Diagnostics

National Reference Centre Helicobacter pylori

National Reference Centres (NRC) are designated by the Federal Ministry of Health in coordination with the Robert Koch Institute to monitor important infectious agents. Since 1 January 2017, the NRC for Helicobacter pylori has been located at the Max von Pettenkofer Institute of the LMU Munich under the direction of Prof. Dr. Sebastian Suerbaum. The NRZ is the point of contact for microbiological laboratories and treating physicians from all over Germany for questions on the diagnosis, therapy and epidemiology of H. pylori.
The NRZ also provides information for patients and other interested parties on its website. In addition to counselling, the NRZ also offers special microbiological diagnostics for H. pylori.

 

Helicobacter pylori

Helicobacter pylori is a Gram-negative rod-shaped bacterium. It infects the mucous membrane of the stomach in more than half of the world’s population and is therefore one of the most common bacterial infectious agents of all. The infection is usually acquired in childhood and persists for decades if not actively treated.

Infection with H. pylori always causes an inflammatory reaction of the stomach mucosa, which can be detected in a fine tissue examination of the stomach. However, it does not necessarily cause any symptoms; more than 80 % of those infected remain asymptomatic. However, secondary diseases can develop on the basis of H. pylori gastritis. The most important secondary diseases are

  • Stomach ulcer
  • Duodenal ulcer
  • Stomach cancer (adenocarcinoma)
  • Lymphoma of the stomach (MALT lymphoma)

Diagnostic evidence of H. pylori infection is usually obtained during a gastroscopy, where samples (biopsies) are taken and examined for H. pylori. It is also possible to detect an
H. pylori infection by a breath test or a stool test.

A vaccination against H. pylori is currently not available.

Therapy is carried out with a combination of antibiotics and acid secretion inhibitors. The aim of the therapy is the complete elimination of the pathogens from the patient’s body (eradication). Since the risk of infection among adults in Germany is low, the risk of acquiring an H. pylori infection again after successful eradication therapy is also very low (less than 1% per year).

 

Helicobacter pylori and cancer

An existing infection with H. pylori increases the risk of stomach cancer by a factor of 4-6. H. pylori has been officially classified as a carcinogen since 1994, and this classification was confirmed in 2009.

As with many other carcinogens, H. pylori infection only leads to cancer in a small proportion of those infected, and there are usually decades between infection and the onset of cancer. This makes it difficult to prove the effect of a therapy on the incidence of cancer. However, there are now several studies from countries with high H. pylori infection rates and high gastric cancer incidence that show that in such countries, consistent treatment of H. pylori infections can reduce gastric cancer mortality. Therefore, in many countries, treatment of every H. pylori infection is now recommended for cancer prophylaxis. In Germany, the current DGVS guideline recommends offering patients eradication therapy even in cases of asymptomatic H. pylori infection.

 

Fr. Dr. Beate Spießberger

Nationales Referenzzentrum Helicobacter pylori
Max von Pettenkofer-Institut
Elisabeth-Winterhalter-Weg 6
81377 München
+49 89 2180 72801

Recommendations

Below you will find a selection of the extensive literature on Helicobacter pylori. Decisive for patients and doctors are above all the recommendations on diagnostics and therapy, which are drawn up by German and European expert groups on the basis of extensive studies. The NRZ team will be happy to answer any questions on current guidelines.

Recommendation of the German Society for Gastroenterology, Digestive and Metabolic Diseases:

Recommendation of European Helicobacter and Microbiota Study Group and Consensus Panel:

Overview of the development of new therapeutic options for H. pylori infection:

Further information:

  • H. pylori with resistance to the antibiotic clarithromycin is one of the “high priority” pathogens for which the World Health Organisation (WHO) is calling for special efforts to develop new treatment options. WHO statement:: Global priority list of antibiotic-resistant bacteria (Englisch)
  • The following excerpt from the medical textbook “Medical Microbiology and Infectiology” (S. Suerbaum, G.-D. Burchard, S. H. E. Kaufmann, T. F. Schulz; 8th edition, 2016) was kindly provided by Springer-Verlag: Kapitel 32: Helicobacter (Prof. Dr. S. Suerbaum)

 

Sending in

In special cases it is possible to send samples for microbiological diagnostics directly to the NRZ. Please use our submission form, which you can download here:: Form H.pylori

Please note the following

  • Currently, the NRZ can offer the listed diagnostic examinations free of charge.
  • The costs for sample transport cannot be covered.
  • No (laboratory) referral slips or cost transfer forms are required for submission to the NRZ.
  • Only stomach biopsies or culture isolates are suitable for diagnosis.

 

Consultation

If you need advice on the diagnosis and treatment of H. pylori infection, please do not hesitate to contact the NRZ. Consultation is possible both by telephone and in writing via email.

