Dyspepsia Research Articles

New CagL Amino Acid Polymorphism Patterns of Helicobacter pylori in Peptic Ulcer and Non-Ulcer Dyspepsia

Background and Objectives: Helicobacter pylori infection is associated with chronic gastritis, ulcers, and gastric cancer. The H. pylori Type 4 secretion system (T4SS) translocates the CagA protein into host cells and plays an essential role in initiating gastric carcinogenesis. The CagL protein is a component of the T4SS. CagL amino acid polymorphisms are correlated with clinical outcomes. We aimed to study the association between CagL amino acid polymorphisms and peptic ulcer disease (PUD) and non-ulcer dyspepsia (NUD). Materials and Methods: A total of 99 patients (PUD, 46; NUD, 53) were enrolled and screened for H. pylori by qPCR from antrum biopsy samples. The amino acid polymorphisms of CagL were analyzed using DNA sequencing, followed by the MAFFT sequence alignment program to match the amino acid sequences. Results: Antrum biopsy samples from 70 out of 99 (70.7%) patients were found to be H. pylori DNA-positive. A positive band for cagL was detected in 42 out of 70 samples (PUD, 23; NUD, 19), and following this, these 42 samples were sequenced. In total, 27 different polymorphisms were determined. We determined three CagL amino acid polymorphism combinations, which were determined to be associated with PUD and NUD. Pattern 1 (K35/N122/V134/T175/R194/E210) was only detected in PUD patient samples and was related to a 1.35-fold risk (p = 0.02). Patterns 2 (V41/I134) and 3 (V41/K122/A171/I174) were found only in NUD patient samples and were linked to a 1.26-fold increased risk (p = 0.03). Conclusions: We observed three new patterns associated with PUD and NUD. Pattern 1 is related to PUD, and the other two patterns (Patterns 2 and 3) are related to NUD. The patterns that we identified include the remote polymorphisms of the CagL protein, which is a new approach. These patterns may help to understand the course of H. pylori infection.

Management of Helicobacter pylori infection.

Helicobacter pylori infection exhibits a wide disease spectrum ranging from asymptomatic gastritis, peptic ulcer disease, to gastric cancer. H. pylori can induce dysbiosis of gastric microbiota in the pathway of carcinogenesis and successful eradication can restore gastric homeostasis. Diagnostic testing and treatment for H. pylori infection is recommended in patients with active or past history of peptic ulcer, chronic dyspepsia, chronic non-steroidal anti-inflammatory drugs (NSAID) or aspirin use, precancerous gastric lesions, gastric cancer, mucosa-associated lymphoid tissue (MALT) lymphoma, family history of gastric cancer, family history of peptic ulcers, household family member having active H. pylori infection, iron deficiency anemia, idiopathic thrombocytopenic purpura, or vitamin B12 deficiency. Recommended first-line regimens for H. pylori eradication are classified according to clarithromycin resistance. In areas of high clarithromycin resistance (≥15%), we recommend 14-day concomitant therapy or 14-day bismuth quadruple therapy (BQT) as first-line regimen. In areas of low clarithromycin resistance (<15%), we recommend 14-day triple therapy or 14-day BQT as first-line treatment. Second-line regimens are 14-day levofloxacin triple therapy or 14-day BQT if BQT is not previously used. For patients with multiple treatment failure, antimicrobial susceptibility testing (AST) should be performed. If AST is not available, we recommend using antibiotics not previously used or for which resistance is unlikely, such as amoxicillin, tetracycline, bismuth, or furazolidone. High-dose potent proton pump inhibitor or vonoprazan is recommended to achieve adequate acid suppression. Probiotics can be used as an adjuvant treatment to reduce the side effects of antibiotics and enhance eradication rate.

Reporting of Helicobacter pylori associated gastroduodenal diseases: A clinicopathological approach

is one of the most important causes of the varied spectrum of gastroduodenal diseases. It is important to have a collaborative approach between clinicians and pathologists for early initiation of treatment in patients and control the progression of the disease.To evaluate the clinico-histopathological spectrum of gastroduodenal diseases with respect to infection and provide recommendations for reporting and management of the same.All patients of chronic dyspepsia not responding to conventional treatment were subjected to endoscopy, and mucosal biopsy samples were collected. A rapid urease test (RUT) and histopathology was performed on these samples. A histopathological evaluation was done with special reference to the Updated Sydney System for reporting of chronic gastritisThe specificity, sensitivity, positive predictive value, negative predictive value, and diagnostic accuracy of RUT were 97.22%, 94.04%, 98.75%, 87.5%, and 95%, respectively. The specificity, sensitivity, PPV, NPV and diagnostic accuracy of endoscopy were calculated as 98.68%, 88.5%, 95.83%, 96.15% and 96.07% respectively.A clinicopathological approach for diagnosis of associated gastroduodenal diseases which includes clinical assessment, endoscopic evaluation, RUT and histopathological analysis is of prime importance for effective management of such patients.

