The Helicobacter pylori industry
In my neck of the woods HP seems to cause or contribute to most upper GI disorders: DU, GU, gastritis, non-ulcer dyspepsia, most forms of [that complex field] gastritis, lymphoma and gastric carcinoma. The carriage rate in public hospitals is 50 – 70%. Commercially available serological tests are available to general practitioners to test people who feel off colour, have malaise, are disappointed in life or who have some wearying malady; if the test is positive (spin a coin) they are “eradicated”.
It has been suggested that all HP positive people [merely 1/2 the world’s population], certainly in cancer risk areas (China, Indonesia, Pacific brim etc etc), should be eradicated, and this is in trial.
There are groups of people who, CABAL like, have Consensus Meetings from which they [like the sermon on the Mount] make breathtaking statements, which the world are expected to regard as graven in stone.
Anyway, Helicobacter pylori must certainly be one of the top 10 organisms, if not the organism of the century; its got Olympic gold; it needs the Aircraft Industry Award for most business flights ever.
But then – niggling thoughts – why:
1. Are DU and gastric cancer so rare in Africa (my neck of the woods), where the carriage rate is in excess of 70%?
2. Why does it contribute to the aetiology of both DU and cancer, when these two are seldom associated, if not mutually exclusive?
3. Why is acid reduction necessary in the treatment of this infection?
Whats going on in your neck of the woods?
Are you advocating the eradication of H. pylori or the eradication of the patients?
I am not an expert on that famous “bug” and obviously not an expert on what is going on in our neck of the woods. All I know is that local GI guys are obsessed with that stupid bacteria.
Being an avid peptic ulcer surgeon (in your neck of the woods) during the 90’s I was very skeptical about the initial data which blamed everything on the poor Helicobacter. But then, as many others, I succumbed gradually to the huge amount of apparently “good data” which supported the role of this animal in the genesis of peptic ulcer, and later on the genesis of “everything”.
You ask very important questions for which I do not have the answers. Perhaps a well balanced editorial in the Lancet will be of value.
As a finale’ may I raise the issue of the industry whores. Those guys producing so called level 4 or 5 trials for the industry. I know personally many antibiotic whores: those guys will tell you that X agent is better than a Y agent- they will do it for no formal fee- excluding the bucks provided to maintain their labs, around the world trips and much more.
If they are antibiotic- whores there obviously are whores dedicated to the marketing of the products produced to exterminate the poor helicobacter- may he rest in peace.
The internists and many of the family physicians order the H Pylori blood tests which I don’t think are very useful (and the literature doesn’t think are very useful either). I think it would be equally effective (if you were going to follow this tactic) to just treat everyone you think might have H pylori with appropriate antibiotics. The high risk group is over 50, or with ulcers, or GI endoscopists.
Our clinic referring doctors are referring everyone with ulcers or dyspepsia (probably overkill here) or epigastric pain unrelieved by proton pump inhibitors or heartburn for upper GI endoscopy with H pylori testing. Probably about 25% of the people I scope are positive for H pylori on Clo test and Path exam for the bacterium. I have had one recently that had a negative Clo test but obvious H pylori on the Path exam.
Interestingly, one recent article (New England Journal of Medicine or Journal American Medical Association) states that even (NSAID) non-steroidal anti-inflammatory drug ulcers are associated with H pylori, that is, if you get an ulcer on NSAIDs, you most likely have H pylori and if you are treated for H pylori, you will probably be able to take NSAIDs without getting ulcers. This might mean, if this is true, that the older person who takes NSAIDs for arthritis could be treated cheaply and quickly for H Pylori to prevent NSAID ulcers instead of taking misoprostol (expensive) or H2 blockers or proton pump inhibitors (also expensive) for the duration of the NSAID use.
As to whether it is whores promoting meds for H pylori, the cheap bismuth, tetracycline, metronidazole regime is not being promoted by any drug company because it is cheap (not that financially rewarding for the drug companies). The regimes that are being promoted are much more expensive but not much if any more effective. They are promoted as easier to take but Biaxin (part of the promoted Tritec/Biaxin) regime can cause severe diarrhea so I don’t think it is any better tolerated than the older cheaper regime.
You question about why is acid reduction necessary for the eradication of H pylori is an interesting one. As I recall the literature on H pylori, the proton pump inhibitor part of the H pylori regime actually was toxic to the H pylori, that is, it was not working through acid reduction but instead bactericidally or bacteriostatically.
Some interesting questions about Helicobacter pylori and infective theory.
1. Why the DU or GU one-man more frequent and not multiple (that more frequent for infective disorders)?
2. What is the explanation for spontaneous cyclic evolution of ulcer? (remission-relapse-remission)
3. The ulcer disease only about 10% among contaminating. Why?
4. HP colonization maximum among elderly, but ulcer disease – among young. Why?
5. HP colonization male=female, but ulcer disease male:female=4:1 Why?
6. HP colonization maximum – Africa, Asia, ulcer disease – Europe. Why?
7. What is explanation for efficacy of non-antibacterial drugs for PUD?
8. The “aim” of PUD is only human being. Why?
9. In the experiments with volunteers and introduction of HP the ulcer disease was NEVER inducted. Why?
10. After the ulcer surgical operations the ulcer dont relapsing despite of retention of colonization. Why?
11. There is not STRONG correlation between eradication of HP and cicatrization of ulcer. Why?
12. A long list of different disorders and one bacteria – exclusion in the infective diseases?
Good questions. But don’t you realize that the etiology of peptic ulcer- as that of all pathologies- is MULTIFACTORIAL: Genes, stress, socioeconomic status, psyche, nutrition, alcohol, smoking, and-probably- that funny bug.
The unifying factor in the genesis of peptic ulcer is none of the above but ACID.
NO ACID =NO ULCER.
Thus, all damaging factors mentioned above need the acid to produce the ulcer- you stop the acid – you cure the ulcer.
BTW: I was hoping to hear from you that the best way to totall eradicate Helicobater is total gastrectomy…do it.
1. When we accepting the disease as MULTIFACTORIAL, we don’t know its REAL CAUSE. We see only the apexes of icebergs but today don’t know the REAL CAUSE.
2. Your affirmation “NO ACID=NO ULCER” (Sorry, not Your) is too categorical. Only for PEPTIC ulcer, only for duodenal ulcer and gastric type II and partly III, only for SOME ulcers.
3. Your apprehension of term “eradication” is very, very radical. We practising only drugs for eradication.
Regarding your point #2: please tell us which type of gastroduodenal ulcer won’t heal with radical suppression of acid?
So it appears you succumb to the industry-driven medical practices of the corrupted West.
Don’t you think that a square dose of pure Vodka would kill any gastric bacteria?
It would be interesting to know whether the H pylori increased risk of gastric cancer remains high after surgery for ulcer (highly selective vagotomy, vagotomy and pyloroplasty, gastrojejunostomy or antrectomy). You mentioned that H pylori is prevalent in the elderly but ulcers are not more common in the elderly. I rarely see ulcers except in the elderly on non-steroidal anti-inflammatory drugs. That is, they are rare in my practice in young people (but then, maybe the young people don’t get referred to me for endoscopy).
I recall a few papers reporting a prolong follow-up of large groups of peptic ulcer patients who underwent surgery for peptic ulcer. The attrition rate of such patients was higher that “control” population- the main cause of death being ischemic heart disease and lung dis (mainly carcinoma) -both smoking related problems. Only patients who underwent a gastrectomy had a higher incidence of gastric carcinoma.