Helicobacter Pylori:

- Gram -ve curved rods

- Micro-aerophilic
- Has lophotrichous flagella

Pathogenesis:

1. Colonization of gastric mucosa

 Motility : With help of lophotrichous flagella, it can remain suspended in the viscous mucus
over the mucosa. (if suspended nabhako bhaye Gastric acid le garda degrade huna sakthyo)

 Acid resistant: Due to urease enzyme which converts urea into NH3. NH3 buffers the acidic
pH of stomach.

 Adhesins: Mostly, H. pylori remains in the mucosa. Some of them express adhesins and gets
attached to the mucous lining. The adhesins are: - Adherence associated lipoprotein, - Blood
group antigen binding protein

2. Pathological changes:
 Exotoxins: 1. Vacuolating cytotoxin, 2. Cytotoxin associated gene A (cagA)
The vacuolating cytotoxin forms vacuoles in the cytoplasm of lining epithelial cells. (actual
pathway, Presence of vacuolating cytoplasm  expression of anionic channel  osmotically
influx of water  formation of vacuoles) and they also cause decreased proliferation of T-
cell and inhibits antigen presentation of B-cell. They also inhibit NO release from
macrophages and hence survives

 Endotoxin: The LPS of bacteria mimics the antigen expressed on parietal cell of gastric
antrum. (that antigen is H/K ATPase pump)

Factors promoting infection:

- Smoking, eating salty food and canned food. Vitamin C and anti-oxidants have protective effect.
- Inverse relation with : GERD, Barret’s esophagus, adenocarcinoma of esophagus, inflammatory
condition like asthma.

Lab diagnosis:

(A) Invasive test:

Biopsies of gastric mucosa (usually antrum) is collected by endoscopy and subjected to:
- Histopathological staining: by Warthin Starry Silver stain, where bacteria appears black
- Microbiological staining: Gram’s stain: appears pink, rod shaped.
- Culture: Could be done in Campylobacter medium like Skirrow's media or in chocolate medium.
Should be incubated at microaerophilic condition (5-20% CO2). It is highly SPECIFIC but not
sensitive
- Biological test: Catalase, oxidase, urease test +ve
- Biopsy urease test (Rapid urease test): Biopsy is placed in a plate with urea and pH indicator. It is
more SENSITIVE.

(B) Non-invasive test:

 Urea breath test: Labeled nonradioactive Urea (with C13) is ingested and if there is bacteria,
urease enzyme cleaves the urea. Labeled CO2 is released in breath. This is highly SENSITIVE
test
 Stool examination: Bacterial antigen may be found in stool

Urea breath test and stool examination are done for monitoring treatment
 Antibody detection: ELISA could be done to detect IgG in serum.