Helicobacter pylori

Case report:

A 45-year-old patient appears in practice and deplores significant epigastric pain with increasing tendency for eight days. These pains occur especially in the morning hours in the fasted state and would improve slightly by food intake. In addition, heartburn had occurred, associated with nausea and vomiting. Alcohol consumption was associated with increased upper abdominal pain and also the otherwise abundant coffee enjoyment is no longer possible. Physical examination results in a significant pressure pain in the epigastric region, with no broadcasts in the other abdominal cavity or into the thoracic games.

Diagnosis:

The history, the symptoms and the circumscribed epigastric tenderness suggest a gastric or Duodenalerkrankung. The patient is in the duodenum and gastroesophageal copied a 7 mm in diameter ulcer end amount is detected. The urease test on biopsies is positive and histological examination of the three biopsies confirmed the diagnosis of Helicobacter pylori infection. The laboratory tests show no evidence of anemia or other pathological findings.

Pathogenesis:

Helicobacter pylori is a microaerophilic, gram-negative and ureaseproduzierender germ, which colonizes the stomach of man, and can lead to mucosal inflammation as well as a local and systemic immune response. Virulence factors of H. pylori urease are obvious and cytotoxins as VacA and CagA. These cytotoxins are detectable only in a maximum of half of the H. pylori isolates; they are increasingly isolated in peptic ulcer disease, atrophic gastritis and stomach cancer. The adhesion of H. pylori is mainly to epithelial cells and is increased by a low pH. A particular host factor promoting adhesion is obviously the blood group 0-antigen, which explains the increased disposition of people with this blood type.

Therapy:

The goal of any treatment should be an eradication rate of over 80%. In Europe, a triple regimen is now recommended, which consists of a proton pump inhibitor [omeprazole (omeprazole ratiopharm et al), pantoprazole (Pantozol)] in combination with two antibiotics. Usually administered clarithromycin (Klacid, Biaxin) at a dose of 500 mg twice orally, amoxicillin (Clamoxyl others) also twice daily or 500 mg metronidazole (Clont) 500 mg twice or tinidazole (SIMPLOTAN) at a dose of 400 mg twice daily , The duration of therapy should be at least one week. Note the local prevalence of resistance, which can be especially towards nitroimidazoles in Europe to 30% in the selection of antibiotics. In a therapeutic failure or an early relapse resistance testing should be considered. Alternatively, a quadruple therapy consisting of bismuth (TELEN), metronidazole, a tetracycline, for example, Doxycycline (VIBRAMYCIN among others) and is a proton pump inhibitor prescribed.