It is estimated that half of the population in Argentina and the world is infected by
Helicobacter pylori (H. pylori)
, a bacteria that causes everything from chronic gastritis to gastroduodenal ulcers and is the
main cause of stomach cancer
, so the World Organization The World Health Organization (WHO) classifies it as a type I carcinogen.
It has been shown that treatment and eradication of
H. pylori
with antibiotics can
cure gastritis and reduce the risk of cancer
.
But that goal faces at least two problems.
On the one hand, to eliminate the bacteria, the infected person must first
know that they are infected
and currently many are unaware of it, because not everyone develops symptoms.
But the reason that most worries health professionals and health authorities globally is that in recent years it has become
very resistant to antibiotics
and difficult to eradicate.
In 2017, the WHO classified it as a high-priority microorganism that
threatens human health
and encouraged countries to increase research efforts to develop more effective medicines, increase surveillance and generate local data.
Argentine Registry of Helicobacter pylori
In this context, the Argentine Registry for the Management of Helicobacter pylori Infection (Hp-Arg-Reg) was born two years ago, which already has initial data from
almost 1000 patients from six provinces
, thanks to the joint work of researchers from more than 20 institutions.
The treatment schemes used here are based on recommendations generated mainly in the United States, Canada and European countries, explains in dialogue with
Clarín
the director of the registry, Oscar Laudanno, head of the Department of Gastroenterology at the Alfredo Lanari Medical Research Institute of the University of Buenos Aires.
Helicobacter pylori.
Exhaled air test.
Shutterstock illustration.
"We needed to have local data to understand
how the treatments in our hands are working
, because you cannot treat
Helicobacter pylori
the same in Spain, Italy, the United States, Canada, China or Argentina," says the former president of the Argentine Society of Gastroenterology (SAGE). ).
The question that kicked off the registry - which takes the European model as a model and is integrated into the Latin American one and, in turn, into a global one - was: are the schemes that work in those places effective in our country?
"The record shows us that what is happening here is similar to what is happening in Europe:
we are an area of high resistance to antibiotics
that were used for treatment for a long time, such as clarithromycin and levofloxacin," says Laudanno.
To deal with it, one is no longer enough, but rather they must be indicated in combination and for a long time, he says.
What is Helicobacter pylori and what causes the infection
H. pylori
infection
is usually acquired in childhood and over the years produces a
chronic infection in the stomach
, which damages the protective layers of the gastric surface.
In most people, this infection can remain
clinically silent
throughout life, but in a considerable minority it causes gastroduodenal diseases, which include chronic gastritis in 100% of those infected (with or without symptoms), dyspepsia, ulcers. gastroduodenal and, less frequently, stomach cancer.
"It is a very common bacteria in Argentina:
50% of the population is infected
," says Laudanno.
—And do they all develop illness?
-Not all.
Of the population that has the bacteria,
most will remain asymptomatic
throughout their lives.
Despite this, if you look for it with an endoscopy and a biopsy, you can find chronic gastritis due to
H. pylori
that may be causing diseases.
It is estimated that of the population that is infected, around 10% will develop a gastroduodenal ulcer at some point in their lives.
It is a disease clearly related to bacteria, which is treated very well, but can cause complications, such as digestive bleeding, perforation.
And as people increase their consumption of anti-inflammatories, they add a second factor that increases the risk and there is a greater chance of developing an ulcer.
H. pylori
is also one of the most important causes of dyspepsia, one of the most common diseases treated by gastroenterology.
Nowadays, anyone who consults with symptoms of dyspepsia (suffering
discomfort in the tummy, in the pit of the stomach, bloating after eating
, suffering from heartburn) must look for the bacteria and, if present, treat it.
Laudanno (2nd from left) presents the initial results of the registry with colleagues.
Photo Courtesy.
—Dyspepsia are common symptoms that are often underestimated and for which people are not consulted.
-That's how it is.
And the bacteria is in there and you don't know what it's doing to you.
Dyspepsia is one of the most prevalent pathologies in the world: it is estimated that it affects 20% of the population and has a great impact on quality of life.
And although not everyone will be fine, because there are other factors that influence, the best treatment we have today is to eradicate
Helicobacter pylori.
