Helicobacter pylori (H. pylori) is a common spiral-shaped bacterium that infects the stomach lining. Approximately 50% of the global population is estimated to be infected. Endoscopy is a significant tool for early identification, allowing direct examination of the upper digestive tract.
What is H. pylori and Why Early Detection Matters
H. pylori is highly prevalent, with estimates suggesting that 30-40% of people in the United States carry the infection, and about two-thirds of the world’s population is affected. Transmission typically occurs from person to person through oral contact, such as kissing, or via exposure to contaminated food, water, vomit, or stool. Inadequate sanitation and crowded living conditions can also contribute to its spread within families.
Once acquired, H. pylori can damage the stomach’s protective lining, leading to inflammation known as gastritis. While many infected individuals do not experience symptoms, the bacteria can cause chronic irritation and inflammation over time. This persistent inflammation can progress to more serious health issues, including peptic ulcers—open sores in the stomach or small intestine—which affect about 10% to 15% of infected individuals. Less commonly, untreated H. pylori infection is a strong risk factor for certain types of stomach cancer.
Symptoms that might suggest an H. pylori infection and prompt an endoscopy include persistent stomach pain or a burning sensation, especially when the stomach is empty, along with nausea, bloating, frequent burping, loss of appetite, and unexplained weight loss.
The Stomach Endoscopy Procedure
A stomach endoscopy, also referred to as an upper endoscopy or gastroscopy, is a medical procedure used to visually inspect the upper part of the digestive tract. It examines the esophagus, stomach, and the initial section of the small intestine, known as the duodenum. The procedure helps identify various conditions, including inflammation, ulcers, and abnormal growths.
Preparation for an upper endoscopy involves fasting for at least six to eight hours before the procedure to ensure the stomach is empty. This ensures a clear view and prevents aspiration. Patients should also inform their doctor about any medications they are taking, particularly blood thinners or diabetes medications, as adjustments may be needed. In some cases, patients may be advised to stop taking acid-reducing medications, such as proton pump inhibitors, up to two weeks before the procedure.
During the endoscopy, a thin, flexible tube called an endoscope, equipped with a camera and light source, is gently guided through the mouth, down the esophagus, and into the stomach and duodenum. Sedation is commonly administered to help the patient relax and minimize discomfort. The doctor carefully examines the lining of these organs for any abnormalities.
After the procedure, patients are monitored for about an hour until the effects of sedation wear off. Mild bloating or a slightly sore throat are common due to air introduced during the examination. Patients receiving sedation must arrange for a ride home and avoid driving or operating machinery for the rest of the day.
H. pylori Detection During Endoscopy and Treatment
During a stomach endoscopy, H. pylori can be identified through specific methods involving tissue samples. A common technique is a Rapid Urease Test (RUT) biopsy. A small tissue sample is typically taken from the stomach and placed into a urea-containing medium. If H. pylori is present, it produces urease, which breaks down urea into ammonia, causing a color change in the test medium. Results are often available within 5 to 30 minutes.
Another method is a biopsy for histology, where tissue samples are examined under a microscope by a pathologist. This allows for direct visualization of the spiral-shaped bacteria and an assessment of the extent and type of inflammation in the gastric lining. Special stains can enhance the detection of H. pylori and evaluate the severity of gastritis. While RUT offers rapid results, histology is highly accurate and provides additional information about the stomach’s condition. Combining both methods is often recommended for increased accuracy.
Once H. pylori is detected, early identification allows for effective treatment, which typically involves a combination of medications. Treatment typically includes a proton pump inhibitor (PPI) and two different antibiotics. Common antibiotic choices include amoxicillin and clarithromycin, often prescribed for 14 days to prevent antibiotic resistance. For individuals with a penicillin allergy, metronidazole can be used as an alternative.
Completing the full course of prescribed medication ensures eradication. After treatment, follow-up testing is recommended to confirm that the H. pylori infection has been successfully cleared. Follow-up tests, such as a urea breath test or a stool antigen test, are usually performed at least six weeks after completing therapy and two weeks after discontinuing PPIs to avoid false-negative results. Confirming eradication prevents symptom recurrence and reduces the long-term risk of complications like peptic ulcers and stomach cancer.