Epidemiology of Helicobacter pylori infection

Aim of the study: Rosacea, an inflammatory skin disease, may have a potential relationship with helicobacter pylori (H. pylori) infection. This correlation is controversial. This study was designed to assess whether H. pylori infection might play a pathogenic role in rosacea. Patients and methods: 50 patients with rosacea and 50 controls were enrolled. The H.pylori infection was evaluated by C Urea Breath Test (C UBT). A baseline breath sample was obtained and another 30 minutes later. H. pylori infected subjects were treated with PPIs, 1 gr amoxicillin, 500 mg clarithromycin, 500 mg metronidazole, bid. H. pylori status was re-evaluated 4 weeks after completion of therapy. Infection was considered eradicated if patients had a negative test. In terms of H. pylori positivity, no significant difference was observed between the two groups. Among rosacea patients, H. pylori infection does not appear more often compared to the general population. However, the H. pylori positive group on eradication therapy showed significant improvement in the rosacea severity. The results maintained for 1 year. All rocasea patients should be tested for H. pylori infection. The early detection and eradication of H.pylori reduces the risk of complications from long term survival of the microbe. Moreover, it improves the rosacea that could develop into a resistant form.

Objective: To evaluate the prevalence and predictors of Helicobacter pylori (H. pylori) infection among patients attending a healthcare facility in Nigeria. Methods: Blood samples were collected between July-August, 2016 from 240 patients who gave informed consent and completed self-administered questionnaires. Out of the 240 subjects, 101 (42.1%) were male and 139 (57.9%) were female. Plasma samples were examined for anti-H. pylori IgG antibodies using a commercial antibody-based kit. Results: Out of the 240 subjects, 135 (56.3%) were seropositive. Of these, 53 (52.5%) males and 82 (59.0%) females were infected. Age and alcohol consumption were significant predictors of infection (P < 0.05). Although subjects who were female, married, full time house wives and lived in urban areas were more likely to be infected, there was no statistically significant difference (P > 0.05). Conclusions: Infection with H. pylori was found among patients attending a tertiary healthcare facility in Nigeria. High proportions of patients (56.3%) were infected in the study area. Our findings have public health significance for the prevention and control of the infection in Nigeria.

Helicobacter pylori (Hp) infeksiyonu şu an dünyada en yaygın olduğu kabul edilen kronik infeksiyondur. Prevalansı yaşa ve ülkeye bağlı olarak değişebilir. Ülkemizdeki prevalansı %60-84 düzeyindedir (1-3). Hp en önemli gastrik patojenlerden biridir. Bu gram negatif spiral bakteri ile oluşan infeksiyonun; kronik aktif gastrit, duodenal ülser, gastrik ülser, hipertrofik gastropati, gastrik adenokarsinoma ve gastrik MALT lenfoma ile bağlantılı olduğu bilinmektedir (4). Helicobacter pylori, doku hasarından sorumlu olan lokal veya sistemik bir immün cevaba yol

Accurate diagnosis of Helicobacter pylori infection is very important in both clinical practice and research. We evaluated the sensitivity of real-time PCR (RT-PCR) for the detection and quantification of Helicobacter pylori using DNA from 91 human gastric biopsy samples divided into three groups: 46 biopsies from untreated patients who according to the references methods were considered H. pylori-negative (group A); 35 biopsies from patients previously treated against H. pylori and considered to be cured by "gold standard" tests (group B); and 10 biopsies from patients H. pylori-positive by all available methods (group C). The sensitivity of the RT-PCR assay was higher than that of stan- dard methods. Of the 81 patients considered to be uninfected according to the references methods, 16 were H. pylori-positive by PCR, 10 of which were patients who had received H. pylori eradication therapy and 6 were untreated patients. Based on these findings we recommend that RT-PCR should be use in addition to standard methods in clinical studies to monitor the results of H. pylori eradication therapy.

Helicobacter pylori infection is typically acquired in early childhood, and a predominantly intrafamilial transmission has been postulated. To what extent family members share the same strains is poorly documented. Our aim was to explore patterns of shared strains within families by using molecular typing. Family members of H. pylori -infected 10- to 12-year-old index children identified in a school survey were invited to undergo gastroscopy. Bacterial isolates were typed with random amplified polymorphic DNA and PCR-restriction fragment length polymorphism of the genes ureA-B , glmM , or flaA . The presence or absence of the cag pathogenicity island, a bacterial virulence factor, was determined by PCR. GelCompar II software, supplemented with visual inspection, was used in the cluster analysis. In 39 families, 104 individuals contributed 208 bacterial isolates from the antrum and corpus. A large proportion, 29 of 36 (81%) of the offspring in a sibship, harbored the same strain as a...

