What is Helicobacter Pylori?
Helicobacter pylori, often shortened to H. pylori, is a type of bacteria that looks like a spiral and is not friendly to the human body. This bacteria is found in almost half the people in the world, but it’s especially common in developing countries. What’s important to know is that H. pylori is often the reason people develop chronic stomach inflammation, peptic ulcers (sores in the stomach lining), lymphoma (a type of cancer) in the stomach, and stomach cancer. However, these serious issues are not as common in children and teens compared to adults.
Typically, people get infected with H. pylori when they’re kids, and if left untreated, the bacteria can remain in their bodies. There have been studies in China on a new medicine to help prevent this bacterial infection in children. The results from these studies found the medicine, an oral vaccine specifically for H. pylori, to be effective and safe. This could help in reducing the number of people who get an H. pylori infection in the future.
What Causes Helicobacter Pylori?
The H. pylori bacteria can be spread in several ways. It might be transmitted through contact with feces, through contact with stomach secretions, through mouth-to-mouth contact, or through sexual activity. One of the main factors that increases the risk of getting this infection is having a low socioeconomic status.
Risk Factors and Frequency for Helicobacter Pylori
Infection with H. pylori, a type of bacteria, is more common in some parts of the world than others. In the United States, for example, only 5% of children under 10 years old have this infection. Interestingly, it’s more common in Hispanic and African American populations compared to White Americans.
Signs and Symptoms of Helicobacter Pylori
Many kids who have H. pylori infection don’t show any symptoms. But if there are any symptoms, they usually include things like stomach pain, feeling nauseous, vomiting, and indigestion. If children show these gastrointestinal symptoms, it’s important to look into what might be causing them. Some less common symptoms that are linked with H. pylori infection include a type of anemia caused by a lack of iron, and chronic immune thrombocytopenia (cITP), a condition that causes low platelet counts. So, doctors may decide to test for H. pylori infection if a child has cITP or persistent low iron levels, and there’s no clear reason why. Kids with H. pylori infection can also be anemic because it’s been seen that those infected with H. pylori have low iron reserves. Other symptoms like ear infections, respiratory issues, gum disease, sudden infant death syndrome (SIDS), and stunted growth have not been strongly linked with H. pylori infection, so testing for H. pylori is not typically recommended in these cases.
Most kids with H. pylori infection don’t show symptoms.
- If they do have symptoms, they can include stomach pain, nausea, vomiting, or indigestion.
- If kids have these symptoms, it’s important to find out why.
- Less common symptoms linked to H. pylori can include a type of anemia caused by a lack of iron and chronic immune thrombocytopenia (cITP), a condition causing low platelet counts.
- Doctors might test for H. pylori if a child has cITP or persistent low iron levels and no known cause.
- Kids with H. pylori can also be anemic, as H. pylori infections often accompany low iron reserves.
- H. pylori infection is not generally linked with symptoms like ear infections, respiratory issues, gum disease, sudden infant death syndrome (SIDS), and stunted growth, so H. pylori testing is not typically recommended for these symptoms.
Testing for Helicobacter Pylori
H. pylori infection can be determined using both invasive and non-invasive tests. The non-invasive tests include checking for specific H. pylori proteins in stool samples, looking for H. pylori antibodies in blood, urine, and oral samples, or a urea breath test. The stool and breath tests are quite accurate, nearly as much as the tests that involve examining a physical sample from the patient.
H. pylori antibody presence can also be checked through a blood test, but it’s not as accurate as other methods and thus isn’t usually used in the clinic. Invasive tests require samples from the stomach to find the bacteria. These tests include a culture test, rapid urease test (RUT), histopathology, polymerase chain reaction, and fluorescent in situ hybridization (FISH).
An important note is that even though a culture test, where they try to grow the bacteria from a sample, has a 100% specificity (meaning, if positive, there is definitely an infection), it’s not always sensitive. This means it may not always pick up on the bacteria when it’s there. Hence, to ensure the H. pylori status, having two tests is recommended.
A combination of a positive histopathology growth (examination of tissue) and a positive RUT (chemical reaction test) or a positive culture from stomach biopsies is recommended as a valid first diagnosis approach. For children, H. pylori is usually diagnosed via an upper gastrointestinal endoscopy procedure that includes taking samples from the antrum and corpus (parts of the stomach) for testing and culture.
To verify if the H. pylori bacteria has been entirely eradicated after therapy, the UBT and stool tests are reliable, non-invasive methods. But remember to wait at least 2 weeks after you’ve stopped taking proton pump inhibitors (PPIs), a type of acid-suppressing medication, and 4 weeks after stopping antibiotics before getting tested for H. pylori eradication.
Treatment Options for Helicobacter Pylori
For a better success rate in treating H. pylori infection, top gastroenterology societies in Europe and North America have established updated treatment guidelines for children and teens. The primary treatment is known as triple therapy which includes the use of amoxicillin, an antibiotic, and a type of medicine known as Protein Pump Inhibitors (PPIs). This is usually recommended for 14 days but only if the infecting strain responds well to the medication. If the initial treatment doesn’t work, the antibiotic clarithromycin (CLA) can be replaced with another antibiotic called metronidazole (MET) without additional testing.
There’s also an alternative called sequential therapy, where different combinations of drugs are prescribed over a 10-day period. This treatment, though, exposes the young patient to three different antibiotics, which can be a concern. The child’s body weight is also taken into account when deciding the amount of medication to be given.
If the infection is resistant to both CLA and MET, or the susceptibility to antibiotics is unknown, doctors may recommend a complex regimen involving a substance called bismuth salts, together with PPI, amoxicillin or tetracycline, and MET. These multi-drug therapy strategies, though effective, need to be chosen carefully, taking into consideration regional differences in antibiotic resistance patterns.
The emergence of antibiotic resistance is a critical problem; excessive use of certain drugs for respiratory infections, for instance, has led to CLA-resistant H. pylori strains. In situations where treatment fails, physicians may need to select custom-made therapy based on the strain’s response to antibiotics. It’s worth noting that some groups of people metabolize PPIs faster due to genetic differences, and certain PPIs might be a better choice for these individuals. Lastly, despite ongoing research, there’s not enough evidence to suggest that probiotics can improve treatment success rates or lessen side effects.
What else can Helicobacter Pylori be?
These are some health conditions that can cause digestive issues:
- Celiac disease
- Crohn’s disease affecting the upper part of the digestive tract
- Peptic ulcer disease, which are sores in the lining of the stomach or upper part of the small intestine
- NSAID-induced gastritis, which is stomach inflammation caused by certain pain relievers
- Gastroesophageal reflux disease, or GERD, which is a chronic condition where stomach acid frequently flows back into the esophagus
- Eosinophilic esophagitis, which is a chronic immune system disease that damages the esophagus
- Lactose intolerance, a condition where the body cannot easily digest lactose, a type of sugar found in milk and dairy products
- Constipation
