image_pdfimage_print

Helicobacter Pylori

H. pylori infection occurs when a type of bacteria called Helicobacter pylori (H. pylori) infects your stomach, usually during childhood. A common cause of peptic ulcers, H. pylori infection is present in about half the people in the world.

Most people don’t realize they have H. pylori infection, because they never get sick from it. If you develop signs and symptoms of a peptic ulcer, your doctor will probably test you for H. pylori infection, because it can be treated with antibiotics.

Most people with H. pylori infection will never have any signs or symptoms. It’s not clear why this is, but scientists believe some people may be born with more resistance to the harmful effects of H. pylori.

When signs or symptoms do occur with H. pylori infection, they may include:

An ache or burning pain in your abdomen
Nausea
Vomiting
Frequent burping
Bloating
Weight loss

When to see a doctor

Make an appointment with your doctor if you notice any persistent signs and symptoms that worry you. Seek immediate medical help if you experience:
Severe or persistent abdominal pain
Difficulty swallowing
Bloody or black tarry stools
Bloody or black vomit or vomit that looks like coffee grounds

H. pylori bacteria can be passed from person to person through direct contact with saliva, vomit or fecal matter. H. pylori can also be spread through contaminated food or water. The infection is usually acquired during childhood.
Many people contract H. pylori as children. Contracting H. pylori in adulthood is much less common. Risk factors for H. pylori infection are related to living conditions in your childhood, such as:

Living in crowded conditions. You have a greater risk of H. pylori infection if you live in a home with many other people.
Living without a reliable supply of hot water. Having a reliable hot water supply can help you keep your living area clean and reduce your risk of H. pylori.
Living in a developing country. People living in developing countries, where crowded and unsanitary living conditions may be more common, have a higher risk of H. pylori infection.
Living with someone who has an H. pylori infection. If someone you live with has H. pylori, you’re more likely to also have H. pylori.

Complications associated with H. pylori infection include:

Ulcers. H. pylori can damage the protective lining of your stomach and small intestine. This can allow stomach acid to create an open sore (ulcer).
Inflammation of the stomach lining. H. pylori infection can irritate your stomach, causing inflammation (gastritis).
Stomach cancer. H. pylori infection is a strong risk factor for certain types of stomach cancer.

Tests and procedures used to determine whether you have an H. pylori infection include:

Blood test. Analysis of a blood sample may reveal evidence of an active or previous H. pylori infection in your body. A blood sample is usually collected by pricking your finger.
Breath test. During a breath test, you swallow a pill, liquid or pudding that contains radioactive carbon molecules. If you have an H. pylori infection, the radioactive carbon is released when the solution is broken down in your stomach. Your body absorbs the radioactive carbon and expels it when you exhale. You exhale into a bag and your doctor uses a special device to detect the radioactive carbon.
Stool test. A laboratory test called a stool antigen test looks for foreign proteins (antigens) associated with H. pylori infection in your stool.
Scope test. During an endoscopy exam, your doctor threads a long flexible tube equipped with a tiny camera (endoscope) down your throat and esophagus and into your stomach and duodenum. Using this instrument, your doctor can view any irregularities in your upper digestive tract and remove tissue samples (biopsy). These samples are analyzed for H. pylori infection.

H. pylori infections are usually treated with two varieties of antibiotics at once, to help prevent the bacteria from developing a resistance to one particular antibiotic. Your doctor also will prescribe an acid suppression drug, to help your stomach lining heal.

Your doctor may recommend that you undergo testing for H. pylori several weeks after your treatment. If the tests show the treatment was unsuccessful, you may undergo another round of treatment with a different combination of antibiotic medications.

Gastroparesis

Gastroparesis is a condition in which the muscles in your stomach don’t function normally.

Ordinarily, strong muscular contractions propel food through your digestive tract. But in gastroparesis, the muscles in the wall of your stomach work poorly or not at all. This prevents your stomach from emptying properly. Gastroparesis can interfere with digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition.

There is no cure for gastroparesis. Making changes to your diet may help you cope with gastroparesis signs and symptoms, but that’s not always enough. Gastroparesis medications may offer some relief, but some can cause serious side effects.

Signs and symptoms of gastroparesis include:

Vomiting
Nausea
A feeling of fullness after eating just a few bites
Abdominal bloating
Heartburn or gastroesophageal reflux
Changes in blood sugar levels
Lack of appetite
Weight loss and malnutrition
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.

It’s not always clear what leads to gastroparesis. But in many cases, gastroparesis is believed to be caused by damage to a nerve that controls the stomach muscles (vagus nerve).

The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can’t send signals to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested.

The vagus nerve can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine.

Factors that can make it difficult for your stomach to empty properly include:

Diabetes
Abdominal surgery
Infection
Certain medications that slow the rate of stomach emptying, such as narcotic pain medications and antidepressants
Certain cancer treatments
Anorexia
Bulimia
Scleroderma
Parkinson’s disease
Hypothyroidism

Gastroparesis can cause several complications, such as:

Bacteria overgrowth in the stomach. Food that stays in the stomach can begin to ferment and disrupt the balance of good and bad bacteria. This can allow harmful microorganisms to grow out of control.
Undigested food that hardens and remains in your stomach. Undigested food in your stomach can harden into a solid mass called a bezoar. Bezoars can cause nausea and vomiting and may be life-threatening if they prevent food from passing into your small intestine.
Blood sugar fluctuations. Although gastroparesis doesn’t cause diabetes, inconsistent food absorption can cause erratic changes in blood sugar levels, which make diabetes worse. In turn, poor control of blood sugar levels makes gastroparesis worse.

