Chronic Duodenal Ulcer Research Articles

Клинические проявления и эндоскопически-гистологические изменения у детей с хроническим гастритом, индуцированным Helicobacter pylori, с разной токсигенностью

Актуальность. Инфекция Helicobacter pylori является важным фактором хронического гастрита (ХГ) и дуо­денальной язвы у детей. За последнее десятилетие установлена разная вирулентность штаммов H.pylori, которая зависит от его генов токсигенности. Цель: изучить клинические проявления, эндоскопические и гистологические изменения слизистой оболочки желудка (СОЖ) у детей с хроническим гастритом, индуцированным H.pylori, с разной его токсигенностью. Материалы и методы. Проведено клинико-инструментальное обследование 136 детей с хроническим гастритом, индуцированным H.pylori, в возрасте 7–17 лет (основная группа) и 30 здоровых детей этого же возраста (контрольная группа). Пациенты были разделены на 2 группы: IА группу составили 72 ребенка с хроническим гастритом, индуцированным H.pylori CagA «+»; IБ группу — 64 ребенка с хроническим гастритом, индуцированным H.pylori CagA «–», по результатам определения суммарных антител IgG к антигену CagA сыворотки крови и/или определения антигена CagA в биоптатах СОЖ методом полимеразной цепной реакции. Изучали и анализировали клинические проявления, эндоскопические и гистологические изменения слизистой оболочки желудка. Статистическая обработка проводилась с помощью пакета статистических программ Statgrafics 16.0. Результаты. У детей с ХГ, индуцированным H.pylori CagA «+» (IА группа), клинические проявления болевого абдоминального и диспептического синдромов существенно не отличаются от таковых у детей с ХГ, индуцированным H.pylori CagA «–» (ІБ группа). Не выявлены существенные эндоскопические изменения в виде эритематозной гастропатии и антральной нодулярности как у детей с ХГ, индуцированным H.pylori CagA «+», так и у детей с ХГ, индуцированным H.pylori CagA «–». Гистологические изменения в ІА и ІБ группах были разные: детям с ХГ, индуцированным H.pylori CagA «+», свойственны II и I степень активности воспаления и ІІ, І, ІІІ степени обсемененности Н.pylori слизистой оболочки желудка, а детям с ХГ, индуцированным H.pylori CagA «–», свойственны I, II степень активности воспаления слизистой оболочки желудка и II и I степень обсемененности Н.pylori. Выводы. Клиническими проявлениями ХГ, индуцированного H.pylori, у детей в стадии обострения является эпигастральная боль, симптомы диспепсии и хронического интоксикационного синдрома. Эндоскопическими проявлениями являются эритематозная гастропатия и/или антральная нодулярнисть. У детей с ХГ, индуцированным H.pylori СagA «+», и у детей с ХГ, индуцированным H.pylori СagA «–», по клиническим и эндоскопическим проявлениям существенного различия не выявлено. Гистологическим изменением СОШ при ХГ, индуцированном H.pylori, в стадии обострения является диффузная лимфоцитарно-плазмоцитарная инфильтрация собственной пластинки СОЖ с нарушением эпителия. При ХГ, индуцированным H.pylori СagA «+», преобладает II и III степень обсеменения H.pylori в сочетании с I и II степенью активности воспаления СОЖ. При ХГ, индуцированном H.pylori СagA «–», преобладает II и I степень обсеменения H.pylori СОЖ. У детей с ХГ, индуцированным H.pylori, целесообразно диагностировать его токсигенность CagA «+» для оценки H.pylori CagA-статуса ребенка.

Limosilactobacillus reuteri Strains as Adjuvants in the Management of Helicobacter pylori Infection.

