Treatment of Helicobacter pylori infection

The article presents information gained from a survey among Norwegian hospitals in March 1997 concerning their treatment of infections with Helicobacter pylori. Altogether 52 hospitals answered the questionnaire. A combination of proton pump inhibitors, metronidazole and clarithromycin was used by 59% as first choice and urea quick test (94%) and urea breath test (42%) as the primary diagnostic procedures, whereas serology was in little use (17%). Besides ordinary ulcer disease, indications for treatment were: ulcer induced by non-steroid anti-inflammatory drugs (79%), gastrooesophageal reflux (37%), non-ulcer dyspepsia (14%) and cancer prophylaxis (14%). The gastro group at the Department of Pharmacotherapeutics at the University of Oslo invited specialists from all health regions to discuss indications for treatment of H pylori, the diagnosis and the role of general practitioners. The extensive use of clarithromycin might be doubtful due to development of resistance. Indications for treatment of H pylori other than ulcer disease and mucosa associated lymphoid tissue lymphoma are still uncertain. Uncritical use of serological tests in primary care should be discouraged. At present there is no uniform strategy for the diagnosis and treatment of H pylori infection, and a coordinated strategy between general practitioners and specialists is needed.     

Helicobacter pylori infection

CHROMagar, a chromogenic differential culture medium, is claimed to facilitate the isolation and presumptive identification of certain clinically important yeast species, e.g., Candida albicans. This study evaluated the cost-effectiveness and time advantage of using it in comparison with Sabouraud dextrose agar (SDA). Three possible pathways, each of which included the use of one or both media, were compared in a routine laboratory. A total of 21 yeast isolates was cultured from 298 clinical samples from neutropenic and AIDS patients. An overall sensitivity of 95.2% was observed for each medium and primary isolation on CHROMagar was found to be 100% sensitive and 100% specific for C. albicans. For identification purposes, after initial culture the use of CHROMagar provided the most economical and least time-consuming method. Direct inoculation on to CHROMagar is recommended for blood cultures when yeast cells are seen on microscopy and where early appropriate therapy is imperative.     

Physiopathology of Helicobacter pylori infection

The gastric juice of Helicobacter pylori-infected individuals contains substantially higher levels of phospholipase A2 (PLA2) than that of individuals who are not infected. We present a new theory for how this H. pylori-induced PLA2 activity in gastric juice may play a major role in the development of peptic ulcer disease. When activated at neutral pH (pH 6.5-7.0), PLA2 may damage the surfactant-like, phospholipid-rich layer which constitutes an important part of the mucus barrier. Pepsin and other proteases, activated at low pH (pH 1.0-3.5), may then denature and cleave PLA2-exposed proteins. Peptic ulcers therefore tend to develop in regions exposed to changing luminal pH, such as the duodenal bulb when acid production is high or normal, or in the stomach when acid secretion is low.     

Helicobacter pylori infection in children

BACKGROUND: Although immigrants to the United States are usually ethnic minorities and socioeconomically disadvantaged, foreign-born women generally have lower rates of low birth weight infants than do US-born women. OBJECTIVE: To measure the relationship between maternal birthplace, ethnicity, and low birth weight infants. DESIGN: Retrospective cohort study of birth certificate data. SETTING: California, 1992. SUBJECTS: Singleton infants (n = 497 868) born to Asian, black, Latina, and white women. MAIN OUTCOME MEASURES: Very low birth weight (500-1499 g), moderately low birth weight (1500-2499 g), and normal birth weight (2500-4000 g, reference category). RESULTS: Foreign-born Latina women generally had less favorable maternal characteristics than US-born Latinas, yet foreign-born Latina women were less likely to have moderately low birth weight infants (odds ratio, 0.91; 95% confidence interval, 0.86-0.96) than US-born Latinas after adjusting for maternal age, education, marital status, parity, tobacco use, use of prenatal care, and gestational age. While foreign-born Asian women generally had a less favorable profile of maternal characteristics than US-born Asians, there was no statistically significant difference in the odds of very low birth weight or moderately low birth weight infants between foreign- and US-born Asian women. Foreign-born black women had more favorable maternal characteristics than US-born women, but there was no significant nativity difference in very low birth weight or moderately low birth weight between foreign- and US-born black women after adjusting for maternal and infant factors. CONCLUSIONS: The relationship between maternal birthplace and low birth weight varies by ethnicity. Further study is needed to understand the favorable pregnancy outcomes of foreign-born Latina women.     

Helicobacter pylori infection and gastrointestinal lymphomas

Primary gastric lymphoma of the MALT (mucosa-associated lymphoid tissue) is nowadays considered a distinct entity with specific morphological, biological and clinical characteristics. In the pathogenesis of gastric MALT lymphoma, Helicobacter pylori infection plays an important conditioning role, In the case of low grade gastric lymphoma of stage E I, eradication of Helicobacter pylori offers a promising therapeutic option.     

Helicobacter pylori infection and gastric secretion

We examined whether an immunosuppressant, FK506, inhibits delayed neuronal death in the gerbil hippocampal CA1 sector after 5-min forebrain ischemia. After reperfusion, gerbils were injected intravenously with FK506. Gerbils in the early injection group were injected with FK506 immediately after reperfusion, and gerbils in the delayed injection group were injected with FK506 1 or 2 h postischemia. The body temperature of the FK506-treated gerbils in the normothermic group was maintained at 37.5-38.0 degrees C for 2 h postischemia. In the chronic survival group, neuroprotection was assessed after recovery for 45 days. Seven or 45 days after reperfusion, neuronal density in the CA1 was assessed following perfusion fixation. FK506 ameliorated cell death in the CA1 in a dose-dependent manner in every group, although it showed a hypothermic effect. FK506 is neuroprotective against forebrain ischemia in gerbils.     

