Helicobacter pylori colonization in Nepal; assessment of prevalence and potential risk factors in a hospital-based patient cohort

Feeling social change in the gut: gyāstrik and the problematisation of domestic roles among Newar women in contemporary Nepal

Drawing upon 15 months of research conducted in 2018-2019 in Bhaktapur, Nepal, this paper examines how middle-class women experience and make sense of gyāstrik (an umbrella term for multiple gut disorders) as an embodiment of social change. Enumerating dietary injustices and distress following unmet middle-class expectations of well-being and domestic intimacy as a primary cause of the condition, these women narratively problematised social norms and found ways out through the concomitant vocalisation of physical pain and social discontent. While illness epistemologies differ (with the persistence of mind-body dichotomies on the one hand and the centrality of notions of well-being and ideals of self-care on the other), these accounts demonstrate both a passive and active role of the gut in the social change experience, inviting to take the gut as the site where somatic modes of 'attention' and 'action' enable the navigation of personal life trajectories and the negotiation of social change itself.

ABO, Lewis blood group systems and secretory status with H.pylori infection in yemeni dyspeptic patients: a cross- sectional study

BACKGROUND

The ABO and Lewis blood group antigens are potential factors in susceptibility to H. pylori infection. This research aimed to examine the prevalence of Helicobater pylori (H.pylori) infection and its association with ABO, Lewis blood group systems, and secretory status in Yemeni symptomatic patients.

METHODS

In a cross-sectional study, 103 patients referred for endoscopy due to dyspepsia were included. H pylori infection was assessed using stool antigen and serum antibody rapid tests. ABO and Lewis blood group systems were examined using hemagglutination assay. Saliva samples were investigated for identification of the secretory phenotype using hemagglutination inhibition test.

RESULTS

The prevalence of H. pylori infection was (80.6%), with a higher rate of infection in females than males. The ABO blood groups were found to be significantly different between males and females (p = 0.047). The O blood group was prevalent among H. pylori patients, especially secretors. There was a significant association between ABO blood groups and H. pylori infection (p = 0.001). The Le (a + b+) phenotype was the most common, followed by Le (a + b-), Le (a-b+), and Le (a-b-). Lewis blood group systems and secretory status of symptomatic patients were not associated with H. pylori infection. The results showed that serum Ab test for H. pylori achieved poor sensitivity (68%), specificity of 55%; positive predictive value (PPV) 86%, negative predictive value (NPV) 29% and accuracy 65.1%.

CONCLUSION

The prevalence of H. pylori infection was high in Yemeni patients. This infection was linked to the O and Le (a + b+) secretor phenotype. The H. pylori stool Ag test is the most reliable noninvasive diagnostic method for detecting H. pylori infection.

Helicobacter Pylori Infection among Patients Attending the Gastroenterology Department in Tertiary Care Hospital, Kathmandu, Nepal

Helicobacter pylori is one of the most pathogenic organisms that cause gastritis, peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue (MALT) lymphoma in humans. The main aim of this study was to determine the H. pylori infection among patients undergoing upper GI endoscopy and to compare the efficacy of the diagnostic method of H. pylori infection including invasive tests (biopsy-based tests like the rapid urease test (RUT), direct smear, and culture) and the noninvasive test (HpSA). A total of 100 stool samples and 200 gastric biopsy specimens were collected (2 samples from each patient) from June to November 2019. Stool samples were processed for the detection of an H. pylori stool antigen (HpSA) by a kit method. One biopsy specimen was processed for the RUT, and another was transported to the laboratory in an Eppendorf tube containing normal saline for preparation of the smear and culture. Out of 100 participants, 26% were found to be H. pylori positive by the RUT, 11% by the direct smear, 6% by the culture, and 17% by the stool antigen test. The prevalence of H. pylori infection was found to be 14%, considering at least two of the three biopsy-based tests that gave positive results. H. pylori infection was found to be higher in the age group of 46-55 years. The overall prevalence of H. pylori infection was higher in gastric ulcer cases, followed by erosive pangastritis and gastroduodenitis. Tea drinking habits and the frequency of meal consumption more than twice a day were found to be significantly associated with H. pylori infection (P < 0.05). Hence, the RUT was found to be more efficient than the direct smear and the culture method for finding H. pylori in the biopsy sample. However, none of these methods can be considered to be the gold standard alone. Thus, the RUT combined with other tests is preferable for the detection of H. pylori.

Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori infection prevalence of approximately 50%. The most important risk factors in America include being male, poor adherence or difficult access to treatment, and the lack of in-home water service. Despite the descending trend in prevalence worldwide, the overall prevalence in Africa remains very high (70%). Nevertheless, the prevalence of H. pylori in children without gastrointestinal who underwent screening was reported to be only 14.2%. The main risk factors in Africa are having a traditional pit or no toilet, poverty, birth order, source of drinking water, or being a farmer. Asia seems to have the widest variations in terms of H. pylori prevalence. Several risk factors were reported in Asia to be associated with this infection, such as lower income and educational level, house crowding, rural residence, ethnicity, the use of tanks as water supplies, alcohol drinking, active smoking, eating spicy food or raw uncooked vegetables, poor living conditions and sanitation. The overall prevalence of H. pylori infection in European children is almost 25%. Portugal has the highest prevalence of all European countries at 66.2% in children 13 years of age. The risk factors in European individuals consist of living in rural areas, eating unwashed fruits and vegetables, not washing hands after school, low parental education and unemployment, and short education duration. Further studies are required to identify the precise mechanisms involved in the discrepancies of H. pylori prevalence worldwide.

Epidemiology Helicobacter pylori infection in children in the Tyva Republic (Russia)

BACKGROUND

Tyva Republic is a small mountainous area at the geographical center of Asia in southern Siberia, with a high incidence of gastric cancer.

AIM

We examined the prevalence of H. pylori and associated risk factors among children in Tyva.

METHODS

Cross-sectional study was conducted among Tuvan children who had upper gastrointestinal symptoms and underwent upper gastroscopy with gastric biopsies. Informed consent was obtained from the parents and assent from the children. Demographic information, ethnicity, parents' education and employment status, and family size were collected. H. pylori infection was diagnosed by histologic examination.

RESULTS

There were 270 children between the ages 7 and 17 years (mean 13.4 ± 2.7); 64% girls; 147e Tuvan and 123 Caucasians. The overall prevalence of H. pylori was high and similar between boys and girls (55 vs. 57%, respectively, p = 0.42). The infection was highest in Tuvan children (67%. vs. 43%, respectively (OR = 2.4; 95%CI = 1.9.4-3), p = 0.05. H. pylori prevalence increased with age from 44% among 7 to 10 years and 64% among those 14 to 17 (OR = 3.0; 95%CI = 1.6-5.8), p = 0.0.005; the pattern was consistent among both ethnic groups. The prevalence of the infection among Caucasian children was inversely correlated with the level of mother's education (44%, vs. 61%) (i.e., for with and without a college education the OR = 2.3; 95%CI = 1.2-3.7), p = 0.02. Neither the total number of children nor adults living in the same household correlated with H. pylori prevalence.

CONCLUSIONS

Strategies to reduce the incidence of gastric cancer in Tyva will need to start in childhood.

Cancer burden in Nepal, 1990-2017: An analysis of the Global Burden of Disease study

Introduction

Cancer is the second leading cause of death and a major public health problem in the world. This study reports the trend and burden of cancer from 1990 to 2017 along with its risk factors in Nepal.

Methods

This study used the database of the Institute of Health Metrics and Evaluation’s Global Burden of Diseases on cancer from Nepal to describe the most recent data available (2017) and trends by age, gender, and year from 1990 to 2017. The data are described as incidence, prevalence, disability-adjusted life years (DALY), and percentage change.

Results

In 2017, the age-standardized cancer incidence and mortality rates were 101.8/100,000 and 86.6/100,000 respectively in Nepal. Cancer contributed to 10% of total deaths and 5.6% of total DALYs in Nepal. The most common cancers were the breast, lung, cervical, stomach and oral cavity cancers. The number of new cancer cases and deaths in Nepal have increased from 1990 to 2017 by 92% and 95% respectively. On the other hand, age-standardized incidence and mortality rates decreased by 5% and 7% respectively. The leading risk factors of cancer were tobacco use, dietary factors, unsafe sex, air pollution, drug use, and physical inactivity.

Conclusions

This study highlighted the burden of cancer in Nepal, contributing to a significant number of new cancer cases, deaths and DALY. A comprehensive approach including prevention, early diagnosis and treatment, and rehabilitation should be urgently taken to reduce the burden of cancer.

Prevalence and correlates of Helicobacter pylori infection among under-five children, adolescent and non-pregnant women in Nepal: Further analysis of Nepal national micronutrient status survey 2016

Most of the Helicobacter pylori infections occur in developing countries. The risk factors for H. pylori infections are poverty, overcrowding, and unhygienic conditions, which are common problems in under-privileged countries such as Nepal. Despite having a high risk of H. pylori infections, no national level study has been conducted to assess prevalence and correlates of H. pylori infection in Nepal. Therefore, we hypothesized that micronutrients such as iron, vitamin B12 deficiency, socio-economic status, and nutritional status correlate with the prevalence of H. pylori infection in Nepal.