Helicobacter pylori (HP) is a Gram-negative bacterium which finds its suitable habitat in the stomach. The infection affects about half of the global population with high variability in prevalence among regions and for age. HP is the main causative agent of chronic active gastritis, peptic and duodenal ulcers, and may be the primary cause of gastric cancer or MALT lymphoma. Due to the high rate of failure of eradication therapy in various countries and the increase in antibiotic resistance reported in the literature, there is an ever wider need to seek alternative therapeutic treatments. Probiotics seem to be a promising solution. In particular, the Limosilactobacillus reuteri (L. reuteri) species is a Gram-positive bacterium and is commonly found in the microbiota of mammals. L. reuteri is able to survive the gastric acid environment and bile and to colonize the gastric mucosa. This species is able to inhibit the growth of several pathogenic bacteria through different mechanisms, keeping the homeostasis of the microbiota. In particular, it is able to secrete reuterin and reutericycline, substances that exhibit antimicrobial properties, among other molecules. Through the secretion of these and the formation of the biofilm, it has been found to strongly inhibit the growth of HP and, at higher concentrations, to kill it. Moreover, it reduces the expression of HP virulence factors. In clinical trials, L. reuteri has been shown to decrease HP load when used as a single treatment, but has not achieved statistical significance in curing infected patients. As an adjuvant of standard regimens with antibiotics and pump inhibitors, L. reuteri can be used not only to improve cure rates, but especially to decrease gastrointestinal symptoms, which are a common cause of lack of compliance and interruption of therapy, leading to new antibiotic resistance.

Characteristics of gastric mucosa microbiota in children with chronic gastritis and duodenal ulcer

Objective: To investigate the differences of gastric mucosa microbiota between children with chronic gastritis and duodenal ulcer under the condition of Helicobacter pylori (Hp) infection. Methods: This prospective cohort study involved 57 children with Hp infection diagnosed by gastric endoscopy who were admitted to the Children's Hospital of Zhejiang University School of Medicine due to "abdominal pain, abdominal distension and vomiting" between January 2018 to August 2018. According to gastroscopy and pathological examination, the children were divided into chronic gastritis group and duodenal ulcer group. Gastric mucosa from Hp infected patients were sampled, and the flora DNA was analyzed by high-throughput sequencing. The statistical difference of α diversity, β diversity between two groups were analyzed. The relative abundance of the two groups in each taxonomic level was analyzed statistically. T test, Rank sum test or χ2 test was used for comparison between the two groups. Results: A total of 57 children diagnosed with Hp infection were enrolled in this study, including 42 cases of chronic gastritis (the age was (9.3±2.8) years, 22 males and 20 females) and 15 cases of duodenal ulcer (the age was (11.1±3.3) years, 9 males and 6 females). Alpha diversity index Chao and ACE in Hp infected chronic gastritis group were significantly higher than those in Hp infected duodenal ulcer group (217±50 vs. 183±64, t=2.088, P=0.009;218±47 vs. 192±76, t=1.566, P=0.016, respectively). The Beta-diversity index such as nonmetric multidimensional scaling (NMDS) analysis were significantly different in the two groups (analysis of similarity R=0.304, P=0.028). Among the main bacteria genera, there were 6 genera with significant differences between the two groups, which were Prevotella (0.190% (0.008%-1.983%) vs. 0.021% (0.005%-2.398%), Z=-2.537, P=0.011), Alloprevotella (0.097% (0.010%-0.813%) vs. 0.015% (0.003%-0.576%), Z=-2.492, P=0.013), Haemophilus (0.109% (0.004%-0.985%) vs. 0.014% (0.004%-0.356%), Z=-2.900, P=0.004), Neisseria (0.074% (0.004%-0.999%) vs. 0.024% (0.003%-0.255%), Z=-2.718, P=0.007), Streptococcus (0.166% (0.008%-1.869%) vs. 0.045% (0.006%-0.879%), Z=-2.537, P=0.010), and an unclassified-Microbacteriaceae (0.214% (0.060%-1.762%) vs. 0.117% (0.010%-0.954%), Z=-2.120, P=0.034). Linear discriminant analysis (LDA) effect sized analysis showed that at the genus level, only Prevotella was significantly enriched in the duodenal ulcer group (LDA=2.90, P=0.010), while Streptococcus, Neisseria and Haemophilus were significantly enriched in the chronic gastritis group (LDA=2.83, 2.82, 2.69, P=0.011, 0.007, 0.004, respectively). Conclusions: The gastric mucosal microbiota in duodenal ulcer associated with Hp is significantly different from that in chronic gastritis. Hp may promote the occurrence of peptic ulcer together with gastric microbiota.

