Positive Urea Breath Test Research Articles

Early gastric mucosa-associated lymphoid tissue lymphoma treated by endoscopic submucosal dissection.

A previously healthy 66-year-old woman was referred to our hospital for belching with a positive 13C-labeled urea breath test. A coarse nodular lesion was observed upon upper endoscopy ([Fig. 1 a]). She was treated with standard H. pylori quadruple therapy for 2 weeks.

Implications of the paradigm shift in management of Helicobacter pylori infections.

The recent availability of susceptibility testing for Helicobacter pylori infections in the United Sates has resulted in paradigm shifts in the diagnosis, therapy, and follow-up of H. pylori infections. Here, we reviewed the English literature concerning changes in H. pylori diagnosis and therapy with an emphasis on the last 3 years. We focus on the new methods that offer rapid and convenient susceptibility testing using either invasive (endoscopic) or noninvasive (stool) methods of obtaining test material. We also discuss the implications of this availability on therapy and follow-up after therapy. The approach to therapy was categorized into four groups: (1) therapies that can be used empirically, (2) therapies that should be restricted to those that are susceptibility-based, (3) potentially effective therapies that have yet to be optimized for local use, and (4), therapies that contain unneeded antibiotics that should not be prescribed. The most convenient and efficient method of susceptibility testing is by using reflexive stool testing in which if the sample is positive, it is automatically also used for determination of susceptibility. Reflexive testing can also be done via reflexive ordering (e.g., for all positive urea breath tests). The post therapy test-of-cure has emerged as a critical component of therapy as it not only provides feedback regarding treatment success but when combined with susceptibility testing also provide evidence regarding the cause of failure (e.g., poor adherence versus emergence of resistance during therapy. Susceptibility testing has made even the most current H. pylori guidelines for diagnosis and therapy generally obsolete. Clarithromycin, metronidazole, and levofloxacin triple therapies should only be administered as susceptibility-based therapy. Regimens containing unneeded antibiotics should not be given. We provide recommendations regarding the details and indications for all current therapies.

Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial

Peptic ulcers in patients receiving aspirin are associated with Helicobacter pylori infection. We aimed to investigate whether H pylori eradication would protect against aspirin-associated ulcer bleeding. We conducted a randomised, double-blind, placebo-controlled trial (Helicobacter Eradication Aspirin Trial [HEAT]) at 1208 primary care centres in the UK, using routinely collected clinical data. Eligible patients were aged 60 years or older who were receiving aspirin at a daily dose of 325 mg or less (with four or more 28-day prescriptions in the past year) and had a positive C13 urea breath test for H pylori at screening. Patients receiving ulcerogenic or gastroprotective medication were excluded. Participants were randomly assigned (1:1) to receive either a combination of oral clarithromycin 500 mg, metronidazole 400 mg, and lansoprazole 30 mg (active eradication), or oral placebo (control), twice daily for 1 week. Participants, their general practitioners and health-care providers, and the research nurses, trial team, adjudication committee, and analysis team were all masked to group allocation throughout the trial. Follow-up was by scrutiny of electronic data in primary and secondary care. The primary outcome was time to hospitalisation or death due to definite or probable peptic ulcer bleeding, and was analysed by Cox proportional hazards methods in the intention-to-treat population. This trial is registered with EudraCT, 2011-003425-96. Between Sept 14, 2012, and Nov 22, 2017, 30 166 patients had breath testing for H pylori, 5367 had a positive result, and 5352 were randomly assigned to receive active eradication (n=2677) or placebo (n=2675) and were followed up for a median of 5·0 years (IQR 3·9-6·4). Analysis of the primary outcome showed a significant departure from proportional hazards assumptions (p=0·0068), requiring analysis over separate time periods. There was a significant reduction in incidence of the primary outcome in the active eradication group in the first 2·5 years of follow-up compared with the control group (six episodes adjudicated as definite or probable peptic ulcer bleeds, rate 0·92 [95% CI 0·41-2·04] per 1000 person-years vs 17 episodes, rate 2·61 [1·62-4·19] per 1000 person-years; hazard ratio [HR] 0·35 [95% CI 0·14-0·89]; p=0·028). This advantage remained significant after adjusting for the competing risk of death (p=0·028) but was lost with longer follow-up (HR 1·31 [95% CI 0·55-3·11] in the period after the first 2·5 years; p=0·54). Reports of adverse events were actively solicited; taste disturbance was the most common event (787 patients). H pylori eradication protects against aspirin-associated peptic ulcer bleeding, but this might not be sustained in the long term. National Institute for Health and Care Research Health Technology Assessment.

