©2018 Mahoning Valley Water Inc.  New Evidence Linking Drinking Water to Stomach Ulcers An update on Helicobacter pylori By Kelly A. Reynolds, Ph.D.       Helicobacter pylori (H. pylori) is a spiral shaped bacterium that makes its home in the gastric mucous lining, or the cell lining, of the human stomach.  As the bacteria colonize the stomach, the lining is weakened and vulnerable to irritation from natural stomach acids.  The result  —  an ulcer.      Prior to its discovery, ulcers were thought to be caused by stress or spicy foods. Research has now shown that H. pylori causes about nine out of 10 duodenal ulcers, and more than eight of 10 gastric ulcers.  A clear link has been established associating long-term infection with H. pylori to the development of gastric cancer, the second most common cancer worldwide.  Such cancer is especially prevalent in Columbia and China where H. pylori is found to infect over half of the population in early childhood.  The CDC has launched a campaign educating the public that ulcers are a curable infection. Population at risk       Approximately two-thirds of the world’s population is infected with H. pylori.  An estimated 2.5 million new H. pylori infections occur each year in the United States.  Approximately 16,000 people die annually from the affliction.      In countries with poor sanitation, 90 percent of the adult population are infected with H. pylori.  About 30—60 percent of the people in the United States, Europe and Australia harbor H. pylori in their stomachs.  In the United States, H. pylori is more prevalent among older adults, African Americans, Hispanics and lower socioeconomic groups.  In underdeveloped areas, infections are more commonly found in children whose mothers and/or older siblings were infected.  Children attending nursery school were also more likely to become infected.  H. pylori is primarily acquired in infancy (under 2 years of age).      Most infections of H. pylori are chronic and asymptomatic, with an estimated one in six actually developing ulcers.  Symptoms range from nausea and vomiting to bloating and abdominal pain.  Diagnosis of the infection is achieved by a blood antibody test, urease breath test or gastrointestinal endoscopy and biopsy.      While five H. pylori treatment regimens have been approved by the FDA, certain strains of the organism have developed resistance to one or more antibiotic treatments.  The highest treatment success rates (70—90 percent cured) have been found from a three-drug regimen.  Evidence of waterborne route      Researchers have looked for H. pylori in tap and well water, cow feces, flies, and field soil samples in Japan, where the evidence of infection was high.  All sample categories were found to harbor the bacterium.  The primary transmission route has yet to be determined.  Also a mystery is why some infections manifest as clinical symptoms, while others go unnoticed.     The bacteria are most likely spread via person-to-person either through the fecal-oral or oral-oral routes.  Successful isolation of H. pylori from stools of infected people is evidence of a likely fecal-oral route, where contaminated food and water are suspected reservoirs.  Increased prevalence of infection has been associated with consumption of food from street vendors, suggesting that improperly prepared foods may play a role in transmission of H. pylori infections.       In addition, H. pylori has been found in more than 75 percent of tested surface water samples, indicating that the organism is pervasive in drinking water sources.  Interviews with residents that drank water from private, untreated well supplies revealed there was a significant correlation between presence of H. pylori and cases of stomach ulcers.  Once in the stomach, H. pylori may be transmitted to the mouth via reflux action where a portion of the stomach’s contents is forced up the esophagus.  The organism has been isolated from dental plaque of 30 percent of people with gastric infection. Monitoring difficulties      Methods for direct culture detection of H. pylori haven’t been fully developed.  This pathogen can change its cell morphology, metabolism and growth patterns when exposed to different stimuli which make it capable of eluding conventional culture analysis.  Non-cultural methods of detection may be used such as microscopy or molecular methodologies, but these are often limited by interfering compounds.  In addition, they don’t determine if the organism is viable, and thus a threat to humans.       The water industry has relied on bacterial indicators—coliform bacteria– to evaluate the safety of source waters for decades.  Unfortunately, H. pylori is commonly found in waters where coliform indicators were absent.  The high prevalence of H. pylori indicate an urgent need for the development of rapid, specific and reliable detection methods in order to evaluate the potential impact of the waterborne role in H. pylori infections. A need for water treatment      The good news is that H. pylori is sensitive to conventional methods of water treatment (i.e. chlorination) and thus isn’t thought to be a problem with properly treated water supplies.  In addition, proper antibiotic treatment can completely eradicate the organism, with little chance of its reoccurrence.  Preventative programs of vaccination in early childhood may be available in the future.  Conclusion      Since the source of H. pylori is still under investigation, the CDC recommends that people continue to practice methods of good hygiene by washing hands frequently and thoroughly, eating food that has been properly prepared and drinking water from a safe, clean source.  Stomach cancer in the United States is now one-fourth as common as it was in 1930.  Improved sanitation and water treatments are thought to be the main reasons for the reductions.        Reprinted with permission of Water Conditioning & Purification Magazine© Sept. 2000.  Any reuse or republication in part or whole, must be with the written consent of the Publisher. MAHONING VALLEY WATER