Does Omeprazole Improve Antimicrobial Therapy Directed Towards Gastric Campylobacter Pylori in Patients with Antral Gastritis?: A Pilot Study

Unge, Peter; Gad, Adel; Gnarpe, Håkan; Olsson, J.

doi:10.3109/00365528909091311

Cited by 147 publications

(77 citation statements)

References 13 publications

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“…A breakthrough came when Unge and colleagues in Sweden 48 observed that the action of amoxicillin was greatly enhanced when gastric acid was suppressed with a proton pump inhibitor, notably omeprazole 48 . Thus, since 1996, it has been possible to treat H. pylori relatively easily with a seven-day course of omeprazole (to render the gastric pH neutral) in combination with two antibiotics, usually amoxicillin and clarithromycin.…”

Section: Treatmentmentioning

confidence: 99%

Helicobacter pylori: 20 years on

Marshall

2002

Clinical Medicine

116

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This year marks the 20th anniversary of the culture of Helicobacter pylori in Perth, Australia, over Easter 1982. It is now known that the spiral, Gram-negative bacterium inhabits the stomach of more than 50% of humans. Although the new organism was only cultured in 1982 1 , the Italian anatomist Giulio Bizzozero had reported its manifestations in the scientific literature 100 years earlier 2 . He recognised that dogs harboured a gastric 'spirochaete' -certain proof that bacteria could survive in the acid-secreting stomach. Other investigators noticed that urease was usually present in the stomach of carnivorous animals such as dogs and cats 3 , findings that were extended to humans in 1950 4 . It was thought that all these facts were unrelated, and that gastric urease was actually secreted by the gastric epithelial cells, until Charles Lieber showed that it could be suppressed with tetracycline 5 , and Delluva showed that germ-free animals did not develop gastric urease 6 . The presence of spiral bacteria in the human stomach was reported several times, most notably by Freedberg in 1940 7 and Steer and Colin-Jones in 1975 8 , well before the bacteria were found to cause peptic ulcer and gastric cancer 1,9 . The history of H. pylori is the subject of a recent book, Helicobacter pioneers: firsthand accounts from the scientists who discovered helicobacters, 1892-1982 10 . Microbiology and taxonomyH. pylori is named because of its spiral or helical shape (Fig 1). The organism is approximately 0.6 µm thick, taking the shape of a flat spiral with 1.5 wavelengths. The organism has up to seven sheathed flagella. It prefers a microaerophilic (reduced oxygen) environment and can be cultured in gas jars with Campylobacter gas generating envelopes (Oxoid), or in carbon dioxide (CO 2 ) incubators at 37°C. The preferred agar media contain blood, with or without selective antibiotics, but media without blood can also be used 11 . The first helicobacter cultured was actually H. muridarum, a commensal organism colonising the crypts of the mouse caecum 12 . New helicobacter species are discovered regularly, and some are now regarded as human pathogens. Figure 2 summarises the taxonomy of the helicobacter genus as determined by sequencing the 16s ribosomal RNA 13 .According to observations from human and animal helicobacter infections, the genus has the capacity to colonise and cause inflammation in the stomach (H. pylori, H. heilmannii, H. mustelae

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Section: Treatmentmentioning

confidence: 99%

Helicobacter pylori: 20 years on

Marshall

2002

Clinical Medicine

116

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“…Antibacterial therapy in combination with omeprazole was first described in 1989 by Unge and co-workers [80]. Their pilot study indicatoed that omeprazole and amoxicillin have a synergistic antibacterial effect, achieving an eradication rate two to three times higher than that of amoxicillin alone.…”

Section: The Clinical Experiencementioning

confidence: 99%

“…The mechanism of PPI action against the bacterium have not been completely elucidated. As PPIs are known to inhibit growth of H. pylori even at neutral pH [80], specific mechanisms in addition to acid suppression must be assumed. Inhibition of alcohol dehydrogenase [81] and bacterial urease [77 -79] have been demonstrated in vitro, and in vivo at high PPI doses.…”

Section: The Rationale For Use Of Ppi In H Pylori Therapymentioning

confidence: 99%

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Helicobacter pylori infection and peptic ulcer disease

Malfertheiner¹

1999

Proton Pump Inhibitors

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“…In 1989, Unge et al reported that a simple treatment regimen comprising omeprazole and amoxycillin may cure H. pylori infection. 11 During subsequent years, some authors have con®rmed encouraging results with this novel treatment option while others have reported rather disappointing outcomes. 12 Since the minimal inhibitory concentration of amoxycillin substantially decreases with increasing pH and since the effect of omeprazole on acid secretion, and thus on the pH gradient across the mucus layer is dose dependent, it was tempting to speculate that a higher dose of omeprazole would improve the H. pylori cure rate of dual therapy with omeprazole and amoxycillin.…”

Section: Introductionmentioning

confidence: 99%