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Helicobacter pylori

Helicobacter pylori (H. pylori) is a spiral shaped, slow growing, microaerophilic bacteria with a gram-negative stain. It is found in the gastric mucus layer, or adherent to the epithelial lining of the stomach. This bacterium most commmonly causes duodenal and gastric ulcers. It can also cause chronic active, chronic persistent, and atrophic gastritis in both adults and children. Also, people with this bacterium have a 2-6 fold increased risk for gastric cancer.

Historical Information

H. pylori was first discovered as a cause to ulcers in 1982 by Robin Warren and Barry Marshall. At first, people didn't believe Drs. Warren and Marshall, so they infected themselves with the bacteria and later developed ulcers. Before this discovery, ulcers were thought to be caused by stress and diet. Treatment was bed rest and change of diet, but there was a high recurrence of ulcers. In 1996, the FDA approved the first antibiotic for treatment for the H. pylori bacterium. In 1997, medical researchers sequenced the genome of H. pylori. This information would be used to further study the bacterium and develope better treatment options.

Epidemiology/Transmission

Worldwide, H. pylori is more prevalent among lower socioeconomic groups. Even though about 2/3 of the world population is infected with this bacterium, most do not show any symptoms. In the US, H.pylori is more commonly seen in adults over 50. There is no known correlation between this infection and gender. Transmision of the disease is not currently known, however, it is believed that it is transmitted through person to person contact. Sanitation seems to play a role in the prevalence of the disease in certain populations.

Symptoms/Diagnosis

There are 3 main ways in which H. pylori can be diagnosed. The simplest and easiest way is by using a C13 orC14 urea test (see below). This is a test in which the patient swallows a small amount of radioactive urea. This urea is excreted in the breath, if H. pylori is present in the patient's stomach then there will be higher levels of urea in the breath of the infected than in people without the bacterium. The second test is a blood test, which doctors use to test for the anibodies that attach themselves to the H. pylori bacterium. The third test is an endoscopy of the esophagus, stomach, and duodenum. During the test a biopsy maybe be performed and this biopsy will be tested for H. pylori.

The most common symptoms of this diesease are gnawing or burning pain in the stomach which typically occur when the stomach is empty or in the early morning hours. The pain may last for minutes or hours and can be relieved by eating or taking antacids. Less common symptoms are nausea, vomiting, loss of appetite, or bleeding. Minimal bleeding may lead to anemia. Excessive bleeding may cause hematemesis, hematochezia, or melena.

Treatment

It has been proven that treatment with antibiotics and an antacid or proton pump inhibitor is the best course of action.

FDA-approved treatment options

Omeprazole 40 mg QD + clarithromycin 500 mg TID x 2 wks, then omeprazole 20 mg QD x 2 wks -OR- Ranitidine bismuth citrate (RBC) 400 mg BID + clarithromycin 500 mg TID x 2 wks, then RBC 400 mg BID x 2 wks -OR- Bismuth subsalicylate (Pepto BismolŪ) 525 mg QID + metronidazole 250 mg QID + tetracycline 500 mg QID* x 2 wks + H2 receptor antagonist therapy as directed x 4 wks -OR- Lansoprazole 30 mg BID + amoxicillin 1 g BID + clarithromycin 500 mg TID x 10 days -OR- Lansoprazole 30 mg TID + amoxicillin 1 g TID x 2 wks** -OR- Rantidine bismuth citrate 400 mg BID + clarithromycin 500 mg BID x 2 wks, then RBC 400 mg BID x 2 wks -OR- Omeprazole 20 mg BID + clarithromycin 500 mg BID + amoxicillin 1 g BID x 10 days -OR- Lansoprazole 30 mg BID + clarithromycin 500 mg BID + amoxicillin 1 g BID x 10 days.

In The News

Here is a fun little public service announcement promoting H. pylori awareness. Copy and paste this into your browser's "Location" bar close to the top of your screen. You need Real Player to view this link. Click on Real Player in the references section if you need Real Player.

http://www.cdc.gov/ncidod/dbmd/psa/hapengt1.ram

Reference not on the web:

Morello, J.A., Mizer, H.E., Wilson, M.E., Granato, P.A., Microbiology in Patient Care, 6th Ed., McGraw-Hill, 1998, pg 339-340

References on the web

The Helicobacter Foundation
Mayo Clinic On-line
Dr. Barry Marshall's Research Site
National Institute of Health
Centers for Disease Control
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Authors of this page

Email: yarmurd12@aol.com