Pylori Antigen Research Articles

Detection of Helicobacter pylori using Giemsa staining in chronic tonsillitis patients: cross-sectional study

BackgroundHelicobacter pylori (H. pylori) is a well-known bacteria that is recognized as the most prevalent infection in humans and is present in the majority of people in the world.AimTo investigate the presence of an extragastric reservoir of Helicobacter pylori in tonsillectomy specimens to ascertain whether it is an etiologic factor in the development of chronic tonsillitis.Subjects and methodsThe study included 100 patients of both sexes with chronic tonsillitis who visited the ENT (ear, nose, and throat) outpatient department and tested positive for H. pylori antigen in stool and tonsillectomy materials. Giemsa stain was used. The population was patients with chronic tonsillitis who had been diagnosed based on physical examination and history-taking at the (Oto-Rhino-Laryngology) outpatient clinic.ResultsIt is shown that patients with positive H. pylori had considerably more acute tonsillitis attacks per year than those with negative H. pylori. Examining the patients with Giemsa modification staining revealed 40% of them to be positive.ConclusionH. pylori was found in the tonsil tissue of 40% of the patients with chronic tonsillitis using the Giemsa modification staining method, suggesting that H. pylori may be contributing etiologic factors in the development of chronic tonsillitis.

Eradication rate and adherence with high-dose amoxicillin and proton pump inhibitor as first-line treatment for Helicobacter pylori infection: Experience from University Hospital in Chile.

In Chile, more than 70% of adults are infected by Helicobacter pylori. Clarithromycin should not be used in any regimen if there is >15% resistance to this antibiotic, being greater than 26% in our population. In this scenario, the effectiveness of triple therapy (proton pump inhibitor [PPI], clarithromycin, amoxicillin) was only 63.8%. To evaluate the eradication rate and safety of dual therapy (esomeprazole and amoxicillin) in high doses, through a prospective, observational, and descriptive study. Patients with a positive urease test obtained in an upper digestive endoscopy were included. Any other previous H. pylori eradication regimen were excluded. All patients were treated with esomeprazole 40 mg three times a day and amoxicillin 750 mg four times a day for 14 days. The eradication rate of the dual therapy was evaluated with the H. pylori stool antigen test (the Pylori-Strip® test used) 6 weeks after completing the eradication treatment and with at least 14 days without PPI, being a negative result, confirmation of the effectiveness of this regimen. Of 122 patients, 106 had a negative H. pylori antigen in stool; The intention-to-treat and per protocol analysis, the eradication rates were 91.8% [95% CI: 87%-97%] and 94% [95% CI: 90%-98%], respectively. Four patients discontinued treatment due to adverse effects. Smoking and adherence to treatment were associated with eradication rate. In this cohort of patients with H. pylori infection, high-dose dual therapy has a high eradication rate and good adherence, raising the possibility that it could be used as first-line therapy in our country. Studies with a larger number of patients should confirm these results.

Seroprevalence of Helicobacter pylori infections in children and adults in Poland in the years 2020-2023.

Helicobacter pylori is a common cause of gastrointestinal infections in people around the world. Various microbiological methods are used in the laboratory diagnosis of infections, including determining the presence of specific antibodies in the serum. Serological tests can also be used in epidemiological studies aimed at determining the incidence of H. pylori infections. The aim of the study was to obtain insight into the incidence of antibodies to H. pylori in subjects of different ages living in Poland in the years 2020-2023. The research used serum samples obtained between January 2020 and September 2023 from 600 subjects living in Poland. The Anti-Helicobacter pylori ELISA IgG enzyme immunoassay from Euroimmun was used to test the level of IgG antibodies to H. pylori antigens. Additionally, selected serum samples were tested for the presence of antibodies to the most important protein virulence factors of H. pylori by Western Blot. IgG antibodies to H. pylori, at a diagnostically significant level, were detected in 28.3% of the examined persons. Antibodies to H. pylori were least frequently detected in children under 10 years of age (12.1%) and teenagers (13.2%). In adults aged 20 to 50, these antibodies were more common (23.9% to 29.5%). Statistically, H. pylori antibodies were most often detected in subjects over 50 years of age (52.3%). There were no statistically significant differences in the frequency of antibodies to H. pylori depending on the gender of the examined persons. In most serum samples tested by Western Blot, the presence of antibodies to the CagA protein was detected (66.7%). The conducted research and analysis of literature data showed a similar percentage of serum samples with a diagnostically significant level of antibodies to H. pylori in people living in Poland as in people living in other European countries. The epidemiology of infections is also very similar, characterized by low morbidity in children and adolescents and an increase in the incidence of infections with the age of the examined persons. Importantly, compared to research conducted in our country several years ago, the percentage of positive results is much lower, which may be due to the improvement of social and living conditions and hygiene habits.

