Helicobacter Pylori Infection and Its Management for Elderly

Introduction:

Gastrointestinal problems are one of the major health concerns for elderly people. Almost 40 percent of the elderly population in the world suffer from gastrointestinal disorders. In some cases, older individuals are affected by serious disorders like atrophic gastritis, gastric carcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphomas. These disorders are linked to Helicobacter pylori infection. Gastric ulcers and gastric cancer caused by these bacteria are responsible for a large number of deaths among elderly people. That is why eradication of Helicobacter pylori is important.

What Is Helicobacter Pylori?

Helicobacter pylori (H. pylori) is a gram-negative bacteria that may infect the human gastrointestinal tract. It is a spiral-shaped bacteria that affects the lining of the stomach. This bacteria was first identified by Australian doctors Barry Marshall and Robin Warren in 1983 as a causative agent of gastric ulcers. It has infected almost 50 percent of the world's population. Though the predominant shape of this bacteria is helical in type, the inactive has a coccoid form. The length of the bacteria ranges from 2.8 to 3.3 micrometers, with a diameter that varies between 0.55 and 0.58 micrometers.

The virulence factor of H. pylori depends on the following factors;

1. Flagellum: H. pylori usually has two to seven flagella. Flagella helps in the motility and colonization of bacteria. The average length of the flagella is three micrometers. The chemotactic movement of the bacteria is governed by flagella, which helps to burrow through to the epithelial cell layer. As a result, H. pylori travels to the gastric pit and resides in the gastric glands.

2. Urease: This enzyme is produced by H. pylori, which helps neutralize gastric acid. This enzyme helps to break down urea into carbon dioxide and ammonia. Apart from this, the arginase enzyme helps in this process and increases the virulence of the bacteria. This enzyme not only decreases the acidity of the stomach but also consumes arginine. Consumption of arginine reduces the antibacterial action of the macrophages.

3. Adhesins: This is an outer membrane protein of the bacterial surface. This protein helps the bacteria adhere to the epithelial surface. This also prevents the movement of the bacteria against the production of mucus.

4. Catalase: Adhesion of H. pylori into the epithelial surface produces an immune response. Such immune response is characterized by the activation of phagocytes and the production of oxygen metabolites. This enzyme decomposes hydrogen peroxide into water and oxygen and prevents the oxidative response of phagocytes.

5. CagA: Cytotoxin-associated antigen A is a type of oncoprotein. This oncoprotein is associated with the formation of gastric ulcers and gastric cancers.

What Are the Effects of Helicobacter Pylori Infection in the Elderly?

Helicobacter Pylori infection in the elderly population is responsible for several clinical complications. These are;

1. Gastroesophageal Reflux Disease (GERD): This is the most common disorder seen in elderly people. This condition causes movement of the gastric contents in the upper gastrointestinal tract. As a result, patients complain of heartburn, heaviness in the chest, and sour taste in the mouth.

2. Chronic Atrophic Gastritis: This condition is regarded as a precursor lesion for gastric cancer. The prolonged inflammatory process of the gastric epithelium causes the loss of gastric mucosa. Loss of gastric mucosa causes malnutrition due to abnormal absorption of vitamins and minerals. Gradually lost gastric mucosa is replaced by intestinal-type mucosa. However, such cell types often show metaplastic transformation and cancer growth.

3. Peptic Ulcer Disorder: This condition is characterized by loss of gastric epithelium. Patients often complain of abdominal pain, cramps, and discomfort after eating food.

What Are the Diagnostic Tests for Helicobacter Pylori Infection?

The diagnostic tests used to detect H. Pylori infection in elderly are;

1. Rapid Urease Test: This is a rapid test that can detect the presence of H. Pylori infection with 90 percent accuracy. This is a type of invasive test.

2. Histology: Histological evaluation is the most accurate method of diagnosing H. Pylori infection. Endoscopic techniques are used to collect the samples. This technique is highly recommended for elderly individuals to differentiate bacterial infection from upper gastrointestinal tract disorder. Histological evaluations also help review the morphological parameters.

3. UBT (Urea Breath Test): C-urea breath test is a non-invasive test to detect bacterial urease activity. This test is almost 95 percent accurate.

4. Serological IgG Test: In this noninvasive diagnostic test, IgG antibody against H. pylori is detected. However, the chances of a negative result associated with this test are very high, which is why this test is used as a prognostic test.

5. H. pylori Stool Antigen Testing: It is an enzymatic immunoassay that is used to diagnose H. pylori antigen in stool.

What Are the Treatment of Helicobacter Pylori Infection in the Elderly?

The administration of antibiotics like Levofloxacin and Metronidazole is useful to treat such cases. However, a lot of people have shown resistance to this.

• A combination of PPI (proton pump inhibitors), Clarithromycin, and Amoxicillin or Metronidazole is a good alternative to such cases. In recent times, several cases have been reported of possible resistance to this therapy.

• Bismuth-containing quadruple therapy is a good alternative in such cases. This therapy includes a proton pump inhibitor (PPI), bismuth, and two antibiotics. These antibiotics include Amoxicillin and Clarithromycin or Metronidazole. This therapy usually lasts for seven to fourteen days. The most commonly used combination in such cases consists of 20 milligrams of Esomeprazole, 500 milligrams of Tetracycline, 500 milligrams of Metronidazole, and 240 milligrams of Bismuth subcitrate tablets twice daily for ten days. Recently introduced potassium-competitive acid blockers like Vonoprazan can be used in triple therapy.

• Antibiotic therapy can alter the population of intestinal microorganisms. Also, for some older individuals, there may be other options. Chinese herbal therapy, which consists of Coptidis Rhizoma, can be a good alternative.

Conclusion:

Helicobacter Pylori is one of the common infections of the gastrointestinal tract. This is responsible for several gastrointestinal disorders like gastric ulcers, atrophic gastritis, and gastric cancer. Several diagnostic methods can be used to detect H. pylori infection. For eradication of H. pylori infection, antibiotic therapy along with proton pump inhibitors can be used. Apart from this, bismuth can be used in such cases.