Helicobacter pylori infections

Helicobacter pylori infections

• 1.
  HELICOBACTER PYLORI INFECTIONS Dr RamanGhimire
• 2.
  OUTLINES • Introduction • Microbiology •Pathogenesis • Indications for tests • Investigations • Treatment guidelines • MCQs
• 3.
  INTRODUCTION • Helicobacter pyloriinfection is the most common bacterial infection worldwide • In developing countries, 70 to 90% of the population carries H. pylori • H pylori may be detected in 90% of individuals with PUD • No specific clinical signs and symptoms have been described • 85% -asymptomatic 10% -peptic ulcer 1% - gastric cancer
• 4.
  • H. pyloriinfection is associated with Idiopathic Thrombocytopenic Purpura ( anti-CagA antibodies that cross-react with platelet antigens) • H. pylori infection is protective against GERD ,Oesophageal CA, Asthma • EXTRA-GASTRIC DISEASES: Parkinsonism, MS, GBS,alzheimer’s Rosacea, Psoriasis ,chronic utricaria IDA, ITP ,B12 def open-angle glaucoma , central serous chorioretinitis , blepharitis CAD, stroke DM, metabolic syndrome NAFLD
• 5.
  Mode of transmission: feco-oral  oral-oral routes  iatrogenic (unsterilized endoscopy equipment) • No substantial reservoir of H. pylori aside from the human stomach • Gastric infection and H. pylori in the mouth (Periodontal disease ) • Dental plaque has been reported to be a reservoir for H. pylori.
• 6.
  MICROBIOLOGY • Gram-negative ,microaerophilic, spiralshaped bacilli • Motile: 4-6 lophotrichous flagella • Demonstrated by Gram stain, Giemsa stain, H&E stain, Warthin– Starry silver stain • Culture: Columbia blood agar, Brucella broth • Produces oxidase, catalase and urease • UREA urease CO2 + AMMONIA
• 7.
  Virulence factors:  cytotoxin-associatedgene A antigen (CagA) cag pathogenicity island (cagPAI): cag A gene + T4SS absent in 40% of strains risk of gastric CA enters the cell: interferes with transduction pathway, antiapoptotic  vacuolating cytotoxin (VacA) coded by Vac A gene absent in 60% of strains induces inflammation $ injury to gastric mucosa  Lipopolysaccharides  Adhesins : Ice A , Bab A, Sap A ,Dup A ,Oip A  Enzymes: Urease, proteinase, mucinase ,lipase
• 8.
  PATHOGENESIS
• 10.
  INDICATION FOR TESTINGH. PYLORI • All patients; with active or past history of PUD (unless previous cure of HPI has been documented), low-grade gastric mucosa-associated lymphoid tissue (MALToma ) history of endoscopic resection of early gastric cancer • Patients with dyspepsia who are undergoing upper endoscopy (gastric biopsy specimens) • Patients on long-term, low-dose aspirin • Patients initiating long-term therapy with NSAIDs • Patients with unexplained iron deficiency anemia following standard workup • Adults with idiopathic thrombocytopenic purpura
• 11.
  • Post-treatment testingto prove eradication of HPI  urea breath test,  fecal antigen test  biopsy-based testing at least 4 weeks following completion of antimicrobial therapy and after proton pump inhibitors have been withheld for 1-2 weeks. American College of Gastroenterology (ACG),2017 guidelines for the treatment of H pylori infection (HPI) include the following recommendations for testing for H pylori [26] :
• 12.
  TESTS FOR H.PYLORI 95-98
• 13.
  1.INVASIVE:  Endoscopy +biopsy sample required  Expensive  Drug sensitivity can be done in Culture  Histology provides additional information about gastric mucosa  Can be used to start antimicrobial therapy and confirm eradication 2.NON-INVASIVE: Easy & cheaper Sample : blood, stool , breath  Can be used to start antimicrobial therapy and confirm eradication except serology test serology test cannot differentiate new or old infection
• 14.
  TREATMENT
• 16.
  MCQs 1. All ofthe following can be used as confirmation for eradication of H. pylori EXCEPT: A. urea breath test B. fecal antigen test C. biopsy-based testing D. serology Ans: D
• 17.
  2. Which ofthe following is true regarding H. pylori A. Gram positive B. Non –motile C. carcinogenic effect via the CagA protein D. Levofloxacin based therapy are not used for treament Ans : C Gram negative ,motile Levofloxacin based therapy is used
• 18.
  REFERENCES • The 2017American College of Gastroenterology (ACG) guidelines for the treatment of H pylori infection (HPI) • Pathogenesis of Helicobacter pylori Infection Johannes G. Kusters,* Arnoud H. M. van Vliet, and Ernst J. Kuipers • Helicobacter pylori: Toward effective eradication Susan Collazo, RN, MSN, ACNP • Diagnosis of Helicobacter pylori by invasive test: histology Ju Yup Lee and Nayoung Kim • Helicobacter pylori infection: Host immune response, implications on gene expression and microRNAs Aline Cristina Targa Cadamuro, Ana Flávia Teixeira Rossi, Nathália Maciel Maniezzo, Ana Elizabete Silva
• 19.
  THANK YOU