Helicobacter bacterium: symptoms, causes and treatment

Photo: Helicobacter pylori bacterium in the stomach (treatment, symptoms)

Abdominal pain, nausea, belching of air - all this may indicate that a dangerous, harmful Helicobacter bacterium has settled in the body, the treatment of which must be serious and thorough. Helicobacter pylori is a very dangerous pathogenic microorganism that can lead to gastric and duodenal ulcers, gastritis and other diseases dangerous to the digestive system.

Helicobacter was first discovered only 30 years ago. Medical research conducted since that time has proven that gastritis can have an infectious etiology. Also, according to studies of this bacterium, scientists have proven that, according to statistics, 75% of cases of stomach cancer in developed countries are caused by Helicobacter. In developing countries, this figure is even more frightening: 90% of patients with stomach cancer contracted the disease due to Helicobacter pylori.

Thus, it is worth pointing out the special role of early diagnosis of gastritis and gastric ulcers. It is a timely visit to a doctor that can save health and life.

• What is the Helicobacter bacterium?
• What happens in the body
• Causes of Helicobacter pylori infection
• Symptoms
• Diagnostics Cytological examination
• Urease test
• Other tests

What it is?

Helicobacter pylori is just a bacterium that is found in patients with various diseases of the stomach and intestines, the duodenum in particular.

As for the name of the bacterium Helicobacter pylori, it is not at all accidental. One part of it, “pylori”, indicates the main habitat of the bacterium - the pyloric section of the stomach, and the second part, “heliko”, characterizes the shape of the bacterium: helical, spiral.

Previously in medicine it was believed that a microorganism capable of surviving in the acidic, salty environment of the stomach did not exist in principle. But then doctors did not suspect the existence of Helicobacter. Helicobacter pylori was discovered only in 1979 by Australian scientist Robin Warren. Together with scientific colleague Dr. Barry Marshall, the “discoverers” managed to grow this Helicobacter bacterium in laboratory conditions. Then they only assumed that it was she who was the culprit of gastritis and stomach ulcers, and not unhealthy diet or stress, as previously thought.

In an attempt to confirm the correctness of his guess, Barry Marshall conducted an experiment on himself by drinking the contents of a Petri dish in which Helicobacter pylori was cultivated. Just a few days later, the scientist was diagnosed with gastritis. He was cured by taking metronidazole for two weeks. And already in 2005, the authors of this discovery, scientists, received the Nobel Prize in the field of medicine for their discovery. The whole world has recognized that ulcers and gastritis, with all the resulting and associated diseases, appear precisely because of Helicobacter.

How can you get infected?

Infection occurs when bacteria are transmitted from one person to another through the fecal-oral or oral-oral route. In addition, there are hypotheses about the transmission of this bacteria from cats to humans, as well as about its mechanical transfer by flies.

Most often, infection occurs in childhood. The most likely route of infection is transmission of Helicobacter pylori from person to person, which can occur in three ways:

1. Iatrogenic (caused by medical procedures) pathway. In this case, infection is caused by the use of an endoscopic or other medical instrument that came into contact with the gastric mucosa of an infected patient in another person.
2. Fecal-oral route. H. pylori is shed in the stool of infected people. The source of infection can be water or food contaminated with feces.
3. Oral-oral route. There is evidence that Helicobacter pylori can be present in the oral cavity. Therefore, transmission of bacteria is possible through sharing cutlery and toothbrushes, or kissing.

Bismuth preparations

Bismuth was one of the first drugs to eradicate H. pylori. There is evidence that bismuth has a direct bactericidal effect, although its minimum inhibitory concentration (MIC - the smallest amount of drug that inhibits the growth of a pathogen) against H. pylori is too high. Like other heavy metals such as zinc and nickel, bismuth compounds reduce the activity of the enzyme urease, which is involved in the life cycle of H. pylori. In addition, bismuth preparations have local antimicrobial activity, acting directly on the bacterial cell wall and disrupting its integrity.

What happens in the body?

At the initial stage, after entering the stomach, H. pylori, quickly moving with the help of flagella, overcomes the protective layer of mucus and colonizes the gastric mucosa. Having established itself on the surface of the mucous membrane, the bacterium begins to produce urease, due to which the concentration of ammonia increases in the mucous membrane and the layer of protective mucus near the growing colony and the pH rises. By a negative feedback mechanism, this causes an increase in the secretion of gastrin by the cells of the gastric mucosa and a compensatory increase in the secretion of hydrochloric acid and pepsin, with a simultaneous decrease in the secretion of bicarbonates.

