Helicobacter pylori infection natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
If left untreated, H. pylori infection may progress to develop gastritis which can be acute or chronic, peptic ulcer disease, adenocarcinoma and MALT lymphoma. Comnmon complications of the infection include gastric, duodenal ulcers, gastric adenocarcinoma, MALT lymphoma, pseudomembranous colitis following H. pylori treatment, B12 and iron deficiency anemia. Prognosis is generally regarded as good. It is associated with less than 1% risk of gastric MALT lymphoma and 1-2% lifetime risk of stomach cancer.
Natural History
If left untreated, H. pylori infection may progress to develop
- Gastritis which can be acute or chronic
- Peptic ulcer disease
- Adenocarcinoma
- MALT lymphoma
Complications
Common complications of H. pylori infection include:[1]
- Gastric and duodenal ulcers
- Gastric adenocarcinoma
- MALT lymphoma
- Pseudomembranous colitis following H. pylori treatment
- B12 and iron deficiency anemia
Post Treatment Complications
Clostridium difficile infection
For further information on C. diff infection please click here
Pseudomembranous colitis following H. pylori infection eradication treatment is very rarely reported due to following reasons:
- Short duration of the therapy
- All treatments are carried out in outpatient (hospitalization is the risk factor for C. difficile infection)
- The use of metronidazole in the triple drug therapy (an efficient drug against C. difficile)[2][3]
- Most of the mild C. difficile cases are most likely not diagnosed, because either the physician do not suspect the development of C. difficile infection or the patient do not consult the physician.[4]
Despite under-reporting of C. difficile infection post-treatment, the following components of H. pylori treatment contribute to development of pseudomembranous colitis:
- Proton pump inhibitors and C.difficile infection
- PPIs facilitate the growth of C. difficile by raising the pH, preventing the gastric contents from killing ingested C. difficile.[5]
- The elevated gastric pH allow conversion of spores to vegetative cells that ultimately produce toxins.[6]
- The risk of developing C. difficile infection increases when the duration of the PPI therapy exceeds two or more days.
- The US food and drug administration (FDA) announced that the use of PPIs may be associated with an increased risk of C. difficile associated diarrhea. Hence a diagnosis of C. difficile is considered in patients taking PPIs who develop diarrhea that does not improve.[7]
- Antibiotics and C.diff infection
- The antibiotics used disturb the normal colonic bacterial flora which promotes the growth of C. difficile and the release of toxins leads to mucosal inflammation and damage.[3]
- Amoxicillin and clarithromycin used in the treatment of H. pylori infection may lead to C. difficile infection.[8]
- These antibiotics decrease the total count of anaerobes (normal flora) in the gut leading to overgrowth of C. difficile.[9]
Prognosis
- Prognosis is generally regarded as good.
- H. pylori is associated with less than 1% risk of gastric MALT lymphoma and 1-2% lifetime risk of stomach cancer.[10]
References
- ↑ Hung IF, Wong BC (2009). "Assessing the risks and benefits of treating Helicobacter pylori infection". Therap Adv Gastroenterol. 2 (3): 141–7. doi:10.1177/1756283X08100279. PMC 3002520. PMID 21180540.
- ↑ Archimandritis A, Souyioultzis S, Katsorida M, Tzivras M (1998). "Clostridium difficile colitis associated with a 'triple' regimen, containing clarithromycin and metronidazole, to eradicate Helicobacter pylori". J Intern Med. 243 (3): 251–3. PMID 9627163.
- ↑ 3.0 3.1 Nawaz A, Mohammed I, Ahsan K, Karakurum A, Hadjiyane C, Pellecchia C (1998). "Clostridium difficile colitis associated with treatment of Helicobacter pylori infection". Am J Gastroenterol. 93 (7): 1175–6. doi:10.1111/j.1572-0241.1998.00358.x. PMID 9672359.
- ↑ Harsch IA, Hahn EG, Konturek PC (2001). "Pseudomembranous colitis after eradication of Helicobacter pylori infection with a triple therapy". Med Sci Monit. 7 (4): 751–4. PMID 11433206.
- ↑ Cunningham R, Dale B, Undy B, Gaunt N (2003). "Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea". J Hosp Infect. 54 (3): 243–5. PMID 12855243.
- ↑ Bobo LD, Dubberke ER, Kollef M (2011). "Clostridium difficile in the ICU: the struggle continues". Chest. 140 (6): 1643–53. doi:10.1378/chest.11-0556. PMC 3231962. PMID 22147824.
- ↑ C.difficile http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm (February 8, 2012) Accessed on January 18, 2017
- ↑ Trifan A, Girleanu I, Cojocariu C, Sfarti C, Singeap AM, Dorobat C; et al. (2013). "Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication". World J Gastroenterol. 19 (42): 7476–9. doi:10.3748/wjg.v19.i42.7476. PMC 3831232. PMID 24259981.
- ↑ Teare JP, Booth JC, Brown JL, Martin J, Thomas HC (1995). "Pseudomembranous colitis following clarithromycin therapy". Eur J Gastroenterol Hepatol. 7 (3): 275–7. PMID 7743311.
- ↑ Kusters JG, van Vliet AH, Kuipers EJ (2006). "Pathogenesis of Helicobacter pylori infection". Clin Microbiol Rev. 19 (3): 449–90. doi:10.1128/CMR.00054-05. PMC 1539101. PMID 16847081.