Image source: Network
Source: Fifth National Consensus Report on the Management of Helicobacter pylori Infection
Advocate that families implement a meal sharing system and use public chopsticks and spoons. Xinhua News Agency
Recently, the U.S. Department of Health and Human Services released the 15th edition of the Carcinogen Report, and chronic infection of Helicobacter pylori is listed as a clear human carcinogen. As soon as the news came out, it rushed to the hot search.
According to the Fifth National Consensus Report on the Treatment of Helicobacter pylori Infection, the current infection rate of Helicobacter pylori infection in China is as high as about 50%.
What kind of bacteria is Helicobacter pylori? What effects does it have on the human body? Once infected, should I be treated? How is it treated? Bai Qixuan, deputy chief physician of the Department of Gastroenterology of civil aviation general hospital, gave a detailed answer to this question.
Executive Summary
Symptoms: Helicobacter pylori infection can easily cause gastritis, peptic ulcer, etc., may produce abdominal pain, bloating, nausea, anorexia, acid reflux, belching, indigestion and other symptoms, may not have any symptoms.
Odds: Helicobacter pylori infection is 1-5 times more likely than non-infected people to develop stomach cancer for life, but the exact time from infection to stomach cancer is uncertain, perhaps years or decades.
Pros and cons: For normal people, the benefits of Helicobacter pylori treatment outweigh the disadvantages, if the examination has confirmed the infection, please consult a doctor in time to start standardized treatment. Special groups of people with liver and kidney insufficiency and other underlying diseases should ask a doctor to determine whether they can be treated.
Children: Treatment of Helicobacter pylori is not recommended for children, because children have a certain spontaneous clearance rate during their growth and development, while adults with Helicobacter pylori infection cannot be spontaneously cleared without treatment.
Transmission: Helicobacter pylori is mainly transmitted from person to person through mouth-to-mouth transmission, fecal-oral transmission, gastric-oral transmission, etc., and intra-family transmission is one of the main ways of infection, advocating that families divide meals or use chopsticks and spoons to eat.
Symbiosis has long been harmful and unprofitable
"Helicobacter pylori is a spiral-shaped, micro-anaerobic, very demanding bacteria that are very demanding on growth conditions, have strong acid resistance, can survive in the stomach for a long time and continue to multiply, and are the only microorganisms that have been found to parasitize in the stomach." Bai Qixuan said that Helicobacter pylori and humans have been symbiotic for a long time, but have not developed a mutually beneficial model, "previous studies believe that it may reduce the occurrence of asthma, etc., and now also tend to be negative; and helicobacter pylori caused by gastritis, peptic ulcer, stomach cancer, etc. have been confirmed in individuals, eradication of Helicobacter pylori can reduce gastritis symptoms, effective prevention and treatment of peptic ulcer recurrence, reduce the occurrence of stomach cancer, so it is very necessary to eradicate Helicobacter pylori." ”
Bai Qixuan introduced that a large number of research evidence shows that the occurrence of intestinal gastric cancer (accounting for the majority of gastric cancer) is the result of a combination of Helicobacter pylori infection, environmental factors and genetic factors. It is estimated that about 90% of non-cardia gastric cancers are associated with Helicobacter pylori infection, and the general pattern of gastrointestinal carcinoma is: normal gastric mucosal → chronic superficial gastritis→ chronic atrophic gastritis→ intestinal metaplasia → dysplasia → gastric cancer, and Helicobacter pylori is considered to be the "culprit" in accelerating or catalyzing this pattern. "Therefore, Helicobacter pylori infection is currently the most important and controllable risk factor for the prevention of gastric cancer, and eradication of Helicobacter pylori should be a first-level preventive measure for gastric cancer."
"Helicobacter pylori is classified by the World Health Organization as a First Class Carcinogen, but this does not mean that stomach cancer will inevitably occur after infection." Bai Qixuan stressed that the data show that helicobacter pylori infection has a lifetime chance of stomach cancer 1-5 times higher than that of non-infected people, but the specific time from infection to stomach cancer after infection with Helicobacter pylori cannot be determined. "The process varies from person to person, it can be years or decades." Bai Qixuan said that different stages of gastric mucosal lesions may not have specific clinical symptoms, and early gastric cancer may not have any uncomfortable manifestations, and only after examination can they know whether they are infected.
Treat the self-interested person as early as possible
How do I determine if I have Helicobacter pylori infection? Bai Qixuan introduced that in the clinic, the current method of detecting Helicobacter pylori is mainly divided into invasive and non-invasive. The most commonly used non-invasive method is the urea breath test (known as the carbon-13, carbon-14 breath test), which is simple, fast, accurate, non-invasive, highly sensitive and specific, and the diagnostic accuracy is more than 95%. In addition, non-invasive tests include antibody assays and antigen assays, which refer to gastroscopic biopsy by checking for antibodies in blood and urine and antigen determination in feces.
