Dyspeptic Patients Research Articles

Evaluation of QOL in Patients with Dyspeptic Symptoms Who Meet or Do Not Meet Rome IV Criteria.

Health related quality of life (HR-QOL) of functional dyspepsia (FD) patients is impaired. However, the QOL of such patients has not been fully examined. Accordingly, we examined the QOL of Rome IV defined FD, endoscopic negative dyspeptic patients who do not meet the criteria, (non-FD patients) and healthy subjects, and investigated the factors that influence HR-QOL. This was a multicenter, prospective, observational study. Two hundred thirty-five patients (126 FD, 87 non-FD) and 111 healthy subjects were investigated, and non-FD patients were subdivided into three groups: 17 patients failing to meet only the disease duration criterion (Group A), 53 patients failing to meet only disease frequency criterion (Group B) and 17 patients failing to meet both the disease duration and frequency criteria (Group C). They completed a questionnaire survey regarding gastrointestinal symptoms (GSRS), QOL and psychological factors, which were compared among three groups. The total GSRS score was significantly higher in FD patients than non-FD patients (p = 0.012), which was higher than the healthy subjects (p < 0.0001). Furthermore, the total GSRS score of FD patients was comparable to that of Group A (p = 0.885), which was significantly higher than that of the Group B and C (p = 0.028, p = 0.014, respectively). HR-QOL is more impaired in FD patients than non-FD patients, which was significantly lower than the healthy subjects. That GSRS score in FD and Group A was comparable suggesting that an increased frequency of symptoms may have impact on the impairment of patient’s QOL.

Study of Prevalence of H Pylori Infection in Dyspeptic Patients

Background: Helicobacter pylori infection occurs worldwide, affecting more than half of the world population. The clear aetiology of dyspeptic symptoms is still unclear but helicobacter infection is main contributing factor for it we investigated Helicobacter pylori prevalence in dyspepsia. Methods: 100 cases of dyspepsia attended Adichunchanagiri hospital and research center, studied over a period of 18 months (January 2020 to June 2021), were subjected to upper gastrointestinal endoscopy, during which 4 biopsies, two each from the antrum and the pathological areas were taken. Two biopsy specimens, one of the antral area and the other of the pathological finding were immediately inoculated into freshly prepared urea broth containing phenol red as the indicator. Positive test for Helicobacter pylori was indicated by change in colour of the medium from yellow to pink or red. The other two biopsy specimens were sent for routine histopathology. The case was taken as Helicobacter pylori positive when the rapid urease test and/or histopathological examination were positive. Results: Out of 100 dyspeptic patients who were included in the study, there were 65 male patients and 35 female patients. In which 71 patients were found to have been infected with Helicobacter pylori (71%). Conclusion: In this study, we found that in Dyspepsia the Helicobacter pylori was consistently associated and its well proved with various studies done in past and present. Thus we conclude Helicobacter pylori infection definitely have role in the aetiopathogenesis of dyspepsia. Keywords: Giemsa; Helicobacter Pylori; Peptic ulcer disease; Urease; Ulcerative dyspepsia.

Endoscopic Evaluation of Dyspeptic Patient in Tertiary Care Hospital

Objectives: To observe the organic change occurs in dyspeptic patient by upper gastrointestinal endoscopy. Methods: The present prospective, observational, cross-sectional study was conducted at Medicine and Gastroenterology department of Sir Salimullah Medical College &amp; Mitford Hospital, over a period of 6 month from 2019 to 2020.The study population was 200with aged18 years and above, irrespective of sex and who were suffering from dyspeptic symptoms for at least 6 months duration. Data regarding the demographic profile of study population nand endoscopic findings were processed and analyzed using software SPSS (Statistical Package for social science) version 26. Results: It was observed that most of the dyspeptic patients 71%were showing normal endoscopic findings and 29% have abnormal endoscopy findingwhere majority of the patient were 51 – 70 years of age.Out of them 41% of male and 26% of female had organic changes. It was also found that 46% of the patients were smoker and among them 34(37%) had abnormal endoscopic finding where 24(22%) non-smokerpatient had abnormal finding, which were statistically significant (p,0.05) between two group. Among abnormal endoscopic finding, 11% gastric erosions, 08% gastric ulcer, 04% duodenal erosions, 03% duodenal ulcer, 02% reflux oesophagitis, and carcinoma stomach rare 01%. Conclusion: The study concludes that majority of patients with complaints of dyspepsia have no organic lesion and can be considered non ulcer dyspepsia. The common abnormal endoscopic findings included gastric erosion and gastric ulcers relating to dyspepsia. The study findings also suggest that smoking is a risk factor for developing organic changes in dyspeptic patients specially in middle age group. Bangladesh J Medicine July 2022; 33(1) : 3-7

