Gastroduodenal Disorders Research Articles

Lack of association between gastric cancer and hopQ alleles in Helicobacter pylori

Helicobacter pylori use a number of mechanisms to survive in the stomach lumen. The presence of these bacteria in the stomach can lead to gastritis and reduction in stomach acid production. Acute inflammation can directly damage to the peripheral cells that are responsible for the secretion of acid. The risk of developing gastric carcinoma is associated to heterogeneity of Helicobacter pylori virulence factors (such as cagA). The HopQ is one of the outer membrane proteins involved in bacterial adherence to gastric mucosa and has been suggested to also play a role in the virulence of H. pylori. This gene has been shown in two types. The purpose of the current study was to investigate the association between different H. pylori virulence hopQ alleles (types I and II) and patients with gastroduodenal disorders. For this purpose 58 stomach biopsies the of patients with gastric cancer and 100 saliva samples from healthy individuals were collected. Then genomic DNA was purified and PCR for was done for desired genes via specific primers. The H. pylori infections were diagnosed by PCR for GlmM gene. Then frequencies of hopQI+, hopQII+ and hopQI+ hopQII+ genotypes were determined in H. pylori infected cases. Statistical analysis showed that there were not significant differences between healthy and diseased ones for genotypes hopQI+, hopQII+ and hopQI+ hopQII+.

High Frequency of vacA s1m2 Genotypes Among Helicobacter pylori Isolates From Patients With Gastroduodenal Disorders in Kermanshah, Iran

Background:Helicobacter pylori infection and related diseases outcome are mediated by a complex interplay between bacterial, host and environmental factors. Several distinct virulence factors of H. pylori have been shown to be associated with different clinical outcomes. Here we focused on vacA and cagA genotypes of H. pylori strains isolated from patients with gastric disorder.Objectives:The aim of this study was to determine the frequency of two toxins and genotypes of VacA toxin in patients referred to a central hospital in the west of Iran (Imam Reza hospital, Kermanshah) during 2011 - 2012.Patients and Methods:Samples were collected from patients infected with H. pylori. Gastric biopsy specimens from the stomach antrum and corpus were cultured. PCR analysis was performed for genotyping H. pylori vacA and cagA genes.Results:Helicobacter pylori was isolated from 48% (96/200) of patients with gastroduodenal disorders. In 81/96 (84%) cases, the cagA gene was present. Among different genotypes of vacA, two s1m2 and s2m2 genotypes were dominant with frequency of 39.5% and 50%, respectively. The frequency of the s1m1 genotype was 7.2% (7/96), which is much lower than elsewhere. H. pylori isolates with positive results for cagA gene and vacA s1m2 genotypes showed statistically significant correlation with peptic ulcer (s1m2 13/34 [38.2%] P = 0.003). However, isolates of H. pylori infection with cagA gene and vacA s2m2 genotypes were significantly associated with development of gastritis (s2m2 41/42 [97.6%] P = 0.000).Conclusions:About 90% of H. pylori strains potentially contained vacA s2m2 and s1m2 genotypes. Infection with H. pylori strain containing the cagA gene or the vacA s1m1 and s1m2 genotypes was associated with increased incidence of peptic ulcer disease (PUD).

Efficacy of psychotropic drugs in functional dyspepsia: systematic review and meta-analysis

ObjectiveFunctional dyspepsia (FD) is a chronic gastroduodenal disorder. Individuals with FD demonstrate visceral hypersensitivity, abnormal central pain processing, and low mood, but it is unclear whether psychotropic drugs are an...

