Table Of ContentCurren Topics in
t
Microbiology
241 and Immunology
Editors
R.W. Compans, Atlanta/Georgia
M. Cooper, Birmingham/Alabama
1.M. Hogle, Boston/Massachusetts· Y. Ito, Kyoto
H. Koprowski, PhiladelphiajPennsylvania . F. Melchers, Basel
M. Old stone, La lolla/California . S. Olsnes, Oslo
M. Potter, Bethesda/Maryland· H. Saedler, Cologne
P.K. Vogt, La lolla/California . H. Wagner, Munich
Springer
Berlin
Heidelberg
New York
Barcelona
Hong Kong
London
Milan
Paris
Singapore
Tokyo
Gastroduodenal Disease
and
Helicohacter pylori
Pathophysiology, Diagnosis
and Treatment
Edited by T. U. Westblom, S. J. Czinn,
and J. G. Nedrud
With a Foreword by B. Marshall
With 35 Figures and 13 Tables
t
Springer
Professor T. ULF WESTBLOM, M.D.
Texas A&M University, College of Medicine
Chief, Medical Service (Ill)
Central Texas Veterans Health Care System
1901 S. First Street
Temple, TX 76504, USA
Professor STEVEN J. CZINN, M.D.
Case Western Reserve University
Department of Pediatrics
Division of Pediatric Gastroenterology
Rainbow Babies and Children Hospital
2074 Abington Road
Cleveland, OH 44106, USA
Associate Professor John G. Nedrud, Ph.D.
Institute of Pathology
Case Western Reserve University
Biomedical Research Building, Rm. 919
10900 Euclid Avenue
Cleveland, OH 44106-4943, USA
Cover Illustration: Genta G (1996) Helicobacter pylori in a
Gastric Pit. N Engl J Med 335:250-250. Copyrighf'l) 1998
Massachusetts Medical Society. All rights reserved.
Cover Design: Design & Production GmbH, Heidelberg
ISSN 0070-217X
ISBN -13:978-3-642-64221-0 e-ISBN -13 :978-3-642-60013-5
DOl: 10.1007/978-3-642-60013-5
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Foreword
I am delighted to be able to write the foreword for this new book
on Helicobacter pylori by three pioneers in the field, Vlf West
blom, Steven Czinn and John Nedrud. Because of their long
experience in both basic and clinical aspects of H. pylori, the
editors have been able to produce a volume which is authoritative
and up to date in the science of H. pylori, while still being concise
and interesting for the practicing physician or H. pylori novice.
To achieve this, they have collected a very distinguished group of
authors from within the Vnited States and around the world.
The chapters are sequenced in approximately the same order
as developments in H. pylori science over the past 15 years. The
first chapter on the discovery of H. pylori is by Cliodna McNulty,
who was the first person to culture the organism in Europe. The
epidemiology is then described followed by the main clinical as
sociations, which are gastritis and dyspepsia, peptic ulcers, can
cers and lymphoma. This naturally leads to discussion of the
laboratory aspects of H. pylori, especially the microbiology, in
cluding essential information on antibiotic resistance patterns.
Next, virulence and pathogenicity of H. pylori are explained as
defined in studies using animal models, then by discussion of the
metabolism of the organism. Finally, the interaction of the bac
terium with the host immune systems is dealt with, including the
implications of these findings as they relate to the development of
future vaccines.
Chapters by the editors themselves are particularly useful,
especially that on the diagnosis of H. pylori infection, co-au
thored by Vlf Westblom and Bankim Bhatt, and the one on the
host response and vaccine development, by Steven Czinn and
John Nedrud together with Thomas Blanchard. The book also
addresses very controversial areas of H. pylori with a chapter on
economic aspects of H. pylori treatment, which ties in very well
with the specific chapter on new H. pylori therapies by Peter
Vnge, the actual discoverer of the potentiation effect between
proton pump inhibitors and antibiotics. Finally, Nirmal Mann
and Vlf Westblom predict the future developments in H. pylori
VI Foreword
clinical and basic research. This is important reading for those
planning new studies in the field.
With this concise new volume, Westblom, Czinn and Nedrud
will simplify the learning process for H. pylori enthusiasts, en
suring that the mysterious spiral organism continues to be
properly detected, studied and eradicated.
Barry Marshall
Preface
Summer was not yet over, but the morning air felt chilly and
crisp. My eyes wandered down the mountainside, followed the
narrow gravel road, and rested on a large complex of log cabins.
This was Keystone, Colorado. The year was 1986. I had signed up
for the trip just a few weeks earlier without really knowing what
to expect. The program was still preliminary, and I hadn't even
seen it when I arrived. Still, there was something magically at
tractive about the first American meeting on Helicobacter pylori.
In my own humble way,I had entered the field just a year earlier,
and up till now most of the researchers had been just names on
photocopied articles. At Keystone the names took on faces. I was
impressed, but also excited. Every presented paper created new
questions and challenges in my mind. Helicobacter pylori turned
out to be an even more enigmatic organism than I had imagined,
and I felt blessed to be in the midst of all this bursting research.