Endoscopic and histopathological findings in adult dyspeptic patients, and their association with Helicobacter pylori infection in Dhaka, Bangladesh

Conventional upper-intestinal endoscopy is usually performed to diagnose Helicobacter pylori (H. pylori) associated diseases, using gastric mucosa from the biopsy. The objective of our study was to identify the prevalence of H. pylori and its relation with endoscopic findings and histopathological features in dyspeptic adult patients. Gastroduodenal biopsy specimens were collected from 143 adult dyspeptic outpatients who attended the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH), for endoscopy. H. pylori was identified by rapid urease test (RUT), ureC gene PCR, and histological staining (Giemsa). The study population was divided into H. pylori-positive cases (47; 32.9%) and H. pylori-negative cases (96; 67.1%), based on the case definitions used in the study. The highest rate of H. pylori infection was found in the 41-50 years age group (25.5%). Endoscopically, 101 (97.1%) dyspeptic patients had gastritis, with the majority of H. pylori infections found among histopathologically diagnosed duodenal ulcer patients. Endoscopic findings were significantly correlated with histological findings (p < 0.001). Significant correlations between endoscopic and histopathological findings were observed. Early detection and prompt treatment of H. pylori infection are essential for the prevention of serious complications.

The Impact of Gastrointestinal Symptoms on Patients’ Well-Being: Best–Worst Scaling (BWS) to Prioritize Symptoms of the Gastrointestinal Symptom Score (GIS)

Background: The gastrointestinal symptom score (GIS) is used in a standardized form to ascertain dyspeptic symptoms in patients with functional dyspepsia in clinical practice. As a criterion for evaluating the effectiveness of a treatment, the change in the summed total point value is used. The total score ranges from 0 to 40 points, in which a higher score represents a more serious manifestation of the disease. Each symptom is included with equal importance in the overall evaluation. The objective of this study was to test this assumption from a patients’ perspective. Our aim was to measure the priorities of patients for the ten gastrointestinal symptoms by using best–worst scaling. Method: A best–worst scaling (BWS) object scaling (Case 1) was applied. Therefore, the symptoms of the GIS were included in a questionnaire using a fractional factorial design (BIBD—balanced incomplete block design). In each choice set, the patients selected the component that had the most and the least impact on their well-being. The BIB design generated a total of 15 choice sets, which each included four attributes. Results: In this study, 1096 affected patients were asked for their priorities regarding a treatment of functional dyspepsia and motility disorder. Based on the data analysis, the symptoms abdominal cramps (SQRT (B/W): −1.27), vomiting (SQRT (B/W): −1.07) and epigastric pain (SQRT (B/W): −0.76) were most important and thus have the greatest influence on the well-being of patients with functional dyspepsia and motility disorders. In the middle range are the symptoms nausea (SQRT (B/W): −0.69), acid reflux/indigestion (SQRT (B/W): −0.29), sickness (SQRT (B/W): −0.26) and retrosternal discomfort (SQRT (B/W): 0.26), whereas the symptoms causing the least impact are the feeling of fullness (SQRT (B/W): 0.80), early satiety (SQRT (B/W): 1.54) and loss of appetite (SQRT(B/W): 1.95). Discussion: Unlike the underlying assumption of the GIS, the BWS indicated that patients did not weight the 10 symptoms equally. The results of the survey show that the three symptoms of vomiting, abdominal cramps and epigastric pain are weighted considerably higher than symptoms such as early satiety, loss of appetite and the feeling of fullness. The evaluation of the BWS data has illustrated, however, that the restrictive assumption of GIS does not reflect the reality of dyspeptic patients. Conclusions: In conclusion, a preference-based GIS is necessary to make valid information about the real burden of illness and to improve the burden of symptoms in the indication of gastrointestinal conditions. The findings of the BWS demonstrate that the common GIS is not applicable to represent the real burden of disease. The results suggest the potential modification of the established GIS by future research using a stated preference study.

