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A 53-year-old woman visited her primary care physician complaining of a burning pain in the epigastrium...

A 53-year-old woman visited her primary care physician complaining of a burning pain in the epigastrium that developed between meals. She also reported episodic occurrences of nausea. The symptoms had exhibited varying severity over the last 6 months. The patient had been self-medicating with over-the-counter drugs, including proton pump inhibitors (lansoprazole [Prevacid], omeprazole [Prilosec]) and antacids (Maalox, Tums), with limited success. The patient’s vital signs were normal. She did exhibit some tenderness in the epigastric region. Her doctor’s preliminary diagnosis was a gastric ulcer. He referred the patient to the local hospital for a breath test and upper esophagogastroduodenal endoscopy and biopsy.

The breath test is a noninvasive test to detect the presence of Helicobacter pylori, the primary bacterial causative agent of gastric and peptic ulcers. The patient drinks a solution containing radiolabeled urea. The patient’s breath is then monitored for presence of labeled carbon molecules. H. pylori hydrolyzes urea rapidly and releases the radiolabeled carbon. This test is very sensitive and very specific.

The patient’s breath test was positive for urease activity. The follow-up endoscopic examination identified a single lesion located in the distal portion of the stomach along the lesser curvature. Tissue from the lesion biopsy yielded a positive urease test, and histological examination revealed the presence of a spiral-shaped bacterium, confirming infection with H. pylori. The patient was given a 10-day course of amoxicillin and metronidazole for the infection and a proton pump inhibitor to lessen symptoms and promote healing of the gastric mucosa.

The case file gives an example of a digestive system infection caused by a urease-positive organism.

What other system or systems could commonly be colonized by urease-positive bacteria? Why?

Helicobacter pylori metabolizes urea and releases ammonia.

How would this affect the microenvironment of the stomach? Is this an important consideration in the treatment of stomach ulcers? Why or why not?

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Expert Solution

Urease positive bacteria colonize the stomach and urinary tract urease bacteria are helpful to break urea into ammonia and carbamic acid, carbamic acid produced will react with water producing another nitrogen and carbonic acid and make the PH essential to survive the acidic conditions of the stomach and intestinal .

urease is considered a stress response that was developed by several bacteria to counteract a low environmental. In Streptococcus thermophilus, urease is metabolically related to the biosynthetic pathways involved in aspartate, glutamine, arginine, and carbon dioxide metabolism. Notably, urea hydrolysis increases the catabolic efficiency of S. thermophilus by modulating the intracellular pH and increasing the activity of β-galactosidase, glycolytic enzymes, and lactate dehydrogenase .

gastric urease was produce by Helicobacter pylori which caused gastritis, peptic ulcer and gastric cancer. Gastric urease allows the organism to colonize the acidic stomach and serves as a biomarker for the presence of H.pylori.Urease aids in colonization of the host by neutralizing gastric acid and providing ammonia for bacterial protein synthesis. Host defences are avoided by urease by continuing to neutralize acid locally and by shedding urease, which may be bound by immunoglobulin, from the surface of the bacterium.

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Nightingale answered 2 years ago
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