Helicobacter pylori Infection in Rural and Urban Dyspeptic Patients from Venezuela

Health researchers have advocated for a cross-disciplinary approach to the study and prevention of infectious zoonotic diseases, such as Rift Valley Fever. It is believed that this approach can help bring out the social determinants and effects of the zoonotic diseases for the design of appropriate interventions and public health policy. A comprehensive literature review using a systematic search strategy was undertaken to explore the sociocultural and economic factors that influence the transmission and spread of Rift Valley Fever. Although the findings reveal a paucity of social research on Rift Valley Fever, they suggest that livestock sacrificial rituals, food preparation and consumption practices, gender roles, and inadequate resource base for public institutions are the key factors that influence the transmission. It is concluded that there is need for cross-disciplinary studies to increase the understanding of Rift Valley Fever and facilitate appropriate and timely response and mitigation measures.     

High Frequency of A2143G Mutation in Clarithromycin-Resistant Helicobacter pylori Isolates Recovered from Dyspeptic Patients in Iran

Background/Aim:

Resistance to clarithromycin in H. pylori isolates is accepted as a main cause of treatment failure in developing countries. We aimed to determine the prevalence of clarithromycin-resistant strains isolated from dyspeptic patients in northern Iran, furthermore we aimed to assess the relationship between clinical outcomes of infection with point mutations.

Materials and Methods:

A total of 147 consecutive patients infected with H. pylori were included for determining the status of resistant H. pylori strains. With upper gastroscopy, three antral biopsies were taken from each patient, first section for rapid urea test, second for pathology and third section was used for bacterial culture in microbiologic lab. The antimicrobial susceptibility tests in this examination were agar dilution, in accordance with clinical and laboratory standards institue guidelines. Restriction fragment length polymorphism-PCR (RFLP-PCR) method was applied to determine the frequency of point mutations in 23s rRNA gene. Statistical analysis was performed using SPSS software (15.0) (SPSS, Inc., Chicago, Ill). Chi-square and Fisher''s exact tests were applied to our analysis. A P value less than 5% was considered as statistically significant.

Results:

Our results showed that there was no point mutation in clarithromycin-susceptible strains of H. pylori.

Conclusion:

The important findings in our study indicate that A2143G is the most prevalent point mutation (30/32: 93.7%) attributed in clarithromycin resistance among the H. pylori strains. The current study concluded that clarithromycin could still be involved in the empirical treatment of H. pylori infection, although a high frequency of A2143G mutation may increase the concerns regarding treatment failure.     

Higher Prevalence of Helicobacter pylori Infection in Dyspeptic Patients Who Do Not Have Gastric Phase III of the Migrating Motor Complex

Background: So far, only a few and conflicting data are available about the possible correlation between Helicobacter pylori infection and disorders of gastrointestinal motility. Methods: In the present study we have evaluated the interdigestive manometric recordings from the stomach and duodenum of 100 consecutive dyspeptic patients, to ascertain whether the absence of phase III of the migrating motor complex (MMC) might be associated with a different prevalence of H. pylori infection. All the patients who entered a protocol study for functional dyspepsia had endoscopic examinations of the upper gastrointestinal tract with at least two biopsy specimens from both the gastric antrum and corpus (for histologic evaluation, with search for Helicobacter-like organisms). Then, 240-min interdigestive manometric recordings, with evaluation of activity fronts (phase III of the MMC), starting from the stomach and the duodenum, were made. Results and Conclusions: The data obtained suggest that in patients without evidence of gastric phase III of MMC the prevalence of H. pylori colonization is significantly (P = 0.032) higher.     

