Influence of Helicobacter pylori infection on the prevalence of reflux esophagitis in Japanese patients

BACKGROUND AND AIM: Reflux esophagitis is caused by esophageal motor dysfunction in patients with sufficient gastric acid secretion. Helicobacter pylori causes atrophic gastritis and influences gastric acid secretion. Hiatus hernia (HH) of the esophagus causes motor dysfunction in the lower esophagus. Therefore, this study aimed to test whether H. pylori infection, gastric mucosal atrophy and HH are predictive factors for reflux esophagitis. METHODS: Helicobacter pylori infection was examined in 781 patients by the measurement of serum immunoglobulin (Ig)G antibody, bacteriological culture and histological examination of biopsy specimens. The prevalence of HH, endoscopically identified gastric mucosal atrophy (closed- or open-type) and reflux esophagitis were investigated by reviewing endoscopic films. Investigated patients were divided into three age groups, under 49, 50-69, and over 70 years. The prevalence of esophagitis, H. pylori infection, gastric mucosal atrophy, and HH were compared to identify the possible predictive factors for reflux esophagitis by using logistic regression analysis. RESULTS: Sixty-nine patients with reflux esophagitis were found among the 781 investigated cases. The odds ratios of negative H. pylori infection, endoscopically identified closed-type gastric mucosal atrophy, and HH for the prevalence of reflux esophagitis were 1.342, 1.751 and 5.527, respectively. These results indicated that the presence of H. pylori infection was only a weak negative risk factor, and that HH was the most reliable endoscopic predictive factor for reflux esophagitis. CONCLUSION: Helicobacter pylori infection is a weak negative risk factor for the prevalence of reflux esophagitis, while HH is the most reliable predictive factor.     

Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings

BACKGROUND: In patients with diabetes mellitus, chronic infections are frequent and severe, due to the impairment of their immune status. However, data on the prevalence of Helicobacter pylori (H. pylori) infection in diabetics are scanty and contradictory. The aim of our study was to assess the prevalence of H. pylori infection in diabetic patients and to evaluate the association between endoscopic features and H. pylori colonization of the gastric mucosa in diabetes mellitus. METHODS: A cross-sectional study of 172 dyspeptic patients (67 diabetics and 105 nondiabetic subjects) was designed. In all cases, an upper gastrointestinal endoscopy was performed, gastroduodenal lesions were noted, and the presence of gastritis and H. pylori was assessed by histopathological examination. Differences between diabetic patients and nondiabetic subjects were evaluated. RESULTS: The difference of H. pylori prevalence between diabetics (37.3%) and nondiabetics (35.2%) was not significant (P=0.78). Nor did the prevalence of gastritis and peptic ulcer differ significantly between the two groups (59.7% vs. 49.5%, P=0.19; and 32.8% vs. 40.9%, P=0.08, respectively). Studying only H. pylori-positive patients, we found no difference between diabetics and nondiabetics with regard to the prevalence of either gastritis (80% vs. 72.9%, P=0.71) or peptic ulcer (91.8% vs. 76%, P=0.09). CONCLUSIONS: Our data do not support an association between H. pylori infection and diabetes mellitus. This is confirmed by the lack of difference between diabetics and nondiabetics with regard to the prevalence of both H. pylori infection and H. pylori-related gastroduodenal disorders.     