Serological Biomarker Panel in Diagnosis of Atrophic Gastritis and Helicobacter pylori Infection in Gastroscopy Referral Patients: Clinical Validation of the New-Generation GastroPanel® Test.

Prompted by the increasing demand of non-invasive diagnostic tools for screening of gastric cancer (GC) risk conditions, i.e., atrophic gastritis (AG) and Helicobacter pylori (Hp) infection, the GastroPanel® test (GP: biomarker panel of PGI, PGII, G-17, Hp IgG ELISA) that was developed in the early 2000's, was recently updated to a new-generation (unified GP) test version. This clinical validation study evaluated the diagnostic accuracy of the new-generation GP test in detection of AG and Hp among gastroscopy referral patients in a University Clinic. Altogether, 522 patients were enrolled among the patients referred for gastroscopy at the Gastro Center, Oulu University Hospital (OUH). All patients underwent gastroscopy with biopsies classified using the Updated Sydney System (USS), and blood sampling for GP testing. Biopsy-confirmed AG was found in 10.2% (53/511) of the patients. The overall agreement between the GP and the USS classification was 92.4% (95%CI=90.0-94.6%), with the weighted kappa (κw) of 0.861 (95%CI=0.834-0.883). In ROC analysis using moderate/severe AG of the corpus (AGC2+) as the endpoint, AUC=0.952 (95%CI=0.891-1.000) and AUC=0.998 (95%CI=0.996-1.000) for PGI and PGI/PGII, respectively. Hp IgG antibody ELISA detected biopsy-confirmed Hp-infection with AUC=0.993 (95%CI=0.987-0.999). The new generation GastroPanel® is a precise test for non-invasive diagnosis of atrophic gastritis and Hp-infection in dyspeptic patients referred for diagnostic gastroscopy.

Frequency of Helicobacter Pylori in Patients with Dyspepsia in Civil Hospital, Khairpur

Background: The Helicobacter pylori is a gram negative bacterium which is found in majority of population in all over the world. It is possible due to contaminated food consumption, working in unsanitary condition and the use of public toilets with poor sanitation. In the field of gastroenterology infection caused by H. pylori and functional dyspepsia are most common clinical issue but their association is also unclear. Aim: To determine the frequency of Helicobacter Pylori in patients with presenting with Dyspepsia in Civil Hospital, Khairpur Study Design: Descriptive Cross sectional study. Duration of study: One year from 01-Jan- 2019 to 31-12-2019. Setting: Institute of Microbiology, Shah Abdul Latif University, Khairpur. Methodology: All the patients between 15 to 60 years of age, admitted patients of dyspepsia were diagnosed and evaluated for Helicobacter pylori infection through histopathological examination. Results: Total 100 subjects with dyspepsia were screened for Helicobacter pylori infection. Mean age of patients was 40.0 ±15.40. Majority of patients with H. pylori positive were from age group between 40-60 years, from which 56.7% of them were H. pylori positive; while 30% of patients were from age between 20-40 years of age and only 13.3% were from age below 20 years of age Conclusion: The dyspeptic patients are prone to acquire Helicobacter pylori infection therefore present study reported 30% prevalence for H. pylori infection with male gender predominance. Key words: Dyspepsia, Helicobacter Pylori Infection, Peptic ulcer, histopathology, endoscopy

Characteristics of gastric precancerous conditions and Helicobacter pylori infection among dyspeptic patients in north-eastern Iran: is endoscopic biopsy and histopathological assessment necessary?

