Helicobacter Pylori Gastritis Research Articles

Expression of the Cholecystokinin-B Receptor in Neoplastic Gastric Cells

Gastric cancer is an important disease due to its high mortality. Despite the decline in frequency, most cases are discovered late in its course, and most of the cancer patients die within a few years of diagnosis. In addition to Helicobacter pylori gastritis, gastrin is considered an important factor in the development of this disease, and thus, cholecystokinin-B receptor (CCKBR) becomes of interest. The aim of our study was to explore whether CCKBR is expressed in stomach cancers. Thirty-seven tumors from 19 men and 18 women diagnosed with either adenocarcinoma or neuroendocrine neoplasm (NENs) were included in this study. The tumors were classified into 29 adenocarcinomas and eight NENs. Immunohistochemistry with antibodies against chromogranin A (CgA), synaptophysin and CCKBR, and in situ hybridization with probes against CgA, CCKBR and histidine decarboxylase were used to further explore these tumors. Thirty-three (89%) of the tumors expressed CCKBR protein, whereas only 20 (54%) of all tumors expressed CCKBR mRNA. Of the 20 tumors expressing CCKBR mRNA, eight were NENs and 12 were adenocarcinoma. The highest amount of CCKBR was expressed in NEN. Interestingly, a high degree of co-expression of CCKBR and CgA was observed when the two markers were examined together with in situ hybridization. In conclusion, we found that all eight NENs expressed CCKBR and neuroendocrine markers in a majority of tumor cells. The same markers were also expressed in a proportion of adenocarcinomas supporting the view that gastrin is important in the development of gastric cancer.

Lymphoid follicles in children with Helicobacter pylori-negative gastritis.

PurposeThe prevalence of Helicobacter pylori gastritis has been declining, whereas H. pylori-negative gastritis has become more common. We evaluated chronic gastritis in children with regard to H. pylori status and celiac disease (CD).Patients and methodsDemographic, clinical, endoscopic, and histologic features of children who underwent elective esophagogastroduodenoscopy were reviewed retrospectively. Gastric biopsies from the antrum and corpus of the stomach were graded using the Updated Sydney System. H. pylori presence was defined by hematoxylin and eosin, Giemsa, or immunohistochemical staining and urease testing.ResultsA total of 184 children (61.9% female) met the study criteria with a mean age of 10 years. A total of 122 (66.3%) patients had chronic gastritis; 74 (60.7%) were H. pylori-negative. Children with H. pylori-negative gastritis were younger (p=0.003), were less likely to present with abdominal pain (p=0.02), and were mostly of non-Arabic origin (p=0.011). Nodular gastritis was found to be less prevalent in H. pylori-negative gastritis (6.8%) compared with H. pylori-positive gastritis (35.4%, p<0.001). The grade of mononuclear infiltrates and neutrophil density was more severe in the H. pylori-positive group (p<0.001). Pan-gastritis and lymphoid follicles were associated most commonly with H. pylori. Although less typical, lymphoid follicles were demonstrated in 51.3% of H. pylori-negative patients. The presence or absence of CD was not associated with histologic findings in H. pylori-negative gastritis.ConclusionOur findings suggest that lymphoid follicles are a feature of H. pylori-negative gastritis in children independent of their CD status.

Diagnostic yield of esophagogastroduodenoscopy in children with chronic abdominal pain.

IntroductionChronic abdominal pain (CAP) is one of the most common indications of esophagogastroduodenoscopy (EGD) in the pediatric population. However, there is not enough information about the diagnostic yield of EGD in children with CAP. We aimed to evaluate the diagnostic yield of EGD in children with CAP in the Eastern Black Sea region of Turkey.Material and methodsThe study included children (n = 372) who underwent EGD for the primary indication of chronic abdominal pain during an 18-month period. We collected data on demographic features (age, sex), clinical characteristics (alarm symptoms), and EGD results for each patient.ResultsPatients’ mean age was 13 years (range: 4–17 years; mean ± SD: 12.65 ±3.39 years), and the majority were female (n = 234, 62.9%). Endoscopy was diagnostic in 209 patients (56.2%; 95% CI: 30.35–40.05%). The most common diagnosis was Helicobacter pylori gastritis (35.2%) followed by reflux esophagitis. Significantly greater diagnostic yield of EGD was determined in patients with alarm symptoms (65.1%) compared to those without (45.2%) (OR = 2.26, 95% CI: 1.49–3.44, p = 0.001).ConclusionsWe determined a high diagnostic yield of EGD in children with CAP. Although the diagnostic yield of EGD in the assessment of CAP was found to be higher in the presence of alarm symptoms, a significant number of children without alarm symptoms were also found to have gastrointestinal system pathology diagnosed by EGD.

