Tips for preventing Helicobacter pylori infection

This is the 4198th article of Da Yi Xiao Hu

Mr. Chen, 65 years old, came to the outpatient clinic for consultation with a nervous look in his eyes, holding his medical examination report. The report showed that the C-13 urea breath test was positive, and the value was relatively high, which meant that he was infected with Helicobacter pylori. He said that he had acid reflux after meals recently, often accompanied by upper abdominal pain. One year ago, a gastroscopy showed antral erosion and Helicobacter pylori was positive, but he did not receive regular treatment. Recently, he saw on TV that Helicobacter pylori can be transmitted to family members and may also cause gastric cancer. Both parents have a history of gastric cancer, so he felt panic and wanted to cure it as soon as possible, so he was advised to have a gastroscopy reexamination and follow-up in the near future.

So, what should we do if we have Helicobacter pylori? What are the dangers? How to get rid of Helicobacter pylori? Let's learn more about Helicobacter pylori!

1. What is Helicobacter pylori?

Helicobacter pylori (H. pylori or Hp) is a Gram-negative bacillus that likes to live in the human gastric mucosa. It is also the only bacterium that can survive in the stomach. As we all know, the stomach is a highly acidic environment and is not suitable for bacterial growth, but why can only Hp survive? This is because Hp can secrete and release urease to decompose urea to produce ammonia, thereby neutralizing gastric acid and protecting itself from being eroded by gastric acid. Not only that, it can also use its own flagella to enter the gastric mucosa and produce some toxic substances (vacuolar cytotoxins and cytotoxin-related proteins, etc.), leading to inflammatory reactions and causing diseases such as gastritis and peptic ulcers.

2. Current status of HP infection and its hazards

According to surveys, about half of the world's population is infected with Hp, and the Hp infection rate in my country is as high as 60%. Domestic and international consensus defines Hp infection as an "infectious" disease that can be transmitted from person to person. The characteristics of family life in my country and the traditional eating habits of communal dining may increase the risk of cross-infection and family gatherings. As early as 1994, the International Agency for Research on Cancer under the World Health Organization defined it as a Class I carcinogen and the most important risk factor for gastric cancer. In addition to gastric cancer, Hp infection is also closely related to indigestion, peptic ulcer, chronic gastritis, gastric mucosa-associated lymphoid tissue lymphoma, unexplained iron deficiency anemia, idiopathic thrombocytopenic purpura, and delayed growth and development in children. It can be seen that how to prevent infection is particularly important.

3. What are the main symptoms after infection?

Most patients are asymptomatic after Hp infection, while a few present with common nonspecific symptoms of chronic gastritis, such as bad breath or repeated upper abdominal discomfort, early satiety, acid reflux and belching, nausea and vomiting.

4. What are the transmission channels?

Humans are currently the only known source of Helicobacter pylori infection.

Currently recognized important transmission routes are: "oral-oral" transmission and "fecal-oral" transmission.

5. How to detect Helicobacter pylori?

There are four methods for Helicobacter pylori detection:

1. Breath test

C13\C14 breath test is the simplest and most convenient inspection method.

The test subject needs to take C-13 or C-14 labeled urea capsules orally, and the exhaled gas can be used to determine whether the test subject is infected with Helicobacter pylori.

The difference between C13 and C14: C14 has a certain degree of radioactivity (but causes little harm to the human body) and is not suitable for those preparing for pregnancy, pregnant women, breastfeeding women and children; C13 is suitable for any group.

Note: The test must be performed on an empty stomach or 2 hours after a meal.

2. Serum HP antibody detection

This is often used for large-scale epidemiological screening, but it cannot determine whether it is a current infection. Therefore, if the HP antibody is positive, further breath tests are still required to confirm it.

3. Gastroscopy to obtain biopsy specimens for examination

This is an invasive test

4. HP stool antigen test

This is mostly used for scientific research testing

It should be noted that the accuracy of HP infection detection will be affected by some factors, such as PPI, antibiotics, bismuth and Chinese medicine with antibacterial effects. If there is a history of taking the above drugs, it is recommended to stop taking them for 4 weeks before testing.

