The Correlation Between Helicobacter Pylori Infection and Peptic ppt.ppt

7/28/2019 The Correlation Between Helicobacter Pylori Infection and Peptic ppt.ppt

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By: Ivana Putri Oktavia

030.07.123



PEPTIC ULCER DISEASE



Definition

A peptic ulcer is a defect in the lining of the stomachor the first part of the small intestine, an area calledthe duodenum. A peptic ulcer in the stomach is calleda gastric ulcer. An ulcer in the duodenum is called aduodenal ulcer



Epidemiology

Normally, the lining of the stomach and smallintestines have protection against the irritating acidsproduced in the stomach. For a variety of reasons, theprotective mechanisms may become faulty, leading toa breakdown of the lining.



Epidemiology Factors can make person to get an ulcer, including:

• Infection of Helicobacter pylori,

• using NSAIDs,

• alcohol,

• coffee,

• spicy food,

•

smoking cigarettes and using tobacco,• inheritance,

• stress,

• Zollinger Ellison Syndrome.





Diagnosis Clinical manifestation:

• Burning pain is the most common peptic ulcer

symptom Abdominal pain, classically epigastric with severity

relating to mealtimes.

Vomiting may occur with uncomplicated peptic ulcers

but repeated vomiting suggests an ulcer complication



Tests needed to diagnose peptic ulcermay depend on your symptoms and on a medicalhistory and physical exam, for example :

X-ray exam of the esophagus and stomach (upper GIseries)

fecal occult blood test

complete blood count

Endoscopy Blood tests

Urea breath test



Stool antigen test

Tissue tests, tissue tests are usually done using the biopsy sample that is removed with the endoscope. There are

three types of tissue tests: 1. The rapid urease test detects the urease enzyme

2. A histology test allows the doctor to find and examine theactual bacteria;

3. A culture test involves allowing H. pylori to grow in thetissue sample. In diagnosing H. pylori, blood, breath, andstool tests are often done before tissue tests because they are less invasive.



Treatment Antibiotics commonly prescribed for treatment of H.

pylori include amoxicillin, clarithromycin, andmetronidazole.

Acid blockers, include the medications ranitidine,famotidine, cimetidine, and nizatidine



Proton pump inhibitors. These drugs include theprescription medications omeprazole, lansoprazole,rabeprazol, etc. 2

Cytoprotective agents. They include sucralfate andmisoprostol.



Antacids, an antacid may be taken in addition to anacid blocker or in place of one

Surgery is rarely needed to treat peptic ulcer



HELICOBACTER PYLORI INFECTION



Epidemiology About two-thirds of the world's population is infected

with H. pylori. However, most of the infected peopleare asymptomatic, whereas only less than 30% aresymptomatic. Residence in developing countries which transmitted through feco-oral route whereasdeveloped countries through gastro-oral route, poorsosioeconomic conditions and genetic predisposition

are regarded as risk factors. Prevalence of infection ishigher in developing countries and re-infection ishigher among under five children.



Helicobacter pylori is a spiral shaped bacterium thatlives in or on the lining of the stomach. It apparently survives in the forbidding acid environment of thestomach and duodenum by hiding in the mucus andneutralizing stomach acid in its local environment. Itcauses more than 90 percent of ulcers, which are soresin the lining of the stomach or the duodenum



Pathophysiology Host factors Interleukin 1-B is a pro-inflammatory cytokine

and a powerful inhibitor of gastric acid secretion. Hostgenetic factors that affect IL-1B may determine why some

individuals infected with H. pylori develop gastric cancer orulcers while others do not.

Bacterial factors, Virulence factors of H. pylori are: Multiplepolar, sheathed flagella: Corkscrew motility enables

penetration in gastric mucus. Urease: Converts urea intobicarbonate (to CO2) and ammonia, so that can, neutralizethe local acid environment, localized tissue damage.



Prevention Until now, there is no vaccine against H. pylori and the

transmission is not clearly understood. However, it isalways important to make sure all the people noticethese things: Wash hands thoroughly, drink waterfrom a safe source, lifestyle changes, for example eathealthy food such as fruits and vegetables. A diet richin fiber may cut the risk of developing ulcers in half

and speed healing of existing ulcers.

http://www.kidshealth.org/parent/general/sick/hand_washing.html

http://www.kidshealth.org/parent/general/sick/hand_washing.html



Correlation Between Helicobacter

Pylori Infection And Peptic Ulcer

Disease In Elderly Over 55 Years Old



Peptic ulcers can develop in the esophagus, stomach,duodenum, and jejunum (after gastrojejunostomy)and in areas with ectopic gastric mucosa. Althoughthere is an implied pathogenic association with acidand pepsin, present data suggest that there are twocommon types of peptic ulcers: ulcers associated withNSAIDs and those associated with the H. pylori

organism.