Short-term outcomes and intermediate-term follow-up of Helicobacter pylori infection treatment for naïve patients: a retrospective observational study

ObjectivesTo explore the outcomes of Helicobacter pylori infection treatments for naïve patients in the real-world settings.DesignA retrospective observational study.SettingSingle tertiary level academic hospital in China.ParticipantsWe identified patients initially receiving quadruple...

Association of Helicobacter Pylori and Portal Hypertensive Gastropathy in Patients with Cirrhosis of Liver

Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients of cirrhosis of liver. The cause and pathogenesis of PHG in cirrhotic patients is poorly understood. Some studies showed, association of Helicobacter pylori (H. Pylori) with portal hypertensive gastropathy in cirrhosis of liver, but the evidence is not robust. The aim of this study was to assess the association of H. pylori infection and PHG in patients with cirrhosis of liver. This case control study was conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from April 2016 to August 2018. A total of 230 patients with cirrhosis of liver were included in this study. There were 115 cirrhotic patients with PHG as cases and 115 cirrhotic patients without PHG as controls. Upper gastrointestinal Endoscopy and 13C Urea Breath Test (UBT) was done in both cases and controls. In this study, out of 230 cases, 147 (63.91%) found to have H. pylori infection. Among cirrhotic patients with PHG case, 77 (66.95%) was positive in UBT. Out of these 77 UBT positive cases, 55 had mild PHG whereas 22 cases had severe form of PHG. Among 38 cases of cirrhosis with PHG who had negative UBT, 23 had mild PHG and 15 cases had severe form of PHG. The risk of positive urea breath test was not statistically significant in cirrhotic patients with PHG in comparison with cirrhotic patients without PHG (P=0.337, OR 1.303, 95% CI 0.759-2.235). In this study, statistically significant association was not found between H. Pylori and PHG in cirrhotic patients. Bangladesh Med J. 2021 May; 50(2) : 21-27

Helicobacter Pylori Related Gastric Cancer Screening and Cost-Effectiveness Analysis: A Hospital-Based Cross-Sectional Study (SIGES)

To evaluate the effectiveness of Helicobacter pylori (Hp) related gastric cancer screening (Hp-GCS) and cost-effectiveness of protocol candidates in a hospital-based cross-sectional study. A total of 163 gastric cancer patients in West China Hospital were retrospectively collected according to ICD-10 code and histologic proof between April 1, 2013 and March 31, 2014, and 15,599 cancer-free controls were simultaneously collected from the health checkup registry. Hp infection was examined by urea breath test (UBT). The prevalence of Hp infection was compared between patients and controls. The diagnostic performance of UBT-based predictive index was tested in both training and validation settings. Cost-effectiveness analysis was conducted to assess candidates of Hp-GCS protocols. The prevalence of Hp infection was 55.8% and 41.2% in gastric cancers and controls, respectively (p < 0.001). UBT-based model showed moderate diagnostic strength in Hp-GCS (AUC = 0.78, 95% CI 0.74–0.82), better than UBT alone (p < 0.001). The sensitivity and specificity of UBT-based index were 80.2% and 61.9% at optimal cutoff in training setting, comparable in validation setting, which sensitivity and specificity were 76.9% and 59.6%. Number needed to screen was decreased along with older age, as well as stronger positivity of UBT. The optimal cost-effective Hp-GCS protocol with detection rate (DR = 77.9%) was endoscopic screening in age 40–59 years and positive UBT, or age ≥60 years without UBT. Incremental analysis suggested a preferable protocol as endoscopic screening in age ≥40 years without UBT (DR = 93.3%). UBT had moderate diagnostic strength in massive gastric cancer screening, and might be cost-effective in middle-aged population (40–59 years). More robust Hp-GCS protocol needs further investigate in test methods and individual biologic features.

