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Helicobacter Infection

Basics

OVERVIEW

  • Helicobacter species are gram-negative, urease-positive bacteria

  • The discovery of an association of Helicobacter pylori with inflammation of the stomach (known as “gastritis”), stomach ulcers, and stomach cancer has changed the understanding of stomach disease in people

  • Several Helicobacter species have been isolated from stomachs of dogs and cats To date Helicobacter pylori, the most important species affecting people, has only been identified in a single colony of laboratory cats

  • A possible cause-effect relationship of Helicobacter species and stomach inflammation in dogs and cats remains unresolved; inflammation accompanies infection in some, but not all dogs and cats

  • The role of Helicobacter species in intestinal and liver disease in dogs and cats is unclear

  • Helicobacter canis has been isolated from both clinically healthy dogs and cats and also in dogs and cats with diarrhea

  • Helicobacter canis has been isolated from the liver of a puppy with active, multifocal inflammation of the liver (known as “hepatitis”)

Genetics

  • No genetic basis for susceptibility to Helicobacter species infection has been established

Signalment/Description of Pet

Species

  • Dogs

  • Cats

Breed Predilections

  • None known

Mean Age and Range

  • Stomach infection with Helicobacter species appears to be acquired at a young age

  • The puppy with Helicobacter canis–associated inflammation of the liver (hepatitis) was 2 months of age

Signs/Observed Changes in the Pet

  • Helicobacter infection without any signs of disease is common

  • Vomiting, lack of appetite (known as “anorexia”), abdominal pain, weight loss, and/or rumbling or gurgling sounds caused by movement of gas in the intestinal tract (known as “borborygmus”) have been reported in dogs and cats with Helicobacter infections of the stomach

  • Helicobacter canis infection in dogs may be associated with diarrhea

  • Vomiting, weakness, and sudden death was reported in a dog with Helicobacter canis infection of the liver

  • May have signs of dehydration from fluid and electrolyte loss due to vomiting and/or diarrhea

Causes

Helicobacter Infection of the Stomach

  • H. felis, H. heilmannii, H. bizzozeronii, H. salomonis, H. bilis, and Flexispira rappini and H. cynogastricus have been identified in pet dogs

  • H. felis, H. heilmannii and H. baculiformis have been identified in pet cats

  • Helicobacter Infection of the Intestines and Liver

  • H. bilis, H. canis, H. cinaedi, and Flexispira rappini have been identified in bowel movement (feces) from normal dogs and dogs with diarrhea

  • H. cinaedi—has been identified in one cat (significance unknown)

  • H. canis—has been reported in one dog with sudden (acute) inflammation of the liver (hepatitis)

Risk Factors

  • Poor sanitary conditions and overcrowding may facilitate spread of infection

Treatment

Health Care

  • The ability of Helicobacter species to cause disease in dogs and cats is still unclear; therefore, no generally accepted guidelines have been adopted for treatment of Helicobacter infections in dogs and cats

  • Currently pets with Helicobacter infection and no clinical signs do not need treatment; this is in sharp contrast to the situation in people, who are treated regardless of symptoms as Helicobacter pylori infection is associated with an increased risk for stomach cancer

  • Consider treatment of Helicobacter infection in dogs and cats with stomach disorders that have compatible clinical signs, which cannot be attributed to another disease process

  • Fluid therapy in dehydrated pets

Diet

  • Easily digestible diets in pets with signs of gastrointestinal disease

Medications

    Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

  • A triple combination therapy (that is, combination of two antibiotics and one antisecretory drug) is effective in people with H. pylori infection with cure rates of approximately 90%

  • Combination therapy may eliminate Helicobacter infections in dogs and cats less effectively than in people

  • Treat for 2–3 weeks

Drug(s) of Choice

Antibiotics (Two Antibiotics with One Antisecretory Agent)

  • Possible antibiotics: clarithromycin, metronidazole, amoxicillin, azithromycin , or tetracycline

  • Bismuth subsalicylate (original Pepto-Bismol)—used to protect the lining of the stomach and intestines, to counter the effects of bacterial toxins (known as an “anti-endotoxemic effect”), and weak antibiotic properties

Antisecretory Agents (One with Two Antibiotics)

  • Omeprazole, famotidine, ranitidine, or cimetidine

  • Helicobacter Infection in the Intestines and Liver of Dogs

  • Combination of amoxicillin and metronidazole may be effective

Follow-Up Care

Patient Monitoring

  • Serologic tests (blood tests that detect the presence of antibodies to a certain disease-causing agent or antigen; an “antibody” is a protein that is produced by the immune system in response to a specific antigen, in this case to Helicobacter) are not useful to confirm eradication of the bacteria from the stomach—serum immunoglobulin G (IgG) titers may not decrease for up to 6 months after the infection has been cleared

  • 13C-urea breath and blood test have been evaluated to monitor the eradication of Helicobacter in dogs and cats; however, these tests currently are not available commercially If vomiting persists or recurs after cessation of combination therapy, a repeat stomach biopsy to determine whether the infection has been cleared successfully may be necessary

Preventions and Avoidance

  • Avoid overcrowding and unsanitary conditions

Possible Complications

  • Recurrence

  • Zoonotic potential; potential “zoonoses” are diseases that can be passed from animals to people

Expected Course and Prognosis

  • The effectiveness of treatment currently employed in dogs and cats for eradicating Helicobacter infections is questionable

  • Metronidazole, amoxicillin, and famotidine for 14 days effectively eradicated Helicobacter in 6 of 8 dogs evaluated 3 days post-treatment, but all dogs were reinfected by day 28 after completion of treatment

  • Clarithromycin, metronidazole, ranitidine, and bismuth for 4 days was effective in eradicating H. heilmannii in 11 of 11 cats by 10 days, but 2 cats were reinfected 42 days post-treatment

  • Amoxicillin, metronidazole, and omeprazole for 21 days transiently eradicated H. pylori in 6 cats, but all were reinfected 6 weeks post-treatment

Key Points

  • Establishing a definitive diagnosis of Helicobacter infection is difficult

  • Helicobacter may be found in normal dogs and cats; the role of Helicobacter species in gastrointestinal and liver disease in dogs and cats is unclear

  • The effectiveness of treatment currently employed for eradicating Helicobacter infections is questionable, as reinfection has been seen in many dogs and cats

  • Helicobacter infections have zoonotic potential; potential “zoonoses” are diseases that can be passed from animals to people



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    Blackwell's Five-Minute Veterinary Consult: Canine and Feline, Fifth Edition, Larry P. Tilley and Francis W.K. Smith, Jr. © 2011 John Wiley & Sons, Inc.


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