HELICOBACTER

PYLORI
GERMENE:
 gram negativ
 bacil curb
 3/0,5
 4-6 flagele
 cre]te pe orice mediu
 microaerofil
 EPIDEMIOLOGIE
• 50% din popula\ie serologie !
• 2-4 ani 32-95% ;
REZERVOR - UMAN
TRANSMISIE:  ORO-ORAL~
 ORO-FECAL~

HABITAT - MUCOASA ANTRAL~

 Prevalen\`

•ITALIA :15 % URBAN; 37 % RURAL.

•ALASKA : 75 %

•MANITOBA : 95 %
 Inciden\`

• Seroconversie :0,6 % Noua Zeelanda

1,9 % Danemarca

4 % Brazilia
• Factori asocia\i infec\iei:

- fumatul
- sexul
- origine etnic`
- nivel social
- condi\ii de via\`
 Transmisia
• Fecal` : - cercetare fa\` de AcVHA curbe
disociate

• Oral` : - la fete cu inciden\` crescut` cu 2

ani mai devreme

• Ap` : - aparent nu.

• Mu]te : - se cerceteaz`.
Fluorescence in Situ Hybridization (FISH) and Immunohistochemical Analysis of Tissue Specimens

Lecuit M et al. N Engl J Med 2004;350:239-248

H. pylori Closely Adherent to the Cell Membrane (Top), and Spiral-Shaped H. pylori Attached to
Epithelial Surface and Surrounding Microvilli (Bottom)

Parsonnet J. N Engl J Med 2005;353:2421-2423

A 35-year-old man presented with epigastric pain of several months' duration

Genta R and Graham D. N Engl J Med 1996;335:250

 DIAGNOSTIC
I. INVAZIV: - BIOPSIE MUCOAS~
a) CULTURI
b) COLORA|IE
c) TEST RAPID
d) HISTOLOGIE
II. NEINVAZIV:
- TEST RESPIRATOR
- SEROLOGIE
- PCR
 FACTORI DE VIRULEN|~

• FLAGELE  MOTILITATEA

• SPIRALAREA  {N}URUBARE

• REZISTEN|A LA ACID  SUPRAVIE|UIRE

 Patogenitatea
COLONIZAREA
1. Aderen\a : Blood Adherence Binding
Antigen (BABA)
- Lewis cu dubii c`ci [n cultura cu
anticorpi anti Le HP ader`.
2. Supravie\uirea - ureaz` ce poate
depinde de su]`
3. Mobilitatea - Flagelina Fla A
- depinde de v@scozitatea
mucusului
CRONICIZAREA
a) Enzima SCOT ( succinil CoA aceto-acetat
transferaza) realizeaz` colonizarea ]i/sau
supravie\uirea
b) Nα metiltransferaza agonist receptori
H3
c) Inhibarea eliber`rii de stomatostatin`
d) AIF1 (acid inhibitory factor)
e) AIF3 protein` mai mic`
• Factori ce lezeaz` mucoasa :

a) VacA – inhib` transportul C ]i enzime

b) amoniacul inhib` secre\ia de
somatostatin`
c) LPS similare Le xy
d) factori ce promoveaz` inflama\ia IL-8
FACTORI DE PATOGENITATE
• CATALAZA  PREVINE FAGOCITOZA
• FOSFOLIPAZA  SCADE AP~RAREA
• MUCINAZA  DEPLE|IE DE MUCUS
• CAG A
• VAC A
• UREAZA
Pathogen-Host Interactions in the Pathogenesis of Helicobacter pylori Infection

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

 The cag Pathogenicity Island

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

 FIXAREA

• Le b

• MODIFIC~RI CITOSCHELET

• CAG A  protein` "self"

