00:01
Let us now officially move in to H. pylori.
00:04
Remember that H. pylori is associated in both types of peptic ulcer disease.
00:08
It's a gram negative, comma shaped bacillus. Fecal-oral transmission.
00:14
Prevalence increases with age. 50% infection among the general population greater than 60.
00:21
Extremely common. High prevalence in developing countries, much more so.
00:26
Risk factors include low socio-economic status, increased population, institutionalization.
00:34
And by institutionalization, we mean that we're talking about a patient
who might have had psychiatric issues therefore committed.
00:42
In those closed quarters, pretty sure that your patient will have H. pylori.
00:48
Look for such history in your patient.
00:51
Comma-shaped organism, flagellated.
00:55
It has urease activity so that it can then take the urea, produce the ammonia to protect itself.
01:03
Serology. IgG antibody always remains positive after eradication because this is long-term. IgG.
01:12
Urea breath test is important for diagnosis. High sensitivity and specificity.
01:18
Stop the PPI therapy because this then allows for the H. pylori to actually thrive.
01:27
Biopsy urease test. Instant result, low cost, but requires gastric tissue.
01:35
There is a stool antigen test useful for documentation of eradication.
01:40
Histology. Highest sensitivity and specificity. Tissue culture.
01:48
Cumbersome, used however for unfortunately, antibiotic resistance is part of reality.
01:55
Cumbersome but useful with refractory.
02:00
The combination antibiotic and anti-secretory agents result in eradication
with the high percentage of your patient.
02:07
And it is that simple to be diligent about getting rid of your H. pylori
so that you prevent perhaps cancers from taking place.
02:16
Metronidazole seems to be increasing with resistance.
02:19
Re-infection is always a possibility.
02:23
Not recommended for asymptomatic patients.
02:27
Now, briefly just management with antibiotics.
02:31
Bismuth, metronidazole, tetracycline, PPIs.
02:38
We have Lansoprazole plus Amox or amoxicillin, plus clarithromycin.
02:46
This is known as your PrevPac and the most widely used.
02:50
Please be familiar with one of these regimens
or actually both of these regimens so that you eradicate your H. pylori effectively.
03:01
Associated disease with H. pylori. Both duodenal and gastric ulcers.
03:07
The type of what's known as your chronic atrophic gastritis, chronic atrophic gastritis.
03:18
A Helicobacter will give rise to Type B type of chronic atrophic gastritis.
03:27
The gastric primary adenocarcinoma that you're worried about specifically with H. pylori
is called the intestinal type, not the diffuse.
03:37
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.
03:49
With H. pylori, it will be the intestinal type and it will almost never move.
03:55
Another type of major, major GI cancer that H. pylori is associated with.
04:03
Hence, these two bullet points are huge for you and every form of medicine.
04:09
If you're able to properly get rid of the H. pylori,
you might actually treat and prevent these two major cancers from developing.
04:19
The intestinal type of primary gastric adenocarcinoma number one.
04:23
And number two, we have a lymphoma called the mucosa associated lymphoid tissue-oma.
04:29
It's a lymphoma. Keep that separate from adenocarcinoma.
04:34
Two completely separate different types of cancers that H. pylori very much associated with.