Medical Health Encyclopedia

Treatment may also fail if the patients harbor strains of H. pylori that are resistant to the antibiotics used. This is an increasing problem with some of the antibiotics used in the regimens. In such cases, different drugs will be tried.

Reinfection After Successful Treatment. Studies are indicating that, at least in developed countries, once the bacteria are eliminated, recurrence rates are low, well below 1% per year. Reinfection with the bacteria is possible, however, particularly in areas where the incidence of H. pylori is very high and sanitary conditions are poor. In such regions reinfection rates are between 6% and 15%.

Potential Adverse Effects from the Elimination of H. pylori

Weight Gain. Weight gain may be a problem in some cases.

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Gastroesophageal Reflux Disease (GERD). Of ongoing interest are reports of a lower incidence of H. pylori in patients with gastroesophageal reflux disease (GERD). (GERD is inflammation in the esophagus, or food pipe, and the most common cause of heartburn.) There are some important unanswered questions associated with this issue:

• Is the lower incidence of H. pylori in GERD patients significant, and does the bacterium actually protect against GERD? Studies are still not conclusive in showing any significant risk for GERD in people who are not infected with H. pylori, except possibly in certain regions. In a 2003 study, for example, the absence of H. pylori infection in people with GERD was more pronounced in Asian patients compared to those in Europe and North American.
• Does eliminating the bacteria with antibiotic therapy actually produce GERD in some people? One study, for instance, observed that patients with cured infections of H. pylori were twice as likely to develop GERD as those who remained infected. However, a 2003 analysis of eight well-conducted studies reported no higher risk for GERD after antibiotic treatments. Nor was GERD any worse in patients who already had it. Seven of the eight studies, however, were conducted only eight weeks after antibiotic treatment. Longer follow-up studies are needed however to determine long-term consequences, if any.
• How should people who have GERD and are infected with H. pylori be managed? Patients with severe GERD usually require on-going proton-pump inhibitors (PPIs), such as omeprazole (Prilosec), which are powerful acid-suppressors. Some evidence suggests that in such patients, the combination of H. pylori and chronic acid suppression may lead to atrophic gastritis--a precancerous condition in the stomach. Current guidelines then advocate eliminating the bacteria with antibiotics. There is some concern that once the bacteria is eliminated, however, GERD may worsen, which can pose a risk for Barrett's esophagus--also a precancerous condition. (On the encouraging side, however, evidence to date does not suggest any higher risk for more serious GERD complications after H. pylori is eliminated.)

Effects on Other Gastrointestinal Infections. Some evidence exists that H. pylori protects against E. coli and other gastrointestinal infections in children, particularly those that cause diarrhea. If true, then treating infected children for H. pylori should be undertaken very cautiously and only with evidence that the bacteria is causing harm.

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