Helicobacter pylori has these "effects"? Don't be complacent, you still have to treat it!

In 1982, Australian scientists Barry Marshall and Rubin Warren discovered a spiral-shaped bacterium in the mucus layer of the human stomach wall. They found that people with these bacteria in their stomachs showed typical symptoms of gastritis under a microscope. In 1984, the two scientists published a paper in The Lancet, naming the bacterium Helicobacter pylori and proposing the hypothesis that "gastric ulcers and gastric cancer are caused by Helicobacter pylori." After the hypothesis was proposed, scientists and doctors laughed at it mercilessly. Why did they laugh? Because the human stomach is a highly acidic environment, comparable to the acid in a car battery, and the acid is strong enough to kill any kind of bacteria, so scientists and doctors at the time did not believe that bacteria could survive in the stomach.

In order to prove his hypothesis and draw people's attention to this theory, Barry Marshall "tested the bacteria himself" and took the Helicobacter pylori they cultured in a petri dish . Not long after, he developed a gastric ulcer, and he was a scientist who was willing to pay the price of his health in pursuit of the truth. Of course, he later used antibiotics to kill Helicobacter pylori and cure the gastric ulcer. Barry Marshall and Reuben Warren's contributions to isolating Helicobacter pylori, confirming their relationship with gastritis and peptic ulcers, and changing the treatment of gastric ulcers won them the 2005 Nobel Prize in Physiology or Medicine.

01

Helicobacter pylori has attracted great attention from the medical community

The results of gene sequencing analysis show that the human stomach has carried Helicobacter pylori for 100,000 years, which is the limit of what can be detected by current technology. In fact, Helicobacter pylori may have lived in the stomach of human ancestors even earlier. Since the discovery of Helicobacter pylori in 1982, scientists and doctors from all over the world have treated it as a formidable enemy and have taken it very seriously. This is because Helicobacter pylori can be transmitted through the fecal-oral and oral-oral routes and has obvious family aggregation characteristics, so its infection is very wide. Around the world, about half of the natural population is infected .

After Helicobacter pylori infection, 70% of Helicobacter pylori infected people do not show any symptoms , unless a special carbon 14 or carbon 13 breath test or gastroscopy biopsy is done, otherwise it is not easy to detect. However, some patients will experience symptoms such as stomach pain, bloating, nausea, vomiting, acid reflux, heartburn, indigestion, loss of appetite, and stubborn bad breath. The course of the disease progresses slowly, is prone to recurrence, and can also cause a variety of other digestive system diseases. In 1994, the International Agency for Cancer (IARC) announced that Helicobacter pylori was a Class I carcinogen, and it was again listed as a Class I carcinogen in 2017. 36% and 47% of all gastric cancer patients worldwide are caused by Helicobacter pylori. Almost 100% of chronic gastritis, 67% to 80% of gastric ulcers, and 95% of duodenal ulcers are also believed to be caused by Helicobacter pylori.

02

Is it necessary to “eradicate” Helicobacter pylori?

Because Helicobacter pylori causes so many digestive diseases and can also cause stomach cancer, people naturally think that Helicobacter pylori is a bad bacteria and it is best not to have it in the human body. Medical staff around the world have also launched an all-out war against Helicobacter pylori. But is Helicobacter pylori really of no benefit to health?

1. Helicobacter pylori and digestive tract flora imbalance

Martin Blazer is an American expert in microbiology and immunology and the chairman of the President's Advisory Committee on the Prevention and Control of Antimicrobial Resistant Bacteria. In his book "The Lost Microbes", he wrote: There are many microorganisms on and in the human body that "live in peace" with humans. They are involved in the metabolism, immunity, and development of the human body. Many diseases are actually the result of a disruption of this balance. [1] Helicobacter pylori does not necessarily cause disease . Studies have shown that for some people who are positive for Helicobacter pylori, they are infected with Helicobacter pylori because of the imbalance of digestive tract flora and the lack of other microorganisms that inhibit Helicobacter pylori. Therefore, Helicobacter pylori can send out a reminder to tell people that their intestinal flora has changed .

