Peptic Ulcer Disease Patients Research Articles

Characteristics of Hemorrhagic Peptic Ulcers in Patients Receiving Antithrombotic/Nonsteroidal Antiinflammatory Drug Therapy

Background/AimsAntithrombotic/nonsteroidal antiinflammatory drug (NSAID) therapies increase the incidence of upper gastrointestinal bleeding. The features of hemorrhagic peptic ulcer disease in patients receiving antithrombotic/NSAID therapies were investigated.MethodsWe investigated the medical records of 485 consecutive patients who underwent esophagogastroduodenoscopy and were diagnosed with hemorrhagic gastroduodenal ulcers. The patients treated with antithrombotic agents/NSAIDs were categorized as the antithrombotic therapy (AT) group (n=213). The patients who were not treated with antithrombotics/NSAIDs were categorized as the control (C) group (n=263). The clinical characteristics were compared between the groups.ResultsThe patients in the AT group were significantly older than those in the C group (p<0.0001). The hemoglobin levels before/without transfusion were significantly lower in the AT group (8.24±2.41 g/dL) than in the C group (9.44±2.95 g/dL) (p<0.0001). After adjusting for age, the difference in the hemoglobin levels between the two groups remained significant (p=0.0334). The transfusion rates were significantly higher in the AT group than in the C group (p=0.0002). However, the outcome of endoscopic hemostasis was similar in the AT and C groups.ConclusionsPatients with hemorrhagic peptic ulcers receiving antithrombotic/NSAID therapies were exposed to a greater risk of severe bleeding that required transfusion but were still treatable by endoscopy.

Eradication of Helicobacter pylori Infection Reduces the Incidence of Peptic Ulcer Disease in Patients using Nonsteroidal Anti‐Inflammatory Drugs: A Meta‐Analysis

To investigate the association between use of nonsteroidal anti-inflammatory drugs (NSAID) and Helicobacter pylori infection, interactive effect of H. pylori infection and NSAID use on the development of peptic ulcer disease (PUD), and the effect of H. pylori eradication therapy on PUD development. We performed a systematic literature search in EMBASE and PubMed for relevant articles published in English between January 1989 and August 2010, with the following MeSH and/or key words: non-steroidal anti-inflammatory drugs, or NSAIDs, Helicobacter pylori, or H. pylori, peptic ulcer disease or PUD, and randomized-control study or clinical trial. The meta-analysis was conducted using the Review Manager 4.2.2. In the analysis of five studies, the pooled prevalence of H. pylori infection was 74.5% and 71.1% in NSAID users and non-NSAID users, respectively, (OR = 0.65; 95% CI: 0.35-1.20, p = .170). In the analysis of nine studies, the pooled prevalence of PUD in NSAID users was 31.2% and 17.9% in the presence and absence of H. pylori infection, respectively, (OR = 3.08; 95% CI: 1.26-7.55, p = .010). Moreover, in the analysis of seven studies, PUD developed in 6.4% and 11.8% of NSAID users with and without eradication therapy, respectively (OR = 0.50; 95% CI: 0.36-0.74, p < .001). The preventive effect of the eradication therapy was further revealed in NSAID-naive users (OR = 0.26; 95% CI: 0.14-0.49, p < .0001) and in the Asian population (OR = 0.30; 95% CI: 0.16-0.56, p < .001). NSAID use is not associated with H. pylori infection in patients with PUD. PUD is more common in H. pylori positive than in negative NSAID users. Moreover, H. pylori eradication therapy reduces PUD incidence in NSAID users, especially in naive users and in the Asian population.

