[Relation between infection of CagA-positive Helicobacter pylori and upper gastrointestinal diseases]

OBJECTIVE

To study the relation between infection of Helicobacter pylori strains expressing CagA and upper gastrointestinal diseases, and to assess the change of anti-CagA IgG antibody levels after eradication of H. pylori.

METHODS

Gastric biopsy was conducted among eight hundred and eight patients who received endoscopy to determine the pathological changes of mucosa and infectious status of H. pylori. The presence of serum anti-CagA IgG was detected in each H. pylori-positive patient by ELISA. Eradication therapy by PPI was conducted to the H. pylori-positive individuals. The anti-CagA IgG levels were reexamined among 60 patients whose H. pylori infection failed to be eradicated and 120 patients whose H. pylori infection was successfully eradicated after 3 months and 6 months.

RESULTS

The serum anti-CagA IgG-positive rates were 55.4%, 70.5%, 83.2%, 90.8% and 89.7% in H. pylori-positive patients with chronic superficial gastritis (CSG), chronic atrophic gastritis (CAG), gastric ulcer (GU), duodenal ulcer (DU), and gastric cancer (GC) respectively. The serum anti-CagA IgG-positive rates among the latter 4 groups were significantly higher than that in CSG group, and the serum anti-CagA IgG-positive rates among the latter 3 groups were significantly higher than that in CAG group. The serum anti-CagA IgG-positive rate among patients with CAG was significantly higher than that among patients with CSG (P < 0.05). The CagA-positive rates in the groups of intestinal metaplasia (IM), atypical hyperplasia and GC were significantly higher than those in the groups of CSG and CAG (P < 0.05). By the end of 3 and 6 months after the eradication therapy, the antibody level had decreased from a mean value of (69 +/- 38) U/ml to (47 +/- 30) U/ml and (32 +/- 15) U/ml among 120 patients with successful eradication and the serum antibody reverted to negative only in 23 cases from them. There was no significant change in serum anti-CagA IgG level among 60 patients without successful eradication.

CONCLUSION

Infection with CagA-positive H. pylori strains is associated with an increased risk of developing more severe gastroduodenal diseases and more severe gastric mucosa lesions. Despite an overall significant decrease of anti-CagA IgG level in sera after H. pylori eradication, this serological method cannot be used to monitor individual treatment effect because the anti-CagA IgG level decreases slowly.

Fatal gastrointestinal infection with 'Flexispira rappini'-like organisms in a cat

A 4-month-old male British Blue cat with catarrhal to haemorrhagic enteritis showed massive colonization of the stomach, small intestine and caecum with spiral-shaped bacilli. In the stomach, organisms were located in foveolae and gland lumina and within unaltered and degenerate epithelial cells. Inflammatory infiltration was moderate and T cell dominated. In the intestine, bacilli were found in the gut lumen, berween villi, in crypt lumina and within epithelial cells. Degeneration of crypt epithelial cells as well as crypt dilation and moderate to massive macrophage-dominated infiltration of the mucosa and submucosa were observed. Immunohistochemically, bacilli were positive with an antibody against Helicobacter. Ultrastructurally, the organisms strongly resembled 'Flexispira rappini', a spiral-shaped Helicobacter species known as a normal intestinal colonizer in dogs and mice.

Gastrointestinal infections in the immunocompromised host

Gastrointestinal disease is a significant cause of morbidity and mortality in the immunocompromised patient. This article focuses on the infectious gastrointestinal complications associated with the treatment of malignant disease and with solid organ transplantation but not HIV. Gastrointestinal defenses and the various mechanisms by which they are impaired are reviewed. The major pathogens and malignancies of this patient population and an approach to their diagnosis, treatment, and prevention are discussed.

Effectiveness of nystatin in polysymptomatic patients. A randomized, double-blind trial with nystatin versus placebo in general practice

BACKGROUND

Antifungal therapy has been claimed to be effective in polysymptomatic patients with diffuse symptoms from multiple body systems and even well defined diseases, traditionally not related to fungi. Hypersensitivity to fungus proteins and mycotoxins has been proposed as the cause.

METHODS

We conducted a 4-week randomized, double-blind, placebo-controlled study in 116 individuals selected by a 7-item questionnaire to determine whether the antifungal agent nystatin given orally was superior to placebo. At the onset of the study, the patients were free to select either their regular diet or a sugar- and yeast-free diet, which resulted in four different subgroups: nystatin + diet (ND); placebo + diet (PD); nystatin (N); and placebo (P).

