Culture Of Gastric Biopsies Research Articles

Helicobacter pylori infection in infant rhesus macaque monkeys is associated with an altered lung and oral microbiome

It is estimated that more than half of the world population has been infected with Helicobacter pylori. Most newly acquired H. pylori infections occur in children before 10 years of age. We hypothesized that early life H. pylori infection could influence the composition of the microbiome at mucosal sites distant to the stomach. To test this hypothesis, we utilized the infant rhesus macaque monkey as an animal model of natural H. pylori colonization to determine the impact of infection on the lung and oral microbiome during a window of postnatal development. From a cohort of 4–7 month-old monkeys, gastric biopsy cultures identified 44% of animals infected by H. pylori. 16S ribosomal RNA gene sequencing of lung washes and buccal swabs from animals showed distinct profiles for the lung and oral microbiome, independent of H. pylori infection. In order of relative abundance, the lung microbiome was dominated by the phyla Proteobacteria, Firmicutes, Bacteroidota, Fusobacteriota, Campilobacterota and Actinobacteriota while the oral microbiome was dominated by Proteobacteria, Firmicutes, Bacteroidota, and Fusobacteriota. In comparison to the oral cavity, the lung was composed of more genera and species that significantly differed by H. pylori status, with a total of 6 genera and species that were increased in H. pylori negative infant monkey lungs. Lung, but not plasma IL-8 concentration was also associated with gastric H. pylori load and lung microbial composition. We found the infant rhesus macaque monkey lung harbors a microbiome signature that is distinct from that of the oral cavity during postnatal development. Gastric H. pylori colonization and IL-8 protein were linked to the composition of microbial communities in the lung and oral cavity. Collectively, these findings provide insight into how H. pylori infection might contribute to the gut-lung axis during early childhood and modulate future respiratory health.

Helicobacter pylori Antimicrobial Resistance Using Next-Generation Sequencing in stool samples in a pediatric population.

Helicobacter pylori (H. pylori) eradication rates have declined globally, stressing the importance of antimicrobial susceptibility testing to inform treatment. Molecular tests such as next-generation sequencing provide susceptibility data for the antibiotics used in the treatment of H. pylori in a non-invasive, effective, and rapid manner. We obtained stool susceptibility testing using a novel -next-generation sequencing-based analysis and compared results with the current "gold standard" of gastric biopsy culture via agar dilution in 20 pediatric patients with evidence of H. pylori in gastric biopsies. Stool next-generation sequencing-based antimicrobial susceptibility analysis was highly concordant with agar dilution for no resistance (100% agreement), as well as clarithromycin, levofloxacin, and amoxicillin resistance (100%, 67%, and 100% agreement respectively) but not concordant for metronidazole in our cohort of patients. Future studies involving a larger number of patients and geographical regions are needed to further validate this analysis.

Antibiotic resistances and eradication rates in Helicobacter pylori infection

IntroductionThe resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. Patients and methodsAn observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing — EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6–8 weeks after finalising the treatment. ResultsThe study included 80 patients (63.8% females), with a mean age of 11.9 years (SD ± 2.7 DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P = 0.04). ConclusionsThe high rate of H. pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate.

Lessons From a Quality Improvement Project to Standardize the Process of Gastric Biopsy Culture for Helicobacter pylori.

We conducted a quality improvement (QI) project with the aims of increasing the rate of successful primary culture. The QI project involved educational efforts among our gastroenterologists, endoscopy suite personnel, and laboratory personnel. We compared the frequency of gastric biopsy culture sent in patients with international classification of diseases 9th revision code 041.86, and 10th revision codes B96.81 evaluated by pediatric gastroenterologists at Boston Children's Hospital during the 9 months before the QI intervention (February 1, 2019 to October 31, 2019) and 9 months after the QI intervention (November 1 2019 to July 31 2020). We also compared the rate of culture growth in patients with positive histology (culture positivity), and antimicrobial susceptibilities before and after November 1, 2019. We observed an increased frequency of gastric biopsy acquisition by any gastroenterologist, obtained in 39% (28 of 71) preintervention patients compared with 67% (36 of 54) intervention patients (P = 0.004). There was an increase in the percentage of culture positivity across study periods from 21% (3 of 14) preintervention to 45% (5 of 11) postintervention (P = 0.39; 95% confidence interval, 0.64-7.00). Educational initiatives and collaborative work with staff physicians, endoscopy personnel, and hospital laboratory appear to be effective tools to increase usage of gastric biopsy culture as a diagnostic tool for H pylori infection and to increase culture positivity. Improving the surveillance of local resistance rates will improve the selection of the most effective primary treatment in specific geographic areas.