Prevalence of Helicobacter pylori positivity in patients undergoing percutaneous coronary intervention

The adverse effect of haemorrhagic complications after percutaneous coronary intervention (PCI) on outcome is well established with Helicobacter pylori infection known to be an important precipitant of peptic ulcer disease in patients receiving non-steroidal anti-inflammatory drug therapy. The prevalence of H. pylori positivity in patients undergoing PCI and receiving subsequent antiplatelet therapy is unknown. We sought to determine the prevalence and features associated with H. pylori positivity in patients undergoing PCI. All patients undergoing PCI between August 2008 and April 2009 were identified and assessed for H. pylori positivity with serological status determined by using a commercially supplied enzyme-linked immunosorbent assay. A total of 245 patients undergoing PCI during the study period had samples obtained for H. pylori serology. Of these, 91 were positive for H. pylori serology (37%) and 148 were negative (60%) with six samples being equivocal (3%). Of those patients positive for H. pylori, 75% were on agents at admission known to promote or precipitate gastrointestinal haemorrhage. Patients positive for H. pylori tended to be older, with increased creatinine and more likely to be receiving proton pump inhibitor therapy. In an unselected cohort of patients undergoing PCI in a single centre, we detected a prevalence of H. pylori positivity in 37% of patients; this denotes a potentially treatable precipitant of haemorrhage in a considerable portion of patients receiving dual antiplatelet therapy after PCI. Further prospective study is required to determine if the presence of H. pylori positivity is associated with adverse events in terms of gastrointestinal and cardiac outcomes.

A study of psychiatric morbidity in patients of peptic ulcer diseases

Aims and Objectives: To study the prevalence of psychiatric morbidity among patients of peptic ulcer disease and to study the patients of peptic ulcer disease with psychiatric morbidity in comparison to patients of peptic ulcer disease without psychiatric morbidity on following variables: sociodemographic variables and attributes/risk factors of peptic ulcer disease. Materials and Methods: Fifty cases of clinically proven acid peptic diseases and 30 cases of the control group were screened in department of General Medicine, outdoor as well as indoor patients. Instruments applied for the purpose of the study were Personal Bio-data Performa (Appendix-I), (SCL)- 80 (Appendix-II), Hamilton rating scale for anxiety and depression, (P.S.L.E.); clinical diagnosis of psychiatric disorders was made as per ICD- 10 criteria. Data collected shall be subjected to statistical analysis. Results and Findings: The psychiatric morbidity was significantly ( P P P P P P P P 10 years, compared to 23.80% in patients without psychiatric morbidity. Lastly, 48.27% of patients with psychiatric morbidity had significantly ( P Conclusions: There is a significant relationship between the peptic ulcer disease and the various psychiatric morbidity factors as illustrated from the findings of this study.

Clinical Characteristics of Patients Diagnosed as Peptic Ulcer Disease in the Third Referral Center in 2007

In spite of the improvement of medical treatment for the peptic ulcer disease (PUD), PUD is still one of the common upper gastrointestinal diseases. The purpose of this study was to evaluate the risk factors and general characteristics of Korean patients diagnosed as PUD at a single third referral center. A total of 310 patients, diagnosed as PUD through endoscopy during one year of 2007 at Seoul National University Bundang Hospital were, retrospectively, evaluated regarding age, gender, Helicobacter pylori (H. pylori) positivity, clinical manifestations, comorbidities and medications. In addition, PUD was analyzed in the aspect of ulcer location, type of visit, gastrointestinal bleeding, and age. The mean age was 61.5 years old (48.1% over 65) and 208 (66.7%) patients were men. The rate of H. pylori infection was 47.8%, and any ulcerogenic medication history such as antiplatelet agents and NSAIDs was found to be 21.0% (65 patients). The rate of idiopathic peptic ulcer without evidence of H. pylori and NSAIDs was found to be 40.6% (126 patients). Among 310 PUD patients, bleeding symptoms such as melena, hematemesis and hematochezia occurred in 110 patients (35.5%). PUD was more prevalent in the elderly patients and frequently associated with bleeding. Substantial proportion of PUD patients had neither H. pylori infection nor history of ulcerogenic medications, suggesting of increasing prevalence of idiopathic PUD.

