Helicobacter Pylori: China Travel Risk

I just wanted to share something with the gang here, especially those that plan on going to Shaolin. I've mentioned some of the health issues before, but this one is significant. Common. And not that easily detected.

There is a HUGE problem with fecal-oral transmission of diseases in China, mainly because of poor sanitation, improper water treatment, and the use of human shit for fertilization of crops. The ease of transmission of human disease from one individual to another is very high. In fact, most US travelers to China, who stay for any significant period of time, get some sort of dysenteric illness.

It's the non-dysenteric illness, that's going to get you, long term. And that is, H. Pylori infection.

Read this excellent concise report from the CDC about Helicobacter Pylori:

What is H. pylori?

Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that is found in the gastric mucous layer or adherent to the epithelial lining of the stomach. H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. Before 1982, when this bacterium was discovered, spicy food, acid, stress, and lifestyle were considered the major causes of ulcers. The majority of patients were given long-term medications, such as H2 blockers, and more recently, proton pump inhibitors, without a chance for permanent cure. These medications relieve ulcer-related symptoms, heal gastric mucosal inflammation, and may heal the ulcer, but they do NOT treat the infection. When acid suppression is removed, the majority of ulcers, particularly those caused by H. pylori, recur. Since we now know that most ulcers are caused by H. pylori, appropriate antibiotic regimens can successfully eradicate the infection in most patients, with complete resolution of mucosal inflammation and a minimal chance for recurrence of ulcers.

How common is H. pylori infection?

Approximately two-thirds of the world's population is infected with H. pylori. In the United States, H. pylori is more prevalent among older adults, African Americans, Hispanics, and lower socioeconomic groups.

What illnesses does H. pylori cause?

Most persons who are infected with H. pylori never suffer any symptoms related to the infection; however, H. pylori causes chronic active, chronic persistent, and atrophic gastritis in adults and children. Infection with H. pylori also causes duodenal and gastric ulcers. Infected persons have a 2- to 6-fold increased risk of developing gastric cancer and mucosal-associated-lymphoid-type (MALT) lymphoma compared with their uninfected counterparts. The role of H. pylori in non-ulcer dyspepsia remains unclear.

What are the symptoms of ulcers?

Approximately 25 million Americans suffer from peptic ulcer disease at some point in their lifetime. Each year there are 500,000 to 850,000 new cases of peptic ulcer disease and more than one million ulcer-related hospitalizations. The most common ulcer symptom is gnawing or burning pain in the epigastrium. This pain typically occurs when the stomach is empty, between meals and in the early morning hours, but it can also occur at other times. It may last from minutes to hours and may be relieved by eating or by taking antacids. Less common ulcer symptoms include nausea, vomiting, and loss of appetite. Bleeding can also occur; prolonged bleeding may cause anemia leading to weakness and fatigue. If bleeding is heavy, hematemesis, hematochezia, or melena may occur.

Who should be tested and treated for H. pylori ?

Persons with active gastric or duodenal ulcers or documented history of ulcers should be tested for H. pylori, and if found to be infected, they should be treated. To date, there has been no conclusive evidence that treatment of H. pylori infection in patients with non-ulcer dyspepsia is warranted. Testing for and treatment of H. pylori infection are recommended following resection of early gastric cancer and for low-grade gastric MALT lymphoma. Retesting after treatment may be prudent for patients with bleeding or otherwise complicated peptic ulcer disease. Treatment recommendations for children have not been formulated. Pediatric patients who require extensive diagnostic work-ups for abdominal symptoms should be evaluated by a specialist.

How is H. pylori infection diagnosed?

Several methods may be used to diagnose H. pylori infection. Serological tests that measure specific H. pylori IgG antibodies can determine if a person has been infected. The sensitivity and specificity of these assays range from 80% to 95% depending upon the assay used. Another diagnostic method is the breath test. In this test, the patient is given either 13C- or 14C-labeled urea to drink. H. pylori metabolizes the urea rapidly, and the labeled carbon is absorbed. This labeled carbon can then be measured as CO2 in the patient's expired breath to determine whether H. pylori is present. The sensitivity and specificity of the breath test ranges from 94% to 98%. Upper esophagogastroduodenal endoscopy is considered the reference method of diagnosis. During endoscopy, biopsy specimens of the stomach and duodenum are obtained and the diagnosis of H. pylori can be made by several methods: The biopsy urease test - a colorimetric test based on the ability of H. pylori to produce urease; it provides rapid testing at the time of biopsy. Histologic identification of organisms - considered the gold standard of diagnostic tests. Culture of biopsy specimens for H. pylori, which requires an experienced laboratory and is necessary when antimicrobial susceptibility testing is desired.

What are the treatment regimens used for H. pylori eradication?

Therapy for H. pylori infection consists of 10 days to 2 weeks of one or two effective antibiotics, such as amoxicillin, tetracycline (not to be used for children <12 yrs.), metronidazole, or clarithromycin, plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor. Acid suppression by the H2 blocker or proton pump inhibitor in conjunction with the antibiotics helps alleviate ulcer-related symptoms (i.e., abdominal pain, nausea), helps heal gastric mucosal inflammation, and may enhance efficacy of the antibiotics against H. pylori at the gastric mucosal surface. Currently, eight H. pylori treatment regimens are approved by the Food and Drug Administration (FDA) (Table 1); however, several other combinations have been used successfully. Antibiotic resistance and patient noncompliance are the two major reasons for treatment failure. Eradication rates of the eight FDA-approved regimens range from 61% to 94% depending on the regimen used. Overall, triple therapy regimens have shown better eradication rates than dual therapy. Longer length of treatment (14 days versus 10 days) results in better eradication rates.

It wouldn't surprise me, to consider most native born Chinese, to be "carriers" of H. Pylori infection. Remember, people can have this bacteria, and not have any real signs or sypmtoms.

H. Pylori lives in the stomach mucosa by taking urea, which is present in saliva and various foodstuffs, and converting the urea with it's urease, to ammonia and bicarbonate, two bases which counteract the acid in the stomach. The H. Pylori use this cloud of bicarb and ammonia that surround them, to neutralize the stomach acid. It is thought that the body's attempts to get rid of the bacteria, by sending various immune related cells, actually causes the destruction of the stomach tissue.

An H. Pylori infection is also interesting in the fact that it may help cause some gastric reflux. The constant production of ammonia and carbon dioxide causes gas to build up in the stomach, eventually to be released by belching; belching being one sign of H. Pylori infection. Also, the belching of ammonia gas can be inhaled into the lungs, causing significant asthma like symptoms. The long term effects of this infection, gastric cancer, are ominous.

Remember, one of the most common forms of transmitting this bacterium from person to person, is via the use of chopsticks and "sharing food".

Something to think about, if you've traveled, or, plan to travel, to Shaolin and China.