Dyspepsia Research Articles

A multi-center, randomized controlled study on the effect of Saccharomyces boulardii combined with triple therapy for the initial eradication of Helicobacter pylori infection

Objective: To assess the efficacy and safety of Saccharomyces boulardii (S. boulardii) in combination with triple therapy as a first-line regimen for the eradication of Helicobacter pylori (H. pylori) in non-ulcer dyspepsia (NUD) patients. Methods: A total of 497 Helicobacter pylori-positive patients who underwent gastroscopy and diagnosed with NUD were enrolled from June 2018 to January 2020 in 9 medical centers across China. Participants were segmentedly randomly divided into 3 groups. Patients in group A received S. boulardii for 14 days and triple therapy for 10 days, while patients in group B received bismuth quadruple group for 10 days, and patients in group C received triple therapy for 10 days. The H. pylori status was determined by the 13C-urea breath test on the 44th day of the treatment. Symptom improvement and adverse reactions were assessed on the 14th and 44th day. Results: There were 229 males and 268 females in all 497 patients enrolled. They were aged 18-69 (46.1±11.8) years and 472 of them (158 cases in group A, 159 cases in group B, and 155 cases in group C) completed the trial. The intention-to-treat (ITT) eradication rates in patients in patients A, B and C were 77.8% (126/162), 80.1% (137/171) and 65.2% (107/164) respectively, and per protocol-based (PP) eradication rates were 79.7% (126/158), 86.2% (137/159) and 69.0% (107/155) respectively. The differences were statistically significant in ITT and PP analysis among 3 groups (ITT: χ²=11.14, P<0.01; PP: χ²=13.86, P<0.01). There was no significant difference between eradication rates of two quadruple therapys(all P>0.05), but both of them were significantly higher than that of standard triple therapy (both P<0.05). Statistics revealed that both quadruple therapys led to significantly higher symptom improvement of belching compared with that of standard triple therapy in day 14 (P<0.05). The relief of abdominal distension and belching symptom scores of group A were significantly higher than those of group C in day 44(all P<0.05). There was no serious adverse event reported. The incidence of diarrhea in group A was significantly lower than those in the other two groups (both P<0.05). Conclusions: The combination of S. boulardii and triple therapy can achieve a better eradication effect on H. pylori infection with NUD, and has advantages in symptom relief and safety.

Chronic Fatigue Syndrome

Background: Chronic fatigue syndrome is a collection of symptoms characterized by complaints of fatigue that lasts for at least six months or more. It can be accompanied by symptoms of low-grade fever, myalgia, arthralgia, cephalgia, and a sore throat that is sometimes accompanied by enlarged glands. The main psychological symptoms of chronic fatigue syndrome are depression and sleep disturbances.&#x0D; Case Presentation: A 26-year old male patient was treated with a main complaint of feeling tired since 6 months before he was admitted to the hospital. The patient claimed that he was unable to do activities independently because he experienced extreme tiredness. He also complained of a headache that was felt when under stress and was not relieved by rest along with a stabbing-like pain that moved around throughout his body, which also does not decrease with changes in position or rest. He also has heartburn felt since 4 months ago when eating spicy foods, eating late, and especially when experiencing mental stress, which often was accompanied by nausea and vomiting. The results of his physical, laboratory and supporting examinations were all within normal limits. The patient was then diagnosed with chronic fatigue syndrome and functional dyspepsia.&#x0D; Conclusion: Approaches to medical treatment of chronic fatigue syndrome can be done based on general treatment of physical and psychological symptoms experienced. In these circumstances, antidepressant drug therapy and psychotherapy such as cognitive behavioral therapy is needed. In addition, rehabilitation therapy may also be necessary because several studies show that gradual physical exercise yield significant improvement in chronic fatigue syndrome patients.

