Jiangsu released the ＂infection map＂ for the first time. What is the infection rate in your city？

The overall infection rate of HP in the tested population is 30%, including 32.7% for adults and 11.4% for children … Recently, Jiangsu released the "Helicobacter pylori infection and drug resistance map" for the first time.

The infection map shows that the infection rates in Changzhou, Zhenjiang, Taizhou, Xuzhou, Suzhou, Nantong, Nanjing and Yangzhou are all higher than the overall infection rate in Jiangsu Province, with Changzhou being the highest, accounting for 42.9%. The infection rates of 13 prefecture-level cities are shown in the following figure:

2023 Edition of Helicobacter Pylori Infection Map in Jiangsu Province

Helicobacter pylori will live in the epithelium of gastric mucosa, and the urease it secretes can affect the secretion of gastric acid and destroy the barrier of gastric mucosa, which is also one of the important causes of chronic gastric disease, gastric or duodenal ulcer and even gastric cancer. The number of people infected with Helicobacter pylori in China is very high. In recent years, with the promotion of health science popularization, people’s understanding of Helicobacter pylori has gradually deepened.

What is Helicobacter pylori?

Helicobacter pylori is a kind of bacteria. After entering the human body from the oral cavity, it is fixed in the stomach, which can cause a variety of diseases in and out of the stomach. After fixed, it is difficult for the body to remove it spontaneously, resulting in lasting or lifelong infection. In 1994, Helicobacter pylori was listed as a class I carcinogen of human gastric cancer by the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC). In 2022, the United States Department of Health and Human Services listed Helicobacter pylori as a clear carcinogen.

Helicobacter pylori infection is the main risk factor of gastric cancer, which can significantly increase the risk of gastric cancer (3-6 times), and eradication of Helicobacter pylori can reduce the risk of gastric cancer by 54%, which plays a clear etiological role.

How about infectivity?

Helicobacter pylori infection is an infectious disease that can spread from person to person, especially among family members.

Helicobacter pylori infection is a global problem, and the global infection rate has exceeded 50%. A recent screening result shows that the personal infection rate in China is about 40%, and the family infection rate is about 70%. The infection rate increases with age.

People are generally susceptible to Helicobacter pylori. Including people with low education, high family density, low income, eating out more and poor hygiene habits.

It has been pointed out that children are susceptible to Helicobacter pylori, and the infection within the family mainly occurs before the age of 12. Both parents were infected with Helicobacter pylori, and the infection rate of their children was 69.34%. This also suggests that adults in families with children should pay special attention to the detection of HP, find that infection should be actively eradicated, pay attention to not sharing tableware in life, and do not chew and feed infants to avoid HP infection in the family.

75% of adult infected people carry "virulent strains"

In the whole province, 75.6% of HP strains were infected by adults, and 60.5% were infected by children.

Helicobacter pylori strains with certain virulence factors can help them colonize human stomach and survive for a long time, and even induce intestinal differentiation and intestinal metaplasia, leading to the irreversible stage of cancer. There are a large number of virulent strains in the province, which should be paid more attention to. After personal infection, we should cooperate with doctors to actively carry out eradication treatment.

What are the symptoms after infection?

Helicobacter pylori infection sometimes has no obvious symptoms. Symptoms can be manifested as bad breath, belching, loss of appetite, fullness, discomfort in the upper and middle abdomen, dull pain, and even symptoms of acid reflux, nausea and vomiting.

What diseases are they related to?

In the digestive system, Helicobacter pylori infection is an important pathogenic factor of chronic active gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma and gastric cancer. Especially in patients with peptic ulcer, the infection rate of Helicobacter pylori is extremely high. Eradication of Helicobacter pylori can promote ulcer healing and significantly reduce the recurrence rate of ulcer.

In addition, Helicobacter pylori is also related to some non-digestive diseases. Helicobacter pylori infection in the blood system is related to unexplained iron deficiency anemia, primary immune thrombocytopenia, vitamin B12 deficiency and other diseases. For patients with these diseases, Helicobacter pylori should be detected and eradicated. With regard to the manifestations of nervous system, more and more studies have linked this bacterium with multiple sclerosis, Alzheimer’s disease, Parkinson’s disease and Guillain-Barre syndrome. Interestingly, the risk of cardiovascular diseases such as atherosclerosis is also affected by infection.

How to prevent it every day?

