What to do if Helicobacter pylori is positive during physical examination

Author: Hou Jiayi, Deputy Chief Technician, Shanxi Provincial Hospital of Traditional Chinese Medicine

Reviewer: Li Ning, deputy chief physician, Shanxi Provincial People's Hospital

Helicobacter pylori is a bacterium that can parasitize in the stomach. Infection with Helicobacter pylori can cause a variety of diseases, including gastric ulcer, duodenal ulcer, gastric mucosa-associated lymphoid tissue lymphoma and gastric cancer. The International Agency for Research on Cancer has classified Helicobacter pylori infection as a Class I carcinogen. Currently, many physical examinations include Helicobacter pylori testing. So, when this result is positive, does it mean that there is a risk of gastric cancer? Does everyone need bactericidal treatment?

Figure 1 Helicobacter pylori air-blowing inspection pocket

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First of all, not all people infected with Helicobacter pylori will develop gastric cancer . Although it has been medically proven that Helicobacter pylori is closely related to many chronic gastrointestinal diseases and cancers, the occurrence of gastric cancer is also related to other causes, including weak immunity, genetic factors, long-term mental depression, a preference for pickled foods, smoking, alcoholism, etc. If you are found to be positive for Helicobacter pylori during a physical examination, please do not panic too much.

Secondly, the treatment method should be decided based on the results of further gastrointestinal examinations . Being infected with Helicobacter pylori does not mean that it will definitely turn into cancer, but the probability of cancer will increase. The development from a normal stomach to gastric cancer will go through the following process: superficial gastritis → atrophic gastritis → intestinal metaplasia → dysplasia → intestinal gastric cancer, and Helicobacter pylori plays a role in promoting malignant progression in these processes. Some people have no conscious symptoms, but obvious lesions have occurred in the stomach. Only through endoscopic examination can we observe whether the gastric mucosa is normal. If the following situations occur, you must receive standardized Helicobacter pylori eradication treatment.

1. Peptic ulcer (including gastric ulcer and duodenal ulcer).

2. Chronic gastritis accompanied by indigestion, gastric mucosal atrophy or erosion.

3. Patients with gastric cancer, those who have undergone gastric cancer surgery, or those with a family history of gastric cancer.

4. Patients with mucosa-associated lymphoid tissue lymphoma.

5. Patients who plan to take proton pump inhibitors or non-steroidal anti-inflammatory drugs (such as aspirin, ibuprofen, etc.) for a long time.

6. Suffering from unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura.

7. Other Helicobacter pylori-related diseases (such as lymphocytic gastritis, hyperplastic gastric polyps, Menetrier disease).

Finally, being positive for Helicobacter pylori is not terrible. If it is necessary to treat it, it must be treated thoroughly . At present, the bismuth quadruple regimen is recommended as the first and second treatment for infected people in the treatment of Helicobacter pylori. In addition to proton pump inhibitors and bismuth agents, the following antibacterial drug combinations can be used (in no particular order): amoxicillin combined with clarithromycin, amoxicillin combined with levofloxacin, tetracycline combined with metronidazole, amoxicillin combined with metronidazole, and amoxicillin combined with tetracycline. However, due to different drug sensitivity and medical history of patients, it is recommended that doctors customize individualized treatment plans and strictly follow the doctor's instructions for medication. Do not "fish for three days and dry the net for two days". At the same time, maintain good hygiene habits and adhere to the separate dining system to effectively prevent recurrence.

Figure 2 Antimicrobial drugs should be taken according to doctor's advice

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China is one of the countries with a high incidence of gastric cancer. Eradicating Helicobacter pylori is the most direct and effective way to prevent gastric cancer. In short, early detection and treatment of Helicobacter pylori can block the further development of gastric diseases. The earlier the intervention, the better the effect.