Mucinase, protease and lipase produced by the bacterium cause depolymerization and dissolution of the protective stomach mucus, as a result of which hydrochloric acid and pepsin gain direct access to the exposed gastric mucosa and begin to corrode it, causing a chemical burn, inflammation and ulceration of the mucous membrane.

The endotoxin VacA produced by the bacterium causes vacuolation and death of gastric epithelial cells. Products of the cagA gene cause degeneration of gastric epithelial cells, causing changes in cell phenotype (cells become elongated, acquiring the so-called “hummingbird phenotype”). Attracted by inflammation (in particular, the secretion of interleukin-8 by cells of the gastric mucosa), leukocytes produce various inflammatory mediators, which leads to the progression of inflammation and ulceration of the mucosa; the bacterium also causes oxidative stress and triggers the mechanism of programmed cell death of gastric epithelial cells.

Pathogenesis

Not all patients infected with Helicobacter subsequently develop a bacteria-dependent pathology. Colonization of microorganisms on the gastric mucosa occurs through the adhesion of bacteria to epithelial cells. The attachment process occurs due to specific receptor interactions.

Patients with blood type O (one) express adhesion membrane receptors in much greater quantities than those with blood type AB (blood group four). This explains the greatest predisposition to the formation of ulcers in people with the first blood group.

One of the risk factors for the development of duodenal ulcers is gastric metaplasia of the duodenal mucosa, which over time becomes colonized by Helicobacter pylori. The above-described gastric ectopic epithelium occurs in 30% of people. Gastric metaplasia is formed as a result of excessive secretion of hydrochloric acid with the reflux of contents into the duodenum and the subsequent development of nonspecific duodenitis . Predisposing factors include genetic predisposition and the use of drugs from the NSAID group.

Disruption of the structure of the gastroduodenal mucosa can be the result of exposure to several bacterial factors. Almost all strains of Helicobacter produce a huge amount of urease , under the influence of which urea is hydrolyzed to carbon dioxide and ammonia. Ammonia in large quantities has a damaging effect on epithelial cells. Under the influence of other bacterial enzymes, the protective layer of the mucous wall is destroyed.

Misconceptions about Helicobacter pylori

Often, when Helicobacter pylori is detected, patients begin to worry about their eradication (destruction). The mere presence of Helicobacter pylori in the gastrointestinal tract is not a reason for immediate treatment with antibiotics or other agents. In Russia, the number of Helicobacter pylori carriers reaches 70% of the population and the vast majority of them do not suffer from any diseases of the gastrointestinal tract. The eradication procedure involves taking two antibiotics (for example, clarithromycin and amoxicillin).

In patients with hypersensitivity to antibiotics, allergic reactions are possible - from antibiotic-associated diarrhea (not a serious disease) to pseudomembranous colitis, the likelihood of which is low, but the percentage of deaths is high. In addition, taking antibiotics negatively affects the “friendly” microflora of the intestine and genitourinary tract and contributes to the development of resistance to this type of antibiotic. There is evidence that after successful eradication of Helicobacter pylori, reinfection of the gastric mucosa is most often observed over the next few years, which after 3 years is 32±11%, after 5 years - 82–87%, and after 7 years - 90.9% ( Zimmerman Ya.S.).

Until pain appears, helicobacteriosis should not be treated. Moreover, it is generally not recommended to carry out eradication therapy in children under eight years of age, because their immunity has not yet been formed and antibodies to Helicobacter pylori are not produced. If they are eradicated before the age of 8, then a day later, after briefly interacting with other children, they will “catch” these bacteria (P.L. Shcherbakov).

Helicobacter pylori clearly requires eradication if the patient has a stomach or duodenal ulcer, MALTOMA, or if he has had a gastric resection for cancer. Many reputable gastroenterologists (not all) also include atrophic gastritis in this list. Helicobacter pylori eradication may be recommended to reduce the risk of developing stomach cancer. It is known that at least 90% of cases of stomach cancer are associated with H. pylori infection (Starostin B.D.).

Possible side effects

Approximately 15-20% of patients treated with H. Pylori antibiotics experience side effects.

The main ones include:

• abdominal pain;
• cough;
• diarrhea;
• metallic taste in the mouth;
• allergic reaction;
• nausea and vomiting;
• headache and dizziness;
• photosensitivity;
• Women may experience vaginal discharge.

In 5% of cases, negative consequences such as hepatitis, baldness, heart rhythm disturbances, and toxic damage to the central nervous system are observed.

Symptoms and first signs

The development of infection in the digestive tract for a long time is practically asymptomatic. Bacteria attach to the mucous membrane of the intestine and duodenum, producing a toxic enzyme that gradually eats away the cells of epithelial tissues.