Helicobacter pylori infection in congestive gastropathy

This report describes a family who demonstrated anomalies of tooth form and eruption of the lower second premolar. Observation of the second premolars remaining in the mother's and father's dentitions included ectopic eruption with impaction and substantial spacing between the first and second premolars. Four siblings were also examined--three boys aged 15, 14 and 12 years, and one girl aged 11 years. Anomalies of the second premolar recorded in the males and female include: congenital absence, ectopic eruption with impaction, delayed eruption and spacing. Associated anomalies included: congenital absence of other permanent teeth and spacing. It appears that the defect in tooth form and eruption is of a genetic origin, affecting both males and females. The condition(s) did not appear to be associated with a syndrome and the human papilloma virus lesions noted in all family members were not considered to be related to the dental defects. This family demonstrated two anomalies of the lower second premolar: congenital absence and disturbance in tooth eruption. The question raised by this case report is whether these two anomalies are inherited as separate traits or whether failure of tooth eruption is a variation in expression of the same genetic factor that results in oligodontia.     

Clinical aspects of infection with Helicobacter pylori

About 90% of patients with duodenal ulcer and 65% of those with gastric ulcer are infected with Helicobacter pylori. H. pylori infection can be diagnosed by examination of biopsy material obtained at endoscopy; by 14C or 13C-urea breath tests, or by serological means. The relapse rate of duodenal and gastric ulcers can be considerably reduced if the bacteria are eradicated. Some of the current treatment regimens are discussed.     

Gastric MALT lymphoma and Helicobacter pylori infection

The results of an intensive treatment program for patients 16-60 yr of age with de novo acute myeloid leukemia are presented. The patients were given conventional induction treatment with daunorubicin and cytarabine. Patients not entering complete remission (CR) after 1 course of daunorubicin/cytarabine were given 1 course of amsacrine/etoposide/cytarabine. Those entering complete remission received 3 consolidation courses using mitoxantrone, etoposide, amsacrine and cytarabine. One hundred and eighteen patients were enrolled. Complete remission was attained after 1-2 courses in 90 patients (76%). Another 6 patients reached CR after 3-4 induction courses for a total CR rate of 81%. If feasible, patients were offered either allogeneic or unpurged autologous bone marrow transplantation. Twenty-four patients underwent allogeneic bone marrow transplantation; 15 in first remission, 8 in second remission, 1 in early relapse. Thirty patients below 56 yr of age underwent autologous bone marrow transplantation in first remission. The overall probability of survival at 4 yr was 34%, and for patients below 40 yr of age 50%. Leukemia-free survival was 35% for the whole cohort of patients; 52% for patients below 40 yr of age. Patients undergoing allogeneic or autologous bone marrow transplantation in first remission had an overall survival of 86% and 47%, respectively, while the probability of leukemia-free survival in these groups was 87% vs. 40% at 4 yr. The CR rate and long-term results of this intensive treatment program compare favorably with other recent studies using intensive consolidation with allogeneic or autologous bone marrow transplantation or high dose cytarabine.     

Helicobacter pylori infection in recurrent abdominal pain

The superior and inferior gemellus muscles were examined as to their forms and the patterns of nerve supply in 13 human cadavers (20 specimens). The superior gemellus muscle (Gs) was absent in 3 specimens, but showed no accessory slip or fusion with the internal obturator muscle (Oi). The nerve to the Gs originated from the nerve to the Oi (OiN) in 7, the nerve to the quadratus femoris muscle (QfN) in 4, or both in 6 specimens. The inferior gemellus muscle (Gi) was present in all, but fused with the Oi in 3 specimens. In one specimen, an accessory muscle bundle was observed between the Gi and Oi. The Gi always received branches from the QfN at its anterior surface, but received an additional nerve supply at its posterior surface from the OiN or the pudendal nerve in one specimen each, and the accessory bundle was supplied by a branch from the OiN at its posterior surface. In a well preserved specimen, a branch to the Gi from the QfN entered the Oi and communicated with the OiN after supplying and leaving the Gi. The frequency of the dual innervation of Gs by the OiN and QfN was 29.3%, but that of the Gi and Oi could not be determined, because of the occurrence of the fused part, the accessory bundle and nerve communication. There existed some gross anatomical differences between both gemelli muscles; they are considered to be parts of the internal obturator muscle in a broad sense.     

Vaccine development against infection with Helicobacter pylori

Infection with Helicobacter pylori, is one of the most prevalent infections world-wide, where approximately 50% of adults in the developed world and over 90% of inhabitants in the developing world are infected. Chronic infection with H. pylori is the cause of gastritis, peptic ulcer disease and is a risk factor for gastric adenocarcinoma. Recent studies have demonstrated the suitability of an immunization strategy in the prevention and treatment of H. pylori infection, and the potential for management of disease. Mucosal administration of purified recombinant sub-unit proteins of H. pylori, together with a mucosal adjuvant, has identified urease to be highly efficacious in prophylactic and therapeutic animal model studies, and show partial therapeutic activity in humans. Several other antigens are also effective, and the recent sequencing of the H. pylori genome has led to an intensive effort in antigen discovery. Other research has centered on the identification of novel approaches for delivery, and the immunological mechanisms underlying protective immunity. In this review, preclinical data and the results of early-stage clinical trials and directions for future research on Helicobacter vaccines are described.