Helicobacter pylori

Helicobacter pylori is a helical shaped Gram-negative bacterium that infects various areas of the stomach and duodenum.
Many cases of peptic ulcers, gastritis, and duodenitis are caused by H. pylori infection.
However, many who are infected do not show any symptoms of disease. Helicobacter spp. are the only known microorganisms that can thrive in the highly acidic environment of the stomach, thanks to urease, an enzym that creates a sorrounding enviroment where H.pylori can live.

Most of the people are immune carriers, since a balanced immune system protects them from pathogenic power of H. pylori; therefore, people with immunodeficiency are most likely affected by this pathogen.

H. pylori's pathogenic power comes from its ability to reduce gastric acidity. Yet, it increases acid production leading to gastritis and peptic ulcers.

Infection may be symptomatic or asymptomatic (without perceptible ill effects). It is estimated that up to 70% of infection is asymptomatic and that about 2/3 of the world population are infected by the bacterium, making it the most widespread infection in the world. Actual infection rates vary from nation to nation - the West (Western Europe, North America, Australasia) having rates around 25% and much higher in the Third World. In the latter, it is common, probably due to poor sanitary conditions, to find infections in children. In the United States, infection is primarily in the older generations (about 50% for those over the age of 60 compared with 20% under 40 years) and the poorest.

This is largely attributed to higher hygiene standards and widespread use of antibiotics. However, antibiotic resistance is appearing in H. pylori. There are already many metronidazole resistant strains in Europe, the United States, and developing countries.

The bacteria have been isolated from feces, saliva and dental plaque of infected patients, which suggests gastro-oral or fecal-oral as possible transmission routes.

It is widely believed that in the absence of treatment, H. pylori infection—once established in its gastric niche—persists for life. In the elderly, however, it is likely infection can disappear as the stomach's mucosa becomes increasingly atrophic and inhospitable to colonization. The proportion of acute infections that persist is not known, but several studies that followed the natural history in populations have reported apparent spontaneous elimination.

H. pylori infection can leads to, or can be linked to:

• Peptic ulcer: aka PUD or peptic ulcer disease, it's an ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. Contrary to general belief, more peptic ulcers arise in the duodenum (first part of the small intestine, just after the stomach) than in the stomach.
• Gastritis: gastritis is inflammation of the gastric mucosa. Depending on the cause, it may persist acutely or chronically and may coincide with more serious conditions such as atrophy of the stomach.
• Gastric cancer and gastric MALT lymphoma: they have been associated with H. pylori, and the bacterium has been categorized as a group I carcinogen by the International Agency for Research on Cancer (IARC). While the association is reasonably strong, it is not entirely clear that there is a causal relationship involved.Two related mechanisms by which H. pylori could promote cancer are under investigation. One mechanism involves the enhanced production of free radicals near H. pylori and an increased rate of host cell mutation. The other proposed mechanism has been called a "perigenetic pathway" and involves enhancement of the transformed host cell phenotype by means of alterations in cell proteins such as adhesion proteins.
• Acid reflux and esophageal cancer: the infection rate with H. pylori has been decreasing in developing countries, presumably because of improved hygiene and increased use of antibiotics. Accordingly, the incidence of gastric cancer in the U.S. has fallen by 80 percent from 1900 to 2000. However, gastroesophageal reflux disease and esophageal cancer have increased dramatically during the same period. In 1996, Martin J. Blaser put forward the theory that H. pylori might also have a beneficial effect: by regulating the acidity of the stomach contents, it lowers the impact of regurgitation of gastric acid into the esophagus. While some favorable evidence has been accumulated, as of 2005 the theory is not universally accepted.

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