幽门螺杆菌的微生物学概述，发病机制和治疗方案的选择.ppt

Overview of Helicobacter pylori Microbiology, Pathogenesis and Treatment Options
Objectives - Case Based Presentations
To discuss the epidemiology, pathogenesis, and diagnosis of H. pylori
To highlight test and treat practice guidelines
pare and contrast clinical trial results between quadruple and triple therapy
To review antibiotic treatments
Case MB – H. pylori General Information
MB is 29 Cambodian and has been in the US for 5 years.
She lives in the inner city of Los Angeles.
History: 1 - month of moderate mid-epigastric, upper abdominal pain.
plaints of gas, darkening stool, or heartburn.
Non-smoker, no other medical problems, occasional ibuprofen usage.
Case MB – H. pylori General Information
Describe the epidemiology of H. pylori.
Review the pathogenesis of H. pylori and associated symptoms.
Epidemiology
Estimated 50-60% of the world population is infected
Person to Person Transmission
fecal-oral, oral-oral, gastro-oral
Increased risk of infection
younger age
underdeveloped countries
lower socioeconomic status
Go MF. Aliment Pharmacol Ther 2002;16(Supp 1):3-15
National Prescribing Patterns for Eradication
®2007 ZS Associates
History of H. pylori
1890’s: Spirochetes in animal stomachs
1900’s: Spirochetes in human stomachs
1954: No bacteria in gastric biopsies of 1000 patients
1975: Gram negative bacteria in 80% of GU’s (Pseudomonas)
1983: Warren and Marshall characterize H. pylori
2005 Nobel prize in 2005
$6 billion / yr in health care costs due to peptic ulcer disease (PUD) 1
Up to 93% cure rate quadruple therapy2
0-10% of ulcer recurrence after antibiotic (ABX) treatment3
1-3% re-infection rate after ABX treatment3
Economics of H. pylori
1 Sonnenberg A et al. Am J Gastroenterol 1997;92:614-620.
2 O’Morain C et al. Aliment Pharmacol Ther 2003;17:415-20
3 Taylor JL et al. Arch Intern Med 1997;157:87
Immune and Inflammatory Response to H. pylori
Inflammatory Response
Immune Response
H. pylori
Mucosa
Tissue damage
Activated T cell
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