Trypsin may be associated with duodenal eosinophils through the expression of PAR2 in early chronic pancreatitis and functional dyspepsia with pancreatic enzyme abnormalities.

Early chronic pancreatitis (ECP) has been reported to advance into chronic pancreatitis, it may be critical to differentiate the pathophysiology of ECP and functional dyspepsia (FD) in patients with pancreatic enzyme abnormalities (FD-P). This study aimed to clarify differences in the pathophysiology of ECP and FD-P and to determine whether duodenal inflammatory responses in the two diseases were associated with protease-activated receptor (PAR) 2, as the trypsin receptor. Eighty patients who presented with FD-P and ECP were enrolled. In duodenal specimens, PAR2 mRNA levels were determined using real-time PCR. Using immunostaining, CD68-, GLP-1-, PRG2-, and CCR2-positive cells, tight junction proteins, and PAR 2 were evaluated. There were no significant differences in clinical symptoms and gastric motility between ECP and FD-P patients. The CD68-positive cells infiltrations and occludin expression levels in the duodenal mucosa of patients with FD-P were significantly (p<0.001 and p = 0.048, respectively) lower than those in patients with ECP. Although serum trypsin levels in ECP and FD-P patents were significantly (p<0.05 and p<0.001, respectively) associated with duodenal eosinophils counts, elevated trypsin levels were not significantly associated with degranulated eosinophils, occludin, claudin-1 and ZO-1 expression levels in the duodenum of either group. PAR2 mRNA levels were increased in the duodenum of patients with ECP and FD-P. PAR2 was localized in the epithelial cells of the duodenal mucosa and the surface of degranulated eosinophils in ECP and FD-P patients. Elevated trypsin levels might be partly associated with duodenal inflammatory responses through PAR2-related degranulated eosinophils and the reduction of occludin in patients with ECP and FD-P.

Unique CagL Amino Acid Polymorphism Patterns of Helicobacter pylori in Peptic Ulcer and Non-Ulcer Dyspepsia

Unique CagL Amino Acid Polymorphism Patterns of Helicobacter pylori in Peptic Ulcer and Non-Ulcer Dyspepsia

Functional Non-Existent Dyspepsy in Patients with Chronic Pyelonephritis

Introduction: Infectious and inflammatory kidney disease - chronic pyelonephritis - is a widespread disease and has a long course. Prolonged medical treatment can provoke the appearance of abdominal and (or) dyspeptic syndrome, for the correction of which cytoprotective therapy is appropriate. Itopride hydrochloride (itoprid) is known to be widely used in the clinic of internal medicine, in particular for the relief of gastrointestinal symptoms of functional non-ulcer dyspepsia (FND). Goal: The aim of our study was to study the dynamics of clinical symptoms and functional status of the gastric and duodenal mucosa in patients with manifestations of TNF on the background of CP without signs of chronic renal failure. Materials and Methods: Two groups of patients: 32 patients with PN with manifestations of functional non-ulcer dyspepsia, which formed the main group; The comparison group was a group of 30 patients who were treated exclusively allopathically without the appointment of itopride hydrochloride, which by age, sex and clinical form of CP probably did not differ from the main group. Results and Discussion: Pathology of the digestive system was manifested by the phenomena of moderate exacerbation (31.07%) or unstable remission (68.93%). Provoking factors in the emergence of diseases of the digestive system were emotional stress, eating disorders and bad habits, bad habits. The combination of several causal factors was determined in 75.8% of cases. According to the previous treatment of exacerbations of CP, due attention was not paid to the correction of lesions of the digestive system. The structure of clinical syndromes revealed the following symptoms from the digestive organs: pain (61.25%), dyspeptic (87.35%), astheno-autonomic syndrome (100%), autonomic disorders (61.76%). Dyspeptic syndrome manifested itself in the form of gastric and intestinal dyspepsia. External examination revealed a lining of the tongue in all patients. Feeling of discomfort in the epigastric region was observed in 37.12% of patients. In most cases, the pain was mild. Palpation revealed pain under the xiphoid process (35.56%), pyloroduodenal area (24.36%) and in both areas. In some patients (11.23%) palpation revealed pain in the absence of complaints from the digestive system. In the study of acid-forming function of the stomach by pH-metry, the predominance of hyperacid states was established. Unchanged gastric secretion (pH = 1.6-2.2) was in 32.15% of patients, moderately increased (pH = 1.3-1.5) in 31.45% of cases and moderately reduced (pH = 2, 3-3.5) in 24.65% of patients. Patients of the main group on the background of taking itopride hydrochloride noted a decrease in gastrointestinal manifestations. the dynamics of clinical symptoms of pain depending on the localization, which was detected by palpation. After a course of treatment, only 1 patient (3.12%) of the main group showed palpatory pain in the epigastric region, 2 (6.25%) - in the pyloroduodenal area (p &lt;0.05). Whereas in the comparison groups these indicators are slightly worse. Conclusions: Thus, when studying the clinical symptoms of GDZ in patients with TNF on the background of CP in the dynamics of treatment found greater effectiveness in the group with the inclusion of itopride hydrochloride compared to standard treatment.

