The role of H pylori in gastrointestinal disease. A guide to identification and eradication

Clinicopathological characteristics of invasive gastric Helicobacter pylori

Helicobacter pylori organisms have been observed deep within the stomach mucosa with an "intracellular" appearance, although the clinicopathological characteristics of such cases remain poorly understood. We analyzed 18 cases of deep mucosal H pylori and associated clinical (sex, age, history of H pylori infection, or proton pump inhibitor [PPI] use, medications, smoking, alcohol use, comorbidities, treatment response) and pathological (presence of lymphoid aggregates, intestinal metaplasia, PPI effect, active and/or chronic inflammation, quantity of invasive versus surface H pylori) characteristics. Electron microscopy was performed on 6 cases with the highest burden of invasive H pylori. Within our sample, 3 of 16 had a history of H pylori infection, 10 of 15 were receiving PPIs at the time of biopsy, and 12 of 13 had a negative posttreatment follow-up. Histology revealed that invasive H pylori were more commonly associated with chronic inflammation, in both the antrum (15/15 chronic, 8/15 acute) and fundus (17/18 chronic, 8/18 acute). Electron microscopy showed organisms within intercellular and luminal spaces, but no intracellular organisms. Deep mucosal H pylori often have an intracellular appearance but are contained within intercellular and luminal spaces and are responsive to standard therapy.

An African perspective on Helicobacter pylori: prevalence of human infection, drug resistance, and alternative approaches to treatment

Helicobacter pylori is a Gram-negative, micro-aerophilic, motile, curved rod that inhabits the gastric mucosa of the human stomach. It chronically infects thousands of millions of people world-wide, and is one of the most genetically diverse of bacterial species. Infection with the bacterium leads to chronic gastritis, peptic ulceration, gastric cancers and gastric mucosa-associated lymphoid-tissue (MALT) lymphoma. The prevalence of infection appears to be partly determined by geographical and socio-demographic factors, being higher in Africa than elsewhere. Current treatment, based on potent combinations that each consist of a proton-pump inhibitor and two antibiotics, is successful in 80%-90% of patients. Some undesirable side-effects, poor patient compliance and drug resistance are, however, associated with significant levels of treatment failure and with contra-indications for some patients. Antibiotic resistance in H. pylori is a growing global concern that merits the urgent attention of public-health authorities. Numerous pieces of clinical evidence have revealed that eradication of the organism from a patient results in improvement of gastritis and drastically decreases the frequency of relapse of gastric and duodenal ulcers. Natural products, including medicinal plants and honey, may offer useful alternatives in the treatment of H. pylori-related infections.

Mucosa-associated lymphoid tissue (MALT) lymphoma

OBJECTIVES

To review the pathogenesis of MALT lymphoma, and the associations with antigenic stimulation, presentation, and unique treatment.

DATA SOURCES

Research and review articles and textbooks.

CONCLUSION

MALT lymphoma is a heterogeneous but unique pathologic form of extranodal B-cell non-Hodgkin's lymphoma. The gastrointestinal tract is the most common site of disease, but involvement of multiple other organ systems has been reported. In the case of gastric MALT lymphomas, H. pylori has been highly implicated as the stimulating agent. Treatment strategies for early disease involve eradication of H. pylori when it is involved and/or radiotherapy, which alone may result in cure of this lymphoma. Chemotherapy is used in more advanced or resistant disease.

IMPLICATIONS FOR NURSING PRACTICE

Nurses play a significant role in the education of patients about this unique malignancy and follow-up regarding compliance with therapy. Attention to social needs of the patients is critical.

