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.     

Detection of Helicobacter pylori seropositivity in hyperemesis gravidarum and correlation with symptoms

The aim of this study was to investigate whether there was a relationship between H. pylori (Helicobacter pylori) infection positivity and characteristics (time and duration) of hyperemesis gravidarum (HG) symptoms. Forty-seven pregnant women with HG and 39 pregnant controls at the same gestational weeks without any gastrointestinal symptoms were included in this prospective study. H. pylori serum Immunoglobulin (Ig) G concentrations were determined by enzyme-linked immunoadsorbent assay (ELISA) in patients with HG and controls. Positive serology for H. pylori was correlated with the duration of symptoms in patients with HG. The prevalence of H. pylori infection was 85.1% (40 of 47) and 64.1% (25 of 39) in patients with HG and controls, respectively (p <0.05, chi (2) test). Mean values of H. pylori IgG (+/- standard deviation) were significantly higher in patients with HG than in controls (22.66 aIU/mL +/- 22.34 vs. 11.54 aIU/mL +/- 13.89, p <0.01, Student's t-test). In HG group, time (gestational weeks) and the duration (weeks) of HG symptoms for patients serologically positive and negative for H. pylori were 6.95 +/- 1.55 versus 6.58 +/- 1.78 weeks, (p >0.05, Student's t-test) and 8.35 +/- 5.28 versus 11.40 +/- 7.17 weeks (p >0.05, Mann-Whitney U-test), respectively. There was no correlation between duration of HG symptoms and serum H. pylori IgG concentrations. Although a majority of pregnant women with HG were serologically positive for H. pylori infection, there was no correlation between positive serology and duration of symptoms, which is not suggestive of a direct causal relationship between H. pylori infection and HG.     

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.     

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.     

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.     

儿童幽门螺杆菌感染时T淋巴细胞亚群的变化

目的研究儿童幽门螺杆菌(H.pylori)感染时的T淋巴细胞亚群变化。方法流式细胞仪直接免疫荧光法测定38例［H.pylori+慢性浅表性胃炎(CSG)12例；H.pylori+十二指肠溃疡(DU)5例；H.pylori-CSG 21例］儿童胃窦黏膜及外周血T淋巴细胞亚群。各组患儿均在内镜检查下取胃窦黏膜作快速尿素酶试验、组织学检查及淋巴细胞提取，同时抽取外周肝素抗凝静脉血2mL。提取的淋巴细胞经CD3 FITC、CD4 PE、CD8 PerCP染色后行流式测定。其中，胃黏膜T淋巴细胞亚群的检测以CD3设门。结果(1)胃黏膜CD+3(%)细胞的检出率分别为：H.pylori-CSG组3.14±2.03,H.pylori+CSG组4.58±2.30,H.pylori+DU组为6.49±4.49；(2)胃黏膜CD+3细胞中CD+4(%),CD+8(%)的相对比例及CD+4/CD+8值分别为：H.pylori-CSG组为19.81±9.25,47.30±12.83,0.43±0.19，H.pylori+CSG组为40.66±12.52,29.25±8.58,1.42±0.31,H.pylori+DU组为31.98±14.02,49.52±19.00，0.72±0.43。H.pylori+CSG组局部胃窦黏膜CD+4细胞、CD+4/CD+8比值明显高于H.pylori-CSG组，CD+8细胞则低于H.pylori-CSG组(P<0.01)。H.pylori+DU组CD+4、CD+4/CD+8比值也高于H.pylori-CSG组(P<0.05)，但CD+8细胞无统计学差异。H.pylori+DU组CD+8细胞高于H.pylori+CSG组而CD+4细胞无统计学差异，CD+4/CD+8比值则低于H.pylori+CSG组(P<0.01)。(3)外周血T淋巴细胞亚群的变化在三组之间并无明显的差异。结论H.pylori+DU与H.pylori+CSG的宿主的T淋巴细胞反应并不相同，而局部胃窦黏膜的T淋巴细胞亚群的异常可能在儿童H.pylori感染的免疫致病机制中起一定的作用。     

Is Helicobacter pylori a pathogenic agent of the cervix uteri?

