Prevention and treatment of Helicobacter pylori

01

How many people are infected with Helicobacter pylori in China?

Academician Fan Daiming : Data show that the average infection rate of Helicobacter pylori in China is 59%.

In fact, more than that, because no test can guarantee 100% that the negative result is that there is no infection, it may be that Helicobacter
pylori is not taken from the place of testing.

In addition, as life is extended, people who are not infected now may be infected in the future, and the probability of a person's lifetime infection is 90% or more
.

Professor Lin Guole: If you don't have it now, it doesn't mean you don't have it in your life, you can follow up to observe the symptoms of the stomach, if you have symptoms and suspect an infection, you can test
again.

02

Who is more susceptible to Helicobacter pylori?

Professor Lin Guole: Children are susceptible to Helicobacter pylori, and adults are already resistant to Helicobacter pylori and are not easily infected
.

Professor Zhang Kai: Adults are not easy to be infected, adults have strong resistance, and the reinfection rate after treatment is also very low
.
I think as long as you are an adult, don't avoid sharing meals
for fear of being infected with Helicobacter pylori.

03

Can kissing and sharing meals lead to transmission?

Professor Zhang Kai: Don't worry about eating together, and kissing won't be infected
.

The greatest risk of oral-oral transmission, such as shared meals, is in children, who are the most vulnerable to infection; Adults are very contagious and less susceptible to infection
.
Don't affect your life because of cancer prevention, cancer prevention must be done, but cancer prevention affects life is not as good as not preventing, only chronic cancer prevention does not affect life
.

Professor Lin Guole: I personally think that kissing will spread 100%, and sharing meals is also very important
.
Because there are two main ways of transmission of Helicobacter pylori:

First, fecal-oral transmission, such as organic fertilizer fertilized vegetables, not washed and eaten, at this time may cause fecal-oral transmission, so we advocate washing hands before meals and after using the toilet, pay attention to hygiene, do not buy those contaminated food, things are best cooked before eating
.

The second is mouth-to-mouth transmission, bacteria are in the mouth, French tongue kiss for a long time must have problems, but Dr.
Zhang Kai said that part of it is also right, because there are bacteria and you will get sick, it is a problem
of seeds and soil.

Early childhood is the most likely stage to get Helicobacter pylori, chewing food to feed the child, or pursing the mouth, blowing cold, and tasting it yourself before giving the child milk, may transmit the bacteria to the child, so many people have been infected when they are infancy
.

If you have not yet had it in adulthood, it means that you have developed resistance to Helicobacter pylori, and kissing may not be contagious
.

Whether a person will be infected is also related to physical constitution and living habits, often eating spicy, dieting without eating, ordering takeaway every day to eat roadside stalls, chopsticks are not replaced once every half a year, and disinfected once in half a month may increase the infection rate
.

Dr.
Zeng: To prevent Helicobacter pylori, you should prevent the people
closest to you.

04

Is it easier to get infected by eating takeout regularly?

Professor Zhang Kai: It doesn't matter if it's takeaway or not, the amount of this bacteria in vitro is very small
.

05

What are the symptoms of Helicobacter pylori infection?

Dr.
Zeng: About 15%~20% will develop peptic ulcer, and symptoms such as acid reflux, heartburn, stomach pain, and stomach pain may occur
.
Helicobacter pylori-related dyspepsia occurs in 5% to 10% of people, and eventually about 1% develop gastric malignancies
.

Most of the remaining people may not have any uncomfortable symptoms after infection, and they will not be found without going to the examination
.
Even in the early stage of stomach cancer, it has no obvious symptoms, and some uncomfortable manifestations will appear in the middle and advanced stages of stomach cancer, but at this time patients often miss the best time
for treatment.

06

Who is tested for Helicobacter pylori?

Dr.
Liu Jiayong:

Professor Lin Guole: If one person in the family has Helicobacter pylori, the family must be tested and treated, otherwise they may be reinfected after treatment, and cross-infection may also occur in the family, because strict meal sharing and non-kissing are difficult to implement
.

07

Can children be tested for Helicobacter pylori?

Dr.
Zeng: According to the relevant guidelines in our country, routine examination
for children under the age of 14 is not recommended.

On the one hand, for children, some antibiotics for the treatment of Helicobacter pylori are not suitable, and the side effects are relatively large; On the other hand, the period of infection in the child is unlikely to cause a very serious situation, and it is time to wait until adulthood to do a radical treatment; Unless the Helicobacter pylori infection has caused a very serious problem for the child, they will be recommended for testing and treatment
.

