Maternal transmission of Helicobacter pylori in the perinatal period.

OBJECTIVES: Studies indicate that Helicobacterpylori (HP) infection is closely related to gastric mucosa lesions and well-differentiated gastric cancer. In Japan, the HP-positive rate in childhood is 5-6%, which is similar to other developed countries, and in regard to the infection route, oral infection is considered important. To our knowledge there have been no reports on mother-to-child transmission and in this study we investigated maternal HP infection status to determine the potential of mother-to-child transmission in the perinatal period. METHODS: After obtaining informed consent from 1,588 pregnant women, mother's blood and cord blood were collected at delivery to measure HP antibody (Helico-G). Gastric contents from the neonates were cultured to isolate H. pylori (Skirrow medium). Vaginal discharge (73 women) and dental plaque scraping swabs (48 women) were collected before delivery, and milk (66 women) was collected after delivery from 212 HP antibody-positive pregnant women to detect H. pylori by PCR. RESULTS: The HP antibody-positive rate for the pregnant women was 29.2%. H. pylori was not detected in the vaginal discharge from HP antibody-positive pregnant women, but dental plaque scraping swabs from 4 women and milk from 4 women was positive. CONCLUSION: We considered that vertical infection during pregnancy or at delivery is unlikely as a route of mother-to-child HP antibody infection. However, horizontal infection through breast-feeding may occur.     

Endoscopy in hyperemesis gravidarum and Helicobacter pylori infection.

OBJECTIVES: To establish a relationship between hyperemesis gravidarum (HG) and Helicobacter pylori (H. Pylori) infection by histologic testing. METHODS: Twenty patients with severe HG (Group I) and 10 volunteer pregnant women without gastric complaints (Group II) were included in the study. Endoscopic evaluations were done in both groups and biopsies were obtained from the antrum and corpus for the histopathologic diagnosis of H. pylori. The groups were compared with the chi(2)-test and Fisher's exact test where appropriate. RESULTS: H. pylori was diagnosed in 19 (95%) of 20 patients in Group I and 5 (50%) of 10 patients in group II. H. pylori densities in the antrum and corpus were higher in Group I and the differences between the two groups were statistically significant. The biopsy specimens revealed significant inflammation and H. pylori activation processes in patients with HG, and in 18 of 19 patients inflammation scores were greater than +2 on the scale. Pangastritis was demonstrated by endoscopic examination in 17 of 20 patients with HG. Enterogastric reflux was also diagnosed in 10 patients. In the control group, three patients had antral gastritis. CONCLUSIONS: We suggest that in patients with intractable nausea and vomiting during pregnancy, pangastritis and enterogastric reflux are the main endoscopic findings and that these findings are closely associated with H. pylori infection, which can be diagnosed histologically. The degree of gastric complaints may be associated with the density of H. pylori infection.     

Helicobacter pylori infection and persistent hyperemesis gravidarum.

Hyperemesis gravidarum is the most severe spectrum of gastrointestinal complaints in pregnant women. Our purpose is to describe an association of Helicobacter pylori with hyperemesis gravidarum. Three pregnant women are described with the working diagnoses of hyperemesis gravidarum unresponsive to standard therapy. The medical management used to treat Helicobacter pylori in these women are elaborated. The persistence of the symptomatology and/or hematemesis resulted in Helicobacter pylori testing of these women. A 2-week course of antibiotics and a proton pump inhibitor or H2 receptor antagonist resulted in resolution of the hyperemesis. A discussion of the incidence, diagnosis, and management of Helicobacter pylori in pregnancy is described. When the symptoms of hyperemesis gravidarum are persistent into the second trimester, active peptic ulcer disease from Helicobacter pylori should be included in the differential diagnoses.     

Helicobacter pylori infection and dyspepsia in pregnancy

OBJECTIVE: To investigate the relationship of Helicobacter pylori infection with dyspeptic symptoms in early and late pregnancy. Infection with H pylori and pregnancy outcome were also assessed. METHODS: H pylori seropositivity was determined in 416 antenatal patients at 10 to 14 weeks' gestation. Dyspeptic symptoms were recorded at 10 to 14 weeks' gestation and at 30 to 32 weeks' gestation by means of a well-validated questionnaire. Details of pregnancy outcome were recorded from patients' case notes. RESULTS: The incidence of H pylori infection in our population was 41.8% (164 of 404). Patients infected with H pylori were no more likely than controls to experience dyspepsia at 10 to 14 weeks' or at 30 to 32 weeks' gestation (P =.75 and.43, respectively). CONCLUSION: H pylori infection was not associated with preterm delivery, non reassuring fetal status in labor, or birth weight less than the 10th centile (P =.17,.57, and.19, respectively).H pylori infection is not associated with an increase in dyspepsia or with maternal or neonatal morbidity.     

