Gastritis and Helicobacter Pylori

04.05.2020
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Gastritis and Helicobacter Pylori

HP infection is known and accepted as a major etiologic factor in gastric cancer, being known that at least 90% of these are caused by Helicobacter pylori infection. It is established with no doubt that HP eradication is associated with reducing the incidence of gastric cancer.

Chronic gastritis with HP accounts for over 80% of all chronic gastritis. Symptomatology consists of pain or discomfort located in the upper abdomen.

Diagnosis is done using non-invasive tests. Any acid-resistant treatment should be discontinued 2 weeks before testing for HP infection.

For young patients, the "test and treat" strategy is preferred instead of prescribing a specific treatment or a superior digestive endoscopy, thus preventing high cost and discomfort to the patient.

In the case of elderly patients, where non-invasive tests are less relevant, a superior digestive endoscopy is preferred.

General steps for diagnosis:

1. The first step is a discussion between doctor and patient, through which the medical history of the patient and symptoms that he/she presents are verified and also if he/she is following any specific treatment.

2. Next is the physical examination, during which the abdomen is being investigated by hand feel to see if any possible pain or swelling exists.

3. Step three consists of a set of blood and stool tests, followed by the respiratory test

Symptoms that one must pay attention to:

1.    Pain or heat burn in the abdominal (the pain is stronger when the stomach is empty)

2.    Nausea

3.    Loss of appetite

4.    Frequent heat burns

5.    Bloating

6.    Fever

When alarm symptoms are present, such as weight loss, dysphagia, gastrointestinal bleeding or anemia, performing a superior digestive endoscopy is necessary.

            In clinical practice, the rapid urination test, performed at endoscopy, is recommended as the first-line diagnostic test. If it is positive, it allows for the immediate start of the treatment.

Treatment

In the treatment of Helicobacter pylori infection, the antibiotic resistance rate has increased in almost the entire world. A recent analysis of HP antibiotic resistance confirms that the eradication rate has dropped while the prevalence of antibiotic resistance is rising.

In areas with low resistance to clarithromycin, such as our country, triple therapy is recommended as the first line of treatment with proton pump inhibitor, clarithromycin, amoxicillin or metronidazole for a minimum of 7 days. Using proton pump inhibitor doses twice a day increases the effectiveness of triple therapy.

In areas with a high resistance to clarithromycin (> 15%), i.e. Central and South Europe, as well as in the United States, proton pump inhibitors, amoxicillin, metronidazole, with or without bismuth colloidal citrate are associated in the scheme. In areas with dual resistance to clarithromycin and metronidazole, the most relevant being China, bismuth quadrupole therapy, proton pump inhibitor, amoxicillin, tetracycline are recommended as the first line of treatment.

Ideally, clarithromycin can be replaced with drugs whose resistance has not become a problem, such as amoxicillin, tetracycline, furazolidone, rifabutin, or that can be successfully used at higher doses or longer.

Treatment may differ depending on the patient's medical history or allergies that may appear, to the prescribed medications. Following treatment, a follow-up test for H. pylorus is performed so that there is certainty of complete cure. Most of the time, the treatment works, but if the patient continues to show symptoms, a new treatment plan is indicated.

Diet

During treatment, it is recommended to eat foods that provide the body with the nutrients it needs for healing. The patient suffering from chronic gastritis with HP is recommended to consume:

·         Probiotics - good bacteria that stimulate the production of substances and help fighting the bacteria. Probiotics are found in yogurt and kefir.

·         Omega-3 and omega-6 – they reduce stomach bloating and prevent the worsening of the affection. These can be found in: fish oil, olive oil, carrot seeds and grapefruit seeds oil

·         Fiber – important nutrients that help the digestion.

·         Fruits and vegetables – they are easy to digest and contribute to the improvement of the intestinal function.

·         Broccoli, cauliflower and cabbage – they contain substances called isothiocyanates that can reduce the spread of bacteria in the bowel.

·         White meat and fish - due to the low concentration of fat, it helps digestion and prevents food from staying in the stomach for a long time, causing pain. It is not recommended to eat these foods fried.

Transmission to others:

There are several factors that determine the transmission of the disease, including the socio-economic environment and the conditions in which the patient grew up. An untreated person is contagious until the end of treatment and getting the certainty that he has been cured. Transmission from one person to another is done in 3 ways: fecal-oral (when a person does not wash their hands properly), oral-oral, as well as through contact with contaminated food or water.

Prevention of HP chronic gastritis:

The application of general hygiene and nutrition measures help reducing the possibility of HP infection. Therefore, it is recommended:

·         Washing hands before each meal and before cooking each meal

·         Washing hands each time after using the restroom

·         Proper and complete cooking of food

·         Water consumption only from safe sources

Seeing a doctor if there are symptoms of Helicobacter Pylori infection is absolutely necessary, both to reduce the risk of aggravation of the medical problem, and for the sake of the loved ones, to whom the disease can be transmitted.

*Sources: 

https://www.medicinenet.com/helicobacter_pylori/article.htm

https://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori#1

https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171


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