www.DrMirkin.com

Ailments

Helicobacter Pylori Causes Most Ulcers and Other Stomach

www.DrMirkin.com

Ailments

Report #6535 6/15/95
updated 1/17/01

If you have belching, burping, a sour taste in your mouth, mouth odor, a white coated tongue or a burning pain in your stomach or chest that gets worse when you are hungry and better when you eat, you probably have too much stomach acid. Doctors also call it ulcers, esophagitis, gastritis, duodenitis, achalasia, chalazia, hiatal hernia, reflux, etc. These terms mean that stomach acid is burning your gastrointestinal tract. Most people who have these symptoms have an infection with a bacteria called helicobacter pylori.

If you have these symptoms, you need a blood test to see if you have helicobacter and a special x-ray called an upper G.I. Series to check to see if you have a cancer. Most gastroenterologists recommend that you have a tube inserted into your stomach to check for cancer. If you are infected with helicobacter, you can be cured by taking metronidazole 250 mg four time a day, amoxacillin 500 mg three times a day and omeperazole 20 mg once a day for one week. Then you should take a bismuth-containing compound, such as Pepto Bismol, 1 or 2 pills after each meal for up to 6 months, which often causes a black tongue. At least 8 weeks later, you need to follow up with a blood test for helicobacter. If your symptoms are gone and the titre drops, you are probably cured. If your helicobacter titre is still high, your helicobacter is probably resistant to metronidazole and you need to be treated for at least ten days with clarithromycin 500 mg twice a day, tetracycline 500 mg three time a day and omeperazole 20 mg once a day. If you still have symptoms, you need to have a tube put down your throat by a gastroenterologist. If you have regurgitation of stomach acid into your esophagus (reflux, hiatal hernia), you may need to be treated with 20 mg omeperazole once a day.

Blood tests are more dependable than endoscopy (having a tube put down your throat) to treat and follow helicobacter infections.

By Gabe Mirkin, M.D., for CBS Radio News

    1) NA Alsomal, KE Coley, PC Molan, BM Hancock. Role of Helicobacter Pylori Serology in Evaluating Treatment Success. Digestive Diseases and Sciences 1993 (Dec);38(12): 2262-2266.

    2) WM Wang, CY Chen, CM Jan, LT Chen, DS Perng, SR Lin, CS Liu. Long term follow up and serological study after triple therapy of helicobacter pylori associated duodenal ulcer. American Journal of Gastroenterology 89: 10 (Oct 1994):1793-1796.

    3) MA Mendall, RP Jazrawi, JN Marrero, N Molineaux, J Levi, JD Maxwell, TC Northfield. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut 36: 3 (Mar 1995):330-333. It is concluded that serology is the method of choice in screening before direct access upper gastrointestinal endoscopy in those under 45 years. It best combines a high sensitivity for peptic ulcer disease with a large reduction in unnecessary negative endoscopies.

    4) Z Maratka. endoscopic diagnosis of gastritis: Pros and Cons. Journal of Clinical Gastroenterology 20:2(Mar 1995):92-93. The endoscopic characteristics of inflammation in the stomach, in contrast to those of the esophagus and colon, are inconspicuous or lacking. "Endoscopic gastritis" does not correlate sufficiently with "histologic gastritis" and the term "gastritis" is to be limited to cases confirmed histologically.

    Treat non-ulcer dyspepsia also.

    5) McCarthy, C et al. Digestive Diseases and Sciences 1995; 40:114-119.

    Initial treatment should be for one week, not two.

    6) WA Deboer, WmM Driessen, HVPJ Potters, GNJ Tytgat. Randomized study comparing 1 with 2 weeks of quadruple therapy for eradicating Helicobacter pylori. American Journal of Gastroenterology 89: 11(Nov 1994):1993-1997.

    7) JJY Sung, SCS Chung, TKW Ling, MY Yung, VKS Leung, EKW Ng, MKK Li, AFB Cheng, AKC Li. Antibacterial treatment of gastric ulcers associated with Helicobacter pylori. New England Journal of Medicine 332: 3(Jan 19 1995): 139-142.

    8) Hudson N. Successful Helicobacter pylori eradication incorporating a one-week antibiotic regimen. Aliment Pharmacol Theapeut. 1995 FEB;9(1):47-50.

    9) Bell GD, et al. Rapid eradication of Helicobacter pylori infection, Aliment Pharmacol Therapeut 1995 FEB;9(1):41-46.

    10) Bazzoli F et al. Short term, low dose triple therapy for eradication of H. Pylori. Eur J Gastroenterol Hepatol 1994;6:773-7.

    11) De Boer et al. Lancet 1995 (April 1);345:817-820.

    If you are not cured with the first regimen, you need a different antibiotic treatment.

    12) MT Alassi, FC Ramirez, GM Lew, RM Genta, DY Graham. Clarithromycin, tetracycline, and bizmuth: A new non-metronidazole therapy for Helicobacter Pylori infection. Americal Journal of Gastroenterology 1994(August);89(8): 1203-1205.

    13) F Bazzoli, RM Zagari, S Fossi, P Pozzato, G Alampi, P Simoni, S Sottili, A Roda, E Roda. Short-Term Low-Dose Triple Therapy for the Eradication of Helicobacter pylori. European Journal of Gastroenterology & Hepatolgy 1994 (Sept);6(9):773-777.