Gastroduodenal Diseases Research Articles

Genetic diversity and amino acid sequence polymorphism in Helicobacter pylori CagL hypervariable motif and its association with virulence markers and gastroduodenal diseases.

Genetic variability in cagL gene especially within the Helicobacter pylori CagL hypervariable motif (CagLHM) may affect the development of gastric cancer. Therefore, this study was conducted to investigate the association of CagL diversity with clinical outcomes and with H pylori virulence markers. A total of 126 patients with different gastric diseases including non‐ulcer dyspepsia (NUD), peptic ulcer disease (PUD), gastric erosion (GE), and gastric cancer (GC) were enrolled. H pylori was cultured from gastric biopsies, and the isolates were screened for the presence of cagL, cagA, vacA, babA2, sabA, and cagPAI integrity by PCR. The amino acid polymorphisms of cagL were analyzed using DNA sequencing. We isolated 61 (48.4%) H pylori strains from 36 NUD, eight PUD, 12 GE, and five GC patients. Almost all isolates were cagL positive (97%), and their RGD, RHS, and SKIIVK motifs were highly conserved. Among 10 CagLHM variants identified, NEIGQ and NKIGQ were detected as the most prevalent sequences. Interestingly, a significant association was found between the presence of NKMGK and PUD (P = 0.002). Notably, the NEIGQ isolates with multiple C‐type EPIYA repeat that carried intact cagPAI correlated with disease risk for PUD, GE, and GC (P = 0.021). In conclusion, we identified novel variants of H pylori CagLHM sequences in Iranian population such as NKMGK, which was associated with disease risk for PUD. Further studies using a large number of strains are required to better clarify the function of certain CagLHM motifs in gastric carcinogenesis and disease outcome.

Mechanistic Insight Into the Interaction Between Helicobacter pylori Urease Subunit α and Its Molecular Chaperone Hsp60.

Helicobacter pylori is the etiologic agent in a variety of gastroduodenal diseases. As its key pathogenic factors, both urease and Hsp60 play important roles in the pathogenesis of H. pylori. Previous studies have suggested that there is close relationship between urease and Hsp60, which implied that Hsp60 may act as a chaperone in urease stabilization and assembly. However, how these two proteins interact remains unclear. In this study, the impact of Hsp60 on urease activity of H. pylori lysate was first detected to confirm the interaction between urease and Hsp60. Pull-down assays further indicated that Hsp60 could bind to UreA subunit but not UreB. Then, the 3D structure of Hsp60 was modeled using I-TASSER to simulate the binding complex with UreA by molecular docking. The results showed that UreA is a perfect fit for the cavity of Hsp60. Analysis of the resulting model demonstrated that at least seven residues of UreA, located on two interfaces, participate in the interaction. Site-directed mutagenesis of these potential residues showed reduced affinity with Hsp60 than the wild type UreA through surface plasmon resonance (SPR) experiments, and D68 appears to have an important role in the affinity. Further analysis also showed that mutation of E25 and K26 caused a more rapid association and dissociation than with wild UreA, implying that they have roles in stabilizing the interaction complex. These affinity comparisons suggested that the interfaces predicted by molecular docking are credible. Our study indicated a direct interaction between Hsp60 and urease and revealed the binding interfaces and key residues involved in the interaction. These results provide further evidence for the chaperone activity of Hsp60 toward urease and lay a foundation to better understand the maturation mechanism of urease in H. pylori.

OipA \u201con\u201d status of Helicobacter pylori is associated with gastric cancer in North-Eastern Brazil

