Cause Of Peptic Ulcer Disease Research Articles

Prevalence of Helicobacter pylori Infection in Military Personnel from Northeast China: A Cross-Sectional Study.

PurposeHelicobacter pylori infection is an important cause of peptic ulcer disease and gastric cancer. Current knowledge regarding epidemiology of H. pylori infection in military personnel has insufficiently been updated. This cross-sectional study aimed to estimate the prevalence of H. pylori infection in military personnel and to compare the prevalences in military and civilian groups.Patients and MethodsWe retrospectively enrolled the subjects who underwent 14C-urea breath tests at the Department of Gastroenterology of the General Hospital of Northern Theater Command between January 2017 and July 2020. Subjects were divided into military and civilian groups. H. pylori infection and major endoscopic findings were reviewed.ResultsOverall, 23,496 subjects were eligible, including 2282 subjects in the military group and 21,214 subjects in the civilian group. In the overall analysis, the prevalence of H. pylori infection was not significantly different between military and civilian groups (33.9% versus 34.4%, P=0.592). In the population aged 17–25 years, the prevalence of H. pylori infection was significantly higher in the military group than in the civilian group (35.6% versus 25.9%, P=0.001). Both 14C-UBT and endoscopy were performed in 547 inpatients, including 83 military inpatients and 464 civilian inpatients. There was a significantly higher prevalence of H. pylori in inpatients with peptic ulcer and/or gastric cancer than in those without (65.5% versus 41.4%, P=0.001).ConclusionAmong the adolescent population, H. pylori infection may be more common in military personnel as compared to the civilians. Well-designed prospective studies should be required to validate such a high prevalence and to explain its potential causes.

Fourteen-day sequential therapy is superior to 7-day triple therapy as first-line regimen for Helicobacter pylori infected children

Helicobacter pylori infection is one of the most common causes of peptic ulcer disease among children. This study is aimed to investigate the eradication rate of 14-day sequential therapy and the antibiotic resistance of H. pylori in children. Eighty-seven treatment-naïve children (55 males; median age, 13.5 years) with H. pylori infection from January 2009 to August 2019 were recruited in this study. The status of H. pylori infection was confirmed by culture or histology with the aid of urea rapid test or C-13 urea breathe test. Patients treated with either triple therapy for 7 days or 14 days, or sequential therapy for 14 days was analyzed retrospectively. Thirty-eight (43.7%) patients received 14-day sequential therapy, 24 (27.6%) patients received 14-day triple therapy and the remaining 25 (28.7%) patients received 7-day triple therapy. The eradication rate of 14-day sequential therapy was significantly superior to 7-day triple therapy (97.4% vs. 80%, p=0.032), and tended to be better than 14-day triple therapy (83%, p=0.07). Of the 54 patients with available antibiotic resistance data, the resistant rate of clarithromycin, metronidazole, levofloxacin, and amoxicillin were 22.2%, 16.7%, 9.1% and 2.2%, respectively. Clarithromycin resistance demonstrated an inverse association with eradication success (Odds ratio=0.017, p<0.001). In treatment-naïve children with H. pylori infection, 14-day sequential therapy is superior to triple therapy, and achieve a high eradication rate (above 90%) in an area of high clarithromycin resistance.

Development of a zero-order kinetics drug release floating tablet with anti–flip-up design fabricated by 3D-printing technique

Helicobacter pylori is a common cause of peptic ulcer disease, but patient’s low compliance to treatment can cause antibiotic resistance. The aim of the study was to describe a gastroretentive drug delivery system using an anti–flip-up floating tablet design prepared by using 3D printing with the goal of achieving better therapeutic outcomes. Polylactic acid (PLA) was the printing material for the floating tablet housing, with metronidazole as the model drug. The core tablet was prepared by direct compression and placed in the middle of the housing. The floating system was optimized by using a Box–Behnken experimental design with core tablet main factors of drug release orifice, air volume (height was varied), and compression force. The optimized formulation was prepared to test the prediction efficiency of the model. The optimized model required a drug release orifice of 23.10 mm2, air compartment height of 2.0 mm, and compression force of 3.63 tons, providing constant drug release for 8 h (average R2 = 0.9920). The optimized anti–flip-up tablets did not flip-up during the test. This gastroretentive drug release model shows possibility for constant extended drug dissolution which could enhance therapeutic efficiency of peptic ulcer disease from Helicobacter pylori.