The Related Study on the Pathogenesis of Gastrointestinal Diseases in Gastrointestinal Flora and the Risk of Gastric Ulcer Carcinogenesis

Gastrointestinal diseases are common diseases of many kinds. The pathogenesis of gastrointestinal disease has not been fully understood. In this study with gastric mucosa specimen, among the three groups of chronic gastritis, gastric ulcer, and duodenal ulcer, there were differences of Helicobacter pylori (H. pylori), Lactobacillus, Prevotella, Clostridium, B. fragilis, and Enterobacteriaceae. There was no significant difference in Lactobacillus among chronic gastritis, gastric ulcers, and duodenal ulcers with fecal specimens, but there was a significant difference between these three groups and the gastric cancer group. Correlation analysis showed that six kinds of flora had a negative correlation with H. pylori, procalcitonin (PCT), tumor necrosis factor α (TNF-α), cluster of differentiation 4 (CD4+), cluster of differentiation 8 (CD8+), immunoglobulin G (IgG), and immunoglobulin M (IgM) were different in different gastrointestinal diseases, and PCT, TNF-α and CD8+ were positively correlated with H. pylori and negatively correlated with CD4+, IgM and IgG. Logistic regression analysis showed that age, recurrent gastric ulcer times, atrophic gastritis, and H. pylori were independent risk factors of gastric ulcer canceration. Therefore, we believe that gastrointestinal flora, especially H. pylori, plays a vital role in the pathogenesis of gastrointestinal diseases, and H. pylori is an essential risk factor for gastric ulcer carcinogenesis.

The Relationship Between Hyperplastic Gastric Polyps And Helicobacter Pylori

Objective
 Helicobacter pylori (H. pylori) is a gram-negative bacterium. It is urease positive, mobile, microaerophilic, and spiral-shaped, and it settles in the stomach and the proximal duodenum. It is associated with chronic gastritis, stomach ulcers, duodenal ulcers, stomach cancer, and MALT lymphoma. It can also cause premalignant lesions, such as metaplasia and gastric atrophy. Although several studies are investigating the correlation between H. pylori and hyperplastic polyps (HPs) of the stomach, uncertainty in this regard continues. 
 Methods
 Data from 5378 patients who underwent esophagogastroduodenoscopy at the Department of Gastroenterology, Gülhane Training and Research Hospital, 
 University Of Health Sciences between October 2016 and March 2019 were retrospectively analyzed, and patients with gastric polyps were evaluated for polyp pathologies and normal mucosa biopsies.
 Results
 Sixty-one stomach polyps were detected in 49 patients after the retrospective analysis of the data between October 2016 and March 2019. Of the polyps found, 36 were hyperplastic (73%). There was no statistically significant difference between HPs and the presence of H. pylori, age, gender, anatomical location of polyps in the stomach, size, number, presence of metaplasia, or atrophy. The mean age was statistically lower in H. pylori-positive cases.
 Conclusions
 No correlation was observed between HPs and the presence of H. pylori. There is a need for more extensive, multi-centered, and prospective studies evaluating the relationship between HPs and H. pylori.

