Helicobacter pylori is a bacterial infection mainly damages the stomach. Barry Marshall and Robin Warren, these scientists discovered Helicobacter pylori in 1982.
It is transmitted through oral-to-oral and fecal-to-oral contact and H pylori patients are asymptomatic in nature, with no specific clinical signs or symptoms.
The commonly observed symptoms are abdominal pain, bloating, loss of appetite and vomiting.
Epidemiology
Approximately 50% of the population is infected with this infection worldwide, but the exact number is not known due to the lack of data from developing countries.
Comparing North America and Western Europe to developing regions like sections of Africa, Asia, and America finds that these tend to have greater incidence rates.
Anatomy
Pathophysiology
H pylori attacks on stomach mucous, which allows it to survive in acidic conditions and produce urease that converts urea into ammonia.
The release of host cytokines by H pylori on direct contact with gastric lining epithelial cells may re-call inflammatory cells in the infected area.
H pylori is a bacterium causes chronic active gastritis in susceptible hosts which lead to duodenal and gastric ulcer disease.
Etiology
The adhesion of bacteria to gastric cells lead to cause tyrosine phosphorylation. H. pylori is a human pathogen, with humans are primary reservoir for this disease.
The study shows that H pylori can adapt to gastric stem cells, which affects their biology and contributes to stomach tumorigenesis.
The binding of H. pylori with gastric cells, it decreases the mucosal levels of glutathione.
Genetics
Prognostic Factors
Individual with squamous cell esophageal cancer and gastric carcinoma shows a poor prognosis. The rate of reinfection is very low, but in children and females it shows a higher incidence rate.
H pylori strains has different virulence due to specific factors, which increase the risk of severe gastric diseases in those carrying factors.
Clinical History
Infection with H. pylori can affect individuals of all age groups, but during childhood it affects more.
Physical Examination
Abdominal Examination
Jaundice assessment
Signs of Systemic Illness
Age group
Associated comorbidity
Associated activity
Acuity of presentation
H pylori infection is a major risk factor for the development of peptic ulcers for gastric and duodenal ulcers.
Individuals with H. pylori may remain asymptomatic and never experience any symptoms of the infection.
Differential Diagnoses
Peptic Ulcer Disease
Gastroesophageal Reflux Disease
Irritable Bowel Syndrome
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Physician should prescribe antibiotic therapy to patients with H pylori. Antibiotics drugs are used as first line and second line to treat H pylori infection.
The duration of treatment usually required 10 to 14 days to recover patient.
Antibiotic treatments are effective in >90% of patients but in some critical cases it shows serious symptoms which are challenging to treat.
Physician should consider therapies like acid suppression therapy, triple therapy and combination therapy as treatment options.
In acid suppression therapy involves use of proton pump inhibitors is combined with antibiotics to enhance treatment efficacy.
The US FDA has approved various internationally accepted therapies for treating H pylori infection in patients with gastric and duodenal peptic ulcer disease.
Patient should regularly wash their hands with soap before and after using toilets, food intake.
Physician and consultants should encourage the patients about good hygiene practices and how to minimize exposure to infectious agents which reduces the risk of H pylori infection.
Enough water and fluids intake on regular basis must be followed by patient during period of recovery which reduces risk of any other complications.
Provide enough education about H pylori and its related causes, how it spreads, and how to stop with management strategies.
Use of Antibiotics in the treatment of H pylori infection
Clarithromycin: It is a semisynthetic macrolide antibiotic binds to the P site of the 50S ribosomal subunit in susceptible organisms potentially inhibiting bacterial growth by dissociating peptidyl tRNA from ribosomes.
Amoxicillin: Amoxicillin a derivative of ampicillin which has a similar antibacterial spectrum to penicillin that targets on gram-positive and gram-negative organisms.
Metronidazole: It may cause DNA damage and disrupt nucleic acid synthesis in H. pylori by bacterial enzymes, that causes bacterial cell death.
Use of proton pump inhibitors in the treatment of H pylori infection
Omeprazole: It is used in H. pylori treatment inhibits the proton pump in gastric parietal cells and reduces gastric acid secretion when combined with antibiotics.
Lansoprazole: It inhibits the proton pump inhibitors in gastric parietal cells, thus reduces gastric acid secretion.