DNA Double Strand Breaks in Gastric Epithelium withHelicobacter pyloriInfection

DNA double strand breaks (DSB) is one of the critical types of DNA damage. If unrepaired, DSB is accumulated in the nucleus of cells, the cells become apoptotic or transform to tumor by way of genomic instability. Some of malignant cancers and its premalignant lesions were proven to have DSB in their nuclei. There was no report that Helicobacter pylori (H. pylori), the gastric carcinogen, induce DNA DSB in gastric epithelium in vivo. The aim of this study was to investigate whether H. pylori induce DSB in the gastric epithelial cells of chronic gastritis. Immunohistochemical stains were performed for the DSB markers, phospho-53BP1 and gH2AX, in the gastric epithelium derived from 44 peptic ulcer disease patients before and after H. pylori eradication. DNA fragmentation assay was performed in the cell line to investigate the DNA damage by H. pylori infection. The mean expression score of gH2AX was significantly higher in the H. pylori infected gastric epithelium as compared to the H. pylori eradicated gastric epithelium (8.8±5.5 vs. 6.2±5.3 respectively; p=0.008). The expression score of phospho-53BP1 between before and after eradication of H. pylori was not statistically different, but tended to be higher in H. pylori infection. DNA fragmentation was developed significantly more in the cell lines after infection with H. pylori. DSB of DNA damage was typical feature of H. pylori infection in the gastric epithelium.

The life quality of the patients who have sustained the partial gastrectomy concerning the peptic ulcer

A life quality comparative studying on scale SF-36 of three groups of patients is made: 1st – peptic ulcer disease patients (n=44), 2nd and 3rd – the respondents who have sustained, accordingly, a partial gastrectomy by Bilrot-I (n=75) and Bilrot-II (n=34). A life quality of the patients who have sustained a partial gastrectomy both on Bilrot-I, and on Bilrot-II, has appeared authentically above quality of a life of the patients, suffering a peptic ulcer. A life quality of the patients who have sustained a partial gastrectomy by Bilrot-I, on scales of physical functioning and the general health is authentic above quality of a life of the patients who have sustained a partial gastrectomy by Bilrot-II. Comparative studying of quality of a life of the respondents who have sustained a partial gastrectomy by Bilrot-I in tubular and classical variants has not taped authentic differences on one scale SF-36.

Duodenal Ulceration in a Patient With Celiac Disease and Plasminogen I Deficiency: Coincidence or Cofactors?

Celiac disease (CD) is a gluten-dependent inflammatory disease of the small bowel that affects up to 1% of the worldwide population. Despite severe mucosal abnormalities including total villous atrophy and autoantibody deposition, duodenal ulcer is not a feature of CD. However, a recent study found an elevated rate of peptic ulcer disease in patients with CD. Plasminogen deficiency (PLD) is an autosomal recessive disease that causes pseudomembranous lesions in different organs, but gastrointestinal involvement is rare. Here we report the case of a 6-year-old girl who had a sudden onset of hematemesis caused by duodenal ulcer. On the basis of mucosal atrophy, elevated celiac antibody levels, decreased plasminogen serum activity, and homozygous missense mutation R216H in the plasminogen gene, CD and PLD were diagnosed. This report is, to our knowledge, the first description of the 2 entities, and results of our double-immunofluorescent studies also suggest that both diseases may have a role in the ulceration process. Excessive amounts of fibrin deposition due to PLD caused the distortion of the vessels and was responsible for the unusual celiac immunoglobulin A and tissue transglutaminase 2 in vivo binding pattern. On the basis of this result, patients with CD and unknown cause of gastrointestinal ulcer may require investigation for PLD.

The long-term results of the partial gastrectomy concerning the peptic ulcer

A life quality comparative studying on scale GSRS of three groups of patients is made: 1st - peptic ulcer disease patients (n=44), 2nd and 3rd - the respondents who have sustained, accordingly, a partial gastrectomy by Bilrot-I (n=75) and Bilrot-II (n=34). A life quality of the patients who have sustained a partial gastrectomy both on Bilrot-I, and on Bilrot-II, has appeared authentically above quality of a life of the patients, suffering a peptic ulcer. A life quality of the patients who have sustained a partial gastrectomy by Bilrot-I, on a dyspeptic syndrome scale is authentic above quality of a life of the patients who have sustained a partial gastrectomy by Bilrot-II. Comparative studying of quality of a life of the respondents who have sustained a partial gastrectomy by Bilrot-I in tubular and classical variants has not taped authentic differences. Questionnaire GSRS has shown low sensitivity in dumping syndrome revealing.

