Stomach Ulcers and H. Pylori: Diagnosis and Treatment Insights

Helicobacter pylori and gastric ulcers

In early May of this year, I underwent an endoscopy and was diagnosed with a gastric ulcer, and tested positive for Helicobacter pylori.
I took a 7-day course of antibiotics (two types) along with one ulcer medication.
A month later, in mid-June, a breath test still indicated the presence of Helicobacter pylori.
Therefore, my doctor prescribed another 10-day course of antibiotics along with one ulcer medication.
I asked my doctor if the breath test could determine whether the gastric ulcer had healed, and he replied that if Helicobacter pylori was eradicated, it could be inferred that the gastric ulcer would likely heal as well.
I further inquired whether the previous endoscopy could differentiate between cancer and a simple gastric ulcer.
The doctor responded that this ulcer was unrelated to cancer and advised me to undergo another endoscopy with a biopsy to test for Helicobacter pylori in a month (late July).

Is my doctor's treatment protocol correct? Generally, when a gastric ulcer is found during an endoscopy, is there an additional test for cancer cells besides testing for Helicobacter pylori? I am concerned that my ulcer may be cancerous.
Additionally, can Helicobacter pylori be transmitted through saliva to my family (specifically my husband and children)? Should my family members get tested for Helicobacter pylori infection? Thank you for your response.

nini, 40~49 year old female. Ask Date: 2012/07/13

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello,
(1) If a gastroscopy reveals a gastric ulcer, there are generally two approaches: Approach 1: If the gastric ulcer does not appear malignant under endoscopy, a small tissue sample is taken from the ulcer and cultured in a medium containing urea to detect Helicobacter pylori.
This method can only confirm the presence of H.
pylori and cannot determine if cancer cells are present.
Approach 2: The tissue from the gastric ulcer is sent for pathological examination to check under a microscope for the presence of gastric cancer cells and H.
pylori.
Approach 2 is more commonly used for gastric ulcers.
(2) In Taiwan, approximately 50-60% of adults are infected with Helicobacter pylori in their stomachs.
This bacterium is actually a type of symbiotic organism that can be transmitted through food.
However, treatment is generally not recommended if there are no gastric symptoms, as H.
pylori is not the only trigger for gastric cancer.
Treatment is advised in the following situations: duodenal ulcers, gastric ulcers, low-grade gastric lymphoma, dyspepsia, and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs).
Additionally, for atrophic gastritis, post-gastric cancer surgery, or if a first-degree relative has gastric cancer, treatment should be considered.
Therefore, whether your family members should be tested for H.
pylori depends on whether they have gastric symptoms.
Even after eradication, lifelong immunity is not guaranteed, so reinfection is still possible.

Changhua Hospital cares about your health.

Dr.
Tsai An-shun

Reply Date: 2012/07/13

More Info

Understanding stomach ulcers and the role of Helicobacter pylori (H. pylori) in their development is crucial for effective diagnosis and treatment. Based on your situation, it appears that you have been diagnosed with a stomach ulcer and confirmed H. pylori infection through a gastroscopy. The treatment regimen you have undergone, which includes a combination of antibiotics and ulcer medication, is standard practice for eradicating H. pylori and promoting healing of the ulcer.

Diagnosis and Treatment of Stomach Ulcers
Stomach ulcers, also known as peptic ulcers, are sores that develop on the lining of the stomach or the first part of the small intestine (duodenum). They can be caused by several factors, with H. pylori infection being one of the most common. Other causes include the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, and smoking.

The treatment for H. pylori-related ulcers typically involves a regimen known as triple therapy, which includes two antibiotics and a proton pump inhibitor (PPI) to reduce stomach acid. Your treatment of 7 days of antibiotics followed by an additional 10 days is consistent with this approach. The goal is to eradicate the bacteria, which, if successful, should lead to the healing of the ulcer.

Monitoring and Follow-Up
After treatment, it is common practice to confirm the eradication of H. pylori through a breath test, stool test, or endoscopy with biopsy. Your doctor’s recommendation to perform another gastroscopy and biopsy after a month is appropriate, as it allows for direct visualization of the ulcer and assessment of healing. The presence of H. pylori is often correlated with the healing of the ulcer; if the bacteria are eradicated, the ulcer typically heals as well.

Regarding your concern about cancer, it is standard procedure to evaluate any ulcer found during gastroscopy for malignancy, especially if there are concerning features such as irregular edges or if the ulcer is unusually large. Your doctor’s reassurance that the ulcer is not related to cancer is based on the appearance during the endoscopy, but it is prudent to follow up with the biopsy results for definitive confirmation.

Transmission of H. pylori
H. pylori is primarily transmitted through oral-oral or fecal-oral routes. While it is not highly contagious, it can be spread through saliva, which raises concerns about transmission within families. It is advisable for family members, especially those living in close quarters with you, to be aware of the symptoms of H. pylori infection, which can include abdominal pain, bloating, and nausea. If they exhibit symptoms, they should consult a healthcare provider for testing.

Conclusion
In summary, your treatment plan appears to be appropriate and follows established guidelines for managing H. pylori-related ulcers. Regular follow-up with your healthcare provider is essential to monitor your progress and ensure the ulcer heals properly. If you have ongoing concerns about your health or the potential for cancer, do not hesitate to discuss these with your doctor. They can provide further reassurance and possibly additional testing if warranted. Additionally, consider discussing with your family the importance of hygiene practices to minimize the risk of H. pylori transmission.

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