers.
Untreated ulcers can become dangerous, particularly if they begin bleeding.
Sommer, who previously worked in an intensive care unit, said gastrointestinal bleeding associated with ulcers was something she encountered frequently.
“Sometimes it was caused by bleeding ulcers,” she said.
Warning signs can include vomiting blood or material that resembles coffee grounds, as well as black, tarry stools. Those symptoms can indicate gastrointestinal bleeding and require immediate medical attention.
Although most people with H. pylori will never develop stomach cancer, Sommer said a persistent infection can contribute to cellular changes and increase the risk of certain cancers, including a type of stomach cancer known as MALT lymphoma.
“Not everybody that gets H. pylori is going to develop cancer,” she emphasized. “But if you have it, it’s really important that you treat it and you follow up that it’s been eradicated in your body.”
There are several ways to diagnose the infection. Noninvasive options include a urea breath test and a stool antigen test. An endoscopy may also be recommended, particularly for patients experiencing more advanced symptoms such as unexplained weight loss, vomiting or poor appetite. During an endoscopy, a physician can examine the stomach and take biopsies for testing.
Treatment typically involves multiple medications rather than a single antibiotic.
Sommer said patients may need two or three antibiotics, sometimes combined with other medications that reduce stomach acid. One possible treatment approach, known as quadruple therapy, involves two antibiotics, Pepto-Bismol and a proton pump inhibitor.
The treatment regimen can be demanding, with medications sometimes required several times a day over a 14-day period.
Compliance is particularly important, Sommer said, because failing to complete the prescribed treatment can mean having to undergo another round of therapy using a different combination of medications.
After treatment, patients also need follow-up testing to confirm the bacteria has been eliminated.
Sommer said the breath test is commonly used for that purpose, generally about four weeks after completing antibiotic treatment. Certain acid-reducing medications, including omeprazole, Nexium and pantoprazole, may need to be temporarily stopped before testing because they can affect the results. Patients should follow their healthcare provider’s instructions regarding when to discontinue those medications.
Sommer acknowledged that preventing H. pylori can be difficult because the precise ways people become infected are not always clear.
She recommended good handwashing practices and proper food handling, while noting that exposure can occur through everyday contact, dining out and travel.
She also cautioned against relying on natural remedies or over-the-counter products to eliminate the infection.
For anyone experiencing persistent upper abdominal pain, nausea, unexplained weight loss, bloating or indigestion, Sommer recommended consulting a healthcare professional, particularly if over-the-counter medications are not providing relief.
She offered three important takeaways from the discussion: stomach discomfort is not always caused by something a person has eaten; H. pylori is a common infection that can lead to gastritis and ulcers and increase the risk of certain stomach cancers; and anyone diagnosed with the infection should complete the prescribed treatment and undergo follow-up testing.
“Don’t ignore those warning signs,” Sommer said, particularly when someone continues to feel unwell or simply not like themselves.
Key West Surgical Group Incorporated and Med Spa is located at 3134 Northside Drive in Key West. The office can be reached at 305-294-1041.