Health Tips

While gastric pain may be caused by various reasons, having gastric pain that happened over and over again for an extended period of time is not a good sign. One of the common reasons for gastric pain may be Helicobacter pylori infection, and its health consequences may be more than just discomfort in the stomach. 

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What is Helicobacter pylori infection?

Helicobacter pylori, or H.pylori, is a spiral-shaped bacterium that grows in the mucus layer that coats the inside of the human stomach. H.pylori infection increases the risks of getting stomach ulcers, which can be manifested as gastric pain. 

Image credit: https://www.news-medical.net/life-sciences/Helicobacter-pylori-Life-Cycle.aspx

H. pylori are thought to spread through contaminated food and water and through direct mouth-to-mouth contact. In many cases, H.pylori is first acquired during childhood but adults can get infected by it too. H.pylori infection is more likely to be seen in children living in poverty, in crowded conditions, and in areas with poor sanitation.  

Interestingly, not everyone who is infected by H.pylori will get a peptic ulcer. Most people don't realize they have H. pylori infection, because they never get sick from it. With that being said, in the year 1994, the International Agency for Research on Cancer classified H. pylori as a carcinogen, or a cancer-causing agent, in humans. Since then, it has been increasingly accepted that H. pylori infection is an important cause of gastric cancer and of gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

Image credit: https://www.mayoclinic.org/diseases-conditions/stomach-cancer/symptoms-causes/syc-20352438

The link between H.pylori infection and gastric cancer

Many scientific studies have demonstrated a positive association between H.pylori infection and gastric cancer. According to the EUROGAST Study Group, H.pylori infection increases the risk of gastric cancer by six-fold compared to those who were not infected. Another meta-analysis has confirmed such a relationship while also pointed out that H.pylori-infected patients who are younger have higher risks for gastric cancer than those who are older. Another combined analysis of 12 case-control studies found out that H.pylori infection particularly increased the risk of non-cardia gastric cancer but not the cardia gastric cancer. 

Image credit: https://www.cancer.org/cancer/stomach-cancer/about/what-is-stomach-cancer.html

H.pylori was also found in the histologic samples of the stomach of patients who had undergone gastrectomy for gastric cancer. As such, H.pylori may be a cofactor in the development of intestinal-type gastric cancer.

Until today, the exact mechanism of how H.pylori causes gastric cancer is unknown. It is believed the following all play a role in causing gastric cancer:

• Bacterial properties, such as the difference in H.pylori strains

• Host responses, i.e. how the body of an H.pylori-infected person reacts to the infection

• Environmental factors, such as high consumption of salted food, lack of vitamin C, hyperglycaemia (high HbA1c level)  and obesity. 

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How is H.pylori infection being diagnosed and treated?

If you do not have symptoms consistent with gastric ulcer, your doctor probably will not test you for H.pylori. But if you have them now or in the past, it is better to get tested. Your doctor may ask you about your clinical history, symptoms and medications you are taking, followed by physical examination. For testing H.pylori specifically, you may be referred for:

• Urea breath test. You’ll drink a special liquid that has a substance called urea (not urine!). Then you’ll breathe into a bag, which your doctor will send to a lab for testing. If you have H. pylori, the bacteria will change the urea in your body into carbon dioxide, and lab tests will show that your breath has higher than normal levels of the gas.

• Stool or blood antigen test, in which your stool or blood samples will be sent for testing.

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Your doctor may also order an endoscopy for you, which involves looking at your intestine using a small camera inserted through your throat. 

If you are clinically diagnosed with H.pylori infection, your doctor will prescribe a short-term treatment with antibiotics to eradicate H.pylori. It is important that you take the medications as per instruction, as studies have found out that gastric cancer rate was reduced among H.pylori-infected patients who received antibiotics. 

Image credit: https://www.nejm.org/do/10.1056/NEJMdo005257/full/

Cover image credit:https://www.emra.org/emresident/article/helicobacter-pylori-underappreciated-and-underdiagnosed/

Written by

Ms Joyce Toh