Clinical Pharmacology And Therapy Of Helicobacter Pylori Infection

Helicobacter pylori has attracted widening interest from basic scientists and clinical investigators and the information on this organism is increasing exponentially. It is now accepted that H. Pylori is the most important cause of chronic active gastritis. Furthermore, data have confirmed a marked reduction in the relapse rate of both duodenal and gastric ulcer after eradication of the organism. These important clinical observations have served as a strong stimulus to the investigation of the basic mechanisms involved in the pathogenesis of H. pylori-associated inflammation and the subsequent alterations of gastroduodenal function and gastric mucosal architecture. The book contains chapters by a multidisciplinary, international group of basic scientists and clinical investigators who focus on various microbiological aspects of H. pylori, on the role of H. pylori in peptic ulcer and gastric cancer, and the current status of therapy. The book contains the proceedings of the conference on `Helicobacter pylori: Basic Mechanisms to Clinical Cure', held at Amelia Island, Florida, U.S.A., on November 3--6, 1993.

It has been exciting to witness the discovery that most peptic ulcers are caused by a bacterium that is relatively easy to eradicate. Most doctors now aim to give their patients the benefits of this unexpected breakthrough, but the new knowledge raises many questions. One is precisely which groups of patients to treat. We should restrict ourselves to the infected, but which of the many tests should we use to identify them? Having decided to treat, which of the plethora of regimens should we use? These questions have been particularly difficult to address at a time when knowledge and c1inical techniques are still developing rapidly. This book aims to present the current scene in an objective and digestible form, so that c1inicians can choose strategies which suit their local needs. The relative merits of the various c1inical ap proaches are discussed, together with some scientifie background to prepare the reader for future developments. The book is primarily aimed at practising c1inieians but should be equally useful for stu dents preparing for examinations. It will also provide a source of reference to workers in the pharmaceutical industry, journalism or marketing who need to get 'up-to-speed' in this area.

I am delighted to be able to write the foreword for this new book on Helicobacter pylori by three pioneers in the field, Vlf West blom, Steven Czinn and John Nedrud. Because of their long experience in both basic and clinical aspects of H. pylori, the editors have been able to produce a volume which is authoritative and up to date in the science of H. pylori, while still being concise and interesting for the practicing physician or H. pylori novice. To achieve this, they have collected a very distinguished group of authors from within the Vnited States and around the world. The chapters are sequenced in approximately the same order as developments in H. pylori science over the past 15 years. The first chapter on the discovery of H. pylori is by Cliodna McNulty, who was the first person to culture the organism in Europe. The epidemiology is then described followed by the main clinical as sociations, which are gastritis and dyspepsia, peptic ulcers, can cers and lymphoma. This naturally leads to discussion of the laboratory aspects of H. pylori, especially the microbiology, in cluding essential information on antibiotic resistance patterns. Next, virulence and pathogenicity of H. pylori are explained as defined in studies using animal models, then by discussion of the metabolism of the organism. Finally, the interaction of the bac terium with the host immune systems is dealt with, including the implications of these findings as they relate to the development of future vaccines.

The impact of Helicobacter pylori on basic science and the clinical management of patients with the complications of this infection is bewildering. The explosion of new information both in the laboratory and at the bedside has progressed at an unprecedented rate. Our main objective in furthering this progress has been to integrate this new information and organize a series of top-quality presentations and discussions between investigators and clinicians on all aspects of H. pylori research and to review the current position and future research directions. To that end, the second meeting 'Helicobacter pylori: Basic Mechanisms to Clinical Cure' was organized in June 1996 in Ottawa, Canada, following the successful format of the first such meeting held in Amelia Island, Florida, in 1993. The meeting again focused on all timely aspects of H. pylori research. Internationally renowned basic and clinical scientists, all experts in their respective fields, explored in depth the spectrum of H. pylori infection and the related complications of gastritis, peptic ulcer, gastric cancer and lymphoma.

Helicobacter pylori is an universally distributed bacterium which affects more than half of the world population. H. pylori infection causes persistent inflammation with different clinical outcomes in humans, including chronic gastritis, peptic ulcer disease and gastric cancer. The infection has also been associated with several extradigestive disorders. In this book there is a comprehensive overview of contributors on H. pylori infection in diverse areas, including virulence factors of H. pylori and their importance for the clinical outcome of the diseases, discussions about the principal therapeutic regimens of bacterium eradication, also considering the antimicrobial resistance. H. pylori is clearly a very interesting bacteria and great studies and discussions about all its aspects are welcome to the medical and scientific communities.

The explosion of new information on Helicobacter pylori-related disease, both in the basic sciences and in clinical medicine, has continued to progress at an unprecedented pace. In many instances H. pylori infection, both in man and in the laboratory animal, has become a model to investigate fundamental biological issues such as micro-organism-host interactions, intracellular signalling, development of mucosal atrophy, mechanism of microbial resistance, disease modifying factors etc. In view of this bewildering flood of new information, the time was considered right to organize yet another update on H. pylori in the successful series 'Basic mechanisms to clinical cure' to define the 'state-of-affairs' in H. pylori research at this time. Our main objective was to integrate this new information in a series of top-quality presentations and discussions between investigators and clinicians, addressing all aspects of H. pylori research, and to review the current position and future research direc tions. The format included state-of-the-art presentations by world experts heavily involved in H. pylori research, followed by in-depth discussion on intriguing or controversial issues. The topics discussed were grouped according to the leading theme: characteristics of the organism, mode of transmission, mechanisms of H. pylori-induced inflammation, causation of disturbances of gastric secretory and motor function, aspects of clinical presentation and management, problems related to H. pylori-associated gastric adenocarcinoma and MALT-lymphoma, novel aspects of antimicrobial therapy, and vaccination. The meeting concluded with a synoptic agenda of suggested future studies for the microbiologist, the histopathologist and the clinician.

Helicobacter pylori is one of the most common infections in the world, affecting roughly half of all humans. Although it is not an infection that causes death immediately after infection, it is one of the largest emerging infectious diseases in the history of humankind, causing a wide variety of diseases and, in the long term, serious complications such as stomach cancer. This Reprint contains empirical studies and reviews regarding the diagnosis, treatment, complications, and management of H. pylori infection, including new diagnostic methods, effective eradication regimens, the management of gastric cancer, and other topics.