Use of H2 Receptor Blockers in the treatment of H pylori infection
Famotidine: It is less potent than PPIs in suppressing gastric acid, but they provide some acid reduction in H pylori eradication regimens.
Ranitidine: It is used in H. pylori treatment regimens, but their use falls due to concerns about ranitidine-containing products and the availability of other H2 blockers.
Use of Antidiarrheals in the treatment of H pylori infection
Bismuth subsalicylate: It has a cytoprotective effect on the gastrointestinal mucosa, enhances prostaglandin production and regulates the immune response.
Procedures for Helicobacter pylori infection depends on diagnosis, severity assessment, complications identification, and treatment decision-making by physician.
Upper gastrointestinal endoscopy is a diagnostic procedure used to visualize gastric mucosa and obtain biopsy samples for further analysis.
use-of-phases-in-managing-h-pylori-infection
In the initial diagnosis phase, the physician assesses symptoms related to H pylori, then refers to diagnostic testing such as urea breath test, stool antigen test and endoscopic biopsy to confirm the presence of H pylori.
The regular follow-up visits with the physician are required to check the improvement of patients and newly observed complaints along with treatment response.
Long-term management phase is a very important phase which involves continuous monitoring, supportive care, and surveillance for late effects of treatment.
Take four capsules orally, along with food, every 8 hours for a duration of 14 days
Every dose of four capsules comprises of 1000 mg of amoxicillin, 40 mg of omeprazole and 50 mg of rifabutin Dosage Modifications
Severe renal impairment: do not use
Hepatic impairment: do not use Dosing Considerations
In order to minimize the emergence of drug-resistant bacteria and ensure efficacy, it is advisable to conduct culture and susceptibility tests
Take 300 mg one time a day orally r Take 75 mg four times a day orally Note: Commonly employed together with additional medications as an element of triple therapy
Dose instructions based on weight:
15 to <25 kg: 250 mg orally twice a day
25 to <35 kg: 500 mg orally in the morning and evening
>35 kg: 500 mg orally twice a day
Helicobacter pylori infection
In children of 8 years and above:
Bismuth subsalicylate- 525mg(two chewable tablets of 262.4mg), metronidazole- 250mg, tetracycline- 500mg orally every 6 hours along with meals for two weeks
Note: histamine(H2) antagonist should be taken along with the therapy
Note: Contraindicated for use in the pediatric population
Helicobacter pylori is a bacterial infection mainly damages the stomach. Barry Marshall and Robin Warren, these scientists discovered Helicobacter pylori in 1982.
It is transmitted through oral-to-oral and fecal-to-oral contact and H pylori patients are asymptomatic in nature, with no specific clinical signs or symptoms.
The commonly observed symptoms are abdominal pain, bloating, loss of appetite and vomiting.
Approximately 50% of the population is infected with this infection worldwide, but the exact number is not known due to the lack of data from developing countries.
Comparing North America and Western Europe to developing regions like sections of Africa, Asia, and America finds that these tend to have greater incidence rates.
H pylori attacks on stomach mucous, which allows it to survive in acidic conditions and produce urease that converts urea into ammonia.
The release of host cytokines by H pylori on direct contact with gastric lining epithelial cells may re-call inflammatory cells in the infected area.
H pylori is a bacterium causes chronic active gastritis in susceptible hosts which lead to duodenal and gastric ulcer disease.
The adhesion of bacteria to gastric cells lead to cause tyrosine phosphorylation. H. pylori is a human pathogen, with humans are primary reservoir for this disease.
The study shows that H pylori can adapt to gastric stem cells, which affects their biology and contributes to stomach tumorigenesis.
The binding of H. pylori with gastric cells, it decreases the mucosal levels of glutathione.
Individual with squamous cell esophageal cancer and gastric carcinoma shows a poor prognosis. The rate of reinfection is very low, but in children and females it shows a higher incidence rate.
H pylori strains has different virulence due to specific factors, which increase the risk of severe gastric diseases in those carrying factors.
Infection with H. pylori can affect individuals of all age groups, but during childhood it affects more.
Abdominal Examination
Jaundice assessment
Signs of Systemic Illness
H pylori infection is a major risk factor for the development of peptic ulcers for gastric and duodenal ulcers.