Impact of health insurance coverage for Helicobacter pylori gastritis on the trends in eradication therapy in Japan: retrospective observational study and simulation study based on real-world data

ObjectivesTo explore the prevalence of Helicobacter pylori infection in Japan and the trends of its eradication therapy before and after the changes of the insurance coverage policy, first started in...

A link between platelet to lymphocyte ratio and Helicobacter pylori infection

Chronic Helicobacter pylori gastritis affects two-thirds of the world's population and is one of the most common chronic inflammatory disorders of humans, the infection clearly results in chronic mucosal inflammation in the stomach and duodenum, which, in turn, might lead to abnormalities in gastroduodenal motility and sensitivity and is the most frequent cause of dyspepsia and peptic disease. Some studies showed that there was a correlation between low-grade inflammation as CRP and HP infection. The purpose of this study was to investigate the relationship between the presence of HP infection and platelet/lymphocyte ratio (PLR). A total of 200 patients who met the HP criteria and 180 age- and gender-matched control subjects were included in this randomized controlled trial. Patients were diagnosed to have HP according stomach biopsy and urea breath test, PLR was calculated from complete blood count at time of diagnosis and before initiating the treatment. Patients with HP infection had significantly higher PLR compared to those without HP. Moreover, the patients with symptomatic HP had higher PLR than those with asymptomatic HP. While PLR increased as the severity of HP symptoms increased (r=.452, P<.001). Our study indicated, for the first time, a significant association between HP infection and symptoms based on PLR, a simple and reliable indicator of inflammation. Furthermore, there an increase in PLR as the severity of HP increases.

Gastritis in patients undergoing sleeve gastrectomy: Prevalence, ethnic distribution, and impact on glycemic.

Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables.One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications.Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP.There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results.

Sa1183 - Peptic Ulcer Disease and Non-Ulcer Dyspepsia: The Most Predictive Clinical Manifestations of Helicobacter Pylori Gastritis

Sa1183 - Peptic Ulcer Disease and Non-Ulcer Dyspepsia: The Most Predictive Clinical Manifestations of Helicobacter Pylori Gastritis

Alterations in Gastric Microbiota After H. Pylori Eradication and in Different Histological Stages of Gastric Carcinogenesis

The role of bacteria other than Helicobacter pylori (HP) in the stomach remains elusive. We characterized the gastric microbiota in individuals with different histological stages of gastric carcinogenesis and after receiving HP eradication therapy. Endoscopic gastric biopsies were obtained from subjects with HP gastritis, gastric intestinal metaplasia (IM), gastric cancer (GC) and HP negative controls. Gastric microbiota was characterized by Illumina MiSeq platform targeting the 16 S rDNA. Apart from dominant H. pylori, we observed other Proteobacteria including Haemophilus, Serratia, Neisseria and Stenotrophomonas as the major components of the human gastric microbiota. Although samples were largely converged according to the relative abundance of HP, a clear separation of GC and other samples was recovered. Whilst there was a strong inverse association between HP relative abundance and bacterial diversity, this association was weak in GC samples which tended to have lower bacterial diversity compared with other samples with similar HP levels. Eradication of HP resulted in an increase in bacterial diversity and restoration of the relative abundance of other bacteria to levels similar to individuals without HP. In conclusion, HP colonization results in alterations of gastric microbiota and reduction in bacterial diversity, which could be restored by antibiotic treatment.