RETRACTED: Intelligent hospital and clinical effect of omeprazole in the treatment of patients with gastric ulcer based on embedded system

Abstract The most common cause of peptic ulcer disease has been implanted medical Helicobacter pylori infection and used test for the detection and treatment strategies. Pylori, based on the larger of the age of more than 55 years, to reduce the risk of gastric cancer, non-alarm condition is young, is a good situation. Most of the other patients, should undergo endoscopy to rule out cancer of serious cause indigestion. Urea, and respiratory test and stool antigen test is used to identify the most accurate. Helicobacter pylori infection, and it can be used in order to confirm that it has cured. Serology is convenient, is an alternative less accurate, and cannot be used in order to confirm the healing. Treatment options, the standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. Gastric parietal cell height and quality in patients than in months, biopsies from patients within a few months compared to an increase of drug omeprazole longer. Embedded sections and electron microscopy shows that the expansion of the protruding sparse cytoplasm secretion by parietal cells. Cell wall hypertrophy and hyperplasia of patients develop chronic omeprazole; can be confirmed in a routine examination of tissue sections. These morphological changes and increased duration of treatment.

Discovery of unique African Helicobacter pylori CagA-multimerization motif in the Dominican Republic.

BACKGROUND Helicobacter pylori (H. pylori) colonizes the human stomach and is a major cause of peptic ulcer disease and gastric cancer. However, although the prevalence of H. pylori is high in Africa, the incidence of gastric cancer is low, and this phenomenon is called to be African enigma. The CagA protein produced by H. pylori is the most studied virulence factor. The carcinogenic potential of CagA is associated with the Glu-Pro-Ile-Tyr-Ala (EPIYA) patterns and CagA-multimerization (CM) motifs.AIMTo better understand the EPIYA patterns and CM motifs of the cagA gene.METHODSGastric mucosal biopsy specimens were obtained from 258 patients with dyspepsia living in the Dominican Republic, from which 120 H. pylori strains were cultured. After the bacterial DNA extraction, the EPIYA pattern and CM motif genotypes were determined using a polymerase chain reaction-based sequencing. The population structure of the Dominican Republic strains was analyzed using multilocus sequence typing (MLST). Peptic ulcer disease and gastric cancer were identified via endoscopy, and gastric cancer was confirmed by histopathology. Histological scores of the gastric mucosa were evaluated using the updated Sydney system.RESULTSAll CagA-positive strains carried the Western-type CagA according to the identified EPIYA patterns. Twenty-seven kinds of CM motifs were observed. Although the typical Western CM motif (FPLKRHDKVDDLSKVG) was observed most frequently, the typical East Asian CM motif (FPLRRSAAVNDLSKVG) was not observed. However, “FPLRRSAKVEDLSKVG”, similar to the typical East Asian CM motif, was found in 21 strains. Since this type was significantly more frequent in strains classified as hpAfrica1 using MLST analysis (P = 0.034), we termed it Africa1-CM (Af1-CM). A few hpEurope strains carried the Af1-CM motif, but they had a significantly higher ancestral Africa1 component than that of those without the Af1-CM motif (P = 0.030). In 30 cagA-positive strains, the "GKDKGPE" motif was observed immediately upstream of the EPIYA motif in the EPIYA-A segment, and there was a significant association between strains with the hpAfrica1 population and those containing the “GKDKGPE” motif (P = 0.018). In contrast, there was no significant association between the CM motif patterns and histological scores and clinical outcomes.CONCLUSIONWe found the unique African CM motif in Western-type CagA and termed it Africa1-CM. The less toxicity of this motif could be one reason to explain the African enigma.

The Spectrum of Helicobacter-Mediated Diseases.

Helicobacter pylori is the leading cause of peptic ulcer disease. The infection has been implicated in more than 75% of duodenal ulcer cases and 17% of gastric ulcer cases. H. pylori has been classified as a human carcinogen, since it is the main cause of distal gastric adenocarcinoma and B cell mucosa-associated lymphoid tissue lymphoma. Evidence also links H. pylori with extragastric conditions including iron deficiency anemia, idiopathic thrombocytopenic purpura, and vitamin B12 deficiency. Studies indicate that H. pylori may be protective against other conditions of the gastrointestinal tract (e.g., reflux esophagitis and related pathologies) and elsewhere in the body (e.g., asthma). The infection is asymptomatic in the vast majority of cases; more serious outcomes occur in only 10-15% of infected individuals. Despite extensive research over the past 3 decades, there is no effective vaccine, and the circumstances leading to disease development remain unclear. In addition, there is now a growing prevalence of antimicrobial resistance in H. pylori. This review discusses these important issues.