We studied prevalence and correlates of H. pylori infection among under-five children, adolescents aged 10–19 years and married non-pregnant women aged 20–49 years using data from the Nepal National Micronutrient Status Survey 2016 (NNMSS-2016). H. pylori infection was examined in stool of 6–59 months old children and 20–49 years old non-pregnant women whereas the rapid diagnostic kit using blood sample was used among adolescent boys and girls.

Prevalence of H. pylori infection was 18.2% among 6–59 months old children, 14% among adolescent boys and 16% among adolescent girls aged 10–19 years; and 40% among 20–49 years non-pregnant women. Poor socioeconomic status, crowding, and unhygienic condition were found to be positively associated with higher incidence of H. pylori infections. No significant correlation was observed between nutritional and micronutrients status (iron or risk of folate deficiency) with H. pylori infection.

Findings from this study suggest that poverty-associated markers are primary contributors of H. pylori infections in Nepalese communities. To control acquisition and persistence of H. pylori infection in Nepal, we suggest improved management of safe drinking water and implementation of sanitation and hygiene programs, with a focus on those of lower socioeconomic status.

Helicobacter pylori is associated with a wide spectrum of gastrointestinal diseases and is a common problem in tropical region where inter-human contact is the primary mode of disease transmission. Poor socio-economic status is a crucial fueling factor of H. pylori infection. In this study, the authors present data from Nepal national micronutrient status survey 2016 (NNMSS-2016) and investigated the risk factors associated with H. pylori infections among under-five years old children, 10–19 years old adolescent boys and girls, and 20–49 years non-pregnant women nationwide. Study findings corroborate that poverty-associated markers are the key driving factor of H. pylori infections in Nepal, which can have a manifold effect on nutrition and subsequent child growth retardation. Management of safe drinking water and implementation of sanitation and hygiene practices to decrease acquisition of H. pylori infection is a pressing need in rural parts of Nepal and among marginalized communities. The findings of this study highlight the varied prevalence of H. pylori by age group, gender, place of residence, ethnic group, and ecological regions of the country. Moreover, no significant correlation was observed between nutritional and micronutrients status with H. pylori infection.

Prevalence of Helicobacter pylori among children in a training and research hospital clinic in Istanbul and comparison with Updated Sydney Classification Criteria

OBJECTIVE

Helicobacter pylori (H. pylori) is a gram-negative bacterium and one of the reasons for gastritis, peptic and duodenal ulcers. It is a crucial public health problem for both children and adults, especially in developing countries. This study aims to investigate the prevalence of Helicobacter pylori positivity in children and to compare with updated Sydney classification criteria.

METHODS

This study was conducted from January 2015 to June 2017. This study included 885 children aged 0-17 year(s). Endoscopic biopsies were evaluated for the diagnosis of infection due to H. pylori.

RESULTS

The findings showed that 418 (47.2%) of 885 children were positive for H. pylori, and this positivity had a significantly increasing correlation with the presence of chronic inflammation, neutrophilic activity, lymphoid aggregates, and follicles. Erythematous pangastritis and antral nodularity on endoscopic findings had a correlation with H. pylori positivity.

CONCLUSION

In this hospital-based study, the findings suggest that H. pylori infection is a problem for children and more extensive studies are needed to determine the prevalence of H. pylori positivity among children.

The Gastro-protective Effect of Ginger (Zingiber officinale Roscoe) in Helicobacter pylori Positive Functional Dyspepsia

Purpose: The present study aimed to assess the effect of ginger (Zingiber officinale) powder supplementation on Helicobacter pylori eradication and improvement of dyspeptic symptoms in patients with H. pylori positive functional dyspepsia (FD). Methods: During this pilot study 15 patients with H. pylori positive FD received 3 g/d ginger powder as three 1-g tablets for 4-weeks. Dyspepsia symptoms were asked before and after the intervention using a questionnaire based on the Rome III criteria. H. pylori eradication was also assessed by a non-invasive stool antigen (HpSAg) test. Results: Ginger consumption accompanied by significant H. pylori eradication rate of 53.3% (P = 0.019) and the odds ratio (95% CI) was 8 (1.07 to 357.14). Moreover, our results showed significant changes in most of the dyspepsia symptoms after ginger supplementation. Conclusion: According to our findings, Z. officinale can be considered as a useful complementary therapy for FD. However, due to the small number of clinical trials in this area, further welldesigned clinical trials are needed to explicitly talk about its effectiveness especially about the eradication of H. pylori.