Clinical efficacy of different doses of esomeprazole based quadruple therapy on 248 cases of Helicobacter pylori caused gastritis in Uygur

Objective To compare the efficacy of different doses of esomeprazole based quadruple therapy on Helicobacter pylori (H.pylori) eradication in Uygur population, and to study the relationship between H. pylori eradication and dyspepsia symptoms in H. pylori caused gastritis. Methods From August 2015 to May 2016, Uygur patients diagnosed with H. pylori positive superficial gastritis in Xinjiang Uygur Autonomous Region Kashgar Prefecture were recruited.According to random number table, patients were divided into single-dose group, standard-dose group and high-dose group. In single-dose group patients received esomeprazole 40 mg, once per day; in standard-dose group patients received esomeprazole 20 mg, twice per day; and in high-dose group patients received esomeprazole 40 mg, twice per day; besides esomeprazole the treatment of three groups were all combination of amoxicillin, clarithromycin and bismuth, magnesium compound granules.The treatment course of all three groups was 14 days. The H. pylori eradication rate, clinical efficacy, symptom score and adverse drug reaction were compared. The H. pylori eradication rate was evaluated with intention to treat analysis (ITT) and per-protocol sets (PP). Chi square test, t test and one-way analysis of vaiance were used for statistical comparison. Results A total of 248 patients were enrolled, 82 cases in single-dose group, 83 cases in standard-dose group and 83 cases in high-dose group. There were five, five and six cases lose to follow-up or dropped out respectively in single-dose, standard-dose and high-dose group. The results of ITT analysis showed that the eradication rates of H. pylori in single-dose group, standard-dose group and high-dose group were 62.2%(51/82), 77.1%(64/83) and 89.2%(74/83), respectively; the differences between each two groups were statistically significant (χ2=4.34, 16.33 and 4.30, all P 0.05). Conclusions High dose of esomeprazole based quadruple therapy can increase the eradication rate of H. pylori in Uygur population, and H. pylori eradication therapy can significantly improve the dyspepsia symptoms of H. pylori caused gastritis in Uygur. High dose of esomeprazole may improve the clinical efficacy of H. pylori caused gastritis with dyspeptic symptoms in Uygur with safety. Key words: Helicobacter pylori gastritis; Dyspepsia; Quadruple therapy; Esomeprazole; Uygur nationality

Regulation of Gastric Carcinogenesis by InflammatoryCytokines.

Chronic inflammation caused by infection with Helicobacter pylori and autoimmune gastritis increases an individual’s risk of developing gastric cancer. More than 90% of gastric cancers are adenocarcinomas, which originate from epithelial cells in the chronically inflamed gastric mucosa. However, only a small subset of chronic gastritis patients develops gastric cancer, implying a role for genetic and environmental factors in cancer development. A number of DNA polymorphisms that increase gastric cancer risk have mapped to genes encoding cytokines. Many different cytokines secreted by immune cells and epithelial cells during chronic gastritis have been identified, but a better understanding of how cytokines regulate the severity of gastritis, epithelial cell changes, and neoplastic transformation is needed. This review summarizes studies in both human and mouse models, describing a number of different findings that implicate various cytokines in regulating the development of gastric cancer.

Clinical Manifestations of Helicobacter pylori-Negative Gastritis.

There are data to suggest the existence of non-Helicobacter pylori gastritis. However, the risk factors and clinical course for H pylori-negative gastritis remain unclear. We aimed to examine the prevalence and determinants of H pylori-negative gastritis in a large multiethnic clinical population. We conducted a cross-sectional study among patents scheduled for an elective esophagastroduodenoscopy or attending selected primary care clinics and eligible for screening colonoscopy at a single Veterans Affairs medical center. We identified cases of H pylor-negative gastritis, H pylori-positive gastritis, and H pylori-negative nongastritis, where gastritis was defined by the presence of neutrophils and/or mononuclear cells. Risk factors for H pylori-negative gastritis were analyzed in logistic regression models. A total of 1240 patients had information from all biopsy sites, of whom 695 (56.0%) had gastritis. H pylori-negative gastritis was present in 123 patients (9.9% of all study subjects and 17.7% of all patients with gastritis). Among all patients with gastritis, African Americans were statistically significantly less likely than non-Hispanic whites to have H pylori-negative gastritis (odds ratio, 0.25; 95% confidence interval, 0.14-0.43). Conversely, PPI users were more likely to have H pylori-negative gastritis than H pylori-positive gastritis compared with nonusers (odds ratio, 2.02; 95% confidence interval, 1.17-3.49). The cumulative incidence of gastric erosions and ulcers were higher in patients with H pylori-negative gastritis than H pylori-negative nongastritis. We found that H pylori-negative gastritis was present in approximately 18% of patients with gastritis. The potential for H pylori-negative gastritis to progress or the risk of gastric cancer of those with gastric mucosal atrophy/intestinal metaplasia remains unclear.