BackgroundAlthough, outer membrane protein OipA of Helicobacter pylori has been associated with gastric mucosal damage and gastroduodenal diseases, studies evaluating gastric cancer patients are scarce. We investigated whether the functional oipA “on” status was associated with gastric cancer in the North-eastern Brazil, region with high prevalence of gastric cancer.MethodsWe included samples from 95 H. pylori positive subjects (23 patients with gastritis, 24 with gastric cancer, 32 first-degree relatives of gastric cancer patients and 16 children). oipA was assayed by polymerase chain reaction (PCR) and DNA sequencing. cagA and vacA status were evaluated by PCR.ResultsOverall 81.1% of the H. pylori strains had functional oipA. In adults, the oipA “on” status (OR = 9.20; 95%CI = 1.45–58.48, P = 0.02) and increasing age (OR = 1.08; 95%CI = 1.03–1.14; P = 0.003) were independently associated with gastric cancer in a logistic model. The oipA “on” status (OR = 14.75; 95%CI: 2.53–86.13, P = 0.003) was also associated with first-degree relatives of gastric cancer patients when compared with gastritis. The frequency of oipA “on” status did not differ between children and adults (P = 0.87). The oipA “on” status was significantly correlated with the presence of cagA and vacA s1 m1.ConclusionoipA “on” status was independently associated with gastric cancer and first-degree relatives of gastric cancer patients in North-eastern Brazil.

Helicobacter pylori infection and associated factors

Background and Objectives: Helicobacter pylori is linked to gastroduodenal pathologies. To determine the frequency and potential risk factors of the H. pylori infection. Material and methods: A cross-sectional study was conducted, including 227 patients, submitted to upper gastrointestinal endoscopy. A questionnaire was applied to the patients, before endoscopy. The biopsy specimens were obtained from the antrum and gastric body for histology and PCR. The chi-square test was used for the categorical data analysis. P-values 0.05). However, we observed a significant association between the number of persons per household and presence of H. pylori (p=0.04). A statistically significant relation also was found between H. pylori and the patient’s age (p=0.04) and between the histological and endoscopic diagnoses and the H. pylori infection (p≤0.01). Conclusions: We found a significant relation between household crowding and presence of H. pylori, which seems facilitate the person-to-person transmission H. pylori within families. Our results also suggest a cohort phenomenon. The increase in the frequency of H. pylori infection according to age may be due the acquisition of bacterium predominantly in childhood, when the sanitary conditions were deficient, and not during adulthood. Once acquired and untreated, the persistent H. pylori infection might have led to the development of severe gastroduodenal diseases.

A NEW METHOD OF DIAGNOSIS OF THE HIATAL HERNIA ASSOCIATED WITH GASTROESOPHAGEAL REFLUX DISEASE

Introduction: Gastroesophageal reflux disease (GERD) is one of the most common gastroduodenal diseases. The relationship between the hiatal hernia and the GERD is established. It is advisable to develop an accessible non-invasive diagnostic method for this combined pathology. The aim of the research was to estimate measuring of calcium in patients' saliva samples as simple non-invasive diagnostic method of GERD associated with the hiatal hernia. Materials and methods: The samples of saliva were obtained from 37 patients with hiatal hernia associated with GERD and 22 healthy volunteers. The content of calcium in saliva was measured using calcium-sensitive dye Arsenazo III by photometrical method at a wavelength of 590-650 nm. Results: It has been established that in the saliva of patients with hiatal hernia, the calcium content was increased by 100.9% compared to the control group. Such a significant increase in the level of calcium in the saliva of patients with hiatal hernia may be due to the fact that the development of this pathology is a disorder of calcium homeostasis. Conclusions: It has been found that the calcium content in the saliva of patients with hiatal hernia exceeded the norm almost twice. Thus, the determination of calcium content in saliva can be used as a simple non-invasive diagnostic marker of hiatal hernia associated with GERD.

Анализ изотопического состава выдыхаемого воздуха методами диодной лазерной спектроскопии в районе 2 μm для диагностики Helicobacter pylori-ассоциированных заболеваний-=SUP=-*-=/SUP=-