Abstract OR-5: Helicobacter pylori Surface Structures

Background: Helicobacter pylori, which infects at least half of the human population, is an etiopathogenetic factor in the development of chronic gastritis (CG), gastric and duodenal ulcer disease (UD), and is also considered a risk factor in the occurrence of some forms of stomach cancer. Various surface structures of H. pylori are important pathogenic factors. Methods: Reference (NCTC 11637, NCTC 11639) and freshly isolated H. pylori strains as well as samples of the gastric mucosa were examined using transmission (TEM) and scanning electron microscopy (SEM) by means of “JEM-100 В” (JEOL, Japan) and “Quanta 200 3D” (FEI Company, USA) systems, respectively. Samples for SEM fixed with formalin and not subjected to dehydration were sprayed with an electrically conductive layer of gold. Samples for TEM were prepared using negative contrast (NC) with ammonium molybdate and ultrathin sections (US) contrasted by Reynolds; fixation by Ito-Karnovsky was used in both cases. Accelerating voltage at TEM and SEM was 80 and 10 kV, respectively. Results: Three types of H. pylori surface structures were found: flagella, fimbria, and vesicles. Flagella were found both in the material of cultures maintained in vitro and in each native sample of the gastric mucosa. SEM images suggest the involvement of flagella in biofilm formation. On longitudinal sections of the flagellum, the outer electron-dense layer and the inner content in the form of a filament were visualized; on cross sections, the flagellum looked like an annular structure with a centrally located point accumulation of electron-dense matter. Paradoxically, the H. pylori forms with a defective cell wall also possessed flagella. Freely located flagellar sheaths without central filament were often found in vitro only. Fimbriae were found exclusively in negatively contrasted pure bacterial cultures material. In addition, vesicles detaching from the surface of bacterial cells were found both in the material of aging H. pylori pure cultures and in native samples of the gastric mucosa under CG and UD. A small part of the vesicles retains their connection with the cell wall, while detached vesicles are present in excess in the surrounding space. Massive detachment of vesicles leads to the formation of spheroplasts, devoid of an outer membrane. Conclusion: H. pylori has a representative set of surface structures that play an important role in the onset and development of the infectious process in the gastroduodenal area.

How did the ancient bacterium, Helicobacter pylori, cause an epidemic of chronic duodenal ulceration?

The association of Helicobacter pylori with chronic duodenal ulceration was a seminal observation in the short history of gastroenterology. However, H. pylori is now known to be an ancient bacterium, whereas there is persuasive evidence that the epidemic of duodenal ulceration began in the second half of the 19th century and continued into the second half of the 20th century. Possible explanations for the epidemic include genomic changes in the organism and environmental or other influences on the human host. While genomic changes resulted in the appearance of virulence factors, these seem likely to have appeared thousands of years ago with minimal effects on gastritis because of coexisting suppression of gastric immunity. In contrast, the emergence of duodenal ulceration is best explained by a change in the pattern of gastritis from inflammation involving the antrum and body in most individuals to a significant minority (10–20%) with antral gastritis but with relative sparing of the body of the stomach. In the latter group, the increase in serum gastrin (particularly G17) associated with antral gastritis had trophic effects on gastric parietal cells with an increase in the parietal cell mass and hypersecretion of gastric acid. Hypersecretion of acid is seen as the major risk factor for duodenal ulceration with significant contributions from environmental factors including smoking and use of nonsteroidal, anti‐inflammatory drugs. Host factors favoring changes in the pattern of gastritis include delayed acquisition of infection and improved nutrition; both with enhancing effects on mucosal immunity.

Presence of Helicobacter pylori and H. suis DNA in Free-Range Wild Boars.

Simple SummaryHelicobacter pylori and H. suis are associated with gastric pathologies in humans. To obtain better insights into the potential role of wild boars as reservoirs of these pathogens, gastric samples of 14 animals were tested for the presence of H. pylori and H. suis DNA. Two wild boars were found PCR-positive for H. pylori and one for H. suis. This indicates that these microorganisms may colonize the stomach of wild boars.Helicobacter pylori (H. pylori) is a Gram-negative bacterium that infects half of the human population worldwide, causing gastric disorders, such as chronic gastritis, gastric or duodenal ulcers, and gastric malignancies. Helicobacter suis (H. suis) is mainly associated with pigs, but can also colonize the stomach of humans, resulting in gastric pathologies. In pigs, H. suis can induce gastritis and seems to play a role in gastric ulcer disease, seriously affecting animal production and welfare. Since close interactions between domestic animals, wildlife, and humans can increase bacterial transmission risk between species, samples of gastric tissue of 14 free range wild boars (Sus scrofa) were evaluated for the presence of H. pylori and H. suis using PCR. Samples from the antral gastric mucosa from two animals were PCR-positive for H. pylori and another one for H. suis. These findings indicate that these microorganisms were able to colonize the stomach of wild boars and raise awareness for their putative intervention in Helicobacter spp. transmission cycle.