Raised liver enzyme in a patient receiving Helicobacter pylori triple regimen: A case report

infection remains a worldwide spread disease with a definitemorbidity and mortality.Indeed, this infection is the main cause of non-ulcer dyspepsia, peptic ulcers and gastric tumors, including bothlow-grade MALT-lymphoma and adenocarcinoma. A 65-year-old female patient visited outpatient department of Gastroenterology clinic for a routine follow-up after completion of 14-day triple drug therapy for . After a few days of empirical treatment for raised liver enzymes, her liver enzymes normalized. Clinicians should be aware about the rare adverse event during eradication treatment.

The role of sodium lauryl sulfate on formulation of directly compressed tablets containing simvastatin and aspirin: Effect on drugs dissolution and gastric mucosa

According to the American College of Cardiology/American Heart Association (ACC/AHA), both aspirin and statin are used in the primary prevention of cardiovascular diseases. Aspirin (ASA) is contraindicated if there is gastrointestinal bleeding because it will exaggerate the condition. In this study, the effect of surfactant; sodium lauryl sulfate (SLS), in enhancing the in vitro dissolution of simvastatin (SIM) and ASA, as well as gastric irritation and upset, was studied. Oral tablets containing both ASA and SIM with and without the SLS were manufactured using the direct compression technique. The prepared tablets were characterized with respect to hardness, friability, uniformity of dosage units, in vitro disintegration, and dissolution. The effect of the addition of SLS in reducing the in vivo irritation and protection of gastric mucosa were also investigated. The results showed that the compressed tablets possessed sufficient hardness, acceptable friability, and are uniform with respect to disintegration, drugs contents, and tablet weight. The results showed that SIM alone exhibited a gastroprotective effect on the induced irritation. In addition, the incorporation of the SLS in the tablets containing SIM and ASA significantly enhanced the dissolution rates of both drugs and significantly decreased the gastric irritation and the ulcer index. The ulcer index of aspirin was decreased from 2.3 for tablets manufactured without SLS to 0.8 for tablets containing SLS. In a conclusion, the addition of pH modifier surfactant; SLS could enhance the dissolution rate of poorly soluble acidic drugs, reduce gastric upset and irritation without any effect on the main characters of the tablets. Moreover, the addition of SLS is very useful in improving the therapeutic activities and reducing the side effects of ASA and SIM for patients who require long-term administration of these drugs.

Clinical Factors Implicated in Antibiotic Resistance in Helicobacter pylori Patients.

Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. pylori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strategies. Consensus guidelines recommend use of proven locally effective regimens; however, eradication data are inconsistently generated in several regions of the world. In this review, we describe several clinical factors associated with increased rates of antibiotic resistant H. pylori, including history of previous antibiotic exposure, increasing age, female gender, ethnicity/race, extent of alcohol use, and non-ulcer dyspepsia. Assessment of these factors may aid the clinician in choosing the most appropriate empiric treatment strategy for each patient. Future study should aim to identify locally effective therapies and further explore the clinical factors associated with antibiotic resistance.

Can we consider soluble herpes virus entry mediator (sHVEM) as a tumor marker?

Immune checkpoint molecules have critical roles in directing immune responses into co-inhibitory and co-stimulatory signals. Herpes virus entry mediator (HVEM) is a receptor of tumor necrosis factor receptor superfamily with unique features due to its interaction with both inhibitory and stimulatory ligands. The aim of this study was to measure the serum level of the soluble form of HVEM in patients with gastric, colorectal and breast cancers and evaluating its diagnostic and prognostic value. The concentration of the soluble HVEM (sHVEM) was determined in the serum of 36 patients with breast cancer, 50 patients with colorectal cancer and 59 patients with gastric cancer using ELISA method. Moreover, 50 healthy donors (HD) as well as 31 patients with non-ulcer dyspepsia (NUD) were used as control groups. The patients' samples were obtained from the Biobank of Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran. The level of sHVEM was significantly higher in patients with gastric (P=0.001) and breast cancer (P=0.01) than in control groups (HD). The higher level of sHVEM was observed in colorectal cancer patients in comparison with HD group, although it was not significant. Moreover, the elevated level of sHVEM was shown to be higher significantly in stage III and IV compared to stage I and II in breast cancer (P=0.03). Similar finding was detected in gastric and colorectal cancers, but not to be statistically significant. The results of the present study suggest that the serum level of sHVEM may be considered as a promising indicator for diagnosis as well as evaluating the progression of cancers such as gastric, breast and colorectal cancers.

