Current consensus on the diagnosis and treatment of H. pylori-associated gastroduodenal disease

Abstract

Abstract. Helicobacter pylori (H. pylori) is a spiral shaped bacterium that resides in the stomach mucosa. Isolation of H. pylori from the stomach mucosa changed the erstwhile widely held belief that the stomach contains no bacteria and is actually sterile. Once H. pylori is safely ensconced in the mucus, it is able to neutralize the acid in the stomach by elaborating an enzyme called urease. Urease converts urea, of which there is an abundant supply in the stomach (derived from saliva and the gastric juice), into bicarbonate and ammonia, which are strong bases. These bases form a cloud of acid neutralizing chemicals in the vicinity of the organisms, protecting them from the acid in the stomach. This urea hydrolysis reaction is utilized for the diagnosis of H. pylori infection in the urea breath test (UBT) and the rapid urease test (RUT). In Japan, both invasive tests, such as bacterial culture, histopathology and RUT, and non-invasive tests such as UBT and serology are conducted for the diagnosis of H. pylori infection. For confirming the results of eradication therapy, UBT is considered to be the most sensitive and specific. In order to treat H. pylori infection, a new one-week triple therapy regimen (lansoprazole or omeprazole+amoxicillin+clarithromycin) has been approved for use in patients with peptic ulcer disease in Japan. As for H. pylori eradication in the case of other diseases in which the bacterium has been implicated (e.g., chronic atrophic gastritis, gastric MALT lymphoma, gastric cancer, non-ulcer dyspepsia, chronic urticaria, idiopathic thrombocytopenic purpura (ITP)), further basic and clinical investigation is required. (Keio J Med 52 (3): 163-173, September 2003)

Clinical significance of expression of apoptotic signal proteins in gastric carcinoma tissue

“…Recent evidence suggests that apoptosis of cells is closely related to occurrence, progress and metastasis of the tumor [8][9][10] . At present, studies on the apoptosis of tumor cells are an important field of tumor therapy and tumor molecular biology [11][12][13][14] . The abnormalities in expressions of apoptotic signal proteins always influence the gastrocellular apoptosis, thus leading to the incidence and development of gastric carcinoma [15][16][17] .…”

Molecular Approaches and Modern Clinical Strategies for the Management of Helicobacter pylori Infection in Japan

“…is recommended as the firstchoice treatment for eradication of H. pylori. 57 At the 2008 meeting of the JSHR, the mean national clarithromycin resistance rates from 2002 to 2006 were reported to be 18.9%, 21.2%, 27.7%, 29.0%, and 27.2%. The mean nationwide clarithromycin resistance rate determined by the Japanese Society of Chemotherapy in 2000 was 7.0%, so the resistance rate has increased by approxi- 58 Recently, a European group performed a randomized, open-label, non-inferiority, phase 3 trial comparing the efficacy and safety of first-line quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline (quadruple therapy) for 10 days versus omeprazole, amoxicillin, and clarithromycin for 7 days (standard therapy) in adults with known H. pylori infection.…”

Novel effects other than antisecretory action and off-label use of proton pump inhibitors

“…Currently, it is generally accepted that H. pylori infection is an important factor in the development of peptic ulcer disease [21]. It is strongly recommended that all patients with peptic ulcers who are demonstrably infected with H. pylori be treated with a PPI along with antibiotics, regardless of whether they are experiencing the initial manifestations of the disease or a recurrence [7].…”

“…In vitro studies have also demonstrated the inhibitory effect of PPIs on the growth of H. pylori, with a MIC of 6.25 -12.5, 3.1 -6.25 and 1.6 -3.1 mg/l for omeprazole, lansoprazole and rabeprazole, respectively [23]. PPI-based triple therapies are generally considered the best available treatment in the eradication of H. pylori [21,24], as their pHelevating effect promotes intragastric stability of antibiotics.…”