Med j club nejm h pylori.

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Journal club NEJM H Pylori

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Med j club nejm h pylori.

  1. 1. Prepared by: Dr.Mohammad Shaikhani. MBChB-CABM-FRCP.
  2. 4. Introduction: <ul><li>HP, a gram-negative bacterium found on the luminal surface of the gastric epithelium, first isolated by Warren/ Marshall in </li></ul><ul><li>It induces chronic inflammation of the underlying mucosa. </li></ul><ul><li>The infection is usually contracted in the first few years of life& persist indefinitely unless treated. </li></ul><ul><li>Its prevalence increases with older age&with lower socioeconomic status during childhood& thus varies markedly around the world. </li></ul><ul><li>At least 50% of the world’s population has H. pylori infection. </li></ul><ul><li>The organism can survive in the acidic environment of the stomach partly owing to its remarkably high urease activity; urease converts the urea present in gastric juice to alkaline ammonia& carbon dioxide. </li></ul><ul><li>H. pylori is a cofactor in the development of three important UGl diseases: DU or GU (in 1- 10% of infected patients), gastric cancer (in 0.1- 3%), & gastrice (MALT) lymphoma (in <0.01%). </li></ul>
  3. 5. Introduction: <ul><li>The risk of these disease outcomes in infected patients varies widely among populations. </li></ul><ul><li>The great majority of patients with H. pylori infection will not have any clinically significant complications. </li></ul>
  4. 6. DU: <ul><li>In DU, the inflammation of the gastric mucosa induced by the infection is most pronounced in the non–acid-secreting antral region of the stomach& stimulates the increased release of gastrin. </li></ul><ul><li>The increased gastrin levels in turn st imulate excess acid secretion from the more proximal acid-secreting fundic mucosa, which is relatively free of inflammation. </li></ul><ul><li>The increased duodenal acid load damages the duodenal mucosa, causing ulceration&gastric metaplasia. </li></ul><ul><li>The metaplastic mucosa can then become colonized by H. pylori, which may contribute to the ulcerative process. </li></ul><ul><li>Eradication of the infection provides a long-term cure of duodenal ulcers in more than 80% of patients whose ulcers are not associated with the use of NSAIDs. </li></ul><ul><li>NSAIDs are the main cause of H. pylori–negative ulcers. </li></ul>
  5. 7. GU: <ul><li>Ulceration of the gastric mucosa is believed to be due to the damage to the mucosa caused by H. pylori. </li></ul><ul><li>As with duodenal ulcers, eradicating the infection usually cures the disease, provided that the gastric ulcer is not due to NSAIDs. </li></ul>
  6. 8. Gastric cancer: <ul><li>There is strong associations between H. pylori infection& noncardia gastric cancers (distal to the gastroesophageal junction). </li></ul><ul><li>The infection is classified as a human carcinogen by WHO. </li></ul><ul><li>The risk of cancer is highest among patients in whom the infection induces inf lammat ion of both the antral& fundic mucosa&causes mucosal atrophy& intestinal metaplasia. </li></ul><ul><li>Eradication of H. pylori infection reduces the progression of atrophic gastritis, but there is little evidence of reversal of atrophy or intest inal metaplasia& it remains unclear whether eradication reduces the risk of gastric cancer. </li></ul>
  7. 9. Gastric MALTOMA: <ul><li>There is a strong associations between H. pylori infect ion and the presence of gastric MALT lymphomas&eradication of the infection causes regression of most localized gastric MALT lymphomas. </li></ul>
  8. 10. Others:NUD <ul><li>At least 50% of persons who undergo endoscopy for UGI symptoms have no evidence of esophagitis or DU/GU ( NU or functional dyspepsia)& biopsy of the gastric mucosa often reveal H. pylori& inflammation, </li></ul><ul><li>This f inding is also common in persons without UGIsymptoms. </li></ul><ul><li>Most CRTs of HP trt shown no significant or marginal benefit regarding symptoms </li></ul><ul><li>There is thus little evidence that chronic H. pylori infection in the absence of GU/DU causes UGI symptoms. </li></ul>
  9. 11. Others:GERD <ul><li>The prevalence of H. pylori infection is lower among patients with (GERD)&esophageal adenocarcinoma (which may arise as a complication of GERD) than among healthy controls. </li></ul><ul><li>H. pylori–associated atrophic gastritis, which reduces acid secretion, may provide protection against these diseases. </li></ul><ul><li>A recent meta-analysis showed no significant association between H. pylori eradication&an increased risk of GERD. </li></ul>
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