H. pylori was previously known as Campylobacter pylori.
The bacterium is helical shaped and gram-negative, usually found in the stomach.
H. pylori are closely associated with the colon, rectum, stomach, esophagus in the mucosa-associated lymphoid tissue.
Initially, the H. pylori infection is asymptomatic and rarely cause inflammation in the stomach (gastritis).
This infection is also sometimes associated with the development of cancers.
H. pylori secrete urease, which creates a suitable alkaline environment for its survival.
It gets attached to the epithelial lining of gastric cells with the help of outer inflammatory protein adhesion (OipA) and Blood group antigen adhesion (BabA).
The stomach mucosa is inflamed and is associated with the increased secretion of stomach acid – a condition known as hyperchlorhydria or reduction in the acid secretion – a condition referred to as hypochlorhydria.
Acid secretion of the parietal cell is inhibited by inflammatory cytokines and in turn, H. pylori secrete compounds that inhibit hydrogen potassium ATPase and activate sensory neurons via the activation of calcitonin.
Activation of calcitonin increased the somatostatin production to inhibit acid production by parietal cells, eventually reducing gastric secretion.
Reduction in gastrin causes gastric ulcers.
Whereas, increased acid production is associated with reduced somatostatin production and increased gastrin secretion.
As a result of the above process, enterochromaffin cells secrete elevated levels of histamine, thus leading to high acid production.
The human immune system also plays a major role in blocking the entry of bacteria.
The human tumor necrosis factor (TNF), interleukin 1 beta (IL1B), and lymphotoxin alpha play a major role in causing gastric inflammation.
Symptoms of Peptic Ulcer
Abdominal pain during mealtime is an important sign of a gastric ulcer, in the case of duodenal ulcer, abdominal pain occurs after meals (usually 3 hours) and wakes the patient up during midnight.
Bloating of the stomach due to the feeling of fullness.
Appetite starts to decrease that eventually leads to weight loss.
The major symptom of in duodenal ulcer is pain and it subsides after having a meal.
Nausea and vomiting along with salivary rush after regurgitation – a condition known as waterbrash.
Hematemesis- bleeding during vomiting. This is due to gastric or esophageal ulcers.
Acute peritonitis with extreme pain along with gastric or duodenal perforation is the serious symptoms of peptic ulcer that demand immediate medical attention and surgical procedure.
The feces will be smelly due to the excretion of oxidized iron in hemoglobin.
Diagnosis and Treatment of the Peptic Ulcer
Diagnosis of peptic ulcer:
The diagnosis is symptom-based and the most common symptom is stomach pain.
The diagnosis procedures include endoscopy, contrast X-rays, and esophagogastroduodenoscopy (EGD) also known as gastroscopy.
Blood tests are not reliable for peptic ulcers.
Diagnosis of H. pylori is by a urea breath test, rapid urease test to detect the presence of urease, histology, and staining to tissue from a biopsy, and stool antigen test.
Prevention of peptic ulcer:
It is necessary to eradicate the bacteria during the early stages with the help of an antibiotic treatment.
One should quit smoking and tobacco consumption along with alcohol.
Treatment strategies:
The standard first-line therapy for H. pylori infection is “triple therapy†for one week
The treatment consists of proton-pump inhibitors, for example, omeprazole, a combination of antibiotics such as amoxicillin and clarithromycin.
Treatment strategy improvement included the usage of various other proton pump inhibitors such as rabeprazole, pantoprazole, and metronidazole.
Triple therapy is the only treatment option available currently for a peptic ulcer caused by H. pylori.
However, the other symptoms of peptic ulcers can be treated with several pharmacological interventions that can help reduce the pain and inflammation.
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