Gastric precancerous lesions:occurrence, development factors, and treatment

Patients with gastric precancerous lesions (GPL) have a higher risk of gastric cancer (GC). However, the transformation of GPL into GC is an ongoing process that takes several years. At present, several factors including H.Pylori (Hp), flora imbalance, inflammatory factors, genetic variations, Claudin-4, gastric stem cells, solute carrier family member 26 (SLC26A9), bile reflux, exosomes, and miR-30a plays a considerable role in the transformation of GPL into GC. Moreover, timely intervention in the event of GPL can reduce the risk of GC. In clinical practice, GPL is mainly treated with endoscopy, acid suppression therapy, Hp eradication, a cyclooxygenase-2 inhibitor, aspirin, and diet. Currently, the use of traditional Chinese medicine (TCM) or combination with western medication to remove Hp and the use of TCM to treat GPL are common in Asia, particularly China, and have also demonstrated excellent clinical efficacy. This review thoroughly discussed the combining of TCM and Western therapy for the treatment of precancerous lesions as conditions allow. Consequently, this review also focuses on the causes of the development and progression of GPL, as well as its current treatment. This may help us understand GPL and related treatment.

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 and epithelial mesenchymal transition in human gastric cancers: An update of the literature

Gastric cancer, a multifactorial disease, is considered one of the most common malignancies worldwide. In addition to genetic and environmental risk factors, infectious agents, such as Epstein-Barr virus (EBV) and Helicobacter pylori (H.pylori) contribute to the onset and development of gastric cancer. H. pylori is a type I carcinogen that colonizes the gastric epithelium of approximately 50% of the world's population, thus increasing the risk of gastric cancer development. On the other hand, epithelial mesenchymal transition (EMT) is a fundamental process crucial to embryogenic growth, wound healing, organ fibrosis and cancer progression. Several studies associate gastric pathogen infection of the epithelium with EMT initiation, provoking cancer metastasis in the gastric mucosa through various molecular signaling pathways. Additionally, EMT is implicated in the progression and development of H. pylori-associated gastric cancer. In this review, we recapitulate recent findings elucidating the association between H. pylori infection in EMT promotion leading to gastric cancer progression and metastasis.

Determining Gastric Cancer-Related Risk Factors in Mongolian Population Using ABC(D) Method: A Matched Case-Control Study

Objective:

We aimed to identify gastric cancer-related risk factors and evaluate the efficacy of screening ABC(D) method in determining high risk gastric cancer individuals in Mongolian population.

Methods:

A total of 240 participants (120 gastric cancer patients and 120 healthy individuals) were included in this study. Data were collecting using a structured questionnaire consisting of 56 questions covering 5 categories. Serum Helicobacter pylori IgG (H. pylori IgG), pepsinogen I (PGI), and pepsinogen II (PGII) were tested in one third of all the participants (40 gastric cancer patients and 40 controls). PGI, PGII, and H. pylori IgG levels were measured using GastroPanel enzyme-linked immunosorbent assay kit (Biohit, Helsinki, Finland).

Results:

Habits of having leftover meals (OR 2.22, 95%CI 1.27-3.86, p<0.01), daily consumption of tea with salt (OR 1.97, 95%CI 1.18-3.30, p<0.01), smoking on an empty stomach (OR 2.44, 95%CI 1.11-5.37, p<0.05), daily consumption of vegetables (OR 0.45, 95%CI 0.27-0.76, p<0.01), and daily consumption of fruit juice (OR 0.36, 95%CI 0.15-0.85, p<0.05), family history of gastric cancer (parents OR 2.88, 95%CI 1.07-7.78, p<0.05, siblings (OR 3.09, 95%CI 1.09-8.81, p<0.05), and history of gastric diseases (OR 3.65, 95%CI 2.10-6.35, p<0.0001) were identified as protective factors. A low PGI level (<35.25ng/ml) and low PGI/II ratio (<4) were associated with gastric cancer risk. According to ABC(D) method, groups C and D had higher proportion of gastric cancer cases than group A and B (group C, OR 7.50, 95%CI 1.20-47.05, p<0.05; group D, OR 8.3, 95%CI 1.33-51.26, p<0.05).

