Eradication of this common bacterium, discovered in 1982, is the key to curing a wide range of chronic gastric conditions and some cancers.
The 2005 Nobel Prize in Physiology or Medicine was awarded to a pair of Australian physicians for what the prize committee described as a “remarkable and unexpected discovery.” Working together, Drs. Robin Warren and Barry Marshall had identified a previously unknown bacterium called Helicobacter pylori (H. pylori) that eventually was proved to be the cause of most cases of gastritis and peptic ulcer disease as well as a significant factor in the development of stomach cancer.
“Before H. pylori, the thinking was that stress, lifestyle or hyperacidity was the cause of duodenal ulcers,” says Dr. Sunil Khurana, co-managing director of Premier Medical Group. “In those days, we could heal ulcers with acid suppression medications, but since the underlying cause was not addressed, they would almost always return. Currently, when H. pylori is implicated, we can usually cure the problem in a matter of weeks.”
Testing and treatment
The National Institutes of Health estimates that, in the U.S., about 20 percent of people under 40, and half of the adults over 60 years old are infected with H. pylori. Since most people with H. pylori will never experience symptoms or develop an illness because of the bacterium, routine screening has not been recommended. “The guidelines we follow,” says Khurana, “call for testing for H. pylori in patients with peptic ulcer disease, gastric cancer, MALT lymphoma, uninvestigated dyspepsia, atrophic gastritis, or unexplained iron deficiency anemia. We also recommend testing for patients who have a first degree relative with gastric cancer.”
There are several types of test available for H. pylori, both endoscopic and non-invasive. The patient’s condition, symptoms, and the medications he or she is taking factor into the decision on which test should be given.
If a patient is infected with the bacterium, treatment is relatively simple. The standard “triple therapy” to eliminate H. pylori consists of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and amoxicillin taken over a period of about two weeks.
“In the last few years we’ve been seeing resistance developing to the antibiotics, predominantly clarithromycin,” says Dr. Khurana. “When this treatment was first introduced, we could successfully treat up to 80 percent of patients with just one course of therapy, but that number has come down significantly because of the resistance factor.” Alternate drugs and treatment durations are available for patients whose initial course of therapy is unsuccessful.
“The way I normally prescribe antibiotics, though it takes a little time, is by first asking my patients what antibiotics they’ve used in the last 5 years,” says Khurana. “If someone tells me they’ve used Biaxin, for example, three or four times in the last few years, I may suspect they’ve developed a resistance to clarithromycin. In such a case, I’d want to prescribe quadruple therapy, adding an additional antibiotic. It’s important to ask patients their history and not just prescribe strictly according to the guidelines.”