S1582 Abnormal Glucose Breath Test Does Not Correlate With Patient’s Self-Reported Symptoms and Their Severity

Introduction: Glucose Hydrogen Breath Testing (GBT) is commonly used for diagnosing Small Intestinal Bacterial Overgrowth (SIBO). However, patients present with clinical symptoms (sx) and their predictive value for a positive (pos) GBT remains unclear. AIM: To assess the prevalence of self-reported GI sx profiles in adults with unexplained upper GI symptoms and correlate this with GBT. Methods: We retrospectively analyzed all adult patients presenting to a single medical center from 6/20 –12/21 for GBT. A pos GBT for SIBO was defined by the North American Consensus (≥20 ppm H2 increase over basal within 90 minutes (mins) and/or ≥10 ppm CH4 at any time). Pts completed a GI questionnaire assessing 17 key sxs: regurgitation (RG), chest pain (CP), heartburn (HB), belch (BH), abdominal pain (AP), bloating (BT), gas (GS), nausea (NA), vomit (VT), abdominal cramps (AC), indigestion (ID), distension (DN), fullness (FL), early satiety (ES), diarrhea (DR), constipation (CN), and fatigue (FT). Sxs measured by frequency (None, < 1/week (wk), 1/wk, ≥ 1/wk), intensity (None, Mild, Moderate, Severe), and duration (None, < 10 mins, 10 – 30 mins, ≥ 30 mins). Sub-groups, GERD, Dyspeptic, and IBS were constructed assessing the mean summation scores for Frequency, Intensity, and Duration between negative (neg) and pos GBTs. Univariate analysis and logistic regression analysis was performed. A P-value of < 0.05 was considered statistically significant. Results: We evaluated 184 pts, mean age of 51.7 (18 – 85), 78.3% female, 82.8% Caucasian, and mean BMI of 27.2. No significant differences were seen between GI sx frequency and intensity categories for pts with GBT neg and pos groups. A trend for a higher percentage of pos GBT pts reporting FL (P=0.09) and DR (P=0.07) in sx duration categories of 10 -30 mins (FL: 30.8% vs 27.5%; DR: 31.8% vs 23.4%) and ≥ 30 mins (FL: 51.3% vs 41.3%; DR: 37.2% vs 22.1%) was noted. Regression analysis showed a trend toward a pos GBT for VT frequency of Less than 1/wk: (P = 0.07; OR = 2.99; 95% CI: 0.91, 9.83) and NA intensity of Severe: (P = 0.09; OR = 2.24; 95% CI: 0.86, 5.84). No differences were seen between the GERD, Dyspeptic, and IBS sub-groups (Figure). Conclusion: The pre-test predictability of GI symptoms as it relates to a pos or neg GBT is poor. The yield for a pos GBT varies between 31%-55% and depends on age. In routine practice, when the index of clinical suspicion is high for SIBO, clinicians should consider objective testing with GBT rather than empiric antibiotic treatment.Figure 1.: (Left) Mean Summation Scores for Self-Reported Frequency, Intensity, and Duration Responses to GI Symptoms Relative to the Gastroesophageal Reflux Disease (GERD), Dyspeptic, and irritable bowel syndrome (IBS) Groups. (Right) Prevalence of Positive Glucose Breath Test (GBT) Among Age Cohorts and Glucose Breath Test Measurements

Prevalence of Helicobacter pylori infection among asymptomatic children in southeastern Brazil: a cross-sectional study.

ABSTRACTBACKGROUND:The prevalence of Helico bacter pylori (H. pylori) infection is decreasing worldwide, but is still high in developing countries. We previously observed an H. pylori infection rate of 52% among children and adolescents with chronic non-ulcer dyspepsia.OBJECTIVE:To investigate the prevalence of H. pylori infection among asymptomatic children living in a single region and to evaluate the risk factors for this infection.DESIGN AND SETTING:Cross-sectional study in which 161 children aged 5-13 years (mean age 7.8 years), at a public school in Botucatu, state of São Paulo, southeastern Brazil, were assessed.METHOD:The children's H. pylori infection status was determined through the urea breath test and the risk factors for acquisition of the infection were determined based on a sociodemographic questionnaire.RESULTS:The overall prevalence of H. pylori infection was 20.5%: 18.7% among females and 22.2% among males. The results from the sociodemographic survey did not differ between children with and without H. pylori infection. 30.9% of the children had previous records of upper gastrointestinal symptoms, which consisted of H. pylori infection in only 26.5% of these cases. Family histories of gastritis and peptic ulcer disease were found in relation to 50% and 32.3% of the children with H. pylori infection respectively.CONCLUSION:The prevalence of H. pylori infection among asymptomatic children in southeastern Brazil is lower than that recorded among symptomatic children in the same region and similar to the prevalence of H. pylori infection observed in developed countries.