Helicobacter Pylori Is Not the Predominant Etiology for Peptic Ulcers Requiring Operation

As the number of patients requiring operation for peptic ulcer disease (PUD) declines, presumed contemporary ulcer etiology has largely been derived from medically treated patients not subjected to surgery. The purpose of this study was to examine the specific causes of PUD in patients requiring surgery. Our Acute Care Surgical Service registry was reviewed for patients operated on for complications of PUD from 2004 to 2009. Emphasis was placed on individual etiologic factors for PUD. There were 128 patients (52% male, 81% white) who underwent emergency operation including: simple patch closure (n = 61, 48%); gastric resection (n = 22, 17%); gastric resection with vagotomy (n = 21, 16%); vagotomy and pyloroplasty (n = 18, 14%); or other procedures (n = 6, 5%). Complications necessitating operation were perforation (n = 79, 62%); bleeding (n = 29, 23%); obstruction (n = 12, 9%); and intractability (n = 8, 6%). Perioperative mortality was 12.5 per cent. Risk factors for PUD included tobacco use (50%), alcohol abuse (34%), and steroids (21%). Nonsteroidal anti-inflammatory use was confirmed in 68 (53%) patients. Of the 128 patients, 82 (64%) were tested for Helicobacter pylori, 33 (40%) of which were positive and 49 (60%) negative. Helicobacter pylori, thus, was the confirmed ulcer etiology in only 26 per cent of cases. Unlike contemporary series of medically treated PUD, Helicobacter pylori may not be the predominant etiologic factor in patients who experience complications requiring surgery. A "traditional" surgical approach with liberal use of vagotomy, not antibiotic triple therapy, may well be the preferred treatment consideration in such cases.

Quality of Life among Adult Patients with Peptic Ulcer in the City of Sulaimani

Objectives: To assess the quality of life for adult patients with peptic ulcers in the city of Sulaimani.Methodology: A descriptive study, using the assessment approach was conducted on patients with peptic ulcerdisease from January 12th, 2009 to September 30th, 2009. A purposive "non-probability" sample of (100) paƟents(males and females) with peptic ulcers who attended Kurdistan Center for Gastroenterology and Hepatology wereselected for the study. A questionnaire was adapted from the World Health Organization quality of life questionnaire(1998) for the purpose of the study. It is comprised of (3) parts that included sociodemographic characteristics form,medical history form and adult peptic ulcers patients' quality of life (QoL) questionnaire. A pilot study was carried outon (10) paƟents for the period of January 12th through January 28th, 2009 to determine the study quesƟonnaire'sreliability through the use of stability (test-retest method). A panel of (14) experts was involved in the determinationof the questionnaire's content validity. Data were analyzed through the application of the descriptive statistical dataanalysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearsoncorrelation coefficient and chi-square).Results: The findings of the study indicated that quality of life was affected in physical domain and that age, gender,marital status, and monthly income had significant relationship with quality of life domains.Recommendations: The study recommends that young adults, particularly Individuals with blood group (O) should behighly aware from gastrointestinal (GI) symptoms and avoids risk factors for the development of peptic ulcer disease(PUD). Also, the study recommends providing health assurance and conducting further multi centers studies in orderto demonstrate the differences in QoL issues for PUD patients.

