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Giới thiệu
Dyspepsia
Dyspepsia is the presence of ≥1 of the following: Bothersome postprandial fullness, early satiation, epigastric pain, and epigastric burning. There is no evidence of structural disease that is likely to explain the symptoms. The symptoms were present within the last 3 months with onset ≥6 months prior to diagnosis (Rome IV criteria). Though the relationship between functional dyspepsia and H pylori is unclear, improvement of functional dyspepsia symptoms was seen with elimination of H pylori infection.
Helicobacter pylori
Helicobacter pylori Infection_Disease Background
Helicobacter pylori is a spiral-shaped, Gram-negative bacterium involved in the development of gastritis, duodenal and gastric ulcers, and gastric cancer. Helicobacter pylori gastritis may decrease or increase acid secretion and cause dyspeptic symptoms. Up to 90-95% of patients with nonsteroidal anti-inflammatory drug (NSAID)-related duodenal ulcers and 80% of patients with non-NSAID-related gastric ulcers are infected. The adaptability in gastric conditions and production of urease allow it to colonize the stomach. Acute infection is mostly asymptomatic and is acquired through human-to-human contact via oral-oral, gastro-oral and fecal-oral routes. Chronic infection is strongly associated with the development of gastric epithelial and lymphoid malignancies.
Dịch tễ học
The global prevalence of H pylori differs widely and is influenced by factors such as a country’s economic status, as well as an individual’s gender, ethnicity, and overall socioeconomic conditions. In developed nations, infection rates typically range from 25% to 50%, whereas in many developing countries, prevalence can reach up to 90%. Studies show that H pylori accounts for about 74% of non-cardiac gastric cancer cases in developed nations and 78% in less developed regions.
Across Asia and Africa, H pylori prevalence varies widely. Most African nations report infection rates exceeding 50%. In Asia, the prevalence is also high in some countries—such as South Korea (43.9%) and China (44.2%)—but significantly lower in others, including Indonesia (10.4%) and Sri Lanka (2.5%).
Sinh lý bệnh
Helicobacter pylori Infection_Initial AssesmentHelicobacter pylori infection is usually acquired in childhood and, without targeted treatment, tends to persist for life. Once established, H pylori attach to or penetrates the gastric mucosa, triggering both localized inflammation in the stomach and systemic inflammatory responses, which can contribute to diseases beyond the gastrointestinal tract. Once the bacteria colonize the stomach lining, they activate immune cells to produce proinflammatory mediators including cytokines, eicosanoids, and acute-phase proteins. These processes lead to a spectrum of gastric changes, ranging from active superficial gastritis to chronic deep gastritis, and may progress to intestinal metaplasia or even gastric cancer.
Yếu tố nguy cơ
The risk factors for Helicobacter pylori infection are age, male gender, hygiene, living in overcrowded areas, lower socioeconomic status, smoking, NSAIDs and periodontitis. Age helps predict both the likelihood of acquiring H pylori infection and the risk of developing intestinal metaplasia afterward. Higher rates of H pylori infection have been observed among individuals living in overcrowded environments. Smoking is widely recognized as a contributing factor to increased H pylori positivity. Periodontitis is a chronic inflammatory disease affecting the supporting tissues of the teeth and is associated with increased microbial growth that makes the oral cavity a reservoir for bacteria. A large retrospective study in Taiwan found that periodontitis was linked to a higher risk of H pylori infection.