HELICOBACTER PYLORI

GERMENE: ♦ gram negativ ♦ bacil curb ♦ 3µ /0,5µ ♦ 4-6 flagele ♦ cre]te pe orice mediu ♦ microaerofil

EPIDEMIOLOGIE
• 50% din popula\ie serologie ! • 2-4 ani 32-95% ; REZERVOR - UMAN TRANSMISIE: ♦ ORO-ORAL~
♦ ORO-FECAL~

HABITAT - MUCOASA ANTRAL~

Prevalen\`
•ITALIA :15 % URBAN; 37 % RURAL. •ALASKA : 75 % •MANITOBA : 95 %

Inciden\`
• Seroconversie :0,6 % Noua Zeelanda 1,9 % Danemarca 4 % Brazilia

• Factori asocia\i infec\iei: - fumatul - sexul - origine etnic` - nivel social - condi\ii de via\`

Transmisia
• Fecal` : - cercetare fa\` de AcVHA curbe disociate • Oral` : - la fete cu inciden\` crescut` cu 2 ani mai devreme • Ap` : - aparent nu. • Mu]te : - se cerceteaz`.

Fluorescence in Situ Hybridization (F

H. pylori Closely Adherent to the Cell Membrane (Top), and Spiral-Shaped H. pylori Attached to Epithelial Surface and Surrounding Microvilli (Bottom)

Parsonnet J. N Engl J Med 2005;353:2421-2423

A 35-year-old man presented with epigastric pain of several months' duration

Genta R and Graham D. N Engl J Med 1996;335:250

DIAGNOSTIC
I. INVAZIV: - BIOPSIE MUCOAS~ a) CULTURI b) COLORA|IE c) TEST RAPID d) HISTOLOGIE II. NEINVAZIV: - TEST RESPIRATOR - SEROLOGIE - PCR

FACTORI DE VIRULEN|~

• FLAGELE → MOTILITATEA • SPIRALAREA → {N}URUBARE • REZISTEN|A LA ACID → SUPRAVIE|UIRE

Patogenitatea
COLONIZAREA 1. Aderen\a : Blood Adherence Binding Antigen (BABA) - Lewis cu dubii c`ci [n cultura cu anticorpi anti Le HP ader`. 2. Supravie\uirea - ureaz` ce poate depinde de su]` 3. Mobilitatea - Flagelina Fla A - depinde de v@scozitatea mucusului

CRONICIZAREA a) Enzima SCOT ( succinil CoA acetoacetat transferaza) realizeaz` colonizarea ]i/sau supravie\uirea b) Nα metiltransferaza agonist receptori H3 c) d) Inhibarea eliber`rii de stomatostatin` AIF1 (acid inhibitory factor)

e) AIF3 protein` mai mic`

• Factori ce lezeaz` mucoasa : a) VacA – inhib` transportul C ]i enzime b) amoniacul inhib` secre\ia de somatostatin` c) LPS similare Le xy d) factori ce promoveaz` inflama\ia IL-8

FACTORI DE PATOGENITATE
• CATALAZA → PREVINE FAGOCITOZA • FOSFOLIPAZA → SCADE AP~RAREA • MUCINAZA → DEPLE|IE DE MUCUS • CAG A • VAC A • UREAZA

Pathogen-Host Interactions in the Pathogenesis of Helicobacter pylori Infection

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

The cag Pathogenicity Island

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

FIXAREA
• Le b • MODIFIC~RI CITOSCHELET • CAG A → protein` "self" • VAC A → furnizeaz` masa

AC|IUNI PATOLOGICE
PRODUC|IE: IL-6, TNFα , NF-KB a) SUBIECT IL-1β b) INDIVIZI NON IL- 1β

SUBIECT IL-1β
HP INHIB~ SECRE|IA ACID~ GASTRITA CORPOREAL~ GASTRITA ATROFIC~ METAPLAZIE INTESTINAL~ LEZIUNI ADN MUTA|II ADENOCARCINOM

Proposed Cascade of Pathologic Events in Gastric Adenocarcinoma

Fox J and Wang T. N Engl J Med 2001;345:829-832

SUBIECT NON IL-1β (GENOTIP)
SECRE|IE ACID~ NORMAL~ GASTRITA ANTRAL~ SC~DEREA CELULELOR D HIPERGASTRINEMIE HIPERSECRE|IE ACID~ METAPLAZIE GASTRIC~ COLONIZARE ULCER DUODENAL

REZULTATELE INFEC|IEI HP
• GASTRITE ACUTE → FLEGMON GASTRIC • GASTRITE CRONICE • ULCER GASTRIC • ULCER DUODENAL • MALTOM • ADENOCARCINOM • DISPEPSIA ?

