Helicobacter pylori: Kurzabriss zu ausgewählten historischen Etappen des Erkenntnisprozesses und ihre Bedeutung für die klinische Medizin, insbesondere auch die Chirurgie – was der (Allgemein-/Viszeral-)Chirurg wissen sollte

 

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Zusammenfassung

Die Entdeckung von Helicobacter pylori (H. pylori) stellt nicht nur ein bedeutsames Ereignis für den Fachbereich der Gastroenterologie dar, sondern auch für den gesamten Bereich der experimentellen und klinischen Medizin mit weitreichender Bedeutung bis hin zur Chirurgie. So wurde bspw. im Paradigmenwechsel der peptischen Geschwürbildung des Magens und Duodenums der bislang wichtigste Beitrag geliefert. Über 1 Jahrhundert lang beschrieben Forscher aus verschiedenen Bereichen der Medizin spiralförmige Bakterien in Mägen von Säugetieren und Menschen. Allerdings dauerte es bis zum Beginn der frühen 1980er-Jahre, als es Robin Warren und Barry Marshall gelang, den Keim anzuzüchten und ihn in kausalen Zusammenhang mit der chronischen Gastritis und peptischen Ulkuskrankheit zu setzen. Unser Wissenstand über Helicobacter pylori und assoziierte Krankheitsmanifestationen hat sich seitdem um viele Details vermehrt. Der Keim gilt als wesentlichster Verursacher der chronischen Gastritis, peptischen Ulkuskrankheit, des MALT-Lymphoms und als wichtigster Risikofaktor für die Entstehung des Magenkarzinoms. Die Entdeckung von H. pylori und die Erkenntnis seiner Bedeutung hat zu einem Umdenken in der Ätiopathogenese vieler Erkrankungen des Gastroduodenums geführt. Insbesondere mit der Eradikation von H. pylori konnte der ätiologische Therapie- wie auch Präventivansatz der aufgeführten Erkrankungen krankheits-, befund- und stadienadaptiert bzw. manifestationsspezifisch entwickelt und die Rolle der Chirurgie neu definiert werden. Darüber hinaus mehren sich die Hinweise für einen Zusammenhang zwischen der Infektion und einer Reihe nicht auf den Verdauungstrakt bezogener Erkrankungen.

Abstract

The discovery of Helicobacter pylori (H. pylori) represents one of the most notable events in the field of experimental and clinical medicine with great impact to daily practice even to surgery. It has led to a paradigm shift in the treatment of peptic ulcer disease. For the time period of almost one century, several scientists had described spiral-shaped bacteria in the stomach of animals and humans. However, it lasted till the early 1980s when Robin Warren and Barry Marshall successfully cultured H. pylori and recognised its causal relationship to chronic gastritis and peptic ulcer disease. Since then, our knowledge about H. pylori and related diseases has been continuously growing. Today, the bacterium is known to be mainly responsible for the development of chronic gastritis, peptic ulcer disease, MALT lymphoma and is considered as the main risk factor for the development of gastric cancer – all this led to a switch in the basic aetiopathogenetic considerations. In particular, eradication of H. pylori helped to i) develop an aetiology-based therapeutic and preventive approach to the diseases listed above according and adapted to findings, stage and manifestation, and ii) define a new role of surgery in the treatment concept. In addition, more and more evidence is being gathered for a possible association between the bacterium and several extragastric diseases.

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