13C Urea Research Articles

Association of Helicobacter pylori infection and white blood cell count: a cross-sectional study.

Helicobacter pylori is a type of Gram-negative microaerobic bacteria that inhabits the gastric mucosal epithelium. It can cause various gastrointestinal diseases including gastritis, peptic ulcer and gastric cancer. White blood cells (WBC) are common immune cells, the increase in whose countoften indicates the presence of an infection. Currently, the relationship between H. pylori and WBC count remains full of controversy. This study aims to further elucidate the effects of H. pylori on WBC count in a population undergoing physical examination. A total of 864 participants who underwent physical examination and 14C urea breath test (UBT) were retrospectively enrolled in this study from January to June 2021. The overall population was divided into H. pylori-negative (Hp-) and H. pylori-positive (Hp+) groups based on the disintegration per minute (DPM) value detected by UBT. Spearman's correlation analysis was used to assess the correlation between DPM and WBC count. General linear regression models were applied to assess the potential factors contributing to the increase in WBC count. Generalised additive model (GAM) was performed to identify the non-linear relationship between DPM and WBC count. Additionally, a piecewise linear regression was used to examine the threshold effect of the DPM on WBC count. 403 subjects were diagnosed with H. pylori infection. The WBC and platelet (PLT) counts in the Hp+ group were significantly higher than those in the Hp- group. Additionally, the prevalence of H. pylori infection gradually increased with the WBC count quartiles (38.89% and 54.67% in quartile 1 and quartile 4, respectively). Spearman's correlation analysis showed that the DPM value significantly correlated with WBC count (r=0.089, p=0.009) and PLT count (r=0.082, p=0.017). The linear model revealed a positive independent association of H. pylori infection and DPM with WBC count (βHp+=0.398 (95% CI 0.170, 0.625), p<0.001; βDPM=0.002 (95% CI 0.000, 0.0030), p=0.018). The results of the GAM and the piecewise linear regression suggested that the cut-off points of the association between DPM and WBC count were 40 and 155 of DPM, that is, the effect of DPM on WBC count varied with the difference of DPM <40, 40-155, and >155 (βDPM=-0.005 (95% CI -0.017, 0.007), p=0.423; βDPM=0.006 (95% CI 0.002, 0.013), p=0.047; and βDPM=-0.007 (95% CI -0.012, -0.002), p=0.004, respectively). H. pylori infection was independently and positively correlated with WBC count; however, the effect of DPM on WBC count varied across different WBC count intervals, suggesting distinct immunological responses at different stages of infection.

Data-driven rapid detection of Helicobacter pylori infection through machine learning with limited laboratory parameters in Chinese primary clinics

BackgroundHelicobacter pylori (H. pylori) is a significant global health concern, posing a high risk for gastric cancer. Conventional diagnostic and screening approaches are inaccessible, invasive, inaccurate, time-consuming, and expensive in primary clinics. ObjectiveThis study aims to apply machine learning (ML) models to detect H. pylori infection using limited laboratory parameters from routine blood tests and to investigate the association of these biomarkers with clinical outcomes in primary clinics. MethodsA retrospective analysis with three ML and five ensemble models was conducted on 1409 adults from Hubei Provincial Hospital of Traditional Chinese Medicine. evaluating twenty-three blood test parameters and using the C14 urea breath test as the gold standard for diagnosing H. pylori infection. ResultsIn our comparative study employing three different feature selection strategies, Random Forest (RF) model exhibited superior performance over other ML and ensemble models. Multiple evaluation metrics underscored the optimal performance of the RF model (ROC = 0.951, sensitivity = 0.882, specificity = 0.906, F1 = 0.906, accuracy = 0.894, PPV = 0.908, NPV = 0.880) without feature selection. Key biomarkers identified through importance ranking and shapley additive Explanations (SHAP) analysis using the RF model without feature selection include White Blood Cell Count (WBC), Mean Platelet Volume (MPV), Hemoglobin (Hb), Red Blood Cell Count (RBC), Platelet Crit (PCT), and Platelet Count (PLC). These biomarkers were found to be significantly associated with the presence of H. pylori infection, reflecting the immune response and inflammation levels. ConclusionAbnormalities in key biomarkers could prompt clinical workers to consider H. pylori infection. The RF model effectively identifies H. pylori infection using routine blood tests, offering potential for clinical application in primary clinics. This ML approach can enhance diagnosis and screening, reducing medical burdens and reliance on invasive diagnostics.

