H. pylori may not cause symptoms

DEAR DOCTOR K: I’m in my mid-80s and am infected with H. pylori. I don’t have any symptoms. Do I need to be treated?

DEAR READER: Helicobacter pylori – H. pylori – is a species of bacteria. In the mid-1980s, two Australian doctors found H. pylori in many peptic ulcers. These ulcers, which were common in the mid-1980s, occur in the stomach and the first part of the small intestine.

Before this discovery, it was widely believed that peptic ulcers were caused by stomach acid. Most people thought that bacteria couldn’t possibly live in such acid. Today we know that H. pylori causes not only many peptic ulcers, but also many cases of stomach cancer.

But many people who are infected with H. pylori never get ulcers or stomach cancer. In fact, doctors don’t usually test for H. pylori in people without symptoms. So I’m curious about why you were tested. Perhaps many of your relatives have suffered from peptic ulcers or stomach cancer. Or perhaps you’re of East Asian or Eastern European extraction, populations in which stomach cancer is more common than it is elsewhere.

Most people become infected with H. pylori in early childhood. So if you’re in your mid-80s, you have probably been living with this infection for most of your life – and it apparently hasn’t caused you any trouble. In my opinion, this increases the likelihood that it won’t cause trouble in the future.

What I ask patients like you is this: Does knowing that you have an infection that has a very small chance of causing cancer make you worried and anxious? If so, let’s treat you to make a small risk even smaller. Treatment is effective and simple. You take several antibiotics for seven to 14 days. As with any treatment, though, there can be side effects.

On the other hand, you may figure that if you were going to get an ulcer or cancer from H. pylori, you would have gotten it by now. If you don’t want the bother and possible side effects from treatment, I wouldn’t disagree.