—How is the bacteria searched for and detected?
—We recommend endoscopy systematically after the age of 45-50 in people who have symptoms such as those of dyspepsia.
But there are also what are considered "red flags" or warning symptoms, such as anemia, bleeding, weight loss.
In those cases, yes or yes, endoscopy must be performed.
And also when there is a family history.
In young people with symptoms and no history, it is not necessary to perform invasive studies such as endoscopy; a breath test or a fecal antigen test can be done.
If the bacteria appears, treatment should be indicated.
—That is to say: if there are symptoms or history, the bacteria is searched. And if it appears, is it always treated?
-Yes or yes.
In all people, if there is bacteria and it is detected, it is treated.
This was questioned for many years, but a few years ago, major world experts established through the Kyoto Consensus that if
Helicobacter
exists , it must be systematically eradicated.
Nowadays we say that it is an infectious disease and it must be treated as such.
If you have an infection, don't you treat it?
—And in practice, is that fulfilled?
—In Argentina there are still gastroenterologists who resist.
The patient goes to the consultation with symptoms, they indicate the study, the bacteria appears, but if the endoscopy looks normal, they do not treat it.
It is an erroneous behavior, because over the years, if it is not treated, that patient can develop an ulcer or gastric cancer, which is the most controversial issue.
-Because?
—Because Argentina is a country with a low frequency of gastric cancer, it is not like Japan or China, which is very high.
Being a low frequency country, there are those who wonder what the need is to treat the bacteria that produces it.
But what we see is that, despite not being common, people arrive with advanced stomach tumors, which are very complex to treat (immunotherapy is only now playing a role).
Many have symptoms previously and,
if they had been treated, perhaps they would never have reached this point
.
Furthermore, as the population ages, the possibility of gastric cancer increases.
And there is very concrete data that treating
Helicobacter pylori
decreases its frequency.
—Do we live with bacteria all our lives?
—If it is not treated, yes.
Although it is not 100% proven, it is estimated that transmission is through the fecal-oral route, it usually occurs in the first months of life and is very common within families.
That's why the message is:
if you don't have anything, don't go looking for it
.
But if you have symptoms, look for it.
And especially if you have a history in the family.
How Helicobacter pylori infection is treated
As a consequence of the antibiotic resistance that the bacteria developed, treatment schemes have been very varied and changing over time.
The initial data analyzed in the Argentine
multicenter registry
- which were presented at the Gastroendo congress in September - showed that quadruple treatment schemes (combining two or three antibiotics, with or without associated bismuth) achieve
eradication rates greater than 90%
.
"We must abandon the so-called triple regimens that use a single antibiotic, such as clarithromycin, amoxicillin or levofloxacin, because they are not working well and the only thing they are generating is more resistance," Laudanno emphasized.
The gastroenterologist synthesized three current recommendations: two or three antibiotics
must be combined
, the therapies must be prolonged (10 or 14 days) and gastric protectors such as omeprazole in high doses must be indicated during treatment to increase the sensitivity of the bacteria to the treatment. .
The exhaled air test and the fecal antigen test are used to detect the bacteria.
Photo Shutterstock.
To check if it worked (that is, if it eradicated the bacteria), a control test is indicated using exhaled air or fecal antigen tests.
Two local prides
The registry was born in the middle of the pandemic, when it was prohibited by protocol to perform breath tests, because it involves blowing into a mouthpiece.
As a result, researchers began to massively use the fecal antigen test (the bacteria are looked for in a small sample of fecal matter), "which
greatly reduced costs
, with similar yields," Laudanno is proud.
The gastroenterologist also comments with satisfaction on another contribution arising from research carried out in Argentina.
Through studies carried out on people with obesity who were going to undergo bariatric surgeries, they observed that the treatment indicated for those who were detected with
H. pylori
had lower effectiveness rates than in the general population (they were around 60-70%).
The hypothesis they use is that the problem lies in the dose.
"In adults we have always managed with fixed doses. When antibiotics were developed, body weight was more uniform, around 70-80 kilos. Today that weight does not exist. That is why we are working on
modifying the doses
to adjust it to the patient's weight," Laudanno said.
Preliminary data will be presented in May at Digestive Disease Week in the United States.
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