Analysis of Risk Factors and Circumferential Distribution of Exposed Cardiac Glands

Effects of Helicobacter pylori and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Disease: A Systematic Review

Introduction: The role of Helicobacter pylori (HP) in gastroesophageal reflux disease (GERD) remains controversial particularly in children since there is limited published data. Previous studies in adult populations suggested that there is an increased prevalence of GERD following successful eradication of HP. These studies suggested that HP infection might protect against GERD by its propensity to produce atrophic gastritis and reduced gastric acid secretion. The objective of our study is to determine the significance of HP for GERD in the pediatric population. Methods: A retrospective analysis of 437 patients (M:F = 227:210) who underwent upper endoscopies with biopsies between January 2000 and April 2006 was conducted. The prevalence of reflux esophagitis (RE) in two groups, HP+ and HP- was reviewed. The prevalence of RE in HP+ and HP- was further analyzed based on their gender and age (0-1 yr, 1-10 yr, 10-20 yr). The mean age of the study population was 8.15 years (range 0-20 yr). Statistical analysis used Chi-square test. Results: Of 437 patients, 17 patients were HP+ and 100 patients were found to have RE with an incidence of 22.9%. The prevalence of RE in HP+ was 41.2% and in HP- was 22.1% (P = 1.31E-05). In 227 male patients, the prevalence of RE in HP+ was 40.0% and in HP- was 25.8% (P = 3.57E-05). In 210 female patients, the prevalence of RE in HP+ was 42.9% and in HP- was 18.2% (P = 1.05E-06). In the first age group (0 - 1 yr), there was 0 patients with HP +. In the second age group (1 - 10 yr), the prevalence of RE in HP+ was 50.0% and in HP- was 27.6% (P = 5.64E-11). In the third age group (10 - 20 yr), the prevalence of RE in HP+ was 33.3% and in HP- was 21.3% (P = 1.19E-02). Conclusions: Our study results suggest that there is an increased prevalence of RE in HP+ group compared with HP- group in both male and female patients in all age groups, except for infants in which there were zero patients with HP+. The findings do not support a hypothesis that HP infection may have a protective role against GERD in the pediatric population.

American Gastroenterological Association Institute Guideline on the Role of Upper Gastrointestinal Biopsy to Evaluate Dyspepsia in the Adult Patient in the Absence of Visible Mucosal Lesions

Central Adiposity and Risk of Barrett’s Esophagus

The effects of Helicobacter pylori (HP) eradication on gastroesophageal reflux disease (GERD) are yet to be fully elucidated. Few studies have investigated the mechanisms underlying the correlations between HP and GERD with prospective methods. The objective of this prospective clinical study was to explore the effects of HP eradication on GERD. Patients diagnosed with both GERD and HP were included. High-resolution esophageal manometry (HRM), 24-h esophageal pH monitoring, and the Gastroesophageal Reflux Disease Questionnaire (GerdQ) were performed before and after the successful eradication of HP, and the data were compared using statistical analysis. Sixty-eight patients diagnosed with both GERD and HP were included. The After HP eradication group showed significantly decreased median distal contractile integral (DCI) [610.40 (847.45) vs. 444.90 (559.60)] and significantly increased median inefficient esophageal motility (IEM) [36.00 (50.00) vs. 60.00 (57.00)] in the HRM compared with those of the Before HP eradication group, indicating that HP eradication reduced esophageal peristalsis. The 24-h esophageal pH monitoring showed that the longest reflux event, the percentage of time that the pH was <4, the number of reflux episodes, and the DeMeester score were all significantly different between the Before and After HP eradication groups (P < 0.05), suggesting that HP eradication increased esophageal acid exposure. The After HP eradication group also had a significantly higher GerdQ score than that of the Before HP eradication group (P < 0.05). HP eradication reduced esophageal peristalsis, enhanced esophageal acid exposure, and aggravated GERD symptoms, suggesting that HP infection may be a protective factor for GERD.