Only when erosions and ulcers appear on the walls of the organ does the patient begin to be bothered by the unpleasant symptoms of Helicobacter pylori:

• feeling of bloating and fullness in the stomach after eating;
• frequent belching with an acidic taste in the mouth;
• stomach pain regularly;
• there is a burning sensation in the esophagus, a bitter taste in the mouth;
• regular attacks of nausea, vomiting;
• increased gas formation, which provokes colic and discomfort.

In adults, unpleasant signs of Helicobacter pylori bacteria appear most often after eating and do not go away even after bowel movements. The patient is overcome by lethargy, loss of strength, drowsiness, and irritability. The presence of helicobacter pylori in the stomach or duodenum may be accompanied by a small skin rash, particularly on the face. With gastritis or ulcers caused by Helicobacter pylori, the patient complains of changes in stool (constipation or diarrhea), bad breath, brittle nail plate and constant general malaise.

Is it necessary to treat Helicobacter pylori?

It is irrational to prescribe antibacterial treatment to every second person, although the consequences of helicobacter pylori infection can lead to serious complications. First of all, it is gastritis and peptic ulcer disease, affecting the stomach and duodenum. Untreated pathologies of the digestive system with reduced immunity transform into malignant formations and can cause bleeding, perforation of the stomach wall, sepsis and death.

When to start therapy for heliobacteriosis, what to take, how long the course of treatment lasts - all these questions will be answered by a qualified specialist from a medical institution.

What diseases can be caused by H. pylori

The presence of H. pylori in the stomach is not a disease in itself. However, these bacteria increase the risk of developing various diseases of the digestive tract.

Although colonization of the gastric mucosa by Helicobacter causes histological gastritis in all infected individuals, only a small proportion of them develop clinical symptoms of this disease. Scientists estimate that 10-20% of people infected with Helicobacter pylori develop ulcers, and 1-2% develop stomach cancer.

Diseases the development of which is associated with Helicobacter pylori infection:

1. Gastritis is an inflammation of the gastric mucosa. Soon after infection with H. pylori, a person develops acute gastritis, sometimes associated with dyspepsia or nausea. An acute inflammatory process affects the entire stomach and leads to a decrease in acid secretion. After a certain period of time after acute gastritis, chronic gastritis develops.
2. Ulcer of the stomach and duodenum. According to scientific data, 70-85% of all stomach ulcers and 90-95% of all duodenal ulcers are caused by bacteria
3. Functional dyspepsia is pain in the upper abdomen that is not caused by an ulcer or other stomach lesions. Scientific research has shown that some types of dyspepsia are associated with infection. Treatment to eradicate the bacteria provides relief for many patients with functional dyspepsia and also reduces the risk of developing stomach ulcers and cancer in the future.
4. Stomach cancer. Helicobacter pylori is a scientifically recognized etiological factor in the development of stomach cancer. According to one hypothesis, bacteria promote the production of free radicals and increase the risk of mutations in stomach cells.
5. MALT lymphoma of the stomach. The infection's association with this disease was first reported in 1991. This bacterium is believed to cause 92-98% of gastric MALT lymphomas.

Diagnostics

To detect infection in the body, various examination methods are used, each of which has its own advantages, disadvantages and limitations. Traditionally, all methods are divided into non-invasive and invasive.

Invasive detection methods:

1. Histological examination - examination of specially stained samples of stomach tissue obtained through biopsy during endoscopic examination under a microscope.
2. Microbiological seeding and isolation of Helicobacter bacteria. To obtain material for culture, a biopsy or a sample of gastric juice is used, which is obtained during an endoscopic examination.
3. Polymerase chain reaction (PCR) - can detect infection in small tissue samples obtained through biopsy.
4. Rapid urease test - this method uses the ability of bacteria to process urea. The tissue sample obtained by biopsy is placed in a medium containing urea and a pH indicator. Bacteria break down urea into carbon dioxide and ammonia, which increases the pH of the medium and changes the color of the indicator.

Non-invasive detection methods:

1. Serological blood tests that can detect antibodies to Helicobacter.
2. Urea breath test. During this examination, the patient is given a solution with urea, the molecule of which contains a labeled carbon isotope, to drink. Helicobacter breaks down urea into ammonia and carbon dioxide, which contains a labeled carbon atom. This gas enters the bloodstream and is expelled through the lungs with air. Half an hour after consuming the urea solution, the patient exhales into a special bag, in which a labeled carbon atom is detected using spectrometry.
3. Detection of H. pylori antigens in stool.

How to get rid of Helicobacter pylori?