Importance of Delta Over Baseline Values in Predicting the Severity of Helicobacter pylori Infection in Children

Introduction:Although severe forms of the disease are seen in adults, the Helicobacter pylori (H. pylori) infection is usually acquired during childhood. Therefore, prompt diagnosis of H. pylori infection in childhood is of prime importance. In the present study, we aimed to identify the sensitivity and specificity of 13C urea breath test (UBT) in the diagnosis of H. pylori infection and to assess the severity of the disease with delta over baseline (DOB) values. Materials and Methods: UBT was administered to 200 children who presented with epigastric pain and/or nausea. Esophagogastroduodenoscopy (EGD) was performed in patients. UBT results were compared with histopathological findings. In the Area Under the ROC Curve analysis, a cutoff DOB value was found for the severity of H. pylori infection. Results: 193 children with a mean age of 13.50±2.98 years were included in the analysis. Of these, 71 (36.8%) patients had a positive UBT and 122 (63.2%) had a negative UBT. EGD was performed in 60 out of 71 patients with positive UBT and in 30 out of 122 patients with negative UBT. The sensitivity and specificity of UBT were 85.1% and 100%. DOB was found to be a significant predictor of moderate/marked H. pylori density at a cutoff value of 6%. Conclusions: The positive correlation detected between the level of DOB values and the density of H. pylori and inflammatory activity can be an advantage for detecting the severity of disease

Lessons learned from upper gastrointestinal endoscopy in asymptomatic Chinese.

The Helicobacter pylori (H.pylori) infection-related diseases, peptic ulcer, and gastric cancer are frequently asymptomatic until the onset of complications. This study aimed to investigate the prevalence of H.pylori, erosive esophagitis, peptic ulcer, and precancerous lesions such as atrophic gastritis, intestinal metaplasia, gastric dysplasia, and upper gastrointestinal (GI) malignancy in asymptomatic Chinese. From January to December 2017, a questionnaire was administered to consecutive asymptomatic patients undergoing routine physical examination, which included their first screening esophagogastroduodenoscopy. H.pylori infection was determined by one of positive 13 C urea breath tests or rapid urease test and histology. The presence of H.pylori infection, erosive esophagitis, peptic ulcer, precancerous gastric histology, and upper GI malignancy was analyzed in relation to demographic factors. A total of 1108 subjects (mean age: 48, range 21 to 79, 39.5% men) were included. The findings were: erosive esophagitis 7.8%, active H.pylori infection 44%, peptic ulcer 9.1% (duodenal 5.8%, gastric 2.5% or both 0.8%); 0.5% had gastric cancer. Male, smoking history, and current H.pylori infection were all significantly related to the presence of peptic ulcer. Totally, 1095 patients had gastric histopathology and premalignant gastric lesions were present in 67.4%; atrophic gastritis (67.4%), intestinal metaplasia (27.4%), and gastric dysplasia (0.5%). Age, current and previous H.pylori infection were risk factors significantly associated with precancerous lesions. Upper GI pathology as a sequelae of H.pylori infection is common in asymptomatic Chinese. These findings support institution of a nationwide test and treat program to eradicate H.pylori in China.

