Infekcija bakterijom Helicobacter pylori, izvan želučane manifestacije bolesti i rana detekcija karcinoma kardije, jednjaka i želuca

master's thesis

• Title (english): Helicobacter pylori infection, extragastric manifestations of disease and early gastric, esophageal cardia and esophageal cancer detection
• Author: Matej Percan
• Mentor: Žarko Babić (mentor)
• Committee member: Žarko Babić (predsjednik povjerenstva)
• Committee member: Marko Banić (član povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Helicobacter pylori je gram negativna bakterija koja kolonizira gornji probavni sustav oko polovice svjetske populacije. H.pylori se smatra najvećim faktorom rizika u razvoju teških želučanih komplikacija te naposljetku malignih bolesti želuca. Uz pomoć polarnih flagela adherira na želučanu sluznicu, a produkcijom enzima ureaze neutralizira želučanu kiselinu. Glavni čimbenici virulencije H.pylori su Cag A i Vac A geni. U dijagnostici razlikujemo invazivne i neinvazivne metode. Od neinvazivnih metoda koriste se urea izdisajni test, test antigena u stolici te serološka ispitivanja na IgG specifična protutijela, dok je kod invazivnih metoda endoskopija gornjeg gastrointestinalnog trakta s pripadajućom biopsijom glavna metoda izbora u dijagnozi bakterije. Standardna terapija eradikacije infekcije poznata i pod nazivom „trojna terapija“ sastoji se od kombinacije jednog od IPP, amoksicilina i metronidazola. Iako je ciljni organ H.pylori želudac brojne su izvan želučane komplikacije povezane s prisustvom te bakterije. Od neuroloških bolesti uočena je moguća povezanost bakterije s težinom kliničke slike kod Parkinsonove i Alzheimerove bolesti dok se kod kardioloških bolesti povezuje s razvojem koronarne arterijske bolesti te kao mogući neovisan faktor razvoja esencijalne hipertenzije. Kod hepatobilijarnih bolesti dovodi ju se u vezu s nealkoholnom masnom bolesti jetre, jetrenom fibrozom, kao i autoimunim bolestima jetre. Povezanost s rosaceom već je odavno opisana, kao i s idiopatskom trombocitopeničnom purpurom te anemijom uzrokovanom nedostatkom željeza. S druge strane uočeni su i protektivni učinci infekcije kao kod upalnih bolesti crijeva. Literatura poznaje i brojne druge poglavito štetne učinke H.pylori infekcije, ali i neke protektivne koji ovdje nisu navedeni. Kako je H.pylori snažan faktor rizika za razvoj maligniteta jednjaka, želuca i dvanaesnika, njezina eradikacija pokazala se važnim čimbenikom njihove prevencije. U svrhu što ranijeg otkrivanja malignih komplikacija danas je u razvoju identifikacija bakterije pomoću novih biomarkera kao što je miRNA, ili pak korištenjem poznatih serumskih pepsinogena. Ipak endoskopska metoda zlatni je standard rane detekcije te taj segment bilježi znatan napredak razvojem novih endoskopskih metoda.

Abstract (english)

Helicobacter pylori is a gram negative bacterium, it colonizes the upper digestive system in about half of the world's population. It seems to be the biggest risk factor in the development of severely gastric complications and ultimately of malignant gastric diseases. It adheres to the gastric mucosa with polar flagella and neutralizes gastric acid by producing urease enzymes. The main virulence factors of H. pylori are the Cag A and Vac A genes. In diagnostics, we distinguish between invasive and non-invasive methods. From non-invasive methods, urea breath test, stool antigen test and serological tests for IgG specific antibodies are used, while the main invasive method of choice in the diagnosis of bacteria is upper gastrointestinal tract endoscopy with biopsies. Standard eradication therapy also known as "triple therapy" consists of a combination of IPP, amoxicillin and metronidazole. Although the target organ of H. pylori is the stomach, there are numerous extragastric complications. In neurological diseases, the possibility of bacterial inpact on the severity of Parkinson's and Alzimer's disease has been observed, while in cardiac diseases H.pylori is associated with the development of coronary artery disease and is also suggested as the independent risk factor for the development of essential hypertension. In hepatobiliary diseases, it is associated with non-alcoholic fatty liver disease, liver fibrosis, as well as autoimmune liver diseases. The link between rosacea and H. pylori is already known, as is idiopathic thrombocytopenic purpura and iron deficiency anemia. On the other hand, the protective effects of infection have been observed in inflammatory bowel diseases. Many other mostly adverse effects as well as some protective effects have been described, but they are not listed in this article. As H. pylori is a strong risk factor for the development of esophageal, stomach and duodenal malignancies, its eradication has proved to be an important factor in their prevention. New biomarkers such as miRNAs, or well known serum pepsinogens are used in the bacterial identification in order to detect malignant complications as early as possible. However, the endoscopic method of early malignant detection is the gold standard and significant advances in the development of new endoscopic methods are being made.

• Keywords: infekcija; Helicobacter pylori; izvan želučane manifestacije bolesti; karcinom; detekcija
• Keywords (english): infection; Helicobacter pylori; extragastric manifestations of disease; cancer; detection
• Language: croatian
• URN:NBN: urn:nbn:hr:105:466972
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Public note: Pohranitelj objekta unio ključne riječi.
• Repository: Dr Med - University of Zagreb School of Medicine Digital Repository
• Created on: 2021-08-31 12:47:17