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Thursday, April 3, 2008

H. Pylori and why it's important

All my life, well, since I was a teenager, I had had mild acid reflux "indigestion" especially after eating cooked plum tomatoes, and food "allergies" to shellfish (mussels, oysters, clams, etc). I lived with it without much thought. If I accidentally ate a scallop in a restaurant I would have a horrible bout of vomiting a few hours later, silly me.

In 2003, after Don had been living with me for 10 years, he got a serious ulcer. He became very ill from blood loss. Our doctor put him on some kind of acid reduction pills and told him to stop eating spicy food and take iron supplements. "Oh the stress of our life is making him sick," we thought. Actually we, and she, were wrong.

When Don got ulcers again a few months later (he recognized the symptoms before he got very ill) we did some research. We found that ulcers are caused by a bacterium (Helicobacter pylori), which can also cause cancer of the stomach and esophagus. It is likely transmitted by water or oral-oral contact, however it is not very contagious. There is a simple breath test for the infection.

Our doctor took a lot of persuasion; she was a technophobe and considered anything we read "on the Internet" to be akin to reading a supermarket tabloid. Don went to see her, armed with a lot of serious references, and she was very surprised. When he went back for the next appointment she had read up on it and, knew everything there was to know :-)

Don was sent to a gastrenterologist who put him on a course of simple antibiotics to kill the H.Pylori, but his post test still showed positive. I went along to his next appointment and suggested that I might be reinfecting him. That doctor admitted the possibility, but also said the organism was hard to kill - it hides in the stomach lining. I was tested and found to be positive, so he put us both on the next level of treatment. This is the so-called triple-therapy: high doses of two different antibiotics and a drug to reduce stomach acid; in our case metronidazole, tetracyclin and pantoprazole, along with use of bismuth in the form of Pepto-Bismol.

I developed a lot of sympathy for people who are on serious long-term drug therapies. These pills had to be taken in a strict schedule, every two hours starting two hours before breakfast (!) and washed down with generous doses of Pepto-Bismol. I came to associate the wintergreen taste of "Pepto-Dismal" with the nausea caused by tetracycline. It was one of the hardest two weeks of my life, although it sounds trivial: "keep taking the tablets." Constant nausea, lowered mental function - I could barely work, even from home. Yuck.

However, a month later we were tested again. We were apprehensive; the GI guy had made the point that there was a third line of attack against H. Pylori - but he suggested that we should sincerely hope that we didn't have to have that. Fortunately we were both negative.

The result is good news; Don has had no more ulcers and I have had no indigestion since. I can eat shellfish again - although I don't see the point of eating tasteless bivalves that live in the sea filtering out any shit that happens to float by. Whether the reflux was caused by H.Pylori (probable) or by other organisms that were offed by the treatment (possible) I am not sure.

I was probably infected when living in Fiji as a child, over 40 years ago - this bacterium is very long-lived and much more common in the Third World. My mother was also positive, and also had reflux as long as she could remember. Fortunately she responded to the simple therapy.

So if anyone still has a doctor that thinks ulcers are a lifestyle disease, get yourself tested. Marshall and Warren are two Australian doctors who got the Nobel prize for medicine in 2005 for this discovery. It is also possible that if you experience constant reflux, chronic indigestion, or weird food "allergies" that change from one year to the next you have this potentially serious infection.

In Ontario the simple blood test for antibodies is free to residents, however the more definite urea breath test costs about $60. It's required after the therapy because the antibodies persist for a long time giving false positives.

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