To resist the harsh intrinsic milieu, several lines of defense exist in the stomach. The aim of this study was to investigate the effect of the gastric pathogen Helicobacter pylori on these mechanisms in vivo. We used FVB/N mice expressing human α-1,3/4-fucosyl transferase (producing Lewis b epitopes) and inoculated with H. pylori 1. Mice were anesthetized with isoflurane or Hypnorm-midazolam, the stomach was exteriorized, and the surface of the corpus mucosa was exposed. Mucus thickness was measured with micropipettes, juxtamucosal pH (pHjm) was measured with pH-sensitive microelectrodes, blood flow was measured with laser-Doppler flowmetry, and mRNA levels of the bicarbonate transporter SLC26A9 were quantified with real-time PCR. The increase in mucosal blood flow seen in response to luminal acid (pH 1.5) in control animals (140 ± 9% of control) was abolished in infected mice. The firmly adherent mucus layer was significantly thinner in infected mice (31 ± 2 μm) than in control mi...

Helicobacter pylori infection is typically acquired shortly after birth in both low and high-income regions of the world and once the infection is established, it commonly persists life long unless treated. This infection has been identified as an important risk factor for the development of peptic ulcer disease and is probably the most important cause of relapse in those previously treated for peptic ulcer disease. The aim of this study was to determine the prevalence of H. pylori infection in patients with peptic ulcer disease at the University College Hospital (UCH) Ibadan; South West Nigeria. Fifty-two (52) patients who had symptoms of dyspepsia were recruited for the study and each of them went through endoscopy. Forty-three (43) (82.7%) of the patients were diagnosed with peptic ulcer disease while nine (9) (17.3%) patients were diagnosed normal. The presence of H. pylori was determined using culture and Urease Breath Test (UBT). The culture result showed that thirty-five (35) (81.4%) of the patients diagnosed with peptic ulcer disease had H. pylori infection also, eight (8) (88.9%) of the normal patients were culture positive for H. pylori. The UBT result showed that 65.1% of the diagnosed peptic ulcer patients were positive for H. pylori, also 55.6% of the normal patients were found UBT positive for H. pylori. In all, H. pylori infection is very common among dyspepsia patients and the organism is closely associated with the disease in South West Nigeria.

Helicobacter pylori (H. pylori) infection historically happens in early childhood, particularly in low-and middleincome countries. Most carriers of these bacteria are usually asymptomatic. This study was conducted to determine the seroprevalence of Helicobacter pylori infection among children attending selected hospitals in Keffi metropolis between April and June 2015. Two milliliters (2ml) of blood sample was collected from one hundred randomly selected children of age 0-15years via venipuncture. The blood samples were serologically analyzed using immuno-chromatographic rapid test kits (Global). Out of the 100 samples examined, only 6.0% of the children were seropositive for H. pylori infection. The prevalence of H. pylori infection was higher in female (7.1%) than in male (4.6%) and rose with increase in ages of the children. Statistically there was no significant difference (p>0.05) with respect to gender and age. There was also no significant difference when H. pylori infection was associated with socio-demographic characteristics and predisposing factors such as sources of drinking water (p=0.9875), type of toilet (p=0.7165), hand washing behaviour (p=0.5049) and eating habit (p=0.9936). The comparison between symptomatic (14.3%) and asymptomatic (5.4%) children was also insignificant (p=0.9056). The results of the study further revealed that there was an increase in awareness of hygienic practices. Improved sanitary conditions and proper public health Education on the possible mode of transmission of the bacteria is still recommended for further eradication.

Background and Aims: Chile ranks fifth in the world among countries with the highest incidence of gastric cancer. The aim was to quantify the association between Helicobacter pylori infection and gastric cancer mortality at the county of residence. Methods: A cross-sectional household survey, a probability sample of the Chilean adult population, provided 2,615 participants in whom serum H. pylori IgG antibodies were measured (ELISA). The spatial pattern of 48,367 deaths due to gastric cancer which occurred from 1985 to 2002 was analyzed using a hierarchical Poisson regression model; 333 counties were categorized as low, medium, and high gastric cancer mortality with median gastric cancer death rates of 11.4, 19.1, and 26.0 per 100,000 inhabitants, respectively. The association between H. pylori positivity and gastric cancer mortality in the county of residence was assessed by multivariate Poisson regression for complex samples. Results: H. pylori prevalence was 73.0% [95% confidence...

Experimental data on long term helicobacter pylori (HP) infection indicate that inflammation can develop in gastric mucosa after infection so that it could be very important the prevention of neonatal and childhood infection. Few reports have been published concerning horizontal and vertical transmission of HP infection (1,2,3). We investigated newborns from HP positive mothers to evaluate HP infection transmission. From June 2002 to December 2004 we evaluated 165 pairs mother-newborn. Mothers: serological test for HP antibodies (HPab; Helicobacter pylori IgG Elisa, Eurospital, Italy) and stool antigen testing (Helori, Eurospital, Italy); urea Breath test (UBT) was performed only in positive cases. Newborns: stool antigen testing (Helori, Eurospital) in the first month of life and every six months until eighteen months or three years in positive cases, in which we evaluated HPab against CAG-A (Cag-A IgG EIA,Radim, Italy) at three months. Statistical analysis: chi-square test. Preliminary results. Mothers: 62/165( 37.5%) were both serological and stool-antigen testing positive. UBT in 57/62 (92%) resulted positive in 52/57 (91.2% ). 649 stool samples of newborns have been analyzed: 3/52 (5.7%) resulted positive in first month of life (HPab against CAG-A all positive): one became negative at one year and two cases were still positive at eighteen months. No newborns of negative mothers had a positive antigen stool testing, with a statistical difference compared to newborns from positive mothers (pϽ0.05). Conclusion. HP infection could be acquired in neonatal age from HP positive mothers. Stool antigen testing represents an easy and non-invasive method for the diagnosis of infection in newborns. References.

