As you know, we don’t live on planet earth alone. We live with many other creatures and species in a well-balanced ecosystem. But do you know that we have other creatures that we can’t see? 

Of course, we have animals, fish, and plants, but we also live with other creatures that can only be seen under the microscope. Have you guessed what I am talking about yet? 

I am mainly talking about the super tiny organisms that live around us such as bacteria and viruses.

We are going to talk about one of these organisms. We are going to talk about Helicobacter Pylori or also known as H.Pylori.

What is this Bacterium? What is H. Pylori? 

H.Pylori is a common type of bacteria that has a spiral shape. It can cause infection in the digestive tract, especially in the first part of the duodenum or the stomach. This infection usually happens during childhood. 

Although some people have H.pylori and live their lives normally, H.Pylori can attack the lining of the stomach and cause inflammation and irritation. In fact, it is the most common cause of peptic ulcers. Many people have it. 

And when we say many people have it, we mean it. 

You might ask, how common is H.Pylori infection?

You will be surprised when you hear this but H.pylori infection may be present in more than half the people in the world. It is present in about 50% to 75% of the world’s population. It mostly occurs in children, especially those who live in crowded conditions and areas with poor sanitation. It is also more common in developing countries. 

The fact that it doesn’t cause illness in most people makes it undetectable unless it causes symptoms. 

That’s why most people don’t realize they have H.Pylori infection. 

But how do people usually get H.Pylori? How does it spread? 

If you know where H. Pylori lives, you can tell how it spreads. 

It can spread from one person to another.

It can be found in saliva, plaque on teeth, and stools. 

So, it can spread through kissing or by transferring the bacteria from the hands of those who don't thoroughly wash their hands after using the bathroom after a bowel movement.

Some doctors also think that H.pylori can spread through contaminated food and water. 

So, apparently, the exact way H.Pylori infects someone is still unknown. But scientists believe that it is most probably acquired during childhood. They also believe that there are risk factors that increase the probability of infection, including: 

• Living in crowded conditions. People who live in crowded homes with so many people have a higher risk of infection with H.Pylori.
• Contaminated supplies of water. Having a reliable clean source of water helps reduce the risk of getting H.Pylori infection.
• Living in a developing country. Developing countries are known to be more crowded and unsanitary, so people who live there are more likely to be infected with H.Pylori.
• Living with an infected person who has H.Pylori infection. If you live with someone who has H.Pylori infection, you are more likely to be infected.

When the bacteria enter the digestive system of humans it causes damage. So, how does the infection with H.pylori cause damage? 

When H.pylori enters the digestive system, like any other organism, it multiplies in the mucus layer of the stomach lining and duodenum. 

H.Pylori then secretes an enzyme called the urease enzyme. This enzyme converts urea to ammonia. This ammonia is a protective mechanism of the bacteria against the acidity of the stomach. It protects the bacteria from being killed by the strong acid of the stomach. And as the bacteria multiply, it eats into the stomach tissue which, at some point, leads to gastritis and peptic ulcers.

But as we said, some people might get H.Pylori infection without even knowing that they have it.

However, some symptoms might raise suspicion that someone has H.Pylori infection. 

What are these symptoms? 

As we mentioned before, some people will never have any signs or symptoms. We don't know yet how this happens. But maybe some people may be born with a strong natural resistance against the harmful effects of the bacteria. 

When symptoms and signs occur, they include:

• Burning pain or ache in the abdomen. The pain may last for minutes or hours and it may come and go over several days to weeks.
• Abdominal pain, that is worse when the abdomen is empty.
• Nausea.
• Loss of appetite.
• Bloating.
• Frequent burping.
• Unintentional weight loss 
• Indigestion.
• Dark stool from the blood in the stool.

Most of the symptoms arise when the bacterial infection causes gastritis or peptic ulcers.

