Q: We would like you to help us dealing with my wonderful, but stubborn, sister. Her doctor recently sent her to a specialist due to her ongoing complaints of indigestion. After eliminating certain foods, going easy on takeout and changing some of her medications, she was still rather miserable. After two months she had an endoscopy. This is when it was discovered that she had an inflammation of her stomach. She also was found to have an infection, which is apparently responsible for some of her symptoms.

This is when the problems started. My sister had a very hard time tolerating the treatment. The doctor insisted she has to take antibiotics for two weeks and she is refusing. She told me that she does not understand what an infection has to do with her stomach complaints. We are trying to understand how important it is to complete this treatment and if it will make my sister better. We also want to know if the rest of the family can get the stomach infection from my sister. I know that you can convince her to restart the treatment. She reads your column so we hope that you can talk some sense into her.


A: You obviously care about your sister and want her to feel better. I think I can try to help. I can truly empathize with how difficult this treatment is for some patients. Before we go there, however, let's first talk about the stomach infection your sister was treated for.

We are talking about bacteria -- organisms similar to those causing pneumonia or urinary tract infections -- that are responsible for indigestion and can lead to stomach ulcers and even cancer. This bacterium is called Helicobacter Pylori. It has a rod-like shape and can survive in the acid environment inside our stomach. It gets attached to the lining of the stomach and produces substances that damage the protective cell layer inside gastrointestinal tract. This, in turn, makes the acid inside the stomach erode the protective layer causing inflammation, ulcers and even (although rarely) cancer.

The understanding that bacteria may be causing stomach ulcers is relatively new. We all used to blame stress and spicy food. Although some researchers saw bacteria in stomach contents as early as beginning of the 20th century, it was not until 1982 that two physicians from Australia -- Barry Marshall and Robin Warren -- made their announcement about H pylori. I distinctively remember this as I was a young medical school student. Many famous doctors initially did not agree with Marshall and Warren. Over time, however, their discovery revolutionized treatment of stomach-related complaints. In 2005, they were even awarded the Nobel Prize in ,edicine.

Interestingly, half of the world's population has these bacteria inside their body and more than 80 percent of people infected with it never have any symptoms. Most people get infected as children and do not even know. People in developing countries with poor access to running water and those living in crowded spaces get it more often.

The most common symptoms of H Pylori are indigestion, burping, nausea, heartburn, weight loss, bloating and even vomiting. There are many ways the doctor can diagnose infection with H pylori. There is a blood test, a stool test, and breath test. The most accurate test is a biopsy done with an endoscope, which is used to see the inside of the stomach. This is how Varsha's sister got diagnosed.

The treatment of this infection is not that long -- only two weeks -- but it can be challenging. Two antibiotics are used to assure that the bacteria will not get resistance. There is also a medication to protect the stomach lining and minimize the stomach acid secretions. Many people struggle with this treatment. Some side effects include loose bowels and a metallic taste in the mouth. Having said that, the completion of the treatment assures that the chance for the bacteria to keep causing symptoms will be much less. Sometimes a doctor may re-test for H pylori and even re-treat if bacteria are still present.

There is quite a controversy in medical world surrounding the question of whether people who have no symptoms should be tested and later treated for H pylori. Most physicians do not test unless a patient presents with complaints suggestive of this infection.

Although H pylori is contagious, it is not clear how exactly one gets it. We know it can travel person to person or through contaminated water. Infection usually spreads within the family but again, most members will probably not have any symptoms until way later in life.

Having been infected with H pylori and then treated I can attest as a patient that this is not an easy thing at all. I remember vividly counting every single day until I had finished my medications. What helped me was the realization that infection is probably still easier to control and contain than, say, my level of stress or my food preferences. My recommendation for Varsha's sister is to finish the treatment as well.

Now, some people will still have other stomach complaints. Hiatal hernia may be present at the same time as H pylori. If this is the case, there still may be the need for a course of treatment and maybe even serious discussion about modifying diet and even eliminating some foods. Hiatal hernia as we have discussed previously is a situation when some part of the stomach gets through the opening inside a large muscle called diaphragm. This may result in stomach contents spilling into the esophagus or a food pipe. The symptoms are similar -- heartburn is the most common one. If a person keeps struggling with hiatal hernia symptoms, he or she may be prescribed medications to lower the stomach acid level for a prolonged period of time. The best approach here would be to work with your primary doctor and, if necessary, a specialist. I sincerely hope that Varsha's sister will feel well very soon.
