Pretreatment gastric histology is helpful to predict the symptomatic response after H. pylori eradication in patients with nonulcer dyspepsia

A novel model might predict the risk of chronic atrophic gastritis: a multicenter prospective study in China

OBJECTIVE

To find a new way to predict the risk of chronic atrophic gastritis (CAG).

MATERIAL AND METHODS

All the participants received endoscopy and histological examination as well as a standard questionnaire. Multivariate analysis was performed by logistic regression to build the CAG risk model. The accuracy was evaluated by 1418 subjects recruited from six medical centers. 63 subjects received another endoscopy after 1-year follow-up and divided into three groups according to the comparison of the histological results (improved, no change and worse).

RESULTS

The model showed relatively good discrimination, with an AUROC of 0.888 (95% CI 0.852-0.925). A final probability cut-off score of 0.73 was used to predict the presence (>0.73) or absence of CAG (≤0.73). Sensitivity, specificity, PPV and NPV were 82.8%, 74.7%, 91.8% and 56%, respectively. The predicted results of 1418 subjects compared with the histological results were quite similar. There was a significant difference of the scores between three groups who were followed-up for 1 year (F = 3.248, p = 0.046). In multiple comparisons, a significant difference existed between Group A (the histological results had improved after 1-year follow-up) and Group C (the results were worse) (p = 0.019).

CONCLUSIONS

This is the first demonstration of the use of a mathematical model for CAG risk screening. Endoscopy should be recommended to those who are positive according to the model, to detect CAG early and conserve medical resources. In those who have a high-risk score, closer follow-up is needed.

WITHDRAWN: Eradication of Helicobacter pylori for non-ulcer dyspepsia

BACKGROUND

Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer dyspepsia is less clear.

OBJECTIVES

To determine the effect of H pylori eradication on dyspepsia symptoms in patients with non-ulcer dyspepsia.

SEARCH STRATEGY

Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and with pharmaceutical companies.

SELECTION CRITERIA

All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer dyspepsia.

DATA COLLECTION AND ANALYSIS

Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms.

MAIN RESULTS

Twenty one randomised controlled trials were included in the systematic review. Eighteen trials compared antisecretory dual or triple therapy with placebo antibiotics +/- antisecretory therapy, and evaluated dyspepsia at 3-12 months. Seventeen of these trials gave results as dichotomous outcomes evaluating 3566 patients and there was no significant heterogeneity between the studies. There was a 10% relative risk reduction in the H pylori eradication group (95% CI = 6% to 14%) compared to placebo. The number needed to treat to cure one case of dyspepsia = 14 (95% CI = 10 to 25). A further three trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia.

AUTHORS' CONCLUSIONS

H pylori eradication therapy has a small but statistically significant effect in H pylori positive non-ulcer dyspepsia. An economic model suggests this modest benefit may still be cost-effective but more research is needed.

Role of Helicobacter pylori infection on neuronal expression in the stomach and spinal cord of a murine model

OBJECTIVE

To investigate the effect of Helicobacter pylori (H. pylori) infection on neuronal expressions in the stomach and spinal cord of mice so as to explain dyspepsia symptoms in H. pylori infected patients.

METHODS

C57BL/6 female mice were studied at 2 weeks (acute infection group) and 12 weeks (chronic infection group) after H. pylori inoculation. Histological analyses for gastric inflammation and bacterial colonization were assessed by HE staining and Warthin-Starry staining. Fos, vasoactive intestinal polypeptide (VIP) and calcitonin gene-related peptide expressions (CGRP) were studied by immunohistochemistry.

RESULTS

H. pylori colonization was present mainly in pyloric region, but bacterial density was similar in both infected groups. The intensity of mucosal inflammation and activity was significantly higher in two infected groups than in those in the control group. The degree of mononuclear and polymorphonuclear cell infiltration in proventricular-glandular region and gastric corpus at 12 weeks after H. pylori inoculation was higher than that at 2 weeks after inoculation. The neuronal expressions of fos, VIP, and CGRP in the stomach and spinal cord were significantly more marked in the infected groups than in the control group, but there was no significant difference between two infected groups.

CONCLUSION

H. pylori infection induced different degrees of gastric mucosal inflammation in the murine model. Both early and chronic infection groups of mice showed enhanced neuronal expressions of fos, VIP and CGRP of stomach and spinal cord and these could form a basis for appearance of functional dyspeptic symptoms in patients with H. pylori infection.

