Background:
Hyperemesis gravidarum affects between 0.3-10% of pregnant women.1 The exact pathogenesis remains unclear but it is likely to represent a multifactorial disease process. Management of severe cases of hyperemesis can result in polypharmacy and frequent hospitalisations, creating an ever-increasing health care burden.
Helicobacter Pylori is a flagellated gram-negative bacterium found in approximately half of the general population.2 It is hypothesised that in pregnancy, the organism can be reactivated due to hormonal and immunological changes, precipitating inflammation and toxins causing hyperemesis.3
Recent research suggests an association between hyperemesis and Helicobacter Pylori (HP) infection. We discuss a case series of 3 patients with severe hyperemesis gravidarum and the effects of their HP eradication.
Case Series:
Patient 1 experienced hyperemesis gravidarum from 11/40 with subsequent electrolyte disturbance and epigastric pain. She underwent successful HP eradication therapy at 27 weeks gestation with significant symptomatic benefit.
Patient 2 developed severe hyperemesis and weight loss from 6/40. Endoscopic biopsies confirmed HP gastritis. Her symptoms improved post eradication and she temporarily ceased steroids for 3 weeks, however symptoms recurred at a reported lower level post treatment.
Patient 3 had severe hyperemesis from 4/40 with weight loss, reflux and nutritional deficiencies. An upper endoscopy demonstrated severe HP oesphagitis and gastritis. She had a significant clinical and symptomatic improvement following eradication therapy at 12/40.
Conclusion:
This Case Series aims to highlight the association between hyperemesis gravidarum and Helicobacter Pylori infection and that the organism could be a contributory causative agent in the disease.
Recommendations:
Consideration of Helicobacter Pylori testing and eradication as part of hyperemesis gravidarum management and incorporation into Australasian guideline recommendations could help to reduce the morbidity associated with the condition.
Larger population studies looking at an association between HP positivity and hyperemesis and the effects of organism eradication would be of considerable benefit in future management.