Dramatic Decline in Prevalence of Helicobacter pylori and Peptic Ulcer Disease in an Endoscopy-referral Population

Purpose To determine if endoscopic Helicobacter pylori and peptic ulcer disease prevalence has changed over an 11-year period in a rural region. Methods Current endoscopic records were reviewed and compared with similar data obtained over a time period 11 years earlier at the same institution with regard to H. pylori status, endoscopic findings, microscopic pathologic findings, and medication use. Results There were 251 records reviewed in the current study group (mean age 52.8 years, 59.0% female) and 263 in the previous group (mean age 60.1 years, 56.7% female). H. pylori was positive in 17 (6.8%) in the current study and 173 (65.8%) in the earlier study ( P <.0001). Peptic ulcer disease (PUD) was present in 14 (5.6%) in the current study and in 102 (38.8%) in the earlier study ( P <.0001). H. pylori was positive in 1 of the 14 PUD patients (7.1%) in the current study and in 78 of 102 (76.5%) in the previous study ( P <.0001). Conclusions Endoscopic H. pylori prevalence in our rural locality has decreased substantially over the past decade and may reflect local overall prevalence trends, although underestimation is likely due to widespread prior noninvasive H. pylori diagnosis and treatment. Endoscopic PUD also has decreased precipitously, possibly related to changes in regional H. pylori characteristics and prolific use of antisecretory agents. Changing geographic trends regarding acid-peptic disease may prompt modification of diagnostic approach and treatment.

Reappraising the Surgical Approach on the Perforated Gastroduodenal Ulcer: Should Gastric Resection Be Abandoned?

BackgroundAdvancements in medical care for peptic ulcer disease (PUD) have reduced the need for invasive surgical procedures such as gastric resection (GR). Community-based PUD studies from a large sampling of PUD patients designed to analyze hospital resource use and outcomes after different surgical procedures have been rare. We aimed to exhaustively reappraise the risk factors and patient demographics that affect PUD patient recoveries after GR compared to those after simple closure (SC).MethodsWe used a Japanese administrative database for 6 consecutive months each year between 2006 and 2010. The database included a total of 68,432 PUD patients; we analyzed 6,334 perforation cases and 3,148 cases of patients who underwent GR or SC. Study variables were demographics, comorbidities, characteristics of PUD, and operative day. Study outcomes that were analyzed included mortality, postoperative complications, ventilation administration, postoperative blood transfusions, length of stay, total charges, operating room (OR) time, and the postoperative fasting period (defined as the day of surgery to the day oral food intake was resumed.) To reduce selection bias in study procedures and to control the variation in hospital practice, a propensity score (PS) matching cohort analysis and a mixed linear regression model were used to assess the effects of GR on the outcomes.ResultsIn 699 hospitals, 322 GRs and 2,826 SCs were observed. Younger age, duodenal ulcers, preexisting anemia and an operative day no more than 24hours were significant associated with the choice of SCs. No significant differences were observed in study outcomes after either GR or SC; more postoperative blood transfusions and longer OR times but shorter postoperative fasting periods were observed after GR. Longer OR times, ventilation and postoperative blood transfusion were significantly associated with mortality. Not GR but longer OR times use of ventilation and complications were the most significant indicators of increased resource use.ConclusionsThere were no major significant differences in GR when compared to SC with regards to patient recoveries. Surgeons should obtain the skills and establish strategies to optimize either type of surgical procedure including minimizing OR time and establishing the best perioperative critical care.KeywordsPeptic ulcer perforation; Simple closure; Gastric resection; Outcome; Resource use

Association between clinical manifestations of complicated and uncomplicated peptic ulcer and visceral sensory dysfunction

