The United States lists Helicobacter pylori as a clear carcinogen, how to prevent it?

Recently, the U.
S.
Department of Health and Human Services released the 15th edition of the Carcinogens Report, which added eight new carcinogens
.

Including chronic infection of Helicobacter pylori is listed as a definite carcinogen, antimony trioxide is listed as a reasonably suspected carcinogen, and 6 kinds of haloacetic acid by-products after tap water disinfection are considered to have teratogenic and carcinogenic side effects
.

In particular, Helicobacter pylori is extremely common in daily life
.

Helicobacter pylori (Hp) is the most common chronic bacterial infection in humans, accounting for more than 50% of natural bacterial infections worldwide
.

Among them, the infection rate in developing countries exceeds that in developed countries
.

According to the 2001-2014 National Helicobacter pylori survey, the infection rate of Helicobacter pylori in China is between 40% and 90%, with an average of 59%
.

Helicobacter pylori and gastric cancer Gastric cancer is one of the most common digestive tract tumors in China, and about half of the world's gastric cancer cases occur in China
.

According to data from the National Cancer Center, the incidence of gastric cancer in China ranked second among all malignant tumors in 2015, with 679,100 new cases and 498,000 deaths
.

Helicobacter pylori infection is the main cause of gastric cancer in China
.

More than half of Chinese people are infected with Helicobacter pylori, and even among people under the age of 20, the infection rate is still as high as 37.
1%
.

Although China has made many advances in the detection and treatment of Helicobacter pylori over the past 30 years, the infection rate in China is still high compared to developed countries
.

In December last year (last month), The Lancet published a gastric cancer study on Chinese people, and found that the higher the education level, the higher the infection rate of Helicobacter pylori, and the overall infection will lead to non-cardia gastric cancer in Chinese.
The risk was nearly 6-fold increased, and the risk of cardia cancer was approximately 3-fold increased
.

The study used samples from the Kadoorie Biobank in China, and the researchers used a sensitive western blot analysis method to test the stored sample plasma for Helicobacter pylori biomarkers as a standard of infection
.

doi: 10.
1016/S2468-2667(21)00164-X.
After 10 years of follow-up, the incidence of non-cardia gastric cancer in the entire cohort was 57 6/100,000 person-years, and the incidence of cardiac cancer was 10.
5/100,000 person-years , both increase with age, and the incidence is about 3 times higher in men than in women
.

The infection rate of Helicobacter pylori was 94.
4% in patients with non-cardia gastric cancer, 92.
2% in cardiac cancer, and 75.
6% in the general population
.

An interesting finding was that the prevalence of H.
pylori infection was higher in the urban population or in the highly educated population, regardless of gender and age
.

In addition, overall, Helicobacter pylori infection was associated with a 5.
94-fold increased risk of non-cardia gastric cancer and a 3.
06-fold increased risk of cardiac cancer, regardless of gender
.

doi: 10.
1016/S2468-2667(21)00164-X.
After that, the researchers changed the detection of Helicobacter pylori infection from the western blot analysis method to the current clinical method, and found that the infection rate showed a downward trend, which also showed that the western blot analysis method The sensitivity of the method is higher
.

Specifically, after the change, the positive rate of Helicobacter pylori was 84% ​​in patients with non-cardia gastric cancer, 80% in cardiac cancer, and 58% in the general population.

.

The hazard ratios were 4.
68 times (non-cardia gastric cancer) and 2.
36 times (cardia cancer), respectively
.

The authors say that this study shows that both non-cardia gastric cancer and cardia cancer, Helicobacter pylori infection is a huge risk factor for gastric cancer in the Chinese population
.

It shows that among Chinese people, about 80% of non-cardia gastric cancers and more than 60% of cardiac cancers are caused by Helicobacter pylori infection
.

doi: 10.
1016/S2468-2667(21)00164-X.
After clarifying the relationship between Helicobacter pylori and Chinese gastric cancer, what needs to be done is to formulate relevant medical policies
.

But to date, there is no prophylactic or therapeutic vaccine against Helicobacter pylori
.