The rotavirus (RV) is the major causative agent of acute viral diarrhea in children under 5 years old and is responsible for approximately 6% of the deaths in this age group making necessary the use of quick and reliable diagnosis methods. The aim of this study is to evaluate the sensibility and specificity of the immunochromatographic method (ICG) on which many commercial kits used for the diagnosis of A rotavirus group are based taking as a reference the polyacrylamide gel electrophoresis (PAGE). Feces samples were collected from 317 patients with acute that attended a private laboratory from May to November, 2006 for rotavirus analysis. All the information of the patients was managed confidentially. Kits of the commercial brands simple Operon (n=154) or SD Bioline rotavirus (n=163) were used strictly following the instructions of the manufacturers.

Background and aims Intestinal metaplasia (IM) is a gastric preneoplastic lesion that appears following Helicobacter pylori infection and confers an increased risk for development of cancer. It is induced by gastric expression of the intestine-specific transcription factor CDX2. The regulatory mechanisms involved in triggering and maintaining gastric CDX2 expression have not been fully elucidated. The Cdx2 +/À mouse develops intestinal polyps with gastric differentiation and total loss of Cdx2 expression in the absence of structural loss of the second allele, suggesting a regulatory defect. This putative haplo-insufficiency, together with the apparent stability of IM, led to the hypothesis that CDX2 regulates its own expression through an autoregulatory loop in both contexts. Methods Gastrointestinal cell lines were co-transfected with wild-type or mutated Cdx2 promoter constructs and CDX2 expression vector for luciferase assays. Transfection experiments were also used to assess endogenous CDX2 autoregulation, evaluated by RT-PCR, qPCR and western blotting. Chromatin immunoprecipitation was performed in a cell line, mouse ileum and human IM. Results CDX2 binds to and transactivates its own promoter and positively regulates its expression in gastrointestinal human carcinoma cell lines. Furthermore, CDX2 is bound to its promoter in the mouse ileum and in human gastric IM, providing a major contribution to understanding the relevance of this autoregulatory pathway in vivo. The results of this study demonstrate another layer of complexity in CDX2 regulation by an effective autoregulatory loop which may have a major impact on the stability of human IM, possibly resulting in the inevitable progression of the gastric carcinogenesis pathway.

The bracken fern Pteridium aquilinum is a plant known to be carcinogenic to animals. Epidemiological studies have shown an association between bracken fern exposure and gastric cancer development in humans. The biological effects of exposure to this plant within the gastric carcinogenesis process are not fully understood. In the present work, effects in the gastric mucosa of mice treated with Pteridium aquilinum were evaluated, as well as molecular mechanisms underlying the synergistic role with Helicobacter pylori infection. Our results showed that exposure to Pteridium aquilinum induces histomorphological modifications including increased expression of acidic glycoconjugates in the gastric mucosa. The transcriptome analysis of gastric mucosa showed that upon exposure to Pteridium aquilinum several glycosyltransferase genes were differently expressed, including Galntl4, C1galt1 and St3gal2, that are mainly involved in the biosynthesis of simple mucin-type carbohydrate antigens. Concomitant treatment with Pteridium aquilinum and infection with Helicobacter pylori also resulted in differently expressed glycosyltransferase genes underlying the biosynthesis of terminal sialylated Lewis antigens, including Sialyl-Lewis x . These results disclose the molecular basis for the altered pattern of glycan structures observed in the mice gastric mucosa. The gene transcription alterations and the induced glycophenotypic changes observed in the gastric mucosa contribute for the understanding of the molecular mechanisms underlying the role of Pteridium aquilinum in the gastric carcinogenesis process.

A retrospective review of endoscopic gastric antral biopsies in children was conducted in sequential specimens at Newark Beth Israel Medical Center. Hematoxylin-and-eosin and Whartin-Starry modified stain (paraffin-embedded tissue) were done in 95 pediatric specimens and 188 adult gastric biopsies. Cases were evaluated for the presence of chronic active inflammaton (CAI), chronic inflammation without activity (Cl), or no inflammation (NI} to determine the age distribution in the pediatric population and for the presence and age distribution of Helicobacter pylori-like organisms in these biopsies. In children, 76.8% had inflammation (CAI in 26. 3%; CI in 50,5%; NI in 23.2%) and 20% had H pylori-like organisms (44% in CAI; 14.6% of Cl; 4.5% of NI). The age distribution of H pylori was 6.2% in children under age 5 and 23% in those 5 years or older. The age distribution of CAI was similar for both age groups (25% vs. 27.5%). A comparative group of 188 adult biopsies showed CAI in 58.8%; CI in 32.9%; and NI in 8.5%, with H pylori in 45.7% {62,7% CAI}. frequency of H pylori in adults increased from 25% to 49.9% after age 30. In conclusion, a high incidence of CAI-associated with H pylori was observed in children older than age :5. Detection of H pylori increased 3.7-fold after age 5. Younger adults have a similar frequency of H pylori than older children, increasing twofold after age 30. The epidemiology of H pylori-associated chronic active gastritis may be age dependent. The pathologic significance of detecting H pylori in symptomatic patients with no gastric antral inflammation remains unclear.