Comparative study between noninvasive techniques for diagnosis of helicobacter pylori in patients with dyspepsia

Background and Aim Helicobacter pylori (H. pylori) is a common etiology for infection-related cancers and represents 5.5% of global cancer burden that increases the need for more sensitive noninvasive diagnostic techniques. The aim was to evaluate the role of saliva and stool samples in the diagnosis of H. pylori infection to replace invasive techniques and to compare between three noninvasive diagnostic tests: salivary culture, PCR, and rapid stool antigen test (RSAT). Patients and methods The study was conducted on 45 patients with dyspepsia and 45 healthy participants as a control. Saliva and stool samples were taken from all groups and subjected to culture, PCR for detection of 16SrRNA gene of H. pylori, and RSAT to detect H. pylori. Gastric biopsy samples were taken for H. pylori culture, rapid urea test, and histopathology from 20 patients. Results A total of 15.6% specimens were positive by salivary culture in patients’ group and 2.2% specimens were positive in the control group. About 31% were positive by salivary PCR in patients’ group and 6.7% were positive by salivary PCR in the control group. About 71% were positive by RSAT in patients and 49% were positive by RSAT in controls. From 20 patients, gastric biopsy samples were taken, 11 patients were positive for H. pylori infection by gastric biopsy culture, 20 were positive by histopathological examination, and 13 were positive by rapid urea test. The salivary culture showed (100%) specificity, (38.5%) sensitivity, and (60%) accuracy. While PCR on saliva showed specificity (100%), (61.5%) sensitivity, and (75%) accuracy. RSAT showed (71.4%) specificity, 92.3% sensitivity, and 85% accuracy. Conclusion The oral cavity is an important extragastric reservoir of H. pylori; salivary PCR technique shows a much higher specificity and sensitivity than salivary culture. RSAT shows high sensitivity but with lower specificity.

Resistencias antibióticas y tasas de erradicación en infección por Helicobacter pylori

IntroductionThe resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. Patients and methodsAn observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing – EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6-8 weeks after finalising the treatment. ResultsThe study included 80 patients (63.8% females), with a mean age of 11.9 years (SD±2.7DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P=.04). ConclusionsThe high rate of H.pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate.

First national survey on the diagnosis of Helicobacter pylori infection in Clinical Microbiology Laboratories in Spain

IntroductionThe aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data. MethodsThe survey requested information about the diagnostic methods performed for H. pylori detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October–December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain. ResultsOverall, 51 centres from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%). ConclusionCulture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to ‘first-line’ antibiotics.

Low Adherence to Society Guidelines for the Management of Helicobacter Pylori Among Pediatric Gastroenterologists.

The revised ESPGHAN/NASPGHAN 2016 guideline on the diagnosis and management of Helicobacter pylori (H pylori) infection discourages a "test and treat" strategy. Instead, upper endoscopy (EGD) is recommended when a valid clinical indication is present. Likewise, new treatment recommendations for first-line therapies strongly encourage obtaining antimicrobial susceptibility before treatment. We conducted this study to assess the effect of revised guidelines on clinical practice at our center. Retrospective chart review of patients with H pylori infection diagnosis either by serology, stool antigen test, urea breath test, or EGD at Boston Children's Hospital between January 2013 and July 2019. We compared demographic and clinical data between initial guideline and 2016 revision (January 2013 to November 2016) and period after revised guideline (December 2016 to July 2019). Two hundred and fifty-six patients were included. EGD was the initial diagnostic test in 49% (50/103, prerevised guideline) and in 52% (79/153, postrevised guideline). Biopsy culture was sent in 3% of patients for both periods (3/103 and 4/153, respectively). PPI-clarithromycin-amoxicillin triple therapy was the most common regimen in both periods. Clarithromycin use was lower in postrevised guideline period (P = 0.003) whereas the opposite was noted for metronidazole and tetracycline (P = 0.009 and P = 0.02, respectively). There was no significant difference in eradication rate between periods (86% vs 81%). Low adherence to the updated H pylori guideline recommendations was observed among pediatric gastroenterologists at our center with low use of gastric biopsy culture. The guideline revision was associated with avoidance of clarithromycin use as a second-line therapy, but no change in eradication rates. Future interventions should address the importance of obtaining gastric biopsy culture for antibiotic susceptibilities to guide therapy.

