Helicobacter Pylori Infection

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.