Half of the world is infected with Helicobacter pylori, should we be afraid?

Half of the world is infected with Helicobacter pylori, should we be afraid?

May 09, 2019 Source: Back to the ID: fanpu2019

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In 2017, the World Health Organization released 12 “superbugs” that are in urgent need of new antibiotics, and Helicobacter pylori is on the list. What kind of bacteria are there in 66% of the world? Should humans feel awe?

Do you know what is the "most successful" pathogen in human history? It is a bacterium called Helicobacter pylori. It can enter the body and survive in the digestive tract, so its infection is very common. According to the US Centers for Disease Control and Prevention, approximately 66% of the world's population is infected with this bacterium. In developing countries, this number is even worse, with up to 80% of adults and 10% of children likely to be infected. In most cases, people infected with Helicobacter pylori may not feel any symptoms throughout their lives. A small number of people have been causing ulcers in the stomach mucosa or the upper part of the small intestine for many years after infection; for a smaller number of people, this infection can lead to stomach cancer.

At the end of February 2017, the World Health Organization (WHO) published 12 drug-resistant “superbugs” that are in urgent need of new antibiotics, and Helicobacter pylori is listed [1] . What kind of existence is this high-capacity bacteria? Should humans feel awe?

Bacteria behind gastric ulcer

Today, stomach diseases have become a common disease like a cold. A significant proportion of people with stomach upsets have gastritis and stomach ulcers. In the 1980s, mainstream medicine believed that stomach ulcers were caused by spicy diet, excessive stress and other lifestyle habits, and were often given to patients with sedatives, antidepressants, psychotherapy or antacids. Until Helicobacter pylori, a long-standing bacterium in the stomach, was discovered, doctors changed their knowledge and treatment of gastric ulcers.

In 1979, Australian pathologist Dr. Robin Warren observed a curved bacterium on the antral mucosal tissue of patients with chronic gastritis, and found that there was always inflammation in the adjacent gastric mucosa of the bacteria. He realized that this bacteria may be closely related to chronic gastritis. In 1984, Australian scientist Neil Noakes extracted some of the curved bacteria from the culture dish, mixed them with the lukewarm beef extract, and handed the mixture to his colleagues, the gastrointestinal tract. Barry Marshall, a sick scientist, Marshall did not hesitate to drink. Three days later, Marshall felt sick and began to vomit. After suffering from the symptoms of a few days of discomfort, he began taking antibiotics to kill the bacteria in his stomach. In fact, before the "roast", Marshall speculated that the bacteria can cause acute gastritis and gastric ulcer, and gastroscopy confirmed his guess: Helicobacter pylori in the stomach. This famous self-certification experiment eventually led Marshall and Robin Warren to the 2005 Nobel Prize in Physiology or Medicine [2-3] .

Helicobacter pylori, which brings "no honor", is actually a Gram-negative bacterium, usually home to a mucosal layer that covers and protects the inner wall of the stomach and small intestine. For most people, it does not cause ulcers and other symptoms, but sometimes Helicobacter pylori enters the body and attacks the inner wall of the stomach. The inner wall of the stomach is an important barrier that cuts off gastric acid and other tissues. When Helicobacter pylori causes enough damage to the inner wall of the stomach, stomach acid can pass through the inner wall of the stomach, causing ulcers, and may also cause bleeding, infection, or food. Through the digestive tract. Studies have shown that more than 90% of duodenal ulcers and more than 80% of gastric ulcers are caused by Helicobacter pylori, which is also considered to be related to gastric cancer [4].

Exposure to contaminated food, water or utensils can infect Helicobacter pylori, which is common in countries or communities that lack clean water or good drainage systems. Direct contact with infected people's saliva, vomit or feces can also infect and spread Helicobacter pylori, kissing and sharing tableware are two common modes of transmission. In countries such as Europe and the United States, the Helicobacter pylori carrying rate is lower than that in Asian countries, which has a lot to do with eating habits - the meal system has blocked the microbial infection between people to some extent. It has also been reported that Helicobacter pylori has a family heredity, which is mainly passed on from the mother to the next generation.

Helicobacter pylori has been with humans for a long time

In fact, Helicobacter pylori is an old friend of mankind - this bacterium has existed for tens of thousands of years. In September 1991, two German hikers discovered the ice mummy, the “Otzi”, which was later identified as the oldest natural preserve in the glaciers of the Alps. "Iceman" is estimated to have died five thousand years ago, and scientists have used high-tech such as non-invasive diagnosis and genome sequencing to study his mysterious past. It has been determined that the "Iceman" died around the age of 45, with a height of about 1.60 meters and a weight of 50 kilograms. In order to study his eating habits, the scientists dissected his stomach to find out: In addition to the residue of the last meal, Helicobacter pylori was found in the stomach, and the strain seems to be related to the pathogenicity found in Central Asia and South Asia today. Asian strains are most similar [5] .

As one of the most common pathogens in humans, Helicobacter pylori and its human host are distributed globally, forming a unique distribution pattern that scientists can use to reconstruct the history of human migration. For example, the existing European Helicobacter pylori population is a hybrid of Asian and African bacteria, but there are different assumptions about the timing and location of hybridization, reflecting the complex population history of Europeans. "Iceman" Helicobacter pylori is almost a pure representative of Europe before the hybridization of bacterial populations of Asian origin, indicating that the African population has reached Europe in the past few thousand years [5] .

Currently, highly recombinant Helicobacter pylori has been well adapted to the acidic environment of the human stomach. A new study shows that genetic variation in Helicobacter pylori complicates vaccine development. At the same time, its variability allows it to constantly adapt to the challenges posed by the acidic environment, thereby creating a persistent infection that, if left untreated, may be lifelong [6] .

