Bacterium to blame for some stomach ills


May 24, 1994|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Medical Tribune News Service

A new culprit has emerged for two chronic health conditions, and it has taken the medical world by surprise.

Peptic ulcers and gastritis have been associated with several factors, including stress, diet, gender and genetics.

Now there is another factor to consider -- a bacterium named Helicobacter pylori. The existence of this organism and its link with these stomach disorders actually may be good news for some ulcer sufferers, who in the past would have been put on lifelong regimens of diets, antacids and anti-secretory drugs.

H. pylori first was described in 1982 by researchers who noted it in the stomachs of patients suffering from chronic gastritis, an inflammation of the stomach lining. Since then, further research has identified H. pylori as a definite cause of gastritis and a contributing factor in peptic ulcers, along with other risk factors not yet clearly understood.

Several studies also have shown a link between the bacteria and a specific type of stomach cancer, where H. pylori is believed to play a role.

To learn more about H. pylori and its role in stomach disease, I consulted Dr. Mary Allen Staat, chief resident for the General Preventive Medicine Residency at the Johns Hopkins School of Public Health.

Q: Who is most at risk of infection? How is it transmitted?

A: Anyone can be infected with the bacteria, although infection seems more prevalent among lower socioeconomic groups. Internationally, we see more cases of infection in less-developed countries. Crowding -- that is, close personal contact -- may play a role. The method of transmission still is not clear. Most believe the bacteria are transmitted by contact with feces or through mouth-to-mouth contact.

Q: How is the infection diagnosed?

A: A diagnosis of H. pylori can be performed in several ways. The physician can insert an endoscope through the mouth and then biopsy the stomach lining to determine if the organism is present. A simple new test analyzes a person's breath to determine the presence of an enzyme that is produced by H. pylori, or a blood test may be used. It is important to remember that these last two tests cannot determine the existence of an ulcer or other stomach diseases. X-rays or endoscopy must be done to determine if an ulcer is present.

Q: Does the presence of the bacteria mean one has, or will develop, an ulcer or stomach cancer?

A: Probably not. Other risk factors come into play, and may include familial tendency to the above conditions, diet, alcohol, smoking and the use of aspirin and nonsteroidal anti-inflammatory products such as indomethacin, naproxen and ibuprofen. Keep in mind that only a relatively small percentage of people infected with H. pylori develop peptic ulcers or stomach cancer.

Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.

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