A142 TRENDS IN HELICOBACTER PYLORI TREATMENT AND CURE IN EDMONTON: 2015–2020

Abstract Background Therapies for Helicobacter pylori infection have changed significantly over time due to changes in resistance patterns. In 2016, the Toronto H. pylori consensus guidelines recommended treatment for 14 days. First-line therapies are concomitant therapy with a proton-pump inhibitor (PPI) and clarithromycin-amoxicillin-metronidazole (CLAMET) or bismuth-based quadruple therapy (PPI-bismuth-metronidazole-tetracycline, PBMT). Second and/or third line therapies are PBMT or PPI-amoxicillin-levofloxacin (PAL) and the fourth line PPI-amoxicillin-rifabutin (PAR) for 10 days. Aims To describe and compare the efficacy of current treatment regimens for H. pylori infection in Edmonton. Methods This retrospective study reviewed records of patients treated for H. pylori infection at the University of Alberta Hospital (UAH) in Edmonton, Alberta from January 1, 2015 - November 1, 2020. Diagnosis of H. pylori infection and test-of-cure were documented with a positive urea breath test, stool antigen test, histology on endoscopy, or positive culture. Patients who had no post-treatment testing were excluded. The per protocol efficacy of different regimens was calculated as well as cumulative success rates when given as 2nd, 3rd or 4th line therapy. Results Overall, 170 of 237 (71.7 %) confirmed H. pylori cases achieved cure. The majority were female (64%) and 113 (48%) were born outside of Canada. CLAMET initiated at UAH had the highest success rate 41/45 (91%), and in referred patients who were previously treated was successful as first-line therapy in 45/70 (64%). Overall success rate of regimens were as follows (Table 1): CLAMET 49/98 (50%), PBMT 45/114 (40%), PAL 33/99 (33%), and PAR 16/31 (51%). Alternative regimens were not successful 27/223 (12%). Cultures and resistance profiles were available for 53 cases that failed initial treatment. Resistance to clarithromycin (84%), metronidazole (48%), and levofloxacin (41%) was highly prevalent (Figure 1). Conclusions Test-of-cure is important to verify H. pylori eradication as antibiotic resistance is common to clarithromycin, metronidazole, and levofloxacin when prior treatments failed. These results support the H. pylori treatment regimens recommended by the Toronto consensus guidelines. Funding Agencies None

Helicobacter pylori Eradication in Parkinson's Disease: A Randomized Placebo‐Controlled Trial

Helicobacter pylori (HP) infection has been associated with worse motor function in Parkinson's disease (PD). We aimed to evaluate the effects of HP eradication on PD symptoms. In this parallel-group, double-blind, randomized placebo-controlled, single-center trial, patients with PD with positive HP urea breath test and serology were block randomized (1:1) to receive standard eradication triple therapy or identically appearing placebo capsules for 1 week. Prespecified motor (International Parkinson and Movement Disorder Society Unified PD Rating Scale [MDS-UPDRS], timed tests, and home-based wearable sensor measurements), nonmotor (Leeds Dyspepsia Questionnaire and Montreal Cognitive Assessment), and quality-of-life (Parkinson's Disease Questionnaire-39) outcome measures were assessed at weeks 6, 12, 24, and 52. The primary outcome was the baseline-to-week 12 change in ON medication MDS-UPDRS motor scores. Lactulose-hydrogen breath testing for concomitant small intestinal bacterial overgrowth was performed at baseline and repeated at week 24, together with the urea breath test. A total of 310 patients were screened for eligibility and 80 were randomly assigned, of whom 67 were included in the full-analysis set (32 treatment group patients, 35 placebo patients). HP eradication did not improve MDS-UPDRS motor scores at week 12 (mean difference 2.6 points in favor of placebo, 95% confidence interval: -0.4 to 5.6, P = 0.089). There was no significant improvement in any motor, nonmotor, or quality-of-life outcome at weeks 12 and 52. Both the full-analysis and per-protocol analyses (based on eradication status) supported these conclusions. Small intestinal bacterial overgrowth status did not influence treatment results. HP eradication does not improve clinical outcomes in PD, suggesting that there is no justification for routine HP screening or eradication with the goal of improving PD symptoms. © 2020 International Parkinson and Movement Disorder Society.

Association between Severity of Dyspepsia and Urea Breath Test Results in Patients with Positive Helicobacter pylori Serology

Background: Active Helicobacter pylori infection is considered to cause more severe dyspepsia symptoms compared to inactive infection. This study was aimed to determine the association between severity of dyspepsia and urea breath test (UBT) results in subjects with positive H. pylori serology.Method: This study was a cross-sectional study in 60 subjects with positive H. pylori serology in Provincial General Hospital of West Nusa Tenggara. Severity of dyspepsia was measured using modified Glasgow Dyspepsia Severity Score (GDSS) questionnaire. Diagnosis of active H. pylori infection was made using 14C UBT examination.Results: Proportion of active H. pylori infection in subjects with positive serology was 20%. The average of modified GDSS score in all patients was 1.95 (SD + 1.78), with minimal score of 0 and maximal score of 7. There was a statistically significant difference between average of modified GDSS score and positive and negative UBT results, (p = 0.027). The cut-off point value of modified GDSS to diagnose positive UBT was 3.8. Results of diagnostic test with modified GDSS as a test and UBT results as the gold standard indicated sensitivity of 41.6% and specificity of 85.4%. Conclusion: There was a significant difference between modified GDSS score in patients and positive and negative H. pylori infection. In areas which did not have UBT examination, eradication in patients with positive serology and GDSS score of more than or equal to 4 could be considered.