Helicobacter Pylori and CagA: Relationships With Esophageal and Gastroduodenal Disorders in Iranian Patients

Background: The severity of Helicobacter pylori infection is associated with virulence factors of the bacteria and host immune response. H. pylori has several virulence factors which a number of them are essential to emerge clinical outcomes. Cytotoxin-associated gene A (CagA) is the most important H. pylori virulence factor. Objectives: The aim of our study was to assess a significant relationship between presence of cagA and severity of clinical manifestation in esophageal and gastroduodenal disorders. Patients and Methods: A total of 240 gastric biopsies were collected between March 2012 and August 2013 from Tehran's hospitals. Three sets of biopsy specimens were obtained from the antrum and rapid urease tests, histological examination, Polymerase Chain Reaction (PCR) assay were performed on the biopsy specimens. Results: One hundred and eight (45%) of biopsy specimens were positive with rapid urease test and ureC gene PCR. Moreover, thirty eight (35.1%) of positive specimens had cagA gene. The rate of gastric and duodenum inflammation was more in patients who carried CagA positive H. pylori strains. Whereas less inflammation and sever lesions in esophagus were found in CagA negative H. pylori strains. Conclusions: Our study demonstrates a strong relationship between CagA and esophageal and gastroduodenal disorders. The number of CagA negative H. pylori was larger than CagA positive in esophagus lesion grade A, C, and D. Therefore, cagA may have a protective effect on some esophageal diseases. In addition, the number of CagA positives was larger than CagA negative H. pylori in gastric antrum and duodenum ulcer. Thus, CagA play a role to emerge peptic and duodenal ulcers.

Dietary, non-microbial intervention to prevent Helicobacter pylori-associated gastric diseases.

Since the discovery of Helicobacter pylori (H. pylori) infection as the major cause of gastroduodenal disorders including acute and chronic gastritis, gastroduodenal ulcer, chronic atrophic gastritis, and gastric cancer almost three decades ago, the possibility of preventing these clinical diseases through eradicating H. pylori has been the focus of active research, but soon debate in the scientific community, though eradication opens the feasibility of cancer prevention and the removal of bacteria significantly prevents development or recurrence of peptic ulcer diseases and some clinical diseases, was proposed due to uncertainty in either achievement of complete eradication or inefficacy in cancer prevention with eradication alone. Still its linkage to gastric cancer is incontestable. Since the multiple combination of bacterial factors, environmental insults, and the host immune response that drives the initiation and progression of mucosal atrophy, metaplasia, and dysplasia toward gastric cancer is intervened, simple eradication deemed the feasibility of cancer prevention. Therefore, our group open strong hypothesis that non-microbial, dietary approach might be the alternate, for which several interventions of nutritional components can highlight rejuvenation of chronic atrophic gastritis as well as amelioration of H. pylori-associated procarcinogenic inflammation. In this review article, the experience and outcome regarding nutritional application to rejuvenate gastric atrophy will be introduced, using Korean red ginseng, garlic extracts, cancer preventive Korea kimchi, n-3 polyunsaturated fatty acids (PUFA), special form of licorice, and probiotics. The detailed influence of dietary intervention and bacterial eradication therapy on disease progression and reversibility of premalignant lesions are discussed.

Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case-control study.

The overlap of unexplained gastrointestinal (GI) and somatic symptoms is well established in patients with functional gastrointestinal disorders (FGID). Joint hypermobility syndrome (JHS) is a non-inflammatory connective tissue disorder associated with GI and somatic symptoms. We aimed to determine whether there is an association between diagnosis of JHS and FGID and the impact of this association on comorbidities and quality of life (QOL). Prospective case-control study in secondary care GI clinics over 2 years. JHS was assessed by the first author prior to consultation in 641 consecutive new patients. Diagnosis of FGID (cases, n = 336) or organic disorders (controls, n = 305) was established blind to JHS status. JHS prevalence was compared in cases (FGID patients) and controls (organic disorders patients). Extra-intestinal comorbidity and QOL were compared in FGID patients with and without JHS. JHS prevalence was higher in FGID compared to organic GI disorders (39.0% vs 27.5%, ORadj: 1.51, CI: 1.07-2.12, p = 0.02), and particularly associated with functional gastroduodenal disorders (44.1%, ORadj: 2.08, CI: 1.25-3.46, p = 0.005), specifically postprandial distress syndrome (51%, ORadj: 1.99, CI: 1.06-3.76, p = 0.03). FGID patients with JHS had increased chronic pain (23.2% vs 11.9%, p = 0.01), fibromyalgia (10.5% vs 3.1%, p = 0.01), somatization scores (13 vs 10, p < 0.001), urinary autonomic scores (30.5 vs 20.7, p = 0.03), and worse pain-related QOL scores (45.0 vs 63.5, p = 0.004). JHS is significantly associated with FGID, and this subgroup of patients have increased comorbidity and decreased QOL. Further research is required to understand the pathophysiological basis of this association.