Radioactivity concentration of 14C in the air of 14C urea breath test rooms and the resulting internal dose to medical staff

ObjectiveTo monitor the radioactivity concentration of 14C in the air of rooms used to perform 14C urea breath tests, and evaluate the contamination status of 14C released during such tests, and assess the occupational health risk to medical staff working in such areas. Methods14CO2 in air was absorbed from the air and turned into calcium carbonate through a chemical reaction. Then, calcium carbonate was prepared into a suspension in a low-potassium glass vial. The sample was analyzed using a low-background liquid scintillation counter. ResultsThe radioactivity concentrations of 14C in air of the breath-test rooms in hospitals and physical examination institutions range from 1.35 to 18.41 Bq/m3. The annual committed dose for medical staff was estimated to be between 2.01 × 10−2 and 2.74 × 10−1 μSv. ConclusionsOur results reveal a significant increase of 14C radioactivity concentration in the air of breath-test rooms, but the resulting committed dose is much lower than the limits prescribed by the International Commission on Radiological Protection (ICRP). However, the potential risk of long-term exposure to low-dose radiation should be paid more attention.

ABSORPTION AND DISTRIBUTION OF ULTRATRACE EXOGENOUS 14C UREA IN RATS

ABSTRACT The absorption and distribution of radiocarbon-labeled urea at the ultratrace level were investigated with a 14C-AMS biotracer method. The radiopharmaceutical concentrations in the plasma, heart, liver, spleen, lung, kidney, stomach, brain, bladder, muscle, testis, and fat of rats after oral administration of 14C urea at ultratrace doses were determined by AMS, and the concentration-time curves in plasma and tissues and pharmacokinetic distribution data were obtained. This study provides an analytical method for the pharmacokinetic parameters and tissue distribution of exogenous urea in rats at ultratrace doses and explores the feasibility of evaluation and long-term tracking of ultratrace doses of drugs with AMS.

The mutual interactions among Helicobacter pylori, chronic gastritis, and the gut microbiota: a population-based study in Jinjiang, Fujian.

Helicobacter pylori (H. pylori) is a type of bacteria that infects the stomach lining, and it is a major cause of chronic gastritis (CG). H. pylori infection can influence the composition of the gastric microbiota. Additionally, alterations in the gut microbiome have been associated with various health conditions, including gastrointestinal disorders. The dysbiosis in gut microbiota of human is associated with the decreased secretion of gastric acid. Chronic atrophic gastritis (CAG) and H. pylori infection are also causes of reduced gastric acid secretion. However, the specific details of how H. pylori infection and CG, especially for CAG, influence the gut microbiome can vary and are still an area of ongoing investigation. The incidence of CAG and infection rate of H. pylori has obvious regional characteristics, and Fujian Province in China is a high incidence area of CAG as well as H. pylori infection. We aimed to characterize the microbial changes and find potential diagnostic markers associated with infection of H. pylori as well as CG of subjects in Jinjiang City, Fujian Province, China. Enrollment involved sequencing the 16S rRNA gene in fecal samples from 176 cases, adhering to stringent inclusion and exclusion criteria. For our study, we included healthy volunteers (Normal), individuals with chronic non-atrophic gastritis (CNAG), and those with CAG from Fujian, China. The aim was to assess gut microbiome dysbiosis based on various histopathological features. QIIME and LEfSe analyses were performed. There were 176 cases, comprising 126 individuals who tested negative for H. pylori and 50 who tested positive defined by C14 urea breath tests and histopathological findings in biopsies obtained through endoscopy. CAG was also staged by applying OLGIM system. When merging the outcomes from 16S rRNA gene sequencing results, there were no notable variations in alpha diversity among the following groups: Normal, CNAG, and CAG; OLGIM I and OLGIM II; and H. pylori positive [Hp (+)] and H. pylori negative [Hp (-)] groups. Beta diversity among different groups show significant separation through the NMDS diagrams. LEfSe analyses confirmed 2, 3, and 6 bacterial species were in abundance in the Normal, CNAG, and CAG groups; 26 and 2 species in the OLGIM I and OLGIM II group; 22 significant phylotypes were identified in Hp (+) and Hp (-) group, 21 and 1, respectively; 9 bacterial species exhibited significant differences between individuals with CG who were Hp (+) and those who were Hp (-). The study uncovered notable distinctions in the characteristics of gut microbiota among the following groups: Normal, CNAG, and CAG; OLGIM I and OLGIM II; and Hp (+) and Hp (-) groups. Through the analysis of H. pylori infection in CNAG and CAG groups, we found the gut microbiota characteristics of different group show significant difference because of H. pylori infection. Several bacterial genera could potentially serve as diagnostic markers for H. pylori infection and the progression of CG.