Helicobacter pylori infection and platelet counts during pregnancy.

OBJECTIVE: To investigate whether there is any correlation between Helicobacter pylori infection and platelet counts during pregnancy. METHODS: One hundred and twenty pregnant women without any complications were evaluated. Platelet counts were determined during pregnancy and postpartum. H. pylori infection was assessed by the detection of serum antibodies at the 3rd day postpartum. Statistically significant differences of platelet count between H. pylori-positive and -negative patients were determined. RESULTS: H. pylori infection was found in 29 of 120 (24.2%). Platelet counts in the 3rd trimester were 22.7+/-4.7 x 10(3)/microl in H. pylori-positive group and 22.8+/-5.6 x 10(3)/microl in negative group (p=0.98). Platelet count in the 3rd trimester in positive and negative patients were 93+/-17% and 94+/-20%, respectively, of that of the 1st trimester (p=0.92). The incidence of hyperemesis gravidarum in both groups was not significant (p=0.28). CONCLUSION: A correlation between H. pylori infection and thrombocytopenia during pregnancy was not found in this study.     

上海地区不同家庭环境中儿童幽门螺杆菌感染的流行病学

目的研究上海地区不同职业家庭不同年龄组的儿童幽门螺杆菌(H.pylori)感染的流行病学情况，以探讨不同经济状况下，儿童感染H.pylori的年龄阶段以及家庭H.pylori人群的分布对儿童H.pylori感染的影响。方法1119名就读于上海地区市中心与郊区学校的学生，男性568名，女性551名，年龄7~l4岁。问卷调查每位学生的居住环境、常住人口、父母职业和受教育程度、家庭的经济收入，有无消化道症状及慢性胃炎、溃疡病史等，同时采用ELISA方法检测血中H.pylori IgG抗体。结果无症状儿童中7岁年龄组的H.pylori感染率为30.91%，在7~12岁年龄阶段随着年龄的增加H.pylori感染率也逐渐上升，平均年递增3.28%；工人和农民家庭的儿童较小的年龄即有较高的H.pylori感染率；生活在父母感染H.pylori家庭中的儿童更容易感染H.pylori。结论经济水平较低的家庭中，儿童H.pylori感染率高，而且较小年龄即有感染；H.pylori感染有家庭聚集现象。     

Relationship between Helicobacter pylori infection and erosive gastroesophageal reflux disease.

BACKGROUND AND PURPOSE: The role of Helicobacter pylori in the pathogenesis of gastroesophageal reflux disease remains controversial. The aims of the study were to assess the factors that influence the severity of erosive esophagitis in Taiwanese and to determine the prevalence of H. pylori infection in symptomatic patents. METHODS: Patients with erosive esophagitis confirmed by upper endoscopy from January 2002 to December 2002 at National Taiwan University Hospital were enrolled. The severity of erosive esophagitis was graded endoscopically according to the Los Angeles classification. H. pylori infection was determined by pathology and culture of biopsies at the gastric body and/or antrum. A sex-matched control was selected to determine the prevalence of H. pylori infection. RESULTS: A total of 104 patients were recruited for the study, 3 of whom were excluded due to previous eradication of H. pylori infection. The prevalence of H. pylori infection in the 101 eligible patients with erosive esophagitis was 34.7%, which was significantly lower than the 64.9% prevalence in the control group (p < 0.001). Age and hiatal hernia were significantly associated with the severe erosive esophagitis (odds ratio, 1.05 and 4.44, respectively). H. pylori infection status, gender, smoking, alcohol drinking, and coexistent systemic diseases such as diabetes and hypertension were not correlated with the severity of erosive esophagitis. CONCLUSIONS: The overall prevalence of H. pylori infection was significantly lower in symptomatic patients with erosive esophagitis than in controls. Age and hiatal hernia were significantly associated with the severity of erosive esophagitis. H. pylori infection was inversely correlated with the occurrence of erosive esophagitis, but was not correlated with its severity.     