BACKGROUND: Helicobacter pylori is a gram-negative, microaerophilic rod-shaped bacterium that lives beneath the gastric mucosal layers, on the surface of epithelial cells. Gastric infection with this organism causes inflammation of the gastric mucosa, which can lead to gastritis, duodenal or gastric ulcers and even in rare cases to gastric carcinoma or MALT lymphoma. Approximately 50% of the population of the entire world is believed to be infected with H. pylori, but the exact route of transmission is still uncertain. It has been speculated that the cervix, with its endocervical columnar epithelium and acidic mucous layer, might provide a suitable environment for H. pylori. H. pylori might be a pathogenic agent for cervical infection. In order to address this issue we studied H. pylori in the endocervical tissue. METHODS: To investigate our hypothesis, we examined cervical tissue using PCR, culture, and Gram-stain. Thirty-three cervices from women who underwent total hysterectomy for noninvasive non-cervical benign uterine diseases were analyzed in this study. Twenty-one patients had cervicitis and 12 patients were included as controls. RESULTS: Of the 29 patients studied, none showed evidence of H. pylori infection. H. pylori was not detected by PCR, histology, or culture. CONCLUSIONS: We could not detect H. pylori in the cervix of patients with cervicitis. H. pylori-infected patients' cervices remain to be investigated, and a larger study is needed to draw firm conclusions.     

Correlation between the degree of duodenal bulbar deformity and the density of Helicobacter pylori infection in patients with active duodenal ulcers.

BACKGROUND: Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer disease. This prospective study was carried out to investigate the relationship between the degree of bulbar deformity and the density of Helicobacter pylori infection in patients with duodenal ulcer. METHODS: Patients with endoscopically proven active duodenal ulcers and a positive diagnosis of H. pylori infection were enrolled. Duodenal ulcers were divided into three types according to the degree of deformity of the bulb: type I, normal bulb; type II, mildly deformed; type III, markedly deformed. In each case, we evaluated the H. pylori density histologically. The density was graded according to the Sydney system (normal, mild, moderate, and marked). RESULTS: A total of 95 duodenal ulcer patients were studied, including 25 with type I, 40 with type II, and 30 with type III duodenal ulcers. H. pylori density was correlated with deformity of the duodenal bulb: 16/25 (64%) patients with a type I ulcer had mild infection, 19/40 (47.5%) patients with a type II ulcer had moderate infection, and 15/30 (50%) patients with a type III ulcer had marked infection. CONCLUSION: Patients with active type II or III duodenal ulcers had greater densities of H. pylori than did those with type I ulcers. A tendency for higher H. pylori density was seen as the degree of deformity of the duodenal bulb increased.     

Cytotoxin associated gene A-positive Helicobacter pylori strains in dyspeptic pregnant women

OBJECTIVE: The aim of the present study was to compare the Helicobacter pylori (HP) seropositivity and cytotoxin associated gene A (cagA) status in pregnant women with dyspeptic complaints and pregnant women with no gastrointestinal symptoms. STUDY DESIGN: Seventy-one consecutive pregnant women with gastrointestinal complaints and 72 age-matched pregnant women without any gastrointestinal symptoms or a history of gastrointestinal disease were included in the study. Demographic characteristics and H. pylori and cytotoxin associated gene A status of the groups were analysed. RESULTS: The prevalence of H. pylori seropositivity was slightly but not significantly higher in patients with dyspeptic complaints compared to the controls (74.6% versus 63.8%, respectively, P > 0.05). The incidence of dyspeptic complaints were 53.5% in HP-seropositive and 40.9% in HP-seronegative women (P > 0.05). The prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls (75.5% versus 45.7%, respectively, P = 0.002). Among HP-seropositive women, the incidence of dyspeptic complaints was significantly higher in cagA-positive patients compared to the cagA-negative ones (65.6% versus 34.2%, respectively, P = 0.002). When analysed according to the trimesters, the prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls in the first trimester (68.0% versus 34.8%, respectively, P = 0.021). CONCLUSION: Cytotoxin associated gene A-positive, virulent H. pylori strains were found to be more frequently associated with dyspeptic complaints in pregnant women.     

The surgical treatment of postgastrectomy reflux gastritis

Eighteen patients with postgastrectomy reflux gastritis were treated between 1970 and 1981 by Roux-en-Y diversion. All of the patients had a typical history of midepigastric burning pain and the majority had bilious vomiting as well. The diagnosis was confirmed by endoscopic results and histopathologic study of the gastric mucosa. Twelve surviving patients--one patient died postoperatively--experienced a dramatic relief of the symptoms. In five patients, gastrointestinal tract complaints reappeared but did not have the typical character of reflux gastritis. The macroscopically apparent gastritis subsided completely after revisional operations; while the histologic signs and symptoms of chronic gastritis remained. The Roux-en-Y diversion for patients with post-gastrectomy reflux gastritis proved to be a safe and relatively simple procedure with a high chance of relieving the complaints of the patient. The preoperative and postoperative gastric mucosal biopsies were not of much use in confirming the diagnosis or substantiation of the beneficial effect of the remedial operation.     