Unique meteorological characteristics in the upper gastrointestinal bleeding by different etiologies in Beijing Area, China.

Unique meteorological characteristics in the upper gastrointestinal bleeding by different etiologies in Beijing Area, China.

S2957 Chronic Mesenteric Ischemia: A Rarer Cause of Refractory Gastric Ulceration

INTRODUCTION: H. pylori and non-steroidal anti-inflammatory drug (NSAID) use are common causes of peptic ulcer disease (PUD). In cases of refractory PUD after addressing these factors and treatment with a proton pump inhibitor (PPI), mesenteric ischemia should be considered. CASE DESCRIPTION/METHODS: A 74 year-old male experienced a non-ST segment myocardial infarction, underwent drug eluding coronary stenting, and was initiated on clopidogrel and aspirin therapy. That admission, he developed epigastric abdominal pain and “dark stools”. H. pylori serology was positive, and he was treated with high dose pantoprazole and amoxicillin. Despite twice daily PPI and NSAID avoidance, his epigastric pain persisted, so EGD was performed, revealing superficial, non-bleeding ulcerations and erythema in the gastric body; biopsies showed reactive gastropathy and congestion without H. pylori. 2 weeks later he developed overt melena, and small bowel enteroscopy revealed gastric mucosa pallor and an adherent clot overlying a 1 cm oozing peptic ulcer along the greater curvature. The ulcer was successfully treated with epinephrine and hemostatic clips. His pain symptoms and bleeding resolved, though a surveillance EGD 12 weeks later revealed persistent smaller ulcers, flat pigmented spots, and congestion adjacent to site of the larger ulcer. Sucralfate thus was added to his PPI regimen. He remained asymptomatic until his clopidogrel was discontinued, shortly thereafter developing severe epigastric pain. Physical exam was unremarkable and labs were notable for lactate 1.6 mmol/dL, hemoglobin 12.2 g/d, and gastrin 169 pg/ml (on PPI). CT angiogram showed 90% stenosis at the superior mesenteric artery (SMA) origin, high grade stenosis of the celiac and inferior mesenteric arteries, and dilated bowel. Endovascular intervention was attempted, but revascularization failed due to extent of disease, leading to open mesenteric bypass graft from the external iliac artery to proximal SMA. His dyspeptic symptoms completely resolved at 1 month follow up. DISCUSSION: Chronic ischemia rarely causes PUD due to highly-vascularized gastric mucosa. However, in cases such as this with severe stenosis of the major branches of the aorta this rare complication may occur. Mesenteric ischemia is an important diagnosis to consider in patients with refractory gastric ulcers, especially in the setting of known atherosclerotic disease. Mesenteric ischemia and its associated symptoms and mucosal injury can be successfully managed by revascularization.Figure 1.: EGD with superficial, non-bleeding ulcerations and erythema in the gastric body.Figure 2.: CT angiogram with stenosis of the superior mesenteric artery.Figure 3.: CT angiogram with stenosis of the superior mesenteric artery.

S1348 Triple Therapy for Primary Treatment of Helicobacter pylori: A 19-Year U.S. Single Center Experience

