The New Nation - Internet Edition

Helicobacter pylori and Peptic Ulcer

Easir Abedin

M.Sc Microbiology (D.U), MBA

What is a peptic ulcer? A peptic ulcer is a sore on the lining of the stomach or duodenum, which is the beginning of the small intestine. Peptic ulcers are common: One in 10 Americans develops an ulcer at some time in his or her life. One cause of peptic ulcer is bacterial infection, but some ulcers are caused by long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), like aspirin and ibuprofen. In a few cases, cancerous tumors in the stomach or pancreas can cause ulcers. Peptic ulcers are not caused by stress or eating spicy food, but these can make ulcers worse.

What is H. pylori?

Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers.

H. pylori infection is common in the United States. About 20 percent of people under 40 years old and half of those over 60 years have it. Most infected people, however, do not develop ulcers. Why H. pylori does not cause ulcers in every infected person is not known. Most likely, infection depends on characteristics of the infected person, the type of H. pylori, and other factors yet to be discovered.

Researchers are not certain how people contract H. pylori, but they think it may be through food or water.

Researchers have found H. pylori in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact such as kissing.

How does H. pylori cause a peptic ulcer?

H. pylori weakens the protective mucous coating of the stomach and duodenum, which allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.

H. pylori is able to survive in stomach acid because it secretes enzymes that neutralize the acid. This mechanism allows H. pylori to make its way to the "safe" area-the protective mucous lining. Once there, the bacterium's spiral shape helps it burrow through the lining.

What are the symptoms of an ulcer?

Abdominal discomfort is the most common symptom. This discomfort usually

is a dull, gnawing ache

comes and goes for several days or weeks

occurs 2 to 3 hours after a meal

occurs in the middle of the night-when the stomach is empty

is relieved by eating

is relieved by antacid medications

Other symptoms include

weight loss

poor appetite

bloating

burping

nausea

vomiting

Some people experience only very mild symptoms or none at all.

Emergency Symptoms

If you have any of these symptoms, call your doctor right away:

sharp, sudden, persistent stomach pain

bloody or black stools

bloody vomit or vomit that looks like coffee grounds

They could be signs of a serious problem, such as

perforation-when the ulcer burrows through the stomach or duodenal wall

bleeding-when acid or the ulcer breaks a blood vessel

obstruction-when the ulcer blocks the path of food trying to leave the stomach

How is an H. pylori-related ulcer diagnosed?

Diagnosing an Ulcer

H. pylori bacteria To see whether symptoms are caused by an ulcer, the doctor may do an upper gastrointestinal (GI) series or an endoscopy. An upper GI series is an x ray of the esophagus, stomach, and duodenum. The patient drinks a chalky liquid called barium to make these organs and any ulcers show up more clearly on the x ray.

An endoscopy is an exam that uses an endoscope, a thin, lighted tube with a tiny camera on the end. The patient is lightly sedated, and the doctor carefully eases the endoscope into the mouth and down the throat to the stomach and duodenum. This allows the doctor to see the lining of the esophagus, stomach, and duodenum. The doctor can use the endoscope to take photos of ulcers or remove a tiny piece of tissue to view under a microscope. This procedure is called a biopsy. If an ulcer is bleeding, the doctor can use the endoscope to inject drugs that promote clotting or to guide a heat probe that cauterizes the ulcer.

Diagnosing H. pylori

If an ulcer is found, the doctor will test the patient for H. pylori. This test is important because treatment for an ulcer caused by H. pylori is different from that for an ulcer caused by NSAIDs.

H. pylori is diagnosed through blood, breath, stool, and tissue tests. Blood tests are most common. They detect antibodies to H. pylori bacteria. Blood is taken at the doctor's office through a finger stick.

Urea breath tests are an effective diagnostic method for H. pylori. They are also used after treatment to see whether it worked. In the doctor's office, the patient drinks a urea solution that contains a special carbon atom. If H. pylori is present, it breaks down the urea, releasing the carbon. The blood carries the carbon to the lungs, where the patient exhales it. The breath test is 96 percent to 98 percent accurate.

Stool tests may be used to detect H. pylori infection in the patient's fecal matter. Studies have shown that this test, called the Helicobacter pylori stool antigen (HpSA) test, is accurate for diagnosing H. pylori.

Tissue tests are usually done using the biopsy sample that is removed with the endoscope. There are three types:

The rapid urease test detects the enzyme urease, which is produced by H. pylori.