S2407 Pyloriin the Patch

Introduction: Helicobacter pylori is the most common chronic bacterial infection found in humans. H. pylori is restricted in its ability to colonize only gastric mucosa; however, this can occur anywhere in the gastrointestinal tract where gastric mucosa is found. Heterotopic gastric mucosa of the upper esophagus (inlet patch) is thus a potential reservoir for H. pylori. We present a case of H. pylori infection in an inlet patch. Case Description/Methods: A 44-year-old Hispanic male presented to the gastroenterology clinic for chronic dyspepsia. The patient endorsed a year-long history of uncontrolled acid reflux, nausea with vomiting, loss of appetite and diffuse abdominal pain. He reported being diagnosed with H. Pylori infection through a stool test performed 3 months prior to the visit. He completed treatment with amoxicillin, clarithromycin, and pantoprazole, but had not yet been tested for eradication. The patient underwent an esophagogastroduodenoscopy (EGD) that revealed 2 areas of esophageal inlet patch in the upper third of the esophagus suggestive of ectopic gastric mucosa, with associated nodularity. The biopsy from the esophageal lesion confirmed gastric heterotopia with chronic active gastritis and a positive hematoxylin and eosin (H&E) stain for H. pylori. Random gastric biopsies were also positive for H. pylori (Figure). The patient was treated with quadruple therapy (pantoprazole, bismuth, metronidazole, and tetracycline) for 14 days with subsequent improvement of his symptoms during follow up visit. Discussion: Inlet patches are mostly found in the upper third of the esophagus, typically adjacent to the upper esophageal sphincter. Clinical symptoms of inlet patches can include chronic cough, heartburn, sore throat, globus sensation, dysphagia, and regurgitation. These symptoms likely occur due to the acid production in the heterotopic gastric mucosa. The incidence of H. Pylori in a patch has been found to closely correlate with the density of the bacteria in the stomach. However, H. Pylori colonization of heterotopic gastric mucosa is not seen in all cases of H. Pylori gastritis, which points towards reflux as the inciting event. Isolated H. Pylori infection in an inlet patch without concurrent H. Pylori gastritis and cases of primary adenocarcinoma arising from the heterotopic gastric mucosa have been reported. Biopsies of the inlet patch should be considered in all patients presenting with esophageal and extraesophageal symptoms, especially if it is associated with nodularity.Figure 1.: a) Endoscopy demonstrating esophageal inlet patch with increased nodularity b) Helicobacter Pylori organisms in lumen (H&E, 400x).

High-rate of long-term revision surgery due to weight regain after Laparoscopic Gastric Greater Curvature Plication (LGGCP)

PurposeTo present the long-term clinical outcomes of laparoscopic gastric greater curvature plication (LGGCP) in terms of weight loss and revision surgery rate. Material and methodsThis single-center study involved a retrospective analysis of patients that underwent revision surgery after LGGCP due to weight regain. Demographic and anthropometric data, comorbidities, operation time, hospital stays, mortalities, and immediate and long-term postoperative complications were analyzed. Postoperative Body Mass Index (BMI), %total weight loss (TWL), and complications were collected during follow-up. ResultsOf the 75 patients that underwent LGGCP at our hospital from March 2013 to February 2016, 13 (13/75, 17.3%) underwent revision surgery. All patients except one opted for sleeve gastrectomy. The mean interval between LGGCP and revision surgery was 71.0 ± 12.0 months (range, 54.8–93.6), and mean body weight, BMI, and TWL at revision were 89.2 ± 11.3 kg, 33.9 ± 4.2 kg/m2, and 4.7 ± 9.3%, respectively. The main reason for revision was weight regain. Additional problems were chronic intermittent GERD (4/13, 30.8%), dyspepsia (4/13,30.8%), and chronic relapsing melena (1/13, 7.7%). Two patients experienced immediate postoperative complications (Clavien-Dindo II and III). At one year after revision surgery, the mean body weight, BMI, and additional %TWL from revision surgery were 63.0 ± 5.3 kg, 24.0 ± 2.9 kg/m2, and 28.7 ± 8.0%, respectively. One of four patients (1/4, 25%) that complained of GERD before revision surgery, was still on PPI medication at 1 year after revision surgery. ConclusionAlthough LGGCP showed initial acceptable weight loss outcomes, long term (>5 years) follow-up showed that LGGCP is associated with a high rate of revision surgery (17.3%) due to weight regain.

