That stomach ache could be a pointer to serious infection

The discomfort started like a normal stomach upset on a Friday, late last month.

And he ignored the distress, because, like many Kenyan men, Kelvin’s health-seeking behaviour is reduced to only when the pain is too much to bear.

“I thought the upset was a result of something I ate, therefore it would naturally ease away,” recounts Kelvin.

But the situation got worse with a running stomach and abdominal pains. When he spotted blood in his stool, he contacted a friend, who recommended Flagyl and paracetamol.

“The problem did not go away. Instead, I was getting weak and dehydrated. So I decided to go to the hospital, where I noticed I had lost four kilos.”

The doctor, upon doing a physical exam, put Kelvin on some painkillers and an antibiotic.

TREATMENT

Although the drugs relieved the pain and diarrhoea, he had to return to the hospital where he requested the doctor to test for H. pylori.

He requested the test after a friend, who is a nurse, “recommended it after hearing my symptoms”, Kelvin said.

He has been on H. pylori treatment, commonly known as an Esclam Kit. The 10-day treatment consists of four different medications.

A drug that helps reduce stomach acid production and an antibiotic (amoxicillin) are taken for five days. This is followed by an inhibitor and a combination of two other antibiotics for five more days.

But Kelvin’s case is not isolated, five of his acquaintances are also on Esclam kits.

Many people living in Nairobi are increasingly being diagnosed with Helicobacter Pylori (H. pylori), which has now been flagged as a public health concern.

According to Dr Kimang’a Nyerere, a microbiologist, the bacterium has been spread in the city due to poor sanitation and lack of clean water.

CONTAMINATION

H. pylori is a type of bacteria that interferes with the process that controls how much acid is in the stomach. These germs can enter your body and live in your digestive tract for many years without causing any ailment.

After many years however, they can cause ulcers in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer.

H. pylori is quite common. In fact, it is estimated that about two-thirds of the world’s population has the bacterium.

Often, the bacterium is passed from person to person by faecal contamination in food or water and poor hygiene. H. pylori can also be spread through kissing, Dr Nyerere said.

On whether the germ is common in Nairobi, Dr Nyerere, who is also the chairman of the Department of Medical Microbiology at the College of Health Sciences in JKUAT, agrees.

His team detected high prevalence of the bacterium among patients who went to KNH complaining of dyspepsia — discomfort and pain in the upper abdomen.

“In 2016, my colleagues and I investigated the presence of H. pylori in the water of the Nairobi River basin, which has three major rivers — Ngong, Nairobi, and Mathare,” he said.

PREVALENCE

While Dr Nyerere feels that the infections have increased, Prof Kariuki, who heads Kemri’s microbiology department, thinks otherwise.

In most laboratories, the stool antigen test is a commonly conducted test to determine the bug that is causing illness in the patient, he says.

He explains that sometimes H. pylori may turn positive in tests not because the bacterium could be the reason for the disease at that particular point, but it is ever-present in the samples because one has been repeatedly exposed to it.

“What is not happening is that patients are not being subjected to further confirmatory tests. Instead, they are unnecessarily given Esclam kits, which are very expensive,” said Prof Kariuki, whose sentiments were echoed by Dr Stephen Onyango, a gastroenterologist at KNH.

“The bacteria are very common in almost 80 per cent of the patients we see. But we cannot treat everybody who tests positive. We only treat those who come complaining of hyperacidity and bloating,” he said.

“If you go to a malaria-endemic area and tests people there, they are likely to test positive, even though the parasite doesn’t make them sick,” said Prof Kariuki.

TESTING

He further advised patients to insist on second confirmatory tests should their stool tests give positive results for H. Pylori.

“What is not happening is that patients are not being subjected to further confirmatory tests. Instead, they are unnecessarily given Esclam kits, which are very expensive,” said Prof Kariuki, whose sentiments are echoed by Dr Stephen Onyango, a gastroenterologist at KNH.

Although Dr Kimang’a endorses a test-and-treat strategy, Dr Onyango does not agree.

“The bacteria are very common in almost 80 percent of the patients we see. But we cannot treat everybody who tests positive. We only treat those patients who come to the hospital complaining of hyperacidity and bloating,” said Dr Onyango.