A comparison of techniques to address the frequency of Helicobacter pylori positive dyspeptic patient

Objectives

The study was aimed to compare the diagnostic techniques, for the detection of Helicobacter pylori infection, available in low-income countries, where molecular testing is not available or inaccessible to anyone.

Results

Of total enrolled patient, with the mean age of 41.4 ± 13.33 years, 24 (14 female; 10 male) were diagnosed to have been infected. The diagnosis was established based upon the gold standard test [either two of three tests: Rapid Urease Test (RUT), culture and histological examinations]. Of clinical presentation, the epigastric pain (75%) was the commonest; nevertheless, the endoscopic findings had shown an equivocal specificity since the larger percentile (58.3%) reported as normal findings, in a presumed dyspepsia. Based on the premise—with calculated sensitivity, specificity, and predictive values; the accuracy order observed as histology > RUT > serology > stool antigen test, in H. pylori detection from the clinical samples. The accuracy order of the diagnostic test may vary depending upon the laboratory settings and study population. Therefore, in reference to low-income countries, the clinicians must resort any available positive test so that the supporting positive rudiments would be an ancillary in augmenting the diagnostic accuracy.

Epidemiology of Helicobacter pylori infection in asymptomatic schoolchildren in Bhutan

AIM

Bhutan is a small mountainous country between Tibet and India with relatively homogenous population. According to the World Health Organization, gastric cancer is the most frequent cause of cancer death in Bhutan. This study examined the prevalence of Helicobacter pylori among children in Bhutan with emphasis on water source and living conditions.

METHODS

A cross-sectional sero-epidemiologic study was conducted among schoolchildren who attended public schools in Thimphu, Bhutan. Between 2015 and 2016, blood samples from schoolchildren were collected after obtaining an informed consent from the school management and the children's parents. Demographic information, parents' education, family size living in the same household, and aspects of household environment including type of latrines, boiling drinking water were collected. All serum samples were tested for H. pylori immunoglobulin G (IgG) by commercial ELISA kits.

RESULTS

There were 327 children between 4 and 19 years of age participated, 44% boys, mean age = 13.6 ± 3 years. The overall prevalence of H. pylori was 66% with no difference between boys and girls (66 vs 64%, respectively), P = .42. H. pylori prevalence was 75% among both 4-7 and 15-19 years and not statically different from that of the 8-10 or 11-14 age groups (59% and 63%, respectively), P = .1. H. pylori prevalence was inversely correlated with the level of mother's education (70% vs 55%) for those without and with a college education, respectively (OR = 2.3; 95%CI = 0.9-1.7), P = .08. The total number of people living in the same household did not correlate with H. pylori sero-prevalence, but households had less than 3 children had lower prevalence than those with 3 or more children (62% vs 71%, respectively OR = 1.7, 95% CI = [1.0-2.6], P = .05).

CONCLUSIONS

H. pylori infection is prevalent among all age group children in Bhutan. The results suggest that transmission of H. pylori is related to personal care practices that directly correlate with the mothers' education and crowded living condition with children. Our results are important to developing prevention strategies for gastric cancer in Bhutan.

Influence of Dietary Factors on Helicobacter pylori and CagA Seroprevalence in Bulgaria

The aim of this study was to assess the association between some dietary factors and prevalence of H. pylori infection or strain virulence in 294 adult asymptomatic blood donors. Methods. Seroprevalence was evaluated using ELISA. Logistic regression was used. Results. Anti-H. pylori IgG prevalence was 72.4%, and CagA IgG seroprevalence was 49.3%. In the multivariate analyses, the frequent (>5 days per week) honey consumption was associated with both reduced H. pylori seroprevalence OR, 0.68 with 95% confidence interval (CI), 0.473-0.967 and reduced CagA IgG seroprevalence OR, 0.65 with 95% CI, 0.486-0859. Frequent (>5 days per week) yoghurt consumption also was associated with lower H. pylori virulence of the strains (CagA IgG OR, 0.56 with 95% CI, 0.341-0.921). Smoking and consumption of the other dietary factors resulted in no significant differences in the prevalence of H. pylori IgG and CagA IgG within the subject groups. Conclusion. To the best of our knowledge, this is the first report revealing reverse associations between honey or yoghurt consumption and CagA IgG prevalence as well as between frequent honey consumption and lower prevalence of the H. pylori infection. Regular honey and yoghurt consumption can be of value as a supplement in the control of H. pylori therapy.