It used to be thought that stomach and duodenal (outlet of the stomach) irritation and ulcers were caused by stress and spicy foods. Then, in the late 1970s and early ’80s two researchers in Australia proved that these conditions were caused by bacteria called Helicobacter pylori, commonly known as H. pylori. In 2005, they were awarded the Nobel Prize in Medicine for their work.

H. pylori is present in about 50% of the people in the world, but is more prevalent in undeveloped countries — thought to be due to poorer sanitation. In the U.S. the prevalence is 10% in non-immigrants under the age of 30, and 50% in in those over age 60.

H. pylori resides beneath the mucous that covers the lining of the stomach and duodenum, where it can cause chronic inflammation that contributes to gastritis (irritation of the stomach lining); ulcers of the stomach and duodenum; and stomach cancer. The most common cause of ulcers is NSAIDS such aspirin, ibuprofen, and naproxen, but risk of ulcers is particularly high in people infected with H. pylori who use these drugs.

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Most people with H. pylori have no symptoms, although acute infection may cause nausea and abdominal pain lasting for several days. Gastritis, ulcers and cancer all tend to cause the following symptoms:

• aching or burning pain in the upper abdomen that is often worse when the stomach is empty
• nausea
• loss of appetite
• frequent burping
• bloating
• unintentional weight loss

Gastritis causes discomfort but is not serious. Ulcers in the stomach and duodenum can be serious if they perforate through the stomach, allowing gastric contents to spill into the abdominal cavity, which is a life-threatening condition. Ulcers can also erode into blood vessels, causing life-threatening bleeding. Chronic inflammation caused by H. pylori can also cause stomach cancer, especially in the setting of pickled vegetables, which are common in the diets of Japanese, Chinese, and Koreans (think kimchi) — resulting in a relatively high rate of stomach cancer in these populations.

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People should see a doctor without delay if they have the following red flag symptoms: 1. severe or persistent abdominal pain, especially if it causes awakening at night; 2. bloody or black, tarry stools; 3. bloody or black vomit that looks like coffee grounds; 4. significant weight loss.

The definitive test for diagnosing the cause of upper GI symptoms and for diagnosing H. pylori is an upper endoscopy with biopsies. However, this procedure is invasive and expensive. Other ways of testing for H. pylori are a blood test, a stool test, and a breath test. If bleeding occurs an upper endoscopy with cauterization of the bleeding vessel is imperative. An endoscopy is also strongly recommended in all people age 60 and older with new-onset upper GI symptoms, because they’re at higher risk for stomach cancer.

Treatment of H. pylori involves a course of antibiotics and acid blockers, which is over 90% effective. According to Dr. Michael Greger’s nutritionfacts.org, a more natural way of getting rid of H. pylori is the sulforaphane in cruciferous vegetables, which is particularly plentiful on broccoli sprouts, although this method is only 56% effective.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net