A population-based study of Helicobacter pylori: Does asymptomatic infection mean no gastroscopic lesions?

We determined the common clinical characteristics of patients infected with Helicobacter pylori (H. pylori) and investigated the relationship between H. pylori infection, and clinical symptoms, and gastroscopic manifestations. Our focus was specifically on the clinical manifestations in asymptomatic patients. We obtained the physical examination data of patients who underwent the 14C urea breath test between January 2018 and December 2020 at our Hospital. Basic demographic data, questionnaire data on clinical symptoms, and clinical examination data of the patients were also collected, and the correlation analysis was performed. A total of 2863 participants were included in the study. The overall H. pylori infection rate was 26.30%. The clinical symptoms between H. pylori-positive patients and H. pylori-negative patients did not differ significantly (P > .05). However, H. pylori-positive patients exhibited more severe gastroscopic manifestations (P < .001). The 14C urea breath test disintegrations per minute (DPM) values in H. pylori-positive patients correlated with their serum pepsinogen and gastrin-17 levels. With an increase in the DPM value, more combinations of clinical symptoms appeared in the patients. Among H. pylori-positive patients, DPM levels in asymptomatic patients were lower than those in symptomatic patients (P < .001). However, gastroscopic manifestations did not vary significantly between asymptomatic and symptomatic patients (P > .05). Patients infected with H. pylori showed no specific gastrointestinal symptoms. Patients with asymptomatic infection showed lower DPM levels, but their gastroscopic manifestations were similar to those of patients with symptomatic infection, and their lesions were more severe than H. pylori-negative people.

Gastrointestinal Talaromyces marneffei infection in a man with AIDS: A case report.

Reports of intestinal Talaromyces marneffei infection have increased year by year, but those of gastric infection remain rare. Here, we report disseminated talaromycosis with gastric and intestinal ulcers in an AIDS patient who was treated by antifungal agents and a proton pump inhibitor and achieved a satisfactory outcome. A 49-year-old man developed a gastrointestinal illness with main abdominal distension, poor appetite and a positive HIV infection to our AIDS clinical treatment center. Electronic gastrointestinal endoscopy showed that the patient had multiple ulcers in the gastric angle, gastric antrum and large intestine. Gastric Helicobacter pylori infection was ruled out by paraulcerative histopathological analysis and a C14 urea breath test. The diagnosis was confirmed by gastroenteroscopic biopsy and metagenomic next-generation sequencing of gastric ulcer tissue. Symptomatic and supportive treatments [a proton pump inhibitor and gastrointestinal motility promotion] were initiated. The patient was prescribed sequential antifungal therapy with amphotericin B (0.5 mg/kg·d, 2 weeks) and itraconazole (200 mg, q12h, 10 weeks), and then followed with itraconazole for long-term secondary prevention (200 mg, qd). The combined use of antifungal agents and a proton pump inhibitor improved the patient's condition, and he was discharged home 20 days later. He had no gastrointestinal symptom during 1 year of telephone-based follow-up. In endemic areas, clinicians should be alert to the possibility of Talaromyces marneffei infection presenting with gastric ulcers in patients with AIDS, after excluding Helicobacter pylori infection.

Vonoprazan on the Eradication of Helicobacter pylori Infection.