Peptic ulcer disease (PUD) usually manifests as either dyspepsia or less commonly with complications such as bleeding. Patients with bleeding ulcers are often asymptomatic until the bleeding occurs. A lack of dyspeptic symptoms might be explained by impaired visceral sensory function. The aim of this study was to assess symptom profiles and compare visceral sensory thresholds in patients with bleeding peptic ulcer (BPU) and uncomplicated PUD. A total of 30 patients with BPU, 25 with uncomplicated PUD and 32 healthy controls (HC) without dyspeptic symptoms were recruited. In ulcer patients after at least 8 weeks of ulcer treatment and an 8-hr fast, visceral sensitivity was tested using a standardized nutrient challenge with an enteral feeding solution. Five key symptoms (fullness, abdominal pain, retrosternal/abdominal burning, nausea, and regurgitation) were assessed using visual analog scales (0-100). Twenty-five of the 30 (83%, 95% confidence interval 65-94%) patients with BPU had no dyspeptic symptoms compared with none of the 25 uncomplicated PUD patients. Patients with BPU and HC had significantly lower symptom responses (BPU 127.6 +/- 24.6, HC 89.8 +/- 13.9) to the nutrient challenge than uncomplicated PUD patients (338.4 +/- 56.2, P < 0.0001). Patients with dyspeptic symptoms (30/55) had significantly higher symptom responses (327.3 +/- 47.8) than the 25/55 patients without symptoms (98.9 +/- 23.4, P < 0.0001). Most patients with BPU present without dyspeptic symptoms. Even after healing of the ulcer, patients with uncomplicated PUD have a significantly augmented symptom response to a standardized nutrient challenge compared to patients with complicated ulcers and HC. Differences in the processing of upper gastrointestinal visceral afferents may play a major role in the clinical presentation (complicated vs uncomplicated) of PUD.

Seasonal pattern of peptic ulcer hospitalizations: analysis of the hospital discharge data of the Emilia-Romagna region of Italy

BackgroundPrevious studies have reported seasonal variation in peptic ulcer disease (PUD), but few large-scale, population-based studies have been conducted.MethodsTo verify whether a seasonal variation in cases of PUD (either compicated or not complicated) requiring acute hospitalization exists, we assessed the database of hospital admissions of the region Emilia Romagna (RER), Italy, obtained from the Center for Health Statistics, between January 1998 and December 2005. Admissions were categorized by sex, age (<65, 65-74, ≥ 75 yrs), site of PUD lesion (stomach or duodenum), main complication (hemorrhage or perforation), and final outcome (intended as fatal outcome: in-hospital death; nonfatal outcome: patient discharged alive). Temporal patterns in PUD admissions were assessed in two ways, considering a) total counts per single month and season, and b) prevalence proportion, such as the monthly prevalence of PUD admissions divided by the monthly prevalence of total hospital admissions, to assess if the temporal patterns in the raw data might be the consequence of seasonal and annual variations in hospital admissions per se in the region. For statistical analysis, the χ2 test for goodness of fit and inferential chronobiologic method (Cosinor and partial Fourier series) were used.ResultsOf the total sample of PUD patients (26,848 [16,795 males, age 65 ± 16 yrs; 10,053 females, age 72 ± 15 yrs, p < 0.001)], 7,151 were <65 yrs of age, 8,849 between 65 and 74 yrs of age, and 10,848 ≥ 75 yrs of age. There were more cases of duodenal (DU). (89.8%) than gastric ulcer (GU) (3.6%), and there were 1,290 (4.8%) fatal events. Data by season showed a statistically difference with the lowest proportion of PUD hospital admissions in summer (23.3%) (p < 0.001), for total cases and rather all subgroups. Chronobiological analysis identified three major peaks of PUD hospitalizations (September-October, January-February, and April-May) for the whole sample (p = 0.035), and several subgroups, with nadir in July. Finally, analysis of the monthly prevalence proportions yielded a significant (p = 0.025) biphasic pattern with a main peak in August-September-October, and a secondary one in January-February.ConclusionsA seasonal variation in PUD hospitalization, characterized by three peaks of higher incidence (Autumn, Winter, and Spring) is observed. When data corrected by monthly admission proportions are analyzed, late summer-autumn and winter are confirmed as higher risk periods. The underlying pathophysiologic mechanisms are unknown, and need further studies. In subjects at higher risk, certain periods of the year could deserve an appropriate pharmacological protection to reduce the risk of PUD hospitalization.

Risk Factors for Development and Recurrence of Peptic Ulcer Disease

Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea. From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed. Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirin. H. pylori infection was found as the only risk factor for the recurrence of PUD. For the old patients who are taking drugs, such as NSAIDs and aspirin, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.