Aims-To identify distinguishing and gen- eral histological features related to the use of non-steroidal anti-inflammatory drugs (NSAID). Methods-Slides from gastric antral bi- opsies of 50 patients with osteoarthritis taking NSAID were compared with slides from antral biopsies of 50 control cases matched for age, sex, and race. Semithin sections stained with toluidine blue were used. Results-Chronic gastritis was seen in 76% of the patients taking NSAID and in 58% of the control cases; active inflammation was detected in 10% of the NSAID treated patients and in 24% of the control cases, and it appeared closely related with Hel- icobacter pylori infection. Some histo- logical features common to all slides of patients taking NSAID were recognised. These consisted of focal erosions of the gastric epithelium and macroerosions, and they seemed to represent successive steps of a process of "desquamation". Conclusions-Some distinguishing mor- phological aspects appeared prominent; it is suggested that these may be related to the pathogenesis of NSAID linked peptic ulceration. On the other hand, epithelial damage due to NSAID appears very different from that due to Helicobacter pyloni, another important factor involved in the aetiopathogenesis of peptic disease.

Introduction. Helicobacter pylori infection mostly associated with gastrointestinal disease such as gastritis, peptic ulcer, duodenal ulcer, and gastric adenocarcinoma. Route of transmission of H. pylori are not fully understood, but human-to-human transmission via oral-oral or fecal-oral route is considered the most likely route. Prevalence of this bacterial infection also varies between countries, Indonesia itself has a fairly low prevalence of H. pylori infection at rate of 22.1%. This study aims to determine the prevalence and risk factors of H. pylori infection among Batak ethnicity in Samosir Island. Method. A cross-sectional study was conducted from March-May 2021 to determine the prevalence and risk factors of H. pylori infections in Samosir Island through stool antigen test (SAT) examination. Results. A total of 100 patients reside in Boho Village, Samosir Island enrolled in this study. All of the subjects were tested for H. pylori infection with SAT. The study also collected data using the questionnaire method, and obtained data on age, gender, occupation, education level, history of smoking and alcohol consumption, nutritional status, and also H. pylori diagnostic test results. Conclusion. Prevalence of H. pylori infection in Samosir Island based on SAT is 18% with the risk factors that are significantly associated with environmental sanitation (p=0.001) and personal hygiene (p=0.004).

The aim of the study was to determine the place and role of serologic methods in detecting Helicobacter pylori (H. pylori) infection, on the basis of estimated enzyme-linked immunosorbent assay (ELISA) and complement fixation test (CFT) sensitivity and specificity. A total of 549 patients were included in the study. ELISA and CFT as serologic methods were compared with invasive methods (rapid urease test--CLO test, culture, histology). The sensitivity of serologic methods was above 90%, and their specificity was around 80%. Study results confirmed the value, reliability and usefulness of serologic methods in the detection of H. pylori infection.

Peptic ulcers generally appear in the stomach and the first segment of the duodenum as a result of mucosal erosion caused by pepsin and gastric acid secretion, with up to 70% of these occurring amongst patients aged 25-64. Currently, endoscopic procedures combined with proton pump inhibitors are considered the gold standard for managing complicated peptic ulcers, leaving surgical management as an option for endoscopic management failure or in scenarios such as incoercible bleeding, perforation, penetration and intestinal occlusion. Penetration of a gastric ulcer to adjacent organs is a rare complication; penetration to the liver and endoscopic diagnosis is even rarer. We have presented the case of a 54 year old diabetic male, who presented to the emergency room with upper gastrointestinal bleeding due to a chronic duodenal ulcer, with haemodynamic instability, requiring surgical management, revealing penetration to the liver with rupture of the right hepatic artery. The patient succ...

The immune response to Helicobacter pylori involves a mixed T helper-1, T helper-2, and T helper-17 response. It has been suggested that T helper cells contribute to the gastric inflammatory response during infection, and that T helper 1 (Th1) and T helper 17 (Th17) subsets may be required for control of H. pylori colonization in the stomach. The relative contributions of these subsets to gastritis and control of infection are still under investigation. IL-23 plays a role in stabilizing and expandingTh17 cell cytokine expression. Expression of IL-23, which is induced in dendritic cells and macrophages following co-culture with H. pylori, has also been reported to increase during H. pylori infection in humans and animal models. To investigate the role of IL-23 in H. pylori, we infected IL-23p19 deficient mice (IL-23-/-) and wild-type littermates with H. pylori strain SS1. At various time points post-infection, we assessed colonization, gastric inflammation, and cytokine profiles in the gastric tissue. Specifically, H. pylori -infected IL-23-/-mice have higher levels of H. pylori in their stomachs, significantly less chronic gastritis, and reduced expression of IL-17 and IFNγ compared to H. pylori -infected wild-type mice. While many of these differences were significant, the H. pylori infected IL-23-/-had mild increases in our measurements of disease severity. Our results indicate that IL-23 plays a role in the activation of the immune response and induction of gastritis in response to H. pylori by contributing to the control of infection and severity of gastritis.