At the end of the meeting, during an evening barbecue, I met
Steven Czinn. He, like me, had published his first H. pylori paper
just the year before. Inspired by the meeting, both of us were eager
to continue our work. We had entered the field from two different
angles, one from pediatric gastroenterology, the other from adult
infectious diseases. These were fields that could complement each
other, and over a couple of hot dogs we decided to collaborate on
several future projects. Later I got to know John Nedrud, and his
background in pathology and immunology provided us with yet
another valuable point of view. We are now several years down
the road. Though not yet gray like the sages, we feel that this book
bridges a lot of the things we have worked with in the past. It also
presents the exciting and insightful work of our many talented
contributors. We have aimed at compiling a book that can appeal
to both researchers and practicing physicians. You will find cut
ting-edge information as well as chapters with specific clinical
recommendations. We are honored to have been asked by
Springer-Verlag to put this book together, and it has been a very
rewarding experience. We hope you will enjoy it too.
T. Ulf Westblom
List of Contents
C.A.M. McNULTY
The Discovery of Call1py/ohac!er-like Organisms ....... .
H.M. MITCHELL
The Epidemiology of He/icohac!er pylori ..... II
J. KALANTAR, G.D. ESLICK, and N.J. TALLEY
Chronic Gastritis and Nonulcer Dyspepsia. . . . . . . . . . .. 31
S.J.O. VELDHlJYZEN VAN ZANTEN and A. LEE
The Role of He/imhac!er pylori Infection
in Duodenal and Gastric Ulcer ...... . 47
P. M lJKHOPADHY AY
Gastric Cancer and Lymphoma ...... . 57
B.D. GOLD
Pediatric HC'licohac!er pylori Infection:
Clinical Manifestations, Diagnosis, and Therapy ... 71
A. MARAIS, L. MONTEIRO, and F. MEGRALJD
Microbiology of He/icohac!er pylori . ........ . 103
K.A. EATON
Animal Models of He/icohac!er Gastritis 123
D.J. MCGEE and H.L.T. MOBLEY
Mechanisms of Helimhac!er pylori Infection:
Bacterial Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 155
T.G. BLANCHARD, SJ. CZINN, and J.G. NEDRLJD
Host Response and Vaccine Development
to He/icohacter pylori Infection ........ . 181
T.U. WESTBLOM AND B.D. BHATr
Diagnosis of Helicohacter pylori Infection .. 215
A. SONNENBERG and J.M. INADOMI
Economic Perspectives in the Management
of Helicohacter pylori Infections ........ . 237
P. UNGE
Antibiotic Treatment of HC'licohac!er pylori Infection 261
N.S. MANN and T.U. WESTBLOM
He/icohac!er pylori and the Future: An Afterword 301
Subject Index .......................... . 309
List of Contributors
(Their addresses can be found at the beginning of their respective
chapters.)
BHATI, B.D. 215 McNULTY, C.A.M.
BLANCHARD, T.G. 181 MEGRAUD, F. 103
CZINN, S.l. 181 MITCHELL, H.M. 11
EATON, K.A. 123 MOBLEY, H.L.T. 155
ESLICK, G.D. 31 MONTEIRO, L. 103
GOLD, B.D. 71 MUKHOPADHYAY, P. 57
INADOMI, 1.M. 237 NEDRUD,l.G. 181
KALANTAR,l. 31 SONNENBERG, A. 237
LEE, A. 47 TALLEY, N.l. 31
MANN, N.S. 301 UNGE, P. 261
MARAIS, A. 103 VELDHUYZEN VAN
MARSHALL, B. V, VI ZANTEN, S.l.O. 47
MCGEE, DJ. 155 WESTBLOM, T.U. 215,301
The Discovery of Campylobacter-Iike Organisms
C.A.M. McNULTY
Introduction
2 First Reports. 2
3 Dissemination of Work 3
4 Earlier Descriptions 3
Escalation of Work 4
5.1 Believers and Non-believers 5
6 19X5 7
References 7
1 Introduction
Work in the primary care setting in 1980 showed that about I 'Yc) of a United
Kingdom population presented to their general practitioner with food-related up
per abdominal pain (GEAR and BARNES (1980). On investigation one third of these
patients had a peptic ulcer. a third had no obvious abnormality (non-ulcer dys
pepsia) and the remainder various other disorders such as gallstones. irritable
bowel etc. The two main aims of management of peptic ulcer disease were healing
of the acute lesion and prevention of recurrence. In the late 1970s and early 1980s
numerous studies confirmed that this could be attained by controlling gastric acid
secretion with the histamine H1 antagonists; thus proving Karl Schwarz' maxim -
no acid no ulcer - (SCHWARZ 1910; BURLAND and SIMKINS 1977; GUT MULTI
CENTRE TRIAL 1979; WATT et al. 1981). Soon the histamine H1 antagonist became
the mainstay of treatment; accounting for a substantial proportion of drug costs
worldwide. The outcomes of large drug company sponsored multicentre studies.
involving gastroenterologists across the world. supported the lifelong use of
maintenance H1 antagonists (GOUGH et al. (1984).
Public Health Laboratory. Gloucestershire Royal Hospital, Great Western Road, Gloucester, GLI 3NN,
UK
