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When you think about stomach ulcers, the main culprits that come to mind are stress, smoking, alcohol consumption, overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), genetics, or an underlying medical issue. The medical condition Zollinger-Ellison syndrome, for instance, causes the stomach to produce excessive amounts of acid that erode the stomach lining, leading to gastric ulcers. Individuals who experience high-stress levels have an increased production of stomach acid that leads to ulcers. Prolonged use of NSAIDs like aspirin, ibuprofen, or naproxen can irritate the stomach lining and also cause ulcers.
Helicobacter Pylori – the bacteria of poor hygiene
It turns out that poor hygiene can also indirectly contribute to stomach ulcers caused by the bacterium Helicobacter Pylori (H.pylori). This unique bacterium is transmitted through close contact with infected bodily fluids, such as saliva, vomit, or feces. Individuals who use water to self-clean after using the toilet and consume meals with their hands may introduce the bacterium into their gut. Additionally, unsanitary food handling by individuals in the food industry can also contribute to the transmission of H.pylori. The infection caused by this bacterium can lead to gastritis (inflammation of the lining of the stomach), peptic ulcers, and increase the risk of stomach cancer. H. pylori remains a significant human health problem, responsible for ~90% of gastric cancer cases. Approximately four billion individuals have been detected with H. pylori infection worldwide in 2015.
The stomach maintains one of the most acidic environments in the body. This low pH enables the breakdown of food into smaller components and facilitates rapid absorption into the small intestine. Proteins, for example, are broken down into amino acids by the digestive enzyme Pepsinogen. This enzyme that behaves like a pair of "scissors" is activated by the stomach's acid into its active form called Pepsin. The activated Pepsin can now break down the protein into amino acids. The acid's second role involves killing most microbes that enter the digestive system through food and other sources. Although H. pylori is classified as a bacterium, it has evaded the stomach's hostile acidic environment due to a critical enzyme that it contains called urease. This enzyme in the bacterium allows it to break down urea in the stomach into ammonia. Its ability to generate this base enables it to neutralize the gastric acid, preventing acidization of the bacteria's inner membrane.
H. pylori causes stomach ulcers
The stomach is protected from the acid by a mucus lining created by the stomach's mucous cells. Furthermore, the mucus offers protection to the stomach from the active Pepsin. H. pylori causes detrimental changes in the mucus coat integrity and weakens the stomach's protective lining. These changes are the actions caused by the bacterium's elaborate proteases and lipases that disintegrate the structure of the mucin and degrade the lipids. The loss of the protective mucus exposes the stomach lining, leading to stomach ulcers.
Poor hygiene and sanitation can increase the prevalence of H.pylori
The prevalence of H. pylori in the developing world is higher than in the Western world. This difference can be attributed to food scarcity and clean water sources. In the Western world, the level of contamination is strongly dependent on the environmental context, with significant effects from living in conditions with inadequate hygiene and poor sanitation practices. Furthermore, infection status remains high in immigrants coming from countries with a high prevalence of H. pylori infection. Individuals lacking proper hygiene maintenance will subject themselves to repeated infections, especially when using their hands to self-clean and handle food.
Methods of detecting H.pylori
Aside from the pain inflicted by gastric ulcers, there are invasive and non-invasive detection methods that can inform an individual whether they are affected by H. pylori. The presence of the bacterium can be detected using the urea breath test and stool antigen detection. A bleeding ulcer may produce blood in the stool or give the stool a black/tar-colored appearance. In addition to these multiple detection methods, an endoscopy coupled with a biopsy of the ulcer region can help to identify the cause of H. pylori ulcers. Symptoms of H. pylori infection may include abdominal pain, bloating, loss of appetite, vomiting, and nausea, although some people may not experience any symptom.
Treatments and medications to combat H.pylori
The treatment for H. pylori infection usually involves a combination of antibiotics and acid-suppressing medications. Antibiotics kill the bacteria, while acid-suppressing medicines known as proton pump inhibitors (PPIs) alleviate the symptoms and allow the stomach lining to heal. Here is a list of medications commonly used to treat H.pylori and the over-the-counter medicines that provide temporary relief.
• Antibiotics: Possible mechanisms of action
Biaxin (Clarithromycin): Inhibits protein synthesis in bacteria
Amoxil (Amoxicillin): Prevents the bacteria from building their cell walls, leading to their eventual death.
Metronidazole: Interferes with the bacteria's DNA, preventing them from growing and reproducing.
• Proton pump inhibitors (PPIs): Reduces the amount of acid the stomach generates
Prilosec (Omeprazole Magnesium)
Prevacid (Lansoprazole)
• Histamine-2 (H2) blockers: Reduces the amount of acid the stomach generates
Zantac (Ranitidine)
Famotidine
• Antacids and acid blockers: Provides temporary relief by neutralizing stomach acid
Maalox
Tums
Lifestyle modifications can reduce the chances of contracting H. pylori
• Maintaining good hygiene practices can help prevent stomach ulcers.
• Wash your hands frequently with soap and water, especially when handling food.
• Avoid contaminated water and food that may harbor the bacteria. Ensure that any food you consume is prepared and cooked correctly.
• Avoid sharing utensils like forks, spoons, drinking glasses, and personal items. H. pylori can be transmitted through saliva.
• During the infection period, one should limit contact with other bodily fluids to limit the spread of the infection.
• Using gloves when self-cleaning after using the toilet can help to significantly reduce the incidence of H.pylori infection.
• Applying a hand sanitizer can further help keep infection levels low.
Maintaining a healthy lifestyle, eating a healthy balanced diet, avoiding smoking and excessive alcohol consumption, exercising, and reducing stress can help support a healthy immune system that can help protect against H.pylori infection.
If you believe you have an H.pylori infection, it is essential to consult with a healthcare professional for proper diagnosis and treatment.
References
Berger A. Scientists discover how helicobacter survives gastric acid. BMJ. 2000 Jan 29;320(7230):268. PMID: 10650011; PMCID: PMC1117475.
Kotilea K, Bontems P, Touati E. Epidemiology, Diagnosis and Risk Factors of Helicobacter pylori infection. Adv Exp Med Biol. 2019;1149:17-33. doi: 10.1007/5584_2019_357. PMID: 31016621.
Gritti I, Banfi G, Roi GS. Pepsinogens: physiology, pharmacology pathophysiology and exercise. Pharmacol Res. 2000 Mar;41(3):265-81. doi: 10.1006/phrs.1999.0586. PMID: 10675278.
Slomiany BL, Slomiany A. Mechanism of Helicobacter pylori pathogenesis: focus on mucus. J Clin Gastroenterol. 1992;14 Suppl 1:S114-21. PMID: 1378466.
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