Helicobacter pylori: causes, symptoms and modern therapies

Abdominal pain, bloating and digestive complaints are a blight on many people's lives. Although these symptoms can be caused by many factors, they are often caused by one tiny bacterium: Helicobacter pylori. This micro-organism colonises the lining of the stomach and can cause chronic inflammation, ulcers and, in more serious cases, stomach cancer.

Many people are not aware that their symptoms may be caused by this infection and are afraid of medical tests. In this article, we explain in detail what exactly Helicobacter pylori is, what symptoms it causes, how it can be diagnosed and what modern treatment options are available to eradicate the infection. Our aim is to give you clear and reassuring information to help you understand this topic, and to show you how Endomedix Gastroenterology Centre how our experts can provide an effective solution to the problem.

What is Helicobacter pylori?

Helicobacter pylori (H. pylori) is a spiral-shaped, Gram-negative bacterium that is highly adapted to the acidic environment of the stomach. The key to this is the enzyme urease it produces, which breaks down urea into ammonia and carbon dioxide. The ammonia neutralises the stomach acid in the bacterium's immediate environment, allowing it to survive and multiply.

The infection is highly prevalent worldwide, with an estimated half of the world's population carrying the bacteria. The prevalence (incidence) varies considerably geographically: in developing countries, where hygiene conditions are poorer, up to 80% of the population may be infected, while in developed regions the rate is lower. In Hungary, approximately 50-60% of the adult population may be affected.

How is the infection spread?

H. pylori infection spreads from person to person, with childhood infection being the most common. The exact routes of transmission are:

• Fekal-oral route: The bacteria is shed in the faeces and can enter the body through contaminated food, water or objects. This mode of transmission is more common in communities with poor sanitation.
• Oral-oral route: The bacteria can also be found in saliva and dental plaque, so the infection can be transmitted by kissing or sharing cutlery and glasses.

Factors that increase the risk of infection include a crowded lifestyle, sharing a bed, having a large number of siblings and not having access to running water. Most people become infected in childhood and if left untreated, the infection can cause lifelong chronic inflammation.

What symptoms and diseases can H. pylori cause?

Most infected people (about 80%) are asymptomatic and do not even know they are carrying the bacteria. However, H. pylori infection is a major aetiological (causative) factor in the development of many gastrointestinal diseases.

Bacterial chronic gastritis (type B chronic gastritis) is the most common consequence of infection. This inflammation can lead to further complications:

• Dyspepsia (poor digestion): Patients often complain of abdominal pain, discomfort, nausea, belching and loss of appetite.
• Peptic ulcer disease: H. pylori is responsible for about 90% of duodenal ulcers and 70-90% of gastric ulcers. The bacterium weakens the protective lining of the mucous membranes of the stomach and duodenum, allowing stomach acid to damage the tissues.
• Chronic atrophic gastritis: In the long term, chronic inflammation can lead to atrophy of the stomach lining. This leads to a decrease in acid production and is considered a precursor of gastric cancer.
• Stomach cancer (adenocarcinoma): H. pylori infection is the most important risk factor for developing stomach cancer. The WHO (World Health Organization) classifies the bacterium as a class I carcinogen. Infected people have a 3-6 times higher risk of stomach cancer.
• MALT lymphoma: It is a low-malignant (malignant) tumour arising from lymphoid tissue associated with the lining of the stomach. MALT lymphoma detected at an early stage can often be completely cured by eradication of H. pylori alone.
• Other diseases: The infection has also been associated with iron deficiency anaemia of unclear origin and idiopathic chronic urticaria.

It is important to stress that although infection is common, serious complications such as stomach cancer or lymphoma are relatively rare. Nevertheless, any infection that causes symptoms should be treated.

How is the infection diagnosed?

Both invasive (endoscopic sampling) and non-invasive methods are available for detecting Helicobacter pylori. At Endomedix Gastroenterology Centre uses the latest diagnostic techniques to ensure accurate and reliable results.

Invasive (endoscopic) methods

These tests are performed on a tissue sample (biopsy) taken during gastroscopy (gastroscopy). A gastroscopy is essential if the patient has symptoms of ulcers or tumours, or in the case of new dyspepsia over the age of 45-50.