Symptom Patterns and Pathophysiological Mechanisms in Dyspeptic Patients with and Without Helicobacter pylori

Helicobacter pylori (HP) has been proposed as a mechanism of functional dyspepsia, but its role is still unclear. Our aim was to investigate the association between HP infection and dyspeptic symptoms and to verify whether the infection affects the pathophysiological mechanism of functional dyspepsia. The presence of HP and its association with dyspeptic symptoms were studied in 326 patients. Also, the effect of HP infection on solid/liquid gastric emptying rates, gastric sensitivity, and accommodation to meal was studied. HP was present in 17% of the patients, who showed symptom prevalence similar to that of HP-negative patients. Presence of HP did not significantly affect gastric emptying rates for solids and liquids, discomfort sensitivity thresholds (8.7 +/- 0.3 vs 9.8 +/- 0.9 mm Hg), or meal-induced gastric relaxation (133 +/- 12 vs 125 +/- 29 ml; all P's NS). In conclusion, in patients with functional dyspepsia the presence of HP infection does not seem to affect significantly the overall prevalence of symptoms or the gastric sensory-motor functions.     

儿童幽门螺杆菌感染的诊断和治疗

幽门螺杆菌（H．pylori）感染主要发生在儿童期，儿童期许多消化系统疾病，如慢性胃炎、消化性溃疡等与H．pylori感染密切相关，并可能与成年后胃癌的发生相关。H．pylori感染还可导致儿童缺铁性贫血。H．pylori感染主要经“口-口”或“粪-口”以及“胃-口”途径从人到人传播，社会经济因素对H．pylori感染的影响是主要的。胃镜活检胃黏膜细菌学检查是诊断H．pylori现症感染的“金标准”，粪抗原的测定和^13C-尿素呼气试验可用于诊断和评价疗效。质子泵抑制剂（PPI）加两种抗生素的三联疗法是目前最佳治疗方案，抗生素耐药的不断增加给治疗带来了困难．儿童H．pylori感染对大环内酯类药物的耐药高于成人。     

Effect of Helicobacter pylori Infection on Gastric Emptying and Gastrointestinal Hormones in Dyspeptic and Healthy Subjects

There is no general agreement as regards the effect of Helicobacter pylori infection on gastric emptying in patients with functional dyspepsia. Food releases several gastrointestinal hormones, and some of these are known to contribute to the regulation of gastric emptying. The aim of this study was to investigate the influence of H. pylori on gastric emptying in dyspeptic and healthy subjects and to verify whether different hormone secretion patterns are affected by the presence of the bacterium. Twenty-seven patients affected by functional dyspepsia and 30 asymptomatic healthy subjects entered the study. H. pylori presence was assessed in controls by IgG antibodies to H. pylori and [¹³C] urea breath test, and that in patients by Warthin-Starry stain on gastric biopsies. After ingesting a standard solid-liquid meal, an ultrasound examination of gastric emptying was performed. Plasma concentrations of gastrin, cholecystokinin, and pancreatic polypeptide were measured in the fasting and postprandial period for 4 hours. The incidence of H. pylori infection was not higher in functional dyspepsia patients than in controls. As regards gastric emptying, no difference was detected between patients and controls with and without H. pylori infection. On the contrary, the presence of H. pylori infection determined alterations in gastrin levels, which were higher in controls than in patients. Basal CCK levels were higher in the H. pylori-negative patients than H. pylori-positive patients and controls. In conclusion, H. pylori infection seems not to cause alterations in gastric emptying, but rather alterations in gastrin levels. In contrast, the altered levels of CCK account for its involvement in the pathophysiology of H. pylori-negative dyspepsia.     

Oral Fluid Antibody Detection in the Diagnosis of Gastric Helicobacter pylori Infection

The aim of this study was to evaluate an enzyme - linked immunosorbent assay (ELISA) for the detection of anti - helicobacter pylori (H. pylori) specific IgG antibodies in specimens of oral fluid.All subjects over the age 18 years undergoing endoscopy for any reason were asked to participate in the study. Two groups of 44 patients in each were selected as HP+ and HP-. At the same time, 5 milliliters of unstimulated saliva was collected from these patients, and the antibody titration against H.P. was evaluated by "ELISA" method.In overall, the level of salivary antibody in H.P+ group was significantly more than those in H P- group (P<0.001). In the best cut - off, sensitivity and specificity obtained in this test were respectively 88.6% and 81.8% and positive predictive and negative predictive values were determined as 83% and 87.8%, respectively. Positive Likelihood Ratio and negative likelihood ratio were 6.8 and -0.083, respectively.Oral fluid ELISA is relatively a comfortable, fast and noninvasive test for diagnosis of H. pylori infection.     