RESULTS

Nystatin was significantly better than placebo in reduction of the overall symptom score (P < 0.003). In six of the 45 individually recorded symptoms, the improvement was significant (P < 0.01). All three active treatment groups reduced their overall symptom scores significantly (P < 0.0001), while the placebo regimen had no effect (P = 0.83). The benefit of diet was significant within both the nystatin (ND > N) and the placebo groups (PD > P).

CONCLUSIONS

Nystatin is superior to placebo in reducing localized and systemic symptoms in individuals with presumed fungus hypersensitivity as selected by a 7-item questionnaire. This superiority is probably enhanced even further by a sugar- and yeast-free diet.

Gastrointestinal basidiobolomycosis in Arizona: clinical and epidemiological characteristics and review of the literature

Gastrointestinal basidiobolomycosis (GIB) is an unusual fungal infection that is rarely reported in the medical literature. From April 1994 through May 1999, 7 cases of GIB occurred in Arizona, 4 from December 1998 through May 1999. We reviewed the clinical characteristics of the patients and conducted a case-control study to generate hypotheses about potential risk factors. All patients had histopathologic signs characteristic of basidiobolomycosis. Five patients were male (median age, 52 years; range, 37--59 years) and had a history of diabetes mellitus (in 3 patients), peptic ulcer disease (in 2), or pica (in 1). All patients underwent partial or complete surgical resection of the infected portions of their gastrointestinal tracts, and all received itraconazole postoperatively for a median of 10 months (range, 3--19 months). Potential risk factors included prior ranitidine use and longer residence in Arizona. GIB is a newly emerging infection that causes substantial morbidity and diagnostic confusion. Further studies are needed to better define its risk factors and treatment.

Fluorescence spectroscopy application in the express-evaluation of the gastrointestinal microflora

Possible application is studied for fluorescence spectroscopy in the express-evaluation of the gastrointestinal microflora. This diagnostic approach is feasible because of the difference in fluorescent spectra from different microorganisms, with anaerobic microorganisms exhibiting the most pronounced fluorescence. It was found that fluorescence strength raised with an increase in the bacteria Bacteroides and bifid bacteria, whereas it decreased with an increase in Escherichia coli. The bacteria Bacteroides and bifid bacteria are the most typical representatives of anaerobic bacteria, whereas the bacteria Escherichia coli are the typical representatives of aerobic bacteria. According to the literature, Bacteroides and bifid bacteria reveal an intense fluorescence. Bearing in mind that these genera of bacteria play an important role in the gastrointestinal microbiocenosis, fluorescence spectroscopy can be used as a diagnostic means for gastrointestinal dysbacteriosis.

Mucosal and systemic antibody responses to the lipopolysaccharide of Escherichia coli O157 in health and disease

Mucosal immunity in the gastrointestinal (GI) tract is a primary defence against GI pathogens. We hypothesise that a mucosal response to lipopolysaccharide (LPS), especially to the common (core) determinants of GI pathogenic Escherichia coli strains, is protective. The aims of this study were to investigate the specificities, levels and development of humoral responses in health and GI disease to the R3 LPS core and O-polysaccharide of E. coli O157. The purpose was to try to predict whether vaccination or passive immunisation might induce protection. Wherever possible, paired whole gut lavage fluid (WGLF) and serum samples were collected for comparison of the mucosal and systemic responses. Matched saliva samples were also collected from some study groups. The patient groups included those with acute E. coli O157 disease (serum only), patients convalescing after E. coli O157 infections, and patients undergoing routine investigation for GI conditions but subsequently shown to be immunologically normal. Some samples of WGLF from patients with Crohn's disease (CRO) and ulcerative colitis (UC) were included to allow comparisons with patients with inflammatory conditions known to alter antibody secretion in the GI tract. The healthy groups from whom serum and saliva only were taken included blood donors, healthy volunteers and a group of slaughterhouse workers. This latter group was likely to have been exposed regularly to faecal bacteria from animals and antibody specificities might have been expected to be different from other healthy individuals. Levels and classes of antibodies were determined by ELISA with microtitration plates coated with polymyxin complexes of whole LPS extracted from E. coli O157 and LPS from the E. coli R3 rough mutant. Antibodies of IgG and IgM classes were measured in serum and IgA was measured in WGLF and saliva. IgG antibodies to the O157 LPS and the R3 core oligosaccharide were detected in the serum of healthy blood donors. Patients with acute E. coli O157 disease showed elevated levels of serum IgM to O157 LPS and R3, with IgG levels raised only to R3. In serum from convalescent patients, IgG to O157 LPS was significantly above the control groups only in the period 6-16 weeks after infection. Total IgA levels were similar in WGLF specimens from all groups, except the patients with UC, whose levels were much higher. Specific IgA levels were higher in the E. coli O157 convalescent group, but there were no significant correlations overall. UC patients had significantly lower levels of IgA to O157 and CRO patients had higher O157 IgA levels than UC patients and healthy volunteers. In serum, inhibition of ELISA showed that the response to the O157 LPS was due in part to a response to the R3 oligosaccharide component. This response was much more pronounced in the healthy and non-O157 groups than in convalescent patients. There was no correlation between specific IgA antibody levels in saliva and matched specimens of WGLF, and levels in sequential saliva specimens fluctuated widely. The significant IgG and IgA responses to the R3 core suggest that there is immunological memory to this oligosaccharide LPS component which may have a role in protection against E. coli LPS both systemically and locally in the GI tract. Boosting of this mucosal response to the LPS core, either naturally through exposure or by active or passive immunisation, may confer protection. Finally, antibody responses to E. coli O157 must be interpreted with caution, as the response detected is a sum of responses to the O-specific polysaccharide and the R3 core.