INTRODUCTION: Helicobacter pylori (H.pylori) is an important worldwide cause of peptic ulcer disease, gastric cancer and upper gastrointestinal symptoms. Triple therapy with a proton pump inhibitor, clarithromycin, and amoxicillin (PCA) or metronidazole (PCM) for 14 days remains the mainstay of first-line therapy for H. pylori infection in the US, however, there is evidence that antibiotic resistance, particularly to macrolides, is increasing in the United States (US). Aim: (i) Determine the effectiveness of PCA & PCM for eradicating H.pylori infection over the past 19 years (ii) Determine the impact of compliance on eradication rates with PCA & PCM. METHODS: A retrospective analysis was performed on all patients (pts) referred for a 13C urea breath test (UBT) following first line PCA or PCM therapy for H. pylori at a single US medical center between January 2001 – October 2019. Patients included in this analysis had H. pylori infection documented by gastric biopsy, UBT or fecal antigen test. All patients were treated with PCA or PCM for 10-14 days. Time frames for comparison included a cure rate over the entire 19-year study period and sub-divided into four 5-year blocks (2001-2005, 2006-2010, 2011-2015, and 2016-2019). Cure rates & 95% confidence intervals were calculated for PCA & PCM combined and each regimen separately. Logistic regression was conducted to determine if therapy compliance influenced H.pylori eradication. RESULTS: Data was analyzed on 1058 pts (mean age 51.1 (SD = 15.4; Range:18-90), 61.8% female, and 49.5% Caucasian). H.pylori eradications rates using PCA or PCM was 78.1%. PCA (79.1%) and PCM yielded similar eradication rates (79.1% vs. 77.8%, NS). Eradication rates for PCA & PCM divided into 5-year time blocks were similar [Table 1]. Therapy compliance did not significantly influence eradication rates. CONCLUSION: Real world eradication rates of PCA & PCM at a large midwestern US medical center have remained stable over almost 2 decades. The eradication rates of < 80% raise questions about whether these regimens deserve to be the preferred first-line therapies for H. pylori in the US.Table 1.: Cumulative Eradication Rates (2001-2019)Table 2.: Five Year Interval Eradication Rates

Efforts to Eradicate Helicobacter Pylori in Hospitalized Patients: A Quality Improvement Project to Recognize and Overcome the Hurdles

Helicobacter pylori (H. pylori) is a common infection found in hospitalized patients undergoing upper gastrointestinal (GI) endoscopy. H. pylori is a major cause of peptic ulcer disease and carries carcinogenic properties, hence once diagnosed it must be treated. Antibiotics for the H. pylori treatment are often not well tolerated during hospitalization and hence carries a risk of patients being untreated after they are discharged. The aim of the project is to improve H. pylori treatment rates for the patients diagnosed with H. pylori infection at gastric biopsy performed during their hospitalization. The study was performed as a quality improvement project. Biopsy results of all the upper endoscopies performed during July 2017 to September 2019 were reviewed for the presence of H. pylori. Each month, one gastroenterology fellow covering the medical floors consult service was assigned to follow up results of all inpatient upper endoscopies and to ascertain outpatient follow-up for H. pylori treatment if found positive. A follow up phone calls were made for the patients who failed to comply with outpatient appointments. Patients who responded to phone call were either given a walk-in appointment to the gastroenterology clinic or were prescribed anti-microbial agents and instructed over the phone. Certified letters were sent to patients who could not be reached through phone calls and recall alert was created into electronic medical record (EMR) which will give notification to any provider who sees these patents for any other reasons and advise them to inform patient to make an appointment or treat them for H. pylori. A total of 1500 endoscopies were performed from July 2017 to September 2019 from which 52% (n=789) had the gastric biopsy to evaluate for the H. pylori infection. There were 101 patients with positive H. pylori infection on gastric biopsy from which 55% (n=55) were treated during their hospitalization (n=31) and remaining (n=24) were treated in the out-patient setting. Endoscopy indications are depicted in Figure 1. Quality improvement protocol was implemented on 45% (n=46/101) patients who missed out-patient follow up appointment. The assigned gastroenterology fellows were able to reach 58% (27 out of 46) patients for H. pylori treatment. Five patients were treated in outpatient clinic after recall, while 22 patients were instructed over the phone for the antibiotic treatment (Figure 2). There were 46% (19 out of 46) who did not respond to the phone call and the supervising fellow initiated certified letter and recall alert in EMR. Three patients responded to the certified letter and were treated in out-patient setting. As a result of quality improvement project, we were able to treat an additional 30% of H. pylori infections in patients who were not able to follow-up for post-hospital discharge. Amongst patient diagnosed with H. pylori infection during the hospitalization, only about half of patients received antibiotics during their hospitalization. The non-compliance with the outpatient follow-up often leads to the untreated H. pylori infection. The systemic follow-up with phone call increases the H. pylori infection treatment rates. Phone recall was more efficient than a certified letter for increasing the H. pylori infection treatment rates in our patient population. As H. pylori is considered carcinogen, all the efforts must be made to treat it if tested positive.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Association between Metaplasia and Gastric Malignancy with Helicobater pylori Infection

