Fighting ulcers

The identification of this organism has produced a flurry of research activity. 8220;Helicobacter Pylori is no longer a medical curiosity, but has made a place of itself in the mainstream of modern medicine,8221; pointed out Barry Marshall, an Australian physician who first identified Helicobacter Pylori as an important gastrointestinal pathogen. Dr. Marshall has been awarded the famous USA Albert Lasker Award8217; in 1995. Around half of the adults may be infected with Helicobacter Pylori in developed countries, while this figure could be as high as 90 per cent in developing countries.

No other organism infects such vast population all over the globe so chronically, with the infection lasting from first decade of life till death. The frequency of Helicobacter Pylori increases progressively with age. The infection rate appears to be higher in urban than in rural areas. There is evidence that infection by Helicobacter Pylori is a water borne infection and is transmitted by the faeco-oral route.

Now the need is to make the general public aware that their ulcer may be cured with a week8217;s course of antibiotics and traditional ulcer medication. Ulcer sufferers must ask their doctors about new options for curing the disease. A blood test can indicate whether Helicobacter Pylori has ever been present in the body and a biopsy can confirm whether it still lurks there. If Helicobacter Pylori is present, antibiotics can be prescribed to eradicate it.

Eradication of Helicobacter Pylori, however, remains a major clinical challenge. In the laboratory, Helicobacter Pylori is relatively sensitive to a range of antibacterial agents. Yet in practice, it is strangely difficult to eradicate the organism from the human gastroduodenal mucosa.

More fundamentally treatment is difficult as Helicobacter Pylori8217;s habitat below the layer of gastric mucus and thus hinders the necessary access of antimicrobial. Successful treatment depends on facilitating that access, on the sensitivity of the bacterium to the antibiotics and on the compliance with treatment regimens. Antibacterial regimens are under continuing development, but the ideal 8220;Gold Standard8221; fir eradication therapy has yet to be identified. Initially single drug regimen was used. Their place was subsequently taken up by dual, triple and even quadruple therapies.

A surprisingly large number of drug combinations has been employed; few of these have been reported formally and even fewer subjected to rigorous evaluation. At present standard triple therapy, which is probably the most widely used treatment for eradication of Helicobacter Pylori consists of a one week course of colloidal bismuth subcitrate, Metronidazole and either Amoxycillin or Tetracycline.

The low dose, one week triple therapy has few side effects and substitution of metronidazole for tinidazole seems to make little difference to the results. Concurrent administration of proton pump inhibitors such as Omeprazole or lansoprazole reduces ulcer pain more rapidly, but has no effect in ulcer healing. Dual therapy with Omeprazole in combination with amoxycillin or clarithromycin has been approved for the eradication of Helicobacter Pylori in 15 countries.

Eradication rate with conventional triple therapy or dual therapy is dependent on drug compliance and drug resistance etc. However, the most likely reason for lower eradication is drug resistance. The resistance of Helicobacter Pylori to Metronidazole varies from 6 8211; 84 per cent. Being higher in the 3rd World countries where metronidazole is used for treatment of suspected amoebiasis and giardiasis.

Since the exposure to the bacteria occurs at frequent unpredictable times during life and obviously it is not feasible8217; to continuously administer antibiotics to prevent infection. The only prevention strategy is the use of a vaccine 8211; the most cost effective approach, that provides prolonged protection and offers numerous other advantages.

The development of a vaccine against the bacterium would rid the world not only of a common infection but also of a major disease. The oral vaccine to treat Helicobacter Pylori infection, to prevent reinfection in the previously infected persons and to stimulate immunity in uninfected persons has reached an advanced stage of development. Hopefully in another decade we will be talking about Peptic Ulcer disease as a disease of past.