New Vaccines in the Pipeline 2020

H-Pylori: What Is It? Its Symptoms, Dangers And Treatment

 

Abdominal pain is one of the common symptoms of H. Pylori infection. [File, Standard]

Several Twitter users on Thursday, November 25, took to the micro-blogging site to narrate their experiences with bacteria Helicobacter pylori (H. Pylori).

The users observed that H. Pylori seems to be a common infection that most city dwellers risk contracting at one point or another.

"When you visit any city hospital to seek treatment for a stomach upset, chances are high that the doctors will test you for H. Pylori, and the results will return positive," said one of the Twitter users.

This observation is supported by research, which shows that the prevalence of H. Pylori in Kenya is about 65 per cent in all age groups.

Kenyans living in urban centres are at a higher risk of contracting H. Pylori infection, with the prevalence in the towns standing at 62 per cent compared to 56 per cent in rural settings.

People who have contracted H. Pylori know it's a terrible bacterium.

What is H. Pylori?

Medical publication Web MD states that Helicobacter pylori (H. Pylori) is a type of bacteria. The 'H' is the short form for Helicobacter. "Helico" means spiral, meaning the bacteria is spiral-shaped.

"Germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer," the publication says.

Causes of H. Pylori

Research conducted by microbiologists in Kenya in 2019 show that poor sanitation could cause someone to contract H. Pylori.

According to the research, the infections are prevalent in areas where there is poor sewerage system. Urban centres in Kenya are the most affected with Nairobi and Meru counties leading the pack at 87,770 and 84,280 cases in 2020 respectively.

"People usually catch it from another person (through saliva) or if they eat food or drink water that has been contaminated with faeces," Kimang'a Nyerere, a Microbiology lecturer at the Jomo Kenyatta University of Agriculture and Technology (JKUAT), wrote.

Healthline.Com also attributes causes of the infection to contaminated water and food, and through direct contact with saliva.

Symptoms

American academic medical centre Mayo Clinic says most people may not immediately show signs and symptoms of the infection. This is because "some people may be born with more resistance to the harmful effects of H. Pylori".

The common symptoms, however, include nausea, abdominal pain, bloating, loss of appetite, excessive burping, dark stools (due to presence of blood in stool), heartburn, headache, weight loss and general body weakness.

Treatment

H. Pylori treatment lasts two weeks.

If you've been diagnosed with H. Pylori, avoid taking nonsteroidal anti-inflammatory drugs. These drugs can increase your risk of developing an ulcer.

H. Pylori-caused ulcers are treated with a combination of antibiotics and an acid-reducing proton pump inhibitor, says my.Clevelandclinic.Org.

Antibiotics: usually two antibiotics are prescribed. Among the common choices are amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline.

Proton pump inhibitor: commonly used proton pump inhibitors include lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) or esomeprazole (Nexium).

Bismuth subsalicylate: sometimes this drug (for instance, Pepto-Bismol) is added to the antibiotics plus proton pump inhibitor combinations mentioned above. This drug protects the stomach lining.

How do you reduce chances of contracting H. Pylori? Drink clean water and use clean water during food preparation. This is especially important if you live in areas known to have a contaminated water supply.

It's also advised that you wash your hands thoroughly (20 seconds) with soap and water before eating and after using the bathroom.

So far, there is no vaccine to prevent H. Pylori infection. However, there are promising results from a late-stage clinical trial. In this trial, children given the vaccine were protected against H. Pylori infection for up to three years.

What are the risks that H. Pylori pose to a patient?

H. Pylori has been identified as a Group I carcinogen by the International Agency for Research on Cancer as approximately 89 per cent of all gastric cancers can be attributed to H. Pylori infection, says Scientific Research (www.Scirp.Org).

Gastric cancer is one of the leading causes of cancer mortality worldwide and the ninth-highest cause of cancer in Kenya: a major cause of morbidity and mortality.

The incidence of gastric cancer is highly variable by region and culture, however, is more frequently diagnosed in developed nations.

The frequency of gastric cancer in the study was 1.4 per cent, which is considerably lower than as reported in a study conducted in 2018 where the prevalence was 3.67 per cent.

Despite Kenya posting a 65 per cent H. Pylori prevalence rate, there are other countries in Africa that have higher prevalence percentages.

Egypt has a prevalence rate of 91.7 per cent, Gambia (97 per cent), Ghana (75.4 per cent).

The figures in Africa are almost twice as high as the average rates in developed countries of 34.7 per cent.

National Referral Hospital Utilising Device To Detect Antimicrobial Resistance To H. Pylori

Antimicrobial resistance to Helicobacter pylori or H. Pylori can slow down the rate at which H. Pylori bacteria can be eradicated. Antimicrobial resistance is when bacteria develop resistance towards antibiotics, nullifying the effects of a drug. To detect H. Pylori drug resistance in the country, a device is being used at the national referral hospital. H. Pylori is a bacteria known to be a major risk factor for stomach cancer.

The device takes the gastric juice of a person during endoscopy. The results, which shows the status of H. Pylori and antimicrobial resistance to H. Pylori will be ready within 15 to 40 minutes.

Last month alone, about 70 people took the test and more than 20 per cent of them were found to have resistance to H. Pylori antibiotics.

The device was provided to the national referral hospital as part of the Science and Technology Research Partnership for Sustainable Development project, which is supported by JICA.