Role of Helicobacter pylori infection in iron deficiency during pregnancy

OBJECTIVE: We investigated the possible role of Helicobacter pylori infection in iron deficiency during pregnancy in a large group of mothers in Germany after the birth of their baby under special consideration of iron supplementation. STUDY DESIGN: All women who were delivered of their baby between November 2000 and November 2001 at the Department of Gynecology and Obstetrics at the University of Ulm, Germany, were recruited for the study. Hemoglobin levels at various points of time during pregnancy were obtained from the mothers' health charts. Current H pylori infection was determined by 13 C-urea breath test. We used multiple linear regression analyses to assess the impact of infection status on hemoglobin level at the beginning of pregnancy and on hemoglobin change during pregnancy. RESULTS: Twenty-three percent of the 898 mothers had a H pylori infection, and 20% of the mothers had a hemoglobin level below 12 g/dL at the beginning of pregnancy. Compared with uninfected mothers, mothers with H pylori infection had a lower mean hemoglobin level at the beginning of pregnancy (-0.25 g/dL; 95% CI, -0.49, -0.003) and a more unfavorable change in hemoglobin level during pregnancy (-0.14 g/dL; 95% CI, -0.38, 0.10). CONCLUSION: This study supports a possible moderate, but still relevant, independent role of H pylori infection in iron deficiency during pregnancy.     

抗幽门螺杆菌感染治疗后患儿肠道菌群的变化

【摘要】目的探讨儿童幽门螺杆菌(H·pylori)感染及抗H·pylori治疗对儿童肠道菌群状 态的影响。方法将浙江大学医学院附属儿童医院2004年4~10月门诊收治的68例慢性胃炎、十二指肠球炎患儿分为H·pylori阳性组36例、H· pylori阴性组32例二组。称取68例患儿新鲜粪便1.0g，分别进行需氧和厌氧培养，分离肠道菌群中最有代表性的三种需氧菌(肠杆菌、肠球菌、 酵母菌)和四种厌氧菌(双歧杆菌、乳杆菌、类杆菌、产气荚膜梭菌),菌落记数，同时计算B/E比值来代表定植抗力。对36例H·pylori阳性组中 的26例患儿进行“三联”抗H·pylori治疗1周后留取新鲜粪便进行肠道菌群分析，5例患儿在停药1个月后再次进行肠道菌群分析。结果H· pylori阳性组和H·pylori阴性组上述三种需氧菌和四种厌氧菌的菌落检出率比较，差异无统计学意义(P>0.05)。抗H·pylori治疗1周后双歧杆 菌、乳杆菌、类杆菌菌落数量较治疗前明显降低(P<0.05),B/E值明显下降(P<0.01)，酵母菌的检出率明显增加(P<0.05)，产气荚膜梭菌检出率 下降(P<0.05)。5例患儿在停药1个月后，乳酸杆菌数量仍继续下降，肠杆菌数量继续增加，双歧杆菌、类杆菌数量有所恢复，但仍低于治疗前 。结论儿童H·pylori感染后对肠道菌群影响不大；三联疗法抗H·pylori治疗对儿童肠道菌群产生明显的影响，因此在治疗H·pylori感染时须 考虑到大量抗生素治疗后可能对患儿的副作用及潜在的危险。     

Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review

OBJECTIVE: To systematically review studies examining the relationship between hyperemesis gravidarum and Helicobacter pylori (H pylori) infection. DATA SOURCES: A 1966 to January 2007 search using MEDLINE/PubMed, EMBASE, and Web of Science included MeSH terms: "Helicobacter pylori," "Helicobacter infections," "hyperemesis gravidarum," and the text words "nausea," "vomit," "pregnancy," and "Helicobacter." References of selected papers were examined for additional relevant studies. METHODS OF STUDY SELECTION: We evaluated studies investigating a relationship between hyperemesis gravidarum and H pylori infection. Studies were included in which the diagnosis of hyperemesis gravidarum was made at or before entry into the study, and H pylori diagnosis was made by serum antibody sample, gastric biopsy, saliva test, or stool sample. The search produced 169 titles; 22 were reviewed in further detail. TABULATION, INTEGRATION, AND RESULTS: Fourteen case-control studies met established criteria, involving 1,732 participants and controls tested for H pylori infection. Studies were evaluated according to patient demographics and study methodology (case definition, exclusion criteria, H pylori testing). An estimate of the odds ratios with 95% confidence intervals was calculated by using a random effects model for dichotomous variables with review article software. Ten studies showed a significant association between hyperemesis gravidarum and H pylori infection. Odds ratios varied from 0.55 to 109.33; three results were less than 1.0. Tests for heterogeneity applied to several subgroups were considerable with values above 75% for all groups. CONCLUSION: An association between hyperemesis gravidarum and H pylori infection is suggested by this systematic review. However, the considerable heterogeneity among studies highlights study limitations.     