The association of Helicobacter pylori infection with increased total IgE antibodies in Sana'a city, Yemen: a case-control study

Background: This study aimed to determine the association between Helicobacter pylori (H. pylori) infection and the total serum IgE antibodies.
 Methods: This case-control study was conducted during a period from August 2018-July 2020. Two hundred individuals were enrolled in this study. They were divided into 100 individuals infected with H. pylori (case group) and 100 individuals were not infected with H. pylori (control group). Three ml peripheral blood was withdrawn from each individual. The blood sample was used for the detection of total IgE antibodies using an electrochemiluminescence immunoassay. A stool sample was collected from each individual for the determination of H. pylori antigen using a rapid immunochromatography assay.
 Results: Total IgE antibodies were positive among 46% of H. pylori-infected cases versus 19% of controls. There was a statistically significant association between H. pylori infection and total IgE antibodies (p=0.001). Regarding the risk factors for H. pylori infection, there was a statistically significant association between smoking and H. pylori infection. In contrast, there was no statistically significant association between the type of water, washing vegetables, washing and chewing qat, and family history with H. pylori infection.
 Conclusions: It could be concluded that total IgE antibody level increased in patients infected with H. pylori compared to the non-infected individuals.

Frequency of H-Pylori Infection in Immune Thrombocytopenic Purpura

Objective: To determine the frequency of Helicobacter pylori infection in patients with Immune Thrombocytopenia (ITP) and the impact of eradication therapy on platelet counts. Study design & Setting: It was a cross-sectional study conducted at National institute of blood disease and bone marrow transplant (NIBD) hospital, Karachi, Pakistan from January 2021 to September 2022. Methodology: Adults between 18 to 70 years of either gender with thrombocytopenia (platelet count less than 100x109/L) with or without bleeding manifestation from last six months were recruited. The immunoassay was used for stool sample to detect H. pylori antigen, eradication therapy was administered and platelet counts were evaluated at 3rd and 6th month of treatment. Results: Of 120 patients with ITP, the mean age was 36.67±15.32 years, and 76.7% were female. 35.83% had H. pylori positive. The eradication treatment on platelet counts was statistically significant (p=0.001). Median platelet counts at baseline, 3 months and 6 months were 43.50(23.00- 77.00), 136.50 (57.00- 237.00), and 192.00 (130.50-275.50) patients respectively. Platelet counts were statistically different between baseline with three and six months (p=0.007 and p=0.001, respectively). Conclusion: People with ITP frequently have H. pylori infections, and eradication treatment could contribute to the increase in platelet count.

<i>Helicobacter pylori</i> infection in children with immune thrombocytopenia

To detect the association between Helicobacter pylori (H. pylori) infection and immune thrombocytopenia in children and adolescents. Immune thrombocytopenia (ITP) is a common bleeding disorder in childhood. H. pylori is a widespread organism that is present in about 50% of the global population. There is an obvious relation between helicobacter pylori infection and chronic idiopathic thrombocytopenic purpura. A cross-sectional study was conducted in 95 patients with ITP who were recruited from the Hematology Unit, Department of Pediatrics, Menoufia University Hospital in the period from June 2021 to June 2022. The age of the patients ranged between 3.5 and 7.5 years. Fifty-five of them were males and 40 were females. The study was approved by the Ethical Committee of the Faculty of Medicine, Menoufia University. Out of the studied ITP children, 62 (65.3%) were positive for H. pylori antigen in stool, and 33 (34.7%) were negative. There was a significant difference between H. pylori-positive and H. pylori-negative patients regarding the grade of bleeding at presentation; 51 (82.3%) H. pylori-positive patients presented with grade 3 bleeding, 35 (56.5%) of them presented with skin and gum bleeding, 16 (25.8%) presented with skin bleeding and epistaxis. There was a statistically significant difference in the rate of recovery between H. pylorinegative patients (78.8%) and H. pylori-positive patients (22.6%). There was a significant rise in the platelet count in H. pylori-positive patients after the treatment of H. pylori. The prevalence of H. pylori infection in ITP pediatric patients was 65.3%. There was a significant rise in the platelet count in H. pylori-positive ITP children after the treatment of H. pylori.