6. Who needs eradication treatment?

1. Peptic ulcer.

2. Gastric mucosa-associated lymphoid tissue lymphoma.

3. Helicobacter pylori positive chronic gastritis accompanied by indigestion.

4. Chronic gastritis accompanied by gastric mucosal atrophy or erosion, especially those accompanied by intestinal metaplasia and dysplasia.

5. After gastric surgery.

6. Long-term use of proton pump inhibitors (prazoles).

7. Family history of gastrointestinal cancer, especially first-degree relatives.

8. Plan to take non-steroidal anti-inflammatory drugs (such as aspirin, warfarin, ibuprofen, indomethacin, etc.) for a long time.

9. Some extragastric diseases related to Helicobacter pylori infection, such as anemia.

7. What are the susceptibility factors?

1. Age

Helicobacter pylori infection is related to age. Hp infection is more common in adults than in children. Globally, the Hp infection rate in adults is significantly higher than that in children, and the infection rate increases with age.

2. Living Environment

Due to differences in geographical environment, living environment and living habits, Helicobacter pylori infection presents different infection rates in different living areas.

3. Bad living habits

The infection rate of Helicobacter pylori is related to different living habits and conditions. Frequent consumption of pickled vegetables, drinking unclean water, cooking with vegetable oil, smoking, etc. are positively correlated with Helicobacter pylori infection, while consumption of fresh vegetables, drinking tea, eating garlic, etc. are negatively correlated with Helicobacter pylori infection.

8. How to prevent infection in daily life?

Because family members of HP-infected patients have a high infection rate, blocking the infection route is the most critical measure to prevent infection with this bacterium (emphasis added):

1. Avoid bad feeding habits

1. Abandon mouth-to-mouth feeding for infants and young children.

2. Do not give chewed food to children.

2. Dining Out

1. If tableware is reused and not disinfected in time, it may also transmit Helicobacter pylori, so it is recommended to use serving chopsticks and spoons.

2. Separate dining system.

3. Eating at home

1. Household bowls and tableware should be disinfected regularly and replaced every three months or so.

2. Parents and children should use separate tableware.

4. Personal Hygiene

1. Brush your teeth and wash your hands frequently before going to bed and after meals, and replace or disinfect your toothbrushes regularly.

2. Maintain oral health and actively treat oral diseases

5. Daily diet

1. Keep food clean, eat more fresh food, avoid drinking raw water and eating raw food, do not eat moldy food, and eat less smoked and pickled food.

2. Avoid eating too rough, strong, spicy food and drinking large amounts of alcohol and smoking for a long time.

6. Daily Lifestyle

1. Exercise more to enhance immunity.

2. Maintain a good mental state and get enough sleep.

7. Prevention of reinfection after radical cure

1. Prevent re-infection through daily close contact.

2. Family members should receive treatment together to avoid cross-infection and reinfection.

Caring for health is everyone’s responsibility. Let’s work together to get rid of the sticky Helicobacter pylori!

References

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[3] Yang Liang, Liu Gaifang, Zhu Xinying, Yu Chunyan. Investigation and analysis of the current status of family clustering of Helicobacter pylori infection[J]. Gastroenterology, 2019, 24(07): 416-419.

[4] Graham DY. Helicobacter pylori update: gastric cancer, reliable therapy, and possible benefits []. Gastroenterology, 2015, 148(4):719-731.e3.

[5] Helicobacter pylori and Peptic Ulcer Group of the Chinese Society of Gastroenterology, National Helicobacter pylori Research Collaboration Group, Liu Wenzhong, et al., The Fifth National Consensus Report on the Management of Helicobacter pylori Infection[J]. Chinese Journal of Gastroenterology, 2017, 37(6):364-378.

[6] Ge Junbo, Xu Yongjian, Wang Chen. Internal Medicine 9th Edition[M]. Beijing: People's Medical Publishing House, 2018: 340-367.

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Author: Liuzao Community Health Service Center, Pudong New Area, Shanghai

Wu Beijing Ding Meihua