What about H. pylori
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I mean, H. pylori is a very interesting organism. It’s certainly been associated with gastric ulcer disease. And you know you can treat gastric ulcers with antibiotics and H. pylori has been associated with two forms of cancer; the endemic form of gastric cancer with intestinal metaplasia and achlorhydria and it also has been associated with lymphomas, particularly the MALTomas. What do we know about H. pylori? well, it was in 1991 in this article in the New England Journal of Medicine that the first questions were really posed to a very widespread medical audience about H. pylori and gastric cancer. There were several observations made that most of the stomachs with endemic gastric cancer with intestinal metaplasia were colonized with H. pylori. Most patients with cancer were seropositive. The truth was also that most age-matched controls, so it’s a relatively ubiquitous infection as far as being exposed to H. pylori. The other thing that’s interesting here is that H. pylori is not associated with GE junction or gastrocardial cancers. Interestingly enough, chronic gastritis with H. pylori is associated with achlorhydria. You can think of chronic gastritis with H. pylori as being almost protective for Barrett’s esophagus. It’s like a potent H2 blocker, or Prilosec in a sense. The question was, does H. pylori cause gastric cancer? And obviously this is too simplistic. I think what we know now is H. pylori is a cofactor in the causation of gastric cancer. There is an increased risk of intestinal gastric cancer, decreased risk in the cardioesophageal junction and increased risk of the mucosal-associated lymphoid tumors, or the MALTomas. And MALTomas are interesting. You actually might see a question on the Board. “Well differentiated lymphatic mucosal tumors in the stomach.” And the answer to the question is, you can treat them with antibiotics at an early form and they go away because they are polyclonal proliferations. Eventually they become monoclonal lymphomas which require chemotherapy. Most of the intestinal forms of gastric cancer, the endemic in the high incidence countries, are associated with H. pylori. Only a relatively small amount of the diffuse cancers are associated with H. pylori infection.
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Now it appears that H. pylori is a cofactor in producing gastritis. You get an infection with gastritis, infection, gastritis, chronic mucosal injury. The chronic mucosal injury leads to intestinal metaplasia, achlorhydria and carcinoma. There are particular strains of H. pylori which appear to be more important. There is something called the KAG-A strain of H. pylori that the infectious disease people talk about, that appears to be more virulent in producing the gastritis and higher incidence of cancer.