Helicobacter pylori (synonyms: H. pylori; ICD-10-GM B98.0: Helicobacter pylori [H. pylori] as a cause of disease classified in other chapters) is a Gram-negative, microaerophilic rod-shaped bacterium that colonizes the human gastrointestinal tract (GI tract) and can cause ulcers in the stomach and duodenum.
The most important pathogen reservoir is humans.
Occurrence: The infection occurs more frequently in developing countries, which suggests that the infection is dependent on the prevailing hygienic conditions. Similarly, the incidence is region-dependent. For example, 80.8% of the population in Korea is infected and 13.4% in the United Kingdom (UK).
The transmission of the pathogen (route of infection) is still unclear. It can be observed that transmission is mainly intrafamilial (within the family).
Human-to-human transmission: Yes
Frequency peak: The disease increases with age (approx. 1% per year of life in industrialized nations). Infection is thought to occur in childhood (depending on the infection status of the mother).
The prevalence (disease incidence) ranges from 20 to approx. 50 % in adults and 3 % in children in Germany, 80 % in developing countries and 50 % worldwide. This makes Helicobacter pylori infection one of the most common chronic bacterial infections. Overall, however, the prevalence has decreased worldwide.
The following are data on the rate of infection as a function of age (in Germany):
- Children aged 4 years: 3.0%.
- Children between 5 and 7 years: 5-7 %.
- Women/men < 30 years: 19/25 %.
- Women/men > 30 years: 35/55 %
- Women/men > 65 years: 69/90 %
Course and prognosis: infection with Helicobacter pylori always leads to chronic active gastritis (type B gastritis), at the bottom of which in the course of a ventriculi ulcer (gastric ulcer) or duodenal ulcer (duodenal ulcer) may develop. Affected individuals may be asymptomatic (about 80% of cases), but may also suffer from dyspeptic symptoms. If the complaints persist for more than four weeks, a gastroduodenoscopy (endoscopy of the stomach and duodenum) is usually ordered. If organic causes can be ruled out, eradication (elimination of the germ), which leads to healing of the gastritis (inflammation of the gastric mucosa) triggered by the bacterium and its complaints, is started. The standard therapy lasts between 7 and 14 days and consists of three different agents (triple therapy – see “Drug therapy/pharmacotherapy”): one agent inhibits the production of gastric acid, two agents are from the group of antibiotics. After successful eradication, regular controls are carried out, at the earliest after two weeks (breath test, stool antigen test, control endoscopy). If the infection does not cause any symptoms, therapy is usually not necessary.10-20% of infected persons develop a ventriculi ulcer (stomach ulcer) or a duodeni ulcer (duodenal ulcer), and 2% develop gastric carcinoma (stomach cancer). Conversely, Helicobacter pylori infection can be detected in more than 95% of patients with duodenal ulcers and in about 75% of patients with ventricular ulcers.
In industrialized countries, reinfection with the germ occurs in only 2% per year after successful eradication, in developing countries in 6-12% per year. If a new infection occurs within the first year, it is usually a relapse (recurrence of the disease), while a new infection after 12 months is a new strain of the bacteria.
Vaccination: a vaccine against Helicobacter pylori is not available.
