Tom Storskrubb, of the Center for Family and Community Medicine, studied the prevalence of the bacterium Helicobacter pylori in the stomachs of study participants. Helicobacter pylori is a main cause of peptic ulcer disease and the main risk factor for stomach cancer. Storskrubb also looked at the prevalence of scar formation and cell changes in the mucous lining of participants’ stomachs. The investigation used gastroscopy, a procedure in which the physician inserts a long, flexible tube into the stomach via the mouth to examine the stomach from the inside and simultaneously collect tissue samples.
An active Helicobacter pylori infection was found in approximately a third of the 1000 people examined. A further 10 percent of participants showed signs of previous infection. Using the tissue samples, Storskrubb also looked for signs of risk factors for cancer of the stomach and found them in approximately 15 percent of those with active or past Helicobacter pylori infection.
Scar formation and cellular changes caused by Helicobacter pylori are the single most common cause of stomach cancer and may explain up to 90 percent of all cases. Storskrubb’s examination of the mucous lining of participants’ stomachs revealed no cellular changes in those under the age of 50 years, even if they were infected with Helicobacter pylori. It thus seems plausible that eliminating the bacteria in time in patients who seek care for dyspepsia could prevent them from developing stomach cancer later in life.
In another study, Storskrubb showed that a simple laboratory test works as well as gastroscopy to identify patients who have or had a Helicobacter pylori infection. Together, these findings challenge the prevailing strategy used in Sweden during recent years (known as scope them all) in which gastroscopy has been the most common diagnostic method used when a stomach ulcer is suspected. Storscrubb’s challenge to his fellow physicians is clear:
– Be conservative with gastroscopy in young patients with dyspepsia. There is nothing to be found in the stomach of people under age 50, so we can use scope time for something else.
Instead of routinely sending patients to have gastroscopies, Storskrubb wants family practitioners to learn to interpret the results of blood tests correctly and to treat patients with antibiotics if the results show it to be necessary. It is true that this would increase the comparatively low level of antibiotics used in Sweden, but the level would still be lower than in many other countries. Moreover, the blood test is the international standard, and in another study, Storscrubb showed that the advantages of treating more patients with antibiotics outweigh the disadvantages.
– We can allow ourselves to increase use of antibiotics in this case, he says.
The laboratory tests that were used in the study consist of a panel of tests that together can show antibodies to Helicobacter pylori (indicating active or previous infection), as well as the degree, if any, of scar formation in the mucous lining of the stomach.
Doctoral dissertation: Helicobacter pylori infection and associated stomach pathology in the adult general population, Tom Storskribb, CeFAM, a collaboration between Karolinska Institutet and Stockholm County Council.
Facts: The bacterium Helicobacter pylori were discovered by Australians Robin Warren and Barry Marshall in 1982. The discovery revolutionized the treatment of ulcers and the understanding of the origin of stomach cancer, and Warren and Marshall were awarded the Nobel Prize in Physiology or Medicine in 2005. A large proportion of the world’s population is infected by Helicobacter pylori, but only a small proportion develops ulcers. In the western world, the number of people who are infected has decreased in tandem with improvements in living conditions, while frequency of infection remains high in poorer and more highly populated parts of the world. Every year, 1000 cases of stomach cancer are diagnosed in Sweden. Of these, at least 700 are caused by a previous Helicobacter pylori infection.