• Histopathological examination (histology): The tissue sample taken is examined under a microscope using special staining techniques (e.g. Giemsa staining) to directly visualise the bacteria. This method also provides information about the extent of inflammation and the condition of the mucosa (e.g. atrophy).
• Rapid Urease Test (RUT): The tissue sample is placed in a gel containing urea and a pH indicator. If the sample contains H. pylori, the urease enzyme produced by H. pylori breaks down the urea and the ammonia released changes the colour of the gel. The result can be read within minutes.
• Breeding: The tissue sample is then used in a laboratory to try to grow the bacteria. Although this is a slow and cumbersome process, it has the advantage of allowing an accurate determination of antibiotic resistance, which can be key to treatment planning.
• PCR (Polymerase Chain Reaction): This is a modern molecular biology method that detects the bacterial DNA in a sample. It is highly sensitive and can detect resistance to clarithromycin and fluoroquinolone.

Non-invasive methods

These tests do not require endoscopic intervention and are therefore less stressful for the patient. They are mainly used to confirm infection or to monitor the success of treatment.

• Urea Breath Test (UBT): The patient drinks a liquid containing urea labelled with an isotope (¹³C or ¹⁴C). If H. pylori is present in the stomach, the urease enzyme breaks down the urea and the labelled carbon atom is released into the bloodstream as carbon dioxide and then into the lungs, where it is measured in the exhaled air. This is the most reliable non-invasive method for post-treatment monitoring.
• Stool antigen test (SAT): This test detects the antigens (proteins) of the bacteria in a stool sample. Its reliability is similar to that of an exhalation test and it is also useful for diagnosing infection and monitoring the success of therapy.
• Serological testing: A blood test detects antibodies (IgG) produced against H. pylori. It has the disadvantage that it cannot distinguish between active and established infection, as antibodies can remain in the blood for years after successful treatment. For this reason, it is not suitable as a control test.

How can Helicobacter pylori infection be treated?

Treatment of H. pylori aims to eradicate the bacteria completely (eradication), which prevents ulcers from recurring and reduces the risk of stomach cancer. The treatment is usually a combination of several drugs and lasts 10-14 days.

Proton pump inhibitors (PPIs), which strongly reduce the production of stomach acid, are the basis of the therapy. This both helps the mucosa to heal and creates a more favourable environment for antibiotics to work. PPIs are combined with two or three types of antibiotics.

Modern treatment strategies

Due to the spread of antibiotic resistance (especially in the case of clarithromycin and metronidazole), the efficacy of the traditional triple therapy (PPI + clarithromycin + amoxicillin/metronidazole) has fallen below 80% in many regions. Guidelines suggest that a therapy with an efficacy of at least 80-85% should be chosen.

From Endomedix Gastroenterology Centre specialists always choose the most appropriate therapy, taking into account the latest international recommendations and local resistance patterns.

• Bismuth-based quad therapy: This is the current first-line recommended treatment in Hungary, where clarithromycin resistance rates exceed 15-20%. The course of treatment lasts 14 days and consists of:

- Proton pump inhibitor (PPI) at double the dose

- Bismuth subsalicylate

- Tetracycline (or doxycycline)

- metronidazole

• Non-bismuth-based (concomitant) quad therapy: Here, a third antibiotic is used instead of bismuth. The course of treatment consists of PPI, clarithromycin, amoxicillin and metronidazole given simultaneously for 14 days.
• Sequential therapy: This is a 10-day course of treatment, where the patient is given PPI and amoxicillin for the first 5 days and then PPI, clarithromycin and metronidazole for the next 5 days. Its effectiveness is now questioned.
• Second-line (rescue) therapies: If the first treatment is unsuccessful, a second-line treatment is needed. Ideally, this should include antibiotic resistance testing. Often a levofloxacin-based triple therapy (PPI + amoxicillin + levofloxacin) or a bismuth quadruple regimen is used if it was not the first-line therapy of choice.

What to do after treatment

The success of the therapy should always be monitored. The most suitable test is an exhalation test or a faecal antigen test. The control test should be performed at least 4 weeks after the end of the antibiotic course and after at least 2 weeks without PPI, as these drugs can cause false negative results.

Contact the experts at the Endomedix Gastroenterology Centre

Helicobacter pylori infection is a treatable condition, with no need to fear diagnosis or treatment. The Endomedix Gastroenterology Centre offers a modern, friendly environment, state-of-the-art equipment and highly qualified, empathetic specialists.

We put the patient at the centre. We understand that the thought of a gastroenterology examination can cause anxiety for many people, so we do our utmost to ensure that the diagnostic process is as unpleasant as possible. Our specialists will explain the procedure in detail and answer any questions you may have patiently. By planning a personalised therapy and careful follow-up after treatment, we ensure a complete recovery and freedom from complaints.

Don't let persistent digestive complaints ruin your quality of life! Take the first step towards recovery and make an appointment with your Endomedix Gastroenterology Centreba.