Serum pepsinogen level as a biomarker for atrophy, reflux esophagitis, and gastric cancer screening in Indonesia.

Chronic dyspepsia's symptoms are frequently seen in primary to tertiary healthcare in Indonesia. This study aimed to describe the potential usability of pepsinogen (PG) values in determining gastric mucosal conditions, including superficial gastritis and atrophic gastritis. We recruited 646 adult dyspeptic patients and then analyzed PG values (including PGI, PGII, and PGI/II ratio) with endoscopic findings, gastric mucosal damages, and Helicobacter pylori infection. The gastric mucosal damage and H. pylori infection were evaluated using histological examination based on the updated Sydney system. Among 646 enrolled patients, 308 (47.2%), 212 (32.8%), 91 (14.1%), 34 (5.2%), and 1 (0.2%) patient were diagnosed with normal mucosa, gastritis, reflux esophagitis, peptic ulcer disease, and gastric cancer, respectively. Significant differences in PGI, PGII, and PGI/II ratio values were observed among ethnic groups (all P < 0.01). The PGI and PGII levels were significantly higher and PGI/II was significantly lower in H. pylori-infected patients than in uninfected ones (all P < 0.001). The optimal cutoff value for PGII and PGI/II was 12.45 ng/mL with an area under the curve (AUC) value of 0.755 (0.702-0.811), sensitivity 59.3%, and specificity 77.1%; and 4.75 with AUC value of 0.821 (0.763-0.855), sensitivity 81.5%, and specificity 78.7%, respectively, to determine moderate-severe atrophy. Serum PG levels, a useful biomarker, represent the endoscopic findings, especially for reflux esophagitis. In addition, the benefits of PG values detecting atrophic gastritis were limited to moderate-severe atrophic gastritis. This usefulness requires careful attention for several ethnic groups in Indonesia.

Evaluation of acute toxicity and antiulcer activity of Pepgard tablet: An Ayurvedic formulation.

In traditional Indian medicine, several plants have been used to treat gastrointestinal disorders, including gastric ulcers. Pepgard tablet is an Ayurvedic compound formulation widely used in clinical practice as an antacid for treating nonulcer dyspepsia, gastroesophageal reflux, and drug-induced gastritis. Evaluation of acute toxicity of Pepgard tablet and antiulcer activity against gastric ulcer induced by aspirin plus pyloric ligation in albino rats. Acute toxicity was studied as per OECD 425 guideline at a limit dose of 2000 mg/kg in female albino rats. Antiulcer activity was assessed by aspirin plus pyloric ligation model at two dose levels (90 and 180 mg/kg, po). Gastric juice parameters, stomach tissue parameters, and histopathological study along with an assessment of ulcer index were assessed. Pepgard did not produce any toxicity or lethality at a limit dose of 2000 mg/kg and was found safe in female albino rats. Pepgard at both dose levels showed an antiulcer effect as evidenced by an increase in pH value, decreased acidity, and peptic activity of gastric juice along with a decrease in ulcer index and increased antioxidant status of damaged gastric mucosa as revealed by an increase in catalase, glutathione, etc., in stomach homogenate of albino rats. The present study of Pepgard tablet revealed its safety in acute toxicity studies and can be categorized as substances with low health hazard potential. Pepgard has been shown to be effective as an antacid, anti-ulcer, and to have gastroprotective effects against experimentally-induced ulcerogenesis in albino rats.

The Efficacy of Probiotics in the Management of Helicobacter Pylori: A Systematic Review.

