HELICOBACTER PYLORI

INTRODUCTION

The stomach secretes gastric juice every day.

Gastric juice consists of digestive enzymes and
concentrated hydrochloric acid, which can tear
apart the toughest food and microorganism.It used
to be thought that the stomach contained no bacteria
and was actually sterile, but H. pylori changed that
view.
Why and how does HP cause diseases?
Let’s talk about HP in this lecture?
 CONTENTS
 General description of H.pylori
 Biological characteristics of H.pylori

 Defense mechanism of H.pylori

 Pathogenesis

 Detection and treatment

 Epidemiology
BACKGROUND
• 1983-discovered by Warren and Marshall in Australia

 The bacterium lives in the stomach of about half the people in

the world. Many are apparently well, and most have an
inflammation of the stomach lining, a condition which is
called "gastritis“

 Gastritis is the underlying condition which causes ulcers and

other digestive complaints - cancer of the stomach.

• Earned them the Nobel Prize for Medicine in 2005

• Formerly known as Campylobacter pyloridis

• Nearly 20 species of Helicobacter are now
recognised

• The gastric helicobacters colonise the stomachs of

animals. The monkey, cat, dog, cheetah all harbour
their own species

• H. cinaedi and H. fennelliae are associated with

proctitis in homosexual men

• H. pylori are found in the human stomach. Molecular

studies suggest transmission from an animal source.
BIOLOGICAL PROPERTIES OF H. PYLORI
 MORPHOLOGY AND STRUCTURE

 GN- bacteria
 HP have typical morphology
 S or spiral-shaped bacterium
 Almost all the bacteria have
the same size
length:2.5~4.0μm
width:0.5~1.0μm
 MICROSCOPIC STRUCTURE OF
H.PYLORI

 There are 2~6 flagella

at one end of HP –
unipolar tuft of
lophotrichous
 The flagella can exist at
two ends during fission
 Flagella play important
role in motion and
adhesion
 Helicobacter pylori

McColl K. N Engl J Med 2010;362:1597-1604

 DEFENSE MECHANISM OF
H.PYLORI
1. Reaction of urea hydrolysis
 Once H. pylori is ensconced in the mucus, it is able to
fight the stomach acid that does reach it with an
enzyme called urease.
 Urease converts urea, of which there is an abundant
supply in the stomach (from saliva and gastric juices),
into bicarbonate and ammonia, which are strong bases.
This creates a cloud of acid neutralizing chemicals
around the H. pylori, protecting it from the acid in the
stomach.

 The reaction of urea hydrolysis is important for
diagnosis of H.pylori by the breath test.
 DEFENSE MECHANISM OF
H.PYLORI
2. Escape of natural defense
 Escape means that the body's natural defenses cannot
reach the bacterium in the mucus lining of the stomach.
 The immune system will respond to an H. pylori
infection by sending white cells, killer T cells, and other
infection fighting agents which cannot easily get through
stomach lining.
 Infection fighting agents do not go away either and the
immune response grows and grows. Polymorphnucleas
die, and spill their destructive compounds (superoxide
radicals) on stomach lining cells.
 PATHOGENESIS

Cytotoxin associated proteins(Cag A) and Vac A

is the main factor of the virulence
LPS also play great importance

Flagellum and urease is necessary for its

adhesion and inhabitation
Adhesin
DISEASES ASSOCIATED WITH
HELICOBACTER PYLORI

Duodenal Ulcers
Gastric (Stomach) Ulcers

Non-ulcer dyspepsia

Gastric malignancies

MALT – mucosa associated lymphoid tissue

lymphoma
Gastric-biopsy specimen showing Helicobacter pylori adhering to gastric epithelium and
underlying inflammation

McColl K. N Engl J Med 2010;362:1597-1604

LABORATORY DIAGNOSIS:
NON-INVASIVE TESTS
• Serology : detect an immune response by examining a
blood sample for abs to the organism (ELISA)
: poor accuracy
• Faecal antigen test : detect H. pylori antigens in
faecal specimens
• Polymerase chain reaction (PCR) : detect HP
within a few hours. Not routine in clinical use.
• Urea breath test : a urea solution labelled
with C14 isotope is given to pt. The C02
subsequently exhaled by the pt contains the C14
isotope and this is measured. A high reading
indicates presence of H. pylori
INVASIVE TESTING

2. Histological examination of biopsy

specimens of gastric/duodenal mucosa take at
endoscopy.
4. Culture :
 -No more sensitive than skilled
microscopy of histological sections
 -Used for antibiotic sensitive testing
 -Requires selective agars and
incubation periods
 Tests for Helicobacter pylori Infection

McColl K. N Engl J Med 2010;362:1597-1604

FIRST LINE TREATMENT

• Combination of two or more antimicrobial agents

increases rates of cure and reduces the risk of
selecting for resistant H. pylori
• Tetracycline + bismuth subsalicylate and
metronidazole for 2 weeks.

• Many factors may result in failure of treatment

 microbial factors
 patient compliance
 geographical differences
INFECTIVE RATIO ALL OVER THE WORLD