A histology test allows the doctor to find and examine the actual bacteria.

A culture test involves allowing H. pylori to grow in the tissue sample.

In diagnosing H. pylori, blood, breath, and stool tests are often done before tissue tests because they are less invasive. However, blood tests are not used to detect H. pylori following treatment because a patient's blood can show positive results even after H. pylori has been eliminated.

How are H. pylori peptic ulcers treated?

H. pylori peptic ulcers are treated with drugs that kill the bacteria, reduce stomach acid, and protect the stomach lining. Antibiotics are used to kill the bacteria. Two types of acid-suppressing drugs might be used: H2 blockers and proton pump inhibitors.

H2 blockers work by blocking histamine, which stimulates acid secretion. They help reduce ulcer pain after a few weeks. Proton pump inhibitors suppress acid production by halting the mechanism that pumps the acid into the stomach. H2 blockers and proton pump inhibitors have been prescribed alone for years as treatments for ulcers. But used alone, these drugs do not eradicate H. pylori and therefore do not cure H. pylori-related ulcers. Bismuth subsalicylate, a component of Pepto-Bismol, is used to protect the stomach lining from acid. It also kills H. pylori.

Treatment usually involves a combination of antibiotics, acid suppressors, and stomach protectors. Antibiotic regimens recommended for patients may differ across regions of the world because different areas have begun to show resistance to particular antibiotics.

The use of only one medication to treat H. pylori is not recommended. At this time, the most proven effective treatment is a 2-week course of treatment called triple therapy. It involves taking two antibiotics to kill the bacteria and either an acid suppressor or stomach-lining shield. Two-week triple therapy reduces ulcer symptoms, kills the bacteria, and prevents ulcer recurrence in more than 90 percent of patients.

Unfortunately, patients may find triple therapy complicated because it involves taking as many as 20 pills a day. Also, the antibiotics used in triple therapy may cause mild side effects such as nausea, vomiting, diarrhea, dark stools, metallic taste in the mouth, dizziness, headache, and yeast infections in women-most side effects can be treated with medication withdrawal. Nevertheless, recent studies show that 2 weeks of triple therapy is ideal.

Early results of studies in other countries suggest that 1 week of triple therapy may be as effective as the 2-week therapy, with fewer side effects.

Another option is 2 weeks of dual therapy. Dual therapy involves two drugs: an antibiotic and an acid suppressor. It is not as effective as triple therapy.

Two weeks of quadruple therapy, which uses two antibiotics, an acid suppressor, and a stomach-lining shield, looks promising in research studies. It is also called bismuth triple therapy.

Drugs Used to Treat H. pylori Peptic Ulcers

Antibiotics: metronidazole, tetracycline, clarithromycin, amoxicillin

H2 blockers: cimetidine, ranitidine, famotidine, nizatidine

Proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprozole

Stomach-lining protector: bismuth subsalicylate

Can H. pylori infection be prevented?

No one knows for sure how H. pylori spreads, so prevention is difficult. Researchers are trying to develop a vaccine to prevent infection.

Why don't all doctors automatically check for H. pylori?

Changing medical belief and practice takes time. For nearly 100 years, scientists and doctors thought that ulcers were caused by stress, spicy food, and alcohol. Treatment involved bed rest and a bland diet. Later, researchers added stomach acid to the list of causes and began treating ulcers with antacids.

Since H. pylori was discovered in 1982, studies conducted around the world have shown that using antibiotics to destroy H. pylori cures peptic ulcers. The prevalence of H. pylori ulcers is changing. The infection is becoming less common in people born in developed countries. The medical community, however, continues to debate H. pylori's role in peptic ulcers. If you have a peptic ulcer and have not been tested for H. pylori infection, talk to your doctor.

Points to Remember

A peptic ulcer is a sore in the lining of the stomach or duodenum.

The majority of peptic ulcers are caused by the H. pylori bacterium. Many of the other cases are caused by NSAIDs. None are caused by spicy food or stress.

H. pylori can be transmitted from person to person through close contact and exposure to vomit.

Always wash your hands after using the bathroom and before eating.

A combination of antibiotics and other drugs is the most effective treatment for H. pylori peptic ulcers.

Healthy lifestyles

Easir Abedin

Choosing a healthy lifestyle can help you improve your health and reduce your risk of heart disease and diabetes. Healthy lifestyles include eating a healthy diet, maintaining a healthy weight, exercising regularly, quitting smoking (or not starting), and minimizing stress. (Note: Specific guidance for maintaining a healthy lifestyle may change over time as new scientific recommendations become available.)

