This is a very common bacterial infection of the stomach lining. It was first discovered by Drs Warren and Marshall (subsequently awarded Nobel prizes for their amazing finding). It is thought to be caught in childhood and is very common in developing countries. In about 10% of infected individuals the bacterium may lead to a significant increase in the amount of acid produced by the stomach and this may lead to a duodenal ulcer or in older people, a stomach ulcer. Curing the infection (called eradication) will heal the ulcer and prevent it recurring.

Most people with H. pylori infection will be unaware of the infection or may develop intermittent indigestion (dyspepsia); the benefit of eradication therapy in such cases is less clear cut.

There is an association between long standing infection with H. pylori and an increase in the risk of developing cancer of the stomach. The latter condition is however getting less and less common in the UK and this is probably related, at least in part, to the decrease in the number of people infected with H pylori.  Large studies in South East Asia and more recently from Sweden, have shown a decrease in stomach cancer after eradication of the infection.

The infection has evolved with humans and some believe that is may confer a health benefit in some people (ie in those where it doesn’t cause an ulcer or stomach cancer). Thus, recent data found a possible protective role against Barrett’s oesophagus, eosinophilic oesophagitis (a chronic inflammatory disease of the oesophagus) and inflammatory bowel disease (a chronic inflammatory disease of the colon).

Patients who see their GP with indigestion (dyspepsia) may be checked (by a blood, stool or breath test) to see if they are infected with H. pylori and if so, offered treatment to cure the infection to see if the dyspepsia improves. This improvement in symptoms is most likely if the dyspepsia was due to a duodenal or stomach ulcer caused by the bacterial infection. Success or failure may be determined either by improvement in symptoms or by performing a special breath test (can be prescribed by your GP and undertaken either at home or in the GP surgery).

Curing (or eradicating) infection with H. pylori is more difficult than treating other infections. It requires treatment with 2 antibiotics (eg metronidazole, amoxicillin or clarithromycin) and an acid-lowering drug (eg omeprazole or lansoprazole) all taken twice or three times daily for 7-10 days. This treatment will work in about 80-90% of cases. In an era of growing antibiotic resistance, there is no evidence-based treatment for H. pylori patients with penicillin allergy and prior exposure to clarithromycin.

For more information about H. pylori and potential treatment options, please do not hesitate to contact Dr. Adam Harris.

A hiatus hernia is when part of the stomach is pushed (herniated) into the lowest part of the chest through an opening (the hiatus) in the diaphragm. In most cases, the portion of stomach is pushed across the hiatus in a vertical direction and may move up and down producing a sliding hiatus hernia. In less than 10% of cases the stomach may herniate next to the gullet or oesophagus leading to a rolling or para-oesophageal hernia. Hiatus hernias can affect anyone, but they are more common in people who are over 50 years of age, overweight or during pregnancy.

Many people with a hiatus hernia are unaware of it but it may be associated with gastro-oesophageal reflux disease (GORD) due to the movement (reflux) of stomach acid into the gullet. The commonest symptom of GORD is heartburn; other symptoms may include food regurgitation, a bitter or sour taste, bad breath and prolonged coughing. These symptoms occur because the hiatus hernia weakens the barrier between the top of the stomach and the bottom of the gullet (lower oesophageal sphincter complex)

In some patients with GORD and a hiatus hernia, the oesophagus is exposed to long periods of acid induced inflammation that may lead to erosive oesophagitis or even, Barrett’s oesophagus, a condition whereby the lining of the gullet changes its appearance in response to long-standing and regular acid-induced damage.

So how can this all be diagnosed? Most commonly a patient will have an  Upper GI endoscopy whereby a flexible tube is guided carefully and slowly through the mouth and into the stomach and duodenum. This allows the gastroenterologist to examine the lining of the oesophagus, stomach and duodenum (first portion of the small intestine). Alternatively, a barium swallow may be undertaken in the XR department.

How can this condition be treated? Lifestyle changes and medications are the preferred treatments. Lifestyle suggestions include:

  • Adapting eating habits, eating smaller meals more frequently
  • Avoiding lying down for 3 hours after eating or drinking
  • Removing any foods or drinks from your diet that make symptoms worse

There are two classes of medication that supress acid secretion – histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). H2RAs work by blocking the effect of food on acid secretion whereas PPIs block the enzyme making acid. PPIs have emerged as the most effective therapy for relieving symptoms and improving quality of life, as well as healing and preventing damage to the oesophagus.

If patients fail to respond to PPIs or are intolerant of them, surgical repair of the hiatus hernia may be helpful such as laparoscopic fundoplication or lower oesophageal sphincter augmentation (LINX system). Surgery is particularly effective in patients with a hiatus hernia with regurgitation.

For more information about hiatus hernia and potential treatment options, please do not hesitate to contact Dr. Adam Harris.

At West Kent Gastroenterology, we work hard to provide our patients with top-class care. You will enjoy friendly, fast and modern treatment by a highly experienced gastroenterologist. We carefully review patient satisfaction and feedback, and at West Kent Gastroenterology we are continuously making improvements to our services, ensuring the highest level of care possible.

Clinic Locations

Nuffield Hospital
Kingswood Road, Tunbridge Wells, Kent, TN2 4UL

Sevenoaks Medical Centre
London Road, Sevenoaks, Kent, TN13 2JD

LycaHealth Canary Wharf
1 Westferry Circus, London, E14 4HD

OneWelbeck Digestive Health
1 Welbeck Street, London, W1G 0AR


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