Helicobacter Pylori/Peptic Ulcer

What Is H. Pylori and Peptic Ulcer?

Helicobacter pylori (H. pylori) is a common bacteria that is the primary cause of peptic ulcer disease and gastritis (inflammation of the stomach lining). An H. pylori infection occurs when the bacteria come in contact with the stomach, commonly during childhood. It’s estimated H. pylori infection is present in 50 to 75 percent of the world’s population, but only 20 percent of those infected will develop any type of symptoms. 

What Is H. Pylori Infection?

An H. pylori infection occurs in the stomach or duodenum, the first part of the small intestine. It is very common in children because it is easily spread from person to person. While H. Pylori is present anywhere, the infection is more common in developing countries and areas where sanitation is poor. The bacteria can be found in saliva, plaque (from teeth), and from feces. It is easily transmitted through kissing or by spreading germs with unwashed hands after a bowel movement. Some believe that H. Pylori can also be spread through contaminated water and food. 

What Is a Peptic Ulcer?

A peptic ulcer can be described as a sore (crater in tissue lining) that develops on the mucosal wall of the stomach and duodenum. Typically, the mucosal wall is thick, but many factors can damage the tissue over time, and then stomach acid begins to attack the mucosal lining, causing peptic ulcers. It’s estimated that 1 in 10 people will develop an ulcer. One of the more common contributing factors, particularly in children, is  H. pylori infection. The other is overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, naproxen, and ibuprofen. With such a high estimate of the world’s population having an H. pylori infection, certain factors can increase your chances of developing a peptic ulcer, such as:

• Moderate-to-heavy alcohol consumption
• Smoking
• Family history of ulcers
• Liver, kidney, or lung disease

How Does H. Pylori Cause Peptic Ulcers?

In a person with an H. pylori infection, the bacteria attach to the mucosal wall over time, which causes irritation. Irritation turns to inflammation, and the protective barrier of the mucosal wall begins to break down. Once the tissue is broken down, stomach acid can wear away at the stomach tissue, causing sores (ulcers).

What Are the Symptoms of Peptic Ulcer?

Of the 10 to 15 percent of people with H. Pylori infection who develop peptic ulcers, some don’t experience symptoms at all, while others experience noticeable and painful symptoms. Some of the common symptoms of peptic ulcer include:

• Bloating
• Heartburn
• Nausea 
• Pain that disappears with eating or with taking antacids
• Burning pain in the midsection between meals and at night

These are common symptoms of many types of gastrointestinal conditions, however, if GI upset continues for more than a day or two, consult your gastroenterologist. 

More severe symptoms of peptic ulcer include:

• Severe pain in the midsection
• Vomiting
• Unintentional weight loss
• Black, tarry stools

Black, tarry stools are a common sign of gastrointestinal bleeding. If you experience any of these symptoms, seek urgent care or see your healthcare provider as soon as possible. 

How Are Peptic Ulcers Diagnosed?

If you’re experiencing GI symptoms and a peptic ulcer is suspected, your doctor will first likely ask you about NSAID use. If you don’t use over-the-counter NSAIDs or rarely use them, the culprit is probably H. pylori infection. Your physician may run one of several diagnostic tests to confirm the diagnosis.

If your symptoms are severe, your physician may order an upper GI endoscopy. This outpatient, nonsurgical procedure involves a small, thin tube with a camera at the end to be inserted into the throat and into the esophagus, stomach, and duodenum. The photos that the small camera takes can show abnormalities anywhere within the upper GI tract. 

Imaging tests are sometimes used to determine if peptic ulcer disease is present. You will drink a certain liquid (dependent upon the test, but typically barium), which lights up your digestive system either via X-ray or CT scan. 

The easiest way to detect an H. pylori infection is to perform an H. pylori breath test. During this procedure, you will drink a liquid and then blow into a bag afterward. The contents are then examined for the presence of carbon dioxide, which indicates H. pylori. If you are already scheduling an endoscopy, your healthcare provider may take a tissue sample to detect H. pylori, and the bacteria is also detectable in stool tests. 

What Is the Treatment for Peptic Ulcer Disease?

In many cases, ulcers will disappear on their own. However, this doesn’t mean you should ignore symptoms. Symptomatic ulcers left untreated can lead to internal perforation, gastric outlet obstruction, or internal bleeding. If your ulcer is bleeding or there are other complications, your doctor may clamp or catheterize the ulcer during an upper endoscopy. Your physician may also inject substances directly into the area to stop the bleeding.

Medication is the most common treatment for most types of peptic ulcers. Medication types include:

• Proton pump inhibitors (PPIs), which are acid reducers
• Histamine receptor blockers (H2s), which are also acid reducers
• Antibiotics, for the treatment of peptic ulcer from H. pylori infection
• Protective medications, which place a protective layer on the ulcer to prevent more damage

When it comes to ulcer prevention, limit your use of NSAIDs, and if you do take them, take them with food. Also, drinking in moderation or being abstinent reduces your risk of developing an ulcer, as does quitting smoking.