Conclusion:

Our findings suggested that gastric cancer risk was more closely related to eating habits, smoking, family history, and precancerous lesions. ABC(D) method seems to be a plausible alternative or supplementary method for stratifying patients at high risk of gastric cancer in this country.

The efficacy and safety of furazolidone-bismuth quadruple therapy for Helicobacter pylori eradication with or without probiotic supplementation

Aim

In this clinical trial we use furazolidone-bismuth quadruple therapy with or without probiotics for H.pylori eradication.

Background

Increasing rates of eradication failure in H.pylori infection mainly due to antibiotic resistance has led to search for alternative regimens such as using novel antibiotics and/or using probiotic supplementation as conjunctive to the standard eradication regimens.

Methods

This double blind clinical trial was performed in gastrointestinal clinic of Loghman Hakim University Hospital, Tehran, Iran. Patients with a positive pathology test for H.pylori were enrolled to the study and received a 14 day course of furazolidone 100 mg q.i.d, bismuth 240 mg b.i.d, amoxicillin 1000 mg b.i.d, pantoprazole 40 mg b.i.d plus either probiotic (Familact) b.i.d or placebo b.i.d. Adverse effects and adherence to therapy were evaluated at the end of the treatment course. Eradication was established by H.pylori fecal antigen test.

Results

A total of 200 patients entered the study and were randomly assigned to two groups of placebo and probiotic. There was no significant difference regarding age or gender between placebo and probiotic groups. Adherence to therapy was higher than 90% in total and not significantly different between placebo and probiotic groups. Total eradication rate was 80.5% (n=161). Eradication rate was 84% in probiotic group vs 77% in placebo group (P=0.2). Total rate of adverse effects was 30% in probiotic group vs 62% in placebo group. The most common adverse effects were abdominal pain (15% in probiotic group vs 28% in placebo group, P=0.03) followed by diarrhea (5% in probiotic group vs 12% in placebo group, P=0.1).

Conclusion

According to our results, adding probiotic to furazolidone-bismuth quadruple therapy did no increase the eradication rate significantly. However, adverse effects particularly abdominal pain was lower in the probiotic group when compared with placebo.

Prevalence and Determinants of Helicobacter Pylori Infection among Adult Dyspeptic Patients in Abuja, Nigeria

BACKGROUND

Helicobacter pylori is common in developing countries like Nigeria with significant morbidity and risk of mortality. With rising antimicrobial resistance, risk factors of infection should be explored to develop prevention strategies and improve the health of developing communities.

OBJECTIVE

To identify determinants and clinical correlates of H. pylori among study participants.

METHODS

We conducted a hospital-based cross-sectional study between May and July 2017 of 280 dyspeptic adults in Garki Hospital Abuja. They were tested using serum H. pylori Immunoglobulin G antibody test kits. Data on patient characteristics were collected using pre-tested interviewer administered questionnaires. The data were analysed using SPSS version 25. Logistic regression and odds ratios with 95% confidence intervals were computed to identify risk factors and clinical features associated with H. pylori infection.

RESULTS

The overall prevalence of H. pylori infection was 53.6%. H. pylori was positively associated with age and monthly income. Family history of dyspepsia (OR = 0.32: 95% CI = 0.13 to 0.78), regular consumption of fruits and vegetables (OR = 0.11: 95% CI = 0.046 - 0.281) and regular handwashing with soap and water (OR = 0.02: 95% CI = 0.006 -0.040) were found to be protective against H. pylori infection.

CONCLUSION

There is a high H. pylori prevalence amongst patients with dyspepsia in Garki Hospital Abuja. Interventions to reduce the incidence of H. pylori infection should emphasise regular handwashing with soap and water and regular fruit and vegetable consumption.