Spectral analysis of 13СО2/12СО2 isotope ratio in exhaled air based on tunable diode laser spec-troscopy was applied for diagnostics of digestive organ diseases associated with Helicobacter pylori infection. Special spectrophotometer based on tunable diode laser was developed for the analysis of breath isotope content. Spectral range near 2.05 microns where the rotational-vibration R-branch of the 20013-00001 band of 12CO2 interferes with the P-branch of the 20012-00001 band of 13CO2 was used. The 13C-Urea Breath Test (13C-UDT) was used for the H. pylori infection diagnostic in gastrointestinal tract of 309 tested persons. The results of the isotope breath test were compared with the data of morphological analysis of gastric and duodenal mu-cosa obtained by fibrogastroduodenoscopia. For the first time the total value of the histology analysis results for biopsy material taken in the stomach body, in the distal part of stomach and in the duodenum was proposed to be used for the comparative analysis with 13C-UBT data. A relationship of 13C-UBT data with age, nosology, activity and severity of inflammation process, atrophy degree, and type of eradication therapy was analyzed. Distribution of 13C-UBT data ob-tained before and after therapy was demonstrated to reflect epidemiology of gastroduodenal dis-eases, H.pylori infection incidence, specifics of gastrointestinal tract colonization by H.pylori, parameters of inflammation process, as well as therapy effectiveness and peculiarity of the in-fection restoration at failed eradication therapy.

The value of detecting pepsinogen and gastrin-17 levels in serum for pre-cancerous lesion screening in gastric cancer

The aim of the study was to estimate the value of detecting pepsinogen (PG) I, PGII, and gastrin-17 (G-17) levels in serum for chronic atrophic gastritis (CAG) screening and to determine the clinical applicability of combined measurement of serum G-17, pepsinogens (PGI, PGII) and PGI/PGII ratio (PGR) as a screening test for CAG. The PGI, PGII, and G-17 levels were detected by ELISA in 68 patients with CAG and 86 healthy volunteers who underwent gastroscopy for gastroduodenal diseases at Taizhou Municipal Hospital between January 2016 and December 2016. Concentrations of all measured serum markers were lower in patients with CAG in comparison to healthy volunteers and achieved statistical significance (P<0.01) in PGI (93.25 vs 126.98) and PGR (12.67 vs 17.09). Receiver operating characteristic (ROC) curve analysis revealed the optimal cut-off values for PGI, PGII, PGR, and G-17 at 98.10 μg/l, 6.92 ng/l, 15.77 and 1.94 pmol/l, with sensitivities of 72.10%, 58.10%, 61.60%, and 59.30% and specificities of 61.8%, 51.50%, 77.90%, and 55.90%, respectively. The areas under the curve (AUCs) of PGI, PGR, and G-17 were 0.728, 0.726, and 0.556, respectively. The increase of AUC was observed only in PGR and G-17 combination (0.741) with increased sensitivity (69.10% vs 61.60%) of screening for CAG, whereas the specificity was reduced (72.10% vs 77.90%) in comparison to PGR alone. Combination of serum indicators can raise the diagnosis accuracy of CAG in some respects. However, further research including a larger sample size is necessary in order to accurately determine the sensitivity and specificity of combined detection of serum indicators.

The analysis of associations of Helicobacter pylori babA gene in patients with clinical outcomes of gastroduodenal diseases in Yakutia

The analysis of associations of Helicobacter pylori babA gene in patients with clinical outcomes of gastroduodenal diseases in Yakutia

MORINDA COREIA HAS AN ANTI-HELICOBACTER PYLORI EFFECT AGAINST THE MULTIDRUG-RESISTANT CLINICAL ISOLATE OF NORTH-EAST INDIA

Objective: Antimicrobial resistance is a growing problem in Helicobacter pylori eradication which is a microaerophilic bacterium causing various gastroduodenal diseases. The present study has been designed to test the efficacy of Morinda coreia against the metronidazole clarithromycin and levofloxacin-resistant H. pylori strains isolated from the biopsy taken from the patient suffering from gastric erosion in Guwahati, Assam.Method: The antimicrobial activity of n-hexane and chloroform extract of M. coreia was tested against multidrug-resistant H. pylori isolate of Guwahati, Assam, by agar well method and microdilution method.Result: In the present study, the H. pylori strain resistant for metronidazole (minimal inhibitory concentration [MIC] &gt;64 μg/mL), clarithromycin at (MIC &gt;0.5 μg/mL), and levofloxacin at (MIC &gt;1 μg/mL) was tested against the n-hexane and chloroform extract of M. coreia. Both the extracts of M. coreia showed good efficacy against the multidrug-resistant strain of H. pylori shown inhibition at 1.2 μg/mL with n-hexane extract and 2 μg/mL with chloroform extract of M. coreia. Conclusion: The prevalence of metronidazole-resistant ranges between 50% and 90% in the developing countries, including India, clarithromycin ranges from 0% to 15% in India, and levofloxacin ranges between 50% and 70% in India, so there is a need of alternative therapy for the eradication of this bacterium from the stomach. Hence, this study suggests that M. coreia, which has been used traditionally as a folk medicine for the treatment of many gastric diseases, has also shown good efficacy against the multidrug-resistant H. pylori strain of North-east India.