In 2021, an acceptable regimen for Helicobacter pylori eradication in adults is considered to be a treatment regimen that provides at least 80% of effective re-examination-confirmed cure for Helicobacter pylori infection and healing of ulcers or gastritis, lasting no more than 14 days and having acceptably low toxicity (side effects should develop in no more than 10-15% of patients and in most cases not be so serious as to require early cessation of treatment).

New schemes and protocols for Helicobacter eradication are constantly being developed. This serves several purposes:

• increasing the convenience of treatment for patients and the degree of their compliance with the treatment regimen: eliminating the need for a strict “anti-ulcer” diet
• thanks to the use of powerful proton pump inhibitors;
• reducing the duration of treatment (from 14 to 10, then 7 days);
• reducing the number of drugs taken simultaneously through the use of combination drugs;
• reducing the number of doses per day due to the use of prolonged forms of drugs or drugs with a long half-life (T1/2);
• reducing the likelihood of unwanted side effects;
• overcoming the growing resistance of Helicobacter to antibiotics;
• meeting the need for alternative treatment regimens if there is an allergy to any of the components of the standard regimen or if the initial treatment regimen has failed.

In 2021, Maastricht-IV experts recommended the following Helicobacter pylori eradication regimens:

Treatment regimen recommended at the Maastricht-IV conference

Triple therapy was proposed at the first Maastricht conference and has become a universal treatment regimen for H. pylori infection. It is recommended by all world conciliation conferences.

The regimen includes drugs:

• one of the proton pump inhibitors (PPIs) in a “standard dosage” (omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, esomeprazole 20 mg, or rabeprazole 20 mg twice a day) for at least 7 days
• Clarithromycin (500 mg 2 times a day) 7 days
• amoxicillin (1000 mg 2 times a day) or metronidazole (500 mg 2 times a day) 7 days.

It has been shown that the regimens of PPI + clarithromycin + metronidazole (tinidazole) and PPI + clarithromycin + amoxicillin are equivalent. It has been established that the effectiveness of triple therapy increases when its duration is increased to 10 or 14 days (depending on the degree of Helicobacter pylori contamination and the patient’s tolerance to therapy).

Treatment regimen recommended by the Russian Society of Gastroenterologists

Due to different resistance to antibiotics in different regions of the world, the prevalence of different strains of Hp, and the genetic characteristics of the population, different countries or groups of countries develop their own recommendations regarding the eradication of Hp. Some of these parameters, in particular HP resistance to certain antibiotics, change over time. The choice of a specific regimen is also determined by the patient’s individual intolerance to the drugs, as well as the sensitivity of the HP strains with which the patient is infected.

At the congress of the Scientific Society of Gastroenterologists of Russia, the following HP eradication schemes were adopted; they are relevant for 2019:

1) First option. Three-component therapy, including the following drugs, which are taken for 10-14 days:

• one of the PPIs in a “standard dosage” 2 times a day +
• amoxicillin (500 mg 4 times a day or 1000 mg 2 times a day) +
• clarithromycin (500 mg 2 times a day), or josamycin (1000 mg 2 times a day) or nifuratel (400 mg 2 times a day).

2) Second option. Four-component therapy, including in addition to the drugs of option 1 bismuth drug, its duration is also 10-14 days:

• one of the PPIs in a “standard dosage” +
• amoxicillin (500 mg 4 times a day or 1000 mg 2 times a day) +
• clarithromycin (500 mg 2 times a day), or josamycin (1000 mg 2 times a day), or nifuratel (400 mg 2 times a day) +
• bismuth tripotassium dicitrate 120 mg 4 times a day or 240 mg 2 times.

3) Third option. If the patient has atrophy of the gastric mucosa with achlorhydria confirmed by intragastric pH-metry and it is therefore inappropriate to prescribe acid-suppressing drugs (PPN or H2 blockers), the third option is used (lasting 10-14 days):

• amoxicillin (500 mg 4 times a day or 1000 mg 2 times a day) +
• clarithromycin (500 mg 2 times a day), or josamycin (1000 mg 2 times a day), or nifuratel (400 mg 2 times a day) +
• bismuth tripotassium dicitrate (120 mg 4 times a day or 240 mg 2 times a day).

4) Fourth option. If full eradication therapy is not possible for elderly patients, truncated regimens are used:

• one of the PPIs in a “standard dosage” +
• amoxicillin (500 mg 4 times a day or 1000 mg 2 times a day) +
• bismuth tripotassium dicitrate (120 mg 4 times a day or 240 mg 2 times a day).

Another way: bismuth tripotassium dicitrate 120 mg 4 times a day for 28 days. If you have pain in the stomach, take a short course of PPI.

