DOI QR코드

DOI QR Code

Overview of Helicobacter pylori and Treatment Options

헬리코박터 파일로리(Helicobacter pylori) 감염 및 치료법 개요

  • Song, Young Goo (Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 송영구 (강남세브란스병원 감염내과, 연세대학교 의과대학 내과학교실)
  • Received : 2015.06.23
  • Accepted : 2015.06.28
  • Published : 2015.06.28

Abstract

Helicobacter pylori is an important transmissible human pathogen found on the luminal surface of the gastric epithelium. The organism can persist in the stomach indefinitely and causes gastroduodenal inflammation that may proceed to atrophic gastritis, peptic ulcer, gastric MALT lymphoma, and gastric cancer. Standard triple therapy which consists of proton pump inhibitor (PPI) plus two antibiotics (amoxicillin and clarithromycin) is now generally used in Korea, however, eradication rates of H. pylori has been decreasing due to increasing antibiotic resistance. In this review, current second-line treatment regimens, difficult problems on treatment, necessity of local target therapy, applicability of clay minerals as a drug delivery system (DDS), and a new therapeutic strategy and its study plans will be discussed.

Helicobacter pylori는 사람의 위점막에서 발견되는 전염성이 있는 중요한 병원균이다. 장기간 기생하면서 만성위염, 소화성궤양, 위 변연부 B세포 림프종, 그리고 위암을 일으키는 세균으로 알려져 있다. 국내에서는 프로톤펌프 억제제(proton pump inhibitor, PPI)와 두 가지 항생제(amoxicillin, clarithromycin)를 포함하는 표준 삼제 요법을 1차 치료로 사용하여 왔으나, 점점 증가하고 있는 항생제 내성으로 인해 제균율은 점차 감소하고 있다. 여기서는 H. pylori의 현재의 치료법들과 이들 치료법들의 문제점들을 검토하고, 표적치료의 필요성과 표적치료에 활용할 수 있는 약물전달체로서의 점토광물의 가능성에 대해 알아보고, 이들을 이용한 새로운 치료 방향에 대한 향후 연구계획 등에 대해서 논하고자 한다.