Low prevalence of Helicobacter pylori in individuals with HTLV-I infection

BACKGROUND: The prevalence of Helicobacter pylori in HIV-positive individuals is significantly lower than in HIV-negative controls. However, its prevalence in individuals infected with human T-cell leukaemia virus type I (HTLV-I), another important member of the human retrovirus family, has not been previously investigated. OBJECTIVE: To establish the prevalence of H. pylori in HTLV-I-positive individuals in the Nagasaki Prefecture, which is an area endemic for HTLV-I. METHODS: We examined sera from 146 HTLV-I-positive individuals with a mean age of 56.7 years, consisting of 45 adult T-cell leukaemia (ATL) patients, 13 HTLV-I-associated myelopathy (HAM) patients and 88 healthy carriers. Serum samples of 292 age- and sex-matched HTLV-I-negative controls were also examined. Serum anti-H. pylori immunoglobulin (Ig) G antibody was examined using an enzyme-linked immunosorbent assay kit. Twenty-eight HTLV-I-positive patients were examined endoscopically, assessed for H. pylori by culture, histology and CLO test using gastric biopsy specimens, and gastritis in these patients was also graded histologically. RESULTS: The seroprevalence of H. pylori was 48% in HTLV-I-positive individuals versus 64% in HTLV-I-negative controls (P < 0.01). In the three HTLV-I-positive groups, ATL patients and carriers had significantly lower seroprevalence of H. pylori than the HTLV-I-negative controls (P < 0.05). Assessment of H. pylori using gastric biopsy specimens also showed a significantly lower prevalence of H. pylori infection in HTLV-I-positive patients than controls (46% versus 70%, P < 0.05). Histological examination showed a significantly higher degree of activity, inflammation and glandular atrophy in the antrum and corpus in H. pylori-positive patients compared to H. pylori-negative patients. H. pylori-positive patients with HTLV-I infection had a more severe degree of glandular atrophy in the corpus than H. pylori-positive controls without HTLV-I infection. CONCLUSION: We have found a reduced prevalence of H. pylori in HTLV-I-positive individuals. Whatever the explanation, infection with HTLV-I does not predispose to the risk of H. pylori infection.     

中国汉族炎症性肠病幽门螺杆菌感染状况分析

目的: 调查中国汉族IBD患者H pylori感染情况和IBD治疗药物及克罗恩病(CD)表型与H pylori感染的可能关系.方法: 收集106例IBD患者, 其中包括54例溃疡性结肠炎(UC)和52例CD, 对照组包括106例年龄和性别及社会经济状况与之匹配且接受了常规的体格检查的健康人. 采用H pylori IgG抗体胶体金免疫层析快速诊断试验比较了IBD患者和健康对照者H pylori的感染率.结果: IBD患者和对照组以及UC和CD患者之间H pylori感染率, 均具有显著性差异(31.1% vs61.3%, P<0.01;37.0% vs 25.0%, P<0.05). 在IBD患者中, 曾服用甲硝唑(22.3%)或喹诺酮类抗菌药(19.1%)的患者比对照组H pylori感染率显著降低, 而没有服用抗生素的患者也表明H pylori感染率显著低于对照组. IBD患者的表型特征与H pylori感染率没有显著的关系( P>0.05).结论: 中国汉族IBD患者, 特别是CD患者的H pylori感染率显著的低于正常对照者, 认为H pylori感染在IBD患者中可能是一种低危险因素.     

Assessment of the prevalence of infection with Helicobacter pylori in patients with inflammatory bowel disease

OBJECTIVE: To determine the prevalence of Helicobacter pylori in patients with inflammatory bowel disease (IBD) and compare this to the prevalence in a control population with non-organic bowel symptoms, and to investigate the effect of sulphasalazine and other 5-aminosalicylic acid (5-ASA) drugs on the prevalence of H. pylori in IBD patients. DESIGN: Prospective, controlled trial. SETTING: Gastroenterology out-patient department, City General Hospital, North Staffordshire Hospitals NHS Trust, Stoke-on-Trent. PARTICIPANTS: The population comprised 51 patients with ulcerative colitis, 42 patients with Crohn's disease and 40 patients with irritable bowel syndrome as controls. Patients with X-ray- and/or biopsy-proven disease were eligible to be entered into the study. INTERVENTIONS: Subjects filled in a detailed questionnaire, were assessed for seropositivity of H. pylori and underwent a C13 urea breath test (UBT). MAIN OUTCOME MEASURES: Seropositivity for H. pylori and a positive C13 UBT result. RESULTS: A quarter of the irritable bowel syndrome controls were seropositive for H. pylori. Of the ulcerative colitis patients, 21.6% were currently H. pylori-positive on C13 UBT; 17.6% of the ulcerative colitis patients who had been previously treated with sulphasalazine were positive while 23.1% of the ulcerative colitis patients who had been treated with a non-sulphasalazine 5-ASA drug were positive. Of the Crohn's patients, 11.9% were currently H. pylori-positive; 3.6% of the Crohn's patients who had been previously treated with sulphasalazine were positive while 12.5% of the Crohn's patients who had been treated with a non-sulphasalazine 5-ASA drug were positive. CONCLUSIONS: Patients with IBD and Crohn's disease in particular were less likely to be H. pylori-positive than controls. Sulphasalazine treatment further decreased the prevalence of H. pylori, although the reduced prevalence of H. pylori in IBD patients could not be accounted for by this alone.     

