Disease of upper GI: stomach

Question 1

What is the epidemiology of H. pylori infection?

Answer 1

H. pylori is the most common human bacterial infection, with over 50% of the world population infected. Infection typically occurs in childhood and is lifelong. Risk factors are living in densely populated areas and age, as well as living in developed countries. Passage is via oral-oral, anal-oral, or gastric-oral.

Question 2

What is the pathophysiology of H. pylori infection?

Answer 2

H. pylori has several virulence factors that help it survive the environment of the stomach.
Urease + = ammonia secretion raises pH near H. pylori
Corkscrew shape = allows it to penetrate mucosa and colonize surface epithelia
Inflammatory response = Acute neutrophilic and chronic lymphocytic gastritis

Question 3

What is the treatment for H. pylori infection?

Answer 3

Treatment is first “triple therapy”: Proton Pump Inhibitor, clarithromycin, and amoxicillin.
Second round of treatment is “quadruple therapy”: PPI, Bismuth, Tetracycline, and Metronidazole.