ACP. Best practice no 154. February 1999. Helicobacter pylori
| Autor: | J. I. Wyatt, C. A. M. Mcnulty |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
medicine.medical_specialty
Abdominal pain Biopsy Perforation (oil well) Population Chronic gastritis Gastroenterology Helicobacter Infections Pathology and Forensic Medicine Internal medicine medicine Serologic Tests Helicobacter education Bacteriological Techniques education.field_of_study Helicobacter pylori biology business.industry General Medicine Gallstones biology.organism_classification medicine.disease digestive system diseases Surgery Breath Tests Gastritis medicine.symptom business Research Article |
| Zdroj: | Journal of Clinical Pathology. 52:338-344 |
| ISSN: | 0021-9746 |
| DOI: | 10.1136/jcp.52.5.338 |
| Popis: | Since the isolation of Helicobacter pylori by Marshall in 1982, much evidence has accumulated to show the important role it plays in the pathogenesis of chronic gastritis and peptic ulceration. Revision of long established concepts on the aetiology of peptic ulceration as an acid diathesis has become essential. Dyspepsia is very common; 1% of the United Kingdom population present to their general practitioner with food related abdominal pain. On investigation, one third will have peptic ulceration, one third will have no obvious abnormalities (non-ulcer dyspepsia), and the remainder will have various other disorders such as gallstones, irritable bowel, and so on. It is now accepted that histologically confirmed chronic gastritis and duodenal ulceration is caused by H pylori infection in over 90% of cases and that H pylori is responsible for at least 50% of gastric ulcers. Complications such as bleeding, perforation, and stenosis occur in 3% of ulcer patients a year, and unless maintenance treatment is given 82% of ulcers treated with H2 receptor antagonists relapse within one year. Recurrence of peptic ulceration within two years after initial eradication of H pylori is reduced to 0–15%, 5 so the advantages of H pylori eradication in these patients are enormous. Determination of helicobacter status of patients with current or previous peptic ulcer disease, and treatment of the infection in those found positive, is now the recommended management for peptic ulcer disease. The role that H pylori plays in non-ulcer dyspepsia is more controversial, as studies with short follow up have shown no benefit. However, at one year the benefits of treatment become more evident. Patients with non-ulcer dyspepsia with H pylori have 20 times the risk of developing duodenal ulcer than those who are not infected and a lifetime risk of developing gastric cancer which is up to six times that of an uninfected individual. 8 Although the benefit of treating infected patients without peptic ulceration has not been established by clinical trials, individuals who test positive are increasingly being oVered treatment in view of the estimated 15% risk of subsequent complications and increasing public awareness of the infection. The diagnosis of H pylori infection is therefore very important but as yet there are no internationally agreed guidelines on the management of helicobacter associated dyspepsia—although there have been several national meetings and reports, the most recent being the Maastricht consensus report produced in Autumn 1996. The presence of H pylori should always be verified before initiation of anti-H pylori treatment, as the type of dyspeptic symptoms predicts only poorly the cause of dyspepsia or the presence of H pylori. |
| Databáze: | OpenAIRE |
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