Performance of Two Immunosorbent Assay Kits for the Detection of Serum Immunoglobulin G to Helicobacter pylori in Untreated Greek Patients

Background: The performance of serological methods used to detect Helicobacter pylori varies with the ethnicity and prevalence of the infection in the community. We have prospectively evaluated the performance of two commercially available serum enzyme immunoassays (EIA) detecting H. pylori immunoglobulin G (IgG) antibodies in the sera of untreated Greek patients. Methods: One-hundred-and-thirty consecutive untreated dyspeptic patients underwent endoscopy with biopsies from the gastric body ( n = 2) and antrum ( n = 2). Serum samples were also obtained from each patient. Serum H. pylori IgG antibody titres were determined with two EIA kits (Pyloriset EIA-G and Milenia H. pylori IgG). Sensitivities, specificities and optimal cut-off values of serum EIAs were determined for the population under investigation by using receiver operating characteristic (ROC) curve analysis and histology as gold standard. Results: Ninety-seven patients were defined H. pylori -positive and 33 negative by histology. ROC curve analysis for the Pyloriset kit yielded 86% (95% CI, 78%-92%) sensitivity and 85% (68%-95%) specificity at an optimal cut-off value of &#83 358 units/ml. The respective values for the Milenia kit were 86% (78%-92%) and 82% (65%-93%) at an optimal cut-off value of &#83 51 units/ml. The suggested cut-off values of the manufacturers for Pyloriset and Milenia kits are &#83 300 and &#83 44 EIA units, respectively, which yield 2% and 4% higher sensitivity, but 9% lower specificity for both EIA kits. Conclusions: Both serum EIA kits performed well in our study. Our data show that EIA cut-off values should be optimized for the population under investigation.     

胃十二指肠疾病患者中cagA阳性幽门螺杆菌的普遍易感性

明确cagA阳性幽门螺杆菌（H.pyloril)胃十二指肠疾病患者中的感染情况。方法：用聚合酶链反应（PCR）方法扩增从30例十二指肠球部溃疡、30例慢性胃炎和6例胃癌虱活检组织中分离培养出的H.pylori菌株的cagA基因片段,用酶联免疫吸附测定（ELISA）方法检测血清抗H.pylori抗体,用免疫印迹（Western blot)方法检测血清抗cagA抗体。结果：用PCR方法测得的cagA基因阳性率为：十二指肠球部溃疡70％（21／30）,慢性胃炎73％（22／30）,胃癌83％（5／6）。66份血清标本抗H.phlori抗体均为阳性。用Western blot方法测得的抗cagA抗体阳性率为：十二指肠球部溃疡83％（25／30）,慢性胃炎77％（23／30）,胃癌83％（5／6）。结论：在我国人群中,cagA基因不能作为消化性溃疡的标志物,cagA阳性H.pylori在消化性溃疡和慢性胃炎患者中存在普遍易感性。     

13C-Urea Breath Test for Diagnosis of Helicobacter pylori Infection in the Elderly

Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treatment in the geriatric population are not well defined. The aims of the study were to characterize geriatric patients according to referral patterns and results of the 13C-urea breath test (13C-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The 13C-UBT was performed with 75 mg urea labeled with 13C. Physicians who ordered the test completed a questionnaire covering demographic data, indication for the test, chronic use of a proton pump inhibitor, or nonsteroidal anti-inflammatory drug, and type of eradiction therapy. The study sample consisted of 2128 patients, aged 70-102 years, 958 (45%) men, referred for 13C-UBT. The test was positive on 697 (33%). History of peptic disease was the main indication for referral, following by validation of successful eradication, Israeli origin screening for gastric cancer, treatment with regimen containing metronidazole, history of peptic disease, and recurrence of symptoms were predictive factors for a positive 13C-UBT. Multivariate logistic regression analysis revealed a significant influence of eradication therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for 13C-UBT. Our results are in accordance with the increase in metronidazole resistance of H. pylori stains and the cohort effect of H. pylori infection on the elderly Israeli-born population.     