Keywords

References

  1. al-Moagel, M.A., Evans, D.G., Abdulghani, M.E., Adam, E., Evans, D.J.Jr., Malaty, H.M. and Graham, D.Y. (1990) Prevalence of Helicobacter (formerly Campylobacter) pylori infection in Saudia Arabia, and comparison of those with and without upper gastrointestinal symptoms. American Journal of Gastroenterology, v.85, p.944-948.
  2. Basu, P.P., Rayapudi, K., Pacana, T., Shah, N.J., Krishnaswamy, N. and Flynn, M. (2011) A randomized study comparing levofloxacin, omeprazole, nitazoxanide, and doxycycline versus triple therapy for the eradication of Helicobacter pylori. American Journal of Gastroenterology, v.106, p.1970-1975. https://doi.org/10.1038/ajg.2011.306
  3. Brenciaglia, M.I., Fornara, A.M., Scaltrito, M.M., Braga, P.C. and Dubini, F. (1996) Activity of amoxicillin, metronidazole, bismuth salicylate and six aminoglycosides against Helicobacter pylori. Journal of Chemotherapy, v.8, p.52-54. https://doi.org/10.1179/joc.1996.8.1.52
  4. Gasbarrini, A., Franceschi, F., Armuzzi, A., Ojetti, V., Candelli, M., Torre, E.S., De Lorenzo, A., Anti, M., Pretolani, S. and Gasbarrini, G. (1999) Extradigestive manifestations of Helicobacter pylori gastric infection. Gut, v.45 p.I9-I12. https://doi.org/10.1136/gut.45.2008.i9
  5. Irie, Y., Tateda, K., Matsumoto, T., Miyazaki, S. and Yamaguchi, K. (1997) Antibiotic MICs and short timekilling against Helicobacter pylori: therapeutic potential of kanamycin. Journal of Antimicrobial Chemotherapy, v.40, p.235-240. https://doi.org/10.1093/jac/40.2.235
  6. Kim, J.D. and Kang, Y.G. (2012), 2012 National Health Insurance Statistical Yearbook, National Health Insurance Corporation, Health Insurance Review & Assessment Service.
  7. Kim, J.M., Kim, J.S., Jung, H.C., Kim, N., Kim, Y.J., and Song, I.S. (2004) Distribution of antibiotic MICs for Helicobacter pylori strains over a 16-year period in patients from Seoul, South Korea. Antimicrobial Agents and Chemotherapy, v.48, p.4843-4847. https://doi.org/10.1128/AAC.48.12.4843-4847.2004
  8. Kim, S.G., Jung, H.K., and Lee, H.L. (2013) Korean College of Helicobacter and Upper Gastrointestinal Research. Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition. Korean Journal of Gastroenterology, v.13, n.62, p.3-26.
  9. Klein, P.D., Graham, D.Y., Gaillour, A., Opekun, A.R. and Smith, E.O. (1991) Water source as risk factor for Helicobacter pylori infection in Peruvian children. Gastrointestinal Physiology Working Group. The Lancet, v.337, p.1503-1506. https://doi.org/10.1016/0140-6736(91)93196-G
  10. Lee, J.W., Kim, N., Kim, J.M., Nam, R. H., Chang, H., Kim, J.Y., Shin, C.M., Park, Y.S., Lee, D.H. and Jung, H.C. (2013) Prevalence of primary and secondary antimicrobial resistance of Helicobacter pylori in Korea from 2003 through 2012. Helicobacter, v.18, p.206-214. https://doi.org/10.1111/hel.12031
  11. Lee, J.Y. and Kim, N.Y. (2014) Future trends of Helicobacter pylori eradication therapy in Korea. Korean Journal of Gastroenterology, v.14, n.63, p.158-170.
  12. Lee, J.Y., Kim, N., Kim, M.S., Choi, Y.J., Lee, J.W., Yoon, H., Shin, C.M., Park, Y.S., Lee, D.H. and Jung, H.C. (2014) Factors affecting first-line triple therapy of Helicobacter pylori including CYP2C19 genotype and antibiotic resistance. Digestive Diseases and Sciences, v.59, n.6, p.1235-1243. https://doi.org/10.1007/s10620-014-3093-7
  13. Li, Z., Chang, P.H., Jean, J.S., Jiang, W.T. and Wang, C.J. (2010) Interaction between tetracycline and smectite in aqueous solution. Journal of Colloid and Interface Science, v.341, p.311-319. https://doi.org/10.1016/j.jcis.2009.09.054
  14. NIH Consensus Conference. (1994) H. pylori in peptic ulcer disease. NIH Consensus development panel on Helicobacter pylori in peptic ulcer disease. Journal of the American Medical Association, v.272, p.65-69. https://doi.org/10.1001/jama.1994.03520010077036
  15. Nishizawa, T., Suzuki, H., Suzuki, M., Takahashi, M. and Hibi, T. (2012) Proton pump inhibitor-amoxicillinclarithromycin versus proton pump inhibitor-amoxicillin-metronidazole as first-line Helicobacter pylori eradication therapy. Journal of Clinical Biochemistry and Nutrition, v.51, p.114-116. https://doi.org/10.3164/jcbn.D-11-00029R1
  16. Oh, H.S., Lee, D.H., Seo, J.Y., Cho, Y.R., Kim, N., Hwang, J.H., Park, Y.S., Lee, S.H., Shin, C.M., Cho, H.J., Jung, H.C. and Song, I.S. (2012) Ten-day sequential therapy is more effective than proton pump inhibitor-based therapy in Korea: a prospective, randomized study. Journal of Gastroenterology and Hepatology, v.27, p.504-509. https://doi.org/10.1111/j.1440-1746.2011.06922.x
  17. Park, C.S., Lee, S.M., Park, C.H., Koh, H.R., Jun, C.H., Park, S.Y., Lee, W.S., Joo, Y.E., Kim, H.S., Choi, S.K. and Rew, J.S. (2014) Pretreatment antimicrobial susceptibility-guided vs. clarithromycin-based triple therapy for Helicobacter pylori eradication in a region with high rates of multiple drug resistance. American Journal of Gastroenterology, v.109, p.1595-1602. https://doi.org/10.1038/ajg.2014.222
  18. Rimbara, E., Fischbach, L.A. and Graham, D.Y. (2011) Optimal therapy for Helicobacter pylori infections. Nature Reviews Gastroenterology and Hepatology, v.8, p.79-88. https://doi.org/10.1038/nrgastro.2010.210
  19. Shiota, S., Murakawi, K., Suzuki, R., Fujioka, T. and Yamaoka, Y. (2013) Helicobacter pylori infection in Japan. Expert Review of Gastroenterology and Hepatology, v.7 p.35-40. https://doi.org/10.1586/egh.12.67
  20. Suerbaum, S. and Michetti, P. (2002) Helicobacter pylori infection, New England. Journal of Medicine, v.347, p.1175-1186
  21. van der Voort, P.H.J., van der Hulst, R.W.M., Zandstra, D.F., van der Ende, A., Geraedts, A.A.M. and Tytgat, G.N.J. (2000) In vitro susceptibility of Helicobacter pylori to, and in vivo suppression by, antimicrobials used in selective decontamination of the digestive tract. Journal of Antimicrobial Chemotherapy, v.46, p.803-805. https://doi.org/10.1093/jac/46.5.803
  22. Warren, J.R. and Marshall, B.J. (1983) Unidentified curved bacilli on gastric epithelium in active chronic gastritis. The Lancet, v.321, n.8336, p.1273-1275. https://doi.org/10.1016/S0140-6736(83)92719-8
  23. World Gastroenterology Organisation global guideline. (2011): Helicobacter pylori in developing countries. Journal of Digestive Diseases, v.12, p.319-326. https://doi.org/10.1111/j.1751-2980.2011.00529.x

Cited by

  1. Antimicrobial Activity of Lactobacillus plantarum LP2 against Helicobacter pylori vol.30, pp.4, 2015, https://doi.org/10.13103/JFHS.2015.30.4.372
  2. Anti-inflammatory activities of fermented Rhus verniciflua stem bark extract and its growth inhibitory effect on Helicobacter pylori vol.48, pp.5, 2016, https://doi.org/10.9721/KJFST.2016.48.5.502