An expert opinion on antacids: A review of its pharmacological properties and therapeutic efficacy

Acidity caused by common gastric conditions such as non-ulcer dyspepsia, duodenal ulcer, gastric ulcer, stress gastritis, gastroesophageal reflux disease (GERD), pancreatic insufficiency, bile acid-mediated diarrhea, biliary reflux, and constipation can be treated by administration of potent and efficacious acid suppressant (anti-secretory) agents such as antacids, histamine H2 receptor blockers, and proton pump inhibitors (PPIs). Antacids provide symptomatic relief from hyperacidity as well as other associated conditions by neutralizing the gastric acid directly, thereby raising the gastric pH, attenuating the pepsin activity, restoring acid-base balance, and increasing prostaglandin and bicarbonate secretion. The effectiveness of antacids is determined by its acid neutralizing capacity (ANC) and buffering capacity. Antacids containing a combination of aluminum hydroxide, magnesium hydroxide, and other ingredients such as those present in Digene showed better therapeutic efficacy even at low dosage with fewer side effects, persistent increase in gastric pH, faster and longer duration of pain relief, and fast relief from gas. Various clinical studies suggest that to obtain fast symptomatic relief, the treating physician can utilize antacids with the highest neutralizing capacities like Digene.

Role of BTLA/HVEM network in development of gastric cancer

The immunopathological mechanism underlying intestinal metaplasia and gastric cancer remain incompletely understood. Regarding the role of B- and T-lymphocyte attenuator (BTLA) / herpesvirus entry mediator (HVEM) in tumorigenesis, this research was conducted to determine the BTLA/HVEM expression in development of gastric cancer. Gastric biopsy and peripheral blood was drawn from 32 non-ulcer dyspepsia (NUD) as control group, 19 intestinal metaplasia (IM), and 63 gastric cancer (GC). BTLA/HVEM expression were analyzed by immunohistochemistry and quantitative real-time polymerase chain reaction. Soluble HVEM (sHVEM) and anti-Helicobacter pylori IgG antibody were assessed by ELISA. Our result showed that BTLA mRNA and protein were significantly increased in advanced stages of gastric cancer. HVEM was higher only at the protein level in the GC group. The sHVEM concentration was also higher in the GC group than in the NUD groups. In addition, we observed H. pylori-positive samples had a lower H-score of HVEM than H. pylori-negative ones. These results suggest that BTLA/HVEM/sHVEM inhibitory pathway is involved in immune regulation and progression of gastric cancer. Therefore, this inhibitory pathway might be a therapeutic target to further immunotherapy of gastric cancer.

Rifampicin versus Doxycycline in Prevention of recurrent Boils (A Comparative Therapeutic Study)

Background: Suffering from recurrent boils (furunclosis) is a common problem in our locality as it is noticed by many dermatologists especially in association with increasingly hot weather. The most common causative organisms are staphylococci. Objective: The aim of the study was to shed the light upon this problem and compare two systemic therapeutic agents for the prevention of recurrence, doxycycline and rifampicin. Patient and method: One hundred thirty-five (135) Patients with recurrent boils from Al-Yarmouk teaching hospital dermatology outpatient department were included in this study; age ranged from 10 to 64 years old and out of total patients 32 were males and 103 were females. Patients were assessed by full history and clinical examination done by dermatologist. An aspirate from the content of the boil was taken from 30 patients for bacteriological culture. The patients were treated by topical with or without systemic anti-staph antibiotics followed by a preventive protocol of doxycycline100mg twice daily for two months duration in 50 patients and rifampicin 600mg for ten days in the other 85 patients. Both groups used topical sodium fucidate 2% ointment twice daily in nostrils, axilla and perineum for ten days. All were followed up for 2 years to assess the recurrence after treatment. Results: Out of 135 patients treated, 3 (2.22%) patients defaulted from follow up (they were from doxycyclin group) and out of the remainder 132, only 9 (6.8%) patients had recurrence after treatment; 7 (14.89%) patients from the doxycycline group and 3(3.52%) patients from rifampicin group. Forty 40 (85.1%) patients responded well to doxycycline without recurrence for 2 years compared to 83 (97.65%) patients treated with Rifampicin with no recurrence during the 2 years of follow up. The noticed side effects were gastric upset in doxycycline and urine discoloration in rifampicin. Conclusion: Rifampicin regimen in prevention of recurrent boils significantly showed higher effectiveness in addition to more tolerable, easier, shorter course, and fewer side effects than doxycyclin.

Helicobacter pylori Chronic Gastritis in Children and Adolescents was not Associated with Anaemia

