Helicobacter

A genus of helical, curved, or straight microaerophilic bacteria with rounded ends and multiple sheathed flagella (unipolar or bipolar and lateral) with terminal bulbs. Form nonpigmented, translucent colonies, 1–2 mm in diameter. Catalase and oxidase positive. Found in gastric mucosa of primates, including human beings and ferrets. Some species are associated with gastric and peptic ulcers and predispose to gastric carcinoma. The type species is H. pylori.

- H. cinaedi a bacterial species associated with cases of proctitis and colitis in homosexual men.

- H. fennelliae a bacterial species reported associated with proctitis and colitis in homosexual men.

- H. heilmannii species observed in gastric mucosa. This agent has a low prevalence (less than 1% in patients), has not been cultured in vitro, and is of unknown pathogenic significance.

- H. pylori a bacterial species that produces urease and causes gastritis and is involved in most cases of peptic ulcer disease of the stomach and duodenum; infection with this organism also plays an etiologic role (probably along with dietary cofactors) in dysplasia and metaplasia of gastric mucosa, distal gastric adenocarcinoma, and non-Hodgkin lymphoma of the stomach. SYN: Campylobacter pylori.The organism was first observed in 1982 by Robin Warren and Barry J. Marshall at Royal Perth Hospital in Western Australia in biopsy specimens from patients with chronic gastritis. Originally believed to be a species of Campylobacter, the organism was reclassified as H. pylori in 1989. H. pylori, a curved or spiral, flagellated Gram-negative bacillus, colonizes the gastric mucosa, attaching itself to the surface of mucus-secreting columnar cells. The ability of the organism to survive in an acid medium is due to its production of urease, which converts urea to ammonia and alkalizes the film of mucus in which it resides. Infection with H. pylori is common worldwide, and the incidence of infection increases with age, reaching about 50% among persons aged 60. Transmission is believed to be from person to person by the fecal-oral route. Familial clustering of infection and a higher incidence among blacks and Hispanics have been attributed to social rather than genetic factors. Once infection occurs, it typically remains for life unless treated with antibiotics. Newly acquired infection results in extensive damage to parietal cells, with acute gastritis accompanied by impairment of acid production, which may be transitory. Most people infected have no symptoms (possibly because some strains of H. pylori do not produce cytotoxins) but about 1% of H. pylori–infected adults each year develop peptic ulcer. The risk of progression to peptic ulcer disease is increased by cigarette smoking and long-term use of nonsteroidal antiinflammatory agents. About 70% of all people with gastric ulcers and 90% of those with duodenal ulcers are found to be infected with H. pylori. In the U.S., about 500,000 new cases of peptic ulcer disease occur each year. The disease is responsible for 3–4 million physician visits and approximately 16,000 deaths annually. H. pylori infection has not been associated with nonulcer dyspepsia or inflammatory disorders of the digestive tract other than peptic ulceration. However, the incidence of both gastric adenocarcinoma and gastric lymphoma is higher in infected persons. In addition, the organism has been implicated in some cases of cholecystitis and autoimmune thyroiditis, and some studies have suggested that gastric infection with H. pylori may be a factor, by an unknown mechanism, in some cases of sudden infant death syndrome (SIDS). Diagnosis of H. pylori infection can be confirmed by identification of the organism in stained sections of gastric biopsy material, by culture from biopsy material, by testing biopsy material for urease activity, by identification of bacterial antigen in stool, by finding IgG antibody to the organism in the serum (the method of choice to confirm infection in a previously untreated patient), or by detection of urease activity with various biochemical tests. The urea breath test is more useful than serologic testing to confirm eradication of H. pylori after a course of treatment, since IgG antibody may remain elevated for more than 1 year after eradication. Eradication of the organism with antibiotic therapy does not yield faster healing of a peptic ulcer than treatment with antisecretory agents, but it greatly reduces the likelihood of ulcer recurrence. Recommended regimens for eradication of H. pylori include combinations of bismuth subsalicylate with 2 antibiotics (metronidazole or clarithomycin and tetracycline or amoxicillin). Acquired resistance of H. pylori to the macrolide and imidazole antibiotics is a growing problem. It is estimated that about 30% of strains of the organism in the U.S. are resistant to metronidazole and that almost 10% are resistant to macrolides. A major factor in the emergence of resistant strains appears to be an inadequate or failed first course of treatment. Active vaccination by oral administration of an enzymatically inactive recombinant subunit of H. pylori urease combined with a mucosal adjuvant (labile toxin of Escherichia coli) has elicited microbiologic and clinical cure of H. pylori infection in animal studies and limited human trials.

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hel·i·co·bac·ter 'hel-i-kō-.bak-tər n

1) cap a genus of bacteria formerly placed in the genus Campylobacter and including one (H. pylori) associated with gastritis and implicated as a causative agent of gastric and duodenal ulcers

2) any bacterium of the genus Helicobacter

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n.

a genus of spiral flagellated Gram-negative bacteria. The species H. pylori (formerly classified as Campylobacter pylori) is found in the stomach within the mucous layer. It occurs in the majority of middle-aged people and causes progressive gastritis. It is almost invariably present in duodenal ulceration and usually in gastric ulceration. Eradication of the organism (using various combinations of antibiotics and antisecretory drug) leads to healing of the ulcer. H. pylori has also been implicated in some forms of stomach cancer and in heart disease.

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He·li·co·bac·ter (hel″ĭ-ko-bakґtər) [helico- + -bacter] a genus of gram-negative, microaerophilic bacteria of the family Helicobacteraceae, consisting of motile, spiral organisms with multiple sheathed flagella; formerly classified in the genus Campylobacter.