Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection

Abstract

Helicobacter pylori infection is a major cause of morbidity and mortality worldwide. More than 50% of the global population is estimated to be infected. Differences in prevalence exist within and between countries, with higher prevalence seen among people with lower socio-economic status. Most transmission of infection occurs early in life, predominantly from person to person in the family setting. H. pylori is the cause of most peptic ulcer disease, gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma and causes symptoms in a subset of patients with functional dyspepsia. Choice of diagnostic test depends on the clinical context; urea breath tests and endoscopy with biopsy are the major diagnostic tools. Evidence-based indications for eradication of H. pylori infection are well documented. The most widely used and recommended eradication therapy in Australia is triple therapy comprising a proton pump inhibitor, amoxycillin and clarithromycin, usually for 1 week. Effective alternative regimens are available for patients with proven allergy to penicillin. Antimicrobial resistance is the major determinant of the outcome of eradication therapy. Trends in antibiotic resistance need to be monitored locally, but individual patient susceptibility testing is not usually necessary as it rarely guides the choice of therapy. The outcome of treatment should be assessed not less than 4 weeks after therapy. This is usually done with a urea breath test if follow-up endoscopy is not required. When first-line therapy fails, several proven second-line therapies may be used. Repeat first-line therapy and ad hoc regimens should be avoided. Overall cumulative eradication rates should approach 99%.

Detection of Helicobacter pylori CagA gene and Its Association with Endoscopic Appearance in Balinese Dyspepsia Patients

“…In children, the incidence of H. pylori infection was quite low, but will increase up to 20% in the age of 40 and 50% in the age of 60. 15 The result of this study was similar to the study performed by Darya in 2009 which found that the prevalence of H. pylori infection in gastritis patients in Sanglah Hospital was 18.8% using immunochromatography method. 16 Target population in both studies was similar, which was dyspepsia patients who visited each hospitals for treatment.…”

Risk of malignancy in patients with psoriasis: a 15‐year nationwide population‐based prospective cohort study in Korea

“…Taken together, the IL‐23/Th17 axis which comprise the major immunopathogenesis of psoriasis may also act as an inflammatory pathway in gastric carcinogenesis via H. pylori infection . Although H. pylori infection has been falling due to better living conditions and sanitation, the prevalence is still higher in Korean population compared to the western countries . Along with the shared immunopathogenesis of psoriasis and H. pylori ‐induced gastric cancer, this epidemiological difference might contribute to an increased risk of gastric cancer in psoriatic patients in our cohort, but not in previous Western studies.…”

Functional dyspepsia is associated with duodenal eosinophilia in an Australian paediatric cohort

“…Moreover, antral biopsies were assessed for Helicobacter‐like organisms and duodenal biopsies for visible pathogens. Additional testing of H. pylori was not considered necessary in the absence of suggestive microscopic changes (such as histological gastritis) and H. pylori in Australian children is now rare . The similar racial distribution in cases and controls also minimises the potential influence of diet and/or enteric infections on duodenal eosinophil counts.…”