The original scale prediction of recurrence risk of gastroduodenal ulcer bleeding

Research goal - to examine the effectiveness of active-individualized tactics in treatment of chronic gastric and duodenal ulcers. Material and methods. Analysis of treatment of 251 patients with chronic gastric and duodenal ulcer bleeding was conducted. Duodenal ulcer bleeding was present in 202 cases (80,5%), gastric ulcers were the reason of bleeding in 49 cases (19,5%). Treatment conducted according to principles of active-individualized tactics. Results. The provided characteristics and the acquired results were presented according to the fundamental components of active-individualized tactics in treatment of gastric and duodenal ulcers. Diagnostic and treatment abilities of endoscopy were determined, an unique scale of bleeding relapse risk was presented, the time limits and main indications for surgery were explained,, the role of bleeding relapse was emphasized as crucial in forming the main results of treatment of patients with bleeding gastric and duodenal ulcers. Conclusion. At present time, active-individualized tactics should be used for treatment of gastric and duodenal ulcer bleeding.

Helicobacter pylori and colorectal neoplasms: a concise review.

Helicobacter pylori is the main etiological agent of all malignant tumors caused by an infectious disease. It is a major, at times dominant, factor in the pathogenesis of a large spectrum of diseases such as acute and chronic gastritis, gastric and duodenal ulcers, gastric carcinoma, and lymphoma. Epidemiological and experimental studies suggest that H. pylori chronic infection may be related to different extragastric diseases, including colorectal neoplasms. This concise review aims to explore the association of H. pylori infection with colorectal cancer and adenoma, including the recent epidemiological findings, the diagnostic methods employed to detect H. pylori and virulent factors, and the potentially involved mechanisms. Furthermore, is attempted to establish the current data integration for causal inference using the Bradford-Hill causality criteria. The weak, although global, strength of the epidemiological positive association between H. pylori infection and colonic neoplasms associated to new mechanisms postulated to explain this interaction, including intestinal dysbiosis, should stimulate future studies. Prospective confirmatory studies to establish the role of H. pylori eradication in the process of carcinogenic transformation of the colonic epithelium may define its eventual role in the treatment and prevention of colonic neoplasms.

Alterations of Fucosyltransferase Genes and Fucosylated Glycans in Gastric Epithelial Cells Infected with Helicobacter pylori.

Helicobacter pylori (H. pylori) adhesion to human gastric epithelial cells is closely linked with fucosylated glycans. Therefore, investigation of fucosylation in the interaction of gastric epithelial cells with H. pylori is critical. In this study we used lectin microarrays to detect the expression of fucosylated glycans in gastric epithelial cells (GES-1) infected with H. pylori strains isolated from patients with different diseases including chronic gastritis, duodenal ulcers, and gastric cancer (each containing two strains) at 4 h. In addition, we investigated the time-course expression of fucosyltransferase (FUT) 1–6 genes in GES-1 cells stimulated with H. pylori strains at 0.5–8 h. At 4 h post-infection, Lotus, AAA, BC2LCN, PA-IIL, CNL and ACG lectins had increased signals in H. pylori-infected GES-1 cells compared to uninfected cells. Higher expression of FUT1 and FUT2 was detected in all H. pylori-infected GES-1 cells within 2 h, regardless of the H. pylori strain. In particular, the expression of FUT2 was higher in H. pylori-infected GES-1 cells with a higher fold change in levels of BC2LCN lectin specific to α1-2 linked fucose (Fuc) at 4 h. The results suggest that the high levels of α1, 2-linked Fuc synthesized by FUT1/2, might play a role in the preliminary stage of H. pylori infection. This provides us with pivotal information to understand the adhesion of H. pylori to human gastric epithelial cells.