Primera encuesta nacional sobre el diagnóstico de la infección por Helicobacter pylori en los laboratorios de microbiología clínica en España

IntroductionThe aim of this study was to know, through a national survey, the methods and techniques used for the diagnosis of Helicobacter pylori (Hp) in the different Clinical Microbiology Services/Laboratories in Spain, as well as antibiotic resistance data. MethodsThe survey requested information about the diagnostic methods performed for Hp detection in Clinical Microbiology laboratories, including serology, stool antigen, culture from gastric biopsies, and PCR. In addition, the performance of antibiotic susceptibility was collected. Data on the number of samples processed in 2016, positivity of each technique and resistance data were requested. The survey was sent by email (October-December 2017) to the heads of 198 Clinical Microbiology Laboratories in Spain. ResultsOverall, 51 centers from 29 regions answered the survey and 48/51 provided Hp microbiological diagnostic testing. Concerning the microbiological methods used to diagnose Hp infection, the culture of gastric biopsies was the most frequent (37/48), followed by stool antigen detection (35/48), serology (19/48) and biopsy PCR (5/48). Regarding antibiotic resistance, high resistance rates were observed, especially in metronidazole and clarithromycin (over 33%). ConclusionCulture of gastric biopsies was the most frequent method for detection of Hp, but the immunochromatographic stool antigen test was the one with which the largest number of samples were analyzed. Nowadays, in Spain, it concerns the problem of increased antibiotic resistance to ‘first-line’ antibiotics.

Frequency of Helicobacter Pylori Infection (Detected by Gastric Biopsy Culture and Histopathology) in Children Presenting with Recurrent Abdominal Pain (RAP)

Frequency of Helicobacter Pylori Infection (Detected by Gastric Biopsy Culture and Histopathology) in Children Presenting with Recurrent Abdominal Pain (RAP)

Sa1282 - Culture of Celiac Gastric Biopsies: New Evidences of a Multisystemic Disorder

Sa1282 - Culture of Celiac Gastric Biopsies: New Evidences of a Multisystemic Disorder

Evaluation of Invasive and Noninvasive Methods for the Diagnosis of Helicobacter Pylori Infection

Objective:The present study was conducted to evaluate invasive and noninvasive diagnostic methods for detection of Helicobacter pylori (H. pylori) in patients admitted with dyspeptic complaints and to compare sensitivities and specificities.Method:Sets of four gastric biopsy specimens were obtained from a total of 126 patients included in the study. The presence of H. pylori was determined by invasive tests including culture, rapid urease test, polymerase chain reaction (PCR) and histopathology. Among noninvasive tests, urea breath test, serological tests and enzyme-linked immunosorbent assay (ELISA) were performed.Results:H. pylori was isolated in 79 (62.7%) gastric biopsy cultures, whereas positivity was concluded for 105 (83.3%) patients by rapid urease test, for 106 (84.1%) by PCR, for 110 (87.3%) by histopathology, for 119 (94.4%) by urea breath test, and for 107 (84.9%) by ELISA. In the present study, the culture findings and histopathological examination findings were accepted as gold standard. According to the gold standard, urea breath test had the highest sensitivity (96.5%) and the lowest specificity (30%), whereas culture and histopathology had the highest specificities (100%).Conclusion:The use of PCR invasively with gastric biopsy samples yielded parallel results with the gold standard. PCR can be recommended for routine use in the diagnosis of H. pylori.

Improvement and optimization of the classical gastric biopsy culture technique for Helicobacter pylori diagnosis using trypsin

Helicobacter pylori infection represents a key factor in the aetiology of various gastrointestinal diseases. H. pylori infection diagnosis is generally achieved using both invasive (e.g. biopsy of the gastric epithelium) and non-invasive methods. Therefore, cultivation on a growth medium becomes complex. Trypsin is a proteinase enzyme that plays a role in an early stage of tissue digestion. In this study, we used trypsin in order to improve the diagnostic sensitivity of the H. pylori cultivation technique. We used 46 duplicate antrum biopsy specimens, divided into trypsin-treated and non-treated groups. The tissues were seeded on a selective H. pylori growth agar medium. We demonstrated that the classic H. pylori culture technique misses the growth of a large number of H. pylori colonies. Significantly more colonies were found in the trypsin-treated specimens group.