INTRODUCTION: Helicobacter pylori (HP) is a common gastric infection with the highest prevalence in Asia, Africa, Central, and South America as well as in U.S. immigrants from these areas. Current American College of Gastroenterology (ACG) guidelines recommend screening for HP in cases such as patients with active or prior peptic ulcer disease (PUD). However, screening is not recommended for patients who exhibit only symptoms of gastroesophageal reflux disease (GERD) irrespective of regional origin. The goal of this study was to determine if patients from endemic regions with GERD should be screened for HP. METHODS: This is a retrospective chart review of all patients who presented to an internal medicine ambulatory care clinic in 2017 with symptoms of GERD and/or PUD for whom orders were placed for HP testing via stool antigen or endoscopic biopsy. GERD symptoms were defined as reflux or heartburn and PUD as any symptom of dyspepsia. Patients were stratified by symptoms: GERD, PUD, or both. Exclusion criteria were as follows: tests ordered but never collected, orders for confirmation of cure for prior infection, multiple tests ordered for the same patient over the study period, tested patients with no symptoms, and patients with symptoms related to a non-H. pylori preexisting disorder. Enrolled patients were further stratified by region of origin. RESULTS: 122 patients that met the selection criteria were included in this study. 43% (52/122) of all patients were positive for HP. Of those that were positive, 92% (48/52) came from an endemic area (83% from South or Central America) and of these 75% (36/48) had PUD symptoms, 25% (12/48) had GERD only, and 52% (25/48) had both GERD and PUD symptoms. Of HP positive patients from non-endemic areas, all had GERD symptoms (4/4), with 1 having GERD only. Of patients that had GERD symptoms only, 25% (12/48) tested positive for HP and were from endemic areas. CONCLUSION: In our study, 25% of patients from endemic regions with solely GERD symptoms tested positive for HP, suggesting that recommendations for screening should include this population. Our data collection was small and skewed towards patients originating from endemic regions of South and Central America, and the results may not be applicable to other endemic regions, such as Asia and Africa. Further studies are needed to establish appropriate screening recommendations that are applicable to other endemic areas, so that the diagnosis of HP is not missed.

Background: There are many risk factors associated with degree of development erosive esophagitis and its complications. Aim of the Study: To evaluate the effect of risk factors on severity of esophagitis and identify the most important risk factors among patients presenting to gastroscopy unit. Patients and Methods: Patients with upper gastrointestinal tract (GIT) symptoms were enrolled in gastroscope examination. For each participant, the body mass index (BMI), waist circumference, and immunoglobulin G Helicobacter pylori were done. Results: A total of 195 patients with upper GIT symptoms were examined by gastroscope. One hundred and twenty patients had erosive esophagitis (Grade II and III) (Group A): 75 of them were men (62.5%) and 45 (37.5%) were women. The rest 75 had gastroesophageal reflux disease Grade I (Group B), 52% of them were males, and the rest were females. Group A patients were more likely to be non-steroidal anti-inflammatory (NSAID) users (42.5%) than Group B (P = 0.0002). Group A was more likely to be obese (body mass index >30) (37.5%) (P = 0.015). Men have waist circumference >102 cm and women have a waist circumference >88 cm constitute 92.5% (P = 0.0001) of Group A. Patient with Group A who had hiatus hernia (HH) were (20%) (P = 0.0001) and those with H. pylori (35%) (P = 0.001). Conclusions: Obesity, abdominal obesity, NSAID, HH, and H. pylori infection are strong risk factors for gastroesophageal reflux grades.

Obesity associated with increased risk of gastric Helicobacter pylori infection in an elderly Chinese population.