Network pharmacology study of Yi medicine Jinweitai Capsules in treating gastrointestinal diseases

The network pharmacology and molecular docking methods were used to explore the mechanism of Jinweitai Capsules in the treatment of acute and chronic gastritis, gastric and duodenal ulcers, and chronic colitis. The chemical components of herbs in Jinweitai Capsules were collected through TCMSP, CNKI and PubMed. Target prediction was performed through PubChem and SwissTargetPrediction databases; genes relating to acute and chronic gastritis, gastric and duodenal ulcers, chronic colitis were collected from OMIM database; potential targets of Jinweitai Capsules for relevant gastrointestinal diseases were obtained by Venny analysis; DAVID database was used to perform GO and KEGG enrichment analysis; protein interactions were obtained by STRING database and visua-lized by Cytoscape; AutoDockVina was used for molecular docking of AKT1, EGFR, PTPN11 and its reverse-selected chemical components. Potential mechanisms of Jinweitai Capsules in treating relevant gastrointestinal diseases were clarified according to the results of the docking. The results showed 86 potential active ingredients of Jinweitai Capsules and 268 potential targets for treatment of acute and chronic gastritis, gastric and duodenal ulcers, and chronic colitis. KEGG pathway enrichment analysis showed that 20 pathways relating to acute and chronic gastritis, gastric and duodenal ulcers, and chronic colitis mainly involved calcium signaling pathway and chemokine signaling pathway. Molecular docking showed a good binding activity between AKT1, EGFR, PTPN11 and its reverse screening chemical components. Jinweitai Capsules may exert an effect in the treatment of acute and chronic gastritis, gastric and duodenal ulcers, and chronic colitis by acting on AKT1, EGFR, PTPN11 and other targets in 15 signal pathways relating to cell inflammation and immunity, cell proliferation and apoptosis, Helicobacter pylori infection, and gastrointestinal tract.

The Relationship between Helicobacter pylori Infection of the Gallbladder and Chronic Cholecystitis and Cholelithiasis: A Systematic Review and Meta-Analysis.

Helicobacter pylori (H. pylori) is proved to be the main pathogenic agent of various diseases, including chronic gastritis, gastric ulcer, duodenal ulcer, and gastric cancer. In addition, chronic cholecystitis and cholelithiasis are common worldwide, which are supposed to increase the total mortality of patients. Epidemiologic evidence on the relationship between H. pylori infection of the gallbladder and chronic cholecystitis/cholelithiasis still remains unclear. We conducted a systematic review and meta-analysis of overall studies to investigate the relationship between H. pylori infection of the gallbladder and chronic cholecystitis/cholelithiasis. Two researchers searched PubMed, Embase, and Cochrane Library databases to obtain all related and eligible studies published before July 2020. The pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by the random-effects model. Subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also conducted. Twenty studies were included in the meta-analysis, involving 1735 participants and 1197 patients with chronic cholecystitis/cholelithiasis. Helicobacter species infection of the gallbladder was positively correlated with increased risk of chronic cholecystitis and cholelithiasis, especially H. pylori (OR = 3.05; 95% CI, 1.81–5.14; I2 = 23.5%). Besides, country-based subgroup analysis also showed a positive correlation between the gallbladder H. pylori positivity and chronic cholecystitis/cholelithiasis risk. For Asian and non-Asian country studies, the ORs were 4.30 (95% CI, 1.76–10.50; I2 = 37.4%) and 2.13 (95% CI, 1.23–3.70; I2 = 0.0%), respectively. The association was more obvious using the bile sample and urease gene primer. In conclusion, this meta-analysis provided evidence that there is a positive correlation between H. pylori infection in the gallbladder and increased risk of chronic cholecystitis and cholelithiasis.

Somatic comorbidities of inpatients receiving treatment for alcohol withdrawal syndrome on a psychiatric ward and their relation to delirium tremens.