Prevalence of Helicobacter pylori infection among children with primary nephrotic syndrome: a cross-sectional study

Background

Limited data are available about the prevalence of helicobacter pylori (H.pylori) infection among primary NS children.

Objectives

To assess the frequency and risk factors of H.pylori infection among children with primary NS.

Methods

A cross-sectional study was carried out in Mansoura University Children's Hospital, Egypt during the period from 2017 to 2019 including 100 NS children (NS group) and 100 healthy controls. NS group included 88 steroid sensitive (SSNS) and 12 steroid resistant (SRNS) cases. All patients were assessed for H.pylori infection using H.pylori stool antigen (HpSA) test. Statistical analysis was done using chi-square, fisher exact and Mann-Whitney tests.

Results

With regard to HpSA test results, no significant differences were detected between control and NS groups (p = 0.193) and between SSNS and SRNS groups (p = 0.286). Concerning total biopsied cases and MCD (proven plus presumed) cases, no significant differences were found between those with positive and negative HpSA test (p = 0.648 and 0.126, respectively). The high dose of steroid therapy was associated with a higher risk of H.pylori infection among NS group (Odds ratio = 3.8; 95% confidence interval = 1.3–11.3).

Conclusion

The current study negates the increased risk of H.pylori infection in children with primary NS.

Concurrent infection of intestinal parasites and Helicobacter pylori among school-age children in Central Ethiopia

Background

Coinfection of multiple intestinal microbial pathogens plays an important role in individuals harboring these organisms. However, data on magnitude and risk factors are scarce from resource limited settings.

Objective

We examined the prevalence and associated risk factors of intestinal parasites and Helicobacter pylori co-infection among young Ethiopian school children.

Method

Data from a total of 434 Ethiopian school children from the Ziway region were analyzed in the study. Stool antigen and blood serum antibody tests were used to detect H. pylori, while the presence of any intestinal parasites was detected using direct wet mount microscopy and formol-ether concentration techniques. A structured questionnaire was delivered to mothers and legal guardians of the children by an interviewer to collect data relevant demographic and lifestyle factors. Multivariate logistic regression analysis was performed to assess the association of these sociodemographic characteristics with the coinfection of H. pylori and intestinal parasites.

Results

The prevalence of coinfection with any intestinal parasites and Helicobacter pylori was 23.0% (n = 92/400). Univariate analysis showed an increased risk for co-infection among children whose mothers had non-formal education (COR: 1.917, p < 0.01) and those who had no history of child vaccination (COR: 3.455, p = 0.084). Children aged 10–14 and those who lived in a house that had a flush or ventilated latrine were found at lower odds of coinfection between intestinal parasites and Helicobacter pylori (COR: 0.670, p = 0.382; COR: 0.189, p = 0.108). Multivariate regression analysis showed increased odds of co-infection among children whose mothers had non-formal education (AOR: 1.978, p < 0.01). Maternal education was also associated with a two-fold increase in odds for H. pylori and any protozoa co-infection (AOR: 2.047, p < 0.01).

Conclusion

Our study shows a moderate prevalence of H. pylori and intestinal parasite co-infection and identified maternal education as a significant risk factor among school children.

The relationship between Helicobacter pylori infection and intestinal parasites in individuals from Khartoum state, Sudan: a case-control study

