Helicobacter Pylori Infection

The bacterial infection H. pylori is most commonly recognized for causing circumscribed lesions in the mucosal membrane, or peptic ulcers. H. pylori releases a toxin that promotes mucosal inflammation and ulceration. It is thought to be present in 50% of the population and is detected in approximately 90% of patients with peptic ulcer disease. However, it is also thought to be associated with some other illnesses, such as mucosa-associated lymphoid tissue (MALT) lymphomas, iron deficiency anemia, GI reflux disease, skin disease, and rheumatologic disorders, although confirmation of the association between H. pylori infection and these conditions is still being investigated.

Causes

The bacteria H. pylori (formerly known as Campylobacter pylori) is passed via person-to-person contact; although the exact mechanism of transmission is not known, the microorganism has been isolated in saliva, in dental plaque, and in stool (in children). Risk factors for H. pylori infection may include crowded living conditions and living with someone who is infected with H. pylori.

Complications

H. pylori infection is the predominant cause of ulcers. Ulceration may lead to GI hemorrhage, which can progress to hypovolemic shock, perforation, and obstruction. Obstruction of the pylorus may cause the stomach to become distended with food and fluid, leading to abdominal or intestinal infarction. A fairly common occurrence in patients with duodenal ulcer is penetration, in which the ulcer crater extends beyond the duodenal walls into attached structures, such as the pancreas, biliary tract, liver, and gastrohepatic omentum. H. pylori infection is also considered a risk factor for stomach cancer.

Assessment Findings

Typically, patients with H. pylori infection do not display symptoms. Instead, symptoms result from the complication of peptic ulcer or gastritis, and this is when the infection is detected. Patients with a gastric ulcer may report recent weight loss or decreased appetite. They may not feel like eating or may have developed an aversion to food because eating causes discomfort. There may be pain in the left epigastrium, often described by the patient as heartburn or indigestion. Discomfort may be accompanied by a feeling of fullness or distention. Commonly, the onset of pain signals the start of an attack.

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