Background: Helicobacter pylori (H. pylori) colonizes the gastric mucosa, leading to chronic inflammation. Epidemiological studies have demonstrated that H. pylori infection is high in areas with a high prevalence of anaemia. Consequently, patients infected with H. pylori are at a higher risk of anaemia. However, the relationship between H. pylori and anaemia remains controversial. Therefore, a study conducted among children with chronic abdominal pain with organic dyspepsia (chronic gastritis due to H. pylori and (or?) Esophagitis), and a functional disorder (Irritable Bowel Syndrome), will be appropriate. Objective: Compare the prevalence of Anaemia in children and adolescents with chronic abdominal pain, divided into: 1) Non-ulcer dyspepsia associated with H. pylori gastritis., 2) Dyspepsia associated with chronic Esophagitis, and Irritable Bowel Syndrome. Methods: The study was a single-centre, observational retrospective cohort. Inclusion and Exclusion Criteria. All children must be well categorized with signs and symptoms consistent with chronic abdominal pain and aged between 5-and 18 years. Exclusion criteria: genetic, metabolic, immune, cardiac, hepatic or renal diseases, neurodevelopmental delay, and previous surgery. Laboratory tests were performed for all patients: complete blood cell count, Erythrocyte Sedimentation Rate, urinalysis, stool for ova &amp; parasites, and H. pylori serology. Another diagnostic test was decided at the discretion of the gastroenterology team. The chronic dyspeptic syndrome with non-ulcer dyspepsia associated with H. pylori if they presented both results: the rapid urease test positive and the histological examination of the gastric mucosa confirming the presence of the bacterium. Dyspepsia associated with chronic Esophagitis was based on clinical symptoms/signs and endoscopic and histologic evaluation. Patients with IBS were diagnosed according to Rome Criteria. Results: Three hundred and seven children/adolescents: H. pylori gastritis (154, 50%), Esophagitis (41, 14%), and IBS (112, 36%) were included. There was a non-statistically significant difference in the baseline characteristics (sex, first-born child, age of mothers, age of fathers, crowding index, duration of pain symptoms, headache and limb pain, overweight/obesity and malnutrition) between the three groups. Clinical characteristics demonstrated: H. pylori and Esophagitis have epigastric pain and IBS periumbilical pain. There was a non-statistically significant difference in haemoglobin values and red cell parameters between the three groups in laboratory investigation. The prevalence of anaemia was very low, with no difference between the groups. Urinalysis and stool for ova &amp; parasites were negative in all children. Conclusion: Anaemia was not present in children with chronic abdominal pain, both organic and functional disorders. Age, good nutritional status, good sanitation and hygiene may have contributed to the results in this study.

Disorders of gut-brain interaction: Highly prevalent and burdensome yet under-taught within medical education.

Background and ObjectiveTo determine the population prevalence and associated health impairment of disorders of gut‐brain interaction (DGBI) across Great Britain, and the emphasis placed upon them within medical education.MethodsAn Internet‐based cross‐sectional health survey was completed by 1906 general population adults across Great Britain without self‐reported organic GI disease. The survey enquired for demographics, symptom‐based criteria for Rome IV DGBI, healthcare use, non‐GI somatic symptoms, and quality of life. As a separate analysis, we evaluated which DGBI are considered core knowledge at undergraduate medical school level and post‐graduate specialization level for Gastroenterologists and General Practitioners.ResultsThe overall prevalence of DGBI across Great Britain was 37%, being similar for England (37%), Scotland (33%), and Wales (36%); p = 0.66. There was no difference between English regions (range 33%–43%, p = 0.26). The prevalence of DGBI was highest in those aged 18–40 years (40%), then 40–64 years (37%), and least amongst those ≥65 years (29%); p < 0.001. The most common DGBI were bowel disorders (30%), followed by gastroduodenal (10.5%), anorectal (8.1%) and oesophageal disorders (6.2%). Individuals with DGBI were significantly more likely than those without DGBI to have increased GI‐related healthcare visits, medication use, surgical interventions, non‐GI somatic symptoms, and reduced quality of life. One‐in‐three people with DGBI had multiple GI organ regions involved and this correlated with increased health impairment (p < 0.001).The only DGBI mentioned across all medical training curricula is irritable bowel syndrome, while the General Practitioner and Gastroenterology Curricula also recognise the outdated term non‐ulcer dyspepsia (as opposed to functional dyspepsia). The 2010 Gastroenterology Curriculum also includes functional constipation and disordered defecation, with the incoming 2022 iteration adding in functional upper GI syndromes, functional abdominal pain, and opioid‐induced GI disturbances.ConclusionDisorders of gut‐brain interaction are common across Great Britain and incur substantial health impairment. However, they are generally under‐taught within the British medical education system. Increasing awareness and education of disorders of gut‐brain interaction might improve patient outcomes.

Assessment of factors associated with pre-hospital delay in seeking medical treatment among patients with myocardial infarction admitted in selected hospital of Kolkata, West Bengal

Myocardial Infarction is a medical emergency which need prompt and early treatment, and delays in seeking care can have adverse consequences on patient’s outcome. Hence a descriptive study was conducted to assess the factors associated with pre-hospital delay in seeking medical treatment among patients with myocardial infarction. Descriptive survey approach was adopted to collect data from 188 subjects selected by non-probability purposive sampling technique. Semi structured interview schedule was used to collect data. Findings revealed that in the aspect of contextual factors, among 188 subjects, majority (44.6%) subjects delayed the treatment because the distance from home to hospital was too far whereas significant people (22.8%) delayed because the symptoms came and went away. In relation to cognitive factors, majority (52.6%) of the subjects delayed because they perceived that the symptoms originated from gastric upset. Similarly in relation to behavioral factors, maximum (49.4%) of the subject delayed because they tried to eliminate the symptoms by doing other activities and taking self- medication. The findings of the study have several implications in nursing. Hence the researcher recommends to undertake similar research in a large group and various interventions can be developed by the nurses to reduce the pre hospital delay in seeking medical treatment in such a disease.