Helicobacter pylori Testing in Patients with Funcional Dyspepsia: What Factors Dictate the Practice?

Purpose: Both functional dyspepsia (FD) and peptic ulcer disease (PUD) are associated with Helicobacter pylori (Hp) colonization. While Hp eradication is beneficial in patients with PUD, the same approach does not always reduce symptoms in FD patients. Despite this uncertainty, Rome III guidelines for FD recommend obtaining gastric biopsies for Hp testing in FD patients undergoing esophagogastroduodenoscopy (EGD). The extent to which this practice is performed is unknown. Methods: We evaluated the practice of obtaining gastric biopsies during EGD in dyspeptic patients with no endoscopic pathology (FD), compared this to patients with endoscopically confirmed PUD, and assessed the predictors of obtaining biopsies. All EGDs performed for evaluation of dyspepsia in adults at an urban hospital during the previous 29 months were identified and reviewed. Demographic and clinical information was extracted along with endoscopic and pathologic findings. Hp colonization was confirmed by histology. Results: A total of 1010 patients (618 women, mean age 50) underwent EGD. FD was diagnosed in 853 (84.5%) while 35 (3.5%) had PUD. The percentage of FD patients who had gastric biopsies taken did not differ significantly from patients with PUD (86.5% vs. 94.3%; p=0.37). Amongst those in which biopsies were obtained, the prevalence of Hp was 45.4% in FD compared to 60.6% in PUD patients (p=0.23). Within the FD cohort, there were significant ethnic differences in biopsy frequencies: Asians 91.7%, Hispanics 86.1%, African Americans 78.6%, and Caucasians 77.6%; p=0.016. FD patients born outside the U.S. were more likely to have biopsies taken than those born in the U.S. (87.2% vs. 65.7%; p=0.01). FD patients in whom gastropathy was noted endoscopically were more likely to have biopsies taken than those without gastropathy (95.7% vs. 63.4%; p<0.001). Neither patient age (p=0.08), gender (p=0.10), language (p=0.35), history of prior gastric surgery (p=0.34), history of prior Hp testing (p=0.39), nor the level of experience of the endoscopist (p=0.14) was predictive of whether or not biopsies would be obtained in the setting of FD. In multivariate logistic regression analysis controlling for age, gender, and ethnicity, both non-U.S. birth (OR 5.7 CI 1.7-18.8; p=0.005) and endoscopic gastropathy (OR 16.5 CI 8.4-32.5; p<0.001) remained significant predictors of obtaining biopsies. Conclusion: While the majority of patients with FD undergoing EGD had gastric biopsies taken, several factors were predictive of this practice including non-U.S. country of birth and the presence of endoscopic gastropathy. Further evaluation of the endoscopic assessment of FD patients may help provide important practice quality improvement measures.

Drug resistance pattern and clonality in H. pylori strains

This aim of this work was to determine the in vitro activity of clarithromycin, amoxycillin, metronidazole and tetracycline against Helicobacter pylori and clonality among resistant and sensitive strains isolated from North India. A total of 68 H. pylori isolates from peptic ulcer disease and non ulcer dyspepsia patients were examined. These strains were subjected for determination of minimum inhibitory concentration of clarithromycin, amoxycillin, metronidazole and tetracycline. For molecular characterization of resistant and sensitive strains, enterobacterial repetitive intergenic consensus sequences (ERIC) and random amplified polymorphic DNA-PCR (RAPD-PCR) methods were used. All the tested isolates were found resistant to metronidazole, while 65% were resistant to amoxycillin and 4.7% were resistant to clarithromycin. However, none of the isolates were found to be resistant to tetracycline. Molecular fingerprinting and cluster analysis of resistant and sensitive strains did not give clues for clonal spread of resistant strains. Various chromosomal mutations were seen in the putative resistance genes of resistant strains, possibly indicating selection pressure as the major cause of high resistance.