Immunoregulation of antigen presenting and secretory functions of monocytic cells by Helicobacter pylori antigens in relation to impairment of lymphocyte expansion.

The role of Helicobacter pylori (H. pylori) antigens in driving a specific immune response against the bacteria causing gastroduodenal disorders is poorly understood. Using a guinea pig model mimicking the natural history of H. pylori infection, we evaluated the effectiveness of immature and mature macrophages in promoting the blastogenesis of splenocytes from H. pylori infected and uninfected animals, in response to H. pylori antigens: glycine acid extract (GE), cytotoxin associated gene A protein (CagA), urease A (UreA) and lipopolysaccharide (LPS). Lymphocyte expansion was assessed in 72 h cell cultures, containing: immature or mature macrophages derived from bone marrow monocytes, unstimulated or stimulated with H. pylori antigens for 2 h. The proliferation was expressed as a ratio of [(3)H]-thymidine incorporation into DNA of antigen-stimulated to unstimulated cells and the DNA damage was determined by DAPI cell staining. TGF-β and IFN-γ were assessed immunoenzymatically in cell culture supernatants. Lymphocytes of control and H. pylori-infected animals proliferated intensively in response to phytohaemagglutinin (PHA) and in co-cultures with immature or mature macrophages treated with CagA or UreA (significantly) and GE (slightly) exluding the cultures containing H. pylori or E. coli LPS. This lymphocyte growth inhibition was related to DNA damage of monocytic cells in response to H. pylori or E. coli LPS and secretion of regulatory TGF-β, but not proinflammatory IFN-γ. Impaired homeostasis of monocytic cell function related to DNA damage and TGF-β release, in response to H. pylori LPS may lead to the suppression of adaptive immune response against the bacteria and development of chronic infection.

Functional gastroduodenal disorders

Functional gastroduodenal disorders are chronic, heterogeneous conditions experienced by adults worldwide. The Rome III consensus recognizes four syndromes: functional dyspepsia, belching disorders, nausea and vomiting disorders and ruminating syndrome. Considerable advances have occurred in the field of functional gastroduodenal disorders. This review provides an overview of the definitions, epidemiology, clinical features, investigations and treatments of some of these disorders. Functional dyspepsia is divided into post-prandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The prevalence of functional dyspepsia is about 11–20% in the western world. Dysfunctional gastrointestinal motility and hypersensitivity are involved in the generation of symptoms in some patients. Several classes of drugs are used to treat patients with functional dyspepsia, and the increasing understanding of pathophysiology will greatly affect future treatment regimens. Belching disorders may have either a behavioural or a physiological background, and therefore behavioural and speech therapies show promise, but definitive studies are required. The effect of fundoplication and drugs, such as a selective gamma-aminobutyric acid agonist baclofen, on belching await confirmatory studies on their usefulness. Mechanisms of functional nausea and vomiting are poorly understood, and their treatment currently focuses on pharmacological and non-pharmacological therapies, including antidepressants and psychological approaches.