Some patients say they don't have stomach upset, and some people report that the results of the test report are "positive" but the value is low, so does this still need treatment?
"The level of the reported single value is not proportional to the number of bacteria, no matter whether the patient has clinical symptoms, no matter how low the value measured by carbon 13, carbon 14 and other detection methods, as long as the value is accurate and the results show positive, it means that the human body has been infected with Helicobacter pylori and should be considered for treatment." Bai Qixuan pointed out that in recent years, domestic experts have gradually reached a consensus that it should be treated as soon as possible, if not treated, it is not only easy to infect the people around it, but also may cause diseases such as gastritis and increase the risk of stomach cancer in the future.
"Of course, before treatment, it is necessary to further consider the individualized 'benefit-risk ratio'." Bai Qixuan said that for children under 14 years of age, patients with severe cardiac, hepatic and renal insufficiency, helicobacter pylori treatment of key drugs allergies or intolerable people, etc., generally do not recommend treatment; the Fifth National Consensus Report on the Treatment of Helicobacter pylori infection recommends 12 indications for eradication (see Table 1).
What methods are commonly used in clinical practice to remove Helicobacter pylori? Bai Qixuan introduced that at present, the mainland recommends quadruple therapy (bismuth + PPI + 2 antibacterial drugs), and the recommended treatment course is 10 days or 14 days. After taking the drug, there may be stomach discomfort, nausea, vomiting, bloating, diarrhea and other adverse reactions, but the incidence is not high, "during the medication, there may be bitter mouth, black tongue, black stool and other phenomena, this is a normal phenomenon, do not be afraid, do not stop the drug because of slight discomfort." He said that after 14 days of standardized treatment and 1 month of discontinuation, the patient needed to review the urea breath test, and the negative result was successful. With a standardized 14-day quadruple course, the success rate of eradication of Helicobacter pylori is about 90%-95%.
"Children have a certain spontaneous clearance rate during their growth and development, while adults with Helicobacter pylori infection cannot be spontaneously cleared without treatment." Bai Qixuan reminded that if it is decided to cure Helicobacter pylori, patients must follow the doctor's instructions to take the drug on time and in quantity, if the medication is interrupted or taken irregularly, it is easy to lead to treatment failure, and may even make the bacteria resistant. Once resistance develops, other regimens need to be changed for remedial treatment.
Bai Qixuan pointed out that there are also some folk remedies that claim to treat Helicobacter pylori, such as eating garlic, dandelion boiling water, etc., there is no evidence to support it in medicine, and the general public should not trust home remedies.
One person infected and the whole family is screened
How is Helicobacter pylori transmitted? Who are susceptible to Helicobacter pylori? Bai Qixuan introduced that the current research has found that whether infants or the elderly, the population is generally susceptible to Helicobacter pylori, but the infection mainly occurs in young children, children and adolescents, and there are also infections in adulthood, but relatively few. Helicobacter pylori is generally believed to be transmitted from person to person mainly through mouth-to-mouth transmission (e.g., unhygienic feeding, sharing of tableware, kissing), fecal-oral transmission (e.g., feces contaminating water sources, food), and gastric-oral transmission (vomit contaminating water sources, food) and other means.
The "Expert Consensus on the Prevention and Control and Management of Helicobacter pylori Infection in Chinese Households" released in 2021 pointed out that intra-family transmission is one of the main ways to cause infection, and family-based prevention and control of Helicobacter pylori infection is an important strategy to block transmission. Co-treatment of family members with Helicobacter pylori infection can help reduce reinfection after eradication.
"We should strive to raise public awareness of Helicobacter pylori infection and comprehensively promote meal sharing or the use of public chopsticks and spoons to eat." Bai Qixuan said that the prevention and treatment of Helicobacter pylori should be carried out in families, change bad hygiene habits, pay attention to oral hygiene, regular replacement and disinfection of tableware, especially advocate that families with children implement a meal sharing system, do not kiss the child's mouth, do not feed the child mouth- If one person is found to be infected, the rest of the family is screened as soon as possible.
"Clinically, we should also pay attention to the detection and treatment of Helicobacter pylori." Bai Qixuan pointed out that patients who seek medical treatment or gastroscopy due to indigestion and other symptoms should be routinely tested for Helicobacter pylori, and once the infection is found, it should be eradicated in time. At the same time, it is recommended to carry out screening for asymptomatic people with Helicobacter pylori infection, "the mainland population base is large, it is not realistic to carry out asymptomatic population screening in an all-round way, and priority can be given to screening people with high incidence of gastric cancer and high-risk individuals with gastric cancer (such as family history of gastric cancer, high-salt diet or smoking, men over 40 years old), and gradually expand the scope of screening." (Reporter Wang Meihua)
Source: People's Daily Overseas Edition