This study aimed to investigate the efficacy and safety of vonoprazan in the eradication of Helicobacter pylori (H. pylori). A total of 120 cases of H. pylori-infected outpatients were selected and randomly divided into the traditional quadruple therapy, vonoprazan triple therapy, and vonoprazan quadruple therapy groups. The traditional quadruple therapy group patients were orally treated with esomeprazole (20 mg) 30 minutes before breakfast and supper, amoxicillin (1000 mg orally) 30 minutes after breakfast and supper, furazolidone (100 mg orally) 30 minutes after breakfast and supper, and bismuth potassium citrate (0.6 g orally) 30 minutes before breakfast and supper. The vonoprazan triple therapy group patients were treated with vonoprazan (20 mg orally) 30 minutes following breakfast and supper, amoxicillin (1000 mg orally) 30 minutes following breakfast and supper, and bismuth potassium citrate (0.6 g orally) 30 minutes before breakfast and supper. The vonoprazan quadruple therapy group patients were treated with vonoprazan (20 mg orally) 30 minutes following breakfast and supper, amoxicillin (1000 mg orally) 30 minutes after breakfast and supper, furazolidone (100 mg orally) 30 minutes after breakfast and supper, and bismuth potassium citrate (0.6 g orally) 30 minutes before breakfast and supper. The 3 groups were treated for 14 days, and adverse reactions, such as vomiting and abdominal distension, were recorded during the treatment period. The 14C urea breath test was used to detect whether H. pylori was successfully eradicated in the patients. The eradication rates of the vonoprazan triple therapy, vonoprazan quadruple therapy, and the traditional quadruple therapy groups were 80%, 95%, and 97.5%, respectively. The eradication rate was higher in the vonoprazan triple therapy and in the vonoprazan quadruple therapy groups compared with that noted in the control group. The adverse reactions were mild in these groups, and the main adverse reactions were nausea, abdominal distension, diarrhea, and constipation. The adverse reaction rate was 25%, 7.5%, and 15%, respectively. This rate was lower in the vonoprazan triple therapy and vonoprazan quadruple therapy groups than that noted in the control group. Both vonoprazan triple therapy and vonoprazan quadruple therapy regimens could increase the eradication rate of H. pylori. Vonoprazan triple therapy exhibited reduced side effects and could be applied in the eradication of H. pylori in the clinic.

Analysis of influencing factors associated with Hp infection in H-type hypertension

Objective to investigate the influencing factors of Helicobacter pylori (Hp) infection in patients with H type hypertension. Methods A total of 1089 patients with h-type hypertension who underwent physical examination in Lanzhou Petrochemical Company of petrochina in Lanzhou city, Gansu Province from May 2021 to September 2021 were selected as the research objects. All the patients were tested by 14C urea breath test and divided into Hp infected group (278 cases) and Hp non-infected group (811 cases) according to the test results. For collected age, sex and other general demographic indicators and determined systolic blood pressure (SBP) diastolic blood pressure (DBP) albumin (ALB) globulin (GLB) total protein (TP) albumin/globulin (ALB/GLB) uric acid (UA) triglyceride (TG) Total cholesterol (TC) High-density lipoprotein (HDL) Low density lipoprotein (LDL) fasting blood glucose (GLU) and other biochemical indicators were analyzed by univariate analysis and multivariate unconditiona Logistic regression analysis. Results Univariate analysis showed that albumin (ALB) in h-type hypertension patients in infection group was lower than that in lung infection group, and the difference was statistically significant (T =3.383, P<0.05). Systolic blood pressure (SBP), globulin (GLB), triglyceride (TG) and fasting blood glucose (GLU) were higher than those in the non-infected group, but the differences were not statistically significant (ALL P>0.05). Diastolic blood pressure (DBP), total protein (TP), uric acid (UA), total cholesterol (TC) and low density lipoprotein (LDL) were higher than those in the non-infected group. There were no significant differences (all P>0.05); Multivariate non-conditional Logistic regression showed that high density lipoprotein (DHL) was an independent protective factor for Hp infection in h-type hypertension patients (OR=0.49, P<0.05). Conclusions Hp infection is associated with lipid metabolism disorder, and high density lipoprotein is a protective factor of HELICobacter pylori infection in patients with H type hypertension.

The Helicobacter pylori infection rate detected in combination by immunohistochemical staining and 14C urea breath test in Xinjiang patient and analysis with its related factors