Background: In developing countries, Helicobacter pylori infection is common, as are intestinal parasites. Socioeconomic circumstances and low personal hygiene lead to the spread of these infections. This research aimed to evaluate the relationship between intestinal parasites and H. pylori in Khartoum, Sudan. Methods: This study was conducted in various hospitals in Khartoum between June and October 2018. The study involved 200 individuals: 100 patients with H. pylori as a case group and 100 healthy individuals as a control group. A stool sample was taken from each individual, and wet preparation, saturated sodium chloride flotation and formal ether concentration were used to detect intestinal parasites. Results: The results showed that 23% of H. pylori patients and 10% of healthy individuals had gastrointestinal parasites; Entamoeba histolytica was found in 12% of H. pylori cases followed by Entamoeba coli (7%) and Giardia lamblia (4%). Control group: Entamoeba histolytica in 5% followed by G. lamblia in 3% and E. coli in 2% of individuals. There was a significant difference in the prevalence of intestinal parasites between groups (P = 0.013). The prevalence rate of intestinal parasites among men and women was 24% and 22%, respectively, in the case group, and 9% and 11%, respectively, in the control group. In the case group, the highest prevalence rates (40% and 38%) were found among the age groups 1-15 and 46-60 years old, respectively, while the lowest rate (10.7%) was found among the 31-45 age group. In the control group, the highest prevalence rate (15%) was among the 31-45 age group, the lowest prevalence rate (8%) was found among the 16-30 age group. Conclusion: Together, we found that intestinal parasites are more common in patients with H. pylori. We also noticed that the rate of infection was not affected by gender while the age group was affected.

The relationship between Helicobacter pylori infection and intestinal parasites in individuals from Khartoum state, Sudan: a case-control study

Background: In developing countries, Helicobacter pylori infection is common, as are intestinal parasites. Socioeconomic circumstances and low personal hygiene lead to the spread of these infections. This research aimed to evaluate the relationship between intestinal parasites and H. pylori in Khartoum, Sudan.

Methods: This study was conducted in various hospitals in Khartoum between June and October 2018. The study involved 200 individuals: 100 patients with H. pylori as a case group and 100 healthy individuals as a control group. A stool sample was taken from each individual, and wet preparation, saturated sodium chloride flotation and formal ether concentration were used to detect intestinal parasites.

Results: The results showed that 23% of H. pylori patients and 10% of healthy individuals had gastrointestinal parasites; Entamoeba histolytica was found in 12% of H. pylori cases followed by Entamoeba coli (7%) and Giardia lamblia (4%). Control group: Entamoeba histolytica in 5% followed by G. lamblia in 3% and E. coli in 2% of individuals. There was a significant difference in the prevalence of intestinal parasites between groups (P = 0.013).

The prevalence rate of intestinal parasites among men and women was 24% and 22%, respectively, in the case group, and 9% and 11%, respectively, in the control group. In the case group, the highest prevalence rates (40% and 38%) were found among the age groups 1-15 and 46-60 years old, respectively, while the lowest rate (10.7%) was found among the 31-45 age group. In the control group, the highest prevalence rate (15%) was among the 31-45 age group, the lowest prevalence rate (8%) was found among the 16-30 age group.

Conclusion: Together, we found that intestinal parasites are more common in patients with H. pylori. We also noticed that the rate of infection was not affected by gender while the age group was affected.

[Halitosis: multidisciplinary diagnostic and therapeutic approaches]

Introduction

L’halitose, état morbide caractérisé par une mauvaise haleine, présente à la fois un aspect pathologique et social. Dans notre contexte, l’halitose pose de nombreux problèmes de prise en charge aux plans diagnostique et thérapeutique en pratique clinique. Le but de notre travail était d’étudier les aspects diagnostiques et thérapeutiques de l’halitose.

Méthodes

Il s’agit d’une étude transversale sur une année. Ont été inclus, les patients âgés de plus de 15 ans qui ont consulté pour halitose au centre hospitalier universitaire Yalgado Ouédraogo. Ont été exclus les patients avec mauvaise haleine mais consultant pour un autre motif. L’haleine a été évaluée par un praticien selon le test organoleptique de Rosenberg.

Résultats

Au total 35 patients ont été inclus pour un sex-ratio de 1,2. L’âge moyen était de 31,9 ans. Dans 57,1% des cas, la plainte venait du patient lui-même. La durée moyenne de l’halitose était de 4,3 ans. Dix-neuf patients avaient un score de Mel Rosenberg ≥ 2. La carie dentaire (07 cas), la sinusite (07 cas), l’infection à Helicobacter pylori (09 cas) et l’ulcère gastro-intestinal (10 cas) étaient associés à l’halitose. Le traitement a été étiologique dans 82.9% des cas avec une amélioration satisfaisante à deux semaines de l’ordre de 71,8%.

