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

Objective. To analyse factors predicting changes in dyspeptic symptoms after Helicobacter pylori eradication. Material and methods. Of a total of 342 patients referred for upper gastrointestinal endoscopy at 23 centres in various parts of Finland, those tested positive for the rapid urease test were recruited in the study. Clinical and demographic data and data on dyspeptic symptoms (Gastrointestinal Symptoms Rating Scale) were collected via a structured questionnaire before and a year after the eradication therapy. Gastric biopsies were analysed according to the updated Sydney system. Results. A total of 216 H. pylori-positive patients treated successfully with eradication therapy had complete data to be analysed. After the therapy, dyspeptic symptoms decreased by 29–32%. In a univariate analysis, it was found that duodenal ulcer, female gender, gastric antral neutrophilic inflammation, smoking and age from 50 to 59 years enhanced symptom improvement whereas atrophy in the gastric body reduced it. In a multivariate analysis, duodenal ulcer (odds ratio (OR) 3.2, 95% CI 1.3–7.8) and age from 50 to 59 years (OR 2.2; 95% CI 1.2–3.9) and antral neutrophilic inflammation (OR 1.9, 95% CI 1.1–3.3) were better predictors of symptomatic response. Conclusion. The symptomatic benefit from H. pylori eradication therapy was greatest among duodenal ulcer patients.     

Impact of Non-steroidal Anti-inflammatory Drug and Aspirin Use on the Prevalence of Dyspepsia and Uncomplicated Peptic Ulcer Disease

Background: Non-steroidal anti-inflammatory drug and aspirin (here collectively called NSAIDs) use is the second most common aetiologic factor for peptic ulcer disease and a major factor for peptic ulcer complications. The role of NSAIDs in the pathogenesis of uncomplicated peptic ulcer is less well understood and the interaction between NSAIDs and Helicobacter pylori infection on ulcer development is controversial. The aim of the present study was to examine the role of NSAIDs in the occurrence and clinical features of uncomplicated peptic ulcer disease. Methods: A total of 1091 consecutive patients referred for open-access upper gastrointestinal endoscopy by general practitioners (GPs) were enrolled. The use of NSAIDs was gathered from a structured questionnaire completed by the patients and from patient files by GPs. The exclusion criteria were previous H. pylori eradication and gastric surgery, as well as symptoms and/or signs suggestive of acute gastrointestinal bleeding. Results: Of the whole study group (n = 1091), 76 (7%) patients had a peptic ulcer. Thirty patients had an NSAID-use-associated peptic ulcer and 46 patients a non-NSAID-use peptic ulcer. Of patients with chronic gastritis (n = 599), 71% were H. pylori-positive and 108 used NSAIDs. Of those with chronic gastritis, 23 had an NSAID-use-associated peptic ulcer and 38 a non-NSAID ulcer. Of patients with normal gastric histology (n = 492), 75 patients used NSAIDs, 7 had an NSAID ulcer and 8 a non-NSAID ulcer. The only independent risk factor for peptic ulcer in patients using NSAIDs was H. pylori infection (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.3-7.3), whereas dyspepsia (OR 1.0, 95% CI 0.4-2.4), male sex (OR 1.4, 95% CI 0.6-3.4), age (OR 1.0 per decade, 95% CI 0.8-1.3) and anaemia (OR 2.9, 95% CI 0.9-8.7) were not risk factors. In patients not using NSAIDs, independent risk factors for peptic ulcer were dyspepsia (OR 4.3, 95% CI 2.1-8.8), male sex (OR 2.0, 95% CI 1.1-2.8), age (OR 1.2 per decade, 95% CI 1.0-1.5), anaemia (OR 6.2, 95% CI 2.6-14.9) and H. pylori infection (OR 7.5, 95% CI 3.4-16.6). When comparing patients using NSAIDs or not, the OR of patients on NSAIDs for peptic ulcer was 2.7 (95% CI 1.5-5.0) among patients with chronic H. pylori gastritis (n = 424) and 5.3 (95% CI 1.8-15.0) among patients with normal gastric mucosa (n = 492). Conclusions: The use of NSAIDs increases the risk of peptic ulcer 3- and 5-fold in H. pylori-positive and H. pylori-negative patients, respectively. Dyspepsia is a poor predictor of peptic ulcer among patients using NSAIDs, and serologic H. pylori testing and treatment for chronic NSAID users is recommended.     

Kinship,dispersal and hantavirus transmission in bank and common voles

Hantaviruses are among the main emerging infectious agents in Europe. Their mode of transmission in natura is still not well known. In particular, social features and behaviours could be crucial for understanding the persistence and the spread of hantaviruses in rodent populations. Here, we investigated the importance of kinclustering and dispersal in hantavirus transmission by combining a fine-scale spatiotemporal survey (4 km²) and a population genetics approach. Two specific host-hantavirus systems were identified and monitored: the bank vole Myodes, earlier Clethrionomys glareolus––Puumala virus and the common vole Microtus arvalis—Tula virus. Sex, age and landscape characteristics significantly influenced the spatial distribution of infections in voles. The absence of temporal stability in the spatial distributions of viruses suggested that dispersal is likely to play a role in virus propagation. Analysing vole kinship from microsatellite markers, we found that infected voles were more closely related to each other than non-infected ones. Winter kin-clustering, shared colonies within matrilineages or delayed dispersal could explain this pattern. These two last results hold, whatever the host-hantavirus system considered. This supports the roles of relatedness and dispersal as general features for hantavirus transmission. N. Charbonnel and J.-F. Cosson have contributed equally.     

Reducing carcinogenic acetaldehyde exposure in the achlorhydric stomach with cysteine

Background: Acetaldehyde, associated with alcohol consumption, has recently been classified as a group 1 carcinogen in humans. Achlorhydric atrophic gastritis is a well‐known risk factor for gastric cancer. Achlorhydria leads to microbial colonization of the stomach. Several of these microbes are able to produce significant amounts of acetaldehyde by oxidation from alcohol. Acetaldehyde can be eliminated from saliva after alcohol intake and during smoking with a semi‐essential amino acid, l‐ cysteine. The aim of this study was to determine whether cysteine can be used to bind acetaldehyde in the achlorhydric stomach after ethanol ingestion. Methods: Seven volunteers with achlorhydric atrophic gastritis were given either slow‐release l‐ cysteine or placebo capsules in a double‐blinded randomized trial. Volunteers served as their own controls. A naso‐gastric tube was inserted to each volunteer. The volunteers ingested placebo or 200 mg of l‐ cysteine capsules, and ethanol 0.3 g/kg body weight (15 vol%) was infused intragastrically through a naso‐gastric tube. Five‐milliliter samples of gastric contents were aspirated at 5‐minute intervals. Results: During the follow‐up period, the mean acetaldehyde level of gastric juice was 2.6 times higher with placebo than with l‐ cysteine (13 vs. 4.7 μM, p < 0.05, n = 7). Conclusions: l‐ cysteine can be used to decrease acetaldehyde concentration in the achlorhydric stomach during alcohol exposure. Intervention studies with l‐ cysteine are needed on reducing acetaldehyde exposure in this important risk group for gastric cancer.     

Association of serum 25-hydroxyvitamin D with the risk of death in a general older population in Finland

Purpose  

To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] concentration, a marker of vitamin D status, and risk of all-cause and cardiovascular mortality in a general older population with relatively low average serum 25(OH)D concentrations.