Helicobacter pylori Infection in Estonian Population: Is It a Health Problem?

The role of Helicobacter pylori infection In traditionally noncommunicable diseases as chronic gastritis, peptic ulcer and gastric carcinoma became more evident during the first decade of H. pylori studies. To analyse and evaluate the prevalence of H. pylori infection in Estonia as a population health problem, the data of three randomly selected samples of Estonian population aged over 15 years were used. The infection rate assessments in two representative samples of the population (Kambja 157 persons and Kuressaare 224 persons) were based on H. pylori colonization in the gastric mucosa, and in one sample (Karksi-Nula 1467 persons) on seroconversion of H. pylori IgG antibodies. The persons studied were divided into groups according to birth cohorts. The population studies in Estonia showed a high prevalence of H. pylori infection among Estonians: 73% in the Kuressaare sample, 78% in the Kambja sample, and 87% in the Karksi-Nuia sample. From the Kuressaare population sample 38 families with 290 persons were included in a family H. pylori infection study and 92.5% of the persons in these families were found to be H. pylori positive. H. pylori infection was frequent in persons who were born at the beginning of this century as well as in those born after World War II up to 30 years ago. It was concluded that H. pylori infection is common in Estonia, both in random persons and their families. It is probable that the infection rate of H. pylori depends to a great extent on the socioeconomic conditions of this country and that acquisition of H. pylori in Estonia starts at an early age.     

What Are the Specific Features of Helicobacter pylori Gastritis in Children?

Children with recurrent abdominal pain and dyspeptic symptoms often present histological gastritis and Helicobacter pylori infection. No specific symptomatology has been found, however, to discriminate H. pylori positive from negative subjects. Certain differences exist in gastritis in paediatric age groups, in comparison with adults. In terms of treatment, children also form a special entity because of the long exposure time of H. pylori infection. This article describes the typical findings of H. pylori gastritis in children and discusses their significance from a clinical point of view.     

Helicobacter pylori: what schemes of eradication are essential today?

Current approaches to treatment of Helicobacter pylori infection, basic international recommendations, problems of growing H. pylori resistance to antibiotics are reviewed. Much attention is given to prospects of new eradication schemes, for example combinations based on bismuth tripotassium dicitrate and successive treatment schedules.     

Helicobacter pylori: aggressor or innocent bystander?

Helicobacter pylori seeks gastric mucosa, whether found in the stomach, duodenum, or Barrett's esophagus. Definitive diagnosis can be secured by appropriate stains of mucosal biopsies and culture, but the rapid urease test, breath isotope studies, and serologic testing are also useful. The frequency of colonization increases with advancing age, but infection occurs earlier in underdeveloped countries. Although the reservoir is uncertain, water or food transmission seems likely. There is sufficient evidence to assign an etiologic role to the bacteria in the causation of type B antral gastritis. H. pylori is found in areas of gastric metaplasia within the duodenum and is associated with duodenitis. Although acute infection leads to hypochlorhydria, chronic colonization has little effect on acid secretion. Studies have thus far failed to establish a convincing relationship between H. pylori and nonulcer dyspepsia, although the bacteria may play a role in selected patients. H. pylori is found in association with most idiopathic gastric and duodenal ulcers, but it is unclear as to whether the bacteria plays a causative or permissive role. The organism has a predilection for intercellular spaces and the mucous layer, thus affording relative isolation from luminally active antibiotics. Monotherapy with bismuth preparations transiently eliminates the bacteria, but recolonization is rapid, probably due to regrowth of sequestered organisms. A combination of metronidazole, bismuth, and tetracycline (or amoxicillin) affords the best eradication rate, but the potential side effects of this program should be considered. The present therapy of duodenal ulcer disease is effective and without significant risk. Treatment of H. pylori should be reserved for those patients who relapse on adequate maintenance therapy. If a safe and effective antibiotic becomes available, more frequent testing and earlier treatment intervention may become more attractive. H. pylori is probably an "innocent bystander" for most patients, but the bacteria may sufficiently impair the defenses of the antral and duodenal mucosa to facilitate the development and relapse of ulcer disease in subsets of patients.     

Detection of Helicobacter pylori infection: when to perform which test?