The Geographic Variance of Helicobacter Pylori Infection in Europe and its Impact on the Incidence of Gastric Cancer

The discovery of Helicobacter pylori was hopeful as this agent was included in the list of ‘preventable- infectious carcinogens’, and many non-treatable gastroduodenal disorders with uncertain causes became treatable infectious diseases. Nevertheless, nowadays frequent antibiotic resistance is observed among H. pylori infections, sometimes as high as 95%. H. pylori is a bacteria that existed for a very long time, which was only recognised in the last 30 years. It can cause a variety of symptoms leading to gastroduodenal disorders from chronic inflammation in the gastrointestinal system to non-cardia gastric cancer. It is acquired in the early years of life and infection is commonly lifelong. The accepted primary route of transmission is person-to-person contact because humans are the only known significant reservoir of H. pylori. The target cell of H. pylori is the gastric mucus secreting cell. The prevalence in Europe shows a huge variety with almost all studies showing a decreasing trend. During childhood the highest prevalence was from Turkey (56.6%) and the lowest was from Czech Republic (4.8%). Among adults, the overall prevalence was found to be between 18.3% (Denmark) and 82.5% (Turkey), with substantial country-to-country variations. The prevalence rate differs by socioeconomic lifestyle characteristics and also genomic structure; it is also higher in less developed countries/populations. While the more commonly used test to determine H. pylori infection is serology, immunoglobulin G by enzyme-linked immunosorbent assay, the urea breath test (UBT), and stool antigen testing are non- invasive tests which are also recommended.

Rumination Syndrome: A Review of Current Concepts and Treatments

Rumination is a normal and common phenomenon among ruminant animals; but in humans, it is always regarded as symptom indicative of abnormal function of the upper gastrointestinal tract, and understanding of the mechanisms explaining this event are still evolving. Learning-based theories, organic factors such as gastroesophageal reflux disease and psychological disturbances (eg, depression, anxiety) and the role of life stresses have been postulated as potential mechanisms of rumination. in this review, we take the approach that rumination syndrome is a distinct and discrete functional gastroduodenal disorder. we review current concepts of the pathophysiology of this entity and diagnostic approaches, then detail the treatment paradigms that have been pursued in rumination syndrome in adults. Patients with rumination syndrome have a very distinct set of symptoms. it was focused on the immediate postprandial period, but recently, there is an awareness of an expanding spectrum of the clinical presentation. This includes the concept of "conditioned vomiting" occurring in the setting of delayed gastric emptying (gastroparesis). Physicians' awareness of rumination syndrome is essential in the diagnosis and management of this disorder. Stress and psychological aspects in rumination syndrome are invariably in the background and have to be addressed. The crucial steps in the treatment strategy for rumination syndrome rely on reassurance, education and a physiologic explanation to the patient and family that this is not a "disease," followed by behavioral and relaxation programs and addressing stress factors.

Novel Idea: Virulence-Based Therapy Against Helicobacter pylori Infection (Smart Therapy).

Helicobacter pylori (H. pylori) is a Gram-negative, spiral, and microaerophilic bacterium, which can usually persist lifelong in gastric mucosa if not treated efficiently. H. pylori infection plays an undeniable role in the development of different gastroduodenal diseases, while its eradication cures ulcer disease and also prevents occurrence of gastric cancer (1–3). At the beginning, as usual, it was thought that antibacterial therapy could easily eliminate the infection in human gastric mucosa. As such, during the last 30 years that we have known about H. pylori, there have been numerous therapeutic regimens suggested (e.g., sequential, triple/dual, quadruple, DANCE, hybrid, salvage, and empirical) (4–8). Therefore, many studies have been conducted to identify the most effective and least harmful therapeutic regimen, although, a unique therapeutic regimen to cure H. pylori infection in all reported colonized individuals is still lacking (8, 9). However, high rates of resistance have been reported to all primary/secondary lines and even to the newly introduced alternative drugs described for H. pylori treatment (10). In 2014, due to the skyrocketing rates of antibiotics resistance, a new scope toward the antibiotic therapy against this mysterious bacterium seems necessary. It has been indicated that virulence factors are the ability of a bacterium to induce certain disease in attributed hosts (1, 11, 12). Accordingly, virulence factors in H. pylori (e.g., cagA, dupA, homB, and vacA) have essential and definite roles in pathogenesis of different gastroduodenal disorders such as chronic gastritis, gastric cancer, and peptic ulcers (13–15). Certain H. pylori strains (specific PCR positive for cagA, dupA, homB, and vacA) harboring virulence determinants are capable to survive longer and induce more severe diseases. Surprisingly, among the currently described studies, no therapeutic regimen according to H. pylori virulence pattern (virutype) has yet been suggested.

