It is widely believed that diseases such as gastritis, peptic ulcer disease, and even cancer arise from poor nutrition and stressful situations. In reality, the true cause of these ailments is infectious.
Expert - Saltanat Kalimoldaeva, immunologist, allergist.
Nobel Prize for the Discovery of Infection
The discovery of Helicobacter pylori was a significant breakthrough in the study of gastrointestinal diseases. The importance of this discovery was so great that its authors were awarded the Nobel Prize in 2005. According to specialists, approximately half of the world's population is infected with H. pylori; however, the prevalence of this infection varies significantly depending on the region. In Russia, the prevalence of H. pylori is quite high: the bacterium is found in 65–92% of adults, in 29% of children aged 5 to 10 years, and in 56% of adolescents aged 11 to 14 years.
What Is Dangerous About This Bacterium?
It resides in the pyloric part of the stomach — before the transition to the duodenum. H. pylori forms a kind of alkaline "protective shell" around itself, which protects it from gastric juice. However, this same shell harms the stomach and duodenum, provoking the development of a chronic condition known as gastritis and duodenitis. The most common cause of stomach disease is indeed Helicobacter pylori: its presence almost inevitably leads to an inflammatory process. There are also other, less common types of gastritis, where the body's immune system mistakenly perceives the cells of the stomach lining as foreign and begins to attack them with antibodies.
Why does the stomach lining, which can withstand the effects of hydrochloric acid, become inflamed in the presence of Helicobacter pylori? The fact is that the health and normal functioning of any organ depend on the balance between protective and aggressive factors. The inner lining of the stomach has natural protection — it produces mucus, which contains substances that neutralize acid. However, the presence of Helicobacter pylori disrupts this balance. In 1994, this bacterium was classified as a class one carcinogen. If H. pylori is not eradicated, it may eventually lead to stomach cancer, although, of course, not every infected person faces such an outcome.
Infection with Helicobacter pylori most often occurs in childhood, before the age of 10–13 years. One of the most common routes of transmission is from mother to child, for example, when a mother licks a pacifier before giving it to her baby or tastes food from a child's spoon. In adulthood, the risk of infection is significantly lower, which raises the question: should diagnosis and treatment of Helicobacter pylori be conducted in children? Before reaching adulthood, therapy is usually not performed unless there is peptic ulcer disease, which is a direct indication for eradicating the bacterium. The thing is that treatment can disrupt the composition of the microbiota, which is still in the process of formation. The risks associated with such disruption often outweigh the benefits of eliminating H. pylori. Preventive treatment to prevent stomach cancer can be considered after reaching the age of 18. Adults, however, should not delay treatment.
How the Infection Enters the Body
There are several routes of transmission:
oral-oral: infection occurs due to saliva entering another person's oral cavity or through the use of shared hygiene items;
fecal-oral: when infection occurs due to non-compliance with hygiene norms and rules, for example, if handwashing is ignored after walks, using the toilet, and before eating.
Due to these transmission characteristics, infection often manifests within families among children. For this reason, if Helicobacter pylori is found in someone in the family, it is necessary to examine all individuals living together in the same household and simultaneously treat those who are in regular contact with each other.
Since Helicobacter pylori can affect not only the gastrointestinal tract, attention should be paid to the results of general and biochemical blood tests. A decrease in iron, erythrocytes, and platelets, as well as a deficiency in vitamin B12, may indirectly indicate the presence of infection.
If you have one or more of the listed symptoms, if there have been cases of stomach cancer in your family, or if you simply want to undergo examination, make an appointment with a gastroenterologist. The gastroenterologist will prescribe the necessary tests to detect or exclude H. pylori.
By the way, gastritis often does not cause pain, as there are few nerve endings in the stomach, so in half of the cases, the disease proceeds without any symptoms. The main threat posed by the disease is that gastritis can become a breeding ground for oncology.
How to Detect Gastritis at an Early Stage?
The key method for detecting the disease is esophagogastroduodenoscopy — a diagnostic method in which the doctor uses a flexible endoscope, inserting it through the oral cavity: this allows him to examine the duodenum, esophagus, and stomach from the inside. Laboratory tests are then conducted. It is extremely important to assess the condition of the mucous membrane: if there are any changes, a biopsy should be performed to determine the cellular processes in the body.
It is especially important not to neglect examination for people with a hereditary predisposition to stomach cancer: they are advised to undergo examination even in the absence of symptoms. Moreover, it is necessary to undergo examination ten years before the age at which a close relative was diagnosed with cancer. For example, if a father faced cancer at thirty-five, his children should be examined at twenty-five.
Although the procedure may not be the most pleasant, it provides valuable information about the condition of the digestive organs. Modern medical technologies allow for gastroscopic examination under sedation: in this case, the patient is put to sleep, and after the procedure, a short time later, he is sent home (preferably accompanied, but definitely not driving a car).
When a predisposition to cancerous tumors of the stomach and esophagus is not established, it is recommended to undergo examination regarding this at age 50+ and then repeat it every three years. However, considering that these cancers are increasingly diagnosed at a younger age, it is worth considering undergoing examination earlier. For example, one can check the stomach and intestines starting at 45 years old.
How to Determine the Presence of Helicobacter and Whether It Needs to Be Eliminated?
Different tests vary in sensitivity, and some of them may be inaccurate. Perhaps among the most convenient and sensitive is the 13C-urea breath test, during which the patient needs to drink some acidic beverage and then exhale into a special container. The amount of CO2 in the air allows determining whether the Helicobacter bacterium is present in the body.
The presence of this microorganism in the stomach (regardless of its concentration) poses a danger, so measures must be taken to eradicate it. In medicine, there is a scheme for eradication therapy, which includes taking two antibiotics and allows for the almost complete elimination of the bacterium.
Can Helicobacter Return After Treatment?
The likelihood of reinfection is quite low, at only 3–5% per year. In most cases, the bacterium is found again due to ineffective treatment: for example, the treatment regimen was chosen incorrectly or the course was not completed. After therapy, it is important to conduct diagnostics; however, many patients neglect this. Sometimes instead, a stool PCR is performed, but this method often yields false-negative results. If a stool test is decided upon, it is better to use two methods simultaneously: immunoassay and immunochromatographic.
