these symptoms are often polymorphic manifestations generally dominating the first clinical symptoms : profound asthenia , extreme adynamia , extreme and continuous fatigue , malaise , sleep disorders , lack of creative activity , lack of initiative , loss of appetite , nausea , frequent and loose stools , itching , tachycardia . the objective examination evidences pale and peeling skin , wrinkles , depressed physical appearance , brittle hair and nails , hypotension . patients with positive test for h. pylori can associate clinical states similar to toxicosis under certain circumstances . the administration of specific medication for the treatment of h. pylori infection can rapidly determine the remission of the symptoms in the first 3 to 5 days . a complex drug combination consisting of : proton pump inhibitors ( ppi ) + colloidal bismuth subcitrate + antibiotics ( amoxicillin and clarithromicyn ) must be used . patients with positive test for h. pylori can associate clinical states similar to toxicosis under certain circumstances . the administration of specific medication for the treatment of h. pylori infection can rapidly determine the remission of the symptoms in the first 3 to 5 days . a complex drug combination consisting of : proton pump inhibitors ( ppi ) + colloidal bismuth subcitrate + antibiotics ( amoxicillin and clarithromicyn ) must be used . i evaluated 89 patients presenting for clinical symptoms associated to h. pylori infection , 62.9% were females and 87.6% had a positive diagnosis of h. pylori infection . during the first 7 days i used the following medication : omeprazole or esomeprazole 20 mg twice daily + colloidal bismuth subcitrate 120 mg four times / day + amoxicillin 1000 mg twice daily and clarithromicyn 250 mg four times / day . between days 8 and 28 , i used omeprazole or esomeprazole 20 mg / day + colloidal bismuth subcitrate 120 mg twice daily . the treatment for h. pylori infection was conducted according to the guidelines of romanian national congress , sinaia , 1996 , european consensus maastricht , 1997 ( gut , 1997 )   and consensus maastricht ii 2000   using first line therapy : ppi 20 mg twice daily + clarithromicyn 500 mg twice daily + amoxicillin 1000 mg twice daily or metronidazole for at least 7 days . in case of failure , second line therapy can be used : ppi 20 mg twice daily + colloidal bismuth subcitrate 120 mg four times / day + metronidazole 500 mg four times / day + tetracycline 500 mg twice daily for at least 7 days . taking into consideration the beneficial effects of the colloidal bismuth compound in gastric and duodenal ulcers during pain periods , the clinical experience of doctor bulbuc traian from county hospital bistrita between 19681997 and also the use of colloidal bismuth compound in university hospitals from cluj - napoca   and other clinical research trials , i decided to use colloidal bismuth subcitrate . considering the particularities of h. pylori infection in the gastric mucosa , the tendency of the bacteria to penetrate into the gastric mucus and to attach to the epithelial cells and avoid the immune system , to persistently multiply and infect areas difficult for the antibiotics to penetrate , i decided to extend the use of ppi and colloidal bismuth subcitrate . i communicated my personal experience with this treatment combination during the maastricht consensus iii in 2005 . male , 48 years old , computer engineer working in a multinational company , active 810 hours daily . in 2001 he presented with malaise , asthenia , adynamia , sleep disorder , reduced mental and physical activity . para - clinical examinations performed were superior endoscopy which showed antral chronic gastritis with high grade activity , positive h. pylori , exulcerations and immune - reactive lymphoid aggregates in the deep chorion ; urea test was positive for h. pylori . 2003 h. pylori was detected positive and the patient did nt follow any medication . in april 2004 the patient described epigastric pain accompanied by gastric burn after eating food at normal room temperature and having a  cold  sensation . the patient complained of painful dyspeptic syndrome located in the epigastric region , sleep disorder , lack of concentration , daily tiredness and depressive mood . a superior endoscopy was performed and the result was : gastric mucosa with discreet erythema . male , 57 years old , professor at the university , came to the medical practice unit on the 20 of october 2002 complaining of asthenic syndrome during spring and summer seasons , headaches , tiredness , could nt get up in the morning to go the work . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . the clinical evolution of the patient was excellent , the patient describing himself as being tireless and having very good appetite . on the 6 of february the patient performed both serological and respiratory tests and they were both negative . male , 65 years old , retired colonel , came to the medical practice unit complaining for asthenia , extreme adynamia , very pale skin , sleep disorder , loss of appetite , nausea and weight loss . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . male , 48 years old , priest , referred to the medical unit for nausea , epigastric pain , asthenia , profound adynamia , difficulty in conducting work activities . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . female , 26 years old , school teacher , addressed to the medical unit for nausea , loss of appetite , asthenia , adynamia , agitated sleep , tiredness . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . one year later , the patient came to the medical practice for asthenia , adynamia , pale and peeling skin , depressed physical appearance , brittle hair and nails . i decided to perform a serological test to the family members living in the same apartment : the mother and the husband . i recommended treatment for the h. pylori infection to all family members with omeprazole + colloidal bismuth subcitrate + amoxicillin + clarithromicyn . the clinical evolution was very good ; the patient regained the lust for life , shiny hair and smooth skin . before coming to the medical practice the patient had been admitted to the psychiatry hospital for psychiatric disorders . male , 48 years old , computer engineer working in a multinational company , active 810 hours daily . in 2001 he presented with malaise , asthenia , adynamia , sleep disorder , reduced mental and physical activity . para - clinical examinations performed were superior endoscopy which showed antral chronic gastritis with high grade activity , positive h. pylori , exulcerations and immune - reactive lymphoid aggregates in the deep chorion ; urea test was positive for h. pylori . 