Background: Helicobacter pylori (H. pylori) infection is the main cause of peptic ulcer disease, gastric mucosa metaplasia, and gastric malignancy. The hypothesis of this study is whether there’s an association between metaplasia and gastric malignancy with H. pylori infection.Method: We conducted a retrospective study on 1.127 dyspepsia subjects who performed endoscopy between 2001 to 2011 at a hospital in North Jakarta. Data is obtained based on endoscopy and histopathology data. Investigation of H. pylori in this study using histopathology examination.Results: Of the 1.127 dyspepsia subjects who performed endoscopy and biopsy, there were 130 (11,54%) H. pylori-positive subjects. Gender proportion was composed of 55,37% men and 44,63% women, with median age was 47 years. On the histopathology examination, we obtained 45 metaplasia subjects with median age of 45 years and 7 malignancy subjects with median age of 64 years. Metaplasia was found in 33 of 997 (3,31%) H. pylori-negative subjects and 12 of 130 (9.23%) H. pylori-positive subjects. All gastric malignancy subjects had H. pylori-negative results.Conclusion: There was an association between metaplasia and H. pylori infection, but no association between gastric malignancy and H. pylori infection.

Clavulanic Acid in the Scope of Helicobacter pylori Treatment: A Literature Review and Beyond.

Helicobacter pylori (H. pylori) infection is the most common cause of peptic ulcer disease and it can be associated with many complications, including malignancies. In clinical practice, some clinicians may use Clavulanic Acid (CA) in combination with amoxicillin or other beta-lactams as an addition to the standard treatment regimens. This practice may be done by habitual mistake, non-evidence based hypothetical assumptions, or by prescribing it as an alternative treatment. This review aims to expose the effect of CA against H. pylori infection and to review the possible mechanisms that may contribute to that effect. A PubMed and Google Scholar literature search was obtained on both pre-clinical and clinical studies related to CA and H. pylori infection. Available clinical studies showed improvement in the eradication of H. pylori by about 10- 20% when CA was added to the treatment regimens. This effect for CA could be related to several mechanisms including inhibition of H. pylori growth by binding to Penicillin-Binding Proteins (PBPs), the transformation of H. pylori from the active filamentous form into coccoidal form, induction of the release of dopamine, modulation of immunological response towards H. pylori infection and its relationship with other microbiota. Randomized-controlled studies on patients with resistance to H. pylori are needed. Moreover, in vitro studies to evaluate the mechanisms by which CA may influence H. pylori are warranted. The presented literature suggests potential avenues for the use of CA in the management of peptic ulcer disease and H. pylori infection.

Fungal Peptic Ulcer Disease in an Immunocompetent Patient.

The lifetime prevalence of peptic ulcer disease (PUD) is 5–10%. While PUD in immunocompetent patients is most commonly associated with Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs), other common causes of PUD must also be considered in the differential diagnosis. We describe a case of endoscopic and histological resolution of PUD related to Candida infection in a healthy, immunocompetent woman.LEARNING POINTSPeptic ulcer disease (PUD) can be secondary to fungal infections, even in immunocompetent patients.A higher index of suspicion needs to be maintained for fungal causes of PUD, particularly if symptoms do not improve.Recognizing fungal causes of PUD may lead to faster diagnosis and treatment.

Phytotherapeutic modalities for the management ofHelicobacter pyloriassociated peptic ulcer

Due to an imbalance between aggressive factors known as hydrochloric acid (HCl), pepsin, leukotrienes, refluxed bile, defensive factors and reactive oxygen species, the peptic ulcer is formed in the stomach and duodenum which mostly include the function of prostaglandins, mucus bicarbonate barrier, enzymatic antioxidants, and some growth factors. H. pylori infection remained one of the considerable causes of peptic ulcer as it caused hypochlorhydria and struck off the defense mechanism of the stomach. The nonsteroidal anti-inflammatory drugs (NSAIDs) and stress are the most prevailing causes of peptic ulcer disease. Lack of physical exercise, little rest and due to poor leisure cause the peptic ulcer disease. Candies, chocolate, coffee, cigarettes, stress, and alcohol are the cause of peptic ulceration and suppression of acid in the stomach due to the utilization of antacid medication. Most of the ancient medical practices in the traditional alternative medicinal system include Unani, Ayurveda, Siddha, Homeopathy, Naturopathy, Chinese customary medicine, African conventional medicine, and Native American medicine. Without a hostile effect, the rate of curing the disease is the significance of natural products research. Peptic ulcer disease is the widespread nature of peptic ulcer in all class of population, which mostly may be due to rapidly changing the food habits and stress, causing the imbalance between gastric offensive and defensive factors. Curcuma longa is the most effective plant for the cure of peptic ulcer. Curcuma longa has anti-inflammatory and antioxidant activity. Curcuma longa remarkably reduces the level of inflammatory mediator (IL1) and (TNF) which was increased during the formation of an ulcer. In the rhizome of Curcuma longa, yellow pigment is present and widely used for the treatment of ulcer and decrease the inflammatory response. Symptoms include abdominal pain after taking a meal, nausea, vomiting, Anorexia and lose weight.

