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

ulcer.

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

2 weeks.

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.