The Helicobacter pylori dupA: A Novel Biomarker for Digestive Diseases.

Helicobacter pylori (H. pylori) infection affects approximately half of the world’s population. Unless eradicated, it remains in the stomach throughout life. After 1983, discovery of H. pylori as persistent resident of gastric mucosa, changed the traditional thoughts and perspectives regarding (i) having sterile stomach lifelong, (ii) infectious potential links existence with various extra gastric disorders, and (iii) ongoing researches on H. pylori-induced diseases (1). Undeniably, colonization with pathogenic H. pylori results in severe gastroduodenal disorders. H. pylori is well-recognized as an established causative agent associated with a wide variety of upper gastroduodenal diseases ranged from a chronic gastritis to gastric cancer. Surprisingly, gastric colonization with H. pylori induces superficial gastritis in all infected individuals, while only a minority develops to severe symptomatic diseases (2). Notably, rationale underlying this unique distribution of diseases is driven by a sophisticated and mysterious interplay between H. pylori and its host. Broadly defined, the certain pattern of H. pylori-induced digestive disease is strongly influenced by bacterial virulence factors which draw the final outcome of infection (2, 3). It is now firmly established that biomarkers allow us for having an early diagnosis and prediction of medical conditions. Moreover, biomarkers provide opportunity to modify current available protocols to manage the infection and its associated outcomes (4). In this case, a biologic biomarker can be used for early diagnosis of certain digestive disease (e.g., gastric cancer, duodenal ulcer); and even identification of high-risk population for disease prevention. As such, biomarkers are becoming increasingly important tools in clinical settings. Thus, potential applications of biomarkers in infectious diseases such as predicting outcomes would be an interesting area of ongoing research. With this regard, the search for relevant biomarkers that diagnose/predict a clinical condition among the H. pylori-infected patients is a challenging area of research. Following several suggested H. pylori biomarkers for certain digestive diseases over the past years (5–8), still a biomarker capable of predicting definitive digestive diseases outcome is lacking for clinical settings.

Herbal Remedy: An Alternate Therapy of Nonsteroidal Anti-Inflammatory Drug Induced Gastric Ulcer Healing

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used therapeutic drug groups used worldwide for curing an array of health problems like pain, inflammation, cardiovascular complications, and many other diseases, but they may cause different side effects including gastroduodenal disorders. So, there is a growing interest and need to search for nontoxic, antiulcer formulations from medicinal plants to treat NSAIDs induced gastric ulcer. Extensive research has reported on many natural plants like Camellia sinensis, Phyllanthus emblica, Myristica malabarica, Piper betle, Picrorhiza kurroa, and so forth, and their active constituents reduced NSAIDs induced gastric ulcer via their antioxidative as well as immunomodulatory activity. Therefore, use of herbal formulations in daily life may prevent NSAIDs induced gastric ulceration and other side effects.

Study of Helicobacter pylori infection and its antibiogram in gastroduodenal disorders in Regional Institute of Medical Sciences Hospital