Comparison of Ten-Day Sequential and Standard Triple Therapy for Helicobacter pylori Eradication

- Helicobacter pylori (HBP) is reported as one of the main causes of peptic ulcer disease (PUD) and gastric cancer in the world. The challenge for finding an optimal treatment regimen for HBP eradication is still a matter of concern. The aim of this study was to compare the HBP eradication rate as well as side effects between two 10-days treatments of the standard triple and sequential regimen. This study was performed on patients with dyspepsia and HBP positive. Patients were categorized in two treatment groups including; standard (Omeprazole, Amoxicillin, and Clarithromycin) and sequential treatment (Omeprazole, Amoxicillin, Clarithromycin, and Metronidazole). HBP eradication rate, side effects, and treatment costs were compared between two groups. One hundred thirty-two patients (58 males, 74 females) with a mean age of 42.7±14.2-year-old were studied in two groups of Standard Treatment (n=66) and Sequential Treatment (n=66). There were not any significant differences between two groups regarding baseline features. The overall rate of HBP eradication was estimated to be 79.5%. Although, there was not any significant difference between the observed side effects, the mean cost of treatment in standard was significantly lower than that in the sequential group (P=0.001). It seems that there are not any clinical differences between 10-day treatment plan of the standard triple and sequential therapy in the case of HBP eradication and side effects. However, the sequential treatment might be a better option as the economic point of view.&#x0D; © 2019 Tehran University of Medical Sciences. All rights reserved.&#x0D; Acta Med Iran 2019;57(4):224-228.

Declining Prevalence of Helicobacter Pylori Infection- A 13C Urea Breath Test (UBT) Based Study in Symptomatic

Background: Helicobacter pylori (HP) infection is an important cause of peptic ulcer disease (PUD) in the world. This study was aimed to know the trend of H.P. infection among the symptomatic subjects&#x0D; Method: This was a retrospective observational study conducted from January 2015 to July 2018 in three different hospitals in Dhaka city. Patient who presented with dyspepsia underwent 13C urea breath test. Positive cases were analyzed. Results: A total 1343 patients were taken for UBT where 308 (23%) patients were found positive. The mean age group was 41.21+13.6. Male were more infected (61%) than female (39%).&#x0D; Conclusion: Improving sanitary and hygienic condition of this region along with significantly increasing HP eradication therapy and PPI use by the symptomatic individuals might have contributed to the decreasing trend of infection&#x0D; Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 121-124

Antigen of 49.6-kDa subunitpili protein of Helicobacter pylori as a potential biomarker for early and rapid detection of the infection.

Background and Aim:Helicobacter pylori infection has been identified as a major cause of peptic ulcer diseases, including gastric and duodenal ulcers, gastritis, chronic and gastric carcinoma, and even gastric lymphoma. In vitro studies using Western blotting analysis, hemagglutination test, adherence inhibition assays, and immunocytochemical staining revealed that the 49.6-kDa subunit pili protein of H. pylori was considered an immunogenic protein. This study aimed to develop a serological diagnostic test using 49.6 kDa for detecting antibodies against H. pylori proteins in an early phase of the infection.Materials and Methods:An in-house immunochromatographic test (ICT) kit was developed and used to test a panel of sera sample obtained from a randomly selected symptomatic patient, in which 40 sera were H. pylori positive and 40 sera were H. pylori negative.Results:The results showed that ICT with 49.6 kDa as an antigen was highly sensitive and specific for detecting anti-H. pylori immunoglobulin G antibodies in human serum, with a high negative predictive value.Conclusion:The developed test could be used to exclude H. pylori infection in symptomatic patients.

