As it is known, the journey of the foods we eat every day starts from our mouth. After the bites are chewed and swallowed, the food that comes to our stomach through the esophagus stays here for a while (approximately 3 hours). The main task of the stomach is to ensure that the food mixes well with the stomach acid, and most of the digestion takes place in this organ. Organs in our body, which is a constantly working machine, need nutrients and energy to maintain their vitality. For this reason, the foods that are eaten must first be digested and made ready for absorption from the intestines. With the acid, pepsin and other enzymes secreted when the food comes to the stomach, the foods are softened, crushed and passed into the duodenum. With the regular work of our stomach, we can eat with pleasure and also provide the necessary substances for our body. Therefore, the regular functioning of our stomach has a special place.
If our stomach is disturbed, complaints that we all know occur. In fact, it has been known for 2500 years (in other words, from the period of Hippocrates) that the source of heartburn, burning, and hunger pain spreading to the back is the stomach. After the sixteenth century, developments were made in concepts such as the presence of acid in the stomach and the control of this acid through nerves, and “ULCER” (which means the formation of wounds or the formation of wounds by deep injury to the stomach or duodenum tissues) was first described by Cruveilher in 1829. At the beginning of the 20th century, it was accepted that ulcers were caused by stomach acid and stress was a facilitating factor. And even in all medical books, the phrase “No acid, no ulcer” was used.
When we look at the general population, the incidence of ulcer is about 2-4%. Ulcer is seen in 11-14% of men and 8-11% of women during life. While surgical procedures had an important place in the treatment of ulcers until about 30 years ago, effective drugs have become the main treatment option today. While deaths due to complications such as ulcer-related bleeding and perforation were 3 per 100,000 in the 1960s, this rate has decreased to 1 per 100,000 today.
Symptoms of ulcers; It is known that the disease progresses silently in half of the patients. In the other half, the symptoms differ according to the location of the ulcer. Hunger pain is typical in duodenal ulcers. In other words, the pain starts 1-4 hours after eating, can wake up at night and decreases with meals. In stomach ulcers, the pain usually starts when you are full (15 minutes after a meal) and rarely wakes you up at night.
There are some factors that normally protect the stomach and intestinal wall; These are the blood flow of the mucosa, cell proliferation, factors called prostaglandins, mucus and bicarbonate secretion that destroys the harmful effect of stomach acid. In addition, there are of course factors that attack the mucosa; these are genetic predisposition to ulcers, acid in the stomach, smoking, pepsin, some (especially antirheumatic) drugs, stress and (to some extent) alcohol. Normally, these protective and offensive factors are in balance. When this balance is disturbed against the attackers, ulcers occur. In 1984, Australian scientists Warren and Marshall succeeded in isolating a microorganism in the stomach. Although the existence of microorganisms in the stomach has been known since 1893, this newly detected microorganism, which was later named Helicobacter pylori, broke new ground in the medical world in terms of stomach – duodenum diseases. Today we know that H. pylori is one of the most important attackers, and even the first. Today, the phrase “no acid, no ulcer” has almost left its place to the phrase “no H. pylori, no ulcer”.
I think that the question of where this microorganism comes from and how it is transmitted immediately comes to your mind. Although there is no definite data on where and how H. pylori is transmitted, it is claimed that it is transmitted from person to person. Available data support the fecal-oral (stool-to-mouth) and oral-oral (mouth-to-mouth) route. The fact that the incidence is high in communal living areas such as nursing homes, the concentration of infection in the family, and the demonstration of contamination with devices (endoscopes) contaminated with this microorganism suggest that human-to-human transmission is the main route. Although isolated in monkeys and domestic cats, humans are considered the main reservoir for H. pylori. City mains water can also be a source of infection, as the microorganism can live in water for days. This bacterium is one of the most common infections in the world and is found at a rate of 20-40% in developed countries with good environmental conditions such as the USA and Canada, and at a rate of 70-90% in developing countries. In our country, about 80% of our people carry this bacterium; but nowadays this ratio is gradually decreasing.
When it was investigated how H. pylori survived in an environment such as the stomach where acid is very intense, it was determined that this bacterium hides itself in the thin mucus layer just above the stomach wall and neutralizes the acidic environment around it with the help of the urease enzyme it carries. The ability of H. pylori to cause ulcers was demonstrated by a 4.5-year follow-up of a group of people. At the end of the follow-up, 15% of those with H. pylori bacteria in their stomachs had ulcers, while those without H. pylori bacteria had no ulcers. Studies have shown that H. pylori is responsible for 92% of duodenal ulcers and 70% of stomach ulcers. In addition, those who had ulcer disease and were treated were also investigated. While the recurrence rate of ulcer after treatment is only 10% in patients without H. pylori in their stomach, this rate reaches 60-80% in the presence of microorganisms.
The diagnosis of stomach and duodenal diseases can be easily made videoscopically with soft, flexible devices called endoscopes. In our country, medical education on endoscopy procedure and gastrointestinal diseases is given to Internal Medicine Specialists and “Gastroenterologists” by Gastroenterology Departments.
In the light of all this information, let’s answer the question of how H. pylori is detected, how it is treated and who should be treated. H. pylori can be detected endoscopically. During this process, small pieces taken from the stomach can be produced in culture medium, evaluated under the microscope or detected by means of colored tests with the help of urease it contains. Without endoscopy, H. pylori can be detected by stool examination, breath tests, or blood. Breath and stool tests can easily, reliably and reliably detect whether this microorganism has disappeared with H.
Who should be treated is extremely important.
At the end of the studies:
1) Those with stomach or duodenal ulcers
2) Those with first degree relatives (mother, father, sibling) with stomach cancer
3) Those with maltoma,
4) Those who have ATROPHIC gastritis
5) Those who have surgery for stomach cancer.
Other applications are still controversial.
It is estimated that more than 50 million people in our country have H. pylori. Removal of this bacterium, which remains silent in most people, is often not necessary. For this reason, those who have H. pylori in their stomach should not make an excessive effort to destroy this bacterium. In fact, when they are told to eradicate H. pylori, they must be questioned whether it is really necessary. Unfortunately, nowadays this bacterium is tried to be destroyed unnecessarily, and people take antibiotics in vain. In fact, it is not a small number of people who use unnecessary drugs without knowing that H. pylori is in their stomach and without an examination.
Recently, there is information that H. pylori causes stomach cancer. Indeed, the World Health Organization has declared H. pylori as a 1st degree carcinogen. However, while the incidence of H. pylori in our society is 80%, the incidence of gastric cancer is only 6 per hundred thousand. For this reason, it is necessary to evaluate the information obtained from the environment by filtering it.
Acid-reducing medication and two different antibiotics are used for 10 – 14 days in treatment. With this treatment regimen, 80 – 90% of bacteria are destroyed. Bacteria reappear at a rate of 5% within a year after treatment.
In summary:
H. pylori is one of the leading causes of ulceration,
H. pylori treatment should be done if necessary,
Treatment should be 10 – 14 days and unnecessary repetitions should be avoided. .
Be healthy, stay happy.