Prevalence of Liver Injury, Gastrointestinal Tract Symptoms, and H. Pylori Infection in Patients of Coronavirus Disease 2019 (COVID-19)

Background COVID-19 most commonly presents with respiratory symptoms, including cough, shortness of breath, sore throat with characteristics of loss of smell and taste. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. Objective To estimate the rate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests for H. Pylori antigen among patients with the suspected or proven COVID-19. Patients and Methods The research performed on 70 Egyptian patients who have suspected COVID-19 symptoms included in this study. The patients are divided into four groups. Asymptomatic group, group with respiratory symptoms, group with digestive symptoms, and group with respiratory and digestive symptoms. Results The asymptomatic patient was 10%, gastrointestinal symptoms with or without respiratory symptoms 24.3%, digestive symptoms only 11.8% of COVID-19, and H. pylori present in 50% of the digestive group of COVID-19 patients. The use of corticosteroids in the low effective dose for ten days to 2 weeks and anticoagulant play an important role in the management of COVID-19, especially in moderate cases. Conclusion The prevalence of gastrointestinal symptoms in COVID-19 increase up to 24.3% and the prevalence of patients with digestive symptoms only was 11.4%. In some cases, the digestive symptoms, particularly diarrhea, can be the initial or only presentation of COVID-19.

Primary Antibiotic Resistance And Effectiveness Of Clarithromycin Vs Metronidazole Based Therapy For Helicobacter Pylori Infection In Children.

NASPGHAN guidelines recommend regional antibiotic susceptibility profiling for H. pylori eradication treatment. Profiling local antibiotic resistance patterns is mandatory for successful H. pylori eradication in children. The aim of our study was to determine primary resistance to Clarithromycin and Metronidazole, most commonly used in the eradication regimens in children presenting with symptomatic H. pylori infection. This study was conducted at Children Hospital PIMS Islamabad from June 2020 to August 2021. The children of either gender age 2-14 years having symptomatic H. pylori infection (hematemesis, chronic abdominal pain) underwent stool for H. pylori Antigen. Children requiring urgent diagnostic endoscopy underwent rapid urease tests. Biopsies were taken from children having positive stool H. pylori Ag and rapid urease test for histological examination. The biopsy specimens were cultured and subsequently tested for antibiotic sensitivity. Out of 54 children having H. pylori infection 40/54 (74.074%) children had strains susceptible to antimicrobials and 14/54 (25.92%) were having resistance to antimicrobials. According to the pattern of antimicrobial sensitivity, they were further grouped into three (a) Clarithromycin and Metronidazole sensitive group (18/40, 45%) (b) Clarithromycin sensitive and Metronidazole resistant group (12/40, 30%) (c) Metronidazole sensitive group (10/40 25%). Clarithromycin and Metronidazole cannot be used as1stline treatment for H. pylori eradication in children and can only be used with known antimicrobial susceptibility.

Cognitive function in UK adults seropositive for Helicobacter pylori.

Associated with gastritis, peptic-ulcer disease, and gastric carcinoma, Helicobacter pylori (H. pylori) also has been associated with decreased cognitive function and dementia. In this study, we used data from the UK Biobank to further examine associations between H. pylori seropositivity and serointensity and performance on several cognitive tasks in adults 40 to 70 years of age (M = 55.3, SD = 8.1). In these analyses, H. pylori seropositivity (i.e., either positive or negative for H. pylori) and serointensity (concentration of antibodies against H. pylori antigens) in adjusted models were associated with worse function on tasks of Numeric memory, Reasoning, and errors on the Pairs matching test but better function on the Tower rearrangement task. Together, these findings suggest that H. pylori seropositivity and serointensity might be associated with worse cognitive function in this age group.

Possible Role of Helicobacter pylori in Ear Nose and Throat Diseases.