Relationship Between Helicobacter pylori BabA and BabB Status with Other Virulence Factors and Their Correlation with Disease Outcome in Iran

Objectives: Helicobacter pylori (Hp) is an important human pathogen associated with gastrointestinal diseases such as gastritis, peptic ulcer disease (PUD) and gastric cancer. A number of pathogenic factors have been described for this bacterium, and some of them have been proposed as predictive markers of the clinical outcomes. However, with the exception of the cag and vacA status, there is no global consensus regarding the role of the other introduced virulence factors. Therefore, the aim of this study was to investigate the status of Hp strains regarding the Hp babA and babB (blood group antigen binding) adhesins and assess any existing association between the status of these genes and clinical outcomes in Iranian patients. Methods: Hp virulence genes were amplified by means of gene-specific polymerase chain reaction in clinical isolates of Hp from 72 Iranian patients (16 GC, 12 PUD, 44 NUD patients). Results: Eleven categories of genotypes were identified with the following frequencies: Group1: A+B+/cagA+/s1(38.0%); Group2: A+B+/cag+/s2(2.8%); Group3: A+B+/cag-/s1(1.4%); Group4: A+B-/cag+/s1(7%); Group5: A+B-/cag+/s2(2.8%); Group6: A-B+/cag+/s1(22.5%); Group7: A-B+/cag+/s2(14.1%); Group8: A-B+/cag-/s1(1.4%); Group9: A-B+/cag-/s2(4.2%); Group10: A-B-/cag+/s1(2.8%); Group11: A-B-/cag+/s2(2.8%). Frequency of Group1 in GC, NUD and PUD patients is 75%, 27.3% and 27.3% respectively and Group7 is prevalent in 36.4% of PUD patients. babA prevalence in GC, NUD and PUD patients was 75%, 47.7% and 33.3% and babB prevalence was 93.8%, 77.3% and 91.7% respectively. 75% of Hp isolates were babA/babB double positive in GC patients. Conclusion: Frequency of babB is higher among Iranian GC and PUD cases but babA frequency is limited to GC cases. Infecting strains from Groups 1 and 7 were found to be associated with GC and PUD respectively. Co-presence of cagA, s1vacA, babA and babB may work synergistically in exacerbating the resulting inflammation which may create grounds for development of intestinal metaplasia and eventually GC, whereas co-existence of cagA, s2vacA, babB may cause susceptibility to PUD development. In GC cases presence of babA/babB double positive are significantly prevalent (p = 0.044). Application of this analysis on additional samples will allow for a more concrete conclusion.

Investigation of cagI and cagII in H. pylori Isolated from Dyspepsia Patients in Iran

Background: The major virulence factor of H. pylori is the cag pathogenicity island divided into two parts: the upstream cagII region and the downstream cagI region. The downstream region includes cagA, cagE, and themost important gene introduced in cagII is cagT. The aim of this study was to investigate the important markers of cagI and cagII regions in Helicobacter pylori isolated from Iranian peptic ulcer and non ulcer disease patients. Methods and materials: 80 clinical isolates of H. pyloriwere collected from 120 patients with gastric disorders. The genomic DNA was extracted from biopsy samples by the QIAgen kit. The PCR was performed for detection of cagA, cagE and cagT in cagPAI. Results: Among 80 H. pylori strains, 20 (25%) and 60 (75%) were isolated from PUD and NUD patients respectively. In PUD patients with rate of 14 (70%), all of isolates were cagA positive and distribution of cagE was 7 (35%) and cagT was 5 (25%). Also the prevalence of cagA, cagE and cagT in NUD patients was 48 (80%), 21 (35%) and 22 (36%) respectively. Discussion: Our results indicated that presence of cag PAI is very common in Iranian strains of H. pylori. The structural variety of the cag PAI might be related to the virulence of H. pylori. Present study showed that the prevalence of cagT, a marker for cagII, in PUD patients is less than NUD patients. In cagI region the presence of cagA in PUD patient is higher than cagE, so it may have an important role in peptic ulcer disease. According to our results it seems that it is not absolutely necessary to coexist of cagII and cagI in peptic ulcer patients.