The World Health Organisation has recently classified the bacterium Helicobacter Pylori (H Pylori) as a definite human carcinogen. This organism is thought to be the main cause of peptic ulcer, estimated to account for 60 per cent of stomach cancer cases worldwide. Transmission is considered to be oral, through saliva, dental plaque, faeces, vomit and drinking water. Poor sanitation, especially in crowded urban areas, contributes to primary infection. The period of greatest susceptibility to the infection is probably during childhood. The prevalence of stomach cancer in developing countries like India can be as high as 80 per cent of children being infected by the age of five.Equally alarming is the fact that this bacteria is also related to gastro-intestinal ulcers, the most common digestive complaint in the country.In the early 1980's, Barry Marshall, an internist at the Royal Perth Hospital in Western Australia, made a discovery that revolutionised gastro enterology. He mixed a cocktail of ulcer bugs and drank it himself. Within a week he developed headaches, indigestion and exhaustion. An endoscopy and biopsy revealed that his stomach lining was severely inflamed (gastritis) and swarming with bacteria.Robin Warren, a senior Histopathologist, was convinced that this organism caused gastritis. With the help of some Perth microbiologists, Marshall succeeded in culturing a spiral-shaped organism called H Pyroli. It has been implicated in almost all cases of upper small intestinal ulcers (80 per cent of ulcers are caused in the duodenum) and in most cases of gastric ulcers or an ulcer in the stomach lining itself (both called peptic ulcers).Ulcers are chronic sores. When the combination of digestive juices secreted in the stomach causes the release of more hydrochloric acid than is normally required to break down food, it results in abrasion. It then penetrates the protective lining of the mucous membrane, reaches the underlying muscle tissue and eventually the lining of stomach is unable to provide protection against its own digestive juices. Throughout the period of its existence, a stomach ulcer will not widen beyond an inch and a half. But if this little abrasion is left untreated, it can be fatal.Ulcer sufferers usually experience a gnawing pain below the sternum for one to three hours after the intake of food. Sour eructations, chronic indigestion, nausea and excessive flatulence are also observed in varying degrees. Stress-related ulcers produce symptoms that seem mild initially. Lower chest pain, heart burn and indigestion are common. Over a period of time, they too begin to display conventional symptoms.However, the millions who are infected with H Pylori don't develop symptoms. More than 60 per cent of gastric cancers are likely to be the result of long-term infection with the H Pylori in combination with a range of, as yet, unidentified co-factors - the strain of the bacterium, the genetic predisposition of the host, diet and environment.Regular use of antacids slow down the acid production. But if the infection is untreated, ulcers usually recur when the drugs are stopped. Antacids with aluminium salts are better than others since they produce proftaglandins which inhibit gastric acid secretion. However chronic use of aluminium salt, especially by those down with kidney problems can result in phosphate deflation. Also if one is suffering from hyper-acidity for a long period, like 10 to 12 years, regular use of antacids can lead to constipation. Those suffering from chronic acidity need to get themselves checked. It depends on you as to how seriously you take your health.The good news is that the H Pylori infection can be detected by using standard histological techniques. Also, sufferers of H Pylori-positive ulcers can be treated with anti-microbial therapy. Therefore, the detection and treatment of H Pylori is often as easy and simple as curing a simple chest infection.(Dr Sanghvi is honorary consultant, department of preventive oncology and professional education, Tata Memorial Hospital)