Objective: Isolation of Helicobacter pylori from biopsy samples taken from cases of gastroduodenal disorder, correlate isolation of H. pylori with urease test, direct modified Grams-stain and H. pylori antibody test, to assess antimicrobial susceptibility pattern of H. pylori isolates. Materials and Methods: Sixty patients with gastroduodenal disorders were included in the study. Urease test, direct modified Grams-stain, H. pylori antibody test, culture and antimicrobial susceptibility were performed as per standard guidelines. Statistical analysis was performed using Fisher's exact test. Results: Antral gastritis was the most common endoscopic findings accounting 43.3%. The study revealed direct Gram-stain positivity of 20%, urease test positivity 46.7%, H. pylori antibody test positivity of 65% and culture positivity rate of 3.3%. Correlation of isolation of H. pylori with Gram-stain found to be significant statistically (P < 0.037). The correlation of isolation with urease test and H. pylori antibody and H. pylori antibody test was statistically not significant. Antimicrobial susceptibility pattern of H. pylori isolates, showed high sensitivity to gentamycin, amoxiclav, tetracycline, clarithromycin, and ciprofloxacin. Higher resistance to metronidazole was observed. Conclusion: Urease test, direct smear, H. pylori antibody test in combination proved to be helpful in the diagnosis of H. pylori infection. Culture from gastric mucosa in infected subjects is low; this could be due to patchy distribution of organisms, prior administration of proton pump inhibitors and antibiotics. Antimicrobial susceptibility testing can be carried out in cases of refractory to treatment.

High Prevalence ofHelicobacter pylori hopQII Genotype Isolated from Iranian Patients with Gastroduodenal Disorders

Helicobacter pylori plays an important role in the pathogenesis of chronic gastritis, peptic ulceration, and noncardia gastric cancer. Several putative virulence factors for H. pylori have been identified including vacA, babA, and iceA. HopQ is one of the outer membrane proteins involved in bacterial adherence to gastric mucosa and has been suggested to also play a role in the virulence of H. pylori. Due to the substantial geographic differences in the prevalence of H. pylori virulence factors reported, the main purpose of the current study was to investigate the association between different H. pylori virulence hopQ alleles (types I and II) and patients with gastroduodenal disorders. The presence of H. pylori and hopQ alleles in gastric biopsy specimens was identified by specific PCR assays. H. pylori type II hopQ was found to be significantly associated with gastric cancer patients (odds ratio: 3.47, 95% CI: 1.56–5.89). Information about the prevalence of H. pylori hopQ type II can be used for determining the high-risk diseases type which is actually colonized by H. pylori hopQ type II positive strains. The presence of H. pylori hopQ type II should be investigated in different geographical regions as confirmatory findings may provide a definite biomarker attributed to the pathogenesis of certain severe digestive diseases.

Helicobacter pylori infection in older people.

Since the discovery of Helicobacter pylori (H. pylori) infection as the major cause of gastroduodenal disorders three decades ago, H. pylori has been the focus of active research and debate in the scientific community. Its linkage to several diseases, such as peptic ulcer disease, gastritis and gastric malignancy is incontestable. In particular, it has been noticed that, as the aged population is increasing worldwide, older people are at increased risk of developing several gastroduodenal diseases and related complications. At the same time, gastric cancer is definitely more frequent in elderly than in adult and young people. In addition, it has been showed that peptic ulcer and related complications occur much more commonly in aged individuals than in young people, resulting in a significantly higher mortality. Although this infection plays a crucial role in gastrointestinal disorders affecting all age groups and in particular older people, only a few studies have been published regarding the latter. This article presents an overview of the epidemiology, diagnosis, clinical manifestations and therapy of H. pylori infection in elderly people.

SPECIAL CHARACTERISTICS OF CHRONIC GASTRODUODENAL DISORDERS DEVELOPMENT IN CHILDREN FROM A REGION WITH ABNORMAL INTENSITY OF GEOMAGNETIC FIELD

Aim : to assess special characteristics of disease course, development of concomitant diseases and enzymatic status of gastro-intestinal tract in children with chronic gastroduodenitis, living over the territory of Kursk magnetic anomaly. Patients and methods: 120 children with confirmed diagnosis of chronic gastroduodenitis (among them 60 patients from Kursk and 60 patients from Zheleznogorsk) were performed complex clinical examination. Results: the prevalence of gastroduodenal disorders were 2,7 times higher among children from Zheleznogorsk, than among children from Kursk. Early beginning of chronic gastroduodenitis in children of Zheleznogorsk must be mentioned. The mean age of the onset of the disease in Kursk is 6,4±0,4 years, while in Zheleznogorsk — 5,0 ± 0,4 years (p &lt; 0,01). The most common concomitant diseases in Zheleznogorsk children were reactive changes of hepatobiliary system and combination of chronic gastroduodenitis with allergic pathology. On coprological test the majority of Zheleznogorsk patients had significantly higher content of fatty acids in faeces. Conclusions : the above-mentioned changes can be evidence of insufficient enzymatic activity of certain components of digestive juices. Children with chronic gastroduodenitis living over the territory of Kursk magnetic anomaly should be isolated into a separate group of patients. It will allow rational correction of standard schemes of treatment with accordance to established characteristics.