目的： 比较检测幽门螺杆菌（Hp）感染时14C尿素呼气试验（14C-UBT）法和胃镜病理活检组织的免疫组织化学（IHC）法差异，同时统计新疆地区Hp感染率并分析相关因素。 方法： 纳入行IHC和14C-UBT法检测Hp感染患者共5 747例；筛选其中“同时”（两种检测间隔<1周，取材包含胃窦）行IHC检测及14C-UBT检测的病例共3 944例，精确比较胃镜病理组织IHC染色及14C-UBT差异；联合两种方法统计5 747例患者Hp感染总体阳性率，统计学分析与常见临床病理因素的相关性。 结果： 同时行14C-UBT及IHC检测病例中14C-UBT检测灵敏度为94.9%，IHC检测灵敏度65.1%，差异有统计学意义（P<0.01）。联合两种检测方法统计，5 747例患者Hp感染总阳性率48.6%。不同性别、年龄组、民族及地域差异均有统计学意义（均P<0.01）；性别、年龄完全匹配的汉/维病例（555对）阳性率分别为41.4%及73.3%，差异有统计学意义（P<0.01）。 结论：14C-UBT法灵敏度显著高于IHC法，但也存在漏诊，联合应用有助于提高Hp感染检出率。新疆Hp总感染率高于既往报道，民族差异是最主要因素，防控重点为维吾尔族群众尤其是年轻人。.

The effects of Helicobacter pylori eradication therapy on salivary pepsin concentration in patients with laryngopharyngeal reflux.

To investigate the effect of Helicobacter pylori (HP) eradication therapy on salivary pepsin concentration in laryngopharyngeal reflux (LPR) patients with HP infection. A total of 477 patients with suspected LPR were enrolled from June 2020 to September 2021. Reflux symptom index, reflux finding score, the positive rates and disintegrations per minute values of HP infection detected by 14C urea breath test and salivary pepsin concentrations analyzed using enzyme-linked immunosorbent assay were compared in LPR patients and non-LPR patients with or without HP infection. HP-positive patients were treated with HP eradication therapy while HP-negative patients with PPI therapy. The scores of nagging cough (0.88 vs. 0.50, P = 0.035), erythema or hyperemia (1.93 vs. 1.78, P = 0.035) and vocal fold edema (1.04 vs. 0.85, P = 0.025) were higher in the LPR (+) Hp (+) subgroup than in LPR (+) Hp (-) subgroup. The concentrations of salivary pepsin in the Hp (+) subgroup were higher than in the Hp (-) subgroup either in LPR patients (75.24ng/ml vs. 61.39ng/ml, P = 0.005) or the non-LPR patients (78.42ng/ml vs. 48.96ng/ml, P = 0.024). Compared to baseline (before treatment), scores of nagging cough (0.35 vs. 0.84, P = 0.019) and erythema or hyperemia (1.50 vs. 1.83, P = 0.039) and the concentrations of salivary pepsin (44.35ng/ml vs. 74.15ng/ml, P = 0.017) in LPR patients with HP infection decreased after HP treatment; yet, this was not observed for the LPR patients without HP infection treated with PPI only (P > 0.05). HP infection may aggravate the symptoms and signs of LPR patients, partly by increasing their salivary pepsin concentration.

Association between Helicobacter pylori infection and the risk of type 2 diabetes mellitus based on a middle-aged and elderly Chinese population.

Evidence about the relationship between Helicobacter pylori (Hp) infection and type 2 diabetes mellitus (T2DM) is inconsistent and contradictory. This study attempted to investigate this association in the middle-aged and elderly Chinese population and analyze the joint effects of Hp infection and some risk factors on T2DM. Following a cross-sectional design, participants were recruited from the First Affiliated Hospital of Anhui Medical University in Hefei City, China. Hp status was measured using a 14C urea breath test. A total of 1,288 participants, including 90 diabetic patients and 1,198 nondiabetic subjects, were recruited in the current study. The participants with T2DM had a greater prevalence of Hp infection than participants without T2DM (26.67% versus 18.11%, p = 0.045). Furthermore, we found that Hp infection was closely associated with an incremental risk of T2DM [odds ratio (OR) = 1.77, 95% confidence intervals (CI): 1.04-3.00] after adjustment for potential confounders. In addition, we observed that the participants who were Hp-positive and ≥60 years old (OR = 9.16, 95% CI: 3.29-25.52), Hp-positive and obese (OR = 3.35, 95% CI: 1.57-7.14) or Hp-positive and hypertensive (OR = 6.10, 95% CI: 3.10-12.01) had a significantly higher risk for T2DM than those who were Hp-negative and ≤50 years old, Hp-negative and nonobese or Hp-negative and nonhypertensive. These findings imply that Hp infection is associated with an increased risk of T2DM in the middle-aged and elderly Chinese population. The association could be further elevated by the combination of Hp infection and some traditional risk factors.

Efficacy and safety of bismuth quadruple regimens containing tetracycline or furazolidone for initial eradication of Helicobacter pylori.

