It's actually such an HP?!

This is the 3663rd article of Da Yi Xiao Hu

-Helicobacter pylori-

What you need to know

Helicobacter pylori

Helicobacter pylori (Hp) is a representative species of the genus Helicobacter. It is a Gram-negative bacterium and a chronic infectious pathogen with a high infection rate worldwide. It is mainly distributed in gastric mucosal tissue. Helicobacter pylori is a chronic infectious pathogen with a high infection rate worldwide. In 2015, about 4.4 billion people were infected with Helicobacter pylori worldwide, accounting for about 50% of the world's population.

1. High risk factors for Hp infection

Age: The infection rate of Hp is related to age. The infection rate of Hp in people aged 25 is close to 50%, that of people aged 35 is >60%, and that of people aged 70 and above reaches 80%. Children are at high risk of Hp infection, and the infection rate increases with age.

Living area: Due to differences in geographical environment, living environment and living habits, Hp infection rates vary in different living areas. By region, the infection rates are from high to low in West China, East China, South China, and North China, with Tibet having the highest infection rate, reaching 90%.

Lifestyle habits and conditions: Many research reports have shown that frequent consumption of pickled vegetables, drinking unclean water, cooking with vegetable oil, smoking, etc. are positively correlated with Hp infection, while eating raw vegetables, drinking tea, and eating garlic are negatively correlated with Hp infection.

Familial clustering: Hp infection in children is closely related to their parents, and Hp infection between husband and wife is also closely related, showing a family clustering phenomenon.

2. Hp pathogenic mechanism

Humans are currently the only clear source of Hp infection, and stomach-to-oral, oral-to-oral, and fecal-to-oral transmission are possible important routes of transmission. Close contact, especially close contact between parents and children within the family, may be a very important factor in causing Hp infection.

Hp infection often causes chronic inflammation of the gastric mucosa, which is mostly asymptomatic. A large number of studies have shown that Hp is closely related to gastrointestinal diseases such as chronic gastritis, peptic ulcers and gastric cancer. After the host is infected with Hp, Hp colonization, damage to the gastric mucosal barrier, inflammation and immune response, virulence genes and other mechanisms damage the gastric mucosa, thus causing some symptoms.

3. Symptoms of Hp infection

Hp infection is the most common chronic infection in humans, and its infection can lead to different outcomes: from asymptomatic chronic active gastritis, dyspepsia (about 10%), peptic ulcer (10%~15%) to gastric malignant tumors (about 1%), and produce corresponding clinical manifestations. Common symptoms include upper abdominal distension and discomfort after meals, belching, acid reflux, nausea and vomiting, etc. The course of the disease is relatively slow, but it is easy to relapse. In addition, Hp infection is also related to the occurrence of some extra-gastrointestinal diseases, such as unexplained iron deficiency anemia, idiopathic thrombocytopenic purpura, etc.

4. Detection methods for Hp infection

Invasive methods include histological testing, rapid urease test (RUT), Hp culture and polymerase chain reaction (PCR) testing. Tissue can also be taken for biopsy under gastroscopy. Non-invasive methods include urea breath test (UBT), Hp stool antigen (HpSA) test and serological testing. Among them, UBT is the most recommended method in clinical practice. It has the advantages of relatively high accuracy of Hp detection, convenient operation and no limitation of Hp focal distribution in the stomach. It should be noted that there is currently no reliable method for self-testing Hp infection at home. If testing is needed, it is recommended to go to the hospital to listen to the doctor's advice for appropriate examinations.

5. Which groups of people need Hp radical treatment?

If you are infected with Hp, regular eradication treatment is recommended regardless of whether you have symptoms or not. But don't worry too much. The currently commonly used quadruple therapy of [proton pump inhibitors + bismuth + two antibiotics] has a good effect on the eradication of Hp. So which groups of people must receive eradication treatment after being infected with Hp? If you have the following conditions, you need to pay special attention:

žPeptic ulcer (whether active or not and with or without history of complications)

Gastric mucosa-associated lymphoid tissue lymphoma

žChronic gastritis with indigestion symptoms

žChronic gastritis with gastric mucosal atrophy and erosion

žUnexplained iron deficiency anemia

žHp infection has been confirmed

Long-term use of proton pump inhibitors, such as omeprazole

ž Family history of gastric cancer

žPrepare to take aspirin for a long time

6.How to prevent Hp infection?

žAvoid family infection: HP infection is mainly transmitted within the family. Avoid bad feeding habits that lead to mother-to-child transmission, promote separate dining to reduce the chance of HP infection, and disinfect tableware regularly.

žMaintain oral health and quit smoking.

žImprove eating habits: avoid drinking raw water and eating raw food. At the same time, the food should be diversified, avoid partiality, and pay attention to supplementing a variety of nutrients; do not eat moldy food; eat less smoked, pickled, and nitrate- and nitrite-rich foods, and eat more fresh foods; avoid overly rough, strong, and spicy foods and drinking large amounts of alcohol for a long time.

Wash your hands frequently and avoid touching anything

žMaintain a good mental state and get enough sleep.

7. Myths about Hp infection

Can a special anti-Helicobacter pylori toothpaste treat Hp infection?

First, there is no effective evidence to prove that anti-H. pylori toothpaste can really "fight H. pylori"; second, there is very little H. pylori in the mouth and it usually has no infectious activity. So even if toothpaste can fight H. pylori, the infection activity of H. pylori in the mouth is not high, so it is unnecessary to use anti-H. pylori toothpaste.

Does bad breath indicate Hp infection?

Hp infection usually has no obvious symptoms. Bad breath is more likely to come from oral diseases, tonsil stones, etc. and has nothing to do with Hp.

If there are no symptoms of Hp infection, there is no need for treatment?

Hp is closely related to the development of gastrointestinal diseases. Without treatment, the infection will not clear up on its own. Studies have shown that treating Hp infection has long-term benefits in reducing the risk of gastric cancer. Therefore, after being infected with Hp, whether or not you have symptoms, it is recommended to undergo standardized eradication treatment.

References

[1] Azami M , Nasirkandy MP , Mansouri A , et al. Global Prevalence of Helicobacter Pylori Infection in Pregnant Women: A Systematic Review and Meta-Analysis Study[J]. International, Journal of Women's Health and Reproduction Sciences, 2017, 5(1).

[2] Zhou Xueliang, Zhou Yuan, Zhu Qiang, Zhang Rongli. Research progress on Helicobacter pylori[J]. Chinese Journal of Continuing Medical Education, 2018, 10(33): 101-104.

[3] Su Qing, Xu Sanping. Research progress on Helicobacter pylori[J]. Journal of Clinical Digestive Diseases, 2014, 26(03):132-133.

[4] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, etc. Guidelines for diagnosis and treatment of Helicobacter pylori infection in primary care (2019) [J]. Chinese Journal of General Practitioners, Vol. 19, No. 5, 2020, pp. 397-402, ISTIC, 2021.

-END-

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Photo: Wang Minghan

Typesetting: Wang Minghan

Review: Xiang Meng

Instructor: Wang Tao