To investigate the association between various risk factors and precancerous lesion of gastric cancer (PLGC) in patients from eastern China. 501 cases of PLGC and 523 cases of superficial gastritis were included. A comparative study of the relation between different risk factors and PGLC was performed. Statistical differences were noted in a series of indexes including Helicobacter pylori (HP) infection, family history of esophageal cancer (EC), gastric cancer (GC) and chronic atrophic gastritis (CAG), a history of CAG, gastric polyps (GP) and gastric ulcer (GU), usage of non-steroids (e.g., aspirin), gastroesophageal reflux disease (GERD), consuming alcohol, eating food rich in nitroso compounds, irregular eating habits with no breakfast, ingestion of smoked meat, fried food and spicy food, anxiety and depression. The risk factors associated with PLGC ranked in an order of a history of CAG, GP, family history of GC, usage of non-steroids (e.g., aspirin), ingestion of spicy food frequently, HP infection, family history of EC, consuming alcohol, anxiety, a history of GU, GERD and family history of CAG. A history of CAG was most associated with PLGC in patients from eastern China, followed by a history of GP and family history of GC.

Research agenda for pediatric gastroenterology, hepatology and nutrition: acid-peptic diseases. Report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the Children's Digestive Health and Nutrition Foundation.

Esophageal Cancers and Helicobacter pylori: Do Host Genes Matter?

Emerging studies have shed light on the association between Helicobacter pylori (HP) infection and cardiometabolic risk. However, there is no evidence to support a causal link for the relationship in the general population. Our aim was to determine whether HP infection is associated with the risks of incident type II diabetes mellitus (DM) in a population-based cohort consisting of adults from the general population. A total of 69235 adults enrolled in the study obtained health examinations at the Tri-Service General Hospital in Taiwan from 2010 to 2016. HP infection detection was performed by rapid urease tests (RUTs), and endoscopic examinations were used to diagnose gastroesophageal reflux disease (GERD), gastric ulcers (GUs) and duodenal ulcers (DUs). Cross-sectional and longitudinal analyses were performed to examine the association between HP infection and cardiometabolic diseases using logistic regression and Cox regression in a large population-based study. HP infection was significantly associated with the presence of metabolic syndrome (MetS) (OR = 1.26, 95%CI: 1.00–1.57) and DM (OR = 1.59, 95%CI: 1.17–2.17) only in male subjects, and abnormal endoscopic findings were also correlated with cardiometabolic diseases. Our findings demonstrated that participants with HP infection had an elevated risk of developing incident DM (HR = 1.54, 95%CI: 1.11–2.13). In addition, endoscopic findings of a DU (HR = 1.63, 95%CI: 1.02–2.63), rather than GERD or a GU, were also predictive of incident DM. In this cohort, HP infection was a statistically significant predictor of incident DM among male population.

BACKGROUND Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial. AIM: To determine the association between reflux disease and gastritis pattern in patients with Helicobacter pylori (H. pylori) infection. METHODS 470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas. RESULTS H. pylori infection rate was 367 (78.1%) with mean age of 59.8 ± 11.4 years. Of them 131 patients (35.7%) were male. Reflux disease was detected in 273 (74.4%) patients. 216 (58.9%) and 102 (27.8%) patients had non-erosive reflux disease (NERD) and gastroesophageal reflux disease (GERD), respectively. Corpus predominant and antral predominant gastritis were seen in 72 (19.6%) and 129 (35.2%) patients, respectively. Antral gastritis was significantly associated with GERD (p<0.01). In regression analysis, antral predominant gastritis had a significant association with GERD (OR=1.92; 95%CI: 1.22- 3.12). The same result was observed in mild to moderate antral and greater curvature gastritis (OR= 1.26; 95%CI: 0.25-6.40 and OR= 3.0; 95%CI: 0.63-14.17, respectively). CONCLUSION According to these finding ,we could suggest that the pattern of gastritis could be associated with reflux disease and GERD.

