Papafragkakis
Charilaos Papafragkakis, MD
Gastroenterologist - Hepatologist

Helicobacter pylori

Helicobacter pylori infection is chronic and is usually acquired in childhood through the fecal-oral route. It is a very common infection in all parts of the world. It was discovered 1984 and has been recognized as the main cause of peptic ulcer disease and as the main risk factor for the development of gastric cancer. It is a group 1 carcinogen according to the World Health Organization. People with helicobacter pylori may have a variety of symptoms, like abdominal pain, dyspepsia, bad breath, nausea or decreased appetite, but most infected people (>70%) are asymptomatic.

Who should be tested for Helicobacter pylori?

  • All patients with active peptic ulcer disease, a past history of peptic ulcer disease, low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer
  • Patients with uninvestigated dyspepsia who are under the age of 60 years and without alarm features, non-endoscopic testing for Helicobacter pylori infection is a consideration.
  • Patients taking long-term low-dose aspirin may be tested for Helicobacter pylori infection to reduce the risk of ulcer bleeding.
  • Patients on chronic treatment with a non-steroidal anti-inflammatory drug
  • Patients with unexplained iron deficiency anemia
  • Adults with idiopathic thrombocytopenic purpura
  • There is insufficient evidence to support routine testing and treating of Helicobacter pylori in asymptomatic individuals with a family history of gastric cancer

How is Helicobacter pylori diagnosed?

Gastroscopy and biopsies. During gastroscopy your gastroenterologist takes biopsies of the gastric mucosa to diagnose if you have the infection.

Breath test. It is a non invasive test for the diagnosis of Helicobacter pylori that can be done at your doctor’s office. It is a safe and reliable test. You need to be off acid suppression medication and antibiotics for a minimum of 4 weeks prior to the test. The day of the test you will to need to have an empty stomach for a few hours. During the breath test, you blow air into small tubes and swallow a small quantity of urea labeled powder dissolved in water. The sample is then sent to the laboratory for analysis. There are no side effects of the test and no allergies have been reported. The result of the test takes a few days to be delivered back to your gastroenterologist.

Treatment of Helicobacter pylori

Helicobacter pylori infection is usually treated with a combination of 2 or 3 antibiotics and an acid-suppressing drug for 10 to 14 days. The treatment may be supplemented with a prescription of a probiotic for prevention of antibiotic associated diarrhea. However, the latter practice is still controversial and debatable. There may be side effects of treatment, such as nausea, bloating, vomiting or diarrhea, so close communication with your gastroenterologist during treatment is important.

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