The study aimed to detect the presence of Helicobacter pylori infection in children using two investigative methods: the rapid urease test and histological methods. It also examined the relationship between socioeconomic status and Helicobacter pylori infection.

Helicobacter pylori infection is invariably related to inflammation and has been linked to benign, premalignant, and malignant lesions of the digestive system, including chronic active gastritis, peptic ulcers, atrophic gastritis, intestinal metaplasia, gastric adenocarcinomas and lymphomas of mucosa-associated lymphoid tissue1. Humans are the primary reservoir and the most common modes of transmission are oral-oral and fecal-oral. Most infections are acquired early in life probably through close contacts with parents, especially the mother and from other children2. In developing countries, the transmission via contaminated food or water might be a significant mechanism of primary infection in children and of reinfection among adults3. Differences among various populations and among ethnic groups are likely related to differences in cultural practices as they relate to hygiene and sanitation4. Abstract – Objectives: Previous studies demonstrated a high prevalence of Helicobacter pyl...

Stomach cancer is a common public health problem in South East Asia including Bhutan. Chronic infection with Helicobacter pylori is regarded as the principal cause of stomach cancer. Herein, we present the incidence of stomach cancer in Bhutan for eight years (from 2014 to 2021). We also discuss the steps taken for the prevention and early detection of stomach cancer.

The extraction of bioactive compounds from plant materials plays a critical role in maximizing their therapeutic efficacy and commercial application. In this study, we investigated the extraction efficiencies of Aonla fruit and cinnamon bark using two solvent systems: distilled water and 80% ethanol, under maceration conditions. The results demonstrated that hydro-ethanol significantly enhanced extraction yields, achieving 25.10 ± 0.90% for Aonla fruit and 29.70 ± 0.30% for cinnamon bark. HR-LCMS (High Resolution-Liquid Chromatography Mass Spectrometry) analysis revealed the presence of functional phytochemicals in extracts, including gallic acid, quercetin, catechin, and ascorbic acid; cinnamaldehyde, cinnamic acid, and ellagic acid. Herein, we explore the underlying physicochemical factors driving this enhanced performance of hydro-ethanol, including optimal solvent polarity, improved cell-wall penetration, superior compound solubility, and accelerated extraction kinetics. By unlocking the potential of post-harvest resources for functional food and nutraceutical applications.

Background: Helicobacter pylori (H. pylori) is a widespread bacterium that causes serious gastrointestinal diseases, including peptic ulcer disease and gastric cancer, particularly in low- and middle-income countries. Although standard triple therapy (PPI + clarithromycin + amoxicillin/metronidazole) was once the standard treatment, rising antibiotic resistance has reduced its effectiveness, leading to the increased use of bismuth-based quadruple therapy, which offers better eradication outcomes. Cost-effectiveness analysis (CEA) is needed to assess both clinical outcomes and economic implications of these regimens, particularly in areas with high H. pylori prevalence.
Methods: A search of MEDLINE, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, was carried out.
Results: five RCTs (N = 1,169) were included. Although dosing regimens of clarithromycin triple therapy were quite consistent between trials, dosing regimens varied considerably for bismuth quadruple therapy. Bismuth quadruple therapy achieved eradication in 82.74% of patients, whereas clarithromycin triple therapy achieved an eradication rate of 77.54%. There was moderate heterogeneity and no evidence for significant publication bias. Subgroup analyses by study location, treatment duration, and study population did not account for the heterogeneity. There were no statistically significant differences in side effects yielded by quadruple vs. clarithromycin triple therapy
Conclusion: Quadruple and triple therapies yielded similar eradication rates as primary therapy for H. pylori infection. Both therapies yielded suboptimal eradication rates. Patient compliance and side effects are similar for quadruple and triple therapies.
Keywords: Helicobacter pylori; bismuth quadruple therapy; triple therapy; first-line treatment

Objective Tranexamic acid (TXA) is an antifibrinolytic agent used to control bleeding in different circumstances. We conducted a randomized controlled trial to assess the efficacy and safety of locally administered TXA in upper gastrointestinal hemorrhage. Methods This single-center, double-blind, randomized controlled trial was performed in a tertiary emergency department (ED) in patients presenting with upper gastrointestinal bleeding symptoms between 2016 and 2018. The patients received either 2000 mg of 5% TXA in 100 mL of isotonic saline solution or 100 mL isotonic saline (control group) via the nasogastric route. As a composite outcome, recurrent endoscopy need, rebleeding, surgery need, recurrent admission to the ED, and mortality parameters were evaluated at the end of a one-month period. Results During the study period, 78 patients were randomized into the TXA group, and 79 patients were randomized into the isotonic saline group. The majority of the bleedings (61%) were in ...