Abstract D109: Helicobacter pylori infections in Navajo communities of Northern Arizona

Abstract Background: Helicobacter pylori (Hp) is a gastric pathogen associated with development of duodenal or stomach ulcers, stomach cancer, and mucosa associated lymphoid-tissue (MALT) lymphomas. While Hp prevalence is declining in many regions, it remains the leading infectious cause of cancer worldwide. In the United States prevalence varies by geographic location, ethnic background, socioeconomic status, and age. This pilot project seeks to understand the role of Hp infection in the development of stomach cancer among Native Americans of Northern Arizona, where stomach cancer incidence rates are approximately three times higher than the general Arizona population and it is the leading cause of cancer mortality. Methods: A cross-sectional survey based on a random sample of households selected using census block vectors for tribal lands overlaid onto satellite imagery. Potential household structures were marked and randomly sorted with recruitment goals set to be proportional to underlying population size. Houses were ‘ground-truthed’ for eligibility and residents approached for participation. A total of 72 households were recruited between June-August 2018 with 105 self-identified Navajo &amp;gt;18 years old living in three communities in northern Arizona participating. Participants were assessed on household and individual level factors associated with infection. A urea breath test (UBT) was performed to test for active infection. We used logistic regression, adjusted for household clustering, to calculate odds ratios (aOR) and 95% confidence intervals (CI) for associations between UBT results and individual and household factors. Results: Active Hp infection was found in 66 of the 101 participants with valid UBT, crude prevalence of 65.4%. Male participants were more likely to be positive (aOR=2.89, 95% CI, 1.03-8.09). Participants with an unregulated household water source had the highest odds for positive UBT (aOR=8.85, 95% CI, 1.50-53.38). There was no association with age or education and a modest association with history of gallbladder disease. Only 23.8% reported they had ever heard of Hp infections and 12.9% previously tested for the infection. Conclusion: Prevalence of Hp is high among individuals in these Navajo communities. Use of household water that was not regulated, was strongly associated with active Hp infection. Further work is needed to determine if there is geographic variation and what Hp substrains are involved for this population. Attention also needs to focus on developing strategies to reduce the infection and target earlier detection. Citation Format: Robin B Harris, Rachel Begay, Priscilla R Sanderson, Carmenlita Chief, Fernando Monroy, Heidi E Brown, Eyal Oren. Helicobacter pylori infections in Navajo communities of Northern Arizona [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D109.

Usefulness of the hydrogen breath test in patients with functional dyspepsia

IntroductionThe pathogenesis of functional dyspepsia is complex and not well understood. Therefore, in this disease there should be considered involvement of different pathogenic factors, including intestinal bacteria.AimTo evaluate the results of the hydrogen breath test in relation to the clinical picture of functional dyspepsia.Material and methodsThe study included 40 healthy subjects (group I), 72 patients with postprandial distress syndrome (PDS, group II), and 84 patients with epigastric pain syndrome (EPS, group III). The diagnosis of functional dyspepsia was based on Rome Criteria IV. The urea breath test (13C-UBT) and lactulose hydrogen breath test (LHBT) were performed in all subjects. Patients with a positive urea breath test were excluded from the study. Patients with a positive LHBT test were assigned to antibiotic therapy (1200 mg daily for 14 days). Before treatment and 6 weeks after the end of antibiotic therapy the LHBT was performed, and severity of dyspeptic symptoms was assessed using a 10-points visual analogue scale.ResultsA positive LHBT test was found in 35 (48.6%) patients in the group with PDS, and in 40 (47.6%) patients with EPS (p > 0.05). A positive correlation between the results of the LHBT test and severity of dyspeptic symptoms was found in both group (p < 0.001). After treatment with rifaximin the mean LHBT result and the index of severity of dyspeptic complaints were significantly decreased (p < 0.001).ConclusionsQuantitative and/or qualitative changes in the gut microbiota may be the cause of functional dyspepsia.