Conclusion

L’halitose reste une pathologie peu étudiée et pose un problème de diagnostic positif, mais aussi étiologique dans notre contexte. Le rôle de l’odontologiste est crucial dans la recherche de la cause de l’halitose. Cependant, une prise en soins pluridisciplinaire de l’halitose permettra d’y apporter une réponse plus efficace.

Accuracy of testing for anti-Helicobacter pylori IgG in urine for H. pylori infection diagnosis: a systematic review and meta-analysis

OBJECTIVES

This meta-analysis aims to systematically measure the potential diagnostic value of anti-Helicobacter pylori IgG in urine for infection diagnosis, using all eligible studies published in English and Chinese languages.

DESIGN

The random effect model was used to analyse the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative LR (NLR), diagnostic OR (DOR), together with the summary receiver operator characteristic curve.

SETTING

Literature searches of databases including PubMed, EMBASE, MEDLINE, Web of Science, Chinese National Knowledge Infrastructure and Wanfang databases were performed to retrieve studies evaluating the diagnostic value of urine IgG antibody for H.pylori infection.

PRIMARY OUTCOME MEASURE

Twenty-three studies with 4963 subjects were included in the current meta-analysis.

RESULTS

The pooled sensitivity, specificity, PLR, NLR, DOR and area under the curve (AUC) were 0.83 (95% CI 0.82 to 0.85), 0.89 (95% CI 0.88 to 0.90), 8.81 (95% CI 6.37 to 12.2), 0.13 (95% CI 0.09 to 0.2), 73 (95% CI 46.45 to 114.74) and 0.9551, respectively. Subgroup analyses showed that diagnostic accuracy of the urine IgG assay was no different in age, region, study population and assay method.

CONCLUSIONS

Anti-H. pylori antibody in urine might serve as a good marker in diagnosing H. pylori infection. However, further validation based on a larger sample is still required.

Sero-prevalence and associated factors of Helicobacter pylori infection among adult patients with dyspepsia attending the gastroenterology unit in a tertiary hospital in Mwanza, Tanzania

BACKGROUND

Prevalence of H.pylori infection varies greatly between populations in different countries. This study was conducted to determine the magnitude of H.pylori among adult patients with dyspepsia attending the gastroenterology unit at Bugando medical centre.

METHODS

A cross sectional study involving 202 dyspeptic patients was conducted between June and July 2014. A Standardized data collection tool was used to collect socio-demographic characteristics. H.pylori antibodies were detected using rapid immunochromatographic tests according to manufacturer's instructions.

RESULTS

The median age of study population was 42 (IQR: 33-54). Females 105 (51.9%) formed majority of the population studied. Of 202 participants; 119 (58.9%) were from rural areas. Seroprevalence of H.pylori infection was found to be 79/202 (39.1%, 95% CI: 32.3-45.7). As the age increased the risk of having H.pylori infection also increased (OR: 1.02 95% CI: 1-1.04, P=0.02). On multivariate logistic regression analysis untreated drinking water was found to predict H.pylori seropositivity (OR: 2.33, CI: 1.09-4.96, p=0.028).

CONCLUSION

The seroprevalence of H.pylori among dyspeptic patients is high in this setting. Therefore the community in Mwanza should be educated on the use of safe drinking water in order to minimize H. pylori infections.

