CHAPTER ONE
BACKGROUND OF STUDY

1.1 INTRODUCTION
Helicobacter pylori is a common type of bacteria that grows in the digestive tract and has a tendency to attack the stomach lining. It infects the stomachs of roughly 60 percent of the world’s adult population. H. pylori infections are usually harmless, but they are responsible for the majority of ulcers in the stomach and small intestine. “Helico” means spiral, which indicates that the bacteria are spiral shaped. H. pylori often infect stomach during childhood (Kamboj, 2017).
While infections with this strain of bacteria typically do not cause symptoms, they can lead to diseases in some people, including peptic ulcers, and an inflammatory condition inside the stomach known as gastritis. H. pylori are adapted to live in the harsh, acidic environment of the stomach. These bacteria can change the environment around them and reduce its acidity so they can survive. The spiral shape of H. pylori allows them to penetrate your stomach lining, where they are protected by mucus and the body’s immune cells are not able to reach them. The bacteria can interfere with immune response and ensure that they are not destroyed. This can lead to stomach ulcers (Kamboj, 2017).
It is still not known exactly how H. pylori infections spread. The bacteria have coexisted with humans for many thousands of years. The infections are thought to spread from one person’s mouth to another. They may also be transferred from oral fecal route. This can happen when a person does not wash their hands thoroughly after using the bathroom. H. pylori can also spread through contact with contaminated water or food (Hooi, 2017).
The bacteria are believed to cause stomach problems when they penetrate the stomach’s mucous lining and generate substances that neutralize stomach acids. This makes the stomach cells more vulnerable to the harsh acids. Stomach acid and H. pylori together irritate the stomach lining and may cause ulcers in the stomach or duodenum, which is the first part of small intestine.
Most people with H. pylori do not have any symptoms. When the infection leads to an ulcer, symptoms may include abdominal pain, especially when your stomach is empty at night or a few hours after meals. The pain is usually described as a gnawing pain, and it may come and go. Eating or taking antacid drugs may relieve this pain. A number of other symptoms may be associated with H. pylori infection, including: excessive burping, feeling bloated, nausea, heartburn, fever, lack of appetite, or anorexia, unexplained weight loss, trouble swallowing, anemia and blood in the stool. These are common symptoms that could be caused by other conditions. Some of the symptoms of H. pylori infection are also experienced by healthy people (Hooi, 2017).

Children are more likely to develop an H. pylori infection. Their risk is higher mostly due to lack of proper hygiene. Adults risk for infection partly depends on the environment and living conditions. The risk is higher among people living in a developing country, share housing with others who are infected with H. pylori, live in overcrowded housing, have no access to hot water, which can help to keep areas clean and free from bacteria.
About 10 percent of people infected with H. pylori develop a peptic ulcer, according to the Mayo Clinic. Long-term use of nonsteroidal anti-inflammatories (NSAIDs) also increases the risk of getting a peptic ulcer. H. pylori infections can lead to peptic ulcers, but the infection or the ulcer itself can lead to more serious complications (Everhart, 2000) .These include:
internal bleeding, which can happen when a peptic ulcer breaks through your blood vessel and is associated with iron deficiency anemia
obstruction, which can happen when something like a tumor blocks the food from leaving your stomach perforation, which can happen when an ulcer breaks through your stomach wall peritonitis, which is an infection of the peritoneum, or the lining of the abdominal cavity Studies show that infected people also have an increased risk of stomach cancer. While the infection is a major cause of stomach cancer, most people infected with H. pylori never develop stomach cancer (Mayo Clinic Staff. 2017).

People suffering from H. pylori normally need to take a combination of two different antibiotics, together with another drug that reduces the stomach acid. Lowering stomach acid helps the antibiotics work more effectively. This treatment is sometimes referred to as triple therapy. Some of the drugs that are used in a triple therapy treatment include: clarithromycin, proton-pump inhibitors (PPI), such as lansoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix), or rabeprazole (AcipHex), metronidazole (for 7 to 14 days) and amoxicillin (for 7 to 14 days). In most cases, only one round of antibiotics is needed to clear the infection, but one might need to take more, using different drugs (Hildreth, 2008).
According to the bulletin, Helicobacter pylori and cancer (2013).There is no evidence that food and nutrition play a role in preventing or causing peptic ulcer disease in people infected with H. pylori. However, spicy foods, alcohol, and smoking may worsen a peptic ulcer and prevent it from healing properly. If the infection still persists after one round of treatment, a peptic ulcer could return or, more rarely, stomach cancer could develop. Very few people infected with H. pylori will develop stomach cancer. However, people with a family history of stomach cancer, should get tested and treated for H. pylori infection (Peptic ulcers (stomach ulcers), 2014).

1.2 Significance of the Study
Rural setting sanitary facilities have been indicted as a cheaper source of carrier of Helicobacter pylori and a possible route of transmission to man.
The presence of asymptomatic carriers among students and other rural dwellers makes Helicobacter pylori a serious public health challenge.
Heavy economic losses are incurred due to consistence treatment of the disease cause by Helicobacter pylori.
Helicobacter pylori is a bacterium infection in Ikot Akpaden of Akwa Ibom State and data on the prevalence and diagnostic test kits of peptic Ulcer is limited.

1.3 Aim and Objectives
To determine the prevalence rate of Helicobacter pylori in Ikot Akpaden community of Akwa Ibom State.
To evaluate the effectiveness of serological diagnostic test in the diagnosis of peptic ulcer disease in Akwa Ibom State.
To determine the possible risk factors in transmission of Helicobacter pylori in the Akpaden community through the analysis of participants questionnaire.