Individuals with H. pylori may remain asymptomatic and never experience any symptoms of the infection.
Peptic Ulcer Disease
Gastroesophageal Reflux Disease
Irritable Bowel Syndrome
Physician should prescribe antibiotic therapy to patients with H pylori. Antibiotics drugs are used as first line and second line to treat H pylori infection.
The duration of treatment usually required 10 to 14 days to recover patient.
Antibiotic treatments are effective in >90% of patients but in some critical cases it shows serious symptoms which are challenging to treat.
Physician should consider therapies like acid suppression therapy, triple therapy and combination therapy as treatment options.
In acid suppression therapy involves use of proton pump inhibitors is combined with antibiotics to enhance treatment efficacy.
The US FDA has approved various internationally accepted therapies for treating H pylori infection in patients with gastric and duodenal peptic ulcer disease.
Gastroenterology
Patient should regularly wash their hands with soap before and after using toilets, food intake.
Physician and consultants should encourage the patients about good hygiene practices and how to minimize exposure to infectious agents which reduces the risk of H pylori infection.
Enough water and fluids intake on regular basis must be followed by patient during period of recovery which reduces risk of any other complications.
Provide enough education about H pylori and its related causes, how it spreads, and how to stop with management strategies.
Gastroenterology
Clarithromycin: It is a semisynthetic macrolide antibiotic binds to the P site of the 50S ribosomal subunit in susceptible organisms potentially inhibiting bacterial growth by dissociating peptidyl tRNA from ribosomes.
Amoxicillin: Amoxicillin a derivative of ampicillin which has a similar antibacterial spectrum to penicillin that targets on gram-positive and gram-negative organisms.
Metronidazole: It may cause DNA damage and disrupt nucleic acid synthesis in H. pylori by bacterial enzymes, that causes bacterial cell death.
Omeprazole: It is used in H. pylori treatment inhibits the proton pump in gastric parietal cells and reduces gastric acid secretion when combined with antibiotics.
Lansoprazole: It inhibits the proton pump inhibitors in gastric parietal cells, thus reduces gastric acid secretion.
Gastroenterology
Famotidine: It is less potent than PPIs in suppressing gastric acid, but they provide some acid reduction in H pylori eradication regimens.
Ranitidine: It is used in H. pylori treatment regimens, but their use falls due to concerns about ranitidine-containing products and the availability of other H2 blockers.
Gastroenterology
Bismuth subsalicylate: It has a cytoprotective effect on the gastrointestinal mucosa, enhances prostaglandin production and regulates the immune response.
Gastroenterology
Procedures for Helicobacter pylori infection depends on diagnosis, severity assessment, complications identification, and treatment decision-making by physician.
Upper gastrointestinal endoscopy is a diagnostic procedure used to visualize gastric mucosa and obtain biopsy samples for further analysis.
Gastroenterology
In the initial diagnosis phase, the physician assesses symptoms related to H pylori, then refers to diagnostic testing such as urea breath test, stool antigen test and endoscopic biopsy to confirm the presence of H pylori.
The regular follow-up visits with the physician are required to check the improvement of patients and newly observed complaints along with treatment response.
Long-term management phase is a very important phase which involves continuous monitoring, supportive care, and surveillance for late effects of treatment.
Helicobacter pylori is a bacterial infection mainly damages the stomach. Barry Marshall and Robin Warren, these scientists discovered Helicobacter pylori in 1982.
It is transmitted through oral-to-oral and fecal-to-oral contact and H pylori patients are asymptomatic in nature, with no specific clinical signs or symptoms.
The commonly observed symptoms are abdominal pain, bloating, loss of appetite and vomiting.
Approximately 50% of the population is infected with this infection worldwide, but the exact number is not known due to the lack of data from developing countries.
Comparing North America and Western Europe to developing regions like sections of Africa, Asia, and America finds that these tend to have greater incidence rates.
H pylori attacks on stomach mucous, which allows it to survive in acidic conditions and produce urease that converts urea into ammonia.
The release of host cytokines by H pylori on direct contact with gastric lining epithelial cells may re-call inflammatory cells in the infected area.