Helicobacter pylori is a Gram-negative microorganism that causes chronic dyspepsia, gastritis, mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric adenocarcinoma. Various antibiotic regimens are employed to eradicate it; however, antibiotic resistance has skyrocketed in recent years, resulting in a reduction in eradication rates. As a result, numerous novel therapeutic approaches are being adopted in clinical practice, and probiotics are being extensively investigated. Probiotics are living bacteria that, when consumed, offer many medicinal advantages that may be accomplished by altering the amount or activity of gut flora. Their beneficial influence on gut health, immune system modulation, and cancer therapy is the subject of extensive investigation. This is owing to their perceived safety and simplicity of use. The primary objective of this review is to learn about and investigate the function of probiotics in the eradication of H. pylori, either alone or in conjunction with traditional treatments.Data have been collected from PubMed, PubMed Central, Medline, Cochrane, and Google Scholar, and relevant articles have been chosen following the PRISMA guidelines. Our search resulted in 2489 records, of which 123 full-text articles were screened for eligibility. Two reviewers independently performed the quality appraisal of 16 relevant articles, and ultimately 11 high-quality studies are included in this review. In conclusion, probiotic monotherapy does not have a significant effect on the eradication rates of H. pylori, but in conjunction with standard treatment regimens, there was mild improvement in the eradication rates but a significant reduction of side effects due to antibiotics.

DIGESTIVE DISORDERS (ANNAVAHA SROTAS VYADHI) IN OLD AGE – ISSUES AND POSSIBLE SOLUTIONS

Old age is the result of the natural process of ageing and the time to enjoy life. As at this time, we are almost free from all responsibilities. But it can be enjoyed only when one is free from major ailments otherwise it becomes a great burden on ourselves as well as on others too. Due to increased health awareness, the average age of people is increasing day by day and the advancement in medical science provides great help in this regard. Therefore, peo- ple live longer but the natural process of ageing and exposure to unfavourable things causes a lot of derangements and weakening of bodily systems and organs in old age. So, there is a great need for geriatric health care in day- to-day practice so that we can improve the quality of life of old age. Besides a lot of major health problems of old age like Heart Disease, Hypertension, Diabetics, Joint disorders, Dementia, Strokes, etc; some minor ailments are equally important as they are often the cause of many major ailments e.g., Gastric Upsets, Insomnia, Anxiety, etc. Keywords: Digestive Disorders, Old age, Vriddhaavastha, Annavahasrotasvyadhi, Issues, Solutions, Agni

How We Approach Difficult to Eradicate Helicobacter pylori

How We Approach Difficult to Eradicate Helicobacter pylori

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

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

Repurposing pentosan polysulfate sodium as hyaluronic acid linked polyion complex nanoparticles for the management of osteoarthritis: A potential approach

Osteoarthritis is still a disease burden for pharmaceutical scientists and strategy makers. It is associated with the chronic inflammation of joints especially weight-bearing joints like knee, hip, backbone, and phalanges. NSAIDs that are used for the management of inflammation associated with osteoarthritis have high side effects related to gastric upset, gastric ulcer, and long term treatment associated with liver and kidney damage. Nanotechnology has gained a huge scope for the management of arthritis as it can reach out to the deep inside the cell and alter cellular physiology as desired. The present study hypothesizes the use of polyion complex nanoparticles of hyaluronic acid linked Pentosan polysulfate sodium, a disease-modifying agent for the treatment of osteoarthritis administered through transdermal route. The hypothesis involves the use of drug repurposing as the drug was initially approved for interstitial cystitis, a condition of the urinary bladder associated with pain and swelling. Being very low oral bioavailability and gastric irritation profile, the transdermal route would be beneficial. To overcome the problem associated with the oral route, there is a need for the targeted approach that will particularly reach at inflammatory sites. Thereby transdermal delivery of hyaluronic acid linked Pentosan polysulfate sodium through polyion complex nanoparticle therapy will be a novel therapeutic approach to combat osteoarthritis.