Contact
Telefon: +49 89 2180-72801
E-Mail: nrzhpylori@mvp.uni-muenchen.de

HelicoPTER-Study

Under the leadership of Prof. Suerbaum (National Reference Centre for Helicobacter pylori at the Max von Pettenkofer Institute of LMU Munich) and Prof. Gerhard (Technical University of Munich), the HelicoPTER study was launched in 2021.

The HelicoPTER study (Helicobacter Prevalence, Therapy (Erfolg=Success), Resistance) is investigating the following questions, among others:

  • How common is H. pylori infection?
  • What is the situation of antibiotic resistance?
  • What is the optimal therapy?
  • What effects does the therapy have on the intestinal flora?
  • What are the complications of H. pylori infection?
  • What are the risk factors for infection?

In order to draw a comprehensive picture of the infection situation, a total of 20,000 test persons will be included over the next few years. This will take place at various study sites throughout Germany.

Do you want to know if you are infected? Find out on the study homepage Helicobacter-testen.de, where and how you can participate in the study free of charge!

Publications

Increasing resistance rates: Europe-wide study on antibiotic resistance of Helicobacter pylori

The National Reference Centre for Helicobacter pylori, together with partners from 18 countries (European Helicobacter pylori Antimicrobial Susceptibility Testing Working Group), has published the data of a Europe-wide study on primary resistance of H. pylori. The local rate of primary resistance (resistance to antibiotics without previous failed therapies) is the basis for deciding which therapy to use in infected patients. The study demonstrated high resistance to the antibiotic clarithromycin, which is the cornerstone of the classic triple therapies. The observed resistance rates in the different countries could be clearly correlated with the respective national antibiotic consumption.

Mégraud et al. (2021) Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community

 

Update: Progress in the study of Helicobacter pylori infection through new methods

This review presents the latest developments and discoveries on the evolution and genetic diversity of H. pylori. Methods to investigate genomic and epigenomic variability, one of the research foci of the Work Group of Prof. Suerbaum,have undergone a number of technical innovations over the last few years. In particular, the use of high-throughput systems has massively expanded the database for analyses of the genetic and epigenetic variability of H. pylori.
The high mutation rate of the germ as well as its ability to absorb genetic material from the environment are responsible for a genetic variability that no other bacterial pathogen exhibits. This variability is also influenced at the epigenomic level, for example by the methylome. Another decisive factor is the large repertoire of restriction-modification systems.

Ailloud et al. (2021) Evolved to vary: genome and epigenome variation in the human pathogen Helicobacter pylori. FEMS Microbiol. Rev.

 

Helicobacter pylori: New insights on evolution in the stomach of infected people

H. pylori strains are characterised by a pronounced genetic diversity. Prof. Suerbaum’s research group has now been able to show that this great heterogeneity already develops in the stomach of a single infected person. Several biopsies from different stomach regions were examined from a total of 16 donors. Depending on the localisation in the stomach, the different germ populations develop differently. However, the evolution of H. pylori in the individual person is also influenced by external factors such as antibiotic therapy, which leads to the formation of resistant subpopulations.

Ailloud et al. (2019) Within-host evolution of Helicobacter pylori shaped by niche-specific adaptation, intragastric migrations and selective sweeps. Nat. Commun.

 

H. pylori: New insights into the origin of genetic variability

The research group of Prof. Dr. Sebastian Suerbaum  (National Reference Centre for Helicobacter pylori, Max von Pettenkofer Institute, Medical Faculty, LMU Munich) has made a further contribution to elucidating the origin of the high genetic variability of H. pylori. The work focused on the variation in the equipment of H. pylori genomes with restriction-modification systems (R-M systems). The genomes of different H. pylori strains each possess about 30 R-M systems, of which only a few are conserved between different strains. The result of this highly variable endowment of H. pylori with R-M systems is a highly variable methylome. Only the methyltransferase enzyme of a single R-M system of H. pylori is active in all strains examined (n = 459) and thus appears to be part of the core genome. The studies show that this MTase, which is specific for the sequence GCGC, has assumed an important coordinating role in gene regulation during the evolution of H. pylori.

Estibariz et al. (2019) The core genome m5C methyltransferase JHP1050 (M.hpy99III) plays an important role in orchestrating gene expression in Helicobacter pylori. Nucleic Acids Res.

 

Genetically highly variable: challenge for vaccine development

In a new study  Prof. Dr. Sebastian Suerbaum (Nationales Referenzzentrum für Helicobacter pylori, Max von Pettenkofer-Institut, Medizinische Fakultät, LMU München) shows with his cooperation partners that H. pylori already shows a high genetic diversity in the early phase of infection. This even results in the loss of genes that play a significant role in virulence and infection of the human stomach. This variability makes it difficult to develop a vaccine against the germ.

Nell et al. (2017) Genome and methylome variation in Helicobacter pylori with a cag pathogenicity island during early stages of human infection. Gastroentology.