BackgroundThe association between H. pylori (Helicobacter pylori) infection and gastroesophageal reflux disease (GERD) is a complex and confusing subject. The aim of this study was to evaluate the association between helicobacter pylori infection and erosive gastroesophageal reflux disease.MethodIn a cross-sectional study, all patients referred for endoscopy due to dyspepsia were enrolled. The diagnosis of erosive GERD was made by endoscopy. Patients with normal esophagus were selected as comparison group. Random gastric biopsies were taken from all participants to diagnose H. pylori infection.ResultIn total, 1916 patients were included in this study, of whom 45.6% had GERD. The mean age (SD) was 42.95 (16.32). Overall, 1442 (75.3%) patients were positive for H. pylori infection. The frequency of H. pylori infection in mild GERD patients was higher than the severe GERD, but this difference was not significant (P = 0.214). Except for sociodemographic status (P < 0.001), other variables including gender, age, ethnicity, body mass index (BMI), smoking, and presence of hiatus hernia in patients had no significant association with the frequency of H. pylori infection. According to Robust Poisson regression models analysis, the association of H. pylori (PR 1.026; 95% CI 0.990–1.064; P = 0.158) and sociodemographic status were not significantly different between the two groups. But smoking, increased BMI, older age, presence of hiatus hernia, and peptic ulcer diseases were significantly associated with GERD compared with the non-GERD group.ConclusionIn our results, there was no association between H. pylori infection and erosive GERD. Further studies are recommended.

Background and Aims: Gastroesophageal reflux disease (GERD) reportedly has increased in prevalence while Helicobacter pylori infection and peptic ulcer disease have been on the decrease. The aim of the present study was to examine the prevalence of GERD as well as the clinical, endoscopic and histologic variables that associate with GERD in patients referred for endoscopy. Patients and Methods: The study population was drawn from 1,562 consecutive patients referred for endoscopy. The exclusion criteria were previous H. pylori eradication, gastric surgery, anemia and weight loss. Thus 1,128 patients were enrolled in the present study. Results: Of the 1,128 patients, 199 (18%) were referred for endoscopy due to heartburn and/or regurgitation. GERD, defined as chronic (>6 months) heartburn and/or regurgitation with or without erosive esophagitis, Barrett’s esophagus, esophageal ulcer or stricture, was detected in 248 (22%) patients. Of the 248 GERD patients, 81 (33%) had endoscopy-negative GERD, but of those aged <50 years (n = 67), 57 (85%) were endoscopy-negative. The overall incidence of GERD was 307 per 100,000 population/year and that of endoscopy-positive GERD 207/100,000/year. The positive and negative predictive values of heartburn and regurgitation for endoscopy-positive GERD were 0.37 (95% CI 0.31–0.44) and 0.90 (95% CI 0.88–0.92), respectively. Independent risk factors for GERD were male sex (OR 1.9, 95% CI 1.3–2.7), previous medication for upper gastrointestinal symptoms (OR 2.7, 95% CI 1.7–4.1), the use of nonsteroidal anti-inflammatory drugs (NSAIDs; OR 2.0, 95% CI 1.3–3.0), histologic esophagitis (OR 2.2, 95% CI 1.5–3.2) and incomplete intestinal metaplasia at the gastroesophageal junction (OR 1.7, 95% CI 1.0–3.1). Chronic gastritis was protective against GERD (OR 0.7, 95% CI 0.5–0.9). No association was observed between GERD and H. pylori infection. The risk of patients aged <50 years (n = 407) of having major lesion (Barrett’s esophagus, esophageal stricture, peptic ulcer, esophageal/gastric carcinoma) was significantly lower than that of patients aged >50 years (n = 721; OR 0.5, 95% CI 0.3–0.9, p = 0.01). Conclusions: The correlation between reflux symptoms and endoscopy-positive GERD is poor and most GERD patients aged <50 years have endoscopy-negative GERD. The use of NSAIDs is a risk factor for GERD, whereas chronic gastritis, but not H. pylori infection, may protect against GERD. Incomplete intestinal metaplasia at the gastroesophageal junction is associated with GERD.