Helicobacter pylori infection and the occurrence and severity of gastrointestinal symptoms during pregnancy

OBJECTIVE: We investigated the possible role of Helicobacter pylori infection in the occurrence and severity of gastrointestinal symptoms during pregnancy in a large group of mothers after delivery. STUDY DESIGN: Between November 2000 and November 2001, mothers were recruited after delivery at the Department of Gynecology and Obstetrics at the University of Ulm. Present H pylori infection was determined by (13)C-urea breath test. Associations between gastrointestinal symptoms during pregnancy (sickness, vomiting, increased saliva production, heartburn) and H pylori infection were quantified by crude and adjusted odds ratios with 95% CI. RESULTS: Twenty-three percent of the 898 mothers had a current H pylori infection. Eighty-four percent of the mothers reported at least one of the evaluated gastrointestinal symptoms, and 30% of the mothers reported at least one physician visit because of the severity of these symptoms. None of the analyzed gastrointestinal symptoms showed an association to a current H pylori infection after an adjustment for the covariates, even after a virulence marker of H pylori infection was taken into account. CONCLUSION: This study does not support an involvement of H pylori infection in the generation of gastrointestinal symptoms during pregnancy.     

Helicobacter pylori, gastritis and duodenitis in the healing process of duodenal ulcer.

The occurrence of antral gastritis, duodenitis, gastric metaplasia and Helicobacter pylori (H. pylori) were compared between 63 endoscopically proven duodenal ulcer (DU) patients and 34 non-ulcer dyspepsia (NUD) patients with no ulcer history and no ulcer present as documented by endoscopy. The DU group showed a significantly higher rate of active antral gastritis (89% vs 41% p less than 0.05), a higher antral H. pylori carrying rate (76% vs 27% p less than 0.01), a higher rate of active chronic duodenitis (75% vs 32% p less than 0.05), and a higher rate of gastric metaplasia in the duodenal bulb (68% vs 27% p less than 0.05) than the NUD group. The H. pylori carrying rate in the bulb was 16% in the DU group and 0% in the NUD group. The difference is evident, although it is statistically insignificant. All 10 cases carrying H. pylori in the duodenum in the DU group had active chronic duodenitis with gastric metaplasia. Further evaluation of the variables (rate of active antral gastritis and duodenitis and the carrying rate of H. pylori in the antrum and bulb) showed no difference between different ulcer stages (active, healing, or scarred). The above findings strongly suggest a close relation between H. pylori and duodenal ulcer. However, the low occurrence rate of the bacteria in the bulb can only indicate a partial etiologic role of the bacteria in DU. No improvement in antral gastritis, duodenitis and H. pylori occurrence, despite the healing of an ulcer, is in agreement with the naturally high recurrence rate of duodenal ulcers.     

Serologic and stool antigen assay of Helicobacter pylori infection in hyperemesis gravidarum: Which test is useful during early pregnancy?

ObjectiveTo investigate the relationship between Helicobacter pylori infection and hyperemesis gravidarum (HG) during early pregnancy by using serologic and stool antigen tests in developing South Anatolia region of Turkey.Materials and MethodsA prospective cross-sectional study was performed on 40 pregnant women with HG and 40 asymptomatic controls without gastric problems at 7–12 weeks of gestation. The sociodemographic characteristics were recorded. The presence of H pylori was analyzed in the sera of the study-group patients by serology-specific IgG test in serum and by a stool antigen test in fecal samples.ResultsThe rates of serology-specific H pylori IgG positivity were 80% (32 of 40) in patients with HG and 35% (14 of 40) in control group. The difference between the two groups was significant [odds ratio: 6.9 (confidence interval: 2.2–22.1); p < 0.01]. The rates of H pylori stool antigen test positivity were 87.5% (35 of 40) in patients with HG and 62.5% (25 of 40) in control groups. The difference between the two groups was significant (odds ratio: 4.5, confidence interval: 1.09–18.5); p = 0.028.ConclusionBoth serology-specific IgG and stool antigen tests seem to be good screening methods to identify H pylori in our pregnant patient population with HG during early pregnancy.     

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.     

Relationship of duodenal ulcer recurrence to gastric metaplasia of the duodenal mucosa and duodenal bulb deformity.