Prevalence of Helicobacter pylori Infection in Male Patients with Osteoporosis and Controls

Cytokines that regulate bone turnover (tumor necrosis factor-, interleukin-6, etc.) may influence the pathogenesis of skeleton disorders, such as osteoporosis. Since Helicobacter pylori infection increases the systemic levels of inflammatory cytokines, we investigated the possibility that this infection increases the risk of developing osteoporosis and affects the bone metabolism in a group of male patients with osteoporosis. We examined 80 osteoporotic male patients and 160 controls for serum antibodies to H. pylori and the CagA protein and determined, in patients alone, the most important biochemical and instrumental parameters of the disease. Fifty-one patients (63.7%) and 107 controls (66.8%) were seropositive for H. pylori infection (nonsignificant); 30 infected patients (58.8%) and 43 infected controls (40.1%) were positive for anti-CagA antibodies (P = 0.028; OR = 2.13). Levels of estradiol in infected CagA-positive patients were significantly lower than in infected CagA-negative patients (28.5 [SD = 10.18] vs. 39.5 [SD = 14.50] pg/ml; P = 0.002) and uninfected patients (35.2 [SD = 12.7] pg/ml; P = 0.028). Levels of urinary cross-laps(a marker of bone resorption) were increased in patients infected by CagA-positive strains compared to patients infected by CagA-negative strains (282.9 [SD = 103.8] vs. 210.5 [SD = 150.1] g/mmol; P = 0.048) and uninfected patients (204.3 [SD = 130.1] g/mmol; P = 0.016). Differences among uninfected and infected patients, independent of CagA status, were observed for other markers of bone turnover, but they did not reach statistical significance. Infection by CagA-positive H. pylori strains is more prevalent in men with osteoporosis, who show reduced systemic levels of estrogens and increased bone turnover. H. pylori infection by strains expressing CagA may therefore be considered a risk factor for osteoporisis in men.     

Low Prevalence of Helicobacter pylori Infection in Patients with Hamartomatous Fundic Polyps

Helicobacter pylori infection of the gastricmucosal surface was investigated in patients withhamartomatous fundic polyps or hyperplastic polyps andin patients without endoscopic evidence of disease(healthy subjects). Presence of H. pylori infection wasdetermined by culture, histologic examination, and theendoscopic phenol red test. Adherence of H. pylori wasevaluated with scanning electron microscopic examination of antral biopsy specimens. Bothprevalence of H. pylori infection (P < 0.001) and H.pylori adherence (P < 0.05) were less in patientswith hamartomatous fundic polyps than in healthy subjects and patients with hyperplastic polyps.However, the percentages of plasma cells in gastricmucosa that contained IgA and of gastric epithelialcells that expressed Lewis b did not differsignificantly among the three groups. These findings suggestthat defense mechanisms against the attachment of H.pylori other than IgA or Lewis b antigen are present inpatients with hamartomarous fundic polyps.     

251例残胃胃镜、病理和幽门螺杆菌检查结果分析

本文对251例胃部分切除术后病例,进行胃镜和病理组织学分析,发现85.65％病例可发生残胃炎,且具有炎症轻微,粘膜水肿、表面上皮增生反应强烈和易有腺体扩张的组织学特点。残胃的Hp感染率仅为24.3％,与非手术的慢性胃炎组相比具有高度显著性差异(P<0.01)。本文提示残胃的低Hp阳性率,可能与残胃腔内胆汁酸含量较高,pH值升高,造成不利于Hp生长的环境有关。