Correlation between expression of MMP-9 and MMP-3 in Helicobacter pylori infected patients with different gastroduodenal diseases

Background and study aimsHelicobacter pylori (H. pylori) has been implicated in the pathogenesis of most important gastro-duodenal diseases, such as gastritis, peptic ulcer disease (PUD) and gastric cancer. H. pylori upregulates the expression and activity of several matrix metalloproteinases (MMPs) in the gastric mucosa, but the role of MMP-3 and MMP-9 in infected patients with H. pylori have not been clearly defined yet. We examined mucosal MMP-3 and MMP-9 mRNA levels in gastric mucosa of H. pylori infected patients and evaluated the effects of virulence factors cagA and vacA allelic variants on these levels. We also determined correlation between mucosal MMP-3 and MMP-9 mRNA levels and types of disease. Patients and methodsTotal RNA was extracted from gastric biopsies of 50 H. pylori-infected patients and 50 H. pylori-negative patients. Mucosal MMP-3 and MMP-9 mRNA expression level in H. pylori-infected and non-infected gastric biopsies were determined by real time-polymerase chain reaction (PCR). Presence of vacA (vacuolating cytotoxin A) and cagA (cytotoxin associated gene A) virulence factors were evaluated using PCR. ResultsThe levels of MMP-3 in gastric mucosa were not different between H. pylori-positive and H. pylori-negative patients. There was no correlation between MMP-3 mRNA expression and virulence factor (cagA and vacA allelic variants) and the different types of disease (gastritis and PUD) in infected patients. But MMP-9 mRNA expression was significantly higher in biopsies of H. pylori-infected patients compared to H. pylori-negative patients. Also mucosal MMP-9 mRNA expression in H. pylori-infected patients was significantly associated with cagA status PUD. ConclusionOur results suggest that MMP-9 might be involved in the pathogenesis of H. pylori. PUD could be associated with cag PAI-dependent MMP-9 upregulation.

Antimicrobial effects of black rice extract on Helicobacter pylori infection in Mongolian gerbil

It has been reported that cyanidin 3-O-glucoside (C3G) is an inhibitor of Helicobacter pylori toxin secretion. C3G is classified as an anthocyanin and is a major component of black rice extract (BRE). The present study aimed to identify a new functional food material to prevent H. pylori infection in Mongolian gerbil model. Toxicity in the liver and kidney were not detected after BRE administration (10 or 50 mg/kg). BRE treatment reduced bacterial colonization in animal gastric tissue, as well as infection signs as observed on the analysis of the hematological data. It was also found that the relative mRNA levels of the inflammatory cytokines were reduced in BRE-treated groups. These findings suggest that BRE acts as a potent inhibitor of H. pylori infection and pathogenesis in Mongolian gerbils. We propose that BRE may be used to manage gastroduodenal diseases caused by H. pylori infection.

Expression levels of A disintegrin and metalloproteases (ADAMs), and Th17-related cytokines and their association with Helicobacter pylori infection in patients with gastroduodenal diseases.

