You may know that the discovery of Helicobacter pylori as the cause of gastritis, and stomach ulcers was made by two Australians: Prof Barry Marshall (our medical advisor) and the late Prof Robin Warren.

But did you know that the Easter weekend marks the ‘birthday of Helicobacter pylori’.

The successful culture of Helicobacter pylori was down to a very lucky Easter break.

Back in 1982 Barryand Robin were investigating spiral bacteria in the stomach biopsies of patients with gastritis, but their initial attempts to culture them had failed because laboratory technicians were discarding the petri dishes after just 48 hours, following the standard protocols for throat swabs.

In April 1982, Barry left a set of samples in the incubator before the Easter weekend. Because of the holiday, the plates were left undisturbed for five days.

Upon returning from the long weekend, Barry discovered that the previously "negative" plates contained small, growing colonies of the bacteria, which were later identified as H. pylori.

The bacteria grew much slower than other pathogens, meaning the standard 48-hour window was too short. The extended incubation period was essential for the discovery. It allowed the pair to prove the bacteria could be grown and further investigate the link to gastric diseases.

Portrait of Prof Barry Marshall Nobel Laureat — We thought that the upcoming birthday was a great time for a guest blog from Barry.
Barry cannot provide medical advice but here’s five things Barry would love you to know about *H. pylori.* Effective treatment is worthwhile, but it requires good teamwork between the patient and their doctor.

1) Talk to your doctor if you have these symptoms or are in a high-risk group

Helicobacter pylori affects around 50% of the world’s population. Many people carry it with only mild symptoms of indigestion, but it is linked to increased risk of gastritis (inflammation and damage to the stomach lining), stomach and duodenal ulcers and gastric cancer.

There are treatments that can cure H. pylori infection. This won’t always solve indigestion, which has many potential causes, but H. pylori eradication does treat gastritis, and reduces the risk of ulcers and stomach cancer.

Helicobacter pylori is relatively uncommon in Australia. Less than 30% of Caucasian Australians become infected with H. pylori, but it is more common in Indigenous Australians and in people who have migrated to Australia, especially from developing countries.

There is no screening program in Australia, but if you have symptoms, especially if you are in a high-risk group, or have a close relative who is infected you should talk to your doctor about testing and treatment, or referral to a specialist. Common symptoms are a burning pain in the stomach (often worse when empty), indigestion and nausea, loss of appetite, frequent burping, bloating, and unintentional weight loss.

2) Natural remedies simply don’t work

Whatever you may have seen on social media, this is one of those times when you need modern medicine. Helicobacter pylori is a highly resilient pathogen and difficult to eradicate. It uses a corkscrew-like motion to burrow into the mucus layer of the stomach and duodenum to avoid being flushed out and to escape the acid. It also has several strategies to evade the immune system. It is a tough cookie to beat.

Honey, green tea, berries, olive oil, herbs, seeds and essential oils might slow growth in the lab., but don’t work in humans.

3) There are effective treatments for Helicobacter pylori

It takes a combination of an acid lowering medication and a mixture of antibiotics to eradicate H. pylori. The standard treatment in Australia is a 7-day course of PPI-based triple therapy:

· a Proton Pump Inhibitor (e.g., esomeprazole 20mg) twice daily,

· amoxicillin 1g twice daily, and

· clarithromycin 500mg twice daily.

Commonly, a single-prescription combination pack (Nexium HP7) is used. In the case of penicillin allergy, the amoxicillin is swapped for metronidazole. It is important that you follow your doctor’s instructions on how to take the medication very carefully and finish the full course.

Triple therapy works for around 70 to 80% of cases, but some strains of H. pylori have resistance to one of more of the antibiotics. If the first line treatment fails, a longer course may work, or your GP may send you to a specialist who can prescribe a different combination of medications. They may even take a biopsy and culture your H. pylori and test for resistance in the lab or look for genetic markers of resistance to specific antibiotics before choosing a treatment plan.

4) Different diagnostic tests are used in different situations

There are several different ways to diagnose H. pylori. Your doctor will work out which is best for you.

Urea Breath Test (UBT): This is the preferred, non-invasive test with high accuracy. The test works by detecting the metabolic byproduct of urea - specifically, labelled carbon dioxide, that is produced when the H. pylori are active in the stomach.
Stool Antigen Test (SAT): A laboratory can test your stool (poo) sample for proteins (antigens) from H. pylori. This is an accurate, non-invasive alternative for identifying active infection, and a good choice for children.

· A Serology or Blood Test: This tests for antibodies your body makes against H. pylori. It only detects if you have ever had an H. pylori infection, not if you have a current infection Levels do drop over time, but it can still show positive results after an infection is effectively treated, so it’s not the best test after treatment. However, a negative blood test can virtually rule out a current infection.

Endoscopy with Biopsy: This is performed if patients have alarm symptoms (e.g., bleeding, older, a family history of gastric cancer, or from a high-risk ethnic group. e.g., Chinese, Japanese, Vietnamese). The endoscopy allows the gastroenterologist to look for visual signs of ulcers or cancer and the biopsy can be used for a rapid urease diagnostic test and histology and possibly culture of the H. pylori.

You need to prepare carefully for breath and stool tests and biopsy

For accurate test results, your doctor will likely ask you to stop taking any antibiotics for four weeks, and proton pump inhibitors (PPIs) for two weeks prior to the test. These medications can suppress the levels of H. pylori in the stomach without wiping it out completely and so lead to false negative results.

5) What to do after treatment

A follow-up breath test to confirm effective eradication of the H. pylori four weeks after treatment is essential to prove the infection is totally cured.

The antibiotics used to eradicate H. pylori are very potent and quite rough on your microbiome. After you have finished treatment, re-building your healthy bacteria with a healthy diet rich in plant foods and fibre, plus a probiotic can help.

It can take a few months for symptoms of dyspepsia to reduce.

And finally

The ‘lucky accident’ that led to the first successful culture of H. pylori demonstrates that taking a break can lead to better outcomes in the long term.

With that in mind, the whole Noisy Guts team, wishes you a very happy Easter break. Enjoy the long weekend, and we hope you come back re-freshed and re-invigorated.

Happy Birthday Helicobacter!