Helicobacter pylori (H pylori) infection can cause chronic gastritis, peptic ulcer, and even gastric cancer, so effective eradication is critical.This study compared the efficacy and safety of bismuth quadruple regimens including either tetracycline or furazolidone for initial eradication.Patients newly diagnosed with H pylori infection from January 2020 to January 2021 were randomly assigned to receive either the tetracycline-containing regimen (n = 116) or furazolidone-containing regimen (n = 168). Both regimens included 1 proton pump inhibitor (rabeprazole 20 mg, or esomeprazole 20 mg, or eprazole 5 mg), colloidal pectin bismuth 300 mg, and amoxicillin 1000 mg in addition to tetracycline 1.0 g or furazolidone 0.1 g. All drugs were administered twice daily for 12 consecutive days. The 14C urea breath test was used for diagnosis, and re-test negativity at one-month follow-up was considered successful eradication. Adverse events were recorded during follow-up by telephone interview.In total, 109 patients in the tetracycline group and 157 in the furazolidone group were re-examined at 1 month. In the tetracycline group, 101 patients tested negative at follow-up, yielding an eradication rate of 92.7% according to per-protocol analysis and 87.1% by intention-to-treat analysis. In the furazolidone group, 141 patients tested negative, yielding eradication rates of 89.8% by PP and 83.9% by ITT. Eradication rates did not differ significantly between regimens (per-protocol: χ2 = 0.637, P = .517; intention-to-treat: χ2 = 0.537, P = .501). However, total adverse events incidence was significantly lower in the tetracycline group (20.2% vs 37.6%; χ2 = 9.193, P = .003).Both bismuth quadruple regimens produce high initial eradication, but the tetracycline regimen appears safer.

Lack of Association Between Helicobacter pylori Infection and the Risk of Thyroid Nodule Types: A Multicenter Case-Control Study in China.

The prevalence of Helicobacter pylori infection is high worldwide, while numerous research has focused on unraveling the relationship between H. pylori infection and extragastric diseases. Although H. pylori infection has been associated with thyroid diseases, including thyroid nodule (TN), the relationship has mainly focused on potential physiological mechanisms and has not been validated by large population epidemiological investigations. Therefore, we thus designed a case-control study comprising participants who received regular health examination between 2017 and 2019. The cases and controls were diagnosed via ultrasound, while TN types were classified according to the guidelines of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Moreover, H. pylori infection was determined by C14 urea breath test, while its relationship with TN type risk and severity was analyzed using binary and ordinal logistic regression analyses. A total of 43,411 participants, including 13,036 TN patients and 30,375 controls, were finally recruited in the study. The crude odds ratio (OR) was 1.07 in Model 1 (95% CI = 1.03–1.14) without adjustment compared to the H. pylori non-infection group. However, it was negative in Model 2 (OR = 1.02, 95% CI = 0.97–1.06) after being adjusted for gender, age, body mass index (BMI), and blood pressure and in Model 3 (OR = 1.01, 95% CI = 0.97–1.06) after being adjusted for total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein on the basis of Model 2. Control variables, including gender, age, BMI, and diastolic pressure, were significantly correlated with the risk of TN types. Additionally, ordinal logistic regression results revealed that H. pylori infection was positively correlated with malignant differentiation of TN (Model 1: OR = 1.06, 95% CI = 1.02–1.11), while Model 2 and Model 3 showed negative results (Model 2: OR = 1.01, 95% CI = 0.96–1.06; Model 3: OR = 1.01, 95% CI = 0.96–1.05). In conclusion, H. pylori infection was not significantly associated with both TN type risk and severity of its malignant differentiation. These findings provide relevant insights for correcting possible misconceptions regarding TN type pathogenesis and will help guide optimization of therapeutic strategies for thyroid diseases.