Dr.
Liu Jiayong: Two situations
.
One is the appearance of peptic ulcer and the other is the appearance of gastric lymphoma, both of which require early treatment
.

Professor Zhang Kai: Children's infection has three characteristics, one is that most of them have no symptoms, the second is that the possibility of being infected again after treatment is very large, and the third is that it has a certain degree of self-healing, and if it is not treated, half of them may be fine
.

Although the current mainstream view is that children do not need to be tested, because for children, the benefits of treatment and the cost of treatment are not cost-effective, but the child's father, mother, grandfather, grandmother should be tested, if the family is infected with Helicobacter pylori, it is easy to transmit to the child
.

08

Is it checked every year?

Professor Zhang Kai: If you are already an adult and positive, Helicobacter pylori will not be automatically cleared without treatment;

If you receive treatment, you can take the test again after taking the medicine with an interval of more than 1 month, if not at that time, then more than 85% of people will not have it again for life
.

09

What are the advantages and disadvantages of current detection methods?

Dr.
Tsang:

Breath test: Helicobacter pylori has urease, which can decompose urea, urea will produce carbon dioxide after decomposition, the tester swallows a urea labeled with a nuclide (carbon 13 or carbon 14), if you have Helicobacter pylori in your body, it will decompose urea to produce carbon dioxide, which is detected by breathing
.

Its advantage is very convenient, exhale a breath can be, the disadvantage is affected by many factors, such as detection has a critical value, beyond the critical value it can be judged as positive, but stuck on the critical value is not good to judge; And it's going to the hospital for a check-up
.

Stool antigen test: If you have Helicobacter pylori, you will carry Helicobacter
pylori in your stool.
We can take a little stool and do a test to see if there is an infection
.

It is more convenient for the elderly, children, people who cannot do gastroscopy or people who do not want to go to the hospital to see a doctor; The disadvantage is that it is not widely popularized, and the awareness rate of the masses is very low
.

Professor Lin Guole:

Breath test: sensitivity and specificity are over 95%; Carbon 14 is currently used less often because it may have some radiation effects
.

Fecal antigen test: no need to go to the hospital to register, no need to queue for nucleic acid testing, painless and non-invasive, no need to take medicine, 10 minutes can get the result, the tester does not need to have medical qualifications, you can test at home, the results and professional test results match the rate of 100%, the sensitivity reaches 96.
53%, and the specificity reaches more than
95%.

10

Is there a relationship between the level of expiratory indicators and the severity?

Professor Zhang Kai: Many people regard the expiration value as the load of bacteria, thinking that the value is high, there are many bacteria, the value is low, and the bacteria are few, but in fact, it has nothing to do with it
.

So far, our human technology has not been able to count the amount of these bacteria, and the carbon-13 results show a relationship
with the activity of the bacteria.
In the process of metabolizing urea, if the activity is strong, the value is high, if the intensity is weak, the value is low
.

If the activity is low, no matter how many there are, the value will not be high
.
So don't rely on that value to decide whether you are treated, whether to share meals with your child, the test is positive, for the sake of your child, you must treat
.

11

Do I need to treat Helicobacter pylori infection?

Academician Fan Daiming : In the case of doctor's diagnosis, Helicobacter pylori infection is found to be present, and there are corresponding disease manifestations, which need to be given appropriate and reasonable treatment
.

Professor Lin Guole: Both types of people are recommended for treatment:

1.
Adults
.
Because adults infected with Helicobacter pylori will have some peptic ulcers, stomach ulcers and even lymphoma
.

2.
People
with a family history of stomach cancer.
Such people are infected with Helicobacter pylori, which increases the risk of
stomach cancer.

Professor Zhang Kai: It is not recommended that everyone should be treated
.

Symptomatic people need treatment, no symptoms but atrophic gastritis, family history of gastric cancer, bad lifestyle habits and frequent use of carrier drugs, treatment will definitely benefit; If you are at high risk of gastric cancer, intervention for Helicobacter pylori is also required
.

12

When is the most appropriate treatment?

Professor Zhang Kai: Treatment between 18-40 years old benefits the most, because at this time, most infected people are in the stage of intestinal epithelial metaplasia, in the stage of atrophic gastritis, eradication of Helicobacter pylori at this stage can prevent the occurrence of gastric cancer and benefit the most
.
At the same time, the elderly over 65 years old are more likely to experience side effects during treatment, and it is difficult to adhere
to treatment.

13

When is treatment not needed?