Risk factors for helicobacter pylori infection in patients with chronic gastritis

AIM: To investigate the risk factors for H pylori infection in patients with chronic gastritis.

METHODS: A total of 345 cases with chronic gastritis confirmed by gastroscopy completed a unified questionnaire survey.H pylori infection was assessed using the ¹⁴C-urea breath test. The 191 H pylori-positive cases were taken as case group while the 154 H pylori-negative cases were taken as control group. The univariable and multivariable analyses were carried out using the Chi-Square Tests and Logistic regression method.

RESULTS: Single factor analysis showed that the H pylori infection was related to educational background, living areas, eating outside, eating speed, engorgement, vinegar use, preference of spicy food, food fried in oil, family history and mental stress (all P < 0.05). The multivariable unconditional Logistic regression analysis showed that the H pylori infection was related significantly to the educational background, eating outside, engorgement, vinegar and preference of spicy food.H pylori infection was negatively associated with the educational background and vinegar use (β = -0.247, -0.510, both P < 0.05), but positively associated with eating outside, engorgement and preference of spicy food (β = 0.617, 0.577, 0.190, all P < 0.05).

CONCLUSION: Eating outside frequently, engorgement and preference of spicy food increase the risk for H pylori infection, while increased d education and proper vinegar use decrease the risk for H pylori infection.

Symptoms, endoscopic findings and histology predicting symptomatic benefit of Helicobacter pylori eradication

OBJECTIVE

To analyse factors predicting changes in dyspeptic symptoms after Helicobacter pylori eradication.

MATERIAL AND METHODS

Of a total of 342 patients referred for upper gastrointestinal endoscopy at 23 centres in various parts of Finland, those tested positive for the rapid urease test were recruited in the study. Clinical and demographic data and data on dyspeptic symptoms (Gastrointestinal Symptoms Rating Scale) were collected via a structured questionnaire before and a year after the eradication therapy. Gastric biopsies were analysed according to the updated Sydney system.

RESULTS

A total of 216 H. pylori-positive patients treated successfully with eradication therapy had complete data to be analysed. After the therapy, dyspeptic symptoms decreased by 29-32%. In a univariate analysis, it was found that duodenal ulcer, female gender, gastric antral neutrophilic inflammation, smoking and age from 50 to 59 years enhanced symptom improvement whereas atrophy in the gastric body reduced it. In a multivariate analysis, duodenal ulcer (odds ratio (OR) 3.2, 95% CI 1.3-7.8) and age from 50 to 59 years (OR 2.2; 95% CI 1.2-3.9) and antral neutrophilic inflammation (OR 1.9, 95% CI 1.1-3.3) were better predictors of symptomatic response.

CONCLUSION

The symptomatic benefit from H. pylori eradication therapy was greatest among duodenal ulcer patients.

Helicobacter pylori-related gastric histology classification using support-vector-machine-based feature selection

This study presents a computer-aided diagnosis system using sequential forward floating selection (SFFS) with support vector machine (SVM) to diagnose gastric histology of Helicobacter pylori (H. pylori) from endoscopic images. To achieve this goal, candidate image features associated with clinical symptoms are extracted from endoscopic images. With these candidate features, the SFFS method is applied to select feature subsets, which perform the best classification results under SVM with respect to different histological features. By using the classifiers obtained from the feature subsets, a new diagnosis system is implemented to provide physicians with H. pylori -related histological results from endoscopic images.

Eradication of Helicobacter pylori for non-ulcer dyspepsia

BACKGROUND

Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer dyspepsia is less clear.

OBJECTIVES

To determine the effect of H pylori eradication on dyspepsia symptoms in patients with non-ulcer dyspepsia.

SEARCH STRATEGY

Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and with pharmaceutical companies.

SELECTION CRITERIA

All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer dyspepsia.

DATA COLLECTION AND ANALYSIS

Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms.

MAIN RESULTS

Twenty one randomised controlled trials were included in the systematic review. Eighteen trials compared antisecretory dual or triple therapy with placebo antibiotics +/- antisecretory therapy, and evaluated dyspepsia at 3-12 months. Seventeen of these trials gave results as dichotomous outcomes evaluating 3566 patients and there was no significant heterogeneity between the studies. There was a 10% relative risk reduction in the H pylori eradication group (95% CI = 6% to 14%) compared to placebo. The number needed to treat to cure one case of dyspepsia = 14 (95% CI = 10 to 25). A further three trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia.