Helicobacter pylori infection of a distinct subtype of cagA may lead to different pathological manifestation. The aim of this study is to determine the presence of cagA gene and its variants in H. pylori infection among different ethnic groups and its effect on gastroduodenal diseases. Overall detection of cagA among the 205 clinical isolates of H. pylori was 94%. Variations in size of the 3 0 region of cagA gene were examined among 192 Malaysian H. pylori cagA-positive strains. Results showed that three cagA variants differing in fragment length of PCR products were detected and designated as type A (621-651 bp), type B (732-735 bp) and type C (525 bp). Although there was no association between any of the cagA subtypes with peptic ulcer disease (p > 0.05), an association between cagA subtypes with a specific ethnic group was observed. Specific-cagA subtype A strains were predominantly isolated from Chinese compared to Malays and Indians (p < 0.0005), and cagA subtype B strains were predominantly isolated from Malays and Indians compared to Chinese (p < 0.05). The cagA type A strains of H. pylori is commonly found in the Chinese patients who have a higher risk of peptic ulcer disease, thus indicating that it could be used as an important clinical biomarker for a more severe infection.

Helicobacter pylori infection in man is associated with chronic gastritis and peptic ulcer disease. The virulence factors of the species are still under investigation. Among these, the lipopolysaccharide (LPS) is a potential pathogenic factor of the micro-organism, whose biological activity can be estimated by immunological parameters. The aim of this study was to determine the ability of pure LPS extracted from clinical isolates of H. pylori to induce mitogenicity, secretion of tumour necrosis factor-alpha (TNF-alpha), and spleen growth in a murine model. Rough and smooth LPS from Salmonella typhimurium were used as controls. The results showed that, like the control LPS, all extracts of LPS induced mitogenic activity, stimulated synthesis of TNF-alpha and induced spleen growth, although the effects produced by the majority of the H. pylori LPS samples analysed were less intensive than those produced by the S. typhimurium LPS. The immunological parameters analysed allowed the detec...

Objective: To determine the incidence of H. pylori recurrent infection after successful eradication in 4-year follow-up study, and to evaluate the influencing factors for re-infection. Material and Method: Thirty-seven patients (age range 20-74 years; average 49.06 + 14.03 years) were recruited of which 64.9% were females. The H. pylori infection was proved to be successfully eradicated in all patients. Annually, urea breath test (UBT) was assessed to determine H. pylori status after eradication. Age, sex, eating habit, water drinking, number of children, and treatment regimens against H. pylori were recorded. A breath test was also performed on the patient's spouse. Results: The H. pylori recurrence occurred in 5/37 (13.51%) of patients observed. There were two patients in the first year, one patient each in the second, third, and fourth year. The cumulative re-infection rate was 5.41% at 1-year, 8.11% at 2-year, 10.81% at 3-year, and 13.51% at 4-year. H. pylori infection of spouse was also frequent (80%). Even if the spouse was infected, 88.89% of patients will remain uninfected after 4-years of H. pylori eradication. No influencing factor for infection recurrence was detected. Conclusions: The risk of re-infection after H. pylori eradication was low in Thai patients after 4-year follow up. Annual re-infection rate was 3.38%. No dependent factors were associated with a recurrence.

Background and aim: Obeticholic acid (OCA), a selective and potent farnesoid X receptor (FXR) agonist, produced significant liver biochemistry improvements, including alkaline phosphatase (ALP) and total bilirubin (bili) in 3 randomized, double-blind (DB) placebo (PBO)-controlled trials in primary biliary cirrhosis (PBC). This pooled analysis from the 3 trials evaluates efficacy of OCA across a range of disease severity based on baseline (BL) ALP tertile and total bili. (≤ULN/>ULN). Material and methods: Key inclusion criteria: ALP 1.5 to 10x ULN and conjugated bili ≤2x ULN for the two 3 month trials and ALP ≥1.67x ULN or total bili >ULN but <2x ULN for the 12 month trial. Data were pooled based on end of DB treatment (EOT). Treatment arms were PBO (n=134) and ≤OCA 10 mg (n=201). Endpoints were LS mean (SE) change from BL to EOT for ALP and percent of patients achieving a composite endpoint (ALP <1.67 ULN, total bili ≤ULN and ALP decrease ≥15%), shown to be correlated with long-term survival in PBC. Safety and tolerability by disease severity were also assessed. Results: Significant differences for OCA compared with PBO for both efficacy endpoints were achieved irrespective of PBC disease severity. The magnitude of ALP reduction was proportional to ALP tertile suggesting improved response even in more advanced patients (Figure). The percentage of OCA patients achieving the composite endpoint was inversely proportional to BL tertile (68% low, 54% mid, and 19% upper) and total bili (49%≤ULN, 17%>ULN). Similar results were observed when subgroups were analyzed by OCA monotherapy or OCA plus UDCA. Pruritus was the most common adverse event. The incidence of pruritus for OCA ≤10 mg was similar for the low and mid tertiles and slightly higher in patients with more severe disease. Conclusions: These data demonstrate efficacy of OCA across a range of PBC severity and confirm ALP and total bili both as continuous and categorical variables predictive of clinical outcomes. This integrated analysis demonstrates robust response with OCA irrespective of BL ALP or total bili. Across the ranges of disease severity, OCA was safe and well-tolerated. These data are clinically relevant given that PBC is a chronic and progressive disease, and demonstrate that even in patients with more advanced disease, OCA improves parameters shown to correlate with improved clinical outcomes and reduced risk.