BackgroundEarly detection and appropriate treatment of precancerous, mucosal changes could significantly decrease the prevalence of life-threatening gastric cancer. Biopsy of the normal-appearing mucosa to detect Helicobacter pylori and these conditions is not routinely obtained. This study assesses the prevalence and characteristics of H. pylori infection and precancerous conditions in a group of patients suffering from chronic dyspepsia who were subjected to gastric endoscopy and biopsy mapping.MethodsThis cross-sectional study included dyspeptic patients, not previously treated for H. pylori, undergoing esophagogastroduodenoscopy (EGD) with their gastric endoscopic biopsies obtained for examination for evidence of H. pylori infection and precancerous conditions. Demographic and clinical data on the gender, smoking, opium addiction, alcohol consumption, medication with aspirin, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) and family history of cancer were collected by interviewing the patients and evaluating their health records. The cohort examined consisted of 585 patients with a mean (SD) age of 48.0 (14.46) years, 397 (67.9%) of whom were women.ResultsH. pylori infection was identified in 469 patients (80.2%) with the highest prevalence (84.2%) in those aged 40–60 years. Opium addiction correlated with a higher a H. pylori infection rate, while alcohol consumption was associated with a lower rate by Odds Ratio 1.98 (95% CI 1.11–3.52) and 0.49 (95% CI 0.26–0.92), respectively. The prevalence of intestinal metaplasia, gastric atrophy and gastric dysplasia was 15.2, 12.6 and 7.9%, respectively. Increased age, positive H. pylori infection, endoscopic abnormal findings and opium addiction showed a statistically significant association with all precancerous conditions, while NSAID consumption was negatively associated with precancerous conditions. For 121 patients (20.7% of all), the EGD examination revealed normal gastric mucosa, however, for more than half (68/121, 56.2%) of these patients, the histological evaluation showed H. pylori infection, and also signs of atrophic mucosa, intestinal metaplasia and dysplasia in 1.7, 4.1 and 1.7%, respectively.ConclusionEGD with gastric biopsy mapping should be performed even in the presence of normal-appearing mucosa, especially in dyspeptic patients older than 40 years with opium addiction in north-eastern Iran. Owing to the high prevalence of precancerous conditions and H. pylori infection among patients with dyspepsia in parts of Iran, large-scale national screening in this country should be beneficial.

ENDOSCOPIC VERSUS HISTOPATHOLOGICAL DIAGNOSIS OF PAN-GASTRITIS IN PATIENTS WITH CHRONIC GASTRIC DYSPEPSIA

Background: Dyspepsia is a clinical syndrome including manifestations related to the upper gastrointestinal tract. Options for evaluating dyspeptic patients include therapeutic trials, testing for Helicobacter pylori, upper gastrointestinal (UGI) radiography, and endoscopy. Objective: To compare the endoscopic and histopathologic diagnosis of gastritis in patients presented with chronic gastric dyspepsia to evaluate the relative frequency and pattern of different types of gastritis in patients presented with chronic gastric dyspepsia. Patient and method: Prospective cross-sectional study on 120 patients with chronic dyspepsia more than 8 weeks. All patients underwent gastroscopy. The findings of gastric inspection were recorded for all patients. Biopsy specimens were taken. Two from the anterior and posterior antrum, two from the anterior and posterior body, and two from any additional area of abnormality. Diagnostic criteria were applied to histological features and each histopathological parameter (chronic inflammation, activity, atrophy, intestinal metaplasia and H. pylori density) were graded for assessment of their severity as 0= absent, 1= mild, 2=moderate or 3= severe in the corpus and antrum. Results: Endoscope revealed normal gastric mucosa in 33 patients (27.5%), gastritis in 64 patients (53.3%) and other lesions in 23 patients (19.2%). As regard gastritis, there was edema in 61 patients (95.3%), erythema in 45 patients (70.3%), atrophy in 10 patients (15.6%) and mucosal nodularity in 10 patients (15.6%). As regard location of gastritis, it was pan-gastritis in 44 patients (68.8%), Antrum predominant gastritis in 10 patients (15.6%) & corpus predominant gastritis in 10 patients (15.6%).As regard other lesions, there was Duodenal ulcer in 7 patients (30.4%), peptic ulcer in 3 patients (13%), esophagitis in 2 patients (8.7%), erosive gastritis in 4 patients (17.4%), upper GIT suspecting malignancy in 2 patients (8.7%) and hiatal hernia in 5 patients (21.7%). Histopathology results were Normal in 18 (18.6%), Chronic inflammation in 79 (81.4%), Neutrophilic infiltration in 60 (61.7%), Glandular atrophy in 10 (10.3%), Intestinal metaplasia in 3 (3.1%) and H. pylori density in 47 (48.5%). Gastritis was detected by Endoscopy in 64 (53.3%) and in 79 (81.4%) by histopathology. This difference was statistically significant (p-value: 0.014). Conclusion: The prevalence of gastritis among the dyspeptic patients is very high since we observed endoscopically gastritis in 64 patients (53.3%) and other lesions in 23 patients (19.2%). The concordance between endoscopic findings and histopathological diagnosis of gastritis was (81%). High prevalence of H.Pylori among the dyspeptic patients (48.5%). Gastritis was better detected by histopathology.