2003 h. pylori was detected positive and the patient did nt follow any medication . in april 2004 the patient described epigastric pain accompanied by gastric burn after eating food at normal room temperature and having a  cold  sensation . the patient complained of painful dyspeptic syndrome located in the epigastric region , sleep disorder , lack of concentration , daily tiredness and depressive mood . a superior endoscopy was performed and the result was : gastric mucosa with discreet erythema . male , 57 years old , professor at the university , came to the medical practice unit on the 20 of october 2002 complaining of asthenic syndrome during spring and summer seasons , headaches , tiredness , could nt get up in the morning to go the work . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . the clinical evolution of the patient was excellent , the patient describing himself as being tireless and having very good appetite . on the 6 of february the patient performed both serological and respiratory tests and they were both negative . male , 65 years old , retired colonel , came to the medical practice unit complaining for asthenia , extreme adynamia , very pale skin , sleep disorder , loss of appetite , nausea and weight loss . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . male , 48 years old , priest , referred to the medical unit for nausea , epigastric pain , asthenia , profound adynamia , difficulty in conducting work activities . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . female , 26 years old , school teacher , addressed to the medical unit for nausea , loss of appetite , asthenia , adynamia , agitated sleep , tiredness . superior endoscopy was performed and the result showed antral gastritis with positive h. pylori infection . one year later , the patient came to the medical practice for asthenia , adynamia , pale and peeling skin , depressed physical appearance , brittle hair and nails . i decided to perform a serological test to the family members living in the same apartment : the mother and the husband . i recommended treatment for the h. pylori infection to all family members with omeprazole + colloidal bismuth subcitrate + amoxicillin + clarithromicyn . the clinical evolution was very good ; the patient regained the lust for life , shiny hair and smooth skin . before coming to the medical practice the patient had been admitted to the psychiatry hospital for psychiatric disorders . the clinical observation of the patients infected with h. pylori bacteria drew our attention to certain clinical manifestations , especially extra - digestive , that are not listed as symptoms for gastric disease described in h. pylori . clinical manifestations are very varied and they are compound by asthenia and depressive symptoms : asthenia , adynamia , lack of strength ; sleep disorders : insomnia , nightmares , headaches , dizziness ; trophic disorders : brittle hair , dry , pale , itchy and peeling skin ; tachycardia , hypotension ; extra - digestive manifestations : loss of appetite , weight loss , frequent and loose stools followed by constipation . we analyzed the manifestations and decided to name them toxicosis to h. pylori infection similar to other clinical states such as giardiasis , uremia , duodenal intoxication . h. pylori has increased bacterial virulence due to bacterial lipoproteins which determine the persistence of the infection by destroying the gastric mucosa integrity and the quality of gastric mucus , as well as the inflammatory process through the neutrophils activating protein . the persistency of h. pylori is caused by the structural similarity between polysaccharide a and lewis blood group antigens present on gastric epithelial cell creating a  camouflage  of the bacteria in the gastric ecological niche favoring the infection . the presence of h. pylori strains with phenotype i vaca + caga , increases gastric acidity   and induces a more intense gastric inflammatory response , but the position of h. pylori in the mucus - epithelial cell complex determines a specific inflammatory and immunologic response by releasing immuno - genetic factors , pro - inflammatory and immuno - modulatory cytokines : interleukin 8 ( il-8 ) , necrosis tumoral factor ( tnf - alpha ) and interleukins 1 ( il-1 ) and interleukins 6 ( il-6 ) . in this complex pro - inflammatory process , gamma - interferon is produced from il-12 and activates nk ( natural killer ) cells and t helper cells ( th1 subset ) , which release il-2 and interferon with pro - inflammatory response and dominates chronic infection with h. pylori . t helper cells ( th2 subset ) activate the immune response through igg and iga . these characteristics of h. pylori can determinate particular clinical manifestations on systems such as the nervous system , digestive system , cardiac system , skin . efficient therapeutic measures similar to tonsillectomy can stop these clinical manifestations . the effect of antibacterial medications , antibiotics , combined with the local immunosuppressive and immunomodulator   effects of colloidal bismuth compound and ppi targeting h. pylori multiplication can determine rapid recovery . our treatment methodology , similar to other medical practitioners , was administrated also based on personal beliefs . the recommendation is to use clarithromicyn for h. pylori infection treatment and prophylaxis of gastric cancer . we propose a new clinical term called toxicosis in h. pylori infection for describing a multiform clinical symptomatology associated with the h. pylori infection . we performed an interpretation for the pathogenesis of inflammatory and immunological mechanisms implicated in the immuno - pathological outbreak determined by h. pylori .
background and aimwe present a new clinical entity in relation to the helicobacter pylori infection characterized by complex and varied clinical extra - digestive manifestations.clinical findings such as asthenia , adynamia , sleep disorders , hair and nails modifications , digestive symptoms and heart rhythm disorders describe the clinical aspect of toxicosis associated with helicobacter pylori infection.methodsthe clinical presentation and therapy of patients with helicobacter pylori infection were analyzed.resultscombined drug therapy : antibiotics + proton pump inhibitors + colloidal bismuth compound determinate remission of the symptoms in the first 3 to 5 days.the characteristic of the relation between helicobacter pylori and the mucus - epithelial cell complex , the properties of the bacterial cell components , and the inflammatory and immunological response targeting other organs describe the immuno - pathological outbreak of helicobacter pylori.conclusionwe support the term of toxicosis associated with helicobacter pylori infection in selected cases .