H. pylori infection often shows no symptoms
DEAR DOCTOR K:
I'm in my mid-80s and am infected with H. pylori. I don't have any symptoms. Do I need to be treated?
Helicobacter pylori -- H. pylori -- is a species of bacteria. In the mid-1980s, two Australian doctors found H. pylori in many peptic ulcers. These ulcers, which were common in the mid-1980s, occur in the stomach and the first part of the small intestine.
Before this discovery, it was widely believed that peptic ulcers were caused by stomach acid. Most people thought that bacteria couldn't possibly live in such acid. Today we know that H. pylori causes not only many peptic ulcers, but also many cases of stomach cancer.
But many people who are infected with H. pylori never get ulcers or stomach cancer. In fact, doctors don't usually test for H. pylori in people without symptoms. So I'm curious about why you were tested. Perhaps many of your relatives have suffered from peptic ulcers or stomach cancer. Or perhaps you're of East Asian or Eastern European extraction, populations in which stomach cancer is more common than it is elsewhere.
Most people become infected with H. pylori in early childhood. So if you're in your mid-80s, you have probably been living with this infection for most of your life -- and it apparently hasn't caused you any trouble. In my opinion, this increases the likelihood that it won't cause trouble in the future.
What I ask patients like you is this: Does knowing that you have an infection that has a very small chance of causing cancer make you worried and anxious? If so, let's treat you to make a small risk even smaller. Treatment is effective and simple. You take several antibiotics for seven to 14 days. As with any treatment, though, there can be side effects.
On the other hand, you may figure that if you were going to get an ulcer or cancer from H. pylori, you would have gotten it by now. If you don't want the bother and possible side effects from treatment, I wouldn't disagree.
All of us carry bacteria and viruses inside us for most of our lives. Some of those bacteria and viruses, like H. pylori, can cause disease. But they cause disease only occasionally. Most of the time they just live harmlessly within us.
We don't fully understand the mystery of why only some people get sick from their H. pylori infection. We know that some strains of the bacteria are more likely to produce disease. We also suspect that the way the body's immune system responds to the bacterial infection plays a role, and the body's immune response is largely determined by the genes we inherited.
Someday research may teach us which people infected with H. pylori are more likely to get sick from it. That will allow doctors to test for the bacteria, and to treat people who are infected when the treatment is most likely to prevent disease.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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