What is H. pylori?
Helicobacter pylori (H. pylori) is a Gram-negative, spiral-shaped bacillus that colonizes the gastric mucosa. It is a microaerophilic organism, meaning it thrives in environments with low oxygen levels, such as the stomach lining. It is one of the most common bacterial infections worldwide, with a significant role in gastrointestinal disorders.
Pathophysiology of H. pylori Infection
H. pylori survives in the acidic environment of the stomach by producing urease, an enzyme that breaks down urea into ammonia, neutralizing stomach acid locally. The bacteria adhere to gastric epithelial cells and cause chronic inflammation, leading to mucosal damage.
Association with Chronic Abdominal Pain
H. pylori is a key contributor to chronic dyspeptic symptoms and various gastroduodenal conditions, including:
- Chronic Gastritis
- Long-standing inflammation of the gastric mucosa caused by H. pylori leads to epigastric discomfort, bloating, and nausea.
- Patients often experience postprandial pain (pain after eating).
- Peptic Ulcer Disease (PUD)
- H. pylori infection is a major cause of gastric and duodenal ulcers.
- Pain Characteristics:
- Duodenal ulcers → Pain relieved by food but worsens a few hours later.
- Gastric ulcers → Pain worsened by food due to acid secretion stimulating ulcer irritation.
- Functional Dyspepsia
- Even in the absence of ulcers, H. pylori infection is linked to non-ulcer dyspepsia, causing chronic, vague abdominal discomfort.
- Gastric Cancer and MALT Lymphoma
- Chronic inflammation from persistent H. pylori infection increases the risk of gastric adenocarcinoma and MALT (mucosa-associated lymphoid tissue) lymphoma.
- Early symptoms are chronic abdominal pain, anorexia, and weight loss.
Diagnosis of H. pylori Infection
- Non-invasive tests:
- Urea breath test (UBT)
- Stool antigen test
- Serology (less commonly used due to inability to differentiate active from past infection)
- Invasive tests (via endoscopy):
- Rapid urease test (RUT)
- Histopathology
- Culture (for antibiotic resistance testing)
Management
- Eradication therapy: Triple therapy (PPI + Clarithromycin + Amoxicillin/Metronidazole) or Quadruple therapy (PPI + Bismuth + Tetracycline + Metronidazole)
- Lifestyle modifications: Avoid NSAIDs, spicy foods, alcohol, and smoking to reduce irritation.