Detection of Helicobacter pylori infection by 14 C urea breath test in asymptomatic adults: A pilot study in Kanbauk village tract

As Helicobacter pylori infection is highly prevalent estimated to be affecting more than 50% of the world's populations and implicated in the pathogenesis of several gastric diseases including gastric cancer, early detection of infection even before symptoms appears to be one of the most important strategies in management. This study was aimed to detect infection by 14C urea breath test and to describe the risk factors in asymptomatic adults at Kanbauk village-tract, located in Southern Myanmar. It was a community-based, cross-sectional prevalence study conducted between 4 and 9 October 2019. After thorough history taking, physical examination, obtaining informed consent, and fasting for 5 h, H pylori infection was detected by 14C urea breath testing. Among 149 volunteers, infection was detected in 68.46% of the study population. The prevalence of H pylori infection in male patients was 66.7% and in female patients was 75%. There was no statistically significant association between H pylori infection and gender (P = 0.36). The mean age of H pylori infected patients was 37.4 years (SD ± 9.14) and it did not differ significantly (P = 0.421). Subjects who never attended government school were found out to have a significant association with H pylori infection (P = 0.006). Other factors such as family income, household numbers, smoking, betel chewing habit, alcohol consumption, BMI and blood groups were found to be no significant risk factors for H pylori infection. The prevalence of H pylori in Kanbauk village tract was comparable to two different community studies conducted in Myanmar.

Involvement of CO2 generated by urease in multiplication of Helicobacter pylori

Helicobacter pylori (H. pylori) urease generates both ammonia (NH3) and carbon dioxide (CO2) from urea. NH3 helps H. pylori to survive in the stomach in part by neutralizing gastric acid. However, the relationship between CO2 and H. pylori is not completed cleared. We examined the effect of CO2 generated by urease on multiplication of H. pylori by using isogenic ureB mutant and ureB complemented strain from H. pylori strain JP26. Wild-type strain survived in the medium supplement with 1mM urea in room air, however, the urease negative strain did not. To discern whether CO2 was incorporated into H. pylori, 14C in bacillus was counted after 6 hours incubation with 14C urea in both acidic and neutral medium. Significant more 14C uptake was detected in wild-type strain compared to ureB mutant strain and this uptake in the wild-type strain was more under acidic condition compared to under neutral condition, but no difference was identified in the mutant strain. These results suggest that CO2 generated by urease plays a role in multiplication of H. pylori.

Diagnostic Value of 14C Urea Breath Test for Helicobacter pylori Detection Compared by Histopathology in Indonesian Dyspeptic Patients.

PurposeHistopathology method is often used as a gold standard diagnostic for Helicobacter pylori infection in Indonesia. However, it requires an endoscopic procedure which is limited in Indonesia. A non-invasive method, such as 14C Urea Breath Test (UBT), is more favorable; however, this particular method has not been validated yet.Patients and MethodsA total of 55 dyspeptic patients underwent gastroscopy and 14C-UBT test. We used Heliprobe® UBT for UBT test. As for the histology, May-Giemsa staining of two gastric biopsies (from the antrum and corpus) were evaluated following the Updated Sydney System.ResultsThe Receiver Operating Characteristics analysis showed that the optimum cut-off value was 57 with excellence Area under Curve = 0.955 (95% CI = 0.861–1.000). By applying the optimum cut-off value, Heliprobe® UBT showed 92.31% for sensitivity, 97.62% for specificity, 92.31% for positive predictive value, 97.62% for negative predictive value, 38.77 for positive likelihood ratio, 0.0788 for negative likelihood ratio, and 96.36% for the accuracy.ConclusionThe 14C-UBT is an accurate test for H. pylori diagnosis with excellent sensitivity, specificity, and accuracy. The different optimum cut-off points suggested that a validation is absolutely necessary for new test prior application to the new population.

Synergistic effect of cumin (Cuminum cyminum L.) decoction alongside with three-drug and four-drug treatment protocols on Helicobacter pylori eradication

Background: Helicobacter pylori is a major cause of peptic ulcer. On the other hand, cumin (Cuminum cyminum L.) is an effective medicinal plant for the treatment of gastrointestinal disease in traditional Persian medicine. This study aimed at investigating the synergistic effect of the decoction of cumin with the three- and four-drug protocols against H. pylori in patients with peptic ulcer. Patients with peptic ulcer infected with H. pylori were treated with cumin decoction, three- and four-drug protocols, and their co-administration to eradicate H. pylori. Materials and Methods: Patients were randomly divided into five groups, including group (1) omeprazole with cumin decoction, (2) cumin decoction with the three-protocol treatment, (3) cumin decoction with the four-drug protocol treatment, and (4 and 5) three- and four-drug protocols alone. The cumin fruit powder was given to patients in 3-g packages and decoction was prepared according to the traditional Iranian medicine guidelines. H. pylori eradication was measured by the 14C–urea breath test (14C-UBT) after 4 weeks of intervention. The Kolmogorov–Smirnov test, χ2 test, logistic regression, and ANOVA (SPSS, 11.5) were used for data analyses. Results: In total, 75 patients (48 male and 27 female patients) participated in this study. The results showed that eradication of H. pylori was observed in all five study groups. Eradication of H. pylori in cumin decoction with the three-drug protocol group was more than the other groups (85.72%), although this difference was not statistically significant. In addition, this eradication was 61.5% in the cumin + omeprazole group, while the H. pylori eradication rates for the three-drug and four-drug protocols were 77.8% and 58.33%, respectively. Conclusions: The results showed that decoction of cumin could be used as a complementary treatment alongside conventional medicine therapy to increase the H. pylori eradication.

