A: H. pylori is a germ, a type of bacteria known medically as Helicobacter pylori that infects the stomach. It commonly begins during childhood; it is much less common during adulthood. The condition can be passed from person to person through direct contact with vomit, saliva, fecal matter, and through contaminated food or water. It is quite common and is present in almost half the people in the world. Most individuals are completely unaware they have the condition because they don’t have any symptoms. When symptoms are present, they include weight loss, vomiting, nausea, boating, and abdominal pain anywhere between the breastbone and the navel. The pain may be present when the stomach is empty, may be relieved by eating or taking an antacid, may last briefly or for hours, and may wax and wane.

Complications of the disorder include inflammation of the stomach lining — a condition known as gastritis, ulcers of the small intestine and stomach lining, and stomach cancer. Factors that increase an individual’s risk for H. pylori include living in undeveloped countries, living with someone who already has the infection, living with numerous other people in substandard conditions, not washing or cooking foods properly, drinking water from a source that may contain bacteria, and not having sufficient hot water that will keep the home clean.

Because symptoms can be attributed to countless other conditions, H. pylori is not likely a first consideration for physicians unless the individual has reason to test for it. Laboratory testing might include drawing blood to determine if it is present or has been present in the past; endoscopy that utilizes a flexible tube inserted into the throat, esophagus and into the stomach. A small camera attached to the tubing will allow a physician to view irregularities of the upper digestive tract and, if he or she determines the necessity, a tissue biopsy can be obtained; stool testing that looks for antigens; and lastly, a breath test that contains radioactive carbon molecules.

Treatment is commonly provided with two or even three antibiotics taken simultaneously to help the bacteria present from developing a resistance to one or the other. The doctor may also recommend an acid suppression drug that will allow the lining of the stomach to heal. As you have discovered, therapy may cause nausea, headache, diarrhea, stomach upset, a metallic taste in the mouth, sun sensitivity, and still more. After about four weeks, the doctor will likely order testing once again to determine if the drugs were successful or if a different combination is necessary for control. Blood tests will not be ordered immediately following treatment because a patient’s blood can test positive for H. pylori even following the elimination of the bacteria. And, more than one course of antibiotics may be necessary, since between 80 and 90% of the bacteria can be eradicated, but not 100%. Because you indicate a month has already passed, my guess is that it is time for retesting; however, her doctor may have specific reasons for waiting. Of importance is that the H. pylori blood test is not a good indicator of disease. A large number of patients will test positive for the bacteria and have no disease. Therefore, if symptoms persist, I recommend you touch base with a gastroenterologist for evaluation and possible endoscopy.

Prevention includes washing hands with soap and water frequently, washing and cooking foods properly, and drinking water from a clean source.

DEAR READER: I received three other letters similar to yours. Two of those also mentioned H. Pylori, along with the food allergies and sensitivities.

H. Pylori is a common type of bacteria thought to be present in about half of the world’s population. Most people do not exhibit symptoms, nor do they experience any complications; however, for others, it can lead to potentially serious problems.

Symptoms include weight loss, bloating, nausea, vomiting, frequent burping and an ache or burning pain in the abdomen. Complications include ulcers of the stomach and small intestine, stomach cancer and inflammation of the stomach lining.

Treatment consists of antibiotics and medications to reduce stomach acid. Further testing to determine whether the infection has been eradicated may be recommended.

Food sensitivities are food allergies. The different names come into play because allergies conjure up thoughts of hives, rashes, swollen throats and tongues, and classic allergic reactions. Sensitivities, on the other hand, are often associated with other symptoms, such as gas, bloating, pain, constipation, diarrhea and more. Again, these are just different symptoms caused by the same problem: the body overreacting to a certain substance.

Avoidance of the offending food is the best treatment. Those who experience potentially life-threatening reactions when the offending food is accidentally ingested should use medication such as diphenhydramine or a prescription EpiPen.

To provide related information, I am sending you copies of my Health Reports “Irritable Bowel Syndrome,” “Allergies” and “Managing Chronic Pain.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 (per report) check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

Also, my heart medications are potassium and torsemide. Lately, my feet and ankles are swelling more than usual, and my physician’s assistant wants me to double the torsemide. Would this injure my kidneys? How long is it safe to take? I usually take half a tab, but I would then be taking one whole pill. Is there a way to swallow my larger pills more easily?

DEAR READER: Let’s start at the beginning. H. pylori is a bacterium that infects the beginning of the small intestine or stomach. This bacterium is said to be present in 50 percent of all people worldwide. There are instances when H. pylori is present but there are no symptoms, and a person is completely unaware he or she has it. When symptoms are present, they include weight loss, nausea, vomiting, a burning sensation in the abdomen and more.

H. pylori enters the body through the mouth and passes into the digestive system. In developed countries, infection in children is unusual, but it becomes more common during adulthood. Complications can include inflammation of the stomach lining, certain types of stomach cancer and ulcers in the stomach and small intestines.

There are several tests available for analysis, such as blood and stool testing, breath testing and endoscopy. The latter utilizes a flexible tube with a camera attached that allows a doctor to look for irregularities in the digestive tract and to take biopsies.

Treatment might include medication to reduce stomach acid, H2 blockers such as ranitidine, cimetidine, antibiotics and several others.

Finally, to answer your question, there is no direct connection between H. pylori and the side effect of diarrhea. That said, the bacterium could cause gastritis — inflammation of the stomach lining. Gastritis can be tied in with diarrhea, but I haven’t found a reputable source that lists it as a common symptom.

Torsemide is a diuretic (water pill) that makes the heart’s job easier. Its purpose is to increase urine output. It causes large amounts of potassium to be excreted from the body and is why you have been prescribed potassium. Side effects include headache, stomach upset, blurred vision, loss of appetite, dehydration, dry mouth, heart arrhythmias and constipation or diarrhea. Some of the symptoms are unusual and don’t affect everyone; however, I believe you may have the answer here. Speak with your physician to determine whether he or she can switch you to another diuretic or potassium pill or modify the dosage of your current meds.

This medication can lead to water and mineral depletion, so you should take it as your physician directs for as long as necessary. I am unaware of any issues with long-term use. Your doctor is attempting to reduce the swelling in your feet and ankles; however, I would hate to have your diarrhea become so disruptive as to prevent you from leaving home or causing you to lose control over evacuations.

Pills too large to swallow can be crushed inside a plastic bag before swallowing or taken immersed in a teaspoon of applesauce.

To provide related information, I am sending you a copy of my Health Report “Constipation and Diarrhea.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.