Emerging Trends in Peptic Ulcer Disease and Damage Control Surgery in the H. Pylori Era

The prevalence of peptic ulcer disease (PUD) and the frequency of operation have been decreasing for decades. Immigration of patients harboring Helicobacter pylori may reverse these longstanding declines. The experience with a large public hospital population in an area of high immigration may portend future national trends. A 10-year retrospective study analyzed the changing demographics of PUD and the frequency and nature of surgical intervention. A total of 2,182 patients were diagnosed with PUD, 1,173 in the early period (1995–1999) and 1,009 in the recent period (2000–2004). The proportion of Hispanic patients increased from 39.3 per cent to 47.5 per cent ( P = 0.017). The ratio of male to female patients decreased from 1.7:1 to 1.3:1 ( P = 0.003). The PUD operation rate decreased from 6.7 per cent to 3.8 per cent ( P = 0.004). Among operated patients, the frequency of H. pylori testing increased from 41.8 per cent to 81.6 per cent ( P = 0.039). Acute perforation and bleeding necessitated the vast majority (87.2%) of operations. The use of acid-reducing operations declined from 50.6 per cent to 31.6 per cent in favor of nonacid-reducing “damage control” procedures. Contrary to historic trends, in the predominately immigrant public hospital patient population studied, 1) the incidence of PUD is decreasing only modestly, 2) male predominance is disappearing, 3) gastric ulcer (GU) is more prevalent than duodenal ulcer (DU), but DU requires operation more frequently than GU, and 4) there is a marked decrease in use of acid-reducing operations reflecting a new “damage control” surgical approach to acute PUD complications in the H. pylori era.

Refractory iron-deficiency anaemia due to silent Helicobacter pylori gastritis in children

We describe the cases of three children with chronic active Helicobacter pylori gastritis and iron-deficiency anaemia without evidence of oesophagogastrointestinal bleeding. In all cases, long-standing iron supplementation became effective only after eradication of Helicobacter pylori.

CONCLUSION

Iron-deficiency anaemia may be due to clinically inapparent H. pylori gastritis.

Sulforaphane inhibits extracellular, intracellular, and antibiotic-resistant strains of Helicobacter pylori and prevents benzo[a]pyrene-induced stomach tumors

Gastric infection with Helicobacter pylori is a cosmopolitan problem, and is especially common in developing regions where there is also a high prevalence of gastric cancer. These infections are known to cause gastritis and peptic ulcers, and dramatically enhance the risk of gastric cancer. Eradication of this organism is an important medical goal that is complicated by the development of resistance to conventional antimicrobial agents and by the persistence of a low level reservoir of H. pylori within gastric epithelial cells. Moreover, economic and practical problems preclude widespread and intensive use of antibiotics in most developing regions. We have found that sulforaphane [(-)-1-isothiocyanato-(4R)-(methylsulfinyl)butane], an isothiocyanate abundant as its glucosinolate precursor in certain varieties of broccoli and broccoli sprouts, is a potent bacteriostatic agent against 3 reference strains and 45 clinical isolates of H. pylori [minimal inhibitory concentration (MIC) for 90% of the strains is Collapse

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MESH Headings

• Agaricales
• Amoxicillin/pharmacology
• Animals
• Anticarcinogenic Agents/pharmacology
• Benzo(a)pyrene
• Brassica
• Clarithromycin/pharmacology
• Drug Resistance, Microbial
• Female
• Helicobacter pylori/drug effects
• Helicobacter pylori/growth & development
• Helicobacter pylori/isolation & purification
• Humans
• Isothiocyanates
• Metronidazole/pharmacology
• Mice
• Mice, Inbred ICR
• Phytotherapy
• Stomach Neoplasms/chemically induced
• Stomach Neoplasms/microbiology
• Stomach Neoplasms/prevention & control
• Sulfoxides
• Thiocyanates/pharmacology

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Grants

• R01 CA094076 NCI NIH HHS
• CA 94076 NCI NIH HHS

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Affiliation(s)

Jed W Fahey Lewis B. and Dorothy Cullman Cancer Chemoprotection Center, Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, 725 North Wolfe Street, Baltimore, MD 21205-2185, USA.
Xavier Haristoy
Patrick M Dolan
Thomas W Kensler
Isabelle Scholtus
Katherine K Stephenson
Paul Talalay
Alain Lozniewski

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