18-24 January 2013 #639

Decoding H pylori

A burning sensation especially on an empty stomach can be caused by a bacteria.
Dhanvantari by Buddha Basnyat, MD

Until the early 1980s, mental stress and excessive acid secretion in the stomach were thought to be responsible for peptic ulcer disease (PUD), a condition where patients feel a burning sensation especially on an empty stomach at the lower end of the breastbone region for days. Doctors advised them to take it easy and prescribed plenty of antacids.

However, it was only in 1982 that the real culprit was identified. To the astonishment of the medical fraternity, two Australian scientists Barry Marshall (pic, left) and John Robin Warren (pic, right) from Perth discovered that bacterium called helicobacter pylori (H pylori) causes PUD and gastritis. Although drugs like aspirin and ibuprofen can independently cause PUD, H pylori are much more common sources and may well exacerbate mucosal injuries in the stomach and duodenum triggered by drugs. 

Marshall and Warren shared the Nobel Prize in 2005 for revolutionising the treatment for PUD and bringing relief to thousands of people across the world. Today, doctors usually recommend antibiotics as treatment. Generally one antacid and two specific antibiotics are used for a total of two weeks, and the recovery rate approaches 90 per cent.

While they may not be as deadly as the bacterium that cause tuberculosis, typhoid or cholera, the spiral-shaped and three microns long H pylori infect a larger population than those three diseases combined. Also the H pylori bug is more prevalent in poorer communities with low levels of education. 80 per cent of those infected reside in developing countries and only 30 per cent in developed nations.

 Not surprisingly, PUD is a well-known problem in Nepal. Many patients visit their doctors complaining about ‘gastric’, meaning gastritis which is an inflammation of the lining of the stomach, a common finding with PUD.

However, like many other aspects of medicine, the relationship between humans and H pylori is staggeringly complex. Some recent scientific evidence strongly suggest that H pylori are not the villians they are usually made out to be. In fact, they provide protection against childhood asthma, hay fever, some skin disorders, and even some forms of gastrointestinal cancer.