"We try to implement two of the tools for eradicating gastric cancer in Bhutan. One is the stool antigen test kit. That gives 15 minutes of the result of the Helicobacter pylori using your stool samples. The other one is the gene-based device, that can be used for asymptomatic patients who have the ulcer and severe gastritis," said Takashi Matsumoto, Professor at Japan Agency for Medical Research and Development.

Doctors from the national referral hospital say the hospital usually detects antibiotics' resistance to H. Pylori by providing medicines and checking its effectiveness.

Doctors added that people detected with H. Pylori are given triple therapy by providing clarithromycin, amoxicillin, and pantoprazole antibiotics. They are re-evaluated after three months.

If the person tests positive again, a person is treated with quadruple therapy with tetracycline, tinidazole, pantoprazole and bismuth antibiotics for two weeks and re-evaluated after another three months.

"Usually, we call them after three months and do either stool check-up or sometimes we do a biopsy, which is also depending on the individual patient. And if infection is still persisting, there can be two reasons; one is probably the antibiotic is not working. Second, is probably the patient's compliance is not there, the patient is not taking medicine on time, and they have not completed the treatment. So, these two factors can lead to persistent infection," said Dr Prabhat Pradhan, Oncosurgeon at national referral hospital.

However, he added that the patients do not come for the follow-ups. He said they only visit the hospital when the case become severe.

Eradication of H. Pylori is one of the strategic actions to prevent and reduce gastric cancer cases and deaths.

During the recent Gastric Cancer Flagship Programme, over 100,000 individuals were detected with H Pylori through screening campaigns.

As a follow-up to the flagship programme, the health ministry is currently developing a sustainable way to solve gastric cancer-related issues including H Pylori.

"We are developing a strategy where the screening will be looked into in the routine services meaning it will be incorporated into the routine services, while we continue to follow up on those that are positive, that have been detected with H. Pylori," said Laigden Dzed, Chief Programme Officer of Non-Communicable Disease Division.

He added the ministry will also provide necessary services such as endoscopy and surgeries.

According to the recent health flagship report, the prevalence rate of H. Pylori is 66-82 per cent in the country.

Singye Dema

Edited by Tshering Zam 

Gut Response

Fighting H. Pylori for Public Health

By Meghan Davis

Scientists at UAB suspect that aggressive treatment of H. Pylori infections could provide a low-cost way to help millions of people.More than half of the people on the planet are infected with the bacterium Helicobacter pylori. For most of them, the stomach-dwelling bug brings no discernible symptoms, although it is the most common cause of ulcers and causes a host of malnutrition issues around the globe. 

Scientists at UAB suspect that aggressive treatment of H. Pylori infections could provide a low-cost way to help millions of women and their children in developing countries, however. Their research recently received a vote of confidence from the Bill & Melinda Gates Foundation, which is funding a UAB-led study in India through its Grand Challenges Explorations initiative. 

Mohammad Khaled, Ph.D., has spent much of his career researching H. Pylori. Khaled, professor emeritus in the Department of Nutrition Sciences in the School of Health Professions, has studied how the bacteria affects different populations, including its role in blocking uptake of vitamins and minerals.

Khaled is particularly concerned about the role of H. Pylori infections in a major malnutrition condition in women of childbearing age. Expectant mothers who don't get enough nutrients face troublesome health risks, including iron-deficiency anemia.

Maternal iron anemia can lead to underweight babies, premature delivery, and postpartum depression; it also increases the risk of fetal and neonatal mortality, Khaled points out.

"Malnourished mothers, particularly in low-income countries, give birth to malnourished babies—who suffer from the consequences of poor infant nutrition for the rest of their lives," Khaled says. 

Absorbing Interest

While nutrient supplements are usually an easy way to treat nutrient deficiencies, Khaled's research has shown that H. Pylori infection also keeps iron supplements from raising iron levels effectively. 

H. Pylori contributes to lifelong malnutrition in mothers and children in developing countries.Comparatively little attention "has been paid to maternal anemia of pregnancy due to iron deficiency, despite the fact that this is a major global health problem, currently affecting nearly half of all pregnant women worldwide," Khaled says. He aims to address that imbalance with the Gates Foundation funding in India.

Khaled's team of five research workers will recruit non-pregnant women of childbearing age and test them for H. Pylori using a combination of urea breath tests and a finger prick. Those who test positive will be administered an aggressive regimen of three antibiotics during the course of a week. The combination of three antibiotics can be difficult to tolerate, Khaled notes, but it is necessary because H. Pylori has shown resistance to common antibiotics in other studies. The project will evaluate whether treating H. Pylori relieves anemia and increases the effectiveness of iron supplements for the women.

Breaking the Cycle

Khaled's innovative, indirect approach attracted the attention of the Gates Foundation. Its Grand Challenges Explorations initiative funds ideas that break the mold in solving persistent global health and development challenges. "We believe... A single bold idea can pioneer solutions to our greatest health and development challenges," says Chris Wilson, director of Global Health Discovery for the Bill & Melinda Gates Foundation. The UAB project was one of 110 Grand Challenges Explorations grants announced in 2011.

Khaled expects to complete his initial research by the end of 2012. If it shows positive results, he says, the next step may be a large-scale community trial that treats H. Pylori infection in women of childbearing age and simultaneously provides them with iron supplements. "Our goal is to break the vicious cycle of malnutrition, particularly undernutrition affecting mothers and infants worldwide," Khaled says.

---