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Helicobacter pylori Helicobacter pylori InfectionInfection

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Helicobacter PyloriHelicobacter Pylori • A bacteria found in the lining of the gastric

system "Helicobacter" is a genus of spiral bacteria that amazingly are able to survive the severe acidity of the stomach.  We have known of the existence of such bacteria since 1889 but it wasn't until nearly 100 years later that the significance of these bacteria was realized.

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Upper gastrointestinal tractUpper gastrointestinal tract

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How is H. pylori Infection How is H. pylori Infection DiagnosedDiagnosed

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Differential diagnosisDifferential diagnosis

• Cholecystitis Cholelithiasis Crohn Disease Esophagitis Gastroesophageal Reflux Pancreatitis and Pancreatic Pseudocyst Peptic Ulcer Disease Zollinger-Ellison Syndrome

•Other Problems to be Considered:

• Eosinophilic gastroenteritisRecurrent functional abdominal painGastritis, atrophicGastritis, chronicGastritis, stress induced

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Causes peptic ulcers

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The InfectionThe Infection

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Figure 1: Antral biopsy showing Figure 1: Antral biopsy showing moderate chronic inflammation and moderate chronic inflammation and

moderate glandular atrophy.moderate glandular atrophy.

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Figure 2: Antral biopsy showing Figure 2: Antral biopsy showing moderate glandular atrophy only moderate glandular atrophy only

without chronic inflammation.without chronic inflammation.

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H.pylori TransmissionH.pylori Transmission

Oral-oral

- Saliva or vomit

Fecal-oral

- Water contaminated with human waste

- Factors linked to poor hygiene

Iatrogenic

- Contaminated endoscopes or pH probes

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Diseases due to Diseases due to Helicobacter pHelicobacter pyloriylori infection infection

• Inflammation of the stomach (gastritis).

• Duodenal ulcer.

• Gastric ulcer.

• Stomach (gastric) cancer.

• Lymphoma.

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Symptoms of Helicobacter pylori Symptoms of Helicobacter pylori bacteriabacteria

• Heart burn

• Belching

• Bloating

• Anorexia

• Abdominal distension

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Investigation of Helicobacter Investigation of Helicobacter InfectionInfection

• Biopsy of the stomach lining. During an upper endoscopy exam, a biopsy of the stomach lining will be collected to test for H. pylori bacteria. A biopsy is the most accurate way to test for H. pylori. It also allows the doctor to check for other possible causes of symptoms (such as cancer). A biopsy is expensive and requires an upper endoscopy exam, which is more invasive than other tests used to detect H. pylori.

• Blood test for H. pylori antibodies. A blood test for H. pylori antibodies is a quick, easy, and inexpensive test to detect them. This blood test may make it possible to avoid having an upper endoscopy exam. However, it cannot distinguish between a past or current infection with H. pylori bacteria; therefore, it is not useful for determining whether an infection has been cured.

• Urea breath test. A urea breath test for H. pylori is very accurate. Unlike the blood test, it will detect only those H. pylori bacteria that are present at the time of the test. This makes it a good test for checking to see whether an H. pylori infection has been cured. The test is somewhat expensive.

• Stool antigen test. This test checks for antigens for H. pylori in the stool. It can be used to diagnose H. pylori bacteria as a cause of peptic ulcer disease and to see whether treatment has eliminated the infection.

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Inclusion Criteria Inclusion Criteria for Endoscopefor Endoscope

• The inclusion criteria conformed with the Rome II diagnostic criteria for functional gastrointestinal disorders

• Persistent or recurrent pain or discomfort centered in the upper abdomen of at least 12 weeks (which need not be consecutive) in the preceding 12 months.

• Pain or discomfort not relieved by defecation or associated with onset of change in stool frequency or stool form.

• No evidence of organic disease from the history, physical examination or laboratory tests that is likely to explain the symptoms.

• No evidence of any mucosal lesion in the oesophagus, stomach or duodenum at upper gastrointestinal endoscopy.

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EndoscopeEndoscope

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Exclusion Criteria Exclusion Criteria for for EndoscopeEndoscope

• Patients whose symptoms were predominantly heart burn and/or regurgitation.

• Patients whose dyspepsia had been investigated previously by radiology, endoscopy or other tests and specific diagnosis established.

• Patients who had used nonsteroidal anti-inflammatory drugs (NSAIDs) in the last 2 weeks prior to endoscopy.

• Attempt at Helicobacter pylori eradication or acid suppressive therapy in the last 2 weeks prior to endoscopy.

• Patients with symptoms suggestive of irritable bowel syndrome i.e., lower abdominal pain or altered bowel habit.

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Drugs Used to Treat Drugs Used to Treat H. pyloriH. pylori Peptic Peptic UlcersUlcers

• Antibiotics: metronidazole, tetracycline, clarithromycin, amoxicillin

• H2 blockers: cimetidine, ranitidine, famotidine, nizatidine

• Proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprozole

• Stomach-lining protector: bismuth subsalicylate

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SUMMARYSUMMARY• Helicobacter pylori, also known as H. pylori, is a bacterium that is com

monly found in the stomach. Most people infected with H. pylori infection have no problems. However, some people develop problems, such as stomach ulcers.

• Ulcers may cause no symptoms, or may cause pain or discomfort (usually in the upper abdomen), bloating, feeling full after eating a small amount of food, lack of appetite, nausea, vomiting, and dark or tar-colored stools. Ulcers that bleed can cause a low blood count.

• H. pylori can be diagnosed with a test of the blood, breath, or stool.• H. pylori testing is recommended for anyone with a stomach ulcer.• Anyone diagnosed with H. pylori should be treated. Treatment helps to

heal the ulcer, lowers the risk that the ulcer will return, and lowers the risk of bleeding from the ulcer.

• Treatment usually includes several medicines. Two medicines are antibiotics that help to kill the bacteria. The other medication causes the stomach to make less acid; lower acid levels help the ulcer to heal.

• Most people are cured after finishing one to two weeks of medicine. About 1 in 5 people need to take another two weeks of medicine. It is important to finish all of the medicine to ensure that the bacteria is killed.

• A breath or stool test is usually done after finishing the medication. This is done to be sure that the bacteria was killed.