But generally, you should make an appointment with your doctor if the symptoms are persistent and they worry you. You should also seek immediate medical help if you experience: 

• Severe persistent abdominal pain.
• Difficulty swallowing.
• Vomiting blood or vomiting something that looks like coffee grounds.
• Blood in the stool or black tarry stool. 

These symptoms need immediate medical attention because there might be an underlying severe complication.

So, we can figure that H.pylori can cause some complications.

But what kind of complications are we talking about?

If a patient knew that they have H.Pylori infection and they neglected it, some serious complications will arise, including:

• Ulcers. As we explained before, H.Pylori can damage the protective lining of the stomach and duodenum. This will allow the stomach acid to create an open sore, or an ulcer, in the wall of the stomach or small intestine. Around 10% of people who have H.Pylori will develop an ulcer. 
• Internal bleeding. It can happen when a peptic ulcer breaks through a blood vessel and is associated with iron deficiency anemia.
• Perforation. It happens when a peptic ulcer breaks through the stomach wall.
• Peritonitis. It is an infection of the peritoneum or the lining of the abdominal cavity.
• Inflammation of the stomach lining. The bacteria can irritate the lining of the stomach and cause persistent inflammation, a condition known as gastritis.
• Stomach cancer. H.Pylori infection is considered one of the strong risk factors of some types of stomach cancer.

You may be surprised now because you heard the word "Cancer". I mean we just said that H.Pylori infection can cause stomach cancer.

But how does this happen? What's the relation between H.Pylori infection and stomach cancer? 

Patients with H.Pylori infection have a higher risk for developing stomach cancer later in life, especially if they have a strong family history of stomach cancer and other cancer risk factors. Although these patients might not have any symptoms or signs of stomach ulcers, their physicians will always recommend getting tested for H.Pylori antibodies.

This is considered a form of screening so that if the patient has H.Pylori infection, he or she would be treated properly.

In addition to screening and treatment, some lifestyle changes should be made such as including more fruits and vegetables in the diet.

The physician will also recommend regular checkups and following to reduce the risk of stomach cancer.

But you can always prevent the disease and kill it at the roots to avoid these severe complications.

How would we prevent H.Pylori infection? 

You can lower your risk of getting H.Pylori infection when you: 

• Drink clean water.
• Use clean water in cooking and food preparations.
• Wash your hands thoroughly with soap and water for about 20 seconds before eating and after using the bathroom. 

Besides, doctors recommend testing healthy people for H.Pylori in areas of the world where H. Pylori infection and its complications are so common so that we can avoid its severe complications. 

Now it is time to know how H.Pylori infection is diagnosed. I mean it lives in the digestive tract, so is a stool analysis enough?

When you or your physician suspect an H.Pylori infection, the first step is physical examination.

Your physician will start with examining you thoroughly and look at your past health records. This can give him a clue whether to proceed with H.Pylori infection probability or not.

After physical examination, your physician may ask for some tests, including: 

