medizin report
High Infection Rates in the Population
Who needs to be tested for Helicobacter pylori infection?
Therapie state of the art
Gastroenterologie/Infektiologie
ISSN: 1614-9041
Ausgabe 01a I Januar 2013
An infection with Helicobacter
pylori (H. pylori) is generally as-
sociated with a range of serious
consequences for the health of
the affected individual. This raises
the question as to who needs to
undergo diagnosis for H. pylori,
and if found positive, which treat-
ment to receive. Professor Mathias
Strowski, consultant at the Char-
ité – University of Berlin, Dept. of
Internal Medicine, explains the
rationale for diagnosis and treat-
ment*.
30 to 50% of the population of West-
ern Europe is infected with H. pylori.
80% of these infections are asymp-
tomatic and 20% symptomatic. The
true relevance of a symptomatic infec-
tion is plainly evident when examining
the statistics: patients suffering from
dyspepsia or chronic gastritis have
a 5 – 15% risk of developing a pep-
tic ulcer in their lifetime. The risk of
developing a gastric adenocarcinoma
is about 1 – 3%, and about 0.5% of
developing a gastric MALT-lymphoma
(mucosa associated lymphoid tissue).
There is a significant correlation be-
tween H. pylori  infection and gastritis,
gastric and small intestinal ulcers and
other malignant diseases of stomach.
60 to 70% of patients with a gastric
ulcer and up to 90% of patients with a
duodenal ulcer have an infection.
An H. pylori  infection generally mani-
fests as 3 gastritic phenotypes:
•
mild pan-gastritis not affecting the
physiology of the stomach.
•
corpus-predominant chronic gas-
tritis, which is associated with
hypochlorhydria (reduced release
and production of hydrochloric acid
by the parietal cells of the gastric
mucosa), mucosal atrophy and in-
creased risk of stomach cancer.
•
Gastritis primarily detected in the
antrum, most often associated with
elevated secretion of hydrochloric
acid and increased risk of a duode-
nal ulcer formation.
In addition to the increased risk of
gastric cancer, there are further rea-
sons to eradicate H. pylori. There is
evidence pointing to a correlation be-
tween H. pylori  infection and iron de-
ficient anaemia and vitamin B12 de-
ficiency.
1,2
An association between
idiopathic thrombocytopenia pur-
pura (ITP) and H. pylori  infection has
also been reported
3
. The benefit of
H. pylori  eradication in patients with
ITP can be detected by a significant
increase of thrombocyte count up to
50%.
4
1 2,3,4,5,6,7,8