2768 Helicobacter pylori Infection: An Important Consideration in Patients With Suspected Cannabinoid Hyperemesis Syndrome

INTRODUCTION: Cannabinoid Hyperemesis Syndrome (CHS) is a clinical diagnosis made by the combination of chronic marijuana use, episodes of cyclic nausea and vomiting, and concurrent stereotypical behavior including use of hot showers for symptom relief during these episodes. CHS represents an emerging problem in part due to the legalization of marijuana in parts of the United States. Despite its recognition, other more common etiologies of chronic, episodic nausea and vomiting should be considered within the correct clinical context. We performed a single center analysis to understand the burden of H. pylori infection in patients diagnosed with CHS. CASE DESCRIPTION/METHODS: We used our electronic medical record to identify all patients 18 years or older with an active diagnosis of CHS from May 2017 to May 2019. Patient charts were reviewed and the presence of H. pylori infection (defined as positive urea breath test, stool antigen, tissue stain or culture) was verified. 30 patients with CHS were identified, and 19 (63%) of these were tested for H. pylori. 6 (32%) of those patients were diagnosed with active infection. All six patients were prescribed standard triple or quadruple therapy, but only one was documented to have completed the therapy in whole. The treated patient was a 52 year-old male who had a longstanding history of episodic nausea and vomiting. Prior upper endoscopy at an outside facility showed duodenal ulcers. He was admitted to the hospital for intractable nausea and vomiting in setting of marijuana abuse. H pylori stool antigen resulted positive during admission. The patient followed-up in outpatient clinic after completing triple therapy and reported complete resolution of nausea and vomiting despite ongoing daily marijuana use. DISCUSSION: This is the first report of the rates of concurrent infection of H. pylori in individuals diagnosed with CHS. The reported prevalence of H pylori in the United States varies widely, with the largest analysis of gastric biopsies revealing a rate of 7.5% with general trends higher in African Americans and populations close to the United States-Mexico border. In CHS patients with H. pylori, compliance issues may contribute to persistent and untreated infection. Our single center analysis suggests that H. pylori rates may be higher than the general population in patients with CHS, but larger patient databases will be needed ascertain true treatment rates, and response to therapy.

No association between Helicobacter pylori infection and gastrointestinal complaints in a large cohort of symptomatic children.

This Polish study estimated the prevalence of the Helicobacter pylori infection in symptomatic children aged 3-18 and investigated its association with gastrointestinal complaints. We prospectively enrolled 1984 children (54% female) with a mean age of 9.5±4.1years, from Silesia, Poland, for the Good Diagnosis Treatment Life screening programme from 2009 to 2016. They underwent a 13 C-isotope-labelled urea breath test (UBT) to assess their Helicobacter pylori status, making this the biggest Polish study to use this approach. Further analysis included parental-reported gastrointestinal symptoms and standard deviation scores (SDS) of anthropometric measurements. The Helicobacter pylori infection was identified in 220 (11%) children (48% female) and was independent of age and sex. The frequency of symptoms did not differ between Helicobacter positive and negative children (all p>0.05). Children with a positive UBT result had a lower body mass SDS (-0.41±0.98 versus -0.26±1.01, p=0.04) and height SDS (-0.45±1.34 versus -0.23±1.27, p=0.02), but similar body mass index SDS. We found a low prevalence of Helicobacter pylori in symptomatic children, and positive UBT results were not associated with symptoms that suggested Helicobacter pylori infections. Our findings support the 2017 European and North American guidelines for Helicobacter infections in children.

