We appreciate the comments of Kaya and colleagues; however, more information about the inoculum size used, the adequacy of the broth, the response in controls, and the use of any quantitative determination of inhibitor activity is necessary to interpret the data they cite.
The issue remains whether Helicobacter pylori is a pathogen or a commensal. At least in the stomach, overwhelming evidence is available in support of a causative role for H. pylori in chronic gastritis, and Koch's postulates have been fulfilled.
1
, 2
, 3
The clinical significance of H. pylori gastritis, however, remains controversial; clearly, H. pylori gastritis is common in totally asymptomatic persons.4
A very strong association has been noted between H. pylori gastritis and chronic duodenal ulcer disease.
1
, 2
In their letter, Kaya and co-workers report that cimetidine, which effectively promotes healing of ulcers, did not have antibacterial or phagocytosispromoting effects. Other investigators have shown that the 90% minimal inhibitory concentration of the H2 antagonists is more than 1,000 mg/liter.5
The lack of effect of cimetidine on phagocytic function of macrophages is of interest; although little information has been published on the role of macrophages in H. pylori gastritis, they are usually considerably increased in this condition. One study suggested that, in vitro, the speed of ingestion of H. pylori by mouse peritoneal macrophages varied with different bacterial strains, but the importance of this finding in vivo is unknown.6
Clearly, ulcers heal with H2-receptor blockers despite the continued presence of H. pylori.
7
This result implies that a decrease in gastric acid is sufficient to allow healing of ulcers, and H. pylori is not independently capable of inhibiting this process. This finding does not, however, negate a possibly important role of H. pylori in duodenal ulcer disease. Indeed, relapse rates for chronic duodenal ulcer disease seem to be substantially less at 1 year in those patients who have had H. pylori infection eradicated in comparison with those who have not,8
, 9
although further data are needed.REFERENCES
- Chronic (nonerosive) gastritis: pathogenesis and management.Dig Dis. 1989; 7: 61-75
- Helicobacter pylori: controversies and an approach to management.Mayo Clin Proc. 1990; 65: 414-426
Ormand JE, Talley NJ, Shorter RG, Carpenter HA, Rouse M, Wilson W, Phillips SF: Prevalence of Helicobacter pylori in specific forms of gastritis. Dig Dis Sci (in press)
- Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons.N Engl J Med. 1989; 321: 1562-1566
- In vitro susceptibility of Campylobacter pyloridis to cimetidine, sucralfate, bismuth and sixteen antibiotics.Acta Pathol Microbiol Immunol Scand [B]. 1987; 95: 147-149
Gavinet AM, Megraud F: In vitro phagocytosis of Campylobacter pylori by macrophages obtained from Biozzi's mice. Proceedings of the first meeting of the European Campylobacter pylori Study Group. Bordeaux, France, October 1988, Abstract No. 119
- Persistence of Campylobacter pyloridis despite healing of duodenal ulcer and improvement of accompanying duodenitis and gastritis.Dig Dis Sci. 1987; 32: 1255-1260
- Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori.Lancet. 1988; 2: 1437-1442
- Campylobacter pylori and recurrence of duodenal ulcers—a 12-month follow-up study.Lancet. 1987; 2: 1109-1111
Article Info
Identification
Copyright
© 1990 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Helicobacter pylori, Peptic Ulcer, and CimetidineMayo Clinic ProceedingsVol. 65Issue 9
- PreviewWe read with interest the article by Fich and associates in the February 1990 issue of the Proceedings (pages 187 to 191). An interesting association between Helicobacter pylori (formerly called Campylobacter pylori) and gastritis or peptic ulcer diseases has been claimed by many authors.1–6 Although we agree with Dooley and colleagues7 that H. pylori infection may be of potential importance in the asymptomatic population, suggesting that the bacterium is a commensal of the stomach, we would like to ask Fich and colleagues whether H.
- Full-Text
- Preview
