Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
Curr Opin Gastroenterol. 2012 Nov;28(6):608-14. doi: 10.1097/MOG.0b013e32835918a7.
Progress continues in our understanding of the role of Helicobacter pylori infection in gastroduodenal as well as extragastric disorders. This review gives an overview on selected areas of the H. pylori infection and their clinical implications.
Indications for therapy have been extended and now include idiopathic thrombocytopenic purpura, iron deficiency anemia, and vitamin B12 deficiency. New data are presented on the role of H. pylori in neurodegenerative disorders and in the metabolic syndrome. H. pylori is associated with a (small) increase in the risk for colorectal adenoma and colon cancer. The biggest challenge is the selection of new therapies and treatment strategies because of the increasing failure of standard triple therapies. The best option in high clarithromycin resistance areas is bismuth-based quadruple therapy. Probiotic bacteria and yeasts reduce adverse effects of standard H. pylori eradication regimens. In gastric cancer prevention, screening programs based on the serological detection of preneoplastic conditions may prove useful.
New algorithms for preventing H. pylori-induced disease and eradicating the organism should be individualized.
我们对幽门螺杆菌感染在胃肠及胃外疾病中的作用的理解不断深入。本综述概述了幽门螺杆菌感染的一些特定领域及其临床意义。
治疗适应症已经扩大，现在包括特发性血小板减少性紫癜、缺铁性贫血和维生素 B12 缺乏症。有新数据表明幽门螺杆菌在神经退行性疾病和代谢综合征中的作用。幽门螺杆菌与结直肠腺瘤和结肠癌的（小）风险增加有关。最大的挑战是选择新的治疗方法和治疗策略，因为标准三联疗法的失败率不断上升。在克拉霉素耐药率高的地区，最好的选择是基于铋的四联疗法。益生菌和酵母可减少标准幽门螺杆菌根除方案的不良反应。在胃癌预防方面，基于检测癌前病变的血清学筛查方案可能会证明有用。
预防幽门螺杆菌引起的疾病和根除该病原体的新算法应个体化。