Professor Lin Guole: Children under the age of 14 and elderly people over 70 years old, if there are no obvious symptoms, even if it is found to be Helicobacter pylori infection, they can not be treated first; However, if the examination finds some serious inflammation of the stomach, it must be treated
.

Academician Fan Daiming : In a state of human resistance, living peacefully with Helicobacter pylori may have certain benefits
for our human body.
In this case, eradication is not necessary
.

Professor Zhang Kai:

There is a view that Helicobacter pylori has lived with humans for many years, and it may be a symbiotic bacterium with humans, and its benefits and disadvantages can be offset
.

According to this view, its benefits include good for immune balance, good for intestinal flora regulation, good for reflux esophagitis, and even helpful
for asthma.

But there is little evidence of these benefits, and the overwhelming evidence of the harms of Helicobacter pylori (such as causing diseases such as severe gastritis) earned Dr.
Marshall and Warren the 2005 Nobel Prize
.

I think Helicobacter pylori does more harm than good, and the evidence is completely different from the same magnitude, so Helicobacter pylori needs to be treated and tested
.

14

What do you think of "Asymptomatic infection with Helicobacter pylori should also be eradicated for treatment"?

Academician Fan Daiming: I have reservations
.
There are two reasons for this:

1.
Few people actually cause stomach cancer after infection
.
The average infection rate of Helicobacter pylori in China is 59%, about 800 million people, and studies show that 1% of infected people will develop stomach cancer, that is, 8 million people, but in fact, the number of stomach cancer cases in China is more than 300,000
people every year.

2
.
Widespread eradication may cause antibiotic resistance.
The previous radical cure was triple drugs, and now it is a quadruple drug, because some bacteria have caused drug resistance, the previous combination of three drugs can kill bacteria, and now the combination of four drugs can kill bacteria
.
If antibiotics are sterilized on a large scale, the resulting problem of drug resistance needs to be carefully considered
.

However, if your gastritis, stomach ulcer, and stomach cancer are caused by Helicobacter pylori infection, you must attach great importance to it and receive reasonable and correct treatment
.

Professor Zhang Kai: People who can't insist on taking medicine are the ones
who cause drug resistance.

Most of the people who insist on 14 days of treatment will destroy the bacteria, and if they only eat for 3 days and 5 days and no longer carry out treatment, they will cultivate drug-resistant bacteria to come out, and the bacteria will spread out, and there will be more and more
drug-resistant bacteria.

15

What should I do if someone in my family finds out about Helicobacter pylori?

Professor Lin Guole: We have found some ways to radically cure Helicobacter pylori, called quadruple therapy, which is an antacid, a gastric mucosal protector, two antibiotics, and takes medicine for about two weeks (10~14 days).

The cure rate is 80~90%, which is already a very great probability, if you buy a stock, 80~90% will rise, do you buy it? I buy
it for sure.
If the first treatment fails, you can get a radical cure if you change the drug, and the reinfection rate after treatment is not high
.

Dr.
Liu Jiayong:

Helicobacter pylori is highly infectious and can be transmitted
through hands, unclean food, dishes, feces, etc.
Wash your hands with antiseptic soap before eating and after using the toilet, and then rinse with
running water.

Tableware should be thoroughly cleaned before use, and should be disinfected
regularly.
When eating together, a split meal system
is implemented.
When eating out, it is best to bring your own special bowl and chopsticks to avoid bacterial or viral infection
.

Patients with Helicobacter pylori at home should pay attention to the isolation of tableware, temporarily separate their dishes and chopsticks from their family members, ensure that their families are not infected, and can return to normal after
cure.

Pay attention to oral hygiene, it is recommended to change the toothbrush
once every 3 months.
Helicobacter pylori is present in saliva, do not feed your child mouth-to-mouth to avoid transmitting the bacteria to children
with low resistance.

16

The dishwasher is not clean, can this bowl be contagious?

Professor Zhang Kai: Think too much, you don't think about this kind of small probability event, which is the possibility of an accident with the second ring, but it will not affect you on the second ring road, because the possibility is unlikely
.

17

What other diseases are Helicobacter pylori associated with?

Academician Fan Daiming : Helicobacter pylori infection is not only related to gastric diseases, but also to extragastric diseases
.

For example, some refractory eczema, paroxysmal tachycardia, unexplained iron deficiency anemia, unexplained platelet purpura, urticaria, asthma, etc
.
By treating Helicobacter pylori, symptoms can improve and even the disease can be cured
.

Professor Lin Guole: The latest study by our Peking Union Medical College Hospital shows that the proportion of Helicobacter pylori carriers getting intestinal polyps is higher, 1.
5 times
that of people without infection.

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