Chronic gastritis and functional dyspepsia. Unity and struggle of two opposites

The review article describes the epidemiology, clinical picture, pathogenesis, approaches to the diagnosis and treatment of chronic gastritis and functional dyspepsia. Chronic gastritis is an unreasonably common diagnosis in our clinical practice, which is diagnosed in patients with disturbing dyspeptic complaints. According to the agreement documents, chronic gastritis is primarily a morphological concept. Chronic gastritis has no pathognomonic clinical signs and should be diagnosed during the histological examination of the gastric mucosa. Functional dyspepsia is a diagnosis that reflects the presence of a certain symptom complex (pain or burning sensation in the epigastrium, a feeling of fullness or early satiety) in the absence of diseases that could explain the symptoms. Secondary dyspepsia is diagnosed in patients with organic diseases of the upper gastrointestinal tract, metabolic or systemic diseases that cause dyspeptic syndrome. In the process of examining a patient with disturbing dyspeptic complaints, it is advisable for the doctor to use the diagnosis “unspecified dyspepsia” – a preliminary diagnosis before laboratory and instrumental examination aimed at identifying the cause of the dyspeptic syndrome. Dyspepsia associated with H. pylori is diagnosed in patients with H. pylori infection. The diagnosis is revised over time and is competent if complaints have been relieved within 6 months after effective H. pylori eradication.The main drugs for the treatment of patients with dyspeptic complaints are proton pump inhibitors and prokinetics. Omeprazole with domperidone sustained release (SR) in a fixed dose combination is characterized by optimal efficacy and a good safety profile in patients with both functional and secondary dyspepsia and ensures a high level of treatment adherence.

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

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

S2747 Hereditary Hemorrhagic Telangiectasia: A Rare Disease Diagnosed From Incidental Liver Lesions

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is a rare, autosomal dominant syndrome characterized by mucocutaneous telangiectasias and AVMs. Epistaxis and GI bleeding are the most common presenting features. HHT-related visceral AVMs have also been well-described and when identified without a prior diagnosis of HHT can present a significant diagnostic challenge. Case Description/Methods: A 60-year-old male with prior history of prior tobacco and alcohol use was referred to GI clinic for two years of chronic diarrhea and dyspepsia. No unintentional weight loss although he reported intermittent episodes of epistaxis every 2-3 months for past 40 years. Physical examination and family history was unremarkable. CT A/P showed a heterogeneous liver with innumerable liver lesions. (Figure 1) An EGD was performed for dyspepsia which revealed an 8mm gastric body ulcer and biopsy negative for H.pylori. The patient’s diarrhea resolved with probiotics and changes to diet. Hepatology recommended a liver biopsy which was suggestive of an arteriovenous or vascular malformation with scarring. Follow up EGD revealed a healed stomach ulcer and a 5mm gastric AVM. Chart review revealed a prior CT chest with a small pulmonary vascular malformation. The patient was referred to genetics for evaluation of HHT. A HHT genetic panel was positive for a pathogenic heterozygous variant in the ACVRL1 gene and the diagnosis of HHT was confirmed. Discussion: HHT is a clinically heterogenous disorder and diagnosis requires at least three of the following Curaçao criteria: epistaxis, mucocutaneous telangiectasias, visceral AVMs and family history of HHT. HHT-related AVMs can involve the brain, lung or liver. Hepatic involvement is common ranging from 32% up to 95%. Hepatic AVMs, are rarely symptomatic and routine screening is not recommended. Symptomatic hepatic AVMs can present with three distinct clinical presentations – high output heart failure from AV shunting, portal hypertension from arterioportal shunting and biliary disease from chronic ischemia. In the absence of routine screening, follow-up of these patients requires close attention to the development of these complications. In these cases, multi-phasic CT may be the preferred imaging modality. In conclusion, hepatic AVMs should be included in the differential for hepatic lesions and genetic evaluation should be considered with concomitant history of epistaxis, GI bleeding and/or evidence of other visceral AVMs.Figure 1.: CT abdomen and pelvis without contrast revealed several liver lesions, largest lesion 3.3cm in diameter.