缺铁性贫血患者抗幽门螺旋杆菌治疗的价值

目的：了解幽门螺旋杆菌（HP）感染对缺铁性贫血（IDA）发病的影响及抗HP治疗对改善贫血的价值。方法：对116例IDA患者补铁治疗并检测HP感染的情况。分组：A组为给予去除缺铁原因治疗和补铁治疗可以达到IDA痊愈者,B组为无明显缺铁原因但单纯补铁效果不好的IDA患者。对B组患者给予抗HP治疗,观察抗HP治疗前后患者Hb、平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）、血清铁蛋白（SF）的变化。结果：116例IDA患者中,A组74例给予去除缺铁原因治疗和（或）补铁治疗可以达到IDA痊愈,其中HP感染43例,感染率58.1%;B组42例无明显缺铁原因但是单纯补铁效果不好的IDA患者中HP感染者36例,感染率85.7%,2组间HP感染率的差异有统计学意义。对B组中HP阳性者给予抗HP治疗,抗HP治疗有效者Hb、MCV、MCH、SF较治疗前有明显提高。结论：HP感染可能与IDA的发生有关,清除HP的治疗可改善IDA的疗效。     

Extremely high prevalence of Helicobacter pylori infection in Bhutan

AIM: To revealed the prevalence of Helicobacter pylori (H. pylori ) infection in the Bhutanese population. METHODS: We recruited a total of 372 volunteers (214 females and 158 males; mean age of 39.6 ± 14.9 years) from three Bhutanese cities (Thimphu, Punaka, and Wangdue). The status of H. pylori infection was determined based on five different tests: the rapid urease test (CLO test), culture, histology, immunohistochemistry (IHC), and serum anti H. pylori -antibody. RESULTS: The serological test showed a significantly higher positive rate compared with the CLO test, culture, histology and IHC (P < 0.001, P < 0.001, P=0.01, and P=0.01, respectively). When the subjects were considered to be H. pylori positive in the case of at least one test showing a positive result, the overall prevalence of H. pylori infection in Bhutan was 73.4%. The prevalence of H. pylori infection significantly decreased with age (P < 0.01). The prevalence of H. pylori infection was lower in Thimphu than in Punakha and Wangdue (P=0.001 and 0.06, respectively). The prevalence of H. pylori infection was significantly higher in patients with peptic ulcers than in those with gastritis (91.4% vs 71.3%, P=0.003). CONCLUSION: The high incidence of gastric cancer in Bhutan may be attributed to the high prevalence of H. pylori infection.     

