Cancer-causing stomach bug troubles medics

Joy Nasimiyu, a communications professional heard about Helicobacter pylori popularly known as H. pylori in 2016.This is after visiting a doctor while suffering from diarrhoea that had lasted for some days.

“Initially, I thought it was just something that I had eaten and resorted to the home remedy of warm water and dry foods, such as bread, rice and bananas and took a lot of Oral Rehydration Solutions (ORS). However, three days down the line, the running stomach became persistent so I decided to get checked,” she recounts.

At the hospital, the doctor ordered a stool test and the results showed that she was suffering from an H. pylori infection. 

Dr Okello Wawengwe, Medical Officer Accident and Emergency department at MP Shah Hospital says H. pylori is a spiral-shaped bacteria that grows in the digestive tract and tends to attack the stomach lining. Classically it has been associated with 80 to 95 per cent of cases of duodenal ulcers and increased gastric acid production. It has also been associated with chronic gastritis, most peptic ulcers and gastric adenocarcinoma and lymphoma.

However, treating the bacteria has proven to be a nightmare.

Unlike previous stomach bugs, which Nasimiyu would treat once and it would go away, that was not the case this time. 

“The bacteria keeps recurring and at one point I had so much pain that I couldn’t walk properly,” she narrates.

So far, she has treated it four times unsuccessfully. 

Both the stool antigen test and blood test, whereby a sample of one’s blood is tested for antibodies to the H. pylori bacteria have brought back a positive H. pylory bacteria result.

Dr Okello says most patients infected with H. pylori don’t have any obvious symptoms (are asymtomatic), but some of the signs one should look out for are an ache or burning pain in the abdomen particularly when your stomach is empty, nausea, loss of appetite, frequent burping, and bloating and unintentional weight loss.

 “The first time I was given the Esclam kit (a treatment remedy), which I took for 14 days. In the second time treatment I was given Esokit, which is also a 14 day dose. The doctor still prescribed the Esokit the third time, but this time it was accompanied by another drug to be taken for seven days after completing the kit. The fourth time they prescribed Esclam, but I was told to only take it for seven days, because I was breastfeeding. Thankfully, I have a medical cover, so the bills have always been catered for by the insurance. Something I know for sure is that the medicines are not cheap since a seven-day kit goes for around Sh3,500 to Sh4,000.”

 Have the drugs eradicated the bacteria from her stomach completely after taking the four kits? She says that she is not sure because she still has the symptoms. 

In frustration, she has, however, decided to take a different route this year by going to a gastroenterologist to rule out any underlying issue, as well as to confirm if it indeed it is H.pylori or something else. 

Her biggest worry now is misdiagnosis since she is not sure if they have been treating the right disease. 

“I have read online reports that say for one to be truly diagnosed with H.pylori they have to take an endoscopy test and probably have a gastroenterologist make the diagnosis,” she says.

“I am not sure if it is H.pylori I have been suffering from or hyperacidity, because even after taking the prescription drugs, I still have stomach upsets and acidity. I always have a feeling it is still the bacteria. Meanwhile, I have been very  keen on my diet, I have cut-out dairy products, I am working on cutting red meat and oily and spicy foods and I am leaning towards steamed or boiled foods. I am also cautious about eating out. I pack food from home to work,” she continues.

Since her first diagnosis and after learning that this is a contagious bacteria, she has refrained from preparing food for her family. She also ensures that high levels of hygiene is practiced at home to ensure her family members are safe. This has helped her not pass the infection to them.

Milcah Kerubo is another patient who encountered the wrath of the bacteria in 2013. However, even after taking and finishing a whole kit, the symptoms were still there. Instead of taking another kit, she chose to manage the bacteria by managing her stress and eating healthy. She also started, making cabbage, carrot, garlic, onion and potato juice, which she took religiously and three weeks later, tests brought back negative results for the bacteria.

As if fate would have it, recently, her two-year-old daughter tested positive for H.pylori. At first, she was confused on whether she should put her daughter on the juice diet or take her to hospital. “After consulting widely, I was advised to use antacids and probiotics. We did not use antibiotics and now she is well,” says Kerubo who is a  medical practitioner.

“From a medic perspective, I feel the H.pylori disease has been given very little attention by our government and the medical institutions, and with country’s general poor sanitation, the situation is getting worse. The disease has become very common. It is also expensive to test and treat and has serious health risks if left untreated, not forgetting it can lead to cancer,” says Kerubo.

Milcah and Kerubo are not the only people that have had horrible experiences with H.pylori. 

Dr Okello says prevalence of the disease is as high as 80 to 95 per cent among the populations in developing countries and 30 to 50 per cent among the populations in the developed countries. The difference has been attributed to poor hygienic standards and low socioeconomic status among developing countries. However, in most of these populations, it remains quiescent without causing any disease.

“This bug may be passed from person to person through direct contact with saliva, vomit or faecal matter. It may also be spread through contaminated food. In developing countries, the prevalence is higher because unsanitary living conditions are more common.In Kenya incidences of H.pylori are on the rise,” says Dr Okello.

He reveals that though available data shows that H.pylori is common and many people have it, not everyone needs to be tested for H.pylori infection. Clinical acumen should be complemented with symptomatology before making this decision. Treatment should be reserved for H.pylori cases associated with symptoms suggestive of peptic ulcer disease and gastritis. The reason is a study done by Aga Khan University Hospital between January 2018 and February 2019 involving 487 dyspeptic patients whereby only 199 were found to be positive of H.pylori.

“The diagnosis of H.pylori infection should be made from history taking, doing a physical examination and confirming bacteriologically using laboratory methods. The most highly sensitive and specific methods are the H.pylori stool antigen test and the urea breath test,” He says.

On whether the bacteria has become resistant as per World Health Organisation classification, Dr Okello says that this is true.The resistance comes from people taking those kits for longer than recommended and the bacteria is also over-diagnosed and over-treated sometimes masking the main causes of gastrointestinal problems.

“The increased rise in the incidence of antibiotic resistance has also affected the antimicrobials used in the treatment of H.pylori eradication among affected individuals. The good thing is that there are ongoing studies to establish if there are natural products, which can heal this bacterium,” he adds.

He says studies, including several randomised control trials and recent meta-analysis have shown that fermented milk-based probiotic preparations improve H.pylori eradication by 10 per cent. However, the studies are small and further research needs to be done on this topic.