Fungal Peptic Ulcer Disease in an Immunocompetent Patient

The lifetime prevalence of peptic ulcer disease (PUD) is 5-10%. While PUD is most commonly associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), less common causes of PUD should be considered in the differential diagnosis. Peptic ulcer diseaes secondary to Candida in immunocompetent patients is uncommon. We describe a case of endoscopic and histologic resolution of peptic ulcer disease related to Candida infection in a healthy, immunocompetent woman. A 50 year-old woman presented with a three month history of post-prandial abdominal cramping, vomiting and seven pound weight loss. There was no history of HIV (human immunodeficiency virus) or diabetes. She denied NSAID use and alcohol consumption and was not taking corticosteroids. Outpatient esophagogastroduodenoscopy (EGD) revealed a 1 cm, non-bleeding, irregular shaped, deep and clean-based ulcer at the pylorus. Histopathology of the biopsies taken revealed an ulcer with necroinflammatory debris and fungal organisms, consistent with Candida species. Periodic acid-Schiff (PAS) fungal stain noted scattered yeast colonizing the fibrinous debris. After a three week course of fluconazole, her symptoms resolved. Repeat EGD revealed ulcer healing. Repeat biopsies of the pylorus were negative for any evidence of fungal organisms. Fungal PUD is more common in the esophagus compared to anywhere else in the GI tract. Gastric candida was found in 0.24% of patients in a large study consisting of outpatient setting. While treatment guidelines have not been established, antifungals and proton-pump inhibitiors have been shown to help resolve this condition.2689_A Figure 1. Endoscopy before resolution. Fungal ulcer at the pylorus.2689_B Figure 2. Periodic acid-Schiff showing fungal elements.2689_C Figure 3. Endoscopy showing resolution of fungal ulcer at pylorus.

Prevalence and factors associated with H. pylori infection in Saudi patients with dyspepsia.

BackgroundHelicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and chronic active gastritis that may progress to gastric cancer. Globally, it has been estimated that 50% or more of the world’s population is infected by H. pylori, making it the most widespread infection across the globe.ObjectivesTo determine the prevalence of H. pylori infection and to identify factors associated with H. pylori infection in Saudi patients presenting with dyspepsia.MethodsIn this prospective cross-sectional study, a total of 404 gastric biopsies were endoscopically obtained from 404 patients with dyspepsia from September 2014 to April 2016 (Jazan Province, Saudi Arabia). The specimens were analyzed using the real-time polymerase chain reaction (PCR). The data was examined using descriptive statistics as well as determining the prevalence, and employing Chi square and Fisher exact test. A p-value of ≤0.05 was considered statistically significant in examining the research hypotheses.ResultsThe overall prevalence of H. pylori in Jazan Province was 46.5% (95% CI: 41.7–51.4) and the prevalence was lower among those > 55 years old. Prevalence was higher among urban (50.0%; 95% CI: 43.1–56.8) versus rural (42.1%; 95% CI: 35.1–49.3), but with no significant difference. Prevalence did not show significant difference among different Body Mass Index (BMI) categories, ranging from 40.2% to 47.7%. The prevalence of H. pylori in females was 47.1% (95% CI: 40.4–53.9) versus 45.6% (95% CI: 38.7–52.6) in males. Histopathology findings were associated with H. pylori infection with prevalence of 58.1% among patients with chronic active gastritis, compared to 24.1% and 34.8% among mild and chronic gastritis, respectively.ConclusionOur results indicate that there is a high prevalence of H. pylori among Saudi patients with dyspepsia. Prevalence of H. pylori was high in ages below 55 years. Chronic active gastritis was significantly associated with H. pylori infection. In depth studies are needed to determine associated factors with of H pylori infection in the region

Helicobacter pylori Infection in Pediatric Patients: Update on Diagnosis and Eradication Strategies.

Helicobacter pylori infection is acquired mainly in childhood and remains an essential cause of peptic ulcer disease and gastric cancer. This article provides commentary on the last ESPGHAN/NASPGHAN guidelines and on publications made after the consensus conference of 2015. The majority of infected children are asymptomatic and pediatric studies do not support a role for H. pylori in functional disorders such as recurrent abdominal pain. The role of H. pylori infection in failure to thrive, children's growth, type I diabetes mellitus (T1DM), and celiac disease remains controversial. The diagnosis of infection should be based on upper-digestive endoscopy with biopsy-based methods. Eradication control after treatment should be based on validated non-invasive tests. Nodular gastritis is the main endoscopic finding of childhood H. pylori infection, but gastroduodenal erosions/ulcers are seen in some children, especially after 10years of age. When indicated, eradication treatment should be given when good compliance is expected and based on the antimicrobial susceptibility profile.