Helicobacter pylori Infection in Children. Antimicrobial Resistance and Treatment Response.

The aim of this study was to determine the appropriateness of the recent recommendations for managing Helicobacter pylori infection in children in a university hospital in Southern Europe. Antimicrobial resistance and response to eradication therapy were also determined. The presence of H. pylori was studied in 143 children: by gastric biopsy culture (GBC), (13)C-urea breath test (UBT) and stool antigen immunochromatography test (SAIT) in 56 children; by GBC and UBT in 20, by GBC and SAIT in 18, and by GBC alone in 49. Antimicrobial susceptibility was determined by E-test. Infection was defined as a positive culture or positivity in both UBT and SAIT. Disease progression was studied in 118 patients. First evaluation of symptoms was carried out at 3-6 months after diagnosis and/or after treatment of the infection. H. pylori was detected in 74 from the 143 children analyzed (100% GBC positive, 98.1% UBT positive, and 58.1% SAIT positive). The main symptom was chronic abdominal pain (n = 121). Macroscopic antral nodularity was observed in 29.7% of infected patients and in 5.8% of uninfected patients, respectively. Resistance to clarithromycin and metronidazole was found in 34.7 and 16.7%, respectively. Eradication when susceptible antimicrobials were used occurred in 78.7% (48/61) versus 37.5% (3/8) when the treatment included a drug with resistance (p = .024). In patients with recurrent abdominal pain, symptoms resolved in 92.9% (39/42) patients with HP eradication versus 42.9% (6/14) without HP eradication (p < .001). Treated patients often failed to meet the criteria established in the guidelines for H. pylori diagnostic screening and treatment because most of them had only recurrent abdominal pain, but remission of their symptoms was associated with H. pylori eradication.

Enhanced expression of indoleamine 2,3-dioxygenase in Helicobacter pylori-infected human gastric mucosa modulates Th1/Th2 pathway and interleukin 17 production.

Indoleamine 2,3 dioxygenase (IDO) interferes with immune responses. Host immune response against Helicobacter pylori is involved in the persistence of the infection and its related diseases. To investigate the role of IDO in the regulation of Th1/Th2 and Th17 pathways in H.pylori infection. Gastric biopsy samples were taken from 42 patients who underwent endoscopy and evaluated for the expression of IDO by Western blotting. Gastritis was assessed by the Sydney system score. In a subgroup of patients, biopsies were treated with the IDO inhibitor 1-methyl-L-tryptophan and the expression of interferon-γ (IFN-γ) mRNA and that of T-bet, interleukin-17 (IL-17), and IL-4 determined by real-time PCR and Western blotting, respectively. IDO expression was found to be enhanced (p=.001) in gastric biopsies from H.pylori-infected (n=18) compared with uninfected (n=24) patients. Levels of IDO expression were inversely related to the gastritis score (r=-.684, p=.002) in H.pylori-infected gastric mucosa, but not in uninfected mucosa. In gastric biopsy cultures, IDO inhibition increased the expression of IFN-γ mRNA (p=.014), T-bet (p=.045), and IL-17 (p=.02) while decreasing that of IL-4 (p=.048). In H.pylori-infected human gastric mucosa, an enhanced expression of IDO is capable of modulating Th1/Th2 and Th17 pathways. This mechanism lowers gastric inflammation, possibly contributing to the persistence of H.pylori. Targeting the IDO pathway may be a new strategy for modulating H.pylori-induced mucosal immune response.

Su1940 Influence of Prostate Stem Cell Antigen Gene Polymorphisms on Risk of Gastric Cancer and Duodenal Ulcer in Japanese Patients

