Helicobacter Pylori

This is a gram-negative helical bacillus (length 3-6 m, width 0.6 um) which exists on the surface of the stomach mucosa, duodenum or lower esophagus. Bacteria with helical shape and the presence of a few flagella can move in the mucus of the relatively high mobility. It is resistant to the acidic environment of gastric acid - the bacteria created several defense mechanisms against destructive effects of low pH. These include the presence of special enzymes (urease decomposes urea - ammonia neutralizes the hydrochloric acid), structures (proton pump, cilia) and proteins (adhesins, cytotoxins).

Pathogenicity

Infection with this bacterium causes: inflammatory changes in the gastric mucosa (gastritis type B) which may result in disorders of hydrochloric acid secretion (in rare cases to achlorhydrii - this predisposes to the development of stomach cancer), peptic ulcer, increasing the probability of developing the intestinal-type gastric cancer, MALT lymphoma. At present considers the impact of Helicobacter Pylori in pathogenesis of other diseases (asthma, liver cancer, COPD, etc.).

Diagnosis

a) Invasive (gastroscopy with biopsy is gold standard in the diagnosing H. pylori infection):

• urease test - slice of the stomach mucosa is placed on a plate with urea - in the presence of bacteria (and enzyme - urease) plate changes color to red;

• histopathology - microscopic evaluation of the preparation;

• microbiological examination - breeding of bacteria on the media (mostly to perform antibiogram). b) Non-invasive:

• breath test - the patient swallows a specially marked urea, then evaluate the exhaled air (bacterial urease breaks down urea into ammonia and carbon dioxide) and labeled carbon dioxide is detected by the camera;

• serological testing of blood - the search of specific antibodies;

• molecular tests - marking of bacterial DNA.

Indications for treatment (absolute)

Duodenal ulcer, gastric ulcer, gastric ulcer or duodenal ulcer history, previous surgery due to peptic ulcer disease, gastritis, precancerous lesions (e.g. profound atrophic gastritis), resection of the stomach, a history of cancer stomach, removal of polyps, MALT lymphoma, Menetrier disease, dyspepsia, chronic use of NSAIDs, the will of the patient.

Treatment

It is used specific guidelines for the eradication of this bacterium. The primary treatment is triple therapy (proton pump inhibitor plus two antibiotics: clarithromycin or metronidazole or amoxicillin). Also developed treatments of infections with resistant strains.