H pylori is a bacterium causes chronic active gastritis in susceptible hosts which lead to duodenal and gastric ulcer disease.
The adhesion of bacteria to gastric cells lead to cause tyrosine phosphorylation. H. pylori is a human pathogen, with humans are primary reservoir for this disease.
The study shows that H pylori can adapt to gastric stem cells, which affects their biology and contributes to stomach tumorigenesis.
The binding of H. pylori with gastric cells, it decreases the mucosal levels of glutathione.
Individual with squamous cell esophageal cancer and gastric carcinoma shows a poor prognosis. The rate of reinfection is very low, but in children and females it shows a higher incidence rate.
H pylori strains has different virulence due to specific factors, which increase the risk of severe gastric diseases in those carrying factors.
Infection with H. pylori can affect individuals of all age groups, but during childhood it affects more.
Abdominal Examination
Jaundice assessment
Signs of Systemic Illness
H pylori infection is a major risk factor for the development of peptic ulcers for gastric and duodenal ulcers.
Individuals with H. pylori may remain asymptomatic and never experience any symptoms of the infection.
Peptic Ulcer Disease
Gastroesophageal Reflux Disease
Irritable Bowel Syndrome
Physician should prescribe antibiotic therapy to patients with H pylori. Antibiotics drugs are used as first line and second line to treat H pylori infection.
The duration of treatment usually required 10 to 14 days to recover patient.
Antibiotic treatments are effective in >90% of patients but in some critical cases it shows serious symptoms which are challenging to treat.
Physician should consider therapies like acid suppression therapy, triple therapy and combination therapy as treatment options.
In acid suppression therapy involves use of proton pump inhibitors is combined with antibiotics to enhance treatment efficacy.
The US FDA has approved various internationally accepted therapies for treating H pylori infection in patients with gastric and duodenal peptic ulcer disease.
Gastroenterology
Patient should regularly wash their hands with soap before and after using toilets, food intake.
Physician and consultants should encourage the patients about good hygiene practices and how to minimize exposure to infectious agents which reduces the risk of H pylori infection.
Enough water and fluids intake on regular basis must be followed by patient during period of recovery which reduces risk of any other complications.
Provide enough education about H pylori and its related causes, how it spreads, and how to stop with management strategies.
Gastroenterology
Clarithromycin: It is a semisynthetic macrolide antibiotic binds to the P site of the 50S ribosomal subunit in susceptible organisms potentially inhibiting bacterial growth by dissociating peptidyl tRNA from ribosomes.
Amoxicillin: Amoxicillin a derivative of ampicillin which has a similar antibacterial spectrum to penicillin that targets on gram-positive and gram-negative organisms.
Metronidazole: It may cause DNA damage and disrupt nucleic acid synthesis in H. pylori by bacterial enzymes, that causes bacterial cell death.
Omeprazole: It is used in H. pylori treatment inhibits the proton pump in gastric parietal cells and reduces gastric acid secretion when combined with antibiotics.
Lansoprazole: It inhibits the proton pump inhibitors in gastric parietal cells, thus reduces gastric acid secretion.
Gastroenterology
Famotidine: It is less potent than PPIs in suppressing gastric acid, but they provide some acid reduction in H pylori eradication regimens.
Ranitidine: It is used in H. pylori treatment regimens, but their use falls due to concerns about ranitidine-containing products and the availability of other H2 blockers.
Gastroenterology
Bismuth subsalicylate: It has a cytoprotective effect on the gastrointestinal mucosa, enhances prostaglandin production and regulates the immune response.
Gastroenterology
Procedures for Helicobacter pylori infection depends on diagnosis, severity assessment, complications identification, and treatment decision-making by physician.
Upper gastrointestinal endoscopy is a diagnostic procedure used to visualize gastric mucosa and obtain biopsy samples for further analysis.
Gastroenterology
In the initial diagnosis phase, the physician assesses symptoms related to H pylori, then refers to diagnostic testing such as urea breath test, stool antigen test and endoscopic biopsy to confirm the presence of H pylori.
The regular follow-up visits with the physician are required to check the improvement of patients and newly observed complaints along with treatment response.
Long-term management phase is a very important phase which involves continuous monitoring, supportive care, and surveillance for late effects of treatment.
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