Hematological and Iron Storage Indices Associated with Helicobacter Pylori Gastritis: A Cross Sectional Study in Minority Population

Hematological and Iron Storage Indices Associated with Helicobacter Pylori Gastritis: A Cross Sectional Study in Minority Population

Tetany Secondary to the Use of a Proton-Pump Inhibitor

Introduction: Chronic PPI use has been reported to cause hypocalcemia, bone density loss and osteoporoticrelated fractures but an acute drop in serum calcium level with PPI use is rare. We present a rare case of symptomatic hypocalcemia with 2 weeks use of PPI. Case Report: 61-year-old female with past medical history of hypothyroidism and hypoparathyroidism secondary to thyroidectomy and parathyroidectomy came to the emergency department(ED) with complaints of spasm and twitching of her upper extremities associated with lethargy and difficulty ambulation. 2 weeks prior to this presentation patient had upper endoscopy done for dyspepsia which showed antral erythema and stomach biopsies came back positive for Helicobacter Pylori gastritis. Patient started taking omeprazole after the endoscopy and later she was given antibiotics treatment for Helicobacter Pylori which she started taking three days prior to the ED presentation. Prior to initiate the omeprazole patient's serum calcium was 8.1 mg/DL. The patient has been taking magnesium citrate 200 mg two times a day and calcium carbonate 1200 mg daily with meals since surgery. No recent change in the dosage of these medications. In ED, EKG done showed QT prolongation, serum calcium was 5.7 mg/DL, magnesium was 1.7 mg/DL and albumin was 3.3 g/DL Thyroid function was within normal limit and parathyroid hormone(PTH) was Discussion Gastric acidic PH is required for absorption of the calcium. Calcium carbonate is a widely use form of calcium supplement which become soluble in the gastric acidic PH and then get absorb in the small intestine. PPI increase the gastric PH so decrease the absorption of calcium which later can cause hypocalcemia. This effect is more seen in the patient with low PTH as it plays a key role in maintaining the serum calcium level within normal limit by stimulating bone resorption, renal tubular calcium reabsorption, and by enhancing gastrointestinal absorption of calcium. The patients with hypoparathyroidism when take PPI their serum calcium needs to be closely monitored to avoid the life threatening complication of hypocalcemia and should be advised to take calcium citrate as a calcium supplement which does not require gastric acidic PH.

Kyoto global consensus report on&lt;i&gt;Helicobacter pylori&lt;/i&gt;gastritis: summary

The aim of review. To present basic issues of Helicobacter pylori gastritis that were covered during Kyoto consensus meeting. Key points. The panel of experts had discussed 22 questions, the answers to which resulted in formulation of 24 statements that were voted with estimation of degree of evidence, recommendation grade and consensus strength. Thus the consent rate has exceeded 80% for all statements. New classification of gastritis and duodenitis, based on the etiological approach has been proposed. It is recommended to qualify dyspepsia cases with sustained symptomatic improvement after successful eradication therapy as H. pylori-associated dyspepsia, and to distinguish them from functional dyspepsia. Broader application of magnification endoscopy methods is recommended for diagnostics of chronic gastritis. It is stressed, that the duly eradication therapy which is carried out before development of severe atrophy is capable to decrease the risk of stomach cancer. Conclusion. Proceedings and conclusions of consensus can become a cornerstone for development of new international gastritis classification.

A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions.

Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM). A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard. A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94 % vs. WLE 83 %; P < 0.001) with no difference in the identification of Helicobacter pylori gastritis (73 % vs. 74 %). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87 % vs. 53 %; P < 0.001) and for the diagnosis of dysplasia (92 % vs. 74 %). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P < 0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98. In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90 % suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation.

Kyoto global consensus report on Helicobacter pylori gastritis and its impact on Chinese clinical practice.