Value of age and alarm features for predicting upper gastrointestinal malignancy in patients with dyspepsia: an endoscopic database review of 4664 patients in Thailand

ObjectiveAge and alarm features are commonly used as indicators for endoscopy in dyspeptic patients; however, the age cut-off and the predictive value of these parameters for identifying upper gastrointestinal (UGI)...

Role of helicobacter pylori in oesophagitis

Background: Reflux oesophagitis is defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Helicobacter pylori (H. pylori) is an important human pathogen involved in the pathogenesis of atrophic gastritis, gastro-duodenal ulcer, gastric cancer. The relationship between Reflux oesophagtis and H.pylori infection is still subject of debate.Aims: To evaluate treatment modality of H.pylori positive patients endoscopic followup and evaluate the incidence of reflux oesophagitis among the followup patients. To evaluate incidence of H.pylori infection in clinically diagnostic dyspeptic patients. To evaluate various modes of presentation.Study design: This is a prospective study done between October 2019 to September 2021 which includes 50 patients diagnosed with dyspeptic symptoms in RMMCH ChidambaramResults: Male population between 30 to 50 were the most affected among all. Lower socioeconomic group appear to be most affected. Majority of the patients had abdominal pain as the most common symptom. Majority of the patients who were treated with triple therapy had incidence of endoscopically proven lower end oesophagitisConclusion: As a result of appropriate treatment given to the hpylori positive patients, majority of the patients had successful eradication of Hpylori and subsequent incidence of endoscopically proven lower end oesophagitis. Thus helicobacter pylori could play a protective role in reflux oesophagitis.

Normalization Effect of Both ST36 and CV11, 12, 13 Meridian Points on the Abnormal Gastric Myoelectrical Activity in Two Cases of Functional Dyspeptic Patients

Objectives: The aim of this study was to introduce the normalization effects of stimulation of both ST36 and CV11, 12, 13 meridian points on the abnormal gastric myoelectrical activity in two cases of functional dyspeptic patients with gastric dysmotility.Methods: Gastric myoelectrical activity was recorded by electrogastrography every two weeks until their gastric myoelectrical activity finally reached the normality. Dominant frequency of gastric slow waves in the fasting and postprandial periods and a dominant power ratio were obtained on each occasion. Patients were treated three times each day: 9 am, 1 pm, and 7 pm. The first treatment consisted of manual and immersion stimulation on all used meridian points for 20 min. In the second and third treatments, electrical stimulation of both ST36 was added. It was conducted for 20 min at a strength intensity of 1.2 times the pain threshold at a frequency of 3 Hz.Results: Stimulation of the above meridian points normalized abnormal gastric myoelectrical activity. The time taken to return from abnormal gastric myoelectrical activity to normal was 16-19 weeks.Conclusion: Stimulation of both ST36 and CV11, 12, 13 meridian points normalized the abnormal gastric myoelectrical activity in the functional dyspepsia of gastric dysmotility.

Value of GastroPanel in the diagnosis of atrophic gastritis.

Analysis of serum biomarkers for the assessment of atrophic gastritis (AG), considered as precursor of the intestinal type of gastric cancer, is of growing interest. The combination of pepsinogen (PG), gastrin-17 (G17) and anti-Helicobacter pylori (H. pylori) antibody serological assays (panel test) is a non-invasive tool for the diagnosis of atrophic gastritis. However, the diagnostic reliability of this test remains uncertain. The aim of our study was to assess the diagnostic performance of the serum panel test (GastroPanel) for the diagnosis of atrophic gastritis. From dyspeptic patients, endoscopic biopsy samples (two from the gastric corpus and two from the antrum) and blood samples were collected. The determination of sPGI, sPGII, sG17 and IgG antibodies to H. pylori (H.p IgG) was performed using an enzyme-linked immunosorbent assay (GastroPanel; Biohit Oyj). Histopathology results were compared with GastroPanel values. Sixty patients were included: 35 (58.3%) females and 25 (41.66%) males; mean age 67.63±9.36 years; 45% H. pylori-positive. A total of 65% of patients had atrophic gastritis. There were no significant differences between the levels of biomarkers and localization of atrophy. The ratio PG1/PG2 was lower in patients with multifocal atrophy; the difference being close to the threshold of statistical significance. In cases of intestinal metaplasia the values of G17, PG1, PG2, H.p IgG were not statistically altered compared to those without intestinal metaplasia; only the ratio PG1/PG2 was lower in intestinal metaplasia; the difference being almost of statistical significance. Our results revealed that, GastroPanel values did not differ depending on the severity of the atrophy. Biomarkers used by GastroPanel do not have enough accuracy for use in the diagnosis of atrophy in the population studied. A low accuracy only for the ratio PG1/PG2 in patients with multifocal atrophy was found. However, our data revealed a correlation in detecting intestinal metaplasia.