Eat a Healthy Diet: The Dietary Guidelines show how good dietary habits can promote health and reduce risk for major chronic diseases.

A heart-healthy diet is one that is:

nutritious and well-balanced

low in saturated fat, trans fat, cholesterol, and salt

high in fruits, vegetables, and whole grains

The Food Guide Pyramid and the Food Label are tools to help consumers make informed food choices in the context of a healthy diet.

Use the Food Guide Pyramid to help you choose healthy foods each day.Use the Food Label Nutrition Facts Panel on the food products you buy for guidance. In general, try to plan your daily food choices so that you eat Less than 100% of the Daily Value (DV) for total fat, saturated fat, cholesterol, and sodium.

at least 100% of the Daily Value (DV) for fiber, calcium, vitamin A, vitamin C, and iron.

Maintain a Healthy Weight: Excess body fat leads to health problems such as type 2 diabetes, high blood pressure, and high cholesterol. Health professionals use a measurement called body mass index (BMI) to classify an adult's weight as healthy, overweight, or obese. BMI describes body weight relative to height and is correlated with total body fat content in most adults.

BMI range:

18.5-25 -- healthy range

25-30 - overweight

30 or higher -- obese

Having excess abdominal body fat is also a health risk. Men with a waist of more than 40 inches around and women with a waist of 35 inches or more are at risk for health problems.

More than 60 percent of U.S. adults are either overweight or obese, according to the Centers for Disease Control and Prevention (CDC). While the number of overweight people has been slowly climbing since the 1980s, the number of obese adults has nearly doubled since then.

Excess weight and physical inactivity account for more than 300,000 premature deaths each year in the United States, second only to deaths related to smoking, says the CDC.

People who are overweight or obese are more likely to develop heart disease, stroke, high blood pressure, diabetes, gallbladder disease and joint pain caused by excess uric acid (gout).

Excess weight can also cause interrupted breathing during sleep (sleep apnea) and wearing away of the joints (osteoarthritis). To lose weight, you must eat less and move more. Your body needs to burn more calories than you take in.

Exercise Regularly: Exercise improves heart function, lowers blood pressure and blood cholesterol, helps manage diabetes, and helps control weight. The National Heart, Lung, and Blood Institute (NHLBI) at NIH recommends that adults get at least 30 minutes of moderate physical activity on most days of the week. Talk to your doctor about what forms of exercise are best for you.

Quit or Do Not Start Smoking: Smoking cigarettes significantly increases your risk of coronary heart disease. Facts about smoking and coronary heart disease:

Tobacco smoke increases your risk or atherosclerosis.

Smokers have more than twice the risk of having a heart attack as non-smokers.

Smoking is the biggest risk factor for sudden cardiac death.

Smokers who have a heart attack are more likely to die than non-smokers who have a heart attack. In the first year that you stop smoking, your risk of coronary heart disease drops sharply. In time, your risk will gradually return to that of someone who has never smoked.

Minimize Stress: The link between stress and coronary heart disease is not entirely clear. However, people who have too much stress or who have unhealthy responses to stress may be at greater risk of having coronary heart disease. Facts about stress and coronary heart disease:

Stress speeds up the heart rate. People with heart disease are more likely to have a heart attack during times of stress.

People sometimes respond to stress with unhealthy habits such as smoking or eating salty or high-fat foods.

Rheumatic fever causes heart disease for children

Humayra Ferdous

Sagar, a 25-year-old honors final year student of Sociology Department of Rajshahi University, often keeps indoor and avoids friends when they roam around the campus. He even skips important classes when he feels uncomfortable.

My friends roam around the campus all day long, but I cannot because I have been suffering from rheumatic fever since my childhoodsays Sagar with tears in his easy.

Sagar did not know about it until 2000 when a doctor, after seeing his X-ray report, had said that the left part of his heart got larger than the right one. He has remained untreated so long as his father could not afford the expensive treatment. Now, eight years later, my life is at stake although Im receiving treatment from my University clinic, but that is not enoughsays Sagar.

According to available statistics, the prevalence of rheumatic disease is 4 per 1000 children in Bangladesh. It is rare under the age of 4 and becomes progressively less common after the age of 15.