Gastrointestinal mucormycosis in a renal transplant patient

The clinical course and management of a rare case of gastrointestinal mucormycosis occurring in a renal transplant patient are presented. The diagnosis was made on pathological examination of surgically resected tissue from the colon, spleen and stomach. The patient did not survive the infection. To the best of our knowledge, this is the 11th reported case of gastrointestinal mucormycosis in a solid organ transplant patient. The pathophysiology, incidence and prognosis of this disease are discussed.

Prevalence of functional dyspepsia and its relationship with Helicobacter pylori infection in a Japanese population

AIM

To investigate the prevalence of functional dyspepsia and Helicobacter pylori infection and their relationship in a Japanese population.

METHODS

Two thousand five hundred people who visited Shimane Institute of Health Science for their annual medical check-up from September 1998 to August 1999 were prospectively enrolled in the study. After routine medical examination, including an upper gastrointestinal study and an ultrasonographic examination, all subjects were asked standard questions to check for the presence of any symptoms that suggested dyspepsia. Helicobacter pylori infection was determined by using a serum IgG antibody concentration with an ELISA.

RESULTS

Of the 2,500 persons investigated, 2,263 showed no abnormal finding in any medical examination. The presence or absence of symptoms and H. pylori infection was investigated in these 2,263 cases. Of these, 201 people (8.9%) experienced nausea, fullness and/or early satiety and were diagnosed as having dysmotility-like dyspepsia, while 118 people (5.2%) experienced pain localized to the epigastrium and were diagnosed as having ulcer-like dyspepsia. The frequency of these symptoms had a tendency to decline with age, although this was not statistically significant. In contrast, the rate of H. pylori infection increased with age. There was no significant relationship between H. pylori infection and any type of functional dyspepsia.

CONCLUSIONS

Helicobacter pylori infection does not influence the prevalence of the dysmotility-like and ulcer-like dyspeptic symptoms.

[Importance of assessment of Helicobacter pylori antigen in faeces]

Diagnostic methods for the detection of Helicobacter pylori (H.P.) can be divided into invasive and non-invasive ones. Among non-invasive methods we can include now also detection of H.P. antigen in faeces. The objective of our study was to evaluate the sensitivity ans specificity of the test when monitoring the eradication therapy, as compared with another non-invasive test and to test the method in common clincal practice. H.P. positivity was based on the result of the histological examination and CLO test. Repeatedly samples of faeces were collected to detect H.P. antigen in faeces before the onset of and after eradication treatment. For detection of H.P antigen the commercial Premier Platinum HpSa set was used which was developed on the principle of enzyme immunoanalysis. From the assembled data the sensitivity value (87.1%) and specificity values (88.5%) was calculated. The test correlates well with the results of the CLO test, histological examination and the breath test and is thus a suitable method for the detection of H.P. positive subjects as well as for checking the success of eradication treatment of H.P.