Helicobacter pylori: kill or stay

Currently, there are two major types of methods for detecting Helicobacter pylori: invasive and non-invasive tests. Invasive testing relies mainly on gastroscopy, including rapid urease testing, gastric mucosal tissue section microscopy, and bacterial culture. Non-invasive tests include 13C or 14C breath test, serum H. pylori antibodies, and Helicobacter pylori antigen detection [7] . After detecting and confirming the infection of Helicobacter pylori, if there is ulcer caused by Helicobacter pylori, it is necessary to cure the bacteria by treatment, thereby curing the inner wall of the stomach and preventing the recurrence of the ulcer. It usually takes 1 to 2 weeks of treatment to get better.

The doctor will use the following different types of medications depending on the situation:

Antibiotics: used to kill Helicobacter pylori in the body. At least two antibiotics are generally required (currently the most commonly prescribed drugs in Chinese hospitals are colloidal pectin, rabeprazole, omeprazole, amoxicillin, clarithromycin and metronidazole). Why use multiple antibiotics? The traditional view is that an antibiotic kills an unkilled bacterium, usually with at least two antibiotics.

Drugs that reduce gastric acid content by inhibiting proton pumps, including Dexilant, Nexium, Prevacid, and Prilocide, Pantoprazole (Protonix) or Rabeprazole (Aciphex).

Alkali salicylate, it can also help antibiotics kill H. pylori.

A drug that blocks anti-histamine because histamine promotes gastric acid secretion. These include gammatidine, famotidine, Pepcid, Axid or Ranitidine.

Treatment options may mean taking 14 or more tablets a day for several weeks. It is very important to follow the doctor's advice. If antibiotics are not taken in the right way, H. pylori in the body may develop resistance, which makes the infection more difficult to treat. Approximately 1-2 weeks after completion of the treatment, a test breath or stool test can be performed again to ensure complete elimination of the infection.

With the excessive use of antibiotics by humans, the commonly used antibiotics for the clearance of Helicobacter pylori often fail to eradicate the bacteria in drug-resistant patients: about 20% of people often fail to sterilize once, and need to adjust antibiotics. Secondary sterilization. And people taking antibiotics to treat Helicobacter pylori will also kill some healthy bacteria. Studies have shown that while taking antibiotics to treat Helicobacter pylori infection, if probiotics are used together, the possibility of eradication of Helicobacter pylori is greater, and the negative impact of antibiotics on the gastrointestinal tract is also smaller. In addition, some food therapy said that eating propolis, broccoli sprouts, garlic, etc. can also help treat Helicobacter pylori infection [8] , but food therapy has yet to obtain more data support.

However, is it a good thing to kill Helicobacter pylori? Some studies have said that while the germs have subsided, other health problems have emerged. The number of patients with allergies, asthma or autoimmune diseases has surged since the 1950s. People and a large number of microbes share their bodies, and human microbial communities (a complex ecology of microbes in our body and in vivo) play an important role in health, especially for immunity and metabolism. Martin Blaser, an infectious disease specialist at New York University, believes that the increase in the number of obese, asthma, and esophageal reflux patients is the result of disrupting the microbiota. In his book Missing Microbes, he pointed out that although antibiotics have saved countless lives, they are an attack on our microbiota, and the disappearance of Helicobacter pylori will lead to diseases such as asthma and obesity. Increase [9] .

Blaze was one of the first scientists to notice that Helicobacter pylori may also be beneficial to humans. When he saw data on patients with gastric ulcers, he thought of its positive aspect, that is, patients with gastric ulcer rarely had heart disease or esophageal cancer. On the other hand, people who do not have Helicobacter pylori in the body do not have many ulcers, but are more likely to have heart burns and reflux problems, sometimes leading to cancer. Nowadays, even the Nobel Prize-winning Marshall mentioned above for the discovery of Helicobacter pylori has seen the "two-sidedness" of Helicobacter pylori - dangerous and beneficial. He said that Helicobacter pylori is not only a blame in the human stomach, but sometimes also serves as a beneficial resident. They will slightly suppress the immune system and help reduce the risk of allergies, so you won't be so susceptible to asthma and excessive reactions in the face of pollen, wheat bran or peanuts [9].

However, if Helicobacter pylori has caused damage to the host, such as ulceration, it must be treated.

"Back to the Park", dedicated to science. The internationally renowned physicist Wen Xiaogang and the biologist Yan Ninglian are the editor-in-chief, and together with dozens of scholars, the editorial committee will work with you. Pay attention to "Back to the Park" (micro signal: fanpu2019) to participate in more discussions. Please contact us if you reprint or cooperate twice.

references

[1] https:// .

[2]https://blogs.scientificamerican.com/guest-blog/when-scientists-experiment-on-themselves-h-pylori-and-ulcers/

[3]https://

[4] https://

[5] Frank Maixner, Ben Krause-Kyora, Dmitrij Turaev, et al. The 5300-year-old Helicobacter pylori genome of the Iceman [J]. Science, 351(6269), 162-165.

[6] Sandra Nell, Iratxe Estibariz, Juliane Krebes, et al. Genome and Methylome Variation in Helicobacter pylori With a cag Pathogenicity Island During Early Stages of Human Infection [J]. Gastroenterology, 2017; DOI: 10.1053/j.gastro.2017.10 .014.

[7] http://gi.dxy.cn/article/521065.

[8] Kafshdooz T, Akbarzadeh A, Majdi Seghinsara A, et al. Role of Probiotics in Managing Helicobacter Pylori Infection: A Review [J]. Drug Res. 2017, 67(2): 88-93.

[9] Martin Blaze, Fu Heyi. Disappearing Microorganisms [M]. Hunan Science and Technology Press, 2016, 8.

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