Let us now officially move in to H. pylori.
Remember that H. pylori is associated in both types
of peptic ulcer disease. It's a gram negative,
comma shaped bacillus. Fecal−oral transmission.
Prevalence increases with age. 50% infection
among the general population greater than 60.
Extremely common. High prevalence in developing countries,
much more so. Risk factors include low socio−economic
status, increased population, institutionalization.
And by institutionalization, we mean that we're
talking about a patient who might have had psychiatric
issues therefore committed. In those closed quarters,
pretty sure that your patient will have H. pylori.
Look for such history in your patient.
Comma−shaped organism, flagellated. It has urease
activity so that it can then take the urea,
produce the ammonia to protect itself. Serology. IgG
antibody always remains positive after eradication
because this is long−term. IgG. Urea breath test is
important for diagnosis. High sensitivity and specificity.
Stop the PPI therapy because this then allows for the
H. pylori to actually thrive. Biopsy urease test.
Instant result, low cost, but requires gastric tissue.
Three major laboratory exams in which you can
confirm your H. pylori or confirm the existence of
it somewhere in your GI tract. There is a
stool antigen test useful for documentation of eradication.
Histology. Highest sensitivity and specificity.
Tissue culture. Cumbersome, used however for
unfortunately, antibiotic resistance is part of reality.
Cumbersome but useful with refractory. The combination
antibiotic and anti−secretory agents result in
eradication with the high percentage of your patient.
And it is that simple to be diligent about
getting rid of your H. pylori so that you prevent
perhaps cancers from taking place. Metronidazole
seems to be increasing with resistance. Re−infection
is always a possibility. Not recommended for
asymptomatic patients. Now, briefly just management
with antibiotics. Bismuth, metronidazole, tetracycline,
H2 blockers. PPIs? No. We have Lansoprazole plus
Amox(amoxicillin) plus clarithromycin.
This is known as your PrevPac and the most widely
used. Please be familiar with one of these regimens
or actually both of these regimens so that
you eradicate your H. pylori effectively.
Associated disease with H. pylori. Both duodenal and
gastric ulcers. The type of what's known as your
chronic atrophic gastritis, chronic atrophic gastritis.
A Helicobacter will give rise to Type B type of
chronic atrophic gastritis. The gastric primary
adenocarcinoma that you’re worried about specifically
with H. pylori is called the intestinal type, not
the diffuse. So whenever you hear about signet−ring
cells that are found in the ovaries, hematogenous
metastasis of, that’s a diffuse type of gastric
adenocarcinoma. With H. pylori, it will be the
intestinal type and it will almost never move.
Another type of major, major GI cancer that H. pylori
is associated with. Hence, these two bullet points
are huge for you and every form of medicine.If
you’re able to properly get rid of the H. pylori,
you might actually treat and prevent these two major
cancers from developing. The intestinal type of
primary gastric adenocarcinoma number one.
And number two, we have a lymphoma called the
mucosa associated lymphoid tissue−oma. It's a
lymphoma. Keep that separate from adenocarcinoma.
Two completely separate different types of
cancers that H. pylori very much associated with.