Helicobacter pylori infection in patients with celiac disease

BACKGROUND AND AIMS: Patients with Helicobacter pylori gastritis are more likely to have increased duodenal intraepithelial lymphocytes (IEL); this can be reversed by H. pylori eradication. We hypothesized that: (1) H. pylori-infected celiac disease (CD) patients could have different clinicopathological features from noninfected subjects; and (2) the histopathological responses to a gluten-free diet could be different in H. pylori-infected and noninfected patients. METHODS: Duodenal and gastric biopsies obtained from 80 adults with histologically and serologically confirmed CD before and after 12-18 months of a gluten-free diet were retrospectively evaluated. Gastritis was classified and scored according to the Updated Sydney System; duodenal biopsies were classified using both the Marsh-Oberhuber and a simplified classification proposed by our group. RESULTS: At baseline, 30 patients had H. pylori infection and 50 did not; at follow-up five new infections were detected. Fifteen patients (3 H. pylori-positive and 12 negative) had lymphocytic gastritis. At baseline, a greater proportion of H. pylori-negative patients had severe villous atrophy (p < 0.01), but milder forms were more prevalent in H. pylori-positive patients (p < 0.01). After a gluten-free diet, significant improvement occurred in all duodenal features (p < 0.001), irrespective of H. pylori status; gastric variables did not change, except for lymphocytic, which resolved in 2 infected and 10 noninfected patients. CONCLUSIONS: The clinical features of CD patients are unrelated to H. pylori gastritis, and a gluten-free diet is equally effective in infected as in uninfected patients. The higher prevalence of milder duodenal lesions in CD patients with H. pylori infection suggests that lymphocytosis induced by H. pylori gastric infection becomes less obvious as profound inflammatory and structural changes alter the mucosal architecture. This study also provides further support for a pathogenetic relationship between CD and lymphocytic gastritis.     

Helicobacter pylori infection in pediatric patients

Helicobacter pylori is a gram-negative, spiral organism that colonizes the gastric mucosa and causes primary antral gastritis and peptic ulcer disease. Recent studies indicate that H. pylori infection acquired in childhood may cause gastric cancer in later life. H. pylori is present in both asymptomatic and symptomatic children as determined by various epidemiologic studies. The natural history of H. pylori infection is still an enigma. Its association with varied symptoms in children is considered controversial because it is frequently associated with nonulcerative gastritis in this age group. This article focuses on some of the newer developments addressing the epidemiology, transmission, pathophysiology, clinical presentation, and treatment of H. pylori infection in the pediatric population.     

Helicobacter pylori infection in elderly patients

PURPOSES: Helicobacter pylori (H. pylori) infection is a chronic gastric Gram-negative infection that increases with age. Acquired in childhood, H. pylori infection may induce a whole cascade of events leading to gastric pathologies such as peptic ulcer diseases, gastric precancerous lesions, and gastric lymphomas (MALT). The characteristics of the diagnosis and the treatment of this infection in geriatrics are thus particularly important to take into account. MAIN POINTS: 1) The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations. Clinical signs such as anorexia and malnutrition are proven to be excellent indications for endoscopic explorations in the elderly. NSAID-use and H. pylori infection were shown to be independent and unrelated risk factors for peptic ulcer and gastroduodenal bleeding in elderly subjects; 2) H. pylori infection diagnosis is difficult to realize in the very old population, and the urea breath test is the test which obtain the best performances in this population. PERSPECTIVES: Recent work showed the part played by H. pylori chronic infection in gastric aging and in appetite regulation in the elderly. Research tasks should be continued in this field in order to better understand the part played by this chronic infection in gastric aging and in other pathologies (i.e. neurological or cardiovascular diseases) in this population.     