Acil servise dispeptik yakınmalarla müracaat eden hastaların yönetiminin değerlendirilmesi

Aim: Dyspepsia means difficulty in the digestive process and consists of symptoms of bloating, pain, burning, early satiety, nausea and burping. Dyspepsia is one of the leading causes for applying to emergency services. Medical workups are overdone since there is still no consensus about the management of dyspeptic patients in emergency service. The aim of this article is to evaluate what is done for the management of patients with dyspeptic complaints in the emergency service.&#x0D; Materials and Methods:This study was conducted by retrospective file scanning method and consisted 2798 cases who applied to the emergency service between 1 January – 31 December 2019 with dyspeptic complaints. &#x0D; Results: Most of the patients who were included in the study were female (%58,1) and the average age was 39.73∓17,34. %77,8 (n=2176) of the included patients were treated by admission to the yellow area while %54,8 (n= 1534) was diagnosed with K29 (gastritis) according to the diagnostic codes. While 98.5% of the patients were discharged with outpatient treatment in the emergency observation room, only 1.5% were hospitalized. One case admitted with dyspepsia diagnostic code and presented with epigastric pain died.&#x0D; Conclusion: In this study, it was determined that patients with dyspeptic complaints present to the emergency department at a significant rate, but patients benefit from outpatient treatment at a rate of %98,5. A careful history taken from and detailed physical examination of patients with dyspeptic complaints for preventing unnecessary examinations and cost-effective behavior in the treatment are considered to be important for the preservation of national wealth.

Association between systemic immune inflammation index and newly diagnosed adult celiac disease

Abstract Objectives The systemic immune inflammation index (SII) is a novel biomarker based on platelet, neutrophil and lymphocyte counts. SII serum levels have diagnostic, prognostic degrees and correlations with various immune, inflammatory diseases. Celiac disease (CD) is an immune-mediated chronic enteropathy with inflammatory situations. Here we aimed to evaluate clinical significance of SII and to compare SII with other inflammatory markers in CD. Methods 161 pathologically confirmed CD and 75 dyspeptic patients were enrolled. Hemogram, biochemical markers, SII, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-platelet ratio (MPR) and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were evaluated. Results There was a statistically significant difference between groups for SII (p&lt;0.001). SII was statistically correlated with and superior to inflammatory markers in relation with CD. There were also statistically significant differences between groups for hsCRP, PLR, NLR, MPR, haemoglobin, platelet count, platelet volume distribution width, plateletcrit, ferritin, total cholesterol and HDL cholesterol (p=0.034; 0.015; 0.032; &lt;0.001; &lt;0.001; &lt;0.001; 0.030; 0.001; &lt;0.001; &lt;0.001; 0.048, respectively). Correlations between SII and NLR, PLR, MHR, hsCRP were statistically significant (p≤0.001; &lt;0.001; 0.033; 0.030, respectively). ROC analysis was used to determine the optimal cut-off value for CD by SII. A baseline SII level &gt;560.0 was associated with CD with 64% specificity, 78% sensitivity (p&lt;0.001). Conclusions To the best of our knowledge, this is the first study analyzed the diagnostic value of SII in CD. SII may serve as a beneficial marker for the diagnosis of inflammatory state superior to that of hsCRP, PLR, NLR, MHR, MPR and WBC.

Assessment of the diagnostic accuracy and relevance of a novel ELISA system developed for seroepidemiologic surveys of Helicobacter pylori infection in African settings.

