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==Overview== | ==Overview== | ||
If left untreated, ''[[H. pylori]]'' infection may progress to develop [[gastritis]] which can be [[acute]] or [[chronic]], [[peptic ulcer disease]], [[adenocarcinoma]] and [[MALT lymphoma]]. Common complications of the [[infection]] include [[Gastric ulcer|gastric]], [[duodenal ulcer|duodenal ulcers]], [[gastric adenocarcinoma]], [[MALT lymphoma]], [[pseudomembranous colitis]] following ''[[H. pylori]]'' treatment, [[B12 deficiency|B12]] and [[iron deficiency anemia]]. Prognosis is generally regarded as good. It is associated with less than 1% risk of gastric [[MALT lymphoma]] and 1-2% lifetime risk of [[stomach cancer]]. | |||
==Natural History== | ==Natural History== | ||
If left untreated, H.pylori infection may progress to develop | If left untreated, ''[[H. pylori]]'' infection may progress to develop | ||
*Gastritis which can be acute or chronic | *[[Gastritis]] which can be [[acute]] or [[chronic]] | ||
*Peptic ulcer disease | *[[Peptic ulcer disease]] | ||
*Adenocarcinoma | *[[Adenocarcinoma]] | ||
*MALT | *[[MALT lymphoma]] | ||
==Complications== | ==Complications== | ||
Common complications of H.pylori infection include:<ref name="pmid21180540">{{cite journal| author=Hung IF, Wong BC| title=Assessing the risks and benefits of treating Helicobacter pylori infection. | journal=Therap Adv Gastroenterol | year= 2009 | volume= 2 | issue= 3 | pages= 141-7 | pmid=21180540 | doi=10.1177/1756283X08100279 | pmc=3002520 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21180540 }} </ref> | Common complications of ''[[H. pylori]]'' infection include:<ref name="pmid21180540">{{cite journal| author=Hung IF, Wong BC| title=Assessing the risks and benefits of treating Helicobacter pylori infection. | journal=Therap Adv Gastroenterol | year= 2009 | volume= 2 | issue= 3 | pages= 141-7 | pmid=21180540 | doi=10.1177/1756283X08100279 | pmc=3002520 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21180540 }} </ref> | ||
*Gastric and duodenal ulcers | *[[Gastric ulcer|Gastric]] and [[duodenal ulcer|duodenal ulcers]] | ||
*Gastric adenocarcinoma | *[[Gastric adenocarcinoma]] | ||
*MALT lymphoma | *[[MALT lymphoma]] | ||
*Pseudomembranous colitis following H.pylori treatment | *[[Pseudomembranous colitis]] following ''[[H. pylori]]'' treatment | ||
*[[B12 deficiency|B12]] and [[iron deficiency anemia]] | |||
===Post Treatment Complications=== | ===Post Treatment Complications=== | ||
====Clostridium difficile infection==== | ====Clostridium difficile infection==== | ||
Pseudomembranous colitis following H.pylori infection eradication treatment is very rarely reported due to following reasons: | For further information on ''[[C. diff]]'' infection please click [[Clostridium difficile infection|here]] | ||
[[Pseudomembranous colitis]] following ''[[H. pylori]]'' infection eradication treatment is very rarely reported due to following reasons: | |||
*Short duration of the therapy | *Short duration of the therapy | ||
*All treatments are carried out in outpatient (hospitalization is the risk factor for C.difficile infection) | *All treatments are carried out in outpatient (hospitalization is the risk factor for ''[[C. difficile]]'' infection) | ||
*The use of metronidazole in the triple drug therapy (an efficient drug against | *The use of [[metronidazole]] in the triple drug therapy (an efficient drug against ''[[C. difficile]]'')<ref name="pmid9627163">{{cite journal| author=Archimandritis A, Souyioultzis S, Katsorida M, Tzivras M| title=Clostridium difficile colitis associated with a 'triple' regimen, containing clarithromycin and metronidazole, to eradicate Helicobacter pylori. | journal=J Intern Med | year= 1998 | volume= 243 | issue= 3 | pages= 251-3 | pmid=9627163 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9627163 }} </ref><ref name="pmid9672359">{{cite journal| author=Nawaz A, Mohammed I, Ahsan K, Karakurum A, Hadjiyane C, Pellecchia C| title=Clostridium difficile colitis associated with treatment of Helicobacter pylori infection. | journal=Am J Gastroenterol | year= 1998 | volume= 93 | issue= 7 | pages= 1175-6 | pmid=9672359 | doi=10.1111/j.1572-0241.1998.00358.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9672359 }} </ref> | ||
