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About this Item
Title: Helicobacter pylori
Publisher: Springer-Verlag Gmbh Nov 2000
Publication Date: 2000
About this title
The fourth meeting in the very successful series Helicobacter pylori: Basic Mechanisms to Clinical Cure was held on the island of Bermuda in late March 2000. This was only some two years after the third meeting in San Diego and it seemed hardly possible that there would be so much new information. However, as the contributions in this volume testify, there was plenty of exciting new information with important implications for both understanding this infection and for clinical management. Some of this information was of a fundamental nature, such as the role of the acid sensitive urel channel in regulating the influx of urea and the formation of ammonia transported back in the microbial periplasmic space to neutralize acid; the observation of genetic polymorphism of the IL-1~ gene as an explanation of achlorhydria and gastric cancer risk in the first-degree relatives of gastric cancer patients; and the peculiar biochemical and physio logical consequences of the genome of the microorganisms. The format of the meeting, with short fifteen-minute state-of-the-art pre sentations by world experts closely involved in Helicobacter research fol lowed by ample time for panel discussions, was again followed this year. Traditional aspects included detailed study of the microbial characteristics, the novel Helicobacters, the interaction with the human host, the peculiarities of the inflammatory immune response, the short and long-term mucosal consequences, the effects on acid secretion, the problem of gastric malignancy and the therapeutic possibilities.From The New England Journal of Medicine:
The extraordinary possibilities suggested by the discovery of the relation of the organism Helicobacter pylori to peptic ulcer disease have now been realized in the clinical management of the disorder. The implications of the various associations of H. pylori with gastric neoplasms and the functional disorders of the upper gastrointestinal tract are gradually being defined. Interest in the organism as a subject of study is beginning to move from the purview of the clinician to that of the research scientist. I approach Helicobacter pylori: Basic Mechanisms to Clinical Cure 2000 with this evolution in mind.
The book is the third in a series of proceedings from the biannual symposia of the same title, organized by the editors. It provides a comprehensive review of the experimental and clinical observations of H. pylori made over the two to three years before the 2000 symposium. The book is organized into 12 sections, each with 2 to 12 contributions written by experts in the field. The editors are to be congratulated on the expeditious publication of such a large body of information less than one year after the symposium.
Section 1 is devoted to the organism itself and contains a succinct chapter on the genetics of H. pylori. However, despite the publication of the entire genomes of two isolates of H. pylori, there is little discussion of the genomes themselves or the evolving technology that is associated with genomics, and thus the section as a whole is disappointing. Since the audience at the symposia were clinical scientists and most of the readers will probably also be clinical scientists, this was a missed educational opportunity. In this and subsequent sections there are "pro" and "con" chapters. These chapters are written by experts in their fields, and they provide useful snapshots of the variety of current viewpoints on some of the controversial aspects of H. pylori.
Section 2 contains three chapters on the epidemiology of H. pylori, and section 3 discusses some recently discovered species of helicobacter that may or may not have relevance in human disease. Investigations of other helicobacter species in large and small mammals may provide valuable insights into human disorders. The chapter entitled "Hepatobiliary Helicobacters" will be particularly useful to those interested in liver disorders of unknown cause.
Sections 5 and 6 present a series of papers relating to the immunology of H. pylori and the pathology of gastritis. The contributions on the immunology of H. pylori are very brief, reflecting the fact that the organism has attracted comparatively little interest from immunologists in general. A chapter on the state of the art of vaccine development would have been more useful in this section than near the end of the book, where it is dealt with in a speculative manner. The chapters on gastritis reflect the broad range of ideas relating to an area of pathology that has, since the discovery of H. pylori, emerged from obscurity to become a subject of vigorous investigation and discussion. The chapter entitled "Mechanisms Involved in Gastric Atrophy" is thoughtful and provocative; it deals with important areas of cell biology and their possible relation to gastric atrophy.
Sections 4 and 7 through 12 are predominantly clinical in focus. One chapter in the very short section 4 deals with the pitfalls of diagnostic tests. This is an area of potentially huge economic importance in the current era of constraints on spending in medicine. The chapter is comprehensive but does not discuss the current trend toward testing as a means of avoiding the limitations of serologic assays in a population with a low prevalence of H. pylori infection.
That the antimicrobial treatment of H. pylori infection has remained in the hands of gastroenterologists and has been largely eschewed by specialists in the treatment of infectious disease is one of the extraordinary facets of modern medicine. The evolution of treatment regimens has been empirical, and after 17 years of clinical trials has progressed to the point at which 80 to 85 percent of infections can be eradicated at the first attempt. Several chapters provide extensive reviews of this empiricism, and one discusses the increasing problem of the failure of first-line therapy. Bacterial resistance remains an important clinical issue but is discussed only in clinical terms -- an up-to-date discussion of methods for detecting resistance and its mechanisms is missing from this book. The final section is devoted to H. pylori and the future. It provides entertaining reading in four chapters containing modest speculations about the developments that may occur in the microbiologic, immunologic, histopathologic, and clinical arenas.
This book provides an extensive compendium of information (with an index) on the recent developments in the broad range of investigations into H. pylori and its various manifestations. It will be a valuable, up-to-date resource for gastroenterologists, microbiologists, and anyone interested in H. pylori.
David Cave, M.D., Ph.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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