This study aimed to assess the influence of somatic diseases and patient characteristics (age, gender) in relation to delirium tremens (DT) episodes in alcohol withdrawal syndrome (AWS). We also analysed the influence of age, gender and specific somatic diseases on the duration of hospital stay and the frequency of comorbid somatic diseases among AWS and DT patients. The medical records of patients admitted to an AWS treatment ward in a Polish psychiatric hospital in 2019 were analysed. In total, 800 hospitalisations of 656 patients (625 hospitalisations for AWS and 175 for DT) were evaluated. The most frequent group of somatic diseases among AWS and DT patients was cardiovascular diseases, with essential hyper tension as the main medical condition. Patients suffering from DT were diagnosed with respiratory system diseases (p < 0.001) and pneumonia (p < 0.000) more often than AWS patients. Hospital stays were longer for patients with pneumonia, chronic obstructive pulmonary disease and duodenal ulcers. Patients with acute pancreatitis were hospitalised for a significantly shorter period of time than other patients. Patient gender and age did not significantly affect the development of DT. However, age was positively correlated with duration of hospitalisation (p < 0.001). The presence of respiratory system diseases, especially pneumonia, was found to influence the incidence of DT in AWS patients. Increased clinical vigilance for the prevention of lower airway infections in AWS patients is essential.

Milk and dairy products as a possible source of environmental transmission of Helicobacter pylori

Helicobacter pylori (H. pylori) is found worldwide, and it is estimated that more than 50% of the population is infected. The presence of H. pylori in the gastrointestinal tract is associated with the occurrence of serious human diseases such as chronic gastritis, duodenal ulcer or gastric cancer. Therefore, the International Agency for Research on Cancer classified H. pylori as a Group 1 carcinogen in 1994. The routes of H. pylori transmission are not yet precisely known. Many authors agree that humans may become infected by H. pylori through foodstuffs. Milk is one of the basic foods of people of all age categories. Helicobacter pylori has been isolated from milk derived from various livestock, such as cows, sheep, goat, camel or buffalo milk. This review research paper indicates that H. pylori may be present in different types of foods and suggests that consumption of milk and selected dairy products may be a source of H. pylori infection for humans.

Preparation and Investigation of Gastro-Retentive Mucoadhesive Microspheres of Clarithromycin-Resin Complex

Introduction: Helicobacter pylori infection is strongly associated with chronic gastritis and duodenal ulcers which can benefit from gastroretentive delivery of clarithromycin. Objectives: The objective of this study was to investigate mucoadhesive microspheres of the antibiotic – resin complex for gastro-retention, thereby increasing the local effective concentrations of clarithromycin. Methods: Clarithromycin-resin complex granules were coated with the mucoadhesive polymers, Carbopol 934 and Polycarbophil in different ratios of 1:1, 1:2, 1:3 and 1:4 by solvent evaporation method. Prepared microspheres were subjected to characterization for particle size and shape, drug content, in vitro mucoadhesion, in vitro drug release and in vivo gastric residence time in albino rats. Results and Discussion: Particle sizes of the microspheres were found to be in the range of 83 μm-87μm. Scanning electron microscopic images of the formulation showed spherical particles with almost smooth surface morphology for carbopol microspheres. Formulations with both polymers showed mucoadhesion for a period of more than 6 hr. In vitro drug release using the USP dissolution test apparatus appeared to follow first order kinetics. Fluorescence imaging of histo-pathological slides of rats gastric and intestinal mucosa reveal that gastric residence time was found to be longer than 6 h for carbopol microspheres and at least 4 h in the case of polycarbophil microspheres. Conclusion: Carbopol coated microspheres of ion exchange resin complexes of clarithromycin for the gastro-retentive delivery of clarithromycin can be a promising alternative to the conventional oral solid dosage forms in the control of H. pylori induced chronic gastritis or duodenal ulcers.

Prediction of complications of chronic duodenal ulcer using the method of determining the ratio of the level of melatonin receptors in the mucosa

Treatment of complications of peptic ulcer disease is an urgent problem in abdominal surgery due to the high prevalence of bleeding (19-57) and perforations (3-14 cases per 100,000 population). The objective of the study was to assess the possibility of predicting the development of ulcerative disease complications determining the ratio of the level of melatonin receptors (MT1/MT2) in the duodenal mucosa. Methods and materials . 56 patients with different course of peptic ulcer disease were examined. All patients underwent esophagogastroduodenoscopy with biopsy of the bulb duodenum. Biopsies were analyzed on a flow cytometer. The results were statistically processed. Results. The ratio of melatonin receptors MT1/MT2 significantly differed in the group of patients with bleeding and in the group with perforation. During the statistical analysis, it was found that at a value of MT1/MT2≥1,7, it is possible to assume the development of complications in the patient in the form of perforation or bleeding. Conclusion. The method of determining the ratio of melatonin receptors (MT1/MT2) in patients with complicated peptic ulcer disease can be used for prediction the risk of complications.