Helicobacter pylori Eradication Rates Higher With Clarithromycin Treatment Despite Increased Resistance

Introduction: Reports of antibiotic resistance and treatment failure of Helicobacter pylori have risen. Due to increased resistance of H pylori to clarithromycin (CLR), fluoroquinolone (FQ) and metronidazole use has increased. We studied H. pylori eradication with CLR, FQ and metronidazole or tinidazole, failure due to gender, previous H pylori and socioeconomic status. Methods: This was a retrospective review at a single tertiary care center of patients who had a C13 urea breath test (UBT) from Jan 2012-Oct 2017. Of a total of 1209 patients, 697 had information regarding H. pylori treatment. We obtained patient demographics, H. pylorihistory, antibiotic use and allergies. We defined failure as Delta over Baseline ≥ 2.4. Generalized linear mixed effects models estimated odds of a positive UBT as a function of univariable and multivariable patient characteristics and clinical measures. Multivariate analyses controlled for sex, FQ and amoxicillin use, penicillin and tetracycline/doxycycline allergy and prior H pylori. Results: Patients were 216 (31%) males and 481 (69%) females. Univariate and multivariate analyses showed females were 70% (OR=1.70, 95 CI: 1.12-2.58, p=.01) and 55% (OR=1.55, 95 CI: 1.02-2.35, p=.04) more likely to have a positive UBT, respectively. Patients on CLR/macrolides and amoxicillin were 49% less likely (OR=0.51, 95 CI: 0.36-0.73) to have a positive UBT (p<.001). Patients on amoxicillin and FQ were 2.22 times more likely (95 CI: 1.05-4.69) to have a positive UBT (p=.04). Patients on FQ were 3.05 times more likely (95 CI: 1.63-5.73) to have a positive UBT compared to not on FQ (p<.001). Patients on metronidazole or tinidazole were 1.46 times more likely (95 CI: 1.00-2.12) to have a positive UBT compared to not on them (p=.05). Patients with prior H. pylori were 2.06 times more likely (95 CI: 1.40-3.04, p<.001) in univariate analysis and 61% more likely (OR= 1.61, p=.03) in multivariate analysis to have a positive UBT compared to no prior history. Socioeconomic status did not influence failure rate. Conclusion: Contrary to recent reports, our study shows higher H. pylori eradication with CLR and our data supports its use as first line therapy in our population. Use of FQ or metronidazole in patients who have failed eradication and as first line therapy resulted in higher failure rates in our population and we do not recommend them over standard first line therapy. Similar to other studies, our data supports that treatment failure is higher in females.

Low Incidence of Esophageal Adenocarcinoma After Eradication of Helicobacter pylori in Japan

Low Incidence of Esophageal Adenocarcinoma After Eradication of Helicobacter pylori in Japan

Helicobacter Pylori Infection Is an Independent Risk Factor for Development of Serrated Colonic Polyps: A Retrospective Analysis

Introduction: Serrated colonic polyps (SPs) are classified into hyperplastic polyps (HP), sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA). SSA & TSA are now recognized as precancerous lesions for colorectal cancer (CRC). Studies have found a positive association between Helicobacter pylori infection (HPI) and the risk of colorectal adenoma and CRC. We investigated this association with SPs. Methods: Using our institutional computerized database we identified patients aged ≥18 years who underwent colonoscopic biopsies between 2005 & 2015. Based on the histological diagnosis they were divided into study group: patients with SP (SSA & TSA but not HP) and control group: patients with polyps without serrated features and no SP diagnosed in 20 years around the index date. Given the possibility of HP with unreported serrated features in this group, we created two more control groups: patients with adenomatous polyp (AP) without HP or SP; patients with no polyp on histology (not including patients with colonoscopy but no biopsies taken). Prior 10 years' records were explored for all groups to capture an exposure to HPI, defined by the identification of HPI by Warthin-Starry staining on gastric biopsy or by a positive stool antigen or urea breath test. Exposure risk was compared using crude and adjusted odds ratios (OR).Table 1: Characteristics of the Study Cohort (Patients with Serrated Polyps)Table 2a: Frequency of Exposure in Different GroupsTable 2b: Association of H . pylori Exposure with Different Polyp OutcomesResults: Characteristics of the study group are listed in table 1. The frequency of HPI in each group is described in table 2a. The highest period-prevalence of HPI (11/100 patients) was seen in Hispanic females with SP and below average socioeconomic status (SES), and the lowest ( < 1/100 patients) was in white men with no polyp. Adjusted ORs indicated that HPI increased the risk of SP as compared to any other polyp type or no polyp, independent of age, gender, race and SES (table 2b). On multiple regression analysis of SP vs. non-serrated polyp, besides exposure to HPI, older age (OR 1.009; 95% CI 1.004-1.014), female gender (OR 1.17; 95% CI 1.03-1.32), smoking (OR 1.47; 95% CI 1.31-1.65), and higher BMI (OR 1.010; 95% CI 1.001-1.019) increased the risk of developing SP. Though lower SES was associated with higher prevalence of HPI, it did not independently increase the risk of SP. Conclusion: HPI is associated with increased risk of developing SPs (SSA & TSA) when compared to patients without SP, AP (without SP and HP), and without colonic polyps. Prospective studies are required to confirm a causal relationship between HPI and SP.

