bacteria in the stomach, symptoms, serious?

Most of the time Helicobacter pylori infection does not cause symptoms. So how do you know? And is it always serious? Answers with Dr Michael Bismuth, specialist in hepato-gastroenterology at Montpellier University Hospital.

Definition: what is Helicobacter pylori bacteria?

Helicobacter pylori is a bacteria that infects the inner lining of the stomach. Untreated, it persists and inflames the stomach. “It has an established role in the development of peptic ulcers and stomach cancers” explains the High Authority of Health (HAS). “7 out of 10 stomach ulcers are directly linked to Helicobacter pylori infection and 9 out of 10 duodenal ulcers”tells us Dr. Michael Bismuth. The two doctors who discovered Helicobacter pylori received the Nobel Prize in Medicine. It is only present in humans. It resists a very acidic environment. “The incidence of Helicobacter pylori infection is different in adults and children. In France, it is lower in those under 30 (20% of people are infected at the age of 20) and older common after the age of 50 (approximately one in two people)” indicates specialist in hepato-gastroenterology.

Contamination occurs in childhood, mainly during the first five years of life and goes unnoticed. “Theoretically, humans can be contaminated by two means: orally or through their stools. Transmission of the bacteria occurs mainly through direct person-to-person oro-oral and especially gastro-oral transmission. That is to say that contamination occurs through direct contact with infected saliva through regurgitation or during vomiting. Transmission through stools, following contact via the hands or because of contaminated water and food, is rarer and is more common in developing countries where hygiene is poor.” indicates the French Helicobacter Study Group (GEFH).

Is Helicobacter pylori serious?

The main danger of infection with Helicobacter pylori is the development of stomach cancer. According to the High Authority of Health, “among those infected, 1% develop stomach cancer”. But “even if this risk is low, Helicobacter pylori is the main cause of stomach cancer (80% of cases). The earlier the treatment takes place, the more effective it is in reducing the risk of this cancer appearing “.

What are the symptoms of Helicobacter pylori?

“Most of the time, the inflammation is silent, causing no symptoms.” answers Dr. Michael Bismuth. It can cause digestive problems with discomfort and pain. The symptoms are then those of complications if they occur: gastritis and ulcer. “Helicobacter pylori infection can be complicated by chronic gastritis (chronic inflammation of the stomach) which persists throughout life if the infection is not treated”specifies the specialist.

Diagnosis: how do you know if you have Helicobacter pylori?

There is no organized screening for Helicobacter pylori infection in France. When the search for the bacteria is decided by the doctor, he can prescribe:

• a serology (blood test) to detect the antibodies produced by the body to fight the bacteria
• the marked urea breath test (not reimbursed by health insurance)
• the search for antigens in stools (not reimbursed by health insurance).
• fiberoscopy with samples taken from the stomach wall and analysis of these samples

The search forH. pylori is not justified for loved ones if one is infected by the bacteria, except in two situations:

• They themselves present symptoms linked to a stomach disease (discomfort, pain).
• Precancerous or cancerous lesions have been detected in your stomach.

What are the treatments for Helicobacter pylori?

“The treatment of Helicobacter pylori and its eradication are recommended in several situations such as the presence of a peptic ulcer, chronic gastritis associated with the bacteria, MALT lymphoma, dyspepsia (after exploration endoscopic), long-term PPI treatment, a first-degree personal or family history of gastric cancer”indicates the specialist. There are several therapeutic strategies proposed by the gastroenterologist. The treatment is based in particular on:

• taking antisecretory medications (to reduce acidity) such as proton pump inhibitors (PPI): Omeprazole, Esomeprazole, Rabeprazole, Lansoprazole, Pantoprazole.
• taking several antibiotic medications such as amoxicillin, Metronidazole, Clarithromycin, Levofloxacin.
• Pylera® which is a medicine composed of antibiotics and a bismuth-based medicine. It is taken in combination with a PPI.

The treatment “helps eliminate the infection in 80 to 90% of cases” indicates the HAS. In 10 to 20% of cases, it may fail either because the bacteria is resistant to the antibiotics used, or because of the difficulties encountered by patients in following the treatment. A control test is therefore prescribed by the doctor to check whether the bacteria has been eliminated. The recommended test is the marked urea breath test (to be done on an empty stomach in the laboratory). It consists of swallowing a labeled urea solution then collecting the exhaled air. If the exhaled air contains carbon dioxide, which is also marked, this means that the bacteria has transformed the urea into carbon dioxide and therefore that it is present. The breath test is contraindicated in pregnant or breastfeeding women.

Thanks to Dr Michael Bismuth, specialist in hepato-gastroenterology at Montpellier University Hospital.