The Kyoto global consensus report on Helicobacter pylori (H. pylori) gastritis has had a great effect on the field of H. pylori studies worldwide. For the first time H. pylori gastritis was defined entirely as an infectious disease and H. pylori-associated dyspepsia as a new category of organic dyspepsia apart from functional dyspepsia, together with a proposed diagnostic algorithm. Accordingly, the report states that the eradication of H. pylori should be regarded as the first-line treatment for dyspepsia. Moreover, H. pylori eradication before the development of pre-neoplastic changes is recommended to reduce the risk of more serious complications of H. pylori gastritis. Despite the recommendations of this new global consensus, the task of transforming them into feasible and practical recommendations for individual countries will require them to become region-specific, which requires further discussion.

CHRONIC HELICOBACTER PYLORI GASTRITIS: THE ERADICATION EFFICACY&amp;NBSP;OF THE&amp;NBSP;BISMUTH-CONTAINING QUADRUPLE REGIMEN (EBMT)

Background: there has not been yet any research on the effectiveness of H. pylori eradication of bismuth-containing quadruple regimen on chronic gastritis patients in our country. Objective: to evaluate H. pylori eradication rate of bismuth-containing quadruple regimen according to intention to treat (ITT), per protocol (PP) analysis, the rate of side effects and medication compliance. Subjects and Methods: from March 2014 to January 2016 we used bismuth-containing quadruple regimen (EBMT) 10 days for H. pylori eradication therapy for 166 chronic gastritis patients diagnosed based on clinical, endoscopic, rapid urease test, histology and culture. Patients were evaluated side effects and medication compliance at the end of treatment (day 11-14). To assess the eradication, repeating endoscopy with both rapid urease test and histological examination were performed at 4 to 8 weeks after stopping treatment course. Results: H. pylori eradication rates on ITT and PP analysis overall, for naïve patients, after one and more two eradication failures were respectively: 80.72-89.33%, 79.51-90.65%, 91.67-91.67% and 75.00-78.95%. Medication adherence rate was 96.99%. The rates of patients experiencing moderate, severe and very severe side effects were: 19.88%, 0.60% and 1.81%. Conclusion: the EBMT 10-day regimen attained high eradication rates in chronic gastritis patients with rare serious side effects and the high compliance rate. We should apply bismuth-containing quadruple regimen in H. pylori eradication therapy for naïve patients or after one eradication failure. Key words: bismuth-containing quadruple regimen, EBMT, eradication, chronic Helicobacter pylori gastritis

Morphological and Cellular Features of Innate Immune Reaction in Helicobacter pylori Gastritis: A Brief Review.

Innate and adaptive immunity are both involved in acute and chronic inflammatory processes. The main cellular players in the innate immune system are macrophages, mast cells, dendritic cells, neutrophils, eosinophils, and natural killer (NK), which offer antigen-independent defense against infection. Helicobacter pylori (H. pylori) infection presents peculiar characteristics in gastric mucosa infrequently occurring in other organs; its gastric colonization determines a causal role in both gastric carcinomas and mucosa-associated lymphoid tissue lymphoma. In contrast, an active role for Epstein-Barr virus (EBV) has been identified only in 9% of gastric carcinomas. The aim of the present review is to discuss the role of cellular morphological effectors in innate immunity during H. pylori infection and gastric carcinogenesis.

Oxyntic gastric atrophy in Helicobacter pylori gastritis is distinct from autoimmune gastritis

AimTo assess characteristics of oxyntic gastric atrophy (OGA) in autoimmune gastritis (AIG) compared with OGA as a consequence of Helicobacter pylori infection.MethodsPatients undergoing oesophagogastroduodenoscopy from July 2011 to October 2014...

Kyoto global consensus report for treatment of Helicobacter pylori and its implications for China

Kyoto global consensus report on Helicobacter pylori gastritis (Gut, July 2015) is another important international consensus since the European Maastricht Ⅳ consensus was published. Kyoto consensus will improve the etiology-based classification, the diagnostic assessment of gastritis, and the treatment of H. pylori-associated dyspepsia and H. pylori gastritis. However, because of high rate of H. pylori infection and antibiotic resistance as well as limited health resources in China, we need to develop our own strategies of H. pylori infection control with the reference of the Kyoto global consensus.