In this comprehensive guide, we will explore not only what H. pylori is and its causes, but also the implications of not treating this issue, the different treatment methods available, and even the special care needed during pregnancy.
Discover effective strategies for treating H. pylori infection, from diagnosis to treatment and prevention of reinfections, ensuring a comprehensive approach to combating the bacteria.
What is H pylori and what are its causes?
Helicobacter pylori, or H. pylori, is a spiral-shaped bacterium that colonizes the human stomach lining. It is estimated that in Brazil, about 60% of people are infected with this bacterium.
This bacterium defies the highly acidic environment of the stomach, where it can lodge and proliferate, causing a series of gastrointestinal disorders. It is also recognized as the main cause of conditions such as peptic ulcers, chronic gastritis, and even gastric adenocarcinoma, a form of cancer.
The causes of H. pylori infection are multifactorial.
Although the exact route of transmission is not fully understood, it is believed that infection occurs mainly through oral-fecal contact, especially during childhood.
This means that the ingestion of water or food contaminated with the feces of infected individuals is one of the main ways of contracting the bacterium.
Poor socioeconomic conditions, bad personal hygiene practices, and lack of access to clean water and safe food are factors that increase the risk of infection.
In addition, close contact with infected individuals, especially in family or community environments, can also contribute to the spread of the bacterium.
This spread can occur even in developed countries, but it is more prevalent in regions with poor sanitary conditions.
What happens if H pylori is not treated?
Not treating the infection by the bacterium can trigger a series of gastrointestinal complications, some of which can be serious and even potentially fatal.
One of the most common and significant consequences of not treating H. pylori is developing peptic ulcers.
These are open sores that form on the lining of the stomach or small intestine, resulting from the deterioration of the protective mucosa by gastric acid.
Without proper treatment, ulcers can worsen and lead to complications such as perforation or bleeding, which require urgent medical intervention.
Beyond peptic ulcers, persistent infection can cause chronic inflammation of the stomach lining, known as chronic gastritis.
This condition can increase the risk of developing other complications, such as atrophic gastritis (a more severe form of inflammation that causes the loss of gastric cells) and intestinal metaplasia (a change in the cells of the stomach, increasing the risk of cancer).
Another serious complication associated with not treating H. pylori is the increased risk of developing gastric cancer.
Studies have shown a strong association between chronic H. pylori infection and the development of gastric adenocarcinoma, the most common type of stomach cancer.
The prolonged presence of the bacterium can cause damage to the DNA of stomach cells, leading to malignant changes and the development of cancer.
Therefore, not treating the infection can result in serious consequences for the gastrointestinal and overall health of the patient.
It is crucial to seek appropriate treatment as soon as the infection is diagnosed, in order to prevent serious and potentially fatal complications.
What treatments for H pylori?
The treatment of the infection usually involves a combined approach of medications, aiming both to eradicate the bacterium and to relieve the symptoms associated with the condition.
The standard therapy consists of a combination of antibiotics and gastric acid suppressant medications, usually administered over a period of one to two weeks.
The most commonly prescribed antibiotics to treat the infection include amoxicillin, clarithromycin, and metronidazole.
These antibiotics are often administered in combination, usually two at a time, to reduce the chance of bacterial resistance and increase the effectiveness of the treatment.
It is important to strictly follow medical instructions regarding dosage and duration of treatment to ensure complete eradication of the bacterium.
In addition to antibiotics, patients with H. pylori infection may also receive acid-suppressing medications, such as proton pump inhibitors (PPIs) or H2 histamine receptor antagonists.
These medications help to reduce the production of acid in the stomach, relieving symptoms associated with the infection, such as abdominal pain, heartburn, and acid reflux. They also help to create a less favorable environment for the growth of the bacterium, contributing to the success of the treatment.
Besides drug therapy, lifestyle changes, such as avoiding irritating foods, reducing stress, and quitting smoking, can also help to improve treatment outcomes and prevent reinfections.
In cases of antibiotic-resistant or recurrent infection, your doctor may recommend alternative therapies or more intensive treatments, such as rescue therapy with different combinations of antibiotics.
It is important to say that always after treatment, a new test is necessary to confirm the elimination of the bacterium.
Another important fact is that after the bacterium has been proven to be eliminated, it is very difficult for the person to become reinfected.
Care in H pylori treatment during pregnancy
Treating this bacterial infection during pregnancy requires special care to ensure the effectiveness of the treatment and the safety of both the mother and the developing baby.
Although the infection may pose risks to maternal and fetal health, the selection of medications and management of treatment must be done cautiously, taking into account the potential adverse effects of the medications on the pregnancy.
Firstly, it is important to consult an obstetrician or medical specialist before starting any treatment during pregnancy. The healthcare professional will be able to assess the individual risks and benefits of treatment and recommend the best therapeutic approach for the patient’s specific situation.
During pregnancy, the use of certain antibiotics may be limited due to potential risks to the developing fetus.
For example, metronidazole, an antibiotic commonly used in the treatment of H. pylori, is generally not recommended during the first trimester of pregnancy due to concerns about fetal development.
However, in cases of severe H. pylori infection, the doctor may consider the use of metronidazole if the potential benefits outweigh the risks.
Besides that, proton pump inhibitors (PPIs), such as omeprazole and pantoprazole, are generally considered safe during pregnancy and may be prescribed to reduce stomach acid production and relieve symptoms associated with the infection, as long as the indication has been made by doctors who follow and know the pregnant woman.
In summary, the treatment of H. pylori infection is essential to avoid serious complications and protect gastrointestinal health. By strictly following medical guidelines, including the combination of antibiotics and acid-suppressing medications, it is possible to eradicate the bacterium and relieve symptoms associated with the infection.
It is also important to be aware of the potential risks and side effects of medications, especially during pregnancy, always seeking the guidance of a qualified healthcare professional to ensure the safety and effectiveness of the treatment, promoting a better quality of life.
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Doutor em Gastroenterologia pela FM-USP.
Especialista em Cirurgia do Aparelho Digestivo (HCFMUSP), Endoscopia Digestiva (SOBED) e Gastroenterologia (FBG).
Professor do curso de Medicina da Fundação Educacional do Município de Assis - FEMA.
Médico da clínica Gastrosaúde de Marília.