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Gastroenterology Medicine & Research

Is it really Necessary to Eradicate Helicobacter pylori?

Fernanda Machado Fonseca1*, Jacqueline Batista Sousa2, Brenda Junqueira Afonso3, Marcela Machado Fonseca4, Anderson de Almeida Amaral4 and Kennio Ferreira Paim3,5

1 Department of Biomedicine, Federal University of Piauí, Brazil

2 Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro, Brazil

3 School of Medicine, Uberaba University, Brazil

4 Santa Casa de Misericórdia Hospital, Brazil

5 Department of Clinical Pathology, Federal University of Triângulo Mineiro, Brazil

*Corresponding author: Fernanda Machado Fonseca, Department of Biomedicine, Federal University of Piauí, Campus Ministro Reis Velloso. São Sebastião Avenue, 2819, Reis Velloso, Parnaíba, Piauí, Brazil

Submission: August 24, 2018;Published: August 27, 2018

DOI: 10.31031/GMR.2018.02.000528

ISSN 2637-7632
Volume2 Issue1

Letter to Editor

Helicobacter pylori is a Gram-negative bacterium that colonizes around 50% of world population. It is frequently associated with gastrointestinal diseases such as gastritis, peptic ulcer, and in some cases, can favour the development of gastric cancer. After the host colonization, H. pylori can cause chronic infection and disease in less than 10% of symptomatic individuals after several years. Thus, the apparent colonization of H. pylori requires a long time of establishment and the continuous stimulation of the inflammatory response to produce enough histological deterioration for disease expression [1].

Several virulence factors of H. pylori have been described (i.e. cagA and vacA genes). The presence of these factors can contribute to the development of a more aggressive form of the disease, although strains not carrying these virulence factors were also recovered from stomach of infected patients. As the colonization of H. pylori can be asymptomatic for decades, most cases of the disease (i.e. peptic ulcers) occur in patients older than 40 years, and around 1% of these individuals can evolve to gastric cancer [2]. Due to its long latent period of infection, the small numbers of cases of that evolve to gastric cancer and the detection of H. pylori in the faeces of mummified humans around 3,000 years ago some authors have hypothesized that this pathogen cold be, in fact, more an ancestral commensal microorganism of humans than a true pathogen [3]. Reinforcing this hypothesis is the fact that the infection is transmitted early in life and is mainly in a family setting.

In the last years, it has been detected a decrease in the prevalence of H. pylori infection, especially in developed countries [4,5]. The improvement of sanitary conditions and changes in family size are two of many other factors that have contributed to the decrease of its transmissibility. As the prevalence H. pylori decline, other diseases have been reported more frequently, such as asthma, obesity and an increase in the susceptibility to develop diarrheal diseases [6-8]. Additionally, H. pylori have been negatively associated with gastro-oesophageal reflux disease, Barrett’s oesophagus, and adenocarcinoma of the oesophagus [9]. Thus, it seems that H. pylori interactions with human being have created double-edged sword.

The pros and cons of H. pylori infection have raised the question whether the eradication of H. pylori is really necessary from those infected and asymptomatic individuals to prevent future clinical complications. We are far to have reached a consensus between the scientific society and clinicians. However, it is important highlight that the eradication of H. pylori in some communities would be desire, like in Japan, where the population has a high risk to develop gastric cancer [10].

In fact, the eradication of H. pylori lead to peptic ulcer healing, reduces ulcer relapse rates, and prevents gastric cancer. But, the wide use of the standard triple therapy consisting of a proton pump inhibitor plus clarithromycin and amoxicillin results in declined rates of success and in resistance to clarithromycin and metronidazole also used in cases of hypersensitivity to amoxicillin [11]. Recent studies have suggested therapies containing fourthgeneration quinolones, as a high rate of H. pylori eradication were demonstrated [12,13]. Thus, additional studies regarding effective therapies for H. pylori infection are necessary and it is important to emphasize that the chosen of antimicrobial has to be done based on susceptibility test and according to geographical region.

Take all these together, it is not possible to conclude if H. pylori act as a pathogen or as an ancestral commensal of humans. Additional studies exploring its interaction with the host and the consequences of its eradication are necessary. One alternative to avoid the massive and unnecessary eradication of this microorganism in colonized and asymptomatic individuals is the early detection of gastric lesions, especially because H. pylori colonization can be important to human stomach.

References

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© 2018 Fernanda Machado Fonseca. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.

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