The incidence of peptic ulcer has risen with age,possibly because of the increased use of NSAIDs andthe increased prevalence of H. pylori in the elderly.

Helicobacter pylori shows an age-related rise inprevalence. About 40% to 50% of individuals are H.pylori seropositive by the age of 50 years. H. pyloriprevalence reaches 95% in those with duodenal ulcersand 65% in those with gastric ulcers. The mechanismby which this bacteria leads to ulceration is notknown. The organism, or factors released by it, might weaken mucosal defenses.



Elderly patients with peptic ulcer disease usually present with nonspecific abdominal discomfort or marked weightloss, or they may be asymptomatic. Many present for the

first time with complications such as bleeding, perforation,or symptoms of obstruction. Some with chronic blood losspresent with cardiac symptoms such as angina or cardiacfailure. The presence of systemic diseases like chronic

obstructive pulmonary disease (COPD), cardiopulmonary diseases requiring aspirin or anticoagulation for therapy,chronic renal failure, or chronic liver diseases predisposethe elderly to peptic ulcer disease and its complications.



Bleeding is most common and has a higher mortality rate than it does in young patients. Esophageal andgastric cancers also present frequently in the elderly,

and therefore all esophageal and gastric ulcers needendoscopic evaluation, including biopsies and follow-up documentation of healing.



Peptic ulcer disease in the elderly patient is treated usingthe same guidelines as for the young. However, becausemany old patients receive drugs for other systemicconditions, one should also be aware of drug interactions

and side effects. Frail elderly people with multiorgan diseases who are high

surgical risks, those who have had complications, those who have had ulcer disease and need anticoagulation, andthose who have frequent recurrences of ulcers despite

avoiding NSAIDs or eradicating H. pylori can be given aH2-receptor antagonist at bedtime for prophylaxis. Patientsrequiring NSAIDs can be given enteric-coated ones, orconcurrent administration of misoprostol can be tried.



CONCLUSION

The incidence of peptic ulcer has risen with age, possibly because of the increased use of NSAIDs and the increasedprevalence of H. pylori in the elderly. Helicobacter pylori

shows an age-related rise in prevalence. About 40% to 50%of individuals are H. pylori seropositive by the age of 50 years.

Elderly patients with peptic ulcer disease usually present with nonspecific abdominal discomfort or marked weight

loss, or they may be asymptomatic. The tests needed todiagnose peptic ulcer disease may depend on yoursymptoms and on a medical history and physical exam.Eradication of H. pylori requires combination therapy.



REFERENCES

1. Kamani F, Moghimi M, Marashi S, Peyrovi H, Sheikhvatan M. Perforated Peptic Ulcer Dissease.Turk J Gastroent 2010; 21: 125-8.

2. Mustapha SK, Bolori MT, Ajayi NA, Nggada HA. Endoscopic Findings and The Frequency Of Helicobacter Pylori Among Dyspeptic Patients. Intern J Gastroent 2007; 6: 126-9.

3. Atherton JC, Blaser MJ. Coadaptation of Helicobacter pylori and humans. J Clin Invest. 2009; 119:2475-87.

4. Mofleh IA, Rashed RS. Nonsteroidal Antiinflammatory Drug-Induced Gastrointestinal Injuriesand Realated Adverse Reactions. Saudi J Gastroent. 2004; 12: 110-1.5. Le TH. Peptic Ulcer Disease. December 29, 2009 [cited 2012 January 6]. Available:

http://emedicine.medscape.com/article/181753-overview 6. Halber JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S, et al. Helicobacter Pylori.

In: Tinetti ME, High KP, editors. Hazzard’s Geriatric Medicine and Gerontology. 6th ed. New York:McGraw-Hill Companies; 2009; p. 899-903.

7. Doherty GM, Way LW, Albanese CT, Bradford DS, Anderson JT, Brennan DC, et al. Stomach andDuodenum. In: Doherty GM, Way LW, editors. Current Surgical Diagnosis and Treatment. 12th ed.

New York: McGraw-Hill Companies; 2006; p. 508-38.8. Pino DD, Siles M, Lanas A. Ulcer Diagnosis in a Population with High Prevalence of H pylori:

Results. 2005 [cited 2012 January 7]. Available: http://www.medscape.com/viewarticle/498108_3

http://emedicine.medscape.com/article/181753-overview







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The Correlation Between Helicobacter Pylori Infection and Peptic ppt.ppt