• Stool tests. As we mentioned, since H.Pylori lives in the digestive tract, it can be detected in the stool. The most common stool test to detect H.Pylori is called the stool antigen test. This test looks for foreign proteins associated with H.Pylori infection in the stool. Sometimes antibiotics and acid-suppression drugs affect the accuracy of this test. That's why doctors usually wait for about 4 weeks after patients complete their antibiotic course and then test again for H.pylori stool antigen. Also, acid suppression drugs and bismuth subsalicylate can interfere with the accuracy of the test. The test is available for adults and children older than 3. A laboratory test called a stool polymerase chain reaction (PCR) test can detect H.pylori infection in the stool and other mutations that may be resistant to antibiotics used to treat it. But this test is more expensive and isn't available at all medical centers. It is also available for adults and children.
• Breath test. This test checks if there is any carbon after the patient swallows a urea pill that has carbon molecules. During a breath test, the patient swallows a pill, liquid, or pudding that contains tagged carbon molecules. If carbon is found or released, it means that H.Pylori has made the urease enzyme and the solution is broken down in the stomach. The human body absorbs the carbon and expels it during exhalation. Your doctor will make you exhale into a bag and use a special device to detect the carbon molecules. As with stool tests, proton pump inhibitors, bismuth, and antibiotics can interfere with the accuracy of the test. If the patient is on proton pump inhibitors or antibiotics, the doctor will ask them to stop the drugs a week or two before the test. If the patient has been diagnosed or treated with H.pylori infection previously, the doctor will wait for about four weeks after the patient has completed their antibiotic course to perform the breath test. It is also available for adults and children.
• Scope test. This test requires sedation. It is also known as the upper endoscopy exam. During this exam, the doctor inserts a long flexible tube equipped with a tiny camera down the throat and esophagus into the stomach and duodenum. This exam allows the doctor to view the gastrointestinal tract to detect any abnormalities or irregularities in the upper digestive tract and remove tissue samples for testing. These samples are later analyzed for H.pylori infection. This test is done to investigate symptoms that may be caused by other digestive tract conditions such as gastric ulcers or gastritis. H.pylori can also induce ulcers and gastritis. The test may be repeated after treatment according to what is found at the first endoscopy or if the symptoms don't go away after H.pylori treatment. At the second trial, biopsies are taken to make sure that H.pylori infection has been eliminated. And if you have been on H.pylori treatment, your doctor will have to wait for at least four weeks after you complete your antibiotic course. This test isn't always recommended solely to diagnose H.pylori infection because it is invasive while there are other non-invasive options like stool test or breath test. However, it is used to perform detailed testing for doctors to determine which antibiotic to prescribe for treatment. Especially if previously prescribed antibiotics fail.

After H.pylori infection is confirmed, what is the proper diagnosis for H.pylori infection?

To treat H.pylori infection, patients must take at least two different antibiotics at once, to prevent the bacteria from developing resistance to one particular antibiotic. Among the common choices are amoxicillin, clarithromycin, metronidazole and tetracycline.

Acid suppression drugs are also prescribed to help the stomach lining heal.

Acid suppression drugs include:

• Proton pump inhibitors ( PPIs). These drugs stop the acid production in the stomach. Proton pump inhibitors include omeprazole, esomeprazole, lansoprazole, and pantoprazole.
• Histamine (H-2) blockers. These medications block the histamine which induces acid production. One example of H-2 blockers is cimetidine.
• Bismuth subsalicylate. It is more commonly known as Pepto-Bismol. This type of drug works by coating the ulcer and protecting it from stomach acid.

This combination of drugs is taken for about 14 days.

After the complete course of treatment, your doctor will recommend that you undergo testing for H.pylori at least four weeks after the treatment. According to the result of this test, you might need no further treatment or you might go undergo another round of treatment with a different combination of antibiotics.

Now, let's talk about ulcers, gastritis and cancer of the stomach that usually accompany H.pylori infection.

Let's start with peptic ulcers.

Peptic ulcer disease is a condition in which painful sores or ulcers develop in the lining of the stomach or the first part of the small intestine. Normally, there is a thick layer of mucus that protects the digestive tract from the acidic juice of the stomach.

However, many things can reduce this protective layer and allow the stomach acid to damage the lining of the stomach.

H.pylori infection and non-steroidal anti-inflammatory drugs are among the causes of peptic ulcers.

Because H.pylori infections are very common, it is possible to be infected without realizing it because infections with H.pylori don't always cause symptoms. And as we said at the beginning of the article, about 50% of the world's population has an H.pylori infection.

What are the symptoms of Peptic Ulcers? 

Signs and symptoms of an ulcer include:

• Burning pain in the middle or upper stomach between meals or at night.
• Bloating.
• Pain disappears if you eat something or take an antacid.
• Heartburn.
• Nausea or vomiting.

In severe cases, symptoms include:

• Dark or black stool.
• Vomiting.
• Weight loss.
• Severe pain in your middle or upper stomach.

Ulcers are usually diagnosed just by talking with your healthcare provider about your symptoms.