Helicobacter pyloriin Pediatric Patients

Helicobacter pylori causes one of the most common chronic bacterial infections. Clinical manifestations include asymptomatic chronic gastritis, gastric and duodenal ulcers, adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma in adults. In children, most H pylori infections are asymptomatic despite being associated with microscopic gastric inflammation, and children rarely develop complications associated with infection. Due to rising resistance and lack of symptomatic improvement in the absence of peptic ulcer disease, testing and eradication therapy are recommended only for the subset of patients in whom there is a high suspicion of peptic ulcer disease. Studies do not support the role of H pylori infection in functional disorders such as recurrent abdominal pain. A variety of diagnostic modalities exist; therefore, it is important to understand the appropriate approach to diagnosing H pylori infection. The joint European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines were updated in 2016. Antibiotic and proton pump inhibitor weight-based dosing guidelines have changed to prevent ineffective treatment from increasing antimicrobial resistance. Treatment can also be guided by antibiotic sensitivities obtained from H pylori culture. Patients should be tested again after treatment to confirm eradication.

Dlaczego nie należy przerywać terapii inhibitorami pompy protonowej i antybiotykami stosowanymi w eradykacji Helicobacter pylori w czasie pandemii COVID-19?

Helicobacter pylori infection is one of the most widespread infectious diseases in the world, but its prevalence varies depending on geographical region and economic and social condition. The percent of infected adult persons in Poland is 67, among younger population under 18 years being as high as about 32%. This infection in some number of the concerned persons can be associated with chronic gastritis, peptic gastric and duodenal ulcers, gastric mucosa-associated lymphoid tissue lymphoma (MALT) and gastric cancer. Extra-gastric manifestation of H. pylori infection are iron deficiency anemia, idiopathic thrombocytopenic purpura and significant B12 deficiency. According to the Maastricht V/Florence Consensus Report considering H. pylori infection a contagious disease that requires treatment in each case, indications for diagnostic evaluation to detect its presence are established, and then to its eradication. The treatment of H. pylori infection is complex and based on the combination of the following groups of medicines: proton pump inhibitors (PPI), antibiotics and anti-microbial nitroimidazoles and bismuth salts and probiotics. Currently, the main challenge in the field of H. pylori infection is antibiotic resistance, which influences the efficacy of eradication regiments. According to Maastricht V/Florence Consensus, in Poland where H. pylori resistance to clarithromycin is more than 15%, quadruple therapy with bismuth, PPI, tetracycline and metronidazole/tinidazole for 10–14 days should be used as first-line treatment. Triple therapy with fluoroquinolone is recommended as second-line treatment. After two unsuccessful attempts to eradicate, bacterial cultures should be should be performed to asses antibiotic sensitivity of the H. pylori strain. There are no reasons in front of pandaemia of COVID-19 to delay eradication of H. pylori infection, when the urgent indications: peptic ulcer complicated with haemorrhage, MALT lymphoma or early gastric cancer exists.

Usage of wheat germ functional products in patients with chronic gastroduodenitis and duodenal ulcers alimentary support at the sanatorium resort treatment stage (literature review)

The article deals with the prevalence of chronic gastroduodenitis and duodenal ulcers among population. Special relevance of this problem for adolescents and young people of employment age is shown. Risk factors and pathogenetic mechanisms of this diseases development are highlighted, and the main clinical distinctive signs in this patients’ group are indicated: pain, dyspeptic and psychoautonomic syndromes. The evidences is given concerning advantage of specialized functional food products and food additives in therapeutic and prophylactic diets of patients with chronic gastroduodenitis and duodenal ulcers, which might be considered as etiopathogenetic treatment method for this patients’ group with significant clinical effects, while pharmacotherapy can be regarded only as a symptomatic treatment. High therapeutic efficiency of wheat gems oil and flour inclusion in the diets of this patients’ group is shown.