*Most of the mild | *Most of the mild ''[[C. difficile]]'' cases are most likely not diagnosed, because either the physician do not suspect the development of ''[[C. difficile]]'' infection or the patient do not consult the physician.<ref name="pmid11433206">{{cite journal| author=Harsch IA, Hahn EG, Konturek PC| title=Pseudomembranous colitis after eradication of Helicobacter pylori infection with a triple therapy. | journal=Med Sci Monit | year= 2001 | volume= 7 | issue= 4 | pages= 751-4 | pmid=11433206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11433206 }} </ref> | ||
Despite under-reporting of C. | Despite under-reporting of ''[[C. difficile]]'' infection post-treatment, the following components of ''[[H. pylori]]'' treatment contribute to development of [[pseudomembranous colitis]]: | ||
# '''Proton pump inhibitors and C. | # '''Proton pump inhibitors and C.difficile infection''' | ||
:*PPIs facilitate the growth of C. | :*[[Proton pump inhibitor|PPIs]] facilitate the growth of ''[[C. difficile]]'' by raising the [[pH]], preventing the gastric contents from killing ingested ''[[C. difficile]]''.<ref name="pmid12855243">{{cite journal| author=Cunningham R, Dale B, Undy B, Gaunt N| title=Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. | journal=J Hosp Infect | year= 2003 | volume= 54 | issue= 3 | pages= 243-5 | pmid=12855243 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12855243 }} </ref> | ||
:*The elevated gastric pH allow conversion of spores to vegetative cells that ultimately produce toxins.<ref name="pmid22147824">{{cite journal| author=Bobo LD, Dubberke ER, Kollef M| title=Clostridium difficile in the ICU: the struggle continues. | journal=Chest | year= 2011 | volume= 140 | issue= 6 | pages= 1643-53 | pmid=22147824 | doi=10.1378/chest.11-0556 | pmc=3231962 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22147824 }} </ref> | :*The elevated gastric pH allow conversion of spores to vegetative cells that ultimately produce toxins.<ref name="pmid22147824">{{cite journal| author=Bobo LD, Dubberke ER, Kollef M| title=Clostridium difficile in the ICU: the struggle continues. | journal=Chest | year= 2011 | volume= 140 | issue= 6 | pages= 1643-53 | pmid=22147824 | doi=10.1378/chest.11-0556 | pmc=3231962 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22147824 }} </ref> | ||
:*The risk of developing C. | :*The risk of developing ''[[C. difficile]]'' infection increases when the duration of the [[PPI]] therapy exceeds two or more days. | ||
:*The US food and drug administration (FDA) announced that the use of PPIs may be associated with an increased risk of | :*The US food and drug administration (FDA) announced that the use of [[Proton pump inhibitor|PPIs]] may be associated with an increased risk of ''[[C. difficile]]'' associated [[diarrhea]]. Hence a diagnosis of ''[[C. difficile]] is considered in patients taking [[Proton pump inhibitor|PPIs]] who develop [[diarrhea]] that does not improve.<ref name="FDA">C.difficile http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm (February 8, 2012) Accessed on January 18, 2017 </ref> | ||
# '''Antibiotics and C.diff infection''' | # '''Antibiotics and C.diff infection''' | ||
:*The antibiotics used disturb the normal colonic bacterial flora which promotes the growth of | :*The [[antibiotics]] used disturb the normal colonic bacterial flora which promotes the growth of ''[[C. difficile]]'' and the release of [[toxins]] leads to mucosal inflammation and damage.<ref name="pmid9672359">{{cite journal| author=Nawaz A, Mohammed I, Ahsan K, Karakurum A, Hadjiyane C, Pellecchia C| title=Clostridium difficile colitis associated with treatment of Helicobacter pylori infection. | journal=Am J Gastroenterol | year= 1998 | volume= 93 | issue= 7 | pages= 1175-6 | pmid=9672359 | doi=10.1111/j.1572-0241.1998.00358.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9672359 }} </ref> | ||
