H pylori is a common cause of iron resistant anemia

 How many members believe that H Pylori infestation is not an uncommon cause of Fe deficiency anemia in pregancy by impairing Fe absorption from duodenum? But, for confirmation of such diagnosis upper G I endoscopy is essential. Is that  true? If confirmed in pregancy period what % of Fe resistant anemia may be attributed  to  H Pylori infection in our country? Any guess??  What is the drug that will be most effective for such diseases, pregnancy period in particular? Have anybody ever prescribed amoxicillin or Metrogyl based on persistent symptom complex of  combination of dyspepsia and Fe resistant anemia?

What is  H Pylori?? How it causes abnormalities in gastro duodenal normal function? Helicobacter pylori is a ubiquitous gram-negative bacterium infecting half the world's population and causing chronic active gastritis in virtually all infected individuals. The majority of individuals who acquire chronic H pylori gastritis will exhibit mild gastritis, more prominent in the antrum compared with the corpus. A minority of infected patients develop marked chronic inflammation in the antrum, with mild inflammation in the oxyntic mucosa (antral-predominant gastritis), and are prone to develop duodenal ulcer.  

How it causes gastric Cancer??  Ans:-Infrequently, some individuals show a corpus-predominant pattern that overlaps with autoimmune gastritis. Recently, epidemiologic and laboratory studies in animals as well as interventional studies in humans strongly suggested that H pylori may play a pathogenic role in the development of adenocarcinoma of the distal stomach. In particular, individuals with corpus-predominant gastritis seem more susceptible to development of adenocarcinoma of the distal stomach. The mechanisms whereby H pylori may cause gastroduodenal disease and contribute to gastric carcinogenesis are still hypothetical .

How useful is commonly used reasonably safe is metronidazole?? Ans: However, the production of specific virulence factors by the bacterium, the inflammatory response of the host, and the association with environmental factors may all play a contributory role

How useful is Metronidazole ??  Ans:- . H pylori is generally highly sensitive to metronidazole, which is actively secreted into gastric juice and saliva, with activity independent of pH.  I believe this can be prescribed empirically in pregancy after 20 weeks. Metronidazole is a prodrug that must undergo activation by bacterial nitroreductases. There are a number of H pylori enzymes with the potential to reduce metronidazole, and it is possible that increased drug dosage and resulting very high concentrations in the stomach allow sufficient drug to become activated to kill the organism. Reduced nitroimidazoles (eg, metronidazole) cause loss of the helical structure of bacterial DNA, strand breakage, and thus, impairment of bacterial function.

Can we empirically use Amoxicillin in Fe resistant anemia, pregancy period in particular ??

Amoxicillin is a close chemical and pharmacologic relative of ampicillin. This agent is stable in acid and inhibits the synthesis of the bacterial cell wall, acting both topically and systemically after absorption into the bloodstream and subsequent delivery into the gastric lumen. H pylori demonstrates good sensitivity to this antibiotic in vitro, but gastric antisecretory cotherapy is required for any significant efficacy.

What about Clarithromycin in nonpregancy period ?

Clarithromycin, a 14-membered ring macrolide antibiotic, is a derivative of erythromycin, with a similar spectrum of activity and clinical application. However, clarithromycin is more acid-resistant, has more consistent absorption, and has a longer elimination half-time compared with erythromycin. Results of studies showing approximately 90% H pylori  eradication with triple-therapy regimens using clarithromycin have led to widespread use of this antibiotic. However, the increasing prevalence of clarithromycin-resistant H pylori strains must be kept in mind before using this antimicrobial agent. In this setting, unlike the situation with metronidazole, there is no evidence that increasing the dosage of drug will overcome the problem of bacterial resistance.

Tetracyclines

The tetracyclines are close derivatives of the polycyclic naphtacenecarboxamides. The site of action of tetracyclines is the bacterial ribosome, which results in the interruption of protein biosynthesis — but at least 2 processes appear to be required for these antibiotics to gain access to the ribosomes of gram-negative bacteria. The first of these is their passive diffusion through hydrophilic pores in the outer cell membrane. The second process involves an energy-dependent active transport system that pumps all tetracyclines through the inner cytoplasmic membrane. Once the tetracyclines gain access to the bacterial cell, they inhibit protein synthesis and bind specifically to the 30-S ribosomal subunit. The latter thereby prevents aminoacyl tRNA access to the acceptor site on the mRNA-ribosome complex, and thus precludes the addition of amino acids to the growing peptide chain. Tetracycline has demonstrated in vitro efficacy against H pylori and is active at low pH.