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Published on: November 1, 2024
Helicobacter pylori infection
Peter Malfertheiner1,2, M Constanza Camargo3, Emad El-Omar4
1Medical Department II, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany. peter.malfertheiner@med.ovgu.de.
Insights
Helicobacter pylori infection, affecting half the global population, can lead to severe conditions like gastric cancer. Early diagnosis and effective treatment strategies are crucial for managing this persistent bacterial infection.
Area of Science:
- Gastroenterology
- Microbiology
- Infectious Diseases
Background:
- Helicobacter pylori infection is a widespread cause of chronic gastritis, potentially progressing to peptic ulcers, gastric cancer, and MALT lymphoma.
- The bacterium colonizes the stomach's acidic environment through unique virulence factors interacting with host immunity.
- Prevalence varies globally, influenced by sanitation, and infection often occurs in childhood, persisting lifelong if untreated.
Purpose of the Study:
- To review the pathophysiology, diagnosis, and treatment of Helicobacter pylori infection.
- To highlight the link between H. pylori and gastric cancer, emphasizing preventive strategies.
- To address the growing challenge of antibiotic resistance in H. pylori eradication.
Main Methods:
- Literature review of H. pylori pathophysiology, epidemiology, and clinical management.
- Discussion of diagnostic approaches, including invasive (endoscopy) and non-invasive tests (breath, stool, serology).
- Analysis of current treatment regimens involving acid suppressants, antibiotics, and bismuth, alongside emerging resistance issues.
Main Results:
- H. pylori infection's progression to severe gastroduodenal pathologies is linked to bacterial virulence and host response.
- Effective diagnosis relies on a combination of methods tailored to patient history and local resources.
- Antibiotic resistance is a significant concern, necessitating susceptibility testing and antibiotic stewardship.
Conclusions:
- Helicobacter pylori infection is a major risk factor for gastric cancer, underscoring the importance of screening and treatment.
- Managing H. pylori requires a comprehensive approach considering diagnostic accuracy, treatment efficacy, and antimicrobial resistance.
- Continued research and surveillance are vital to combat H. pylori-related diseases and antibiotic resistance.
Abstract:
Helicobacter pylori infection causes chronic gastritis, which can progress to severe gastroduodenal pathologies, including peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. H. pylori is usually transmitted in childhood and persists for life if untreated. The infection affects around half of the population in the world but prevalence varies according to location and sanitation standards. H. pylori has unique properties to colonize gastric epithelium in an acidic environment. The pathophysiology of H. pylori infection is dependent on complex bacterial virulence mechanisms and their interaction with the host immune system and environmental factors, resulting in distinct gastritis phenotypes that determine possible progression to different gastroduodenal pathologies. The causative role of H. pylori infection in gastric cancer development presents the opportunity for preventive screen-and-treat strategies. Invasive, endoscopy-based and non-invasive methods, including breath, stool and serological tests, are used in the diagnosis of H. pylori infection. Their use depends on the specific individual patient history and local availability. H. pylori treatment consists of a strong acid suppressant in various combinations with antibiotics and/or bismuth. The dramatic increase in resistance to key antibiotics used in H. pylori eradication demands antibiotic susceptibility testing, surveillance of resistance and antibiotic stewardship.
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