List of sources

• Hulst RWM, Keller JJ, Rauws EAJ, Tytgat GNJ Regular issues of “Breast Cancer” No. 5 dated 03/03/1997, Gastroenterology, “Treatment of Helicobacter pylori infection”
• Loranskaya I.D., Stepanova E.V., Rakitskaya L.G., Mamedova L.D. Regular issues of “Breast Cancer” No. 13 dated July 13, 2015, Gastroenterology “Helicobacter pylori eradication - ways to achieve effectiveness”
• Ivashkin V.T., Maev I.V., Lapina T.L., Sheptulin A.A. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of Helicobacter pylori infection in adults // RZHGGK. 2012. No. 1

Possible complications from antibiotic treatment

Factors that increase the risk of side effects during eradication therapy:

1. Individual intolerance to drugs;
2. Presence of somatic pathologies;
3. Negative state of intestinal microflora during the initial period of treatment.

Complications of eradication therapy – side effects:

1. An allergic reaction to drug components that disappears after discontinuation;
2. Dyspeptic symptoms of the gastrointestinal tract (discomfort in the stomach and intestines, taste of bitterness and metal, nausea and vomiting, diarrhea, flatulence). Usually all these phenomena disappear spontaneously after a short time. In rare cases (5-8%), the doctor prescribes medications against vomiting or diarrhea, or cancels the course.
3. Dysbacteriosis. It more often manifests itself in patients who previously had gastrointestinal dysfunction, and develops during treatment with tetracycline drugs or during therapy with macrolides. A short-term course is not able to upset the balance of intestinal microflora; to prevent dysbiosis, you need to consume fermented milk products more often: yogurt, kefir.

Risk factors

Among the risk factors are the following:

• male gender and middle age;
• inadequate social and living conditions;
• ignoring the rules of personal hygiene;
• the presence of a microorganism in parents;
• working with carriers of bacteria (medical staff);
• promiscuity;
• swimming in open springs and drinking water from them;

It is worth noting that strong immunity is not always able to protect against bacteria. It multiplies well in the intestines even with normal natural defenses, since it can hide from immune mechanisms.

Nutrition and diet

Of course, the main point in the treatment of this pathology is taking medications, but proper nutrition plays an equally important role. To easily get rid of helicobacteriosis, you should follow the following recommendations:

• do not take long intervals between meals;
• eat food in small portions;
• follow a diet of 5-6 meals a day, eating slowly, chewing food well and drinking it with enough liquid;
• the patient should avoid excessively fatty, fried or spicy foods, carbonated drinks, pickled foods, and alcohol.

In reality, these are only general recommendations; in each individual case, nutrition should be calculated based on the level of acidity (low, high) and prescribed only by the specialist conducting the treatment.

Prevention

You can completely recover from helicobacteriosis if, in addition to therapy, you adhere to preventive measures:

1. Maintaining hygiene. Wash your hands before eating, do not consume dirty vegetables and fruits, or questionable water. Do not use other people's household items.
2. Timely detection of the disease. If you feel unwell or suspect the presence of a pathogenic bacterium in the body, it is important to immediately consult a doctor and undergo the necessary tests.
3. Strengthening the immune system. A healthy lifestyle (swimming, running, walking) increases your defenses and prevents pathogens from entering the body.
4. Proper nutrition. Small meals, small doses and avoidance of fried, salty, spicy, smoked foods, alcohol and smoking.

The main danger of helicobacter pylori is that it can provoke gastritis, ulcers, even malignant neoplasms. It is impossible to get rid of harmful bacteria without antibiotics. Therefore, it is important to strictly adhere to special treatment regimens and observe preventive measures.

Therapy

The Helicobacter treatment regimen involves 3 lines of specialized antibacterial therapy. The effectiveness of therapy is only possible if the patient is prescribed antibiotics .

Treatment is not started without research results. The doctor first examines the Helicobacter test and tests. Comprehensive therapy is prescribed. Its focus implies not only the fight against bacteria, but also the elimination of symptoms.

Treatment should include more than just antibiotics. In general, it must meet a number of requirements:

1. Attack of bacteria with its complete destruction.
2. Local action of drugs.
3. Antibiotic resistance to the acidic environment of the stomach.
4. The ability of prescribed drugs to penetrate the mucosa.
5. Rapid removal of drugs from the body without affecting other organs.

The following groups of medications may also be prescribed:

• antispasmodics;
• antacids;
• antinausea;
• astringents.

It is impossible to cure Helicobacter on your own and you need to know this for sure. If you have any suspicion, you need to go to the clinic and undergo an examination.