Cytotoxin-associated gene A increases carcinogenicity of helicobacter pylori in colorectal adenoma

This study aimed to investigate the correlation of Helicobacter pylori (Hp) infection with disease risk and severity of colorectal adenoma, also to explore the association of cytotoxin-associated gene A (CagA) positive (CagA+)-Hp infection with gastrin and ki-67 expressions in colorectal adenoma patients. There were 1000 colorectal adenoma patients and 1500 controls consecutively enrolled, then Hp infection status was determined by 14C urea breath test and rapid urease test. Also, serum CagA expression and gastrin expression of colorectal adenoma patients were determined by enzyme-linked immunosorbent assay. Ki-67 expression in adenoma tissue of colorectal adenoma patients was assessed using immunohistochemistry. Hp+ rate in colorectal adenoma patients (623 (62.3%)) was more elevated than that in controls (814 (54.3%)). Multivariate logistic regression model analysis disclosed that Hp+ was an independent risk factor for colorectal adenoma. Additionally, Hp+ was positively associated with tumor size and high-grade intraepithelial neoplasia in colorectal adenoma patients. Also, serum gastrin expression and intratumoral ki-67 expression were higher in Hp+ CagA+ patients and Hp+ CagA- patients compared to Hp- patients, and they were also higher in Hp+ CagA+ patients compared to Hp+ CagA- patients. Hp infection positively associates with higher disease risk and worse disease conditions of colorectal adenoma, and CagA enhances the carcinogenicity of Hp in colorectal adenoma.

2990 Helicobacter pylori in Chronic Spontaneous Urticaria: An Interim Analysis of a Case-Control Study in Nepalese Population

INTRODUCTION: Chronic spontaneous urticaria (CSU) is defined as the spontaneous appearance of wheals, angioedema or both for more than six weeks due to known or unknown causes. Infections like helicobacter pylori have been implicated as causes of CSU. In this study, we aimed to determine an association of H. pylori infection with CSU. METHODS: This was a case-control study conducted in Lumbini city Hospital, Butwal, Nepal. Study duration was from March to May 2019. Sample size was calculated to be 83 participants in each group. Participants fulfilling the diagnosis of CSU were enrolled. They underwent 14C -Urea Breath Test (UBT) by a standard protocol, for noninvasive detection of H. pylori. HUBT-20P model of the analyzer from Shenzhen, China was used. A value of less than 150 DPM (disintegration per minute) was considered to be negative. We excluded the following from the study: pregnant individuals, participants with recently used of antibiotics and bismuth compounds (&lt;4 weeks), participants with recent use of proton pump inhibitors (&lt;2 weeks), less than two years age, those with previous gastric surgery and those suspected of having coexisting inducible urticaria. The results were compared with age and sex-matched controls. RESULTS: We included 29 patients with CSU and 29 controls in this study. The average age of participants was 25.8 ± 8.69 years. Sixteen (55.17%) patients with CSU were females and 13 (44.82%) were males. Twenty-six (89.65%) patients with CSU tested positive for H. pyloriwith UBT; only 10 (34.48%) participants from the control group tested positive. The distribution of H. pylori by 14-C urea breath test in cases and controls is shown in Table 1. CONCLUSION: In this interim analysis of 29 cases and controls, majority of participants were females with an average age of 25.8 years. In a study of 673 adults with CSU, majority (72%) were reported to be females. Chronic urticaria is sometimes associated with other autoimmune conditions and hence its increased prevalence in females may be indirect evidence of the autoimmune nature of this disease. Most of the participants with CSU tested positive for H. pylori with UBT as compared to the age and sex-matched controls and this difference was statistically significant (P &lt; 0.0001).