To confirm the diagnosis, your doctor will ask for some investigations and tests including:

• Endoscopy.
• H.pylori tests.
• Imaging tests. These tests use X-rays and CT scans to detect ulcers. Patients drink a specific liquid that coats the digestive tract and makes ulcers more visible to imaging techniques.

Ulcers can sometimes heal on their own, however, you shouldn't neglect the warning signs. 

Without proper treatment, ulcers can lead to some severe complications including: 

• Bleeding.
• Gastric outlet obstruction blocks the pass way from the stomach to the intestine.
• Perforation.

For most people with ulcers, doctors usually prescribe them proton pump inhibitors, H-2 blockers, antibiotics and protective medications like a liquid bandage such as Pepto-Bismol.

Now, let's move to gastritis.

Gastritis is a condition that inflames the stomach lining, the mucosa.

It happens when something damages or weakens the protective lining of the stomach. The most common cause of gastritis is H.pylori infection.

The risk of getting gastritis goes up with age because as we get old the lining of the stomach gets thinner, the circulation gets slower, and the metabolism of the mucosal repair gets more sluggish.

In addition, older adults use medications like non-steroidal anti-inflammatory drugs which can cause gastritis.

There are two main types of Gastritis:

• Erosive gastritis. In this type, there is both erosion and inflammation in the stomach lining.
• Non-erosive gastritis. In this type, there is only inflammation of the stomach lining without erosion.

Symptoms of gastritis include: 

• Bloating.
• Black tarry stool.
• Nausea and vomiting.
• Stomach ulcers.
• Loss of appetite.
• Losing weight.
• Upper abdominal pain.
• Vomiting blood.
• Feeling extra full during or after meals.

Gastritis isn't a contagious disease, however, H.pylori is.

It can be transmitted from person to person causing them gastritis.

And just like H.pylori infection, the first line of defense against gastritis is protecting yourself from getting infected. Good hygienic habits will protect you from infection such as good hand washing and proper food sanitation.

And just like H.pylori infection, gastritis is treated the same way.

Antibiotics, antacids and proton pump inhibitors are used to treat gastritis.

What about stomach cancer? 

Stomach cancer is an abnormal growth of cells that begins in the stomach. It can affect any part of the stomach.

It is also known as gastric cancer.

Signs and symptoms of gastric cancer include:

• Indigestion.
• Heartburn.
• Loss of weight.
• Difficulty swallowing.
• Feeling bloated after eating.
• Nausea.
• Stomach pain.
• Feeling full after eating small amounts of food.

Two of the major risk factors of gastric cancer are H.pylori infection and long-term stomach inflammation as it occurs with gastritis.

Long term or neglected infection of H.pylori can cause stomach cancer as we mentioned before.

Is H.pylori deadly?

In fact, the mortality rate of H.pylori is not known precisely.

However, it seems to be minimal, about 2%-4% of all infected people.

And mortality usually is associated with complications of the infection, not the infection itself such as gastric ulcer, perforations or gastric cancer.

That's why it is very important to never ignore gastrointestinal symptoms. Some symptoms can be an indication of a specific disease. 

The earlier the disease is discovered, the better the prognosis and results of treatment. And as we explained, if H.pylori infection is left untreated it may lead to severe complications up to stomach cancer.

So, it is important to check on your health and have regular check-ups with your general practitioner to stay safe and to always make sure that your systems are functioning normally.

And if you already have an H.pylori infection, you should not neglect the treatment and follow up with tests after you finish your course of treatment to make sure that the bacteria have been eliminated.  We also must emphasize the fact that prevention is significantly important in the battle against this bacterium. Following good sanitary and hygienic habits can save your stomach and gastrointestinal tract in general from agonizing symptoms. So, always remember to: 

• Wash your hands after using the bathroom. 
• Wash your food properly before cooking. 
• Cook your food properly. 
• Avoid sharing food or drinks with infected people. 

Protect yourself and stay safe.