To Your Good Health
BY KEITH ROACH, M.D.
DEAR DR. ROACH: My 82-year-old husband was diagnosed with H. pylori and was treated with two antibiotics and omeprazole. Would you please expand on what exactly H. pylori is? — T.R.
ANSWER: Helicobacter pylori is a bacteria species that is able to live in the stomach. It was identified in a paper from 1984 and is now recognized as a major contributor to gastrointestinal ulcers and inflammation. In addition, it plays a role in the development of certain types of stomach cancers.
H. pylori is the underlying cause of most stomach and duodenal ulcers, and people who have these ulcers are tested for H. pylori and treated if the bacteria is present. Treatment helps speed recovery and prevent recurrence of disease.
H. pylori is hard to kill. A common regimen is clarithromycin, amoxicillin and omeprazole. Diagnosis can be made with biopsy specimens taken at the time of upper endoscopy, or by a breath test or stool test. Blood testing is not reliable.
In people with stomach symptoms but who do not require endoscopy, many clinicians choose to look for H. pylori by stool or breath testing, and treat if present. Unfortunately, treating the infection is effective at curing symptoms only a minority of the time.
H. pylori increases the risk of stomach cancer and is the cause of most cases of a cancer called a MALToma. People with this unusual cancer often are cured (or at least have no evidence of disease after multiple years) with successful treatment of H. pylori, making it the first known cancer to be cured with antibiotics.
The risk for stomach cancer in North America is relatively low, so experts do not advise screening for H. pylori solely for the purpose of treating people to reduce their risk of stomach cancer. However, some people at high risk due to family history or other risk factors may elect screening.
DEAR DR. ROACH: My doctor heard a heart murmur and sent me for an echocardiogram. This showed that I have some heart thickening due to high blood pressure, but that my valves are OK. The doctor said the murmur came from “aggressive heart muscle contractions.”
I’m 68, and my blood pressure is around 140/76. What can I expect my heart health to be as I age? Is this progressive? I exercise 150 minutes per week. Should I still push myself? — B.G.
ANSWER: I looked at your echocardiogram report, and it showed your ejection fraction (the percent of blood the heart squeezes out every beat) was 75 percent (just on the border of too high), and the report noted abnormal relaxation of the thickened wall of the left ventricle. These findings are indeed consistent with hypertensive heart disease.
Fortunately, this condition is usually treatable. At the time of the echo, your blood pressure was 158/76. Perhaps you were nervous, or perhaps your blood pressure isn’t under as good control as it could be. Meticulous blood pressure control, ideally with an ACE inhibitor and often a beta blocker, is the best treatment for your condition. With good control, the heart can start to return to normal. Sometimes a 24-hour blood pressure monitor can help decide whether the medication is enough.
Regular exercise is absolutely still indicated, but I don’t recommend overexerting yourself until you speak with your cardiologist about it.