Beside diagnostic uncertainties due to the lack of a perfect gold standard test for Helicobacter pylori infection, the diagnosis and the prevalence estimation for this infection encounter particular challenges in Africa including limited diagnostic tools and specific genetic background. We developed and evaluated the accuracy of an enzyme-linked immunosorbent assay (ELISA) system tailored for H. pylori genetics in Africa (HpAfr-ELISA). Strains belonging to main genetic populations infecting Africans were exploited as sources for whole-cell antigens to establish in-house the ELISA system. A phase II unmatched case-control study explored the diagnostic accuracy of the HpAfr-ELISA using a training set of samples collected from dyspeptic patients from Kinshasa, the Democratic Republic of Congo (DRC) who had been tested with invasive standard tests (i.e., histology, culture, and rapid urease test) in 2017. Then the assay was cross-validated through a community-based survey assessing the prevalence of H. pylori and associated factors in 425 adults from Mbujimayi, DRC in 2018. Bayesian inferences were used to deal with statistical uncertainties of estimates (true prevalence, sensitivity, and specificity) in the study population. At its optimal cut-off-value 20.2 U/mL, the assay achieved an estimated sensitivity of 97.6% (95% credible interval [95%CrI]: 89.2; 99.9%) and specificity of 90.5% (95%CrI: 78.6; 98.5). Consistent outcomes obtained at repeated tests attested the robustness of the assay (negative and positive agreements always > 70%). The true prevalence of H. pylori was estimated 53.8% [95%CrI: 42.8; 62.7%]. Increasing age (adjusted odds ratio [aOR] > 1.0 [95% confidence interval (CI): > 1.0; 1.1]; p<0.001), overcrowding households (aOR = 3.2 [95%CI: 2.0; 5.1]; p<0.001), and non-optimal hand hygiene (aOR = 4.5 [95%CI: 2.0; 11.4]; p = 0.001) were independently associated with the H. pylori-seropositivity. The novel ELISA system has demonstrated good diagnostic accuracy and potential usefulness for management and mitigation strategies for H. pylori infection in African settings.

Individual hosts carry H. pylori isolates with different cagA features - motifs and copy number.

H. pylori strains with different genetic contents may infect different or an individual human host. Genetic diversity of cagA is thought to contribute to differences in H. pylori strains pathogenicity. In this study, diversity of cagA genotype, EPIYA motif and copy number was assessed in H. pylori single colonies isolated from individual patients. Gastric biopsies from 14H. pylori-positive dyspeptic patients were cultured on selective brucella blood agar and incubated at 37°C under microaerobic conditions. Four single colonies were obtained from each biopsy subculture on brucella blood agar under similar incubation condition. Presence of cagA and types of EPIYA motifs was determined by polymerase chain reaction (PCR) and cagA copy number by quantitative real-time (RT) PCR. Single colonies of 5 patients showed no variation in cagA genotype, EPIYA motif and copy number. Out of the remaining 9 patients, 1 patient showed presence or absence of cagA gene, 2 patients had mixed EPIYA motifs, 2 patients had different cagA copy number, 1 patient showed absence or presence of cagA and mixed motifs, 2 patients had cagA genes with different nucleotide sequences, 1 patient showed presence or absence of cagA and difference in cagA nucleotide sequence. Four isolates that contained multiple copies of cagA, carried EPIYA-ABC motif. Genetic diversity of cagA among single colonies isolated from individual patients represents evidence that gastric mucosa of every individual is colonized with a specific and heterogeneous population of H. pylori. Future studies on patients in different disease groups may elucidate the role of mixed populations of H. pylori in development of gastric diseases.

Mitochondrial DNA Copy Number Variations and Serum Pepsinogen Levels for Risk Assessment in Gastric Cancer

Background:Variations in mtDNA-CN of PBLs, as a potential biomarker for GC screening has currently been subject to controversy. Herein, we have assessed its efficiency in GC screening, in parallel and in combination with sPG I/II ratio, as an established indicator of gastric atrophy. Methods:The study population included GC (n = 53) and non-GC (n = 207) dyspeptic patients. The non-GC group was histologically categorized into CG (n = 104) and NM (n = 103) subgroups. The MtDNA-CN of PBLs was measured by quantitative real-time PCR. The sPG I and II levels and anti-H. pylori serum IgG were measured by ELISA. Results:The mtDNA-CN was found significantly higher in GC vs. non-GC (OR = 3.0; 95% CI = 1.4, 6.4) subjects. Conversely, GC patients had significantly lower sPG I/II ratio than the non-GC (OR = 3.2; CI = 1.4, 7.2) subjects. The combination of these two biomarkers yielded a dramatic amplification of the odds of GC risk in double-positive (high mtDNA-CN-low sPGI/II) subjects, in reference to double-negatives (low mtDNA-CN-high sPGI/II), when assessed against non-GC (OR = 27.1; CI = 5.0, 147.3), CG (OR = 13.1; CI = 2.4, 72.6), or NM (OR = 49.5; CI = 7.9, 311.6) groups. Conclusion:The combination of these two biomarkers, namely mtDNA-CN in PBLs and serum PG I/II ratio, drastically enhanced the efficiency of GC risk assessment, which calls for further validations.

