What is Helicobacter pylori (HP)?
ΗΡ is a bacterium that infects the stomach (Figure). Nearly 50% of the global population carries this infection, while in Greece the frequency reaches 20-30%. Infection is usually acquired during childhood.
What are the consequences of HP infection?
Usually HP infection causes no symptoms. A minority of infected individuals may complain of indigestion (dyspepsia). Ulcers of the stomach or duodenum may rarely occur as a consequence of HP infection. HP is also associated with gastric cancer and lymphoma and rarely with iron deficiency, low vitamin B12 levels, and low platelet counts.
How high is the possibility of gastric cancer in case of HP infection?
There is an extremely low risk for gastric cancer in individuals with long-standing HP infection. This is the reason why its eradication is recommended. Testing of the rest of the family members is also suggested.
Who should be tested for HP?
Those with a history of ulcer of the stomach or duodenum, those with symptoms of indigestion, those with gastric lymphoma or a family history of gastric cancer, and those with unexplained iron deficiency anemia, low vitamin B12 levels or low platelet count.
How is HP tested?
Diagnostic tests include breath tests, blood tests, stool tests and biopsies from the stomach that are obtained during upper endoscopy.
How is HP infection treated?
HP treatment includes “proton pump inhibitors” combined with different types of antibiotics. The duration of treatment is usually 14 days.
What happens after treatment?
Your gastroenterologist will recommend the suitable timing and method (usually breath or stool test) of HP eradication control. In case of successful eradication, no follow-up is needed, since HP re-infection is extremely rare. If treatment fails, then a second, different regimen is prescribed. Unfortunately, overuse of antibiotics in Greece has led to significant resistance, which sometimes makes HP eradication troublesome.
It is important, in any case, not to feel undue anxiety due to the presence of HP infection, since the overall risk of significant complications is extremely low. One should remember than man and HP have coexisted for millenia until the organism was discovered by Australian investigators in 1982 (a feat for which they won the Nober Prize in Medicine in 2005).
What is a peptic ulcer?
A peptic ulcer is a sore that may form on the lining of the stomach or duodenum.
How is a peptic ulcer caused?
The two most common causes of peptic ulcers are Helicobacter pylori infection and drugs (mainly non steroidal anti-inflammatory drugs; bisphosphonates for osteoporosis and anti-depressants have also been associated). It has to be clear that smoking and alcohol may also contribute to peptic ulcer development but only along with other offending factors.
What are the symptoms of a peptic ulcer?
Pain in the upper belly is the most frequent symptom. Gastric ulcers cause pain soon after a person eats, while duodenal ones when the stomach is empty. The pain may temporarily decrease with drugs that reduce gastric acid secretion (see peptic ulcer treatment).
Are there any complications?
Possible complications include bleeding, perforation and stenosis at the gastric outlet (pylorus).
How is a peptic ulcer diagnosed?
Your doctor will recommend an upper endoscopy. That way the sore can be seen and biopsies for Helicobacter pylori can be taken (Figure).
How is a peptic ulcer treated?
Medicines that reduce the amount of acid that the stomach produces are the cornerstone of therapy. These drugs (“proton pump inhibitors”- Losec, Nexium, Pariet, Controloc, Penrazol, Laprazol etc.) are given for some weeks, depending on the location of the ulcer. If found, Helicobacter pylori should be also treated. Discontinuation of responsible drugs is also encouraged. Nowadays, peptic ulcer treatment is very effective given that you follow the doctor’s instructions. Of importance, if the ulcer is located in the stomach, a follow-up endoscopy approximately 2 months after treatment initiation should be performed in order to confirm healing.
What are gastric polyps?
Gastric polyps are tiny growths that form on the inside (mucosa) of the stomach. They are usually found incidentally during an upper gastrointestinal endoscopy performed for an unrelated reason.
How many types of gastric polyps exist?
The most common type of gastric polyps is hyperplastic (approximately 75%). Other types include fundic-gland cystic polyps, adenomas and neuroendocrine tumors (Figure 1, 2).
Are there any factors that cause polyps?
Hyperplastic polyps are associated with the presence of Helicobacter pylori. Medications of the class of proton pump inhibitors (PPIs) are associated with fundic-gland cystic polyps, while neuroendocrine tumors are linked to autoimmune atrophic gastritis.
Are gastric polyps associated with cancer?
Malignant transformation of gastric polyps is extremely rare and depends on its histologic type and size. The vast majority of gastric polyps, such as fundic-gland cystic polyps, have no risk of progressing to cancer. Your gastroenterologist will suggest the appropriate treatment and follow-up method.
What is autoimmune atrophic gastritis (AAG)?
The term AAG refers to a type of inflammation in the stomach that leads to destruction of the cells that produce gastric acid.
What are the consequences of AAG?
AAG is associated with decreased absorption of iron and vitamin B12, both leading to anemia (low hematocrit). Low vitamin B12 may result also in neurologic problems (weakness, disturbed gait, sensory disorders etc.). Thyroid disease and vitiligo may also co-exist with AAG.
How is AAG diagnosed?
Upper endoscopy with biopsies as well as specific blood tests are needed for the diagnosis of AAG.
Is there any association between AAG and cancer?
There is only an extremely low risk for development of gastric neuroendocrine tumors and adenocarcinoma. Therefore, loose surveillance with an upper endoscopy every 3 years is recommended.
How is AAG treated?
There is no specific treatment for AAG. Patients receive only supplementation of iron or vitamin B12, depending on their deficiencies.