Ashwagandha-Induced Gastric Upset in Post-Covid Patient-A Case Report and Brief Review of the Literature

Adverse drug reporting of herbal drugs is less common as they are generally considered as safe. It is also very common to use self-medication by people in the case of herbal drugs. But many times, mild to severe events have been seen with the use of herbal or ayurvedic medicines. We have reported a case of post-covid patient, who was having complained of headache, body ache, lethargy, backache, generalized weakness and excessive sweating since one weak. Patient had past history of hospitalization due to COVID-19 moderate pneumonia one month back. Patient also had history of type-2 diabetes mellitus, hypertension and dyslipidemia and was taking anti-diabetic and anti-hypertensive medications continuously. Ashwagandha powder (Withania somnifera), Maha yogaraj guggulu (herbal anti-inflammatory) and Syrup Amynity Plus (herbal immune-booster) were prescribed for these complain. Conversely, moderate severity adverse reaction like nausea, vomiting, diarrhea, and abdominal cramps were noted after the intake of suspected drug i.e. ashwagandha powder. Nevertheless, symptoms were relieved after the de-challenge. This shows a temporal relation of the event with the suspected drug. One more possibility of drug-drug interaction in this case cannot be ruled out completely. Causality assessment was done for this adverse event and it was considered as the “probable” category of the adverse event in WHO causality classification.

Функціональна диспепсія у світлі PимскИх критеріїв IV

Статтю присвячено проблемі функціональної дис­пепсії. Детально описана патофiзiологiя, наведені діагностичні критерії цієї патології, розглядаються аспекти лікування пацієнтів iз функціональною диспепсією. Препаратами першої лінії терапії функціональної диспепсії є прокiнетики і інгібітори протонної помпи. У статті приділено увагу комбінованому препарату, що містить домперидон (прокінетик) і омепразол (інгібітор протонної помпи), — Омез ДСР.

Characterization of gut microbiome and metabolome in Helicobacter pylori patients in an underprivileged community in the United States.

Helicobacter pylori (H. pylori), a bacterium that infects approximately half of the world's population, is associated with various gastrointestinal diseases, including peptic ulcers, non-ulcer dyspepsia, gastric adenocarcinoma, and gastric lymphoma. As the burden of antibiotic resistance increases, the need for new adjunct therapies designed to facilitate H. pylori eradication and reduce negative distal outcomes associated with infection has become more pressing. Characterization of the interactions between H. pylori, the fecal microbiome, and fecal fatty acid metabolism, as well as the mechanisms underlying these interactions, may offer new therapeutic approaches. To characterize the gut microbiome and metabolome in H. pylori patients in a socioeconomically challenged and underprivileged inner-city community. Stool samples from 19 H. pylori patients and 16 control subjects were analyzed. 16S rRNA gene sequencing was performed on normalized pooled amplicons using the Illumina MiSeq System using a MiSeq reagent kit v2. Alpha and beta diversity analyses were performed in QIIME 2. Non-targeted fatty acid analysis of the samples was carried out using gas chromatography-mass spectrometry, which measures the total content of 30 fatty acids in stool after conversion into their corresponding fatty acid methyl esters. Multi-dimensional scaling (MDS) was performed on Bray-Curtis distance matrices created from both the metabolomics and microbiome datasets and a Procrustes test was performed on the metabolomics and microbiome MDS coordinates. Fecal microbiome analysis showed that alpha diversity was lowest in H. pylori patients over 40 years of age compared to control subjects of similar age group. Beta diversity analysis of the samples revealed significant differences in microbial community structure between H. pylori patients and control subjects across all ages. Thirty-eight and six taxa had lower and higher relative abundance in H. pylori patients, respectively. Taxa that were enriched in H. pylori patients included Atopobium, Gemellaceae, Micrococcaceae, Gemellales and Rothia (R. mucilaginosa). Notably, relative abundance of the phylum Verrucomicrobia was decreased in H. pylori patients compared to control subjects. Procrustes analysis showed a significant relationship between the microbiome and metabolome datasets. Stool samples from H. pylori patients showed increases in several fatty acids including the polyunsaturated fatty acids (PUFAs) 22:4n6, 22:5n3, 20:3n6 and 22:2n6, while decreases were noted in other fatty acids including the PUFA 18:3n6. The pattern of changes in fatty acid concentration correlated to the Bacteroidetes:Firmicutes ratio determined by 16S rRNA gene analysis. This exploratory study demonstrates H. pylori-associated changes to the fecal microbiome and fecal fatty acid metabolism. Such changes may have implications for improving eradication rates and minimizing associated negative distal outcomes.