Expression levels of A disintegrin and metalloproteases (ADAMs) (10 and 17) and Th17-related cytokines [interleukin (IL) 17A, IL-17F, IL-33, IL-23, IL-23R] were investigated by quantitative real time polymerase chain reaction in gastric biopsies of patients with different gastroduodenal pathologies in the presence and absence of Helicobacter pylori infection. Patients with gastric cancer (GC) (n = 70, intestinal-type 38 and diffuse type 32), peptic ulcer disease [n = 50, duodenal ulcer (DU) 16 and gastric ulcer (GU) 34] and functional dyspepsia (n = 120) were included in the study. Further, the expression levels of ADAMs and Th17 cytokines were correlated with H. pylori cytotoxin-associated genes pathogenicity island (cagPAI) status. Expression levels of ADAMs (10 and 17) and Th17-related cytokines (IL-17A, IL-23, IL-23R) were significantly higher in H. pylori-positive than in H. pylori-negative gastric biopsies. Significant increase in ADAM17 and Th17 cytokines (IL-17A and IL-23) expressions was observed in patients with GU and intestinal-type GC in the presence of H. pylori infection and in strains harbouring intact cagPAI. Expression levels of IL-17A, IL-23 and ADAM17 were strongly correlated with GU and intestinal-type GC and weakly with DU and diffuse-type GC in the presence of H. pylori infection. Higher expression levels of ADAM17 and Th17 cytokines (IL-17A and IL-23), and their strong correlation with GU and intestinal-type GC patients in the presence of H. pylori and its intact cagPAI status, suggest a possible role of strain specificity in the pathogenesis of these diseases.

Circulating microRNA signatures serve as potential diagnostic biomarkers for Helicobacter pylori infection.

Helicobacter pylor (H pylori), a Gram-negative, microaerobic human pathogen, has been found to be involved in many gastroduodenal diseases. Accurate diagnosis of H pylori infection is a vital part of the effective management of gastroduodenal diseases. Circulating microRNAs (miRNAs) have shown the potential to be used as noninvasive biomarkers for the diagnosis of infectious diseases. The aim of this study was to explore plasma miRNAs as noninvasive biomarkers for H pylori infection. We performed a plasma miRNA expression profile using Illumina high-throughput sequencing and validated the levels of differentially expressed miRNAs in the plasma of 63 H pylori-infected patients and 41 healthy volunteers by quantitative real-time polymerase chain reaction (qRT-PCR). The sequencing results showed that 37 miRNAs were upregulated in the H pylori-infected patients compared with that in the healthy volunteers, while six miRNAs were downregulated. qRT-PCR and receiver operator characteristic analysis suggested that the expression of miR-28-3p, miR-143-3p, miR-151a-3p, and miR-148a-3p were closely associated with H pylori infection. Therefore, the four plasma miRNA panels mentioned above could serve as promising noninvasive biomarkers of H pylori infection.

Gastric Outlet Obstruction as a Manifestation of Recurrent Crohnʼs Disease

Introduction The most common complications of Crohn's disease are the development of fistulas[1], abscess formation, malabsorption of bile acids, and adhesions. Rarely, Crohn's disease involves the stomach and the duodenum. We present a case of gastric outlet obstruction due to recurrent Crohn's disease. Case Report A 55-year-old male with a history of Crohn's disease in remission since 1990 presented with two weeks of nausea, vomiting, and 20 lbs. of weight loss. He had a remote history of antrectomy and ileocecectomy with no available details. In 2011, he had pyloric and postbulbar stenosis that required endoscopic dilatation. A computed tomography of the chest, abdomen and pelvis with contrast showed no acute findings. An outpatient esophagogastroduodenoscopy showed gastric outlet obstruction due to anastomotic stenosis of a previous antrectomy site and he was admitted. Initially, we treated the patient conservatively with intravenous fluids and proton pump inhibitors. However, he continued to have severe symptoms and eventually underwent duodenectomy with gastroduodenostomy. There were massive adhesions secondary to prior surgeries. The pathology report of the pylorus and duodenum resection (Figures 1 and 2) showed suppurative and granulomatous inflammation with focal abscess formation, adhesions, and stenosis consistent with Crohn's disease. On the tenth day of hospitalization, the patient recovered and was discharged home. Discussion While no controlled studies have been reported for the management of gastroduodenal Crohn's disease, the initial treatment typically includes corticosteroids and aggressive suppression of gastric acid using a proton pump inhibitor. Endoscopic balloon dilation can be used in short strictures. More severe strictures may require bypass via a gastrojejunostomy or gastroduodenostomy[2].2085_A Figure 1. Surface ulceration, crypt architecture distortion, and acute inflammation in the lamina propria with focal cryptitis.2085_B Figure 2. Granulomatous formation.