Helicobacter pylori is particularly prone to family cluster infection, so it is necessary to mobilize the whole family to prevent it and treat it at the same time if necessary. Disinfection of bowls and chopsticks, sharing meals, paying attention to oral hygiene, changing toothbrushes regularly and exercising more to enhance immunity are the most critical measures to prevent this bacterial infection. If the tableware is recycled and not disinfected in time, it may also infect Helicobacter pylori. In addition, parents and children’s tableware should be used separately, and the habit of feeding infants or giving chewed food to children should be abandoned. Patients after radical treatment should also pay attention to prevent reinfection, mainly to prevent reinfection through daily intimate contact.

Which groups of people suggest checking?

First of all, people and their families who have been confirmed to have stomach diseases such as gastric ulcer, chronic gastritis and gastric cancer; Secondly, people who feel abdominal distension, abdominal pain, nausea and other digestive tract discomfort symptoms; The latest research recommends that the family members of patients with Helicobacter pylori positive should also be tested for Helicobacter pylori.

The two antibiotics are highly resistant.

According to experts, we usually talk about the drug resistance of Helicobacter pylori, which tests the sensitivity of the strains carried by infected people to antibiotics.

Jiangsu "drug resistance map" shows that the resistance rate of adults and children to clarithromycin is over 50%, of which the resistance rate of adults to clarithromycin is 51.9% and that of children to clarithromycin is 55.8%. This result is obviously higher than the drug resistance reported in the current literature. According to "Systematic Review and Meta-analysis of Primary Antibiotic Resistance of Helicobacter pylori in China", the drug resistance rate of clarithromycin reached 34% from 2016 to 2020.

Jiangsu "drug resistance map" also shows that the drug resistance rate of adults to levofloxacin is nearly 40%, and that of children to levofloxacin is 23.3%. The resistance rate of adults to furazolidone is 10%, and that of children is 4.7%. The two populations were basically not resistant to amoxicillin and tetracycline.

2023 Edition of the "Drug Resistance Map" of Helicobacter pylori in Jiangsu Province

According to the "Urban Drug Resistance Map" released by Jiangsu Province, the drug resistance of Helicobacter pylori in 13 districts and cities in Jiangsu Province is different.

Huai ‘an City has the highest drug resistance rate of levofloxacin among 13 districts and cities, with a drug resistance rate of 66.7%. The resistance rate of clarithromycin in Yangzhou was the highest, accounting for 69.6%. Yancheng is the city with the highest drug resistance rates of amoxicillin and furazolidone, which are 2.3% and 20.9% respectively.

The difference of drug resistance in different cities suggests that each region or even everyone is infected with different strains of Helicobacter pylori, and there are also differences in individual medication history and local medication habits. Therefore, when HP infected people receive eradication treatment, if they can obtain the individual drug resistance of Helicobacter pylori, choose sensitive antibiotics and avoid antibiotics with known drug resistance, theoretically, the success rate of the first eradication can be greatly improved.

Professor Wang Qizhi, chairman of the Gastroenterology Branch of Anhui Medical Association, pointed out that it is very important to know the antibiotic resistance in the eradication of Helicobacter pylori. The drug resistance and corresponding treatment are different in different regions. With empirical treatment, the eradication effect will be different. Drug resistance is also the main obstacle to the prevention and control of this disease.

Which groups of people suggest eradication? What about the treatment plan?

Family members infected with Helicobacter pylori are always potential sources of infection and have the possibility of continuous transmission to other family members, but whether they are infected or not is related to the intimacy of contact and genetic background. All adults infected with Helicobacter pylori in the family should consider eradication treatment. Especially those who are over 35 years old, have a family history of gastric cancer and a history of gastropathy. According to the risk assessment, children with peptic ulcer and gastric MALT lymphoma can consider eradication treatment, and children with chronic gastritis, family history of gastric cancer, unexplained refractory iron deficiency anemia, long-term NSAID (including low-dose aspirin), guardians or elderly children (12-14 years old) who strongly demand treatment can also consider eradication. For the elderly people infected with Helicobacter pylori in the family, they often suffer from a variety of other systemic diseases at the same time, and the combined medication is complicated. Therefore, before eradication treatment, we should evaluate the risks and benefits and choose an individualized and standardized treatment plan. At present, the commonly used treatment for eradicating Helicobacter pylori in China is bismuth-containing quadruple therapy, that is, a proton pump inhibitor (PPI)+ bismuth+two antibiotics. Because Helicobacter pylori is easily resistant to antibiotics, it is very important to choose the first treatment plan. It is suggested that you must go to the gastroenterology department of a regular hospital for treatment. After the eradication of Helicobacter pylori, C13 and C14 breath tests were performed again one month after drug withdrawal to evaluate the curative effect, and gastroscopy should be performed if necessary.