Helicobacter pylori infection is not associated with diabetes mellitus, nor with upper gastrointestinal symptoms in diabetes mellitus

OBJECTIVE

The association between Helicobacter pylori (H. pylori) infection and diabetes mellitus is controversial. We aimed to determine the prevalence of H. pylori infection in patients with diabetes and nondiabetic controls, and assess whether H. pylori infection was associated with upper gastrointestinal (GI) symptoms in diabetes mellitus.

METHODS

A total of 429 patients with type 1 (n = 49) or type 2 (n = 380) diabetes mellitus (48.6% women, mean age 60.7 yr) and 170 nondiabetic controls (34.7% women, mean age 60.4 yr) were evaluated. All subjects completed a validated questionnaire (the Diabetes Bowel Symptom Questionnaire) to determine upper GI symptoms, and a blood sample was tested for H. pylori infection using a validated ELISA kit (sensitivity 96%, specificity 94%).

RESULTS

Seroprevalence of H. pylori was 33% and 32%, respectively, in patients with diabetes and controls (NS). In both groups, the seroprevalence was significantly higher in men than in women; 39% vs 25% (p = 0.002) in diabetic patients, and 40% vs 20% (p = 0.01) in controls. Patients with diabetes had a significantly higher prevalence of early satiety (OR = 2.30), fullness (OR = 3.15), and bloating (OR = 1.50) compared with controls. Upper GI symptoms were present in 49% of H. pylori-positive and 53% of H. pylori-negative patients with diabetes (OR = 0.87, 95% CI 0.58-1.31, p = 0.56). H. pylori infection was also not associated with any of the individual upper GI symptoms before or after adjustment for potential confounding factors. However, patient age and female gender were identified as independent risk factors for upper GI symptoms. Smoking was a risk factor for bloating and early satiety.

CONCLUSIONS

H. pylori infection appears not to be associated with diabetes mellitus or upper GI symptoms in diabetes mellitus.

Significance of Clostridium tertium bacteremia in neutropenic and nonneutropenic patients: review of 32 cases

In the nonneutropenic host, bacteremia due to Clostridium tertium is rare and of unclear significance. We describe a patient in whom presentation with Clostridium tertium bacteremia was the harbinger of Crohn's disease. In order to understand the significance of C. tertium bacteremia in neutropenic and nonneutropenic hosts, we review all 32 cases of C. tertium bacteremia that occurred at Duke University Medical Center from 1992 to 1999.

Questionnaire on NSAID gastropathy among Dutch rheumatologists

Dutch rheumatologists were given a questionnaire on NSAID gastropathy, in which older age (>60 years) and previous ulcers were mentioned by them as being the most important risk factors. Dutch rheumatologists follow different strategies for the prevention of NSAID gastropathy, with a slight preference for proton pump inhibitors and the use of COX-2 selective NSAIDs.

Prevalence of and risk factors for Helicobacter pylori infection among healthcare workers at a teaching hospital in Rome: the Catholic University Epidemiological Study

OBJECTIVES

To evaluate the prevalence of and the risk factors for Helicobacter pylori in a population of medical and non-medical workers at a teaching hospital in Rome, Italy.

DESIGN

A cross-sectional study.

METHODS

From January to October 1998, 655 subjects (65% of the total population) underwent a 13C-urea breath test to assess H. pylori infection. Subjects completed a questionnaire concerning sociodemographic characteristics, work departments and history of some gastrointestinal symptoms. Differences in means and proportions were evaluated and independent predictors of H. pylori infection status were assessed by multiple logistic regression analysis.

RESULTS

Forty percent of the subjects were found to be H. pylori infected. The mean age of positive subjects was significantly higher than that of negative ones (38 +/- 14 versus 34 +/- 12 years; P < 0.01). No significant difference was found between males and females concerning the infection status (40.2% males versus 39.9% females). Lower years of father's education [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.9-5.1] and age older than 35 years (OR, 2.0; 95% CI, 1.3-3.1) were the only independent predictors of the likelihood of H. pylori positivity. Prevalence of gastrointestinal symptoms was similar in infected and uninfected subjects. Physicians were significantly less infected than nurses and auxiliary personnel (26% versus 47% versus 55%, respectively); however, a loss of association was observed after adjustment by multiple logistic regression (OR, 1.8; 95% CI, 0.9-3.7). In all groups, some specific departments appear to be associated with a higher infection status.

CONCLUSIONS

Among healthcare workers, H. pylori infection was associated with specific sociodemographic characteristics, such as age and level of father's education. The prevalence of H. pylori infection was not associated with different professional categories. However, some specific departments seem to increase infection risk.