Helicobacter pylori is assumed to cause many gastric and extragastric diseases. We aimed to assess the possible association role of H. pylori in Otitis media with effusion (OME), nasal polyps and adenotonsillitis. A total of 186 patients with various ear, nose and throat diseases were included. The study comprised 78 children with chronic adenotonsillitis, 43 children with nasal polyps and 65 children with OME. OME patients were assigned to two subgroups: those who have and those who did not have adenoid hyperplasia. Among the patients with bilateral nasal polyps, 20individuals had recurrent nasal polyps and 23 had de novo nasal polyps. Patients who have chronic adenotonsillitis were divided into three groups: those with chronic tonsillitis and those who underwent tonsillitis, those with chronic adenoiditis and adenoidectomy was performed, and those with chronic adenotonsillitis and underwent adenotonsillectomy. In addition to examination of H. pylori antigen in stool samples of all included patients, real-time polymerase chain reaction (RT-PCR) for detection of H. pylori in the effusion fluid was performed, additionally, Giemsa stain was used for detection of H. pylori organism within the tissue samples when available. Frequency of H. pylori in effusion fluid was 28.6% in patients with OME and adenoid hyperplasia, while in those with OME it was only 17.4% with a p value of 0.2. Nasal polyp biopsies were positive in 13% patients of denovo, and 30% patients with recurrent nasal polyps, p=0.2. De novo nasal polyps were more prevalent in the positive stools than recurrent ones, p=0.7. All adenoid samples were negative for H. pylori, only two samples of tonsillar tissue (8.3%) were positive for H. pylori, and stool analysis was positive in 23 patients with chronic adenotonsillitis. Lack of association between Helicobacter pylori and occurrence of OME, nasal polyposis or recurrent adenotonsillitis.

SEROPREVALENCE OF HELICOBACTER PYLORI AND HEPATITIS A VIRUS AMONG ORPHANAGE CHILDREN IN SANA’A, YEMEN

Background: The epidemiological association between Helicobacter pylori (H. pylori) and hepatitis A virus (HAV) has been evaluated by different groups with conflicting conclusions. Aims: The aim of this study was to determine the prevalence of hepatitis A virus and H. pylori infection among children of an orphanage in Sana'a, and to identify the socio-demographic factors associated with their prevalence, both individually and simultaneously. Methods: This is a cross-sectional study carried out among 200 orphaned children who lived at Ahmed's orphanage in Sana’a City, Yemen during the period from October 2022 to February 2023. The stool and blood specimens were collected and the required data were filled in pretested questionnaire. By using the immunochromatographic assay technique, the seropositivity of the HAV antibody was screened in blood plasma while the H. pylori antigen was detected in stool. The obtained results were analyzed using SPSS software. Results: Out of 200 participants; 2(1%) were positive for anti-HAV and 63(31.5%) for H. pylori antigen. The HAV and H. pylori infections, respectively, were significantly higher in the group aged 10-12 and 13-15 years, attending a primary and preparatory school, living with 3-5 individuals/room, their family infected with hepatitis A and H. pylori, and received a blood transfusion. The high risk of hepatitis A infection was in children who their family was infected by HAV and received a blood transfusion while H. pylori was in subjects who had a history of hospitalizations and whose family infected by H. pylori. Conclusion: The high number of children suffering from both H. pylori and HAV antibodies among orphans in Sana'a indicates a high prevalence rate in the community. It is possible that this high prevalence reflects a prevalence specific to this group or age, and this connection is real. Peer Review History: Received: 26 February 2023; Revised: 11 March; Accepted: 17 April 2023, Available online: 15 May 2023 Academic Editor: Dr. Muhammad Zahid Iqbal, AIMST University, Malaysia, drmmziqbal@gmail.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye

Potential contribution of Helicobacter pylori proteins in the pathogenesis of type 1 gastric neuroendocrine tumor and urticaria. In silico approach.

Helicobacter pylori has been linked to several diseases such as chronic urticaria, gastritis, and type 1 gastric neuroendocrine tumors (type 1 gNET). Although these diseases seem to have different mechanisms, their relationship with H. pylori suggests a common inflammatory pathway. To identify potential cross-reactive antigens between H. pylori and humans involved in chronic urticaria and type 1 gNET. Alignment was carried out among human proteins associated with urticaria (9 proteins), type 1 gNET (32 proteins), and H. pylori proteome. We performed pairwise alignment among the human and H. pylori antigens with PSI-BLAST. Modeling based on homology was done with the Swiss model server and epitope prediction with the Ellipro server. Epitopes were located on a 3D model using PYMOL software. The highest conserved sequence was found between the human HSP 60 antigen and the H. pylori chaperonin GroEL with an identity of 54% and a cover of 92%, followed by the alpha and gamma enolases and two H. pylori phosphopyruvate hydratase, both with an identity and cover of 48% and 96%, respectively. The H/K ATPase (Chain A) showed high identity with two H. pylori proteins (35.21% with both P-type ATPase), but with low cover (only 6%). We observed eight linear and three discontinuous epitopes for human HSP 60 and three lineal and one discontinuous epitope for both alpha-enolase and gamma enolase, high conserved with H. pylori sequences. Some type 1 gNET antigens shared potential cross-reactive epitopes with H. pylori proteins, suggesting that molecular mimicry could be a mechanism