Zusammenfassung
In letzter Zeit wurde man auf mögliche Assoziationen
zwischen der Infektion mit Helicobacter pylori und extragastralen Erkrankungen aufmerksam. Dabei
handelt es sich um ein breites Spektrum von verschiedenen Erkrankungen wie
Gefäßerkrankungen, Hauterkrankungen, Autoimmunerkrankungen, Nahrungsmittelallergie,
Lebererkrankungen, hämatologische Erkrankungen, Diabetes mellitus, pädiatrische
Erkrankungen (z. B. plötzlicher Kindstod, Wachstumsstörungen) extragastrale
MALT-Lymphome und sogar kolorektale Karzinome. Eine potenzielle Rolle von H. pylori bei der
Auslösung von extragastralen Erkrankungen stützt sich auf folgende Beobachtungen: 1. die
Infektion mit H. pylori löst nicht nur eine chronische Entzündung in der Magenschleimhaut
aus, sondern geht auch mit einer systemischen Immunantwort einher; 2. im Rahmen der Gastritis
werden verschiedene entzündliche Mediatoren ins Blut abgegeben, die Erkrankungen
außerhalb des Magens auslösen können; 3. eine erfolgreiche Eradikationstherapie
führt zur partiellen oder kompletten Remission der extragastralen Erkrankungen. Die bisher
publizierten Studien liefern zum Teil sehr widersprüchliche Ergebnisse, die durch verschiedene
Störfaktoren in den epidemiologischen Studien erklärbar sind. Anhand der derzeit
verfügbaren Daten konnte keine dieser Assoziationen gesichert werden, was die Notwendigkeit
weiterer prospektiver Studien zur endgültigen Klärung der Rolle von H. pylori bei der
Entstehung von extragastralen Erkrankungen unterstützt.
Extragastric manifestations of H. pylori infection
Recently,
H. pylori has been associated with several
extradigestive diseases such as cardio-vascular, cutaneous, autoimmune, allergic, liver,
hematologic disorders, diabetes mellitus, pediatric diseases (sudden infant death syndrome, growth
retardation), extragastric MALT-type lymphomas and even colorectal cancer. The potential role of
H. pylori infection in the pathogenesis of these
extradigestive disorders has been based on the following facts: 1) local gastric
infection with H. pylori may exert systemic
effects; 2) during chronic H. pylori induced
gastritis several different inflammatory mediators are released that are able to cause disorders
remote to the primary site of infection and 3) the successful eradication of H. pylori infection improves partly or completely the
extradigestive disorders. The available data is conflicting because of the presence of several
confounding factors in epidemiological studies. On the basis of the published data any of
these associations has been proved. Further prospective studies to explain the association between
H. pylori and extradigestive disorders are
needed.
Schlüsselwörter
Helicobacter pylori - extragastrale
Erkrankungen
Key words
Helicobacter Pylori - Extragastric Manifestations
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Anschrift für die Verfasser
Priv.-Doz. Dr. med. Peter Konturek
Medizinische Klinik I
Universität Erlangen-Nürnberg
Krankenhausstraße 12
91054 Erlangen
Fax: 0 91 31/8 53 69 09
Email: Peter.Konturek@med1.imed.uni-erlangen.de