For 100,000 years, half of the world's population has been infected with Helicobacter pylori, which has settled in the stomach, successfully withstanding all kinds of storms and maintaining a balance of microorganisms. So in some cases, could the presence of Helicobacter pylori be beneficial to health? This idea gave Martin Blazer a "brain-opening" idea, and he discovered that Helicobacter pylori is actually both an enemy and a friend: as people age, it increases your chances of developing gastric ulcers and gastric cancer. But at the same time, it also protects the esophagus, reducing your chances of developing gastroesophageal reflux disease or other diseases.

2. Helicobacter pylori and esophageal adenocarcinoma

A German research team has been using antibiotic elimination to treat patients with duodenal ulcers. Three years later, they tested the patients' stomachs and esophagus and found that Helicobacter pylori had indeed been eliminated in nearly half of the patients, but Helicobacter pylori was still present in the other half. At the same time, the proportion of patients who successfully eliminated Helicobacter pylori and had esophageal reflux was significantly higher than that of patients who did not eliminate it . With the disappearance of Helicobacter pylori, the incidence of gastric cancer has begun to decrease, but the incidence of esophageal adenocarcinoma has been rising year by year.

3. Helicobacter pylori and asthma

A large-scale analysis of clinical data from asthma patients found that people who carry Helicobacter pylori develop asthma at an average age of 21, while those who do not carry Helicobacter pylori develop asthma at an average age of 11, indicating that the lack of Helicobacter pylori is closely related to asthma attacks in childhood . There is also evidence that Helicobacter pylori in children's stomachs may protect them from hay fever.

03

Infection with Helicobacter pylori

These groups of people must be treated eradicated

More than 50% of people in my country are infected with Helicobacter pylori. The Helicobacter pylori in many people's bodies does cause harm to their health, but it is not realistic to actively screen all infected people and provide treatment.

In 2022, the Helicobacter pylori and Peptic Ulcer Group of the Chinese Society of Gastroenterology released the "Sixth National Consensus Report on the Management of Helicobacter pylori Infection" (hereinafter referred to as the "National Six Consensus"). The "National Six Consensus" points out that eradication of Helicobacter pylori can effectively reduce the risk of gastric cancer, and can also reduce the risk of Helicobacter pylori-related peptic ulcers, dyspepsia and other diseases. Eradication before gastric mucosal atrophy and/or intestinal metaplasia occurs will have greater benefits. [2] You can refer to the eradication indications recommended in the report and consider whether eradication is necessary.

The "National Consensus" lists 13 eradication indications for Helicobacter pylori infection, and emphasizes that for those infected who meet the eradication indications, the benefits of eradication treatment, general health status, and possible adverse reactions of drug treatment should be fully evaluated before implementing eradication treatment, and individualized treatment should be carried out . Eradication is recommended only for those infected who will benefit the most.

For example, individuals at high risk of gastric cancer generally have a family history of gastric cancer, have undergone endoscopic resection of early gastric cancer, and have gastric mucosal atrophy and/or intestinal metaplasia. The benefits of eradication to prevent gastric cancer are higher than those of low-risk individuals. After infection with Helicobacter pylori, Helicobacter pylori occupies most of the ecological niches in the stomach and becomes the dominant flora. The living space of other bacteria is squeezed, resulting in a significant decrease in the diversity of microorganisms in the stomach. Eradication therapy helps to restore microbial diversity and ecological balance.

04 Conclusion

In summary, although Helicobacter pylori can remind people of digestive tract flora imbalance, its presence is related to the low incidence of esophageal adenocarcinoma, low incidence of asthma, and protection of children from hay fever. But remember, Helicobacter pylori is still closely related to the incidence of gastric cancer, so don't take chances with it! You should still pay attention to screening. If you find Helicobacter pylori, you should seek medical attention immediately and follow the advice of professional doctors to eradicate Helicobacter pylori. Don't "lose the big picture for the small"!

References:

[1] Martin Blazer, Disappearing Microbes: The Health Crisis Caused by the Misuse of Antibiotics, Hunan Science and Technology Press, July 2016.

[2] Helicobacter pylori group of the Chinese Society of Gastroenterology. The sixth national consensus report on the management of Helicobacter pylori infection (non-eradication treatment part)[J]. Chinese Journal of Gastroenterology, 2022, 42(5): 289-303.

Author: Zeng Xinyue, popular science creator

Reviewer: Shi Jindong, Chief Physician of the Respiratory Department, Shanghai Fifth People's Hospital