Helicobacter pylori, commonly known as H. pylori, is a bacteria that is present in the stomach of up to 50 percent of the world's population. Though many people are simple carriers of H. pylori, it is known to contribute to chronic gastritis and the development of gastric or peptic ulcers in the stomach. A variety of treatment regimens including acid reducers, antibiotics and stomach protectors are now in use, and have increased cure rates to nearly 90 percent in some cases because they focus on killing the causes the disorder.
About Helicobacter Pylori
H. pylori causes difficulty in susceptible persons by weakening the lining of the digestive tract, particularly the lower esophagus, pyloric valve and stomach lining, which allows digestive fluids to erode portions of gastric tissue. Symptoms of gastritis or ulcer caused by Helicobacter pylori may include abdominal pain, reflux, bloating, indigestion, nausea and stomach pain. An untreated ulcer caused by H. pylori may result in gastrointestinal bleeding, gastric erosion and perforation and may contribute to the eventual development of esophageal and stomach cancer.
Stomach conditions related to H. pylori may be initially diagnosed by blood antibodies, stool antigen or urea breath tests but in complicated cases, an endoscopy may be recommended to assess total damage to the esophagus and stomach lining. This is particularly important if the patient has difficulty swallowing, throat pain, unexplained weight loss, gastrointestinal bleeding or anemia. H. pylori treatment will include two, three or four drugs chosen from four categories including antibiotics, proton pump inhibitors (PPIs), bismuth salicylate and occasionally histamine (H2) antagonists given over a one to two week period.
Medications for Treatment
Antibiotics found to be effective in treatment of H. pylori related ulcers and gastritis include tetracycline, amoxicillin, metronidazole, and clarithromycin (Biaxin). One or two of these medications will be chosen for combination with PPIs, and will be given two to four times daily depending on the drug chosen. Proton pump inhibitors (PPIs) work by stopping the pump in stomach cells from releasing acid into the stomach. PPIs approved for use in treatment of H. pylori include omeprazole (Prilosec), lasoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium). PPIs will be given one to three times daily depending on the specific drug and regimen chosen.
Bismuth salicylate is the active ingredient in Pepto-Bismol, and is known to protect the stomach against ulcer formation and reduce gastritis and other symptoms of intestinal upset. Bismuth also has some antibacterial properties and is often combined with PPIs and antibiotics in H. pylori treatment plans. Plain H2 antagonists such as ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid) are occasionally used in combination with other medications for ulcer management. A newer drug, ranitidine bismuth citrate (RBC)--which combines the active ingredient ranitidine with the stomach protective agent of bismuth--is used much more frequently and may eliminate the need for separate bismuth salicylate and PPIs.
Effects of Treatment
The effectiveness of treatment regimens ranges from 60 percent for a two-drug treatment including RBC, plus an antibiotic to nearly 90 percent with a four drug regimen including PPI, bismuth salicylate and two antibiotics. The most common complaints regarding H. pylori treatment are the number of pills which must be taken daily as it can range up to 20 pills per day. The treatment cost may also be a consideration as PPIs and clarithromycin can be quite expensive. The least expensive regimen is a combination of generic bismuth salicylate, metronidazole and tetracycline but it is approximately 10-15 percent less effective than other three drug regimens.
Side effects or issues with H. Pylori treatment occur mostly due to problems with the antibiotics including clarithromycin, metronidazole and tetracycline. Both clarithromycin and metronidazole are known to cause nausea and a metallic taste in the mouth. When consumed with alcohol, metronidazole may cause severe stomach cramping, vomiting, headache and muscle tremors. Tetracycline cannot be given with dairy products or mineral supplements containing calcium or iron as the minerals will deactivate the medication.
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