Helicobacter pylori eradication in Mexico with a levofloxacin-based scheme versus standard triple therapy: Results from an open-label, randomized, noninferiority phase IIIb trial

Introduction and aimsHelicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 210-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500mg, lansoprazole 30mg, and amoxicillin 1g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80mg, levofloxacin 500mg and azithromycin 500mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients. Materials and methodsAn open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified with 13C-urea breath testing. Gastric biopsies were tested for fluorescence in situ hybridization (FISH)-clarithromycin resistance prior to any antibiotic administration. Efficacy and safety results were analyzed according to the noninferiority methodological approach. ResultsFrom the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p=0.001). ConclusionsFirst-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments.ClinicalTrials.gov identifier NCT02726269.

COMPLEX THERAPY OF GASTRODUODENITIS WITH THE SYNDROME OF EXCESSIVE BACTERIAL GROWTH

The aim of the study was to evaluate the clinical efficacy and safety of the probiotic containing Lactobacillus acidophilus and Kefir grains (Acipol®) in the complex therapy of chronic gastroduodenal diseases with a syndrome of excessive bacterial growth in children aged 6 to 17 years.We observed 43 children with chronic gastroduodenal diseases associated with Helicobacter pylori infection, accompanied by a syndrome of excessive bacterial growth. Patients were divided into 2 groups: 1 group comprised 28 children who received Acipol 2 weeks on a background of standard therapy, and 2 group (15 people) received standard therapy without Acipol. All children of both groups were assessed pain index, dyspeptic index, hydrogen respiratory test with lactulose, quantitative PCR in feces before treatment, after 2 weeks, after 6 weeks.After 2 weeks, there was a significant decrease in pain index and dyspeptic index in group 1, by 6 weeks this decline continued. The hydrogen breathing test with lactulose, conducted after 2 weeks, became negative in group 1 in 13 children (46%), and was preserved in 15 (54%). The same result was noted after 6 weeks. That is, elimination of the syndrome of excessive bacterial growth was achieved in 43% of children against the background of Acipol.

Structural Analysis of Glutamine Synthetase from Helicobacter pylori

Glutamine synthetase (GS) is an enzyme that regulates nitrogen metabolism and synthesizes glutamine via glutamate, ATP, and ammonia. GS is a homo-oligomeric protein of eight, ten, or twelve subunits, and each subunit-subunit interface has its own active site. GS can be divided into GS I, GS II, and GS III. GS I and GS III form dodecamer in bacteria and archaea, whereas GS II form decamer in eukaryotes. GS I can be further subdivided into GS I-α and GS I-β according to its sequence and regulatory mechanism. GS is an essential protein for the survival of Helicobacter pylori which its infection could promote gastroduodenal diseases. Here, we determined the crystal structures of the GS from H. pylori (Hpy GS) in its apo- and substrate-bound forms at 2.8 Å and 2.9 Å resolution, respectively. Hpy GS formed a dodecamer composed of two hexameric rings stacked face-to-face. Hpy GS, which belongs to GS I, cannot be clearly classified as either GS I-α or GS I-β based on its sequence and regulatory mechanism. In this study, we propose that Hpy GS could be classified as a new GS-I subfamily and provide structural information on the apo- and substrate-bound forms of the protein.