BACKGROUND AND PURPOSE: This study investigated changes in the severity of gastric metaplasia (GM) of the duodenal mucosa before and after ulcer healing and Helicobacter pylori eradication. It also investigated whether deformity of the duodenal bulb affects the severity of GM and the likelihood of ulcer recurrence. METHODS: Eleven patients were consecutively enrolled in this study. They all had duodenal ulcer(s) and H. pylori infection, for which they had received anti-H. pylori triple therapy during the active ulcer stage, and had all undergone serial endoscopic examinations during both the active ulcer and scarring ulcer stages, and at 1 year after ulcer healing. Duodenal biopsies were obtained at each endoscopy to identify the severity of GM. Duodenal ulcers were divided into three types by bulbar shape and GM was classified into four grades of severity. RESULTS: All 11 patients had increased GM severity just after ulcer healing. The 1-year follow-up study revealed that the GM was unchanged in six of eight patients with grade 3 GM severity at the scarring stage, while in the other two it regressed to grade 1 or 2; these two patients suffered ulcer recurrence. A markedly deformed bulb (type III) was found in three patients, of whom two had ulcer recurrence. CONCLUSION: Two characteristic conditions were found in patients with duodenal ulcer recurrence after H. pylori eradication: a markedly deformed bulb with grade 3 GM at the scarring stage, and a change in GM from high to low grade at or around the previous ulcer site after ulcer healing.     

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.     

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.     

Risk factors for intestinal metaplasia in adult residents of Matzu: a cross-sectional study.

BACKGROUND AND PURPOSE: People living on Matzu, a group of small islets, have the highest mortality rate from gastric cancer (GC) in Taiwan. Intestinal metaplasia (IM) is a precursor lesion of GC. We therefore conducted a gastroscopic screening program in this district to evaluate the risk factors associated with IM. METHODS: A total of 274 residents of Matzu, aged 30 years or older, underwent testing for anti-Helicobacter pylori IgG antibody and serum pepsinogen (PG) I/PG II levels, and gastroscopic examination. Univariate and multivariate logistic regression models were used to identify risk factors associated with IM in terms of odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Among the 274 subjects, 118 (43%) were confirmed to have IM by histologic examination. Individuals aged 60 years or older had a 2.66 times higher risk (95% CI 1.38-5.13) of having IM, as compared with those less than 60 years of age. Subjects with duodenal ulcer had a 60% lower risk of coexisting IM (OR, 0.40; 95% CI, 0.19-0.83). Meanwhile, subjects with gastric ulcer were not at increased risk of IM (OR, 0.84; 95% CI, 0.34-2.08). Low serum PG I level, low PG I/PG II ratio, and positive anti-H. pylori IgG antibody, were associated with IM in the univariate analysis. While age and duodenal ulcer maintained their independent effects in the multivariate analysis, only a low PG I/PG II ratio and H. pylori positivity were significantly associated with IM. CONCLUSIONS: This study of residents of Matzu found that age and H. pylori infection are risk factors for IM, while subjects with duodenal ulcer have a lower incidence of coexisting IM. Low PG I/PG II ratio is a potential noninvasive biomarker of IM.     

Serologic assay of Helicobacter pylori infection. Is it useful in hyperemesis gravidarum?

OBJECTIVE: To assess the association of Helicobacter pylori seropositivity with hyperemesis gravidarum. STUDY DESIGN: A prospective study was performed on 160 pregnant women who were admitted to an outpatient clinic for prenatal care from November 2000 to December 2001. Eighty patients with hyperemesis gravidarum and 80 asymptomatic, pregnant women were examined for serum anti-H pylori IgG antibodies. Serum anti-H pylori IgG antibodies were evaluated using a commercially available enzyme-linked immunosorbent assay (ELISA)-based kit. Statistical analysis was conducted by using the Student t, chi 2 and Mann-Whitney U test. A P value < .05 was considered significant. RESULTS: The overall prevalence of H pylori seropositivity was 65.6%. Fifty-six of 80 hyperemesis patients (70%) and 49 of 80 control subjects (61.2%) were positive for anti-H pylori IgG antibodies. No significant difference in H pylori seropositivity was found between the groups. CONCLUSION: H pylori seropositivity is not significantly associated with hyperemesis gravidarum. Since we could not absolutely demonstrate that seropositivity for H pylori is associated with hyperemesis gravidarum, routine serologic analysis for H pylori is not encouraged. Understanding the role of H pylori infection in the pathogenesis of hyperemesis gravidarum necessitates further studies.     

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.