GlycoGAIT: A web database to browse glycogenes and lectins under gastric inflammatory diseases

The perplexing nature of dynamic glycosylation modification plays imperative role in determining the regulatory role of key glycoconjugates involved in immune system. Systematic analysis of change in expression pattern of glycogenes and lectins can bring in a comprehensive understanding of genetic basis of the glycobiological changes occurring in pathological condition. Advancement in the field of glycobiology has capacitated the process of linking gene expression changes of glycogenes with its biological function. This instigated us to systematically analyze changes in expression patterns focusing on glycome genomics under diverse gastrointestinal immune dysfunction background. To necessitate this, as a pilot project, we carefully integrated several publically available databases to construct a glycosylation process associated gene set as well as public expression microarray data associated with gastrointestinal infections into an online database called Glycosylation and Gut Associated Immune Tolerance (GlycoGAIT). Currently the database comprises of 548 well characterized genes belonging to glycogenes and lectins along with gene expression data obtained from human biopsy samples under both H. pylori infection and inflammatory bowel disease (IBD) condition. The user-friendly interface enables the users to quickly compare and interpret changes in expression patterns of glycome genomics under different gut associated inflammatory conditions. The database is available online at: https://apps.connexios.com/glycogait/.

Braf, Kras and Helicobacter pylori epigenetic changes-associated chronic gastritis in Egyptian patients with and without gastric cancer

We aimed to study MLH1 and MGMT methylation status in Helicobacter pylori-associated chronic gastritis in Egyptian patients with and without gastric cancer. 39 patients were included in our study. They were divided into 2 groups; patients without (group I) and with gastric adenocarcinoma (group II). Patients were subjected to clinical examination, abdominal ultrasound and upper endoscopy for gastric biopsy. Biopsies were subjected to urease test, histological examination, and DNA purification. H. pylori, Braf, Kras, MLH1 and MGMT methylation were assessed by quantitative PCR. DNA sequencing was performed to assess Braf and Kras genes mutation. qPCR of H. pylori was significantly higher in patients with adenocarcinoma (group II) than those without adenocarcinoma (group I); with a p < 0.001 as well as in patients with age above 50 years with a p value = 0.008. By applying logistic regression analysis it was reported that the H. pylori qPCR is a significant predictor to the adenocarcinoma with OR = 1.025 (95 % CI: 1. 002-1.048), with sensitivity of 90 % and specificity of 100 %. Adenocarcinoma patients had a significantly higher mean age and levels of H. Pylori, Braf, K-ras, methylated MGMT and methylated MLH1 than those of gastritis patients. DNA sequence analysis of Braf (codon 12) and Kras (codon 600) had genes mutation in gastric adenocarcinoma versus chronic gastritis.

CONCLUSION

H. pylori may cause epigenetic changes predisposing the patients to cancer stomach. Estimation of H. pylori by qPCR can be a good predictor to adenocarcinoma. Braf and Kras genes mutation were reveled in gastritis and adenocarcinoma patients.

Helicobacter pylori Associated Gastritis in Northern Maharashtra, India: A Histopathological Study of Gastric Mucosal Biopsies

INTRODUCTION

Helicobacter pylori (H.pylori) are of major concern today because of its causal relationships with gastrointestinal diseases. It represents one of the most common and medically important infections worldwide. H.pylori plays a key role in the aetiology of chronic gastritis, duodenal ulcer, gastric carcinoma and MALT lymphoma. There is paucity of literature regarding the morphological changes in H.pylori associated gastritis.

AIM

We undertake this study to find out the association and prevalence of H.pylori associated gastritis by histopathological methods in North Maharashtra, India.

MATERIALS AND METHODS

A total 310 patients with various upper gastrointestinal disorders were included in this study over the period of 19 months from July 2013 to January 2015. The detailed clinical history was taken and patients were subjected to video gastroscopy. Each biopsy was studied with Haematoxylin and Eosin/Giemsa method.

RESULTS

The prevalence of H.pylori was high in third to fourth decades. Out of 310 patients of gastrocopy, 144 were H.pylori positive by Haematoxylin and Eosin/Giemsa method. Morphological changes specific for H.pylori was noted as atrophy and irregular gastric mucosa, lymphoid aggregates and reactive atypia. Male patient were outnumbered by female patients.