The Effect of Oral Administration of Pistacia Atlantica Kurdica Gum on the Eradication of Helicobacter Pylori in Patients with Dyspepsia: A Randomized Clinical Trial

&lt;p&gt;&lt;em&gt;H. pylori&lt;/em&gt;&lt;strong&gt; &lt;/strong&gt;infection is one of the most common infections in the world so that the aim of this study was to evaluate the antimicrobial &lt;em&gt;P. Atlantica Kurdica&lt;/em&gt; gum in the eradication of &lt;em&gt;H. pylori&lt;/em&gt;. This study is a randomized clinical trial; Patients with positive Urea Breath Test and symptoms of dyspepsia were entered. Patients were randomly divided into four groups. Group A: three drugs including 500 mg of Amoxicillin twice a day (bd), Clarithromycin 500 mg bd and Omeprazole 20 mg (bd) and Group B: Group A drugs plus the capsule containing 1 g of powdered &lt;em&gt;P. Atlantica Kurdica &lt;/em&gt;gum (bd). In Group C: the capsule containing 1 g of powdered &lt;em&gt;P. Atlantica Kurdica&lt;/em&gt; gum (bd) and Group D: this group took placebo-containing capsule (bd) for 14 days respectively. Dyspeptic symptoms before and after healing period and the UBT results two days before the start of treatment and 30 days after the completion were compared in 4 groups. Patients were not statistically significant difference from each other in the four groups regarding the demographic situation. Moreover, &lt;em&gt;H. pylori&lt;/em&gt; eradication rate was 19/24 in Group A, 18/24 in Group B, 10/23 in Group C and 2/24 in Group D. Relieving symptoms of dyspepsia in Groups B and C were significantly higher than in Group D (P=0.025 and p=0.006 respectively). &lt;em&gt;P. Atlantica Kurdica&lt;/em&gt; significantly led to the treatment of dyspepsia symptoms and &lt;em&gt;H. pylori&lt;/em&gt; eradication.&lt;/p&gt;

Intrafamilial transmission of Helicobacter pylori: genotyping of faecal samples

Background: After more than 20 years of research, there is a little information about the detailed routes of Helicobacter pylori transmission. The aim of this study was to explore intrafamilial transmission of H. pylori in children who had indication for upper gastrointestinal endoscopy and their parents.Methods: Children (aged up to 15 years) were studied during September 2012 to October 2013. The parents of those with positive urea breath test results were asked to provide faecal and blood samples after giving informed consent. Non-invasive tests such as immunoassay for serological antibodies against H. pylori and detection of its antigen in faeces were measured. The genetic similarity of the family strains was investigated by the random amplification of polymorphic DNA (RAPD-PCR) genotyping method.Results: According to the genotyping results of 30 families, in 10 (33.3%) children related H. pylori genotypes to their mothers were found, while only 2 children (6.7%) had similar genotypes to their fathers. Interestingly, children with similar H. pylori genotype with their mothers had higher IgA (35.7 ± 10.8) and IgM antibody titres (87.23 ± 19.15) than other children. In addition, in these children, lower titres of IgG antibodies (9.93 ± 3.31) were found rather than children who had no H. pylori in their faeces or had no similarities with their parents (30.28 ± 6.15).Conclusions: In conclusion, mother-to-child transmission is the main route of intrafamilial transmission of H. pylori in Iranian families. Molecular typing of H. pylori can be useful in identifying a high-risk population.