:*Amoxicillin and clarithromycin used in the treatment of H.pylori infection may lead to | :*[[Amoxicillin]] and [[clarithromycin]] used in the treatment of ''[[H. pylori]]'' infection may lead to ''[[C. difficile]]'' infection.<ref name="pmid24259981">{{cite journal| author=Trifan A, Girleanu I, Cojocariu C, Sfarti C, Singeap AM, Dorobat C et al.| title=Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 42 | pages= 7476-9 | pmid=24259981 | doi=10.3748/wjg.v19.i42.7476 | pmc=3831232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24259981 }} </ref> | ||
:*These antibiotics decrease the total count of anaerobes (normal flora) in the gut leading to overgrowth of | :*These [[antibiotics]] decrease the total count of [[anaerobes]] (normal flora) in the gut leading to overgrowth of ''[[C. difficile]]''.<ref name="pmid7743311">{{cite journal| author=Teare JP, Booth JC, Brown JL, Martin J, Thomas HC| title=Pseudomembranous colitis following clarithromycin therapy. | journal=Eur J Gastroenterol Hepatol | year= 1995 | volume= 7 | issue= 3 | pages= 275-7 | pmid=7743311 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7743311 }} </ref> | ||
==Prognosis== | ==Prognosis== | ||
* Prognosis is generally regarded as good. | * Prognosis is generally regarded as good. | ||
*H.pylori is associated with less than 1% risk of gastric MALT lymphoma and 1-2% lifetime risk of stomach cancer.<ref name="pmid16847081">{{cite journal| author=Kusters JG, van Vliet AH, Kuipers EJ| title=Pathogenesis of Helicobacter pylori infection. | journal=Clin Microbiol Rev | year= 2006 | volume= 19 | issue= 3 | pages= 449-90 | pmid=16847081 | doi=10.1128/CMR.00054-05 | pmc=1539101 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16847081 }} </ref> | *''[[H. pylori]]'' is associated with less than 1% risk of gastric [[MALT lymphoma]] and 1-2% lifetime risk of [[stomach cancer]].<ref name="pmid16847081">{{cite journal| author=Kusters JG, van Vliet AH, Kuipers EJ| title=Pathogenesis of Helicobacter pylori infection. | journal=Clin Microbiol Rev | year= 2006 | volume= 19 | issue= 3 | pages= 449-90 | pmid=16847081 | doi=10.1128/CMR.00054-05 | pmc=1539101 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16847081 }} </ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 04:12, 24 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
If left untreated, H. pylori infection may progress to develop gastritis which can be acute or chronic, peptic ulcer disease, adenocarcinoma and MALT lymphoma. Common complications of the infection include gastric, duodenal ulcers, gastric adenocarcinoma, MALT lymphoma, pseudomembranous colitis following H. pylori treatment, B12 and iron deficiency anemia. Prognosis is generally regarded as good. It is associated with less than 1% risk of gastric MALT lymphoma and 1-2% lifetime risk of stomach cancer.
Natural History
If left untreated, H. pylori infection may progress to develop
- Gastritis which can be acute or chronic
- Peptic ulcer disease
- Adenocarcinoma
- MALT lymphoma
Complications
Common complications of H. pylori infection include:[1]
- Gastric and duodenal ulcers
- Gastric adenocarcinoma
- MALT lymphoma
- Pseudomembranous colitis following H. pylori treatment
- B12 and iron deficiency anemia
Post Treatment Complications
Clostridium difficile infection
For further information on C. diff infection please click here
Pseudomembranous colitis following H. pylori infection eradication treatment is very rarely reported due to following reasons:
- Short duration of the therapy
- All treatments are carried out in outpatient (hospitalization is the risk factor for C. difficile infection)
- The use of metronidazole in the triple drug therapy (an efficient drug against C. difficile)[2][3]
- Most of the mild C. difficile cases are most likely not diagnosed, because either the physician do not suspect the development of C. difficile infection or the patient do not consult the physician.[4]
Despite under-reporting of C. difficile infection post-treatment, the following components of H. pylori treatment contribute to development of pseudomembranous colitis:
- Proton pump inhibitors and C.difficile infection
- PPIs facilitate the growth of C. difficile by raising the pH, preventing the gastric contents from killing ingested C. difficile.[5]
- The elevated gastric pH allow conversion of spores to vegetative cells that ultimately produce toxins.[6]
- The risk of developing C. difficile infection increases when the duration of the PPI therapy exceeds two or more days.
- The US food and drug administration (FDA) announced that the use of PPIs may be associated with an increased risk of C. difficile associated diarrhea. Hence a diagnosis of C. difficile is considered in patients taking PPIs who develop diarrhea that does not improve.[7]
- Antibiotics and C.diff infection
- The antibiotics used disturb the normal colonic bacterial flora which promotes the growth of C. difficile and the release of toxins leads to mucosal inflammation and damage.[3]
- Amoxicillin and clarithromycin used in the treatment of H. pylori infection may lead to C. difficile infection.[8]
- These antibiotics decrease the total count of anaerobes (normal flora) in the gut leading to overgrowth of C. difficile.[9]
Prognosis
- Prognosis is generally regarded as good.
- H. pylori is associated with less than 1% risk of gastric MALT lymphoma and 1-2% lifetime risk of stomach cancer.[10]
References
- ↑ Hung IF, Wong BC (2009). "Assessing the risks and benefits of treating Helicobacter pylori infection". Therap Adv Gastroenterol. 2 (3): 141–7. doi:10.1177/1756283X08100279. PMC 3002520. PMID 21180540.
- ↑ Archimandritis A, Souyioultzis S, Katsorida M, Tzivras M (1998). "Clostridium difficile colitis associated with a 'triple' regimen, containing clarithromycin and metronidazole, to eradicate Helicobacter pylori". J Intern Med. 243 (3): 251–3. PMID 9627163.
- ↑ 3.0 3.1 Nawaz A, Mohammed I, Ahsan K, Karakurum A, Hadjiyane C, Pellecchia C (1998). "Clostridium difficile colitis associated with treatment of Helicobacter pylori infection". Am J Gastroenterol. 93 (7): 1175–6. doi:10.1111/j.1572-0241.1998.00358.x. PMID 9672359.
- ↑ Harsch IA, Hahn EG, Konturek PC (2001). "Pseudomembranous colitis after eradication of Helicobacter pylori infection with a triple therapy". Med Sci Monit. 7 (4): 751–4. PMID 11433206.
- ↑ Cunningham R, Dale B, Undy B, Gaunt N (2003). "Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea". J Hosp Infect. 54 (3): 243–5. PMID 12855243.
- ↑ Bobo LD, Dubberke ER, Kollef M (2011). "Clostridium difficile in the ICU: the struggle continues". Chest. 140 (6): 1643–53. doi:10.1378/chest.11-0556. PMC 3231962. PMID 22147824.
- ↑ C.difficile http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm (February 8, 2012) Accessed on January 18, 2017
- ↑ Trifan A, Girleanu I, Cojocariu C, Sfarti C, Singeap AM, Dorobat C; et al. (2013). "Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication". World J Gastroenterol. 19 (42): 7476–9. doi:10.3748/wjg.v19.i42.7476. PMC 3831232. PMID 24259981.
- ↑ Teare JP, Booth JC, Brown JL, Martin J, Thomas HC (1995). "Pseudomembranous colitis following clarithromycin therapy". Eur J Gastroenterol Hepatol. 7 (3): 275–7. PMID 7743311.
- ↑ Kusters JG, van Vliet AH, Kuipers EJ (2006). "Pathogenesis of Helicobacter pylori infection". Clin Microbiol Rev. 19 (3): 449–90. doi:10.1128/CMR.00054-05. PMC 1539101. PMID 16847081.