Background of H. pylori

Type	Clinical features
Microbiology	Spiral shaped, microaerophilic, gram negative bacteria *Bacterial urease* Converts gastric urea to ammonia to neutralize gastric acid *Motility* Spiral shape and flagella can allow passage through gastric mucosa *Ability to adhere to gastric epithelium* Due to receptor mediated adhesion on gastric surface
Epidemiology	Estimated to affect 50% of adults in developed countries by age 60 Estimated to affect nearly 80% of adults by age 50 in developing countries Exact transmission unclear Reinfection after treatment very unlikely (< 1%)
Pathophysiology	*Attachment to gastric mucosa causes* Increased gastrin release Decreased somatostatin release Increased acid secretion *Inflammation leads to gastritis* Loss of gastrin producing cells and parietal cells Eventual decrease in acid production Atrophy with intestinal metaplasia Eventual antral inflammation Process accelerated by chronic PPIs

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Helicobacter pylori (H. pylori)