Sri Ramachandra University, India
Dr. Vighnesh Vel is a young physician from India who has recently graduated from Sri Ramachandra Medical School in Chennai. He is aspiring to match into a residency program in the USA and is currently preparing for the United States Medical Licensing Examinations. He has passion for teaching and serving underserved populations and is looking forward to a long career as a teaching clinician.
Chronic, undiagnosed Helicobacter Pylori infection represents a growing health concern in both developed and developing countries for various reason including but not limited to development of inflammatory gastritis (acute, chronic, atrophic), peptic ulcer formation with high rate complication development with up to 40% bleeding, and metaplastic changes associated with Mucosa Associated Lymphoid Tissue Lymphoma and malignant changes in gastric glandular epithelium representing gastric adenocarcinoma. Up to 80% asymptomatic carrier status causes frequent under-diagnosis and poor treatment initiative despite 1-2% malignant progression rates even in subclinical infection. The gram negative, microaerophilic, spiral-shaped organism is evolved for penetration of gastric mucosa and remains difficult to treat despite multiple treatment regiments. . CagA Protein positive strains being more virulent and comprise the larger proportion of clinically apparent infection cases are accompanied by antibody presence versus Cag protein A. Standard triple therapy efficacy rates are reported as low as 70%, poor outcomes being closely correlated to high clarithromycin resistance in local populations. Such trends require monitoring and awareness by clinicians, thus preferring to opt for classified second/third line drug selection with bismuth containing quadruple therapy, and/or levofloxacin based regimens, enabling 90% eradication rates and reduction in necessity for exposure of single patients to high quantity multiple antimicrobial therapies, hence preventing resistance development. With successful eradication follows increased healing rates for peptic ulcer disease and reduced incidence of metaplastic progression, and observed regression of Mucosa Associated Lymphoid Tissue Lymphoma and regression of Helicobacter Pylori chronic inflammation triggered cancerous changes. Narrow band imaging techniques are used for vascular and mucosal pattern visualization, and gastric biopsy allows rapid, accurate detection of Helicobacter presence. As such, Sequential and Concomitant therapeutic modalities are preferred in lieu of standard triple therapy regimens, especially those relying on Helicobacter Clarithromycin positive sensitivity status.