Helicobacter pylori medical comic

This comic follows the acid-loving aviator, Helicobacter pylori, as it settles in the stomach lining. It explains how the bacterium survives acid, the toxins that damage the mucosa, the slide from gastritis to ulcer, atrophy and cancer, and how doctors test for it, treat it and confirm that it has gone.

For MBBS, NEET-PG, FMGE, NEXT and USMLE revision.

Helicobacter pylori: what the comic covers

High-yield points

H. pylori is a curved (seagull-shaped), microaerophilic, Gram-negative rod that lives in the gastric mucosa.
Urease turns urea into ammonia, creating a neutral cloud that protects the bacterium from stomach acid.
VacA is a vacuolating cytotoxin; CagA is injected into gastric cells, disturbs cell signalling and is linked to more severe disease.
Untreated infection can progress from gastritis to peptic ulcer to chronic atrophic gastritis, and is linked to gastric adenocarcinoma and MALT lymphoma.
Invasive tests use an endoscopic biopsy: rapid urease test, Warthin–Starry silver stain and culture on Skirrow's medium.
The urea breath test is the most accurate non-invasive test and is used to confirm eradication; stool antigen is useful in children; IgG serology cannot separate past from current infection.
Treatment always uses several drugs: bismuth quadruple therapy (omeprazole, bismuth, metronidazole, tetracycline) for 14 days.
Clarithromycin-based triple therapy should be used only where local clarithromycin resistance is low.

Mnemonics from the comic

Acid survival: The Urease Umbrella Corporation — ammonia shields the bug from acid.
Failed treatment: Breath test twice? Time for advice — culture and sensitivity testing.

Quick questions

Which test confirms that H. pylori has been eradicated?

The urea breath test, done after treatment ends. A stool antigen test is an alternative. Serology stays positive after cure, so it is not used to check eradication.

What is bismuth quadruple therapy for H. pylori?

A proton pump inhibitor such as omeprazole, plus bismuth, metronidazole and tetracycline, usually for 14 days.

Which cancers are linked to H. pylori?

Gastric adenocarcinoma and gastric MALT lymphoma. Early MALT lymphoma can regress after the infection is eradicated.

Is this comic free to read?

The first pages are free to preview. Members read the full comic, and you can sign up free to read one comic in full.