Helicobacter Pylori Induce Gastric Upset

Editorial: Helicobacter pylori is a micro-aerophilic, helical-form gramnegative aggressive bacteria. Accordingly, the idiom “Helico” intimates its helical appearance, “bacter” symbolizes bacteria, while “pylori” denotes stomach due to the first and common site of this bacteria living. Further, Marshall B. and Warren R. observed and described it in 1982. Then, the followed investigators studied this bacterium in detail with its consequences and complexities [1]. Gastric upset (Indigestion), dyspepsia: means impaired gastric digestion. Accordingly, the patient complains of upper abdominal pain, heartburn, belching, nausea, even feeling earlier gastric fullness than expected while eating. Furthermore, there are many causes of indigestion like gastroesophageal reflux disease, ulcer disease, gastritis, and even gastric cancer. Hence, unexplained recent onset dyspepsia in older people may need additional examinations. Moreover, one of the common causes is Helicobacter pylori infection, which needs laboratory and endoscopic examination [2]. Argument Many theories investigated the etiology and pathogenesis of Helicobacter pylori infection, concerning chronic or acute gastritis. Hence, gastric upset is the main presentation of both types of gastritis. Evidences The genotype is valuable in determining the dominant Helicobacter pylori strains as the isolates were different genetically plus heterogeneous distribution. Accordingly, the vac and cag markers operate a significant function in defining clinical consequences. These virulence agents are present in a subset of Helicobacter pylori strains isolates like cagA, iceA, vacA, and ureC. Moreover, the cagA causes cytotoxins induction by the gastric epithelial cell as Interleukin 8 [3]. The molecular intercommunication researches exhibit that the act of acarus calamus in hindering biofilm formation in Helicobacter pylori is due to the inhibitory impact of phytobio-active component, β-sitosterol, on the quorum sensing molecules-ToxB, PhnB, DnaA, plus Sip. Consequently, this opinion may suggest the molecular mechanism of Helicobacter pylori in producing the acidrelated complaints and gives a clue to a new therapy [4]. Helicobacter pylori infection causes lncRNA risk impression linked to H. pylori in gastric cancer patients and can prognosticate the prediction of these patients [5]. There was a close relationship between raised serum IgE levels in Helicobacter pylori infected patients [6]. Counterargument The laboratory investigations of Helicobacter pylori infection depend on several factors like the fluctuations of serum antibody titers in a time series, the antigene detection in stool tests, the false-positive results of lab tests, or the manner of endoscopic biopsy collection. Furthermore, other factors like the variations in Cytotoxin-Associated Gene A (CagA) in East Asian patients. Moreover, the gastric nodularity or atrophy, the patient’s age, the severity of the gastric mucosal infection are causes of variations in Helicobacter pylori detection at the time of the investigation [7]. Refutation The significant markers of H. pylori, the presence of the vacuolating cytotoxin (vacA), the cytotoxin-associated gene A (cagA), which induced by the direct communication with gastric epithelium factor antigen (iceA gene), and the presence of urease C gene (ureC). Consequently, all these factors play the principal factors in deciding the gastric consequences of Helicobacter infections. Conclusion Helicobacter pylori induce gastric upset by several mechanisms to form numerous Gastric diseases.