Helicobacter pylori (H. pylori) is a common bacterium that can infect the stomach lining, often without causing noticeable symptoms. For some, this infection can lead to inflammation of the stomach lining, known as gastritis, and may contribute to the development of peptic ulcers. An upper endoscopy is a procedure frequently performed to investigate upper digestive tract issues. It allows doctors to visually inspect the area, gather information related to a potential H. pylori infection, and determine the cause of symptoms like abdominal pain, nausea, or unexplained weight loss.
Understanding the Endoscopy Procedure
An upper endoscopy, also referred to as an esophagogastroduodenoscopy (EGD), allows a doctor to examine the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). Patients typically receive a sedative to help them relax or even fall asleep during the procedure. A thin, flexible tube called an endoscope, equipped with a camera and light, is then gently guided through the mouth, down the throat, and into the upper digestive tract.
The camera transmits images to a video screen, providing the doctor with a detailed view of the internal tissues. The procedure usually takes less than 30 minutes. During the endoscopy, the doctor can also take small tissue samples, known as biopsies, from areas that appear abnormal. After the procedure, patients may experience some grogginess from the sedation, a feeling of bloating, or a mild sore throat, which generally resolve within 48 hours. It is advisable for patients to arrange for someone to drive them home, as the effects of sedation can linger for several hours.
Visual Clues of H. pylori Infection During Endoscopy
During an upper endoscopy, gastroenterologists search for specific visual indicators on the stomach lining that may suggest an H. pylori infection. One common finding is diffuse redness across the gastric mucosa, which indicates inflammation. Another suggestive sign is mucosal edema, where the stomach lining appears swollen.
The folds within the stomach, known as rugae, may also appear thickened and tortuous. A “goose-pimple-like” or nodular appearance can also be observed. Erosions, which are superficial breaks in the mucosal lining, or even ulcers, may also be present. While these changes provide valuable clues, they are not definitive for diagnosing H. pylori infection on their own, as similar appearances can be caused by other conditions.
Confirming H. pylori Presence During Endoscopy
To definitively confirm an H. pylori infection after visual clues are observed during endoscopy, specific diagnostic tests are performed on tissue samples. Biopsies, small pieces of stomach lining, are collected using instruments passed through the endoscope. These samples are then sent to a laboratory for histological examination, where pathologists can directly visualize the H. pylori bacteria under a microscope using special stains. Histology is considered a reliable method for diagnosis.
Another common test performed on biopsy samples is the Rapid Urease Test (RUT), also known as the CLO test. This test relies on H. pylori’s ability to produce the enzyme urease, which breaks down urea into ammonia and carbon dioxide. A small biopsy sample is placed into a gel or solution containing urea and a pH indicator. If H. pylori is present, the ammonia produced will increase the pH, causing the indicator to change color, indicating a positive result. The RUT is a convenient, rapid, and accurate test that can provide results within minutes to 24 hours.
What Happens After Diagnosis
Once an H. pylori infection is confirmed, treatment is initiated to eradicate the bacteria. Treatment involves a combination of medications, usually two different antibiotics taken simultaneously to prevent resistance. Alongside antibiotics, a proton pump inhibitor (PPI) is often prescribed. PPIs reduce the amount of acid produced in the stomach, which helps the stomach lining heal and enhances antibiotic effectiveness.
Bismuth subsalicylate may also be included in the treatment regimen, as it can coat and protect the stomach lining from acid. It is important to complete the full course of medication, which can range from 10 to 14 days, even if symptoms improve earlier. Follow-up testing, done at least four weeks after finishing the antibiotic treatment, is recommended to ensure the infection has been successfully cleared. If the initial treatment does not eradicate the bacteria, a different combination of medications may be prescribed.