DEALING WITH H. PYLORI STOMACH INFECTION: Is Mexico Getting the Blame?

Stained Helicobacter pylori on Stomach Lining
( Epidemiology and Diagnosis of Helicobacter pylori Infection ) 

     Helicobacter pylori (H. pylori) is a type of bacteria that can infect your stomach and small intestine. Surprise! My doctor decided to test my blood for it this year and the results were positive. I really wasn’t that surprised.

     I knew H. pylori infections are common, though usually do not cause symptoms. As a pharmacist (recently retired), I dispensed prescriptions for many patients who had been diagnosed with H. pylori and their doctor had decided to treat the infection. According to the CDC, H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. Patients with ulcers often develop symptoms that may include severe or persistent abdominal pain, difficulty swallowing, bloody or black tarry stools, and/or bloody or black vomit or vomit that looks like coffee grounds. 
     But I didn’t have any of those symptoms. So why did my doctor decide to test me for H. pylori? Did she think that because I had lived in Mexico for over three years and traveled there extensively for more than twenty-five years that I was a high-risk candidate for an H. pylori infection? My blood test results came back positive. I did have H. pylori bacteria living in my stomach. How long had I had that?
     It turns out, my risk of having H. pylori in my stomach is fairly high based on statistics. Over 50% of the world’s population has this gram-negative bacillus growing on the mucous lining of the stomach. In fact, according to the Centers for Disease Control and Prevention (CDC), two-thirds of the world's population is infected with H. pylori, so the odds that I am one of those who has acquired it isn’t all that strange.

     “It is not known how H. pylori is transmitted or why some patients become symptomatic while others do not. The bacteria are most likely spread from person to person through fecal-oral or oral-oral routes. Possible environmental reservoirs include contaminated water sources,” according to the CDC’s fact sheet. We always dine out at reputable restaurants and drink purified water, wash our hands well, and disinfect our vegetables and fruit at home. So why me?

We Dine at Reputable Restaurants in Mexico & Drink Purified Water

     It is not entirely clear how H. pylori infection is acquired, nor why ulcers or cancer occur in so few of those infected. It is believed that the exposure usually happens during childhood. Now, this surprised me. The more I read about H. pylori, the more I understand that it is commonly contracted at a young age, sometimes from family members, and often remains in the stomach undetected for the person’s entire life. H. pylori could have been traveling along with me for sixty years!

     H. pylori infection is more prevalent in developing countries such as México and those in Central and South America, as well as Asian countries including China. Since I have been traveling to and living in México, as well as Costa Rica and Ecuador, for over 30 years, the odds are that I picked it up somewhere along the way. Of course, H. pylori can be contracted in the U.S., Canada, or any country, so who knows where I picked it up, but living in Mexico is not necessarily to blame, though it could have been the source. Add to that, my 20-year history of GERD (Gastroesophageal reflux disease), sometimes severe enough to cause prolonged vomiting, and it must have occurred to my physician that I was a good candidate for the H. pylori blood test.

     Why was it important for me to be treated for H. pylori? Many people carry these bacteria in the stomach their entire lives and never undergo treatment. Most infected people (more than 70%) are asymptomatic, without symptoms. But there are risks of leaving it untreated, especially once symptoms begin.

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

·       An ache or burning pain in your abdomen

·       Abdominal pain that's worse when your stomach is empty

·       Nausea

·       Loss of appetite

·       Frequent burping

·       Bloating

·       Unintentional weight loss

     Since its discovery in 1982, H. pylori has been known to be a principal cause of peptic ulcer disease and as the main risk factor for the development of gastric cancer. About 15% of infected individuals will develop peptic ulcer (duodenal or gastric) or gastric cancer as a long-term consequence of infection. I already have a genetic risk for gastrointestinal cancer, so, yes, I’m going through with the whole, nasty treatment process.

     What’s so nasty about the treatment? Well, have you ever heard of an infection that requires treatment with three antibiotics at a high dose plus a proton pump inhibitor, all administered simultaneously for two weeks? That’s what it takes to eradicate the resistant H. pylori bacteria and allow the stomach ulcer to heal. There are various FDA-approved treatment regimens. My doctor prescribed amoxicillin 500mg, two capsules twice daily, plus clarithromycin 500mg, two tablets twice daily, plus metronidazole 500mg, one tablet twice daily, plus omeprazole 20mg, one capsule twice daily, all taken for two weeks. I was not looking forward to this course of therapy!

     The side effects of the medications were worse than the symptoms I had been experiencing! The stomach upset, even when taking all pills after meals, and the diarrhea this therapy caused were enough to make me seriously consider stopping the medications after the first week! The horrible metallic taste in my mouth from the metronidazole was one of the worst side effects. At least it didn’t alter the flavor of food. I powered on, determined to complete the treatment and eliminate this nasty bacterial infection.

No Alcohol During Treatment for H. pylori Infection!

     The hardest restriction during treatment was NO alcoholic beverages for 17 days—the two weeks of treatment plus 72 hours! I was well aware, as a pharmacist, that even the amount of alcohol in a cough syrup would interact with metronidazole, causing an Antabuse-like reaction including nausea, flushing, low blood pressure and dizziness, headache, and other symptoms. Though I typically enjoy two glasses of wine each evening, I refrained completely from ingesting all forms of alcohol. Boy, did I get tired of drinking root beer, ginger ale, and grapefruit flavored Perrier while Jon enjoyed his Cabernet Sauvignon!

     One of the most serious potential side effects of taking this much antibiotic for two weeks is developing a Clostridium difficile (C. difficile) intestinal infection, which usually presents as watery diarrhea three or more times a day for two or more days with mild abdominal cramping and tenderness. I know how serious C. difficile infections can be, so I began taking the probiotic, Culturelle, a high-strength lactobacillus, three times a day, beginning as soon as I was diagnosed with H. pylori. This helped build up the good bacteria in my stomach and intestines before bombarding my system with multiple antibiotics. I continued taking Culturelle three times daily during antibiotic therapy plus one more week, then twice daily for another month. So far, I have escaped the horrid C. difficile intestinal illness. I plan to continue taking Culturelle once daily from now on, in addition to eating yogurt every day, usually my own made from Yogurt Starter Mix containing live culture Lactobacillus acidophilus.

Sources of Lactobacillus for a Healthy Stomach & Intestine

     What also surprises me is that when I tested positive for H. pylori, my doctor decided to test my husband, Jon, for it, too--but his blood test was negative for H. pylori. Logically, he would be likely to have acquired it either from me or from the same source that I did since we have lived together for over twenty-five years. In fact, he is at a higher risk than I am because he grew up in the developing country, Ecuador, from the time he was 3 months old, over 68 years ago. But, he was not infected with H. pylori. Lucky guy!

     Well, I survived the treatment for H. pylori. I’ll have to return for another blood test to prove that the bacterial infection has been eradicated. Maybe in a year…my gastrointestinal system needs some time to heal from the antibiotic treatment.

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Terry L Turrell