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H. Pylori

A 50 yo Female, had h. pylori infection, was treated successfully and confirmed after a month by -ve fecal antigen.

Is still there a possibility to get infected again with it? And if yes, what are the precautions should be considered to avoid that?

More about this case

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Review question

Whether testing healthy people for Helicobacter pylori and treating those infected with a course of antibiotics decreases the number of new cases of gastric cancer.

Background

Helicobacter pylori (H. pylori) is a bacteria that lives in the lining of the stomach with people usually not aware they are carrying the infection. People with H. pylori infection are more likely to develop gastric cancer than people who are not infected with the bacterium. For this reason, H. pylori is classed as carcinogenic (causing cancer) to humans. Many people worldwide die of gastric cancer every year, because by the time those affected seek the opinion of a doctor, the condition is often advanced. However, H. pylori infection is easily treatable with a one‐week course of antibiotics.

Study characteristics

A literature search up to 02 February 2020 found seven trials (containing 8323 participants, four trials at low risk of bias). Six of the studies were based in Asia.

Key results

We found that antibiotics for H. pylori have a small benefit in preventing gastric cancer (68 (1.6%) of 4206 participants given treatment developed gastric cancer subsequently, compared with 125 (3.0%) of 4117 given no treatment or a placebo), and in decreasing the number of deaths from gastric cancer (36 (1.1%) of 3154, compared with 59 (1.9%) of 3147); but it is unclear whether or not they increase or decrease the number of deaths due to any cause, or increase or decrease the number of cases of oesophageal cancer. Data about side effects of treatment were poorly reported.

Quality of the evidence

Four trials were at low risk of bias, one trial was at unclear risk, and two trials were at high risk of bias. One study was at high risk of bias because no placebo was used for the active eradication therapy regimen, and so this part of the trial was unblinded, and the other study was at high risk of bias due to inconsistencies in data reporting at the two points of follow‐up. We were unable to resolve this discrepancy despite contacting the original authors. As a result, we downgraded the quality of evidence from high to moderate due to serious risk of bias.

Axial CT images

Axial CT images of the abdomen show a gastric ulcer (arrow) near the pylorus. The duodenal bulb (arrow) is normal. The gastric antrum wall (arrowhead) is thickened. Gastric ulcers are typically caused by H. pylori infection or medication use. Patients may present with pain, upper GI bleeding, and acute pain related to perforation.

53YO WOMAN

Liver with regular margins, volume, limits. Moderate Steatohepatitis with no evidence of lesions. Gallbladder thickened in the walls, with a homogeneous content. No ectasia of biliary and hepatic veins. Pancreas visible. Spleen regular. Absence of ascites and hilar Lymph-nodes swelling. Kidney in regular shape. Pelvis relaxed. Complains mesogastric pain radiating to the left hypochondrium. History of Helicobacter-pylori-infection Ulcer(s) cured 13y.o. ago, external Hemorrhoids with rectal Bleeding-disorders, constipation. IYHO what is the cause of the Pain?

Patient description

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Patient description

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Patient description

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient description

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?