CONCLUSION

Histopathological evaluation is the gold standard for diagnosing H.pylori infection. Prevalence of H.pylori in the present study was 46.5% in patients undergoing videogastroscopic biopsies for gastritis and vague upper gastrointestinal symptoms. Furthermore and large scale studies are required to establish the diagnostic modalities for H.pylori associated gastritis to prevent morbidity and mortality.

Clarithromycin vs. Gemifloxacin in Quadruple Therapy Regimens for Empiric Primary Treatment of Helicobacter pylori Infection: A Randomized Clinical Trial

BACKGROUND Eradication of Helicobacter pylori infection plays a crucial role in the treatment of peptic ulcer. Clarithromycin resistance is a major cause of treatment failure. This randomized clinical trial aimed at evaluating the efficacy of a clarithromycin versus gemifloxacin containing quadruple therapy regimen in eradication of H.pylori infection. METHODS In this randomized double blind clinical trial (RCT 2012102011054N2), a total of 120 patients were randomized to two groups of 60 patients each. Patients with proven H.pylori infection were consecutively assigned into two groups to receive OBAG or OBAC in gastroenterology clinic in Rasoul-e- Akram General Hospital in Tehran, Iran. The patients in the OBAG group received omeprazole (20 mg) twice daily, bismuth subcitrate (240 mg) twice daily, amoxicillin (1 gr) twice daily, and gemifloxacin (320 mg) once daily, and those in the OBAC group received omeprazole (20 mg) twice daily, 240 mg of bismuth subcitrate twice daily, amoxicillin (1 gr) twice daily, and clarithromycin (500 mg) twice daily for 10 days. RESULTS Five patients from each group were excluded from the study because of poor compliance, so 110 patients completed the study. The intention-to-treat eradication rate was 61.6% and 66.6% for the OBAC and OBAG groups, respectively. According to the per protocol analysis, the success rates of eradication of H.pylori infection were 67.2% and 72.7% for OBAC and OBAG groups, respectively (p=0.568). CONCLUSION The results of this study suggest that gemifloxacin containing regimen is at least as effective as clarithromycin regimen; hence, this new treatment could be considered as an alternative for the patients who cannot tolerate clarithromycin.

Effect of Xeroderma pigmentosum complementation group F polymorphisms and H.pylori infection on the risk of gastric cancer

Objective: We conducted a case-control study by genotyping three potential functional SNPs to assess the association of Xeroderma pigmentosum complementation group F (XPF) polymorphisms with gastric cancer susceptibility, and role of XPF polymorphisms in combination with H.pylori infection in the risk of gastric cancer.

Methodology: A hospital case-control study was conducted. A total of 331 patients with gastric cancer and 355 controls were collected. Three SNPs of XPF, XPF rs180067, rs1799801 and rs2276466, were genotyped by Taqman real-time PCR method with a 7900 HT sequence detector system.

Results: The gastric cancer patients were more likely to have smoking habit, a family history of cancer and H.pylori infection. We did not find the significant difference in the genotype distributions of XPF rs180067, rs1799801 and rs2276466 between cases and controls. Multivariate logistic analysis showed a non-significant decreased risk in patients carrying rs180067 G allele, rs1799801 T allele or rs2276466 T allele genotypes. The stratification by H.pylori infection was not significantly different in polymorphisms of XPF rs180067, rs1799801 and rs2276466.

Conclusion: There was no evidence that polymorphisms in rs180067, rs1799801 and rs2276466 significantly affect the risk of gastric cancer. Further large sample size studies are strongly needed to validate their association.

Epidemiology of peptic ulcer disease: endoscopic results of a systematic investigation in iran

BACKGROUND

Peptic ulcer disease is a multifactorial health problem affecting almost all populations worldwide. Large scale population-based studies are crucial to understanding its scope and specifications in various nations. We aimed to explore environmental risk factors of peptic ulcer disease in the first population based study in Ardabil, Northwest Iran.