Dr. Mustafa Zaman, an Assistant Professor of Cardiology at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Fellow of Interventional Cardiologist of Max Heart and Vascular Institute, New Delhi, India, says it is not uncommon these days to see youngsters in the age group of 25-35 years getting into hospital with complaints of angina and in its severe form, acute heart attacks. Even some young people succumb to sudden cardiac death even before reaching any sort of medical helphe says.

Rheumatic heart disease is a condition in which the heart valves are damaged by rheumatic fever. It begins with a strep throat from streptococcal infection. This fever is an inflammatory disease. It can affect many of one body's connective tissues, especially that of the heart, joints, brain or skin. Anyone can get acute rheumatic fever, but it usually occurs in children five to 15 years old. The rheumatic heart disease can last for life.

According to doctors, rheumatic fever leaks the joints but bites the heart. So, rheumatic heart disease is a consequence of rheumatic fever, which leads to damage of the heart valves. Eventually, the damaged heart valves can cause serious, even disabling problems. These problems depend on how bad the damage is and which heart valve is affected. The most advanced condition is congestive heart failure. This is a heart disease in which the heart enlarges and cannot pump out all its blood.

Rheumatic fever is characterized by group A streptococcal (a form of bacteria) infection in early childhood that involves multi-systems in a child.

The World Heart Federation (WHF) focuses primarily on acquired disease, which develops sometime during childhood and includes diseases such as rheumatic heart disease, cardiomyopathy, bacterial endocarditis, pericarditis, Kawasaki disease, and Chagas disease.

Up to 1 percent of all schoolchildren in Africa, Asia, the Eastern Mediterranean region, and Latin America show signs of the disease. The worst affected areas are the Pacific island nations and Sub-Saharan Africa, where about 500,000 children are affected by rheumatic heart disease.

Affected children may need open heart surgery to repair or replace heart valves, which is costly for low and middle-income countries. But without surgery the quality of life is extremely poor. At the same time lack of awareness about treatment and resource shortages are barriers to the disease control in the developing world like Bangladesh.

The Symptoms of rheumatic heart disease vary greatly. Often the damage to heart valves is not immediately noticeable. A damaged heart valve either does not fully close or does not fully open.

Traditionally, heart disease has been divided into broad categories of congenital and acquired heart disease (AHD). Congenital heart disease (CHD) can present as simple structural heart defects like ASD and VSD (hole in the heart) or PDA (extra connection in the heart) or certain forms of complex structural defects which affect the newborns survival drastically like tetralogy of fallot (TOF) and transposition of great arteries (TGA) which lead to mixing of pure and impure blood in the heart.

Congenital defects can also affect the electrical conduction system of the heart (e.g congenital complete heart block), which may require a pacemaker to be put in a tiny heart for proper generation of electrical pulses. The reported incidence of CHD is 8-10/1000 live births, according to information released by World Heart Federation (WHF) and World Health Organization (WHO).

Acquired heart disease in the young is mainly of two types, Rheumatic fever / Rheumatic Heart Disease (RHD) and Coronary Artery disease (CAD).

Dr. Farida Adib Khanum, a physiology professor and the Principal of Eastern Medical College, says the disease is more common among the people of low socio-economic group. Overcrowding, damp environment, poor nutrition and sanitation may play an important role in causing rheumatic fever. All these environmental factors contribute to streptococcal infection and affect immunity.

There is no certain way of establishing the presence of rheumatic fever, but the combination of certain clinical features and laboratory finding is highly suggestive. The aim of the treatment of rheumatic fever is directed towards limiting cardiac damage, relieving symptoms and eliminating the streptococcal infection.

Physicians suggest absolute bed rest, adequate dose of aspirin, and long acting penicillin should be given in acute rheumatic fever. Bed rest must be continued until the indices for continuing disease activity have settled. Sometimes corticosteriod could be used if there is no response to aspirin or there is carditis.

Most importantly, the treatment should be to prevent the recurrence of the disease by giving regular prophylaxis against streptococcal infection preferably by injectable form of long acting penicillin.

Rheumatic fever, according to doctors, is a preventable disease and the primary preventive measures may decrease the morbidity and mortality caused by rheumatic heart disease.