• VAC A  furnizeaz` masa

 AC|IUNI PATOLOGICE

PRODUC|IE: IL-6, TNF, NF-KB

a) SUBIECT IL-1

b) INDIVIZI NON IL- 1

 SUBIECT IL-1
HP

INHIB~ SECRE|IA ACID~

GASTRITA CORPOREAL~

GASTRITA ATROFIC~

METAPLAZIE INTESTINAL~

LEZIUNI ADN

MUTA|II

ADENOCARCINOM
Proposed Cascade of Pathologic Events in Gastric Adenocarcinoma

Fox J and Wang T. N Engl J Med 2001;345:829-832

SUBIECT NON IL-1 (GENOTIP)
SECRE|IE ACID~ NORMAL~

GASTRITA ANTRAL~

SC~DEREA CELULELOR D

HIPERGASTRINEMIE

HIPERSECRE|IE ACID~

METAPLAZIE GASTRIC~

COLONIZARE

ULCER DUODENAL
 REZULTATELE INFEC|IEI HP
• GASTRITE ACUTE  FLEGMON GASTRIC
• GASTRITE CRONICE
• ULCER GASTRIC
• ULCER DUODENAL
• MALTOM
• ADENOCARCINOM
• DISPEPSIA ?
 Natural History of Helicobacter pylori Infection

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

Current Guidelines for the Treatment of H. pylori Infection, According to the Maastricht 2-2000
Consensus Report

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

 TRATAMENT
I. a) IPP
b) claritromicin`
c) amoxicilin` (metronidazol)
II. a) RBC
b) claritromicin`
c) amoxi (metro, tetra)
III. a) IPP
b) bismut
c) metronidazol
d) tetra
DURATA: 14 zile
REZISTENTA LA ANTIBIOTICE

• CLARITROMICINA 4%-17% IRAN.factor de

risc :consumul de macrolide.
• AMOXICILINA 1%
• METRONIDAZOL 30-40%
• TETRACICLINA 0, 5-5%
• FLUOROQUINOLONE
20% PORTUGALIA 3% ROMANIA
 GASTRITE
Inflama\ia mucoasei/peretelui gastric.

• ACUT~
• CRONIC~

CLASIFICAREA A.B.C.
 GASTRITE ACUTE

Boli autolimitate produse prin cauze

exo ]i endogene.

• cuprind ]i alte segmente

• profunzime variabil`
 GASTRITE ACUTE EXOGENE
1. microbiene:
a) stafilococul auriu
b) clostridium botullinum
2. alergice - criteriile INGELFINGER
3. toxice
4. corozive
5. medicamentoase - AINS
6. alcool
 AC. ARAHIDONIC

CORTICOIZI
AINS

CALEA CICLOOXIGENAZEI CALEA LIPOOXOGENAZEI

PG PC TX LT OHacizi
 PRODUC|IA PG

• STIMULEAZ~ SECRE|IA DE MUCUS

• FLUXUL SANGUIN

• CITOPROTEC|IA
 SISTEMUL SIDNEY
I. BRA| ETIOLOGIC (A, B, C, S)
II. BRA| ENDOSCOPIC:
a) LOCALIZARE:
 antral`
 corporeal`
 pangastrit`
b) TIP:
 eroziv
 exudativ
 hemoragie
III. BRA| HISTOLOGIC:
a) inflama\ie
b) activitate
c) atrofie
d) metaplazie:
 complet`
 incomplet`
 tip colonic
e) HP
 GASTRITA ATROFIC~

MECANISM IMUN

 Ac anti:

- FI Castle - glicoproteic

- pompa protoni - lipoproteic

- celul` G
 IMPORTAN|A
• INTERFER~ CU ABSORB|IA VIT. B12
• STARE PRECANCEROAS~:
- RR x 5
- 95% cancere au [mprejur gastrit`
- studii longitudinale
- distribu\ia geografic`
- asocierea cu metaplazie
 GASTRITE SPECIALE
A) GASTRITA VARIOLIFORM~
(4% endoscopic)
1. FORMA DIFUZ~:
- rar`
- imun`
- 50% alergii asociate
2. FORMA ANTRAL~ ASOCIAT~:
- UG, UD
- HH
- cirozei
- litiazei
 B) GASTRITA LIMFOCITAR~ (1985)
• MECANISM:
PEPTIC
ALERGIC: - 25% au eosinofile
- 40% au IgE
• NODULI OMILICA|I
• CLINIC:
 ULCER
 DISPEPSIE
 ANOREXIE
 GASTROPATIE EXUDATIV~
 C) GASTRITA CU EOSINOFILE

• ASOCIAT~ S. CHURG STRAUSS

• LOCALIZAT~ ANTRAL
• MECANISM ALERGIC
• ASOCIERI 50%
• CLINIC: - dispepsie
- diaree
- malabsorb\ie