H pylori is typically acquired in childhood and lives in the gastric mucosa. NICE assumes a prevalence of H pylori infection of around 40% in the UK. It also notes that H pylori infection is associated with social deprivation and that prevalence increases with age.1,17

It is commonly cited as a cause of dyspepsia, reflux symptoms, peptic ulcer and gastric cancers. However, the British Society of Gastroenterology says more than eight out of 10 people who have H pylori do not experience any problems. Indeed, €because there are millions of people who have both H pylori and indigestion, it can be tempting to draw the conclusion that one leads to the other. This is simply not the case in the vast majority of people.€17

For a minority, H pylori does cause problems. Around 15% of people with the infection will develop a gastric or a duodenal ulcer, with associated indigestion. If the ulcer is not treated it can perforate the gut wall.17

Researchers are starting to understand how H pylori can also trigger gastric cancer. Bacteria secrete an oncoprotein capable of changing epithelial cells and can switch on the stem cell-like properties of progenitor cells in the gastric mucosa. It is estimated globally that around 75% of the gastric cancer burden and 5.5 per cent of malignancies involve H pylori-induced inflammation and injury.18

Management

Pharmacists can give advice about avoiding trigger foods, healthier eating and drinking, portion size weight loss and on stopping smoking. Other advice can include raising the head of the bed, and leaving at least three hours after a main meal before going to bed. Review medication to see what has been tried, and also if any ongoing medicines may be contributing to symptoms.21

Clinical management of upper GI problems depend on whether an endoscopic investigation has been conducted (see table). If pharmacological treatment is needed, NICE advises that for most people, self-care with antacids and/or alginates may be used for short-term symptom control, but they are not recommended for long-term, continuous use.22,23