AUTHORS' CONCLUSIONS

H pylori eradication therapy has a small but statistically significant effect in H pylori positive non-ulcer dyspepsia. An economic model suggests this modest benefit may still be cost-effective but more research is needed.

Eradication of Helicobacter pylori for non-ulcer dyspepsia

BACKGROUND

Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer dyspepsia is less clear.

OBJECTIVES

To determine the effect of H pylori eradication on dyspepsia symptoms in patients with non-ulcer dyspepsia.

SEARCH STRATEGY

Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and with pharmaceutical companies. These searches were updated in October 2004.

SELECTION CRITERIA

All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer dyspepsia.

DATA COLLECTION AND ANALYSIS

Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms.

MAIN RESULTS

Seventeen randomised controlled trials were included in the systematic review. Fourteen trials compared antisecretory dual or triple therapy with placebo antibiotics +/- antisecretory therapy, and evaluated dyspepsia at 3-12 months. Thirteen of these trials gave results as dichotomous outcomes evaluating 3186 patients and there was no significant heterogeneity between the studies. There was a 8% relative risk reduction in the H pylori eradication group (95% CI = 3% to 12%) compared to placebo. The number needed to treat to cure one case of dyspepsia = 18 (95% CI = 12 to 48). A further three trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia.

AUTHORS' CONCLUSIONS

H pylori eradication therapy has a small but statistically significant effect in H pylori positive non-ulcer dyspepsia. An economic model suggests this modest benefit may still be cost-effective but more research is needed.

Helicobacter pylori and nonmalignant disease

Helicobacter pylori eradication has become the recognized standard and widely adopted therapy to cure peptic ulcer disease. Other H. pylori associated conditions with potential benefit from eradication therapy are still subject to clinical investigations. The current state of evidence for these indications is summarized in this article. For NSAID associated peptic ulcer disease the current evidence needs to be grouped in three subsets of clinical conditions: a) H. pylori eradication for prevention of ulcers before starting NSAIDs therapy is advisable; b) eradication during PPI treatment for NSAID associated active ulcer shows no advantage on healing; and c) eradication alone is not sufficient for secondary prevention of ulcer complications induced by NSAID, however it appears to protect from further episodes of aspirin induced bleeding. In nonulcer dyspepsia the latest Cochrane collaboration review supports a small benefit in favour of H. pylori eradication. New insight in the relationship of H. pylori with GERD is provided from clinical trials which show that H. pylori eradication does not influence the clinical course of patients with reflux esophagitis. Finally important new data are presented regarding the management of dyspepsia at the primary care level with the confirmation that the H. pylori 'test and treat' strategy in the appropriate setting is more cost-effective than endoscopy.

Immune-mediated neural dysfunction in a murine model of chronic Helicobacter pylori infection

BACKGROUND & AIMS

Neuromuscular changes producing dysmotility and hyperalgesia may underlie symptom generation in functional gastrointestinal disorders. We investigated whether chronic Helicobacter pylori-induced gastritis causes neuromuscular dysfunction.

METHODS

In vitro muscle contractility and acetylcholine release were evaluated in mice before and after H. pylori eradication. H. pylori colonization and gastritis were graded histologically. Substance P (SP)-, vasoactive intestinal polypeptide (VIP)-, and calcitonin gene-related peptide (CGRP) immunoreactivity (IR) and macrophages were studied by immunohistochemistry.

RESULTS

In Balb/c mice, chronic H. pylori infection did not affect muscle function but augmented antral relaxation after nerve electric field stimulation. Infected mice had lower acetylcholine release by electric field stimulation and had higher density of SP-, CGRP-, and VIP-IR nerves in the stomach and of SP- and CGRP-IR in the spinal cord. Cholinergic nerve dysfunction worsened progressively and was associated with increasing macrophage and mononuclear but not polymorphonuclear infiltrate or bacterial colonization. SCID mice had unchanged acetylcholine release despite high H. pylori colonization and macrophage infiltration. Eradication of H. pylori normalized functional and morphologic abnormalities except for increased density of gastric SP- and CGRP-IR nerves.

CONCLUSIONS

H. pylori infection induces functional and morphologic changes in the gastric neural circuitry that are progressive and lymphocyte dependent, and some persist after H. pylori eradication. The data have direct implications regarding the role of H. pylori infection in functional dyspepsia.