Doctors use several tests to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include:

Measuring the time it takes for your stomach to empty. A gastric-emptying study measures how long it takes for food to move through your stomach. There are several ways to measure stomach emptying. In the most common test, you eat food that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach.
Using a scope to see inside your stomach. An upper endoscopy may help rule out other conditions that can cause delayed gastric emptying. During an endoscopy, your doctor passes a thin tube equipped with a camera down your throat and into your stomach and small intestine. The camera transmits images your doctor uses to evaluate your digestive system for abnormalities.

Treating gastroparesis begins with identifying and treating the underlying condition. For instance, if diabetes is causing your gastroparesis, your doctor can work with you to help you control your diabetes. Beyond this, other gastroparesis treatments may include:

Changes to your diet

Your doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest, so that you’re more likely to get enough calories and nutrients from the food you eat. A dietitian might suggest that you try to:

Eat smaller meals more frequently.
Eat low-fiber forms of high-fiber foods, such as well-cooked fruits and vegetables rather than raw fruits and vegetables.
Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet.
Avoid fibrous fruits and vegetables, such as oranges and broccoli, that may cause bezoars.
If liquids are easier for you to ingest, try soups and pureed foods.
Drink water throughout each meal.
Try gentle exercise after you eat, such as going for a walk.
Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube (jejunostomy tube) be placed in the small intestine.

Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can’t be controlled by any other method.

Medications

Medications to treat gastroparesis may include:

Medications to control nausea and vomiting. Anti-emetic medications include prochlorperazine (Compro), diphenhydramine (Benadryl, Unisom) and lorazepam (Ativan).
Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin. There is a risk of serious side effects with these medications, so discuss the benefits and risks with your doctor.

Surgery

If treatment doesn’t help control your nausea, vomiting or malnutrition, you may consider gastroparesis surgery. During surgery, the lower part of the stomach may be stapled or bypassed to help improve stomach emptying.

Experimental treatments

Researchers are working on new ways of treating gastroparesis, such as:

Injecting a nerve toxin to allow the stomach to release food. Botulinum toxin type A (Botox) is a nerve toxin most commonly known for its use in treating skin wrinkles. Researchers have found that Botox injections relax the pyloric muscle in some people, thereby allowing the stomach to release more food into the small intestine. The benefits are temporary, however, and more studies are needed to determine the overall usefulness of this treatment.
Implanting an electrical device to control the stomach muscles. Electrical gastric stimulation uses an electric current to cause stomach contractions. Working much like a heart pacemaker, this stomach pacemaker, consisting of a tiny generator and two electrodes, is placed in a pocket that surgeons create on the stomach’s outer edge. Stomach pacemakers have been shown to improve stomach emptying and reduce nausea and vomiting in some people with gastroparesis, but more studies are needed.

Dumping syndrome

Dumping syndrome is a group of symptoms that are most likely to develop if you’ve had surgery to remove all or part of your stomach, or if your stomach has been surgically bypassed to help lose weight. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach move too rapidly into your small bowel. Common symptoms include abdominal cramps, nausea and diarrhea.

Most people with dumping syndrome experience symptoms soon after eating. In others, symptoms may occur one to three hours after eating. Some people experience both early and late symptoms.

Dumping syndrome is managed by adjusting your diet. In more-serious cases of dumping syndrome, you may need medications or surgery.

Symptoms of dumping syndrome are most common during a meal or within 15 to 30 minutes following a meal. They include:

Gastrointestinal

Nausea
Vomiting
Abdominal cramps
Diarrhea
Feeling of fullness
Cardiovascular

Flushing
Dizziness, lightheadedness
Heart palpitations, rapid heart rate
Signs and symptoms also can develop later, usually one to three hours after eating. This is due to the dumping of large amount of sugars into the small intestine (hyperglycemia). In response, the body releases large amounts of insulin to absorb the sugars, leading to low levels of sugar in the body (hypoglycemia). Symptoms of late dumping can include:

Sweating
Hunger
Fatigue
Dizziness, lightheadedness
Confusion
Heart palpitations, rapid heart rate
Fainting
A study of more than 1,100 people who had their stomachs surgically removed found that about two-thirds experienced early symptoms and about a third experienced late symptoms of dumping syndrome. Some people experience both early and late signs and symptoms.

No matter when problems develop, however, they may be worse following a high-sugar meal, especially one that’s rich in table sugar (sucrose) or fruit sugar (fructose).

When to see a doctor
Contact your doctor if any of the following apply to you.

You develop signs and symptoms that might be due to dumping syndrome, even if you haven’t had surgery.
Your symptoms are not controlled by dietary changes.
You are losing large amounts of weight due to dumping syndrome. Your doctor may refer you to a registered dietitian to help you create the most appropriate eating plan.

In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an uncontrolled, abnormally fast manner. This is most often related to changes in your stomach associated with surgery, such as when the opening (pylorus) between your stomach and the small intestine (duodenum) has been removed during an operation.

The pylorus acts as a brake so that stomach emptying is gradual. When it’s removed, stomach material dumps rapidly into the small intestine. The ill effects of this are thought to be caused by the release of gastrointestinal hormones in the small intestine, as well as insulin secreted to process the sugar (glucose).

Dumping syndrome can occur after any operation on the stomach as well as after removal of the esophagus (esophagectomy). Gastric bypass surgery for weight loss is the most common cause today. It develops most commonly within weeks after surgery, or as soon as you return to your normal diet. The more stomach removed or bypassed, the more likely that the condition will be severe. It sometimes becomes a chronic disorder.

Several types of surgery increase your risk of dumping syndrome. These include:

Gastrectomy, in which a portion or all of your stomach is removed. It typically includes removing the pylorus.
Gastroenterostomy or gastrojejunostomy, in which your stomach is surgically connected directly to your small intestine. Stomach contents then enter the small intestine directly, bypassing the pylorus. Doctors sometimes perform this operation in people with cancer of the stomach.