How to avoid Helicobacter pylori infection?

Recently, the United States listed Helicobacter pylori as a clear carcinogen, and my country's Food and Drug Administration also approved the first Helicobacter pylori consumer self-testing product certificate. It can be seen that Helicobacter pylori has attracted everyone's high attention.

Sometimes I feel sad that if the U.S. HHS (U.S. Department of Health and Human Services) had not listed Helicobacter pylori as a class of carcinogens, many people would probably still ignore Helicobacter pylori. However, my country's Food and Drug Administration has been continuously promoting this aspect. Let's talk about Helicobacter pylori today.

01. Helicobacter pylori is listed as a Class 1 carcinogen by the WHO

Many people may not know that Helicobacter pylori was actually listed as a Class 1 carcinogen by the International Agency for Research on Cancer under the WHO in 2017, which means that it is clearly carcinogenic to humans. This means that Helicobacter pylori is a clear carcinogen like alcohol, tobacco, aflatoxin, etc., and is also another biological factor that is considered to be a clear carcinogen after human papillomavirus (HPV).

This is also a very new substance that is considered to be a clear carcinogen. After all, Helicobacter pylori was first successfully isolated from the gastric mucosal biopsy tissue of patients with chronic active gastritis in 1983, and the researcher who made this discovery at the time, Barry J. Marshall, also won the 2005 Nobel Prize in Physiology or Medicine. This is also a relatively rare situation in the Nobel Prize in Physiology or Medicine in recent years. After all, the Nobel Prize that everyone is familiar with is often awarded to many scientific masters who study biological mechanisms, and Marshall is just a doctor, and he mainly discovered Helicobacter pylori, which is still rare.

However, since Helicobacter pylori was discovered and confirmed to be related to gastritis, people have begun to study the relationship between Helicobacter pylori and cancer.

In fact, as early as 1995, researchers found that the rate of gastric cancer in people infected with Helicobacter pylori was significantly higher than that of the general population, suggesting that Helicobacter pylori and gastric cancer showed a clear correlation [1]. A series of subsequent studies also confirmed that Helicobacter pylori is indeed carcinogenic [2].

Its carcinogenic mechanism has also been elucidated. On the one hand, infection with Helicobacter pylori will increase the production of free radicals near Helicobacter pylori and increase the frequency of gene mutations in host cells. On the other hand, Helicobacter pylori will change the balance of cellular proteins such as adhesion proteins, causing local inflammation and high levels of tumor necrosis factor TNFα and interleukin 6 and other corresponding signaling pathways, ultimately leading to gastric cancer.

Therefore, Helicobacter pylori is recognized as a Class 1 carcinogen by the WHO.

02. Helicobacter pylori is listed as a clear carcinogen in the United States

However, the HHS in the United States is special. This agency has always had its own set of standards. They do not agree with the WHO's views, so the HHS has been establishing a list of carcinogens according to its own standards. Of course, this list does not classify carcinogens like the WHO, but instead gives a statement on whether it is clearly carcinogenic.

As for why Helicobacter pylori itself has only now been listed as a clear carcinogen in the United States, a big reason may be that the proportion of Helicobacter pylori infection in the American population is not that high.

The figure below is from a research paper on the global Helicobacter pylori infection situation, showing the Helicobacter pylori infection situation in different countries [3].

We can see that the level of Helicobacter pylori infection in the United States is relatively low, less than 40%, so the proportion of related cancers caused is relatively low. Therefore, the inclusion of relevant standards in the United States will naturally lag behind.

But this is not the case for other countries. For example, in China, the infection rate of Helicobacter pylori is between 50-69%, which is a very high proportion. This is troublesome. As a clear carcinogenic factor for gastric cancer, we cannot afford to be vigilant.

In fact, gastric cancer is a very common cancer in my country. According to the largest-scale statistical data on cancer incidence in my country published in the top journal CA CANCER J CLIN, gastric cancer is the second most common cancer in my country [4].

It can be said that we should pay more attention to Helicobacter pylori, after all, it is also a relatively clear cause of cancer. Because of this, most hospitals currently provide Helicobacter pylori testing methods.

03. How to detect Helicobacter pylori?

There are currently two main common methods for detecting Helicobacter pylori. We will briefly introduce their principles here.