Gastric precancerous conditions in patients with chronic dyspepsia

Introduction Gastric cancer (GC) is one of the most lethal malignancies worldwide, though a decrease in incidence. Helicobacter pylori is positively associated with gastric precancerous conditions. Detection of these conditions, namely atrophic gastritis (AG) and intestinal metaplasia (IM), and their association with H pylori infection is important for further detection and reduction of overall cancer incidence. Aim To detect the prevalence of H pylori infection and gastric precancerous conditions in patients with chronic dyspepsia by High Definition White Light Endoscopy (HD-WLE) and Narrow Band Imaging with Magnifying Endoscopy (NBI-ME). Methods This was a hospital-based descriptive study including chronic dyspeptic patients aged over 50 years. H pylori infection was diagnosed by a rapid urease test. AG and IM were detected by endoscopy (HD-WLE and NBI-ME) and confirmed by histology. Detection rates of each method were compared. Results Totally 143 patients (55 males/88 females) with a mean age of 64.57 ± 9.957 years were included. H pylori infection rate was 53.84% (n = 77). Twenty-two patients with AG (44.9% of patients with atrophy) and 37.84% (14/37) of patients with IM have H pylori infection. There was a statistically significant difference in detection rates between HD-WLE and NBI-ME for IM (P=0.001) but not for AG (P=0.250). Conclusion H pylori infection is still high in Myanmar. There were significant associations between H pylori and gastric precancerous lesions. Detection of atrophic gastritis and intestinal metaplasia by routine usage of NBI-ME along with test and treat H pylori infection are the strategies to reduce the incidence of gastric cancer.

Prevalence of Helicobacter pylori infection and its Associated Risk Factors among symptomatic Residents of Sulaimani city, Kurdistan region, Iraq, 2020

Helicobacter pylori (H. pylori) bacteria are a microaerobic Gram negative that colonizes in the gastric and duodenum of human. It can cause prolong infection in the human life if not treated. Many of the studies showed that infection by H. pylori can cause some important gastrointestinal illness, such as peptic ulcer, chronic gastritis, gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Recurrence is generally considered as H. pylori recrudescence infection after one year of eradicated treatment. There are many factors involved in the H pylori reinfection, such as the epidemiology of H. pylori infection, condition of the live, development of economical state, and health conditions. The Objectives of this study were to estimate the incidence and determine the risk factors of infection by H. pylori bacteria in dyspeptic patients in Sulaimani city. And the Aims are to estimate prevalence of the Helicobacter pylori and patients’ characteristics in Sulaimani city. This is a cross-sectional study, using a Urea breath test or stained the gastric sample with Giemsa stain, which is including adult participants aged (12-87) years during the period starting from 1 January until 31 December 2020 on Iraqi male and female patients were visiting –Center for Gastroenterology and Hepatology in Sulaimani, city, Iraq. Three hundred and four patients were included, all of them underwent Urea breath test only but eighty-one of the participants underwent endoscopy and stained the gastric sample with Giemsa stain. Urea breath test for Helicobacter pylori was positive in54.9% which have significant correlation with risk factor findings. Results: the incidence rate of H. pylori infection in our study is 54.9%, and mean age of the study participants was (40.49 ±16.39) one hundred and ninety-one cases 62.8% were female and 113 cases 37.2%were male. Infection by H. pylori bacteria is rife in dyspeptic patients; and is more common in the age group of 31-40 years. One of noninvasive test to diagnosis H. pylori is Urea breath test. In conclusions the rate of helicobacter pylori infection in our study is 54.9% among the symptomatic patients, and the overall incidence of H. pylori UBT and Giemsa stain detection rate were 73.4 and 26.6% respectively.