Life Example
Xiao Guo, a 28-year-old patient with chronic superficial gastritis, had a positive H. pylori (Hp) test and was treated with antiseptic drugs such as omeprazole, amoxicillin and clarithromycin, but unfortunately, Hp never turned negative. He was worried about long-term H. pylori infection, prone to cancer in the future, so several courses of continuous sterilization, but the 13C-breath test is still Hp-positive, but also developed epigastric discomfort and other symptoms. He had to come to a tertiary care hospital and was advised by his doctor to stop taking drugs for H. pylori. This confused him: “I thought that the discovery of H. pylori must be completely eradicated?”
The discovery of Helicobacter pylori (Hp) is considered an epoch-making event in the field of modern digestive disease research. Numerous studies have confirmed the strong correlation between Hp infection and chronic gastritis, peptic ulcers and gastric cancer. For this reason, many people were optimistic that the eradication of Hp would cure gastroduodenal diseases and effectively prevent the development of gastric cancer. If this is true, then all patients with Hp infection need to be treated with Hp eradication therapy, and it should be “killed” at all costs with various drugs.
Hp is not an “unforgivable” disease
Unfortunately, epidemiological studies have shown that H. pylori is also present in the gastric cavity of most normal people.
Some studies have also shown that H. pylori eradication will aggravate GERD. A prospective study from abroad showed that the presence of chronic gastritis reduces the risk of reflux esophagitis, so experts believe that total gastritis caused by Hp infection or gastritis dominated by the gastric body may be a protective effect against GERD by decreasing gastric acid secretion. These have led to a significant reduction in interest in the treatment of H. pylori eradication, and some even believe that H. pylori may be a “normal bacterium” in the body and that its removal can cause damage to the body.
In addition, a recent study in the United Kingdom showed that implementing an Hp eradication treatment strategy reduced the risk of functional dyspepsia symptoms, but that Hp eradication did not significantly improve quality of life. Studies have also confirmed that Hp infection and the application of nonsteroidal antipyretic analgesics (e.g., aspirin, anti-inflammatory pain, etc.) are two independent risk factors for the development of peptic ulcers, and the relationship between them is not fully understood. Studies have shown that NSAIDs do not increase the damage to the gastric mucosa from Hp infection, and Hp infection does not increase the damage to the gastric mucosa from NSAIDs; Hp can promote the production of prostaglandins in the gastric mucosa, which helps the healing of ulcers.
”Kill all” or “no kill” differentiation
In view of the above study, experts decided that clinically, whether the patient is serologically tested positive for Hp, found positive for Hp in the mucosal tissue under gastroscopy, or confirmed positive for Hp by 13C-expiratory test, whether the patient needs Hp eradication treatment should be treated differently by the doctor according to the patient’s relevant medical history and symptoms, so as to avoid the mistake of killing all the patients indiscriminately.
1. Hp eradication treatment must be given
Hp eradication treatment must be given in the following cases.
(1) Peptic ulcer or peptic ulcer with bleeding combined with Hp infection;
(2) Clinical gastroscopy is chronic gastritis combined with Hp infection, if the pathology shows chronic gastritis with atypical hyperplasia (epithelioma-like changes), it is necessary to use various drugs at all costs to “kill” to the end” in order to reduce the occurrence and development of gastric cancer;
(3) Postoperative gastric cancer combined with Hp infection;
(4) Family history of gastric cancer combined with Hp infection;
(5) long-term use of anti-inflammatory and analgesic drugs (NSAID) combined with Hp infection and peptic ulcer.
2.No need to give Hp eradication treatment
In the following cases, Hp eradication therapy is not necessary.
(1) No obvious clinical discomfort, occasional physical examination found Hp infection;
(2) Functional dyspepsia (FD) combined with Hp infection;
(3) Clinical gastroscopy for chronic gastritis combined with Hp infection, pathological manifestations of chronic gastritis without atypical hyperplasia (epithelioma-like changes);
(4) Gastroesophageal reflux disease (GERD) combined with Hp infection;
(5) long-term use of anti-inflammatory and analgesic drugs combined with Hp infection, without peptic ulcers.
In short, after the discovery of Hp infection, whether it is necessary to use various antiseptic drugs to “kill” to the end, patients need to fully communicate with their doctors, do not use drugs without authorization.