The Diagnostic Usefulness of Stool Antigen Test with Serum Helicobacter pylori Antibody and CLO Test in the Diagnosis of Helicobacter pylori Infection in Dyspeptic Patients

Introduction: Helicobacter pylori colonization of the human gastric mucosa potentially leads to chronic gastritis that may progress to peptic ulcer disease. Additionally, this micro-organism has been identified as a risk factor for the development of gastric carcinoma and gastric lymphoma. Its relation with non-ulcer dyspepsia has not been clear. Objective: To assess the diagnostic usefulness of stool antigen test with serum Helicobacter pylori antibody and CLO test in the diagnosis of Helicobacter pylori infection in dyspeptic patients. Materials and Methods: This was a cross sectional study was conducted in the Department of Microbiology, Sylhet M.A.G. Osmani Medical College in collaboration with the Department of Gastroenterology Sylhet M.A.G. Osmani Medical College, Sylhet from July 2012 to June 2013. The calculated sample size was 196 but in this study we took 150 patients due to financial constrain and time limitation. Patients upper GI tract for dyspepsia and whoever fulfilled the inclusion and exclusion criteria were considered as study sample. All the findings, previous history and reports of investigations were recorded in a preformed data collection sheet prepared for this purpose. The patient with clinical features suggestive of dyspepsia was selected for upper GI endoscopy. Results: For this purpose, 150 dyspeptic patients fulfilling the inclusion and exclusion criteria were enrolled. The age of the patients ranged from 18 to 80 years with the mean age of 43.35 (SD ± 16.30) years. There were 32 (21.3%) patients in the age group of 21 to 30 years, 31 (20.7%) patients in the age group of 31 to 40 years, 30 (20.0%) patients in the age group of 41-50 years, 26 (17.3%) patients in the age group of 51-60 years, 21 (14.0%) patients in the age group of above 60 years and 10 (6.7%) patients in the age group up to 20 years. There were 93 (62.0%) male and 57 (38.0%) female with a ratio of male to female was 163:1. Showed the distribution of patients according to endoscopic findings. Endoscopic findings was normal in 85 (56.7%) patients, duodenal ulcer in 26 (17.3%) patients, gastritis in 23 (15.3%) patients, and gastric ulcer in 16 (10.7%) patients. The distribution of patients according to CLO test. CLO test was positive in 97 (64.7%) patients and negative in 53 (35.3%) patients. The patients according to serum Helicobacter pylori antibody by ELISA. Serum Helicobacter pylori antibody was positive in 101 (67.3%) patients and negative in 49 (32.7%) patients. Stool antigen test was positive in 73 (48.7%) patients and negative in 77 (51.3%) patients. Using CLO test as the gold standard the sensitivity and specificity of stool antigen test in the diagnosis of Helicobacter pylori infection was 72.7% and 94.3% respectively. Positive and negative predictive values were 95.9% and 64.9% respectively. The overall accuracy was 80.0%. There was moderate agreement between the two test (Kappa, k=0.603; p&lt;0.001). Using CLO test as the gold standard in the diagnosis of Helicobacter pylori infection the sensitivity and specificity of serum Helicobacter pylori antibody was 89.7% and 82.2% respectively. Positive and negative predictive values were 86.1% and 79.6% respectively. The overall accuracy was 84.0%. There was a substantial agreement between the two test (Kappa, k=0.644; p&lt;0.001). Conclusion: The overall accuracy was 80.0%. There was good agreement between the two test (Kappa, k=0.603). Using CLO test as the gold standard in the diagnosis of Helicobacter pylori infection this study showed that the sensitivity and specificity of serum Helicobacter pylori antibody was 89.7% and 82.2% respectively. Positive and negative predictive values were 88.7% and 100.0% respectively. The overall accuracy was 84.0%. In conclusion comparing CLO test (invasive) is still the superior to stool antigen and serology (non-invasive), both of which is going very close to each other in the diagnosis of Helicobacter pylori infection in dyspeptic patients.

The complexity of perioperative management of acute limb ischemia in elderly with multiple comorbidities and underlying diseases: A case report

Background: Aging process commonly associated with multiple comorbidities such as metabolic disorders, vascular, visual, gait, balance and psycho-social problems. Atherosclerosis is one of comorbidities that could occur as a pre-existing condition in elderly with peripheral artery disease (PAD). Elderly patients associated with complex and multi-factorial medical conditions need to be addressed in a comprehensive approach. Here we report the complexity of perioperative management of an elderly with acute limb ischemia in elderly with multiple comorbidities and underlying diseases.&#x0D; Case Presentation: An elderly woman, 77-year-old, was referred to emergency room due to decreased level of consciousness. There were complaints of loss appetite, inactivity, bedridden, pain, paresthesia and muscle weakness in the right lower limb. There was history of chronic hypertension and dyspepsia. Since there was a sign of right lower limb acute limb ischemia, the patient was discussed with the multi-discipline team, planned for primary amputation, and received systemic anticoagulant treatment. Due to multiple comorbidities and underlying diseases, the patient died prior to amputation surgery.&#x0D; Conclusion: Surgery is not contraindication to elderly; however, from this case it shed light the needs of multi-discipline approach to decide the best treatment options for patient’s needs. Utilizing a Comprehensive Geriatric Assessment (CGA) could be an alternative to non-invasive, simple, and effective approach available in any healthcare setting.