This paper reviews current diagnostic techniques for Helicobacter pylori infection and critically questions their value under different diagnostic circumstances. As long as we do not have general treatment recommendations for H. pylori infection, endoscopy is still the basis for primary diagnosis because it assesses therapy indications. In addition, histology characterizes the gastroduodenal lesions observed and may reveal malignant diseases. New rapid urease tests from the biopsies are inexpensive, simple, and quick giving results reliably within 1 h. Culturing H. pylori from gastric samples after therapy failure and testing the strains for antimicrobial susceptibility is becoming increasingly important with higher prevalence of drug resistances. Nonendoscopic tests are more convenient to the patient. Serological tests inexpensively detect circulating IgG or IgA antibodies. However, inspite of the cost attractiveness, serology might be problematic in indicating present H. pylori infection. The tests of choice for noninvasive monitoring therapy success or failure are the 13C-urea breath test and the faecal antigen immunoassay. Both tests are also of value for first diagnosis in children when endoscopy is not indicated. In the future, serological detection of virulence factors and polymerase chain reaction with molecular fingerprinting might help to identify H. pylori strains with high pathogenicity or antibiotic resistance.     

Serum pepsinogen C: A useful marker of Helicobacter pylori eradication?

Medical treatment for Helicobacter pylori (Hp) infection is now recommended in several types of gastroduodenal disease, and its success is usually monitored by hystology. The end-points of our work were to identify the most suitable serum index of Hp eradication among pepsinogen A (PGA), pepsinogen C (PGC), PGA/PGC ratio, gastrin, and IgG anti-Hp (IGG). We studied a total of 289 Hp positive (Giemsa staining) patients, who were treated with 40 mg/day omeprazole (140 cases) or with 480 mg/day bismuth subsalicylate (149 cases) for 4 weeks. All the patients also received 1 g/day metronidazole + 2 g/day amoxycillin for the first 2 weeks of treatment. Two months after the end of therapy, the patients underwent a second endoscopy and Hp histological assessment: the infection was eradicated in 192 and still present in the remaining 97 subjects. Gastrin, PGA, PGC, and IGG were measured before and after therapy. All indices significantly decreased after therapy in eradicated patients, while PGA and gastrin significantly decreased after therapy in both eradicated and noneradicated patients, although in the latter group the variations were less pronounced. We calculated the per cent decrease of the studied indices. PGC, with a decrease of more than 25%, was found to be the most accurate biochemical index. Variation in PGC levels before and after treatment were correlated with corresponding variations in Hp bacterial load. In conclusion, between the different biochemical parameters evaluated, PGC showed the highest clinical efficiency. © 1996 Wiley-Liss, Inc.     

Clinical Translation of Cardiovascular Outcome Trials in Type 2 Diabetes: Is There More or Is There Less Than Meets the Eye?

Randomized controlled trials (RCTs) have become the gold standard of clinical evidence and the staple of guided clinical practice. RCTs are based on a complex set of principles and procedures heavily strung by statistical analysis, primarily designed to answer a specific question in a clinical experiment. Readers of clinical trials need to apply critical appraisal skills before blindly accepting the results and conclusions of trials, lest they misinterpret and misapply the findings. We introduce the fundamentals of an RCT and discuss the relationship between relative risk (RR) and absolute risk (AR) in terms of the different information each conveys. The top results of some recent cardiovascular outcome trials using sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with type 2 diabetes are used to exemplify the merit of assessing both RR and AR changes for a balanced translation of findings into shrewd clinical judgment. We also suggest practical points to assist with a clinically useful interpretation of both within-trial and across-trial reports. Finally, we mention an alternative approach, namely, the restricted mean survival time, to obtaining unbiased estimates of the mean time of missed events in the treatment versus placebo arm for the duration of the trial.     

The prevalence of Helicobacter pylori: are emergency medicine residents at risk?