BACKGROUND AND AIM : IDO plays a role in self-limiting Th1 response and promoting regulatory T cells and Th2 cytokine profile, mainly represented by interleukin (IL)-4. Interleukin (IL)-17, a Th17 cells-derived cytokine up-regulated in H.pylori-infected human gastric mucosa, is involved in the host response against the bacterium and, possibly, in its clearance/ persistence. Aim of this study was to investigate the role of IDO in the host response against H.pylori. MATERIAL AND METHODS : Five antral biopsies were taken from 26 patients (13 M, median age 41 yrs, range 25-70) who underwent endoscopy for dyspeptic symptoms: 1 for urease quick test, 2 for histology (modified Sydney System score) and 2 for protein extraction. A C13-urea breath test was also performed. IDO expression was determined by Western blotting in total proteins extracted from freshly obtained gastric biopsies. In a subgroup of patients, further antral biopsies were taken, immediately placed in an organ culture chamber, and treated with and without IDO inhibitor 1-methyl-L-Trp (Sigma, St. Louis, MO). Expression of interferon (IFN)-γ mRNA and levels of T-bet, a Th1-related transcription factor, IL-17 and IL4 were determined in gastric biopsy cultures, by realtime PCR and Western blotting, respectively. The ratio of IDO, T-bet, IL-17 and IL-4 with beta-actin was calculated by densitometry. The expression of IFNγ gene was normalized to that of RPS9 housekeeping gene and showed as fold changes using the 2(-Delta Delta C(T)) (Livak) method. All values were expressed as means ± SD arbitrary units (a.u.). RESULTS : IDO expression was found enhanced in gastric biopsies from H.pylori-infected (n=11) compared to uninfected (n=15) patients (1.24±0.21 a.u. vs 0.92±0.47 a.u., P=0.033, respectively). In H.pylori-infected patients, IDO expression did not parallel gastritis score (r=-0.29, P=0.41). In gastric biopsy cultures, IDO inhibition significantly (P<0.05) increased T-bet (0.25±0.17 a.u. vs 0.51±0.26 a.u.,) and IL-17 (0.70±0.45 a.u. vs 1.00±0.58 a.u.,) while decreasing IL-4 (0.35±0.34 a.u. vs 0.24±0.23 a.u.) levels. IFN-γmRNA expression was significantly (P=0.014) higher after IDO inhibition (1±0 a.u. vs 3.1±2 a.u.). CONCLUSIONS : This study demonstrates, for the first time, that an enhanced expression of IDO takes place in H. pylori-infected human gastric mucosa. Higher IDO expression downregulates Th1 response and IL-17 levels and upregulates IL-4 production. This molecular mechanism lowers gastric inflammation, possibly contributing to the persistence of H. pylori. Targeting IDO pathway may be a new strategy for modulating H. pylori-induced mucosal immune response.

Su1941 H.Pylori Infection Is a Risk Factor of Osteoporosis in Japan

BACKGROUND AND AIM : IDO plays a role in self-limiting Th1 response and promoting regulatory T cells and Th2 cytokine profile, mainly represented by interleukin (IL)-4. Interleukin (IL)-17, a Th17 cells-derived cytokine up-regulated in H.pylori-infected human gastric mucosa, is involved in the host response against the bacterium and, possibly, in its clearance/ persistence. Aim of this study was to investigate the role of IDO in the host response against H.pylori. MATERIAL AND METHODS : Five antral biopsies were taken from 26 patients (13 M, median age 41 yrs, range 25-70) who underwent endoscopy for dyspeptic symptoms: 1 for urease quick test, 2 for histology (modified Sydney System score) and 2 for protein extraction. A C13-urea breath test was also performed. IDO expression was determined by Western blotting in total proteins extracted from freshly obtained gastric biopsies. In a subgroup of patients, further antral biopsies were taken, immediately placed in an organ culture chamber, and treated with and without IDO inhibitor 1-methyl-L-Trp (Sigma, St. Louis, MO). Expression of interferon (IFN)-γ mRNA and levels of T-bet, a Th1-related transcription factor, IL-17 and IL4 were determined in gastric biopsy cultures, by realtime PCR and Western blotting, respectively. The ratio of IDO, T-bet, IL-17 and IL-4 with beta-actin was calculated by densitometry. The expression of IFNγ gene was normalized to that of RPS9 housekeeping gene and showed as fold changes using the 2(-Delta Delta C(T)) (Livak) method. All values were expressed as means ± SD arbitrary units (a.u.). RESULTS : IDO expression was found enhanced in gastric biopsies from H.pylori-infected (n=11) compared to uninfected (n=15) patients (1.24±0.21 a.u. vs 0.92±0.47 a.u., P=0.033, respectively). In H.pylori-infected patients, IDO expression did not parallel gastritis score (r=-0.29, P=0.41). In gastric biopsy cultures, IDO inhibition significantly (P<0.05) increased T-bet (0.25±0.17 a.u. vs 0.51±0.26 a.u.,) and IL-17 (0.70±0.45 a.u. vs 1.00±0.58 a.u.,) while decreasing IL-4 (0.35±0.34 a.u. vs 0.24±0.23 a.u.) levels. IFN-γmRNA expression was significantly (P=0.014) higher after IDO inhibition (1±0 a.u. vs 3.1±2 a.u.). CONCLUSIONS : This study demonstrates, for the first time, that an enhanced expression of IDO takes place in H. pylori-infected human gastric mucosa. Higher IDO expression downregulates Th1 response and IL-17 levels and upregulates IL-4 production. This molecular mechanism lowers gastric inflammation, possibly contributing to the persistence of H. pylori. Targeting IDO pathway may be a new strategy for modulating H. pylori-induced mucosal immune response.