Co-infection relationship with Epstein-Barr virus in gastroduodenal diseases with Helicobacter Pylori. Quantitative PCR and EBNA-1 gene-based approach.

Helicobacter pylori (Hp) and Epstein-Barr virus (EBV) are involved in gastric cancer (GC) etiology. EBV/Hp co- infection was thought synergistically increase gastroduodenal disease occurence. We aimed to determine the presence of EBV/Hp co-infection in gastroduodenal diseases. The study group had 68 Hp (+) cases [25 GC, 13 IM (intestinal metaplasia), 30 PU (peptic ulcer)], and the control group had 40 NUD (non-ulcer dyspepsia) cases [20 Hp+, 20 Hp-]. EBV-DNA was detected by non-polymorphic EBNA-1 gene-based qPCR. EBV/EBNA-1 IgG levels were determined by quantitative and qualitative ELISA methods, respectively. EBV-DNA positivity was 32% (8/25), 6.6% (2/30) and 5% (1/20) in GC, PU and NUD Hp (+) cases, respectively. There was a significant difference (p = 0.001) between GC (32%) and NUD Hp (+) (5%) cases in terms of EBV-DNA positivity. Mean EBV-DNA copy numbers were 6568.54 ± 20351, 30.60 ± 159.88 and 13.85 ± 61.93 for GC, PU, and NUD, respectively. In terms of the mean EBV-DNA copy number, a significant difference was found between the groups (p = 0.005). In terms of EBV/EBNA-1 IgG antibody positivity, no significant difference was found between GC and NUD cases (p = 0.248). EBV DNA positivity was found to be significant (odds ration [OR] = 26.71 (p=0.009, %95CI 2.286- 312.041) in multivariate logistic regression. Although we had a small number of GC cases, it can be suggested that the estimated risk created by the synergistic effect based on the addition of EBV increased 26 times in the presence of Hp in GC.

Mapping microbiome-redox spectrum and evaluating Microbial-Redox Index in chronic gastritis

Peptic ulcer disease (PUD) and chronic gastritis are prevalent in developing countries. The role of oxidative stress in the pathogenesis of gastrointestinal mucosal disorders is well recognized. In PUD, the gastric mucosa and its associated microbiome are subject to diet and stress-induced oxidative perturbations. Tissue redox potential (ORP) measurement can quantify oxidative stress, reflecting the balance between prooxidants and antioxidants. This study hypothesizes that the oxidative stress quantified by tissue ORP will be associated with characteristic changes in the mucosa-associated microbiome in PUD and gastritis. In addition, we propose using relative microbial abundance as a quantitative marker of mucosal health. Endoscopy was performed to obtain gastric mucosal biopsies from ten PUD and ten non-ulcer dyspepsia (NUD) patients. The tissue ORP was measured directly with a microelectrode using a biopsy specimen. A second specimen from an adjacent site was subjected to 16s rRNA gene sequencing. From the OTUs, the relative abundance of the microbial taxon in each of the samples was derived. We analyzed the genome of the predominant species for genes encoding the utilization of oxygen as an electron acceptor in respiration and for the presence of antioxidant defense mechanisms. The organisms were then grouped based on their established and inferred redox traits. Shannon diversity index and Species richness were calculated on rarefied data. The relative abundance of organisms that prefer high ORP over those that favor low ORP is conceived as the “Microbial Redox Index (MRI),” an indicator of mucosal health. In the gastric mucosa, aerobic species predominate and are more diverse than the anaerobes. The predominant aerobes are Helicobacter pylori and Sphingobacterium mizutaii. The abundance of these two species had an inverse correlation with the abundance of low ORP preferring anaerobes. Their relative abundance ratio (Microbial Redox Index) correlated with the tissue oxidation–reduction potential (ORP), a direct measure of oxidative stress. Correlation analysis also revealed that the abundance of all anaerobes inversely correlated with the dominant aerobic taxa. In addition, Shannon and Species richness diversity indices, the probable indicators of mucosal health, were negatively correlated with Microbial Redox Index. Using PUD as a prototype mucosal disease, this article describes a generalized approach to infer and quantify mucosal oxidative stress by analyzing the relative abundance of microorganisms that preferentially grow at the extremes of the tissue redox potential. This ratiometric Microbial Redox Index can also be assessed using simple qPCR without the need for sequencing. The approach described herein may be helpful as a widely applicable quantitative measure of mucosal health with prognostic and therapeutic implications.