Helicobacter pylori infection
Helicobacter pylori infection
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幽门螺杆菌感染
DOI：
10.1038/s41572-023-00431-8
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发表时间：
2023-04-20
影响因子：
81.5
通讯作者：
Suerbaum, Sebastian
中科院分区：
文献类型：
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作者：
Malfertheiner, Peter;Camargo, M. Constanza;Suerbaum, Sebastian
幽门螺杆菌感染可引起慢性胃炎，可发展为严重的胃十二指肠病变，包括消化性溃疡、胃癌和胃粘膜相关淋巴组织淋巴瘤。幽门螺杆菌通常在儿童时期传播，如果不治疗，它会持续一生。这种感染影响到世界上大约一半的人口，但流行率因地点和卫生标准而异。幽门螺杆菌具有在酸性环境中定植胃上皮细胞的独特特性。幽门螺杆菌感染的病理生理依赖于复杂的细菌毒力机制及其与宿主免疫系统和环境因素的相互作用，导致不同的胃炎表型，决定了可能进展为不同的胃十二指肠疾病。幽门螺杆菌感染在胃癌发展中的致病作用为预防性筛选和治疗策略提供了机会。有创性的、基于内窥镜的和非侵入性的方法，包括呼吸、粪便和血清学测试，用于诊断幽门螺杆菌感染。它们的使用取决于特定的患者个人病史和当地的可用性。幽门螺杆菌的治疗包括一种强酸抑制剂与抗生素和/或铋的各种组合。根除幽门螺杆菌使用的关键抗生素的耐药性急剧增加，需要进行抗生素敏感性测试、耐药性监测和抗生素管理。
Helicobacter pylori infection causes chronic gastritis, which can progress to severe gastroduodenal pathologies, including peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. H. pylori is usually transmitted in childhood and persists for life if untreated. The infection affects around half of the population in the world but prevalence varies according to location and sanitation standards. H. pylori has unique properties to colonize gastric epithelium in an acidic environment. The pathophysiology of H. pylori infection is dependent on complex bacterial virulence mechanisms and their interaction with the host immune system and environmental factors, resulting in distinct gastritis phenotypes that determine possible progression to different gastroduodenal pathologies. The causative role of H. pylori infection in gastric cancer development presents the opportunity for preventive screen-and-treat strategies. Invasive, endoscopy-based and non-invasive methods, including breath, stool and serological tests, are used in the diagnosis of H. pylori infection. Their use depends on the specific individual patient history and local availability. H. pylori treatment consists of a strong acid suppressant in various combinations with antibiotics and/or bismuth. The dramatic increase in resistance to key antibiotics used in H. pylori eradication demands antibiotic susceptibility testing, surveillance of resistance and antibiotic stewardship.