Prof. Dr. Barry Marshall discovered that Helicobacter Pylori causes gastritis, ulcers and stomach cancer, and he won the Nobel Prize in Medicine for this work.
Helicobacter Pylori (Hp) is a rod-shaped, highly mobile and slow-growing organism. The incidence of infection is 10-50% in developed countries and around 80% in developing countries. In other words, 8 out of 10 people in our country carry this bacterium. The most important determinant of this situation is socioeconomic differences. High standard of living, higher education level and better health conditions ensure that the incidence of infection is low. Especially in developing countries, long-term consequences of infection occur. Helicobacter pylori is responsible for the long-term process leading to chronic gastritis, then atrophic gastritis, then intestinal metaplasia and gastric cancer.
Helicobacter Pylori Contamination
Although the path of transmission of the microorganism is not known exactly, it is thought that it can be transmitted between humans by fecal-oral or mouth-to-oral routes (saliva, saliva, etc.). Conditions such as not washing fruits and vegetables, using a medium fork and spoon, eating from the same plate, and unhygienic drinking water facilitate the transmission of Helicobacter pylori. Studies conducted on families who do not have any complaints in terms of H. pylori infection have shown that in the presence of H. pylori infection in one of the family members, the probability of their children and spouse to be infected is up to 70%.
Diseases that have been shown to be related to Helicobacter Pylori
It has been shown in studies that Helicobacter Pylori is responsible for a process that goes from first to chronic active gastritis, then to chronic atrophic gastritis, intestinal metaplasia and stomach cancer. Studies show that people carrying this bacterium are 4 times more likely to get stomach cancer than other people.
1-Development of stomach and duodenal ulcer (20%)
2-Development of stomach cancer (1-3%)
3- Development of gastric lymph cancer (malt lymphoma) (1%- 3)
4-Chronic gastritis, atrophic gastritis and intestinal metaplasia (Intestinal metaplasia is the appearance of intestinal-type mucosal islets in the gastric mucosa and requires close follow-up because some types may transform into cancer)
5-Pain, gas, bloating, nausea Dyspeptic complaints such as postprandial fullness, belching, bad breath are associated with Hp.
Factors that increase the risk of being infected with Helicobacter Pylori
* Consumption of contaminated food and water
* Low socioeconomic status
* Large families and crowded living conditions
* Unhealthy living conditions
* Exposure to stomach contents of persons carrying the organism
(Transfer between healthcare workers and spouses)
Tests used in the diagnosis of Helicobacter pylori
Endoscopy (Gastroscopy) to be taken during endoscopy in patients who need to be performed By examining the tissue sample (biopsy) using rapid urease test (CLO test) or by performing histopathological examination, it is understood whether there is H.pylori in the stomach. The presence or absence of HP is detected by looking at the color change in the biopsy taken in the rapid urease test (CLO test). The CLO test does not report histological conditions such as atrophy, intestinal metaplasia, and severity of inflammation in the stomach tissue. However, biopsy sent to pathology also shows other diagnoses such as atrophy, intestinal metaplasia, inflammation (inflammation) other than Helicobacter pylori. The most reliable method for definitive diagnosis is the examination performed by endoscopy and pathological investigation of the bacteria in the biopsy taken during this time.
If endoscopy is not required, another method, the Urea-Breath Test, or serological tests to detect antibodies against this bacteria in the blood can be applied. In order for the urea-breath test to be performed, it is necessary not to have used antibiotics or a medicine to reduce stomach acid in the last 15 days. Detection of antibodies against H. pylori in the blood only indicates that the person has encountered this bacterium at any time, it does not provide information about whether the bacterium has been treated or not. Apart from these, the presence of H. pylori antigen in the stool can be investigated.
Conditions where Helicobacter Pylori treatment is definitely recommended:
1- Peptic ulcer disease
2- MALToma (malt lymphoma)
3- Atrophic gastritis, intestinal metaplasia
4- Presence of infection in the stomach remaining after gastric cancer surgery
5-Patients with a first-degree relative with gastric cancer
6-If the patient desires treatment for Hp voluntarily
Conditions in which Helicobacter Pylori treatment is recommended:
1- Functional dyspepsia with Hp positive (Pain, gas, bloating, nausea, feeling of fullness after meals, belching, etc.) condition that cannot be shown)
2- Gastro-esophageal reflux disease requiring long-term drug therapy
3- Aspirin and/or non-steroidal antirheumatic drugs need long-term use Diseases
4-Iron deficiency anemia of undetermined cause
5-Functional dyspepsia (nonulcer dyspepsia)
6-Long-term PPI (anti-acid drug) treatment
7-Long-term antirheumatic drug (NSAID) treatment
8-Halitosis (Haitosis)
9-ITP (Idiopathic thrombocytopenic purpura)
Treatment
When the presence of Helicobacter Pylori infection in the stomach is demonstrated by any method, especially as a result of the pathology of endoscopic biopsy, it would be an appropriate approach to treat the infection because of the possible diseases it may cause. The basis of the treatment consists of a drug that suppresses gastric acid secretion and the use of at least two types of antibiotics together for 10-14 days. Since the pH range in which bacteria are sensitive to antibiotics is between 6 and 8, gastric acid secretion should be effectively suppressed during treatment. In patients whose eradication cannot be achieved despite appropriate treatment, different treatment courses should be applied. Consulting a gastroenterologist will help you in this regard.