METHODS

This study was a part of a larger survey on upper gastrointestinal tract health conducted in Ardabil and Meshkinshahr with a total catchment area population of 600,000 persons during 2000-01. Using a random sampling proportional to place of residence, 1122 persons aged 40 or elder were selected. 1011 (90.1%) accepted participation and underwent a comprehensive medical examination and a systematic upper gastrointestinal endoscopy. Point prevalence of peptic ulcers was correlated to various life style risk factors.

RESULTS

Gastric and duodenal ulcers were identified in 33 (3.26%) and 50 (4.94%) participants, making an overall prevalence of 8.20%. Based on multivariable logistic regression analyses, H.pylori infection (OR 3.1, 95% CI: 2.1-4.7), Smoking (OR 1.8, 95% CI: 1.1-6.8), and chronic intake of NSAIDs (OR 2.8, 95% CI: 1.3-4.4) were main risk factors of gastric ulcer. For duodenal ulcer, in addition to H.pylori infection (OR 5.6, 95% CI: 1.9-8.8) and Smoking (OR 2.3, 95% CI: 1.4-6.5), male gender (OR 3.6, 95% CI: 1.2-5.8) and living in an urban area (OR 1.9, 95% CI: 1.1-5.2) were among significant risk factors.

CONCLUSION

This is the first population-based endoscopic study in North West of Iran reporting accurate point prevalence of peptic ulcer disease. The rate of 3.3% for gastric ulcer and 4.9% for duodenal ulcers are substantially lower than the estimates reported in Asian population-based endoscopic studies but higher than European reports.

Non-Helicobacter pylori, non-NSAIDs peptic ulcers: a descriptive study on patients referred to Taleghani hospital with upper gastrointestinal bleeding

AIM

The purpose of the present study was to evaluate the number and proportion of various causes of upper gastrointestinal bleeding and actual numbers of non-NSAID, non-Helicobacter pylori (H.pylori) peptic ulcers seen in endoscopy of these patients.

BACKGROUND

The number and the proportion of patients with non- H.pylori, non-NSAIDs peptic ulcer disease leading to upper gastrointestinal bleeding is believed to be increasing after eradication therapy for H.pylori.

PATIENTS AND METHODS

Medical records of patients referred to the emergency room of Taleghani hospital from 2010 with a clinical diagnosis of upper gastrointestinal bleeding (hematemesis, coffee ground vomiting and melena) were included in this study. Patients with hematochezia with evidence of a source of bleeding from upper gastrointestinal tract in endoscopy were also included in this study.

RESULTS

In this study, peptic ulcer disease (all kinds of ulcers) was seen in 61 patients which were about 44.85% of abnormalities seen on endoscopy of patients. Among these 61 ulcers, 44 were duodenal ulcer, 22 gastric ulcer (5 patients had the both duodenal and gastric ulcers). Multiple biopsies were taken and be sent to laboratory for Rapid Urease Test and pathological examination. About 65.53% of patients had ulcers associated with H.pylori, 9.83% had peptic ulcer disease associated with NSAIDs and 11.47% of patients had ulcers associated with both H.pylori and consumption of NSAIDs. 13.11% of patients had non-NSAIDs non- H.pylori peptic ulcer disease.

CONCLUSION

The results of this study supports the results of other studies that suggest the incidence of H.pylori infection related with duodenal ulcer is common, and that non-H pylori and non-NSAIDs duodenal ulcer is also common.

Molecular Diagnosis of Helicobacter Pylori Strain by 16S rDNA PCR Amplification and Direct Sequencing

Aim

Rapid detection of H.pylori strains by PCR-Sequencing.

Methods

16S rDNA amplification by PCR from template genomic DNA, confirmation of amplicon size by agarose gel electrophoresis, sequencing of amplicons by automated sequencer, analysis of sequences by NCBI –BLAST software.

Results

The PCR –Sequencing and analysis of the sequence data by BLAST resulted in detection of the strain to be of H.pylori strain#26695.

Conclusion

The pathogenicity of H.pylori depends on the strain of the bacteria, PCR-Sequencing and analysis of the sequence data by BLAST can be a very quick and useful diagnostic method of the pathogen.