Ernährung und gastrointestinale Intoleranz

The functional integrity of the gastrointestinal tract is an essential prerequisite in intensive care patients for the sufficient administration of enteral nutrition. Up to 65% of patients in intensive care units develop symptoms of gastrointestinal dysfunction with high residual gastric volume, vomiting and abdominal distension. The pathophysiological alterations of gastrointestinal intolerance and the subsequent effect on the tolerance of enteral nutrition can affect the whole gastrointestinal tract. Gastroduodenal motility disorders in particular, with increased gastroesophageal reflux lead to intolerance. In more than 90% of intensive care patients with gastrointestinal motility disorders an adequate postpyloric enteral nutrition can be carried out using a jejunal tube. In addition to improved tolerance of enteral nutrition this leads to a reduction of gastroesophageal reflux and the incidence of ventilation-associated pneumonia. Apart from the possibility of endoscopic application of the jejunal tube, alternative techniques were developed which allow a faster positioning of the jejunal tube with less complications. Furthermore, there are therapeutic options for improvement of gastrointestinal motility disorders and apart from general measures, also medicinal options for treatment of gastrointestinal intolerance which allow a sufficient enteral nutrition for intensive care patients.

Determination of Helicobacter pylori CagA EPIYA types in Iranian isolates with different gastroduodenal disorders

Helicobacter pylori (H. pylori) cytotoxin-associated gene A protein (CagA) is the first bacterial oncoprotein identified in human gastric cancer. The carboxy terminus (C-terminus) of CagA may undergo polymorphisms to give different types of EPIYA motifs, which may exist in single or combination form within the infected host. Sequence variations in the 3′ region of the cagA impose a functional impact to the translated CagA protein. In this study, we characterize the diversity of the H. pylori CagA EPIYA types, their associations with their hosts’ clinical status, and the potential of using the whole 3′ region of cagA as a genetic marker for the identification of Iranian isolates from different geographic locations. H. pylori was detected in 71 out of 177 examined Iranian patients with different gastroduodenal disorders. Genotyping of the cagA variable EPIYA motif was screened by polymerase chain reaction and gene sequencing was performed for all the detected cagA positive isolates. Out of 44 cagA-positive isolates, there were EPIYA motifs of ABC (30 isolates), ABCC (4 isolates), ABCCC (1 isolate), mixed types (6 isolates) and new types (3 isolates). We termed the newly identified EPIYA segment as EPIYA- A-B/C. Sequence analysis also showed the presence of uncommon EPIYA-like motifs (EPIYT and QPIYP) in some isolates. It is postulated that EPIYA type conversion through the presence of different repetitive sequences give rise to these new strains. We also identified 3 sequence motifs which may be applied as genetic markers for Iranian strains. Furthermore, EPIYA types ABCC and EPIYA- A-B/C showed association with duodenitis and gastric cancer, respectively. Further study with a larger number of strains is necessary to confirm the proposed associations and the identified sequence motifs as genetic markers. In conclusion, our study demonstrates the dominancy of Western type cagA gene and the diversity of the CagA C-terminal region in the tested Iranian strains.

Prevalence of EPIYA motifs in Helicobacter pylori strains isolated from patients with gastroduodenal disorders in northern Iran

Prevalence of EPIYA motifs in Helicobacter pylori strains isolated from patients with gastroduodenal disorders in northern Iran