Natural History of Helicobacter pylori Infection

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

Current Guidelines for the Treatment of H. pylori Infection, According to the Maastricht 2-2000 Consensus Report

Suerbaum S and Michetti P. N Engl J Med 2002;347:1175-1186

TRATAMENT
I. a) IPP b) claritromicin` c) amoxicilin` (metronidazol) II. a) RBC b) claritromicin` c) amoxi (metro, tetra) III. a) IPP b) bismut c) metronidazol d) tetra DURATA: 14 zile

REZISTENTA LA ANTIBIOTICE
• CLARITROMICINA 4%-17% IRAN.factor de risc :consumul de macrolide. • AMOXICILINA 1% • METRONIDAZOL 30-40% • TETRACICLINA 0, 5-5% • FLUOROQUINOLONE 20% PORTUGALIA 3% ROMANIA

GASTRITE
Inflama\ia mucoasei/peretelui gastric. • ACUT~ • CRONIC~ CLASIFICAREA A.B.C.

GASTRITE ACUTE
Boli autolimitate produse prin cauze exo ]i endogene. • cuprind ]i alte segmente • profunzime variabil`

GASTRITE ACUTE EXOGENE
1. microbiene: a) stafilococul auriu b) clostridium botullinum 2. alergice - criteriile INGELFINGER 3. toxice 4. corozive 5. medicamentoase - AINS 6. alcool

AC. ARAHIDONIC CORTICOIZI AINS
CALEA CICLOOXIGENAZEI LIPOOXOGENAZEI CALEA

PG

PC

TX

LT

OHacizi

PRODUC|IA PG
• STIMULEAZ~ SECRE|IA DE MUCUS • FLUXUL SANGUIN • CITOPROTEC|IA

SISTEMUL SIDNEY
I. BRA| ETIOLOGIC (A, B, C, S) II. BRA| ENDOSCOPIC:
a) LOCALIZARE: ♦ antral` ♦ corporeal` ♦ pangastrit` b) TIP: ♦ eroziv ♦ exudativ ♦ hemoragie

III. BRA| HISTOLOGIC: a) inflama\ie b) activitate c) atrofie d) metaplazie: ♦ complet` ♦ incomplet` ♦ tip colonic e) HP

GASTRITA ATROFIC~
MECANISM IMUN ♦ Ac anti: - FI Castle - glicoproteic - pompa protoni - lipoproteic - celul` G

IMPORTAN|A
• INTERFER~ CU ABSORB|IA VIT. B12 • STARE PRECANCEROAS~: - RR x 5 - 95% cancere au [mprejur gastrit` - studii longitudinale - distribu\ia geografic` - asocierea cu metaplazie

GASTRITE SPECIALE
1. FORMA DIFUZ~: - rar` - imun` - 50% alergii asociate 2. FORMA ANTRAL~ ASOCIAT~: - UG, UD - HH - cirozei - litiazei

A) GASTRITA VARIOLIFORM~ (4% endoscopic)

B) GASTRITA LIMFOCITAR~ (1985)
• MECANISM: ♦PEPTIC ♦ALERGIC: - 25% au eosinofile - 40% au IgE • NODULI OMILICA|I • CLINIC: ♦ ULCER ♦ DISPEPSIE ♦ ANOREXIE ♦ GASTROPATIE EXUDATIV~

C) GASTRITA CU EOSINOFILE • ASOCIAT~ S. CHURG STRAUSS • LOCALIZAT~ ANTRAL • MECANISM ALERGIC • ASOCIERI 50% • CLINIC: - dispepsie - diaree - malabsorb\ie

Sign up to vote on this title
UsefulNot useful