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H. Pylori H. Pylori

Helicobacter Pylori l History • 1906 • 1982 (Warren and Marshall) • Antibiotic was Helicobacter Pylori l History • 1906 • 1982 (Warren and Marshall) • Antibiotic was used • Subsequently, they isolated a bacteria • Self-experiments (Marshal ingested H. pylori) • Hundreds of studies followed • NIH • 1994 H. pylori infection was concluded to be a major cause of peptic ulcer (antibiotic therapy)

Prevalence l l It is a worldwide problem ↑ 50% infected Developed vs. Developing Prevalence l l It is a worldwide problem ↑ 50% infected Developed vs. Developing Differences in prevalence due to a variety of factors?

Factors associated with prevalence of H. pylori l l l Age Ethnicity Socioeconomic Status Factors associated with prevalence of H. pylori l l l Age Ethnicity Socioeconomic Status Household crowding Migration from high prevalence regions

Age l Prevalence of H. pylori ↑ with age ØQ. Does that reflect an Age l Prevalence of H. pylori ↑ with age ØQ. Does that reflect an ↑ of risk with age? ØA. ? ? üBirth cohort effect üCohort studies üChildhood (factors) üPeak of acquisition between 3 -4 yrs

Ethnicity l l l Prevalence of H. pylori differs by ethnicity In US more Ethnicity l l l Prevalence of H. pylori differs by ethnicity In US more among Blacks and Hispanic In Germany more among Turkish In Singapore Indians>Chinese>Malays Why? üIs it due to genetic differences üIs it other factors such as: Marker of a variety of lifestyle exposures, such as differences in standards of living or sanitation practices ØCrowding ØPoverty ØEducation ØOrigination from highly prevalent areas

Socioeconomic status l l Studies showed an inverse relationship Some studies showed absence of Socioeconomic status l l Studies showed an inverse relationship Some studies showed absence of the association between prevalence of H. pylori and SES level. ØQ. How could you explain that? üHow was the question asked? üPersistence üDue to limited variation in SES üProbably obscured due to complexity of defining and measuring SES

Detection of H. pylori infection l Invasive l Noninvasive Detection of H. pylori infection l Invasive l Noninvasive

Invasive tests l l l Biopsy urease test Histologic examination Microbiologic culture Invasive tests l l l Biopsy urease test Histologic examination Microbiologic culture

Noninvasive tests l l l Serologic assays Urea breath tests Stool antigen test Noninvasive tests l l l Serologic assays Urea breath tests Stool antigen test

Transmission l l Not well understood Person to person but how? üOral-oral üFecal-oral üGastro-oral Transmission l l Not well understood Person to person but how? üOral-oral üFecal-oral üGastro-oral üWaterborne üZoonotic

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