Immunohistochemistry allowed recent recognition of a distinct focal gastritis in Crohn&#39;s disease. Following reports of lymphocytic colitis and small bowel enteropathy in children with regressive autism, we aimed to see whether similar changes were seen in the stomach. We thus studied gastric antral biopsies in 25 affected children, in comparison to 10 with Crohn&#39;s disease, 10 with Helicobacter pylori infection, and 10 histologically normal controls. All autistic, Crohn&#39;s, and normal patients were H. pylori negative. Snap-frozen antral biopsies were stained for CD3, CD4, CD8, gammadelta T cells, HLA-DR, IgG, heparan sulphate proteoglycan, IgM, IgA, and C1q. Cell proliferation was assessed with Ki67. Distinct patterns of gastritis were seen in the disease states: diffuse, predominantly CD4+ infiltration in H. pylori, and focal-enhanced gastritis in Crohn&#39;s disease and autism, the latter distinguished by striking dominance of CD8+ cells, together with increased intraepi...

Background: This study aimed to characterise epithelial cell adhesion molecule (EpCAM) expression patterns in colorectal carcinomas (CRC) from Nigerian patients, its association with E-cadherin and tumour characteristics, to forecast patient selection for anti-EpCAM therapy among whom no data existed previously. Methods: Tissue microarray blocks of formalin-fixed and paraffin-embedded CRC tissues, with their non-cancer margins of resection, were sectioned and stained with EpCAM and E-cadherin primary antibodies. Scoring for antibody staining was done semiquantitatively by combining staining proportion and intensity. The outcome was correlated with patient age, gender and tumour histological parameters with p ≤ 0.05 regarded as statistically significant. Results: Sixty-three carcinoma tissues had staining status for the two markers and were included in this study. Of these, 36 (57.1%) showed positive EpCAM expression (immunoscore ≥3) out of which 83% (30/36 positive cases) were overexpressed (combined immunoscore ≥4) while 12 (19%) tissues were positive for E-cadherin. Non-tumour margins of resection tissues showed less EpCAM positivity in 24% (6/25) of histospots. The difference in staining between tumour and non-tumour margin tissues with EpCAM was significant (p < 0.001). Also, EpCAM overexpression was significantly associated with reduced E-cadherin (p < 0.035) expression in tumour cells. Tumour extent within the gut wall was equal (50% each) for early and late pT stages among EpCAM overexpressing tumours but two-thirds (8/12) of cases expressing E-cadherin had later pT stage paradoxically, while distant metastasis was negligible among tumours bearing both markers. Also, tumours overexpressing EpCAM had significant association with tumour-associated lymphocytes (p < 0.02 each). CRC in this study preferentially overexpress EpCAM over E-cadherin whose strong cell-cell contact inhibitory role is weakened even when expressed, resulting in further local tumour spread. This, and the observed immune response, supports targeted therapy among eligible patients.

Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. This cross-sectional study was conducted among the patients presenting in the outdoor department of different hospitals. Name, age, gender, presence of oral ulcers and their severity were noted on a predefined proforma. All the data was entered and analyzed with SPSS Ver. 23.0. A total of 80 patients presenting in the outdoor department were included in this study i.e., 40 males (50%) and 40 females (50%). The mean age of the patients was 31.23±5.23 years. Out of these patients, eleven patients presented with oral ulcers, mild to moderate in nature. Further workup was advised accordingly.

Objective: To find the frequency of H pylori infection among the patients of gastroesophgeal reflex disease. Study design: Descriptive study. Setting: Department of Medicine, Unit-I, Services Hospital, Lahore. Subject & method: One hundred patients with gastroesophageal reflux disease (GERD) were included in this study. For detection and confirmation of helicobacter pylori, endoscopy with antral biopsy was done. Specimens were sent for histopathology, and rapid urease test was performed. Main outcome measures: Frequency of H pylori infection, frequency of regurgitation, dysphagia, nausea, vomiting and haemetemesis. Results: 100 patients who fulfilled the inclusion criteria were taken. There were 65 males and 35 females respectively. Their age ranged from 18 to 48 years. 39 (39%) patients were between 29-38 years while 23 (23%) were of 39-48 years. There were 38 (38%) patients between 18-28 years. The mean age of the patients was 31.79±7.56. 40 (40%) were found to be H. pylori positi...

