6-12 February 2015 #744

H. Pylori: the good and the bad.

Dhanvantari by Buddha Basnyat, MD

In 1982, to the astonishment of the medical world, two Australian scientists, Barry Marshall and J. Robin Warren discovered a bacterium ‘helicobacter pylori’ (H. pylori) to be the main cause of gastritis and peptic ulcers.

Peptic ulcer disease (PUD), a distinct ‘break’ in the lining of the stomach, is a well-known problem in Nepal. Many patients come to the doctor saying they have “gastric”, meaning “gastritis”, which is the inflammation of the lining of the stomach. Gastritis is one of the most common medical issues of concern reported in both rural and urban Nepal.

Those who tend to have repeated issues of gastritis are advised to avoid a long list of food, which is not always practical in Nepal.

Prior to the discovery of H.Pylori as the main culprit of PUD: stress, spicy food, production of excessive acid and certain lifestyle habits were believed to be the primary causes. Hence the approach to treatment was completely different. Patients were prescribed rest and medicines such as antacids, but the problem was recurrent.

Marshall and Warren shared the 2005 Nobel Prize for their discovery of H. Pylori. Their discovery has a very interesting story behind it.

Marshall drank a culture of the bug from a Petri dish to confirm if H.Pyloric caused gastritis. He expected to suffer from the effects after days or weeks, but experienced the symptoms of gastritis within 3 days. He found the lining of his stomach wall was swollen and inflamed after a gastric endoscopy was performed on him.

While it may not be as deadly as the bacteria that cause tuberculosis, typhoid or cholera, H. pylori infects more people than all these three diseases combined.

Individuals of low socioeconomic and education status are more likely to get inflected by the H. Pylori. This fact is clearly reflected by the epidemiological evidence which reveals that there is a 30 per cent prevalence of H. Pylori in adults in developed countries whereas it is 80 per cent in developing countries.

The treatment for PUD is generally an antacid and two weeks of two specific antibiotics that successfully cures about 90 per cent of the individuals.

This medical therapy has clearly revolutionised the treatment of PUD and brought relief to thousands of people. Although drugs like aspirin and ibuprofen can cause PUD, H. Pylori is a more universal cause of PUD.

However, it is possible that the story of H.Pylori causing gastritis may not be as straightforward as it seems. There is some recent, strong scientific evidence to suggest that H. Pylori is not just a wayward villain causing PUD. The presence of H. Pylori in humans may be protective for childhood asthma, hay fever and some skin disorders. This is an example of the staggeringly complex relationship between humans and microbes in disease causation.

Finally other than H.Pylori, there are other sinister causes of stomach ulcers which have to be kept in mind. Globally, stomach cancer is the fifth leading cancer and affects more elderly patients than younger ones.

Read also:

Decoding H pylori, Basnyat

The humble aspirin, Buddha Basnyat

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