Prevalence of Helicobacter pylori vacA different genotypes in Isfahan, Iran

Background:It is believed that the Helicobacter pylori (H. pylori) vacA gene, as a major virulence determinant (One of the major virulence determinant, not major), may be a risk factor for the development of gastroduodenal diseases. The frequency of vacA genotypes varies in different human populations. This study evaluated the prevalence of vacA alleles/genotypes among dyspeptic patients in Isfahan.Materials and Methods:One-hundred H. pylori-positive adult patients were examined in this study. After culture of gastric biopsies and DNA extraction from individual H. pylori isolates, the (all H. pylori strains harbor vacA alleles, please replace “presence” with “genotypes”) of the vacA s and m alleles were determined using polymerase chain reaction (PCR).Results:There were four vacA mosaicisms, including 28 for s1a/m1 (28%), 23 for s1b/m1 (23%), 26 for s1a/m2 (26%) and 23 for s1b/m2 (23%). The s2 allele was not found. The predominant vacA genotype in patients with non-ulcer dyspepsia and duodenal ulcer was s1a/m2, whereas in patients with adenocarcinoma was s1a/m1.Conclusion:The results showed there was no significant correlation between different genotypes of the vacA and the clinical outcomes and appears to vacA genotypes were not useful determinants for gastrointestinal diseases in our area.

Giant fungal gastric ulcer in an immunocompetent individual

Candida infection of gastrointestinal tract is frequent in immunocompromised patients and rare in an otherwise healthy person in whom no permissive factor is present. Herein is a case report on 25-year-old woman, 2 months postpartum, with fungal gastric ulcer with invasion leading to fungemia. She developed fever and anemia. Gastric biopsy and blood culture both showed growth of Candida albicans. The patient responded well to parenteral amphotericin B. This supports the hypothesis of invasion of Candida from gastric ulcer into blood.

Evaluation of Helicobacter pylori eradication by triple therapy plus Lactobacillus acidophilus compared to triple therapy alone

The purpose of this study was to evaluate the influence of adding Lactobacillus acidophilus to a triple regimen for Helicobacter pylori eradication in untreated patients with peptic ulcers or ulcer-scars. This was a pre-randomized, single-blind, interventional, treatment-efficacy study with active controls and parallel-assignment, set in Coimbra, Portugal, on 62 consecutive H. pylori-positive untreated adults with peptic ulcers or ulcer-scars, diagnosed by gastroduodenoscopy, with pre-treatment direct Gram-staining and culture of gastric biopsies. The first 31 patients received esomeprazole 20 mg, amoxicillin 1000 mg and clarithromycin 500 mg (EAC), all b.i.d., for 8 days. The remaining 31 added L. acidophilus, 5 × 10(9) organisms per capsule, 3 + 2 i.d. for 8 days (EACL). The main outcome measure was (13)C urea breath test (UBT), ≥6 weeks after completion of therapy. Successful eradication (UBT-negativity after treatment), was similar in both groups (EAC = 80.6%; EACL = 83.9%, p = 0.740) by both intention-to-treat and per-protocol analysis. The non-eradicated strains were susceptible in vitro to both antibiotics. Adding L. acidophilus to EAC triple therapy did not increase H. pylori eradication rates. Considering the cost and the burden of ingesting five extra capsules daily, supplementing the EAC therapy with L. acidophilus, at this dose, shows no benefit. Further studies with different dosages and duration of treatment, and other probiotics or probiotic combinations are required to improve eradication.