Helicobacter pylori infection natural history, complications and prognosis
Helicobacter pylori infection Microchapters
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If left untreated, H. pylori infection may progress to develop gastritis which can be acute or chronic, peptic ulcer disease, adenocarcinoma and MALT lymphoma. Common 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.
If left untreated, H. pylori infection may progress to develop
- 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
- 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)
- 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.
- 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.
- The elevated gastric pH allow conversion of spores to vegetative cells that ultimately produce toxins.
- 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.
- 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.
- Amoxicillin and clarithromycin used in the treatment of H. pylori infection may lead to C. difficile infection.
- These antibiotics decrease the total count of anaerobes (normal flora) in the gut leading to overgrowth of C. difficile.
- 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.
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