How much do you know about Helicobacter pylori?

This is the 3893th article of Da Yi Xiao Hu

Now please recall whether there is anyone around you who has ever been infected with Helicobacter pylori; or is currently infected with Helicobacter pylori and is undergoing medication treatment; or has not yet discovered that he or she has been infected with Helicobacter pylori.

According to health statistics in 2022, the infection rate of Helicobacter pylori in my country has reached 60%, which means that at least 700-800 million people in my country are infected with Helicobacter pylori[i]. my country is a country with a large number of people infected with Helicobacter pylori in the world, and we should pay more attention to the disease of Helicobacter pylori. At the end of 2021, the U.S. Department of Health and Human Services released the 15th edition of the Carcinogen Report, adding 8 new carcinogens, including Helicobacter pylori. Chronic infection of Helicobacter pylori is listed as a clear carcinogen[ii]. After reading this, do you still think that being infected with Helicobacter pylori is a trivial matter? Will you still turn a blind eye to Helicobacter pylori? We should prevent and detect Helicobacter pylori in a timely manner to keep this hidden carcinogen away from our healthy and sunny life.

(This figure shows the 15th edition of the Carcinogen Report released by the U.S. Department of Health and Human Services)

Next, I will introduce Helicobacter pylori to you from different aspects, such as what is Helicobacter pylori, how Helicobacter pylori is transmitted, the symptoms that may occur after infection with Helicobacter pylori (not necessarily 100%, the symptoms of infection are different for each infected person), medical methods for screening Helicobacter pylori, and how to correctly prevent and treat Helicobacter pylori. I believe that after I have popularized Helicobacter pylori in many aspects, all the medical "newbies" will have a preliminary and basic understanding of Helicobacter pylori, and their understanding of Helicobacter pylori will change from nothing to something.

What is Helicobacter pylori?

Helicobacter pylori is a spiral-shaped, slightly anaerobic bacterium that has very demanding growth conditions. It was first successfully isolated from gastric mucosal biopsy tissue of patients with chronic active gastritis in 1983 and is currently the only known microorganism that can survive in the human stomach. On October 27, 2017, the World Health Organization's International Agency for Research on Cancer published a preliminary list of carcinogens for reference, and Helicobacter pylori (infection) was included in the list of Class 1 carcinogens[iii]. Under normal circumstances, the stomach wall can form a series of perfect self-protection mechanisms to prevent microbial invasion through the secretion of gastric acid and protease, and the protective effect of insoluble and soluble mucus layers. However, Helicobacter pylori can pass through the mucus layer, parasitize in the human stomach, adhere to the gastric mucosa and intercellular spaces, and neutralize gastric acid by building an alkaline microenvironment.

What harm does Helicobacter pylori bring to the human body?

Helicobacter pylori can cause mild chronic inflammation of the gastric mucosa, and in severe cases can lead to gastric and duodenal ulcers and gastric malignancies. According to survey statistics, about 15%-20% of patients infected with Helicobacter pylori develop peptic ulcers, 5%-10% develop indigestion, and about 1% develop gastric malignancies such as gastric cancer[iv].

What is the route of infection of Helicobacter pylori?

Helicobacter pylori has been found in human saliva. It exists in the mouth, digestive tract, and feces and can be transmitted from person to person through oral-oral and fecal-oral transmission. Sharing meals, feeding children chewed food, blowing food into the mouth to feed children, kissing, and using unclean tableware are all oral-oral transmission methods. Taking sharing meals as an example, Helicobacter pylori in the mouth may be transmitted to other people through sharing meals. Studies have shown that in the family of Helicobacter pylori, the probability of other people being infected with Helicobacter pylori is 60%, while in the family without Helicobacter pylori infection, the infection rate of Helicobacter pylori is only 13%. If hygiene habits are not good, it is easy to cause fecal-oral transmission. For example, Helicobacter pylori infected person A went to the toilet and his hands were contaminated with Helicobacter pylori, but he did not wash his hands. Not long after, he shook hands with B, and Helicobacter pylori would be on B's hands. B did not wash his hands when eating, so B might be infected with Helicobacter pylori[v].

In addition, Helicobacter pylori exists in dental plaque, saliva, and oral mucosa. Helicobacter pylori in the oral cavity constantly enters the gastrointestinal tract and is a potential source of reinfection with gastric Helicobacter pylori. It also affects the eradication rate of gastric Helicobacter pylori to some extent. Helicobacter pylori is a conditional pathogen. Changes in the oral environment or host immune dysfunction can promote the growth of oral Helicobacter pylori. Helicobacter pylori swallowed into the gastrointestinal tract with saliva can cause Helicobacter pylori reinfection. Oral hygiene first, then removing Helicobacter pylori in the oral cavity can reduce the reinfection rate. Helicobacter pylori infection has familial clustering, which is closely related to close contact between family members and common living habits and dining methods. Helicobacter pylori can be transmitted through the oral route. After the patient is successfully cured, reinfection may occur during close contact with other family members infected with Helicobacter pylori. Therefore, if one person is found to be infected clinically, other family members who have close contact with the patient should be recommended to undergo Helicobacter pylori testing. For family members who are all infected with Helicobacter pylori, joint eradication is encouraged to improve the cure rate and reduce the reinfection rate at the same time [vi].

How to correctly prevent and treat Helicobacter pylori?

The best way to prevent Helicobacter pylori is to develop good hygiene habits in daily life. Next, let me introduce several ways to prevent and treat Helicobacter pylori.