Helicobacter pylori infection in hemodialysis patients

BACKGROUND/AIMS: Studies on the relationship between high serum urea nitrogen, creatinine and Helicobacter pylori infection in hemodialysis patients still give conflicting results. In the present study we investigated the prevalence of Helicobacter pylori positivity in patients with hemodialysis [HD(+)] and without hemodialysis [HD(-)] and assessed the relationship between clinical factors, serum urea nitrogen, creatinine levels and Helicobacter pylori prevalence in these patients. METHODOLOGY: 117 patients with dyspeptic complaints were included in the study. They consisted of 36 HD(+) patients (31%) and 81 HD(-) patients (69%). Endoscopy was performed and gastric antral biopsies were obtained for immunohistochemical analysis for Helicobacter pylori in all patients. RESULTS: Helicobacter pylori was positive in 53(45%) of 117 patients [Hp(+)]. In univariate analysis Hp(+) patients received hemodialysis therapy significantly less often (P = 0.002) and had lower serum urea nitrogen (P = 0.0008) and creatinine (P = 0.003) levels than Hp(-) patients. There was no significant difference in age, gender, endoscopic findings or comorbid conditions (hypertension or diabetes mellitus) between these groups. Multivariate logistic regression analysis revealed that only the serum urea nitrogen level was significantly associated with Helicobacter pylori prevalence (P = 0.008). CONCLUSIONS: These results indicate that high serum urea nitrogen seems to correlate with a low prevalence of Helicobacter pylori infection and hemodialysis patients with high serum urea nitrogen may be protected against Helicobacter pylori infection.     

The prevalence of Helicobacter pylori infection in patients with gastrointestinal symptoms in Chon Buri, Thailand

The prevalence of Helicobacter pylori infection varies between different geographic locations. The objectives of this study were to determine the prevalence of H. pylori infection in patients with gastrointestinal (GI) symptoms and to describe the association of H. pylori infection with demographic data, clinical diagnosis, and previous histories of patients. The study was carried out at the gastroenterology unit of Queen Sawang Wattana Memorial Hospital, Chon Buri, Thailand. The diagnosis of H. pylori infection was done by culture and rapid urease test on the gastric biopsy specimens of 112 patients. The overall prevalence of H. pylori infection by the gastric biopsy-based method was 58%. The prevalence of H. pylori infection in duodenal ulcer (DU) patients (75%) was significantly higher than in gastric ulcer (GU) patients (56.4%) and patients with gastritis (44.1%). A reverse correlation was observed between H. pylori infection and household income. The prevalence of H. pylori infection in patients who usually consumed unboiled water was 61.6%, which was significantly higher than in those who consumed boiled water (30.8%). We conclude that the prevalence of H. pylori infection in patients with GI symptoms is relatively high, and H. pylori infection is associated with DU disease. The data suggests that the household income and not boiling drinking water are related to the high H. pylori infection in our study.     

HTLV-I infection and the low prevalence of Helicobacter pylori infection in Japan

HTLV-I retrovirus infection and Helicobacter pylori infection are common in Japan; however a report in this issue shows a significantly low prevalence of H. pylori in patients infected with HTLV-I. The reasons for this may be due to differences in genetic susceptibility of the infections, the gastric milieu in HTLV-I being unable to support H. pylori, or because antimicrobial therapy in HTLV-I infection has eradicated H. pylori in this susceptible population. Similarities between HIV-1, another retroviral infection, and the prevalence of H. pylori are noted.     

Helicobacter pylori infection in patients with autoimmune thrombocytopenic purpura

AIM: To compare the prevalence of Helicobacter pylori(Hpylori) infection in autoimmune thrombocytopenic purpura (AITP) patients with that of nonthrombocytopenic controls,and to evaluate the efficacy of the treatment in Hpylori(+)and Hpylori(-) AITP patients.METHODS: The prevalence of gastric Hpyloriinfection in 38 adult AITP patients (29 female and 9 male; median age 27 years; range 18-39 years) who consecutively admitted to our clinic was investagated.RESULTS: Hpyloriinfection was found in 26 of 38 AITP patients (68.5%). Hpyloriinfection was found in 15 of 23 control subjects (65.2%). The difference in Hpyloriinfection between the 2 groups was not significant. Thrombocyte count of Hpylori-positive AITP patients was significantly lower than that of Hpylori-negative AITP patients (P＜0.05).Thrombocyte recovery of Hpylori-positive group was less than that of Hpylori-negative group (P＜0.05).CONCLUSION: Hpyloriinfection should be considerecd in the treatment of AITP patients with Hpyloriinfection.