Helicobacter pylori is strongly associated with peptic ulcer disease and gastric cancer. It is a cause of chronic active gastritis. Our hypothesis was that Emergency Physicians might be at increased risk for infection due to their exposure to gastric contents from procedures performed in the Emergency Department. Our goal was to test a group of Emergency Physicians for H. pylori infection. In this cross sectional study, we tested a group of volunteers from an Emergency Medicine residency program for H. pylori infection by serum analysis for IgG. A matched control group was also tested. Forty-five subjects were enrolled; one subject's sample was lost. Three of 44 subjects (6.8%) were positive for H. pylori antibodies. Seven of 44 controls (15.9%) tested positive. Thus, Emergency Physicians do not have increased H. pylori infection rates and may be at less risk than the general population. Routine testing is not recommended.     

Central serous chorioretinopathy: a new extragastric manifestation of Helicobacter pylori?: Analysis of a clinical case

Central serous chorioretinopathy is classically characterized by a shallow, round, serous detachment of the macular retina. It preferentially affects men between 20 and 45 years of age and recurrences have been documented in most cases. Although the aetiopathogenesis of the disease is still unknown, it has been thought to be due to a focal leakage from one or more defects in the retinal pigment epithelium, which allow serous fluid from the choriocapillaris to diffuse into the subretinal space. Moreover, it is theorized that damage of the active fluid transport mechanisms through the retinal pigment epithelium may also play a contributing role. Finally, the reported correlation with psychophysical stress provides support for the concept of the disease being "adrenergically conditioned". Recently, an interesting association has been observed between this chorioretinal pathology and the Helicobacter pylori infection and, consequently, a new etiological hypothesis has been proposed. Here we report a retrospective analysis of a clinical case of central serous chorioretinopathy with Helicobacter pylori positivity.     

Helicobacter pylori infection and asthma: Is there a direct or an inverse association? A meta-analysis

AIM: To analyze the consistency of a potential involvement of the bacterium infection in the asthma disease. METHODS: A systematic literature search of the terms “Helicobacter pylori” (H. pylori) associated to “asthma” using PubMed, Scopus and the Cochrane Library Central was performed. Reference lists from published articles were also employed. Titles of these publications and their abstracts were scanned in order to eliminate duplicates and irrelevant articles. The criteria of inclusion of the studies were: Original studies; the H. pylori diagnostic method has been declared; all ranges of age have been included in our study; a definitive diagnosis of asthma has been reported. RESULTS: We selected 14 articles in which the association between the two conditions was addressed. In 7 studies the prevalence of H. pylori infection in the asthma population and in the control population was made explicit. There was heterogeneity between the studies (Cohran’s Q = 0.02). The H. pylori infection in the asthma population resulted 33.6% (518 of 1542), while in the control population resulted 37.6% (2746 of 7310) (relative risk of H. pylori infection in the asthma population = 0.87, 95%CI: 0.72-1.05, P = 0.015, random effects model). Instead, considering the more virulent strains, the majority of studies showed an inverse relationship between the prevalence of H. pylori infection and asthma. CONCLUSION: In our meta-analysis the prevalence of H. pylori infection in the asthma population resulted not statistically significant lower than in control population (P = 0.15). Instead, considering the more virulent strains, the majority of studies showed an inverse relationship between the prevalence of H. pylori infection and asthma.     

Helicobacter pylori in Peptic Ulcer: Have Koch's Postulates Been Fulfilled?

This brief review considers whether or not Koch's postulates have been fulfilled for Helicobacter pylori and peptic ulceration. The histological features of peptic ulcer disease in man are active chronic gastritis with antral predominance, duodenal gastric metaplasia and active duodenitis. Other features are hyperpepsinogenaemia, relative postprandial hypergastrinaemia and basal acid hypersecretion. The macroscopic features are duodenal bulb ulceration or lesser curve and antral gastric ulceration.

At present, gastric colonization with H. pylori has been produced in small animal species (rats and mice), but the infection is difficult to establish in immunocompetent animals, and histological gastritis is unconvincing. In larger animals the germ-free pig has been the most reliable model but the gastritis tends to be chronic with little activity.

The best examples of acute infection are in three ‘self-administration’ experiments in humans. In these cases acute gastritis with hypochlorhydria developed which, when it converted to active chronic gastritis, tended to be asymptomatic. Either the circumstances were incompatible with ulceration, or the experiments were not continued for the many years necessary to develop peptic ulceration. It is concluded that only one of the many steps required for the development of peptic ulceration has so far been fulfilled, i.e. the ability of H. pylori to produce histological gastritis in a susceptible host.