In addition, China has yet to incorporate H.
pylori screening, treatment and eradication into the national primary cancer prevention program
.

The expert consensus released by China this year also pointed out that eradication treatment is recommended for all adults with H.
pylori infection in the family
.

Because family transmission is the main route of infection of Helicobacter pylori in children, and most Helicobacter pylori infections occur in childhood and adolescence, the level of infection in 12-year-old children is close to that of adults
.

doi: 10.
3760/cma.
j.
cn311367-20210219-00108.
Eradication of Helicobacter pylori is a long and arduous task
.

In addition to promoting healthy eating habits such as public chopsticks and spoons, improving the level of primary medical care and investment in screening are the most critical measures
.

H.
pylori symptoms Most people with H.
pylori infection will never have any signs or symptoms
.

It is not clear why this is the case, some people may be born with greater resistance to the harmful effects of H.
pylori
.

But when signs or symptoms do appear, they may include: Abdominal pain or burning
.

It usually occurs on an empty stomach or between meals and in the early morning
.

Nausea, vomiting, bloating, belching, and loss of appetite
.

Gastrointestinal bleeding may also occur
.

Anemia, fatigue, and even fainting may result
.

If the bleeding is uncontrolled and rapid, melena (black tarry stools) or vomiting blood may occur
.

These symptoms are also specific manifestations of complications such as gastritis, ulcers, and gastric cancer caused by Helicobacter pylori infection
.

How do I know if I am infected with Helicobacter pylori? Routine testing is often not recommended for the generally asymptomatic population
.

But people with chronic symptoms should definitely get tested to see if they have gastritis, peptic ulcers, or even stomach cancer
.

Specific tests and procedures include: Blood tests
.

Analysis of the blood sample may reveal signs of active or previous H.
pylori infection in the body
.

But breath and stool tests are better at detecting active H.
pylori infection than blood tests
.

Breath test
.

Subjects usually swallow pills and liquids containing labeled carbon molecules.
If infected with Helicobacter pylori, the solution will break down in the stomach and release carbon molecules, which will be detected by special equipment when exhaling
.

However, it should be noted that taking acid-suppressing drugs proton pump inhibitors (PPI), bismuth subsalicylate, antibiotics, etc.
should be stopped one or two weeks before the test, so as not to interfere with the accuracy of the test
.

Fecal test
.

Infection is determined by looking for foreign proteins (antigens) associated with H.
pylori infection in the stool
.

As with the breath test, PPIs and bismuth subsalicylate may affect test results, so stop taking them before the test
.

Endoscopy
.

An endoscope, which looks at any abnormalities in the upper gastrointestinal tract and removes a tissue sample (biopsy), can be used to diagnose or differentially diagnose H.
pylori infection, but is more invasive
.

The most accurate method is histological examination of gastric mucosa obtained from two different sites in combination with a rapid urease test or microbial culture
.

After confirmation of Helicobacter pylori infection, standardized treatment is required
.

At present, there are two main international cure programs
.

The first is "triple therapy", which is PPI (such as omeprazole, esomeprazole, lansoprazole and pantoprazole, etc.
) plus two antibiotics, such as omeprazole combined with clarithromycin and amoxicillin
.

The second is "quadruple therapy", including PPI + bismuth + two antibiotics
.

Generally, the duration of treatment does not exceed 14 days
.

For the general population, the most important thing is still to prevent Helicobacter pylori from being contagious on a daily basis, which may be transmitted mainly through the oral-oral or fecal-oral route
.

Living in a crowded environment, not paying attention to hygiene, or living without a reliable source of clean water are all risk factors for H.
pylori infection in daily life
.

Therefore, we need to work hard to observe the following measures: share meals with family members or use public chopsticks and spoons to serve rice and vegetables, not to share vegetables with each other
.

It is forbidden to feed the child with the mouth, and the mouth should be thoroughly cleaned before the couple makes out
.

Wash hands before and after meals, and wash or peel vegetables and fruits
.

Do not eat spicy food, do not drink cold water, do not eat too hot things
.

Cutlery should be regularly boiled and sterilized for 20 minutes
.

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