Protection from gastrointestinal diseases with the use of probiotics

Probiotics are nonpathogenic microorganisms that, when ingested, exert a positive influence on the health or physiology of the host. They can influence intestinal physiology either directly or indirectly through modulation of the endogenous ecosystem or immune system. The results that have been shown with a sufficient level of proof to enable probiotics to be used as treatments for gastrointestinal disturbances are 1) the good tolerance of yogurt compared with milk in subjects with primary or secondary lactose maldigestion, 2) the use of Saccharomyces boulardii and Enterococcus faecium SF 68 to prevent or shorten the duration of antibiotic-associated diarrhea, 3) the use of S. boulardii to prevent further recurrence of Clostridium difficile-associated diarrhea, and 4) the use of fermented milks containing Lactobacillus rhamnosus GG to shorten the duration of diarrhea in infants with rotavirus enteritis (and probably also in gastroenteritis of other causes). Effects that are otherwise suggested for diverse probiotics include alleviation of diarrhea of miscellaneous causes; prophylaxis of gastrointestinal infections, which includes traveler's diarrhea; and immunomodulation. Trials of gastrointestinal diseases that involve the ecosystem are currently being performed, eg, Helicobacter pylori infections, inflammatory bowel disease, and colon cancer.

Helicobacter pylori infection in Chinese subjects with type 2 diabetes

The relationship between diabetes and Helicobacter pylori (HP) infection is controversial. In this study, we examined the possible relationship between HP infection and type 2 diabetes in Chinese subjects. Sixty-three Chinese type 2 diabetic patients (mean age +/- SD: 49.9 +/- 12.0 years; range: 17-76 years) were recruited irrespective of the duration of diabetes or type of therapy. Twenty-nine (46%) of them had upper gastrointestinal symptoms and the other 34 (54%) did not. Another 55 age- and sex-matched non-diabetic subjects (mean age +/- SD: 45.6 +/- 15.6 years, p=0.098; range 18-79 years) with dyspepsia indicated for upper endoscopy were recruited as a comparison group. Upper endoscopy was performed with antral mucosal biopsy specimens taken for rapid urease test (CLO test). HP infection was considered to be present if the rapid urease test was positive. The rates of HP infection of the diabetic and non-diabetic individuals were 50.8% and 56.4% respectively (p: NS). The rate of HP infection was similar between the 2 groups of diabetic patients with or without gastrointestinal symptoms (42.9% vs. 56.3%, p: NS). Using logistic regression analysis (forward stepwise) with age, sex, glycaemic control, duration of diabetes and upper gastrointestinal symptoms as independent variables to predict the risk of HP infection in diabetic patients, none of the parameters enter into the model. In conclusion, the rate of HP infection in Hong Kong Chinese subjects with type 2 diabetes is around 50%, which is similar to control subjects. No association was found between HP infection, glycaemic status, and duration of diabetes and upper gastrointestinal symptoms in these diabetic subjects.

Gastrointestinal histoplasmosis in patients with AIDS: case report and review

Histoplasmosis is the most common endemic mycosis in individuals with AIDS, occurring in 2%-5% of this population. Infection is more likely to be disseminated than in immunocompetent individuals and generally presents insidiously with nonspecific symptoms. The gastrointestinal tract is involved in 70%-90% of cases of disseminated histoplasmosis, yet gastrointestinal histoplasmosis per se is infrequently encountered in patients with AIDS. The diagnosis of gastrointestinal histoplasmosis is often not suspected, particularly in areas of nonendemicity, and a delay in diagnosis may lead to increased morbidity and risk of death. Since antifungal therapy improves outcome for >80% of AIDS patients with histoplasmosis, it is essential that caregivers be aware of the varied presentations of gastrointestinal histoplasmosis in order to diagnose and to treat this potentially life-threatening infection effectively.

[Impact of the impaired intestinal microflora on the course of acne vulgaris]

The paper deals with studies of the intestinal microflora in 114 patients with acne vulgaris (94 and 20 with its papulopustular and nodulocystic forms). Sixty-one (54%) patients have either the first (21%) or second (78.7%) impaired bacterial microflora. At the same time, there are no great differences in the content of the intestinal microflora in different forms of acne. It is noted that adding intestinal microflora-correcting agents to combined therapy in patients with papulopustular acne vulgaris and verified dysbacteriosis reduces the duration of treatment by over twice and makes its duration the same as that in patients without dysbacteriosis.