Helicobacter pylori Western cagA genotype in Egyptian patients with upper gastrointestinal disease

BackgroundInfection with Helicobacter pylori (H. pylori) causes persistent gastritis that may progress to fatal gastric cancer. The cytotoxin-associated gene A protein (CagA), encoded by the cytotoxin-associated gene A (cagA) is the main virulence factor associated with more severe clinical outcomes. It is further divided into Western-type CagA and East Asian-type CagA. The East Asian-type CagA induces more cytoskeleton changes and is more likely to be associated with gastric cancer. Aim of the studyIn the current study we aimed to identify the most prevalent H. pylori cagA genotype among Egyptian patients suffering from dyspepsia and to examine its possible correlation with the associated clinical condition. Patients and methodsFour biopsies were obtained from the antrum and angularis from each of 113 adult patients, who underwent upper endoscopy at the Endoscopy Unit, Theodor Bilharz Research Institute (TBRI) Hospital for the analysis of H. pylori by rapid urease test and detection of 16S rRNA. Nested PCR assay was used to determine cagA genotype. ResultsSixty (53.1%) dyspeptic patients were found infected with H. pylori. Although Egypt has a high prevalence of H. pylori infection, low prevalence of cagA was detected (26.5%). Western type cagA is the predominant type (62.5%) while East Asian type was not detected and others (37.5%) remain uncharacterized. Western-genotype cagA genotype was found in 80% of patients with peptic ulcer disease and 40% of patients with gastritis. ConclusionAbsence of the more virulent East Asian cagA genotype, which is the strongest risk factor for gastric carcinogenesis, may explain the very low gastric cancer rate among Egyptian population compared to other parts of the world. This finding demands further molecular studies using whole genome sequencing and more samples to determine the exact uncharacterized cagA genotype to identify the actual risk in developing gastroduodenal diseases in Egypt.

Gastroduodenal Surgery: A Persistent and Continuing Challenge

The number of patients being treated surgically for gastroduodenal disease has decreased over the past five decades as a result of focus on medical treatment. However, perforated and bleeding peptic ulcer disease (PUD) continues to represent a significant percentage of patients who require emergency surgery. The aim of this study was to characterize these critically ill surgical patients treated for gastroduodenal disease in our hospital. A retrospective, single-center, consecutive cohort study of all patients identified from the hospital National Surgical Quality Improvement Program database who were admitted to our institution requiring emergent surgical intervention over the past two years was conducted. Of 423 patients, 33 (7.8%) had operative procedures for complications of PUD, of which 19 patients (57.6%) had perforation; nine patients (27.3%) had hemorrhage; one patient (3.0%) had both perforation and hemorrhage; two patients (6.1%) had distal gastrectomies for ulcers refractory to medical management alone, and two patients (6.1%) had gastrectomies for malignant gastric neoplasms. There is a significant population of patients who present with life-threatening complications of PUD, despite the decline in PUD worldwide. These patients are critically ill and require careful and diligent management for good outcomes.

Helicobacter Pylori Infection.

Infection with Helicobacter pylori (H. pylori) is a major pathogenic factor for gastroduodenal ulcer disease and gastric carcinoma, as well as for other types of gastric and extragastric disease. As a result of changing epidemiologic conditions (e.g., immigration), changing resistance patterns with therapeutic implications, and new knowledge relating to the indications for pathogen eradication, the medical management of H. pylori is a dynamic process in need of periodic reassessment. This review is based on pertinent publications retrieved by a selective search in PubMed and the Cochrane Database, with particular attention to three international consensus reports and the updated German S2k guideline. H. pylori is now dealt with as an infection, whether or not the infected individual has symptoms or suffers from and H.-pylori-induced illness. H.-pylori-associated dyspepsia and functional dyspepsia are distinct entities that can only be diagnosed when competing elements in the differential diagnosis have been ruled out. H. pylori can be detected with noninvasive methods (13C-urea breathing test, stool antigen detection) and with invasive methods (histology, culture, rapid urease test). An important consideration for treatment is that primary clarithromycin resistance is common in many groups of patients; in Germany, its prevalence is now 10.9%. Primary treatment can be with either standard triple therapy (clarithromycin and amoxicillin or metronidazole) or bismuth-containing quadruple therapy. Treatment for 10 to 14 days is more likely to eradicate the pathogen than treatment for 7 days. When H. pylori infection is initially diagnosed in a patient over age 50, gastritis risk stratification should be performed by means of endoscopic biopsy and histologic examination. The new, clinically relevant developments that are presented and commented upon in this review now enable evidence-based management of H. pylori infection.