A/Prof David van der Poorten
Dr Roslyn Vongsuvanh
  Prof Golo Ahlenstiel
Dr Way Siow

Appointments & Enquiries:  (02) 8711 0160

Helicobacter Pylori

 

Helicobacter Pylori is a spiral shaped bacteria that is uniquely adapted to living in the acidic environment of the stomach. It was first discovered and recognized as an important cause of disease by two Australians, Barry Marshall and Robin Warren in 1982. They were jointly awarded Nobel Prizes for their work in 2005.

 

Who gets Helicobacter Pylori?

Up to 20% of people in Western countries such as Australia are infected with Helicobacter at some point in their life, in some countries over 50% of the population is affected. It is thought Helicobacter is acquired mainly in childhood via close family contacts, primarily via Saliva or faeces. Domestic cats and primates may also be a source of infection.

 

What are the effects of Helicobacter Pylori infection?

Everyone who is infected will get some degree of Gastritis (stomach inflammation), but symptoms and significant complications are variable.

The most important complications of Helicobacter infection are:

  • Peptic Ulcer Disease (Gastric and/or Duodenal Ulcers)
  • Atrophic gastritis with intestinal metaplasia
  • Gastric cancer
  • MALT lymphoma

 

Who should be tested for Helicobacter Pylori?

High Priority for testing and treatment:

  • Patients with established complications such as Gastric or Duodenal Ulcer, Atrophic gastritis, Gastric cancer or MALT lymphoma
  • Good reasons for testing and treatment:
  • Patients with Dyspepsia (upper abdominal pain, bloating etc)
  • Where there is a strong family history of Peptic Ulcer disease or Gastric Cancer
  • Prior to long term use of anti-inflammatory drugs like Aspirin, Ibuprofen, Voltaren, Mobic etc.
  • Patients with persistent bad breath (halitosis), chronic urticaria or ITP where standard causes have been excluded

Less good reasons for testing and treatment:

  • Patients with Reflux (eradication may make the symptoms worse)
  • As a primary risk reduction strategy

 

Options for testing

Helicobcater can be diagnosed on a blood test, via breath test, faecal test or endoscopy. Breath tests are very reliable and show evidence of current active infection. Faecal tests are best for kids as they are not exposed to the tiny amount of radiation used in a breath test. Blood tests show exposure to Helicobactre, but can remain positive even after eradication. Endoscopy is important for documenting the complications of infection and is the gold standard for diagnosis.

 

Treatment

1st line

  • 7 day triple therapy of Amoxycillin, Clarithromycin and Proton Pump Inhibitor (Nexium Hp7 pack)
  • Metronidazole is substituted for amoxicillin in patients with a penicillin allergy
  • Other options are available for patients who find these treatments make them sick

2nd line

  • Levofloxacin triple therapy
  • Rifabutin triple therapy

3rd line and beyond

  • Bismuth based quadruple therapy
  • Novel tailored regimens

 

Why does treatment fail?

Most eradication regimens have a success rate between 65-85%, with the chance of getting rid of Helicobacter reducing with each successive treatment.

Reasons for treatment failure include:

  • Antibiotic resistance
  • Smoking (reduces rate by 20%)
  • Compliance (not taking the full treatment course)

 

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