Erythrocyte Lewis antigen phenotypes of dyspeptic patients in Taiwan--correlattion of host factor with Helicobacter pylori infection.

BACKGROUND AND AIMS: Because of the molecular mimicry between Helicobacter pylori lipopolysaccharide and host Lewis blood-group antigens, Lewis antigen may mediate specific H. pylori binding to surface epithelial cells in gastric mucosa. We, therefore, tested whether different Lewis antigen phenotypes have different prevalence rates of H. pylori infection, and determined the specific H. pylori-related disease entities or histologic features. METHOD: A total of 342 dyspeptic patients without previous anti-H. pylori therapy were enrolled after endoscopy. The Lewis phenotypes, defined as Le(a-b-), Le(a-b+), Le(a+b-), and Le(a+b+) subtypes, were determined from the expression or absence of Lewis antigens (Le(a) and Le(b)) on erythrocytes in each patient using monoclonal antibodies. The H. pylori-specific gastric histology was evaluated using the updated Sydney's system. RESULTS: Of 342 patients, 233 (68.1%) had H. pylori infection. The H. pylori infection rates were significantly higher in patients with Lewis phenotypes Le(a+b-) and Le(a+b+) (p < 0.05). Patients expressing the Le(a) antigen had a higher H. pylori infection rate than those without the Le(a) antigen (80.8 vs 64%, p < 0.005). In H. pylori-infected patients, patients expressing Le(b) antigen had a lower rate of gastroduodenal ulcers than those without Le(b) antigen (46.9 vs 61.4%, p < 0.05). H. pylori-positive patients who expressed the Le(b) antigen had higher bacterial density and inflammation severity in the gastric cardia than those who did not. Patients who expressed the Le(a) antigen had lower bacterial density, less chronic inflammation severity, and lower frequency of lymphoid follicles in the gastric cardia than those who did not (p < 0.05). CONCLUSION: The erythrocyte Lewis phenotype can be a significant host factor related to susceptibility, different histologic patterns, and clinical outcomes of H. pylori infection in Taiwan.     

Helicobacter pylori seropositivity in patients with hyperemesis gravidarum.

OBJECTIVE: The aim of this study was to analyze the hypothesis that there was an association between hyperemesis gravidarum (HG) and Helicobacter pylori (HP) infection. METHODS: The study group consisted of 95 pregnant women with HG and 116 asymptomatic pregnant women who were admitted to our hospital between January 1997 and October 1998. Specific serum immunoglobulin G for HP was assayed in the sera of the study group after informed consent was obtained. Chi-square and Student's t-test were used accordingly for statistical analysis of the data. RESULTS: Serologically positive HP infection was detected in 87 of the 95 patients with HG (91.5%) whereas 52 of the 116 asymptomatic gravidas (44.8%) serving as the control group had positive antibody concentrations against HP. The ratio of HP positivity in pregnant women with HG was significantly higher than asymptomatic pregnant women (P < 0.001). The mean index percentages of IgG titers were 73.8 +/- 9.7% in the hyperemesis gravidarum and 25.8 +/- 5.6% control group (P < 0.01). CONCLUSION: HP infection seemed to be significantly associated with hyperemesis gravidarum in our pregnant patient population with hyperemesis gravidarum.     

Helicobacter pylori seropositivity in patients with hyperemesis gravidarum.

OBJECTIVES: To test the hypothesis that infection with Helicobacter pylori is associated with hyperemesis gravidarum. METHODS: From November 1999 to February 2001, we enrolled 54 pregnant women with hyperemesis gravidarum and 53 asymptomatic pregnant women in a prospective study. Specific serum immunoglobulin G for Helicobacter pylori was assayed in the sera of the study group and compared with the asymptomatic group. Chi-square and Student's t-test were used accordingly for statistical analysis of the data. RESULTS: Serologically positive Helicobacter pylori infection was detected in 44 out of 54 patients with hyperemesis gravidarum (81.5%) whereas 29 out of 53 asymptomatic gravidas (54.7%) had positive antibody titers for Helicobacter pylori. The ratio of Helicobacter pylori seropositivity in pregnant women with hyperemesis gravidarum was significantly higher than asymptomatic pregnant women (P<0.01). The mean (+/-S.D.) of the IgG titer was 69.7 (+/-77.5) in the hyperemesis gravidarum group and 34.5 (+/-47.8) in the control group (P<0.01). CONCLUSIONS: There is a significant association between Helicobacter pylori infection and hyperemesis gravidarum in our hyperemetic pregnant patients.     