The first one is called C13 urea breath method

This principle is based on the metabolism of Helicobacter pylori. First, we collect our normal exhaled breath, and then take isotope-labeled C13. These components will react in the stomach. If there is Helicobacter pylori, they will metabolize these components and then form gas. Finally, collect the exhaled breath and compare before and after to see whether there is C13 metabolized by Helicobacter pylori. This can show whether Helicobacter pylori is infected and the amount of Helicobacter pylori.

In essence, this is a relatively indirect method, which reflects the infection status by detecting the metabolites of Helicobacter pylori.

The second method is stool testing

This method is relatively direct. All living things have life and death, and Helicobacter pylori is no exception. They will continue to die, and these dead components will eventually come into our excrement through the digestive tract. Therefore, we can test the excrement. If the corresponding markers of Helicobacter pylori are found in the excrement, then we can determine whether it is infected with Helicobacter pylori.

In fact, both have their advantages. The former is a common strategy used by hospitals, but there are also some problems, such as the need for fasting testing and the exclusion of antibiotics and Hp-sensitive drugs such as proton pump inhibitors. But these are not the key points. The most troublesome thing is that the former requires special equipment for isotope testing, so special testing must be carried out in the hospital, which limits the detection of Helicobacter pylori.

In fact, according to the infection rate in our country, there are 700 million to 800 million people infected with Helicobacter pylori in our country, but the proportion of people going to the hospital for Helicobacter pylori testing is very low, which also leads to many people not knowing that they are infected with Helicobacter pylori at all.

This is also one of the reasons why my country's Food and Drug Administration approved the first Helicobacter pylori consumer self-testing certificate. The purpose is to make the detection of Helicobacter pylori, a microorganism that causes gastric cancer, closer to the consumer market, so that more people can test for Helicobacter pylori more conveniently.

For example, the Helicobacter pylori consumer self-testing product approved this time can be used to conduct self-tests directly at home, so that people can more conveniently understand their Helicobacter pylori status.

04. How to treat Helicobacter pylori?

So how do you treat Helicobacter pylori? In fact, there are already mature strategies for treating Helicobacter pylori, the most common of which is quadruple therapy.

That is, a bismuth agent + a proton pump inhibitor + two antibiotics. Bismuth agents are mucosal protectors, proton pumps can inhibit gastric acid secretion, and antibiotics can kill Helicobacter pylori. In addition, these three agents will also enhance the effects of each other.

Bismuth preparations include potassium citrate bismuth granules or tablets, colloidal pectin bismuth capsules, colloidal bismuth tartrate capsules, etc.

Proton pump inhibitors such as omeprazole capsules, lansoprazole enteric-coated tablets, rabeprazole enteric-coated tablets, pantoprazole capsules, etc.;

The main antibiotics include amoxicillin, clarithromycin, furazolidone, metronidazole, levofloxacin, moxifloxacin, etc.;

So if your Helicobacter pylori level is high, it is best to go to the hospital to get medication for treatment.

05. How to avoid infection with Helicobacter pylori?

People who have not yet been infected with Helicobacter pylori should also be vigilant.

In fact, Helicobacter pylori is mainly transmitted through human-to-human contact. For example, if parents are infected with Helicobacter pylori, their children are more likely to be infected. This may be largely due to our eating habits. Currently, our main eating habits are to share tableware, which can cause Helicobacter pylori to be transmitted to different people through saliva and other means.

Therefore, in daily life, we should advocate the use of "public chopsticks" to reduce the spread of Helicobacter pylori due to food contact. If there is a Helicobacter pylori infected person in the family, the way of separate meals should also be advocated.

In addition, another common way for Helicobacter pylori to be infected is through "fecal-oral" infection. This method mainly means that Helicobacter pylori in feces may also spread in the bathroom, so you should develop the habit of washing your hands frequently when going to the bathroom.

In daily life, we should also pay attention to avoiding raw and cold food as much as possible and do appropriate disinfection, which can reduce the infection of Helicobacter pylori.

1. Forman, D. "The prevalence of Helicobacter pylori infection in gastric cancer." Alimentary Pharmacology & Therapeutics 9 (1995): 71-76.

2. Mentis, Alexios-Fotios A., et al. "Helicobacter pylori infection and gastric cancer biology: 2tempering a double-edged sword." Cellular and Molecular Life Sciences 76.13 (2019): 2477-2486.

3. Hooi, James KY, et al. "Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis." Gastroenterology 153.2 (2017): 420-429.

4. Chen, Wanqing, et al. "Cancer statistics in China, 2015." CA: a cancer journal for clinicians 66.2 (2016): 115-132.