① Implement the separate dining system, use serving chopsticks and serving spoons to pick up food, and do not cross-use bowls, chopsticks, and cups (whether at home or eating out);

②Disinfect in time, you can use 75% alcohol or high temperature disinfection;

③ Do not feed mouth-to-mouth (forming oral-to-mouth transmission), such as chewing food and feeding it to children;

④ Do not kiss or share tableware with people infected with Helicobacter pylori;

⑤ Wash your hands promptly before meals and after defecation;

⑥ Do not eat raw food or food that is too hot, and eat less spicy food;

⑦Replace dental appliances regularly to repair oral problems;

⑧ Regular testing of Helicobacter pylori in high-risk groups;

⑨ Eat cooked food and store it safely, and drink only clean and safe drinking water[vii].

What symptoms will the infected person experience after being infected with Helicobacter pylori?

① The symptoms of Helicobacter pylori infection are mainly acid reflux, heartburn, stomach pain, and bad breath. This is mainly because Helicobacter pylori induces the crazy secretion of gastrin, which causes acid reflux and heartburn. For patients with gastric ulcer disease, Helicobacter pylori causes the main symptom of stomach pain. One of the most direct pathogens of bad breath is Helicobacter pylori.

② Helicobacter pylori can cause chronic gastritis. The main clinical manifestations are: upper abdominal discomfort, dull pain, sometimes belching, acid reflux, nausea, and vomiting. The course of the disease is relatively slow, but it is easy to relapse.

③ After patients are infected with Helicobacter pylori, they produce a variety of pathogenic factors, which cause damage to the gastric mucosa. The occurrence of clinical diseases is diverse, and patients often experience acid reflux, belching, bloating, etc., which are many times more common in patients infected with Helicobacter pylori than in those not infected with Helicobacter pylori.

④ Helicobacter pylori infection sometimes does not have particularly obvious symptoms. In such cases, it is usually determined through examinations. Helicobacter pylori, a pathogenic bacterium, can easily induce gastrointestinal diseases. [viii]

Medical methods for screening Helicobacter pylori

① Gold label urease test

The antigen sample to be tested is the patient's feces, while the antibody sample refers to the patient's serum, blood, or fingertip blood. The advantages of this testing method are convenience and speed. Generally, the test results can be obtained in 15 minutes, and it is not restricted by other conditions.

②C13 breath test

The sensitivity and specificity of this test are relatively high, but the test must be performed on an empty stomach or two hours after a meal, and the patient must ensure that he has not taken any antibiotics, proton pump inhibitors, bismuth preparations or other Hp-sensitive drugs in the past month to avoid false negative results. Relatively speaking, this is a more expensive test method.

③C14 breath test

This is an effective method for detecting Helicobacter pylori infection. Patients also need to fast before the test and take a urea 14c capsule with 20 ml of cold boiled water. After sitting for 25 minutes, use a blowpipe to blow into the carbon dioxide absorber and hand the sample to the doctor for testing. This is a radioactive test method, so it is not suitable for pregnant women and children.

④ Rapid urease method

This is the most widely used method for detecting Helicobacter pylori in clinical practice. It can help patients directly and quickly observe whether they have Helicobacter pylori infection. It is also a non-radioactive, easy to operate, highly safe, and low-cost examination method. However, this method is an invasive examination method and is more suitable for patients undergoing gastroscopy for the first time, but not for reexamination.

⑤ Gastroscopy and gastric mucosal biopsy

Although pathological sections are highly accurate, it is an invasive examination that many patients find difficult to accept. In addition, small lesions are easily missed during the examination, the chemical reaction accuracy is low, and the examination cost is relatively high.

⑥Saliva testing method

This is a clinically used indirect method for detecting Helicobacter pylori antigen. This test can be used by patients for both initial and follow-up examinations. It has the advantages of being simple, safe, and rapid. [ix]

Each hospital recommends different screening methods. When we suspect that we are infected with Helicobacter pylori, we should immediately take the time to go to a nearby regular tertiary hospital for a regular Helicobacter pylori test.

Having said that, do you "newbies" in medicine have a deeper understanding of Helicobacter pylori? I hope that Helicobacter pylori will never invade our bodies. If you have been infected with Helicobacter pylori, don't worry. As long as you cooperate with the attending doctor and take medicine in time, the bacteria will leave our body soon and we will recover our health soon.

1. Data source: http://blog.eastmoney.com/xue446314265/blog_1128063936.html

2. The data comes from the 15th edition of the Carcinogen Report released by the U.S. Department of Health and Human Services, and the image information comes from https://baijiahao.baidu.com/s?id=1720380882693949614&wfr=spider&for=pc

The data comes from Helicobacter pylori Baidu Encyclopedia, https://baike.baidu.com/item/Helicobacter pylori/1226672?fromtitle=Helicobacter pylori&fromid=681007&fr=aladdin

3. Information from http://www.lunan.com.cn/Home/News/newsDetail/id/6555/nid/41.html

4. The picture comes from Baidu Encyclopedia Picture

5. Information from http://www.lunan.com.cn/Home/News/newsDetail/id/6555/nid/41.html

6. Information source: https://m.baidu.com/bh/m/detail/vc_1316458941108128887

7. Information from http://www.lunan.com.cn/Home/News/newsDetail/id/6555/nid/41.html

8. Information from http://blog.eastmoney.com/xue446314265/blog_1128063936.html

9. Information source: https://baijiahao.baidu.com/s?id=1610466208072617943&wfr=spider&for=pc

10. The picture information comes from the WeChat public account of "Gastrointestinal Disease", https://baijiahao.baidu.com/s?id=1703863621151848820&wfr=spider&for=pc

Author: First-year student majoring in rehabilitation physical therapy at Shanghai University of Traditional Chinese Medicine

Zhu Weiwei