儿童幽门螺杆菌空泡毒素基因的研究

目的探讨儿童幽门螺杆菌vacA基因型并分析各基因亚型与胃十二指肠疾病的关系。 方法对80例H·pylori感染的儿童，采用PCR法扩增胃黏膜vacA基因亚型。 结果南宁儿童H·pylorivacA基因型有s1a/m1和s1a/m2两种组合，基因频率分别为3.75%、66.25%。vacA基因各亚型在慢性浅表性胃炎及消化性溃疡中的检出率差异无显著性(P>0.05)。 结论s1a/m2为南宁地区儿童幽门螺杆菌的vacA优势基因型。部分患儿同时感染多株不同vacA基因型H·pylori。vacA基因各亚型不能作为南宁地区儿童H·pylori菌株毒力强弱的指标。     

Helicobacter pylori infection and risk of preeclampsia: a systematic review and meta-analysis

Objective: Helicobacter pylori is associated with many pregnancy adverse effects such as preeclampsia (PE). We performed this systematic review and meta-analysis study to assess the possible association between H. pylori infection and PE and this is the first meta-analysis to clarify this issue.

Methods: PubMed, ISI (Web of Science), SCOPUS, and Google Scholar databases were searched (up to April 2017) to identify the relevant studies. The Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines were used to do this study. Pooled odds ratio (OR) and 95% confidence intervals (CI) were estimated using a random-effects meta-analysis model. Heterogeneity was assessed with the χ²-based Q-test and I² statistic.

Results: A total of eight studies including 889 participants (460 preeclamptic women and 429 controls) met the eligibility criteria. A positive association was found between H. pylori infection and PE (OR: 3.35; 95% CI: 2.21–5.10). Heterogeneity was acceptable (χ²?=?13.39; I²?=?47.7, 95% CI: 0–77). In subgroup analysis, cytotoxin-associated antigen A seropositivity was a substantial risk factor for PE when immunoblotting methods (OR: 11.12; 95% CI: 5.34–23.16; χ²?=?6.42; I²?=?53.3, 95% CI: 0–85) were used, whereas it was not potential risk factor for PE when ELISA was used as a detecting method (OR: 1.11; 95% CI: 0.6–2.06; χ²?=?1.83; I²?=?0, 95% CI: 0–90).

Conclusions: This study indicated that women with H. pylori infection, especially those infected with Cag A positive strains are more likely to have PE compared with the uninfected women.     

Efficient and non-invasive method for investigating Helicobacter pylori in gravida with hyperemesis gravidarum: Helicobacter pylori stool antigen test

AIM: To investigate the relationship between Helicobacter pylori infection and severe hyperemesis gravidarum (H.Gravidarum) by using Helicobacter pylori Stool Antigen (HpSA) and other serologic test results. METHODS: Twenty-seven pregnant women with H.Gravidarum and 97 asymptomatic pregnant women of matching gestational age without gastric problems were enrolled in a prospective study. Serum samples collected from cases were investigated in terms of specific antibodies for H. pylori (immunoglobulin-IgG, IgA) and feces samples were investigated for HpSA. Statistical analysis of the data obtained from the groups was made by appropriate chi2 tests. RESULTS: Rate of HpSA positivity in patients with H.Gravidarum was 40.7%, while the same rate was 12.4% in the control group. The difference between the two groups was significant (P = 0.001). Rates of positivity for specific IgG formed against H. pylori in gravida with H.Gravidarum and in the asymptomatic gravida were 85.2% and 73.2%, respectively, and the rates for IgA were 48.1% and 41.2%, respectively. There was no difference between groups in terms of specific Igs formed against H. pylori (P > 0.05). CONCLUSION: The HpSA scan showed a statistically significant relation between H. pylori infection and H.Gravidarum. HpSA test gives more efficient, reliable and realistic results than specific Igs formed against H. pylori in the identification of H. pylori positivity in gravida with H.Gravidarum.