Karamcha root extract lowers blood pressure

Jamayet Ali

Karamcha is an indigenous evergreen small crooked tree up to 3m. in height. It grows successfully in marginal and wastelands. The tree is suitable for arid tropics and sub-tropics. The plant for making dense hedges around fruit orchards as it forms an attractive thorny hedge. Its bark is yellowish brown, peeling in squire flakes. Leaves are leathery, light green, elliptic oblong, rounded at both ends. Flowers are white or pink, faintly scented. Its botanical name is Carissa carandas Linn. The plants are commonly raised from seeds but can also be multiplied by hard wood cuttings and air-layering with the aid of growth regulators. Seedlings are transplanted when two years old. Cuttings from a fruiting tree do not root well although those from young nursery plants root successfully. Two types of Karamcha are commonly grown one with dark purple to almost blue fruits and the other with pink and white attractive fmits. The plants once established, are very hardy and thrive without irrigation and much care but require manuring regularly. They start bearing fruits two years after transplanting. The wood is white with an irregular grey or orange-yellow heatt wood, hard, smooth and close-grained. It is used for making combs and spoons. Besides Bangladesh, it also grows in India, Srilanka and Timor.

Karamcha is rich in nutritive value. Analysis of the fruits (fresh basis) by the scientists gave following findings: moisture, 91: protein, 1.1: fat, 2.9; carbohydrate, 2.0; fibre, 1.5; minerals, 0.6 g; calcium, 21; phosphoms, 28 mg./l00g; energy, 42 k calorie; carotene (equivalent to vitatnin A) 1619 I.U.; thiatnine, 0.04; nicotinic acid, 0.6; atld riboflavin 0.07 mg./100g. The flowers yields a light yellow pleasant smelling essential oil. The seeds also yield an oil having the following fatty acid composition: palmitic, 66.4; stearic, 9.4; arachidic, 21.2; oleic, 2.0; and linoleic, 1.0 % (Wealth of India, Raw Materials, Carissa carandas)

Medicinal Properties: All parts of the plant are reputed in indigenous medicine.

The unripe fruit is sour and astringent and is used for pickles. The ripe fruits are sweet, edible atld particularly suitable tatts, salads, puddings and jellies. They can be used to make refreshing juices or carbonated drinks. The roots are credited with bitter stomachic atld anthelmintic properties. The alcoholic extract of roots exhibited cardiotonic activity and prolonged blood pressure lowering effect. An atnorphous water-soluble polyglycoside possessing significant cardiac activity has been isolated. The cardiac activity of water-soluble fraction has been attributed to the presence of the glucosides of odoroside. H-presence of alkaloids is also reported in root atld stembark. The roots also show insecticidal property. The leaves are prescribed in remittent fevers. The ripe fmits are atltiscorbutic, cooling and useful in bilious complaints. The fat soluble fraction of the mature fmits has revealed cytotoxic. (Wealth of India, Raw Materials, Carissa carandas)

Medicinal Values: The unripe fmit is astringent, and the ripe fmit cooling, acid and useful in bilious complaints. The root has the reputation of being a bitter stomachic. It is used as a plaster in the concan to keep off flies, and pounded with lime juice, and camphor as a remedy for itch.

Special Opinions: It is considered to be antiscorbutic and much used in the form of curry and chutney by the natives" (Assistant Surgeon Anund Chunder Mukerji, Noakhally). "Antiscorbutic, expectorant" (Surgeon W. Barren, Bhuj, Cutch). " The juice is irritant and capable of producing ulcers. The ripe fruit is a pleasant acid, goes with food and has I believe, anti scorbutic properties" (Surgeon- Major J. M. Zorab, Balassore, Orissa) The decoction of leaves is very much used at the commencement of remittent fever" (Surgeon -Major P.N. Mukerji, cattack, Oriissa) (Dictionary of the Economic Products of India, Watt, Vol. II, 165, 166)

Medicine: The root is anthelmintic. The fruit is sour, tasty; allays thirst; heating; causes biliousness, "kapha", and blood impurities; when ripe cooling, cures biliousness and "vata" Ayurveda. The fruit is sour, acrid, astringent; appetizer, antipyretic; lessen thirst, biliousness; useful in diseases of the brain; causes indigestion; makes one lethargic; diminishes sexual power (Yunani).

The tmripe fruit is astringent and the ripe fruit is cooling acid and useful in bilious complaints. The fruit has been reported by several medical officers to possess antiscorbutic. The root has the reputation of being a bitter stomachic. Used in Konkan, pounded with horse urine, lime juice and camphor as a remedy for itch. In Cuttack, the decoction of the leaves is very much used at the commencement of remittent fever (Indian Medicinal Plants, K.R. Kirtikar & B.D.Basu, Vol. II, 1547).