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**The US food and drug administration (FDA) announced that the use of PPIs may be associated with an increased risk of Clostridium difficile associated diarrhea. Hence a diagnosis of C.diff is considered in patients taking 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> | **The US food and drug administration (FDA) announced that the use of PPIs may be associated with an increased risk of Clostridium difficile associated diarrhea. Hence a diagnosis of C.diff is considered in patients taking 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> | ||
'''2. Antibiotics and C.diff infection''' | #'''2. Antibiotics and C.diff infection''' | ||
**The antibiotics used disturb the normal colonic bacterial flora which promotes the growth of clostridium 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> | **The antibiotics used disturb the normal colonic bacterial flora which promotes the growth of clostridium 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 clostridium 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> | **Amoxicillin and clarithromycin used in the treatment of H.pylori infection may lead to clostridium 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> | ||
Revision as of 18:32, 18 January 2017
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Helicobacter pylori infection Microchapters |
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Differentiating Helicobacter pylori infection from other Diseases |
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Diagnosis |
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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
Natural History
If left untreated, H.pylori infection may progress to develop
- Gastritis which can be acute or chronic
- Peptic ulcer disease
Complications
Common complications of H.pylori infection include:[1]
- Gastric and duodenal ulcers
- Gastric adenocarcinoma
- MALT lymphoma
- Pseudomembranous colitis following H.pylori treatment
Post Treatment Complications
Clostridium difficile infection
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 (an efficient drug against c.difficile)[2][3]
- Most of the mild c.diff cases are most likely not diagnosed, because either the physician do not suspect the development of C.diff infection or the patient do not consult the physician.[4]
Despite under-reporting of C. diff infection post-treatment, the following components of H.pylori treatment contribute to development of pseudomembranous colitis:
- Proton pump inhibitors and C.diff infection
- PPIs facilitate the growth of C.diff by raising the pH, preventing the gastric contents from killing ingested C.diff.[5]
- The elevated gastric pH allow conversion of spores to vegetative cells that ultimately produce toxins.[6]
- The risk of developing C.diff 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 Clostridium difficile associated diarrhea. Hence a diagnosis of C.diff is considered in patients taking PPIs who develop diarrhea that does not improve.[7]
- 2. Antibiotics and C.diff infection
- The antibiotics used disturb the normal colonic bacterial flora which promotes the growth of clostridium 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 clostridium 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.