II. Treatment For H Pylori: H Pylori Medication; H Pylori Transmission & Prevention
dr.vanta
H pylori infections Part II. In this article you can read details about h pylori tests, the treatment -including medication and how to prevent infections/reinfections.
1. H Pylori Tests
2. H Pylori Treatment- H Pylori Medication
3. H Pylori Transmission, and How To Prevent Infections and Reinfections
Best h pylori tests include : breath, blood test, stool test and endoscopy
Helicobacter pylori breath test: unlike blood test, the breath test can detect active infection with H pylori. It is accurate ( 99% sensitivity and 98% specificity).
H pylori stool test is also a great, accurate way to diagnose the infection ( sensitivity is 94.1% and specificity 91.8 %).
Both -Helicobacter pylori breath test and h pylori stool test may yield false negative results. To avoid false negatives you need to stop taking acid blocker meds (PPIs, anti-H2s), and take the test 8 weeks after stopping the antibiotics.
H pylori blood test accuracy is OK, but not great. The blood test cannot confirm current infection or eradication after antibiotic treatment. H pylori blood test accuracy for detecting initial infection has a sensitivity of 85% and specificity of 79%.
Endoscopy is invasive, therefore used in selected cases. Best h pylori tests to confirm successful treatment (eradication): breath test, stool test or endoscopy [1].
2. H Pylori Treatment – H pylori Medication
Quadruple therapy utilizes combines a proton pump inhibitor (PPI), bismuth product, and 2 antibiotics metronidazole and tetracycline for 10 to 14 days, where triple therapy combines a PPI, amoxicillin, and clarithromycin for 10-14 days. Cases of H. Pylori infections associated with toxicosis seem to respond well to Omeprazole (PPI) Colloidal bismuth subcitrate plus the antibiotics Amoxicillin and Clarithromicyn [2],[3].
The biggest challenge with standard triple and quadruple therapy is that it become less and less effective over the last decade [80], as H pylori developed resistance to antibiotics. Sequential therapy is a new, improved version of antibiotic treatment, with higher success rate than standard triple therapy, and similar efficacy with quadruple therapy [4]. It is a 10 days treatment, PPI taken during the whole period of 10 days, and 3 antibiotics (amoxicillin for the first 5 days, followed by a combination of clarithromycin and tinidazole for the last 5 days [5].
Side effects of h pylori medication: the most common side effects are diarrhea, nausea, and taste disturbances. Less frequent side effects : increased risk of infectious diarrhea in children, eczema, allergies and esophageal cancers. An important side effect is the rapid increase in antibiotics resistance (over 50% of certain H Pylori strains being resistant to antibiotics) [6].
Another big problem with h pylori medication is the significant and long lasting impairments in gut microbiome [7]. I think that these alterations in gut flora are one of the top reasons why re-infections with H pylori, secondary fungal infections with Candida and other health problems are so common following antibiotic therapy.
Wondering why do you need so many drugs to eradicate h pylori ? That’s because one antibiotic-has very low success rate, around 20% for amoxicillin and 40% for clarithromycin . For this reason, another one or two antibiotics had been added. For example, three antibiotics -amoxicillin, clarithromycin and metronidazole can successfully treat 60% of the h pylori infections.
Why do you need acid blockers ? For a few reasons: they increase the efficacy of the therapy (to around 80%). PPIs increase the efficacy of the antibiotics (antibiotics work best in less acidic environments). PPIs directly inhibit the growth of h pylori- when the stomach acidity has a pH of around 6, there is a significant decrease in the survival of h pylori. Finally, PPIs can decrease the symptoms (like pain) associated with ulcers caused by H pylori. Older acid blockers ( H2 antagonists) like ranitidine, cimetidine aren’t as effective as PPIs. The most researched PPI is omeprazole, although esomeprazole is also helpful [7]. PPIs should be used discontinued after h pylori treatment if possible. Long term use of PPIs include significant magnesium deficiency (and therefore increased risk of seizures, heart problems and more)[ 82], disturbed gut microbiome and premature death [83].
Besides resistance to antibiotics, there are other factors that play a role in treatment failure: lack of patient compliance, bacterial factors, obesity, smoking, reinfection, and genetic polymorphisms in CYP2C19.
3. H Pylori Transmission, and How To Prevent Infections and Reinfections
Transmission : oral -oral (through saliva, person to person), and fecal-oral ( ingesting contaminated food and water). In developed countries, infection from family members happen during the first years of life. Later on, the infection can be spread from one partner to another at much lower rates (less than 2% per year)- h pylori is transmitted through kissing and possibly during sexual intercourse [79].
Prevention: Since the exact source of h pylori is not known [80], it is a good idea to wash your hands before eating, eat properly prepared food and drink water from clean sources. Avoid sharing utensils and glasses. Your partner should be tested for h pylori and if necessary-treated. Eat a healthy diet, including the foods with anti h pylori qualities, and black cumin seeds.
Get tested regularly for h pylori , as reinfections can occur. Treat the infection as soon as possible to avoid complications (gastritis, ulcer, stomach cancers), and the less known conditions associated with this infection: iron deficit anemia, cardiovascular conditions and immune mediated conditions [81].