Introducción: la detección de antígeno en heces se ha considerado una prueba prometedora para el diagnóstico de la infección por Helicobacter pylori. Para su introducción en la práctica médica, es un requisito indispensable demostrar el desempeño adecuado del método en la población de estudio. Objetivo: evaluar la capacidad diagnóstica de los sistemas comerciales ELISA SD y SD BIOLINE, del fabricante Standard Diagnostics, Corea, en pacientes cubanos con síntomas gastroduodenales. Métodos: se evaluaron 101 muestras de heces de pacientes previamente clasificados como H. pylori positivos y negativos por las pruebas de referencia de histología y prueba rápida de la ureasa. Se calcularon los parámetros de desempeño de ambos sistemas diagnósticos por el programa EPIDAT 3.1. Resultados: la sensibilidad para los sistemas ELISA SD y SD BIOLINE fue de 85,25 % y 75,41 %, respectivamente. La especificidad para ambos fue de 92,50 %. Los valores predictivos positivos y negativos, los índices de validez y de Youden y la confiabilidad diagnóstica de ambas pruebas fueron satisfactorios. Conclusiones: Los sistemas evaluados exhibieron un desempeño comparable con la histología y la prueba rápida de ureasa para la detección activa de la infección por H. pylori, lo que demuestra su utilidad para el diagnóstico y el manejo oportuno del paciente, sin la necesidad de emplear pruebas invasivas.

Introduction: Helicobacter pylori is an important medical pathogen present in more than half of the world's population. Various treatment regimen are in use for the eradication of H. pylori, but due to the emergence of antibiotic resistance, its management is a big issue for clinicians. Methods: In this study all suspected cases that had visited District Headquarters Hospital Kohat were considered for screening of H. pylori infections. Preliminary information about their age, gender, general health conditions, occupation, etc. was taken for consideration. After recording initial signs and symptoms, samples were considered for H. pylori detection using stool antigen test and endoscopy. Fourteen-day proton pump inhibitor base triple and quadruple therapy were administered to each patient. Results: In total (n = 178), there were high numbers of positivity in patients aged below 30 years (82; 46.06%), most of whom belonged to rural areas. Conclusion: This study concludes that there were high numbers of positive patients aged below 30 years, and according to this study MEL (Metronidazole + Esomeprazole + Levofloxacin) is the most effective treatment regimen for the eradication of H. pylori.

Candida bezoars of the stomach usually occur after gastric surgery. We report a small Candida mass occurring on a non-healing gastric ulcer in a 40-year-old male non-smoker. The ulcer healed with fluconazole and withdrawal of the proton pump inhibitor.

Objective: The relationship between Hepatitis Delta infection and Helicobacter infection in patients with non-cirrhotic hepatitis B infection was retrospectively investigated. Material and Methods: Stool samples of 117 patients included with Delta hepatitis infection in the study At total 36 of them were tested for H. Pylori infection. To detect  H. Pylori, stool samples were tested using a commercial stool H. Pylori antigen assay. Results: Of these, 13 (19%) patients had H. Pylori seropositivity in the Hepatitis B infection group and 23 (48%) patients tested positive for H. Pylori infection in hepatitis delta infection group. There was a statistically significant difference between groups regarding H. Pylori seropositivity by the faecal test (p= 0.001). Conclusion: This study provides new knowledge on H. Pylori infection and reflects the need for evidence-based and comorbid dieases-oriented guidelines in the field of gastroenterology.

Background: Chronic Abdominal Pain (CAP) is common in children/adolescents, and Dyspepsia is a symptom complex. Their investigation represents a significant burden and a great deal regarding the initial work-up. Consequently, scoring based on clinical symptoms and patients&#39; characteristics comparing organic and functional Dyspepsia would be valuable in assessing CAP. Objective: To develop and validate a dyspepsia symptoms questionnaire to identify patients with Dyspepsia and discriminate between functional and organic subtypes. Methods: A single-centre, observational, prospective cohort study in a convenience sample of consecutive cases of children/adolescents for CAP. Inclusion criteria: age of 5- 17 years; CAP according to Apley and von Baeyer & Walker criteria; uninvestigated Dyspepsia. Exclusion criteria: genetic, neurological and mental disorders, history of gastrointestinal surgery, active gastrointestinal bleeding, and inflammatory bowel disease. The Questionnaire was dev...

Background: Helicobacter pylori (H. pylori) colonizes the gastric mucosa, leading to chronic inflammation. Epidemiological studies have demonstrated that H. pylori infection is high in areas with a high prevalence of anaemia. Consequently, patients infected with H. pylori are at a higher risk of anaemia. However, the relationship between H. pylori and anaemia remains controversial. Therefore, a study conducted among children with chronic abdominal pain with organic dyspepsia (chronic gastritis due to H. pylori and (or?) Esophagitis), and a functional disorder (Irritable Bowel Syndrome), will be appropriate. Objective: Compare the prevalence of Anaemia in children and adolescents with chronic abdominal pain, divided into: 1) Non-ulcer dyspepsia associated with H. pylori gastritis., 2) Dyspepsia associated with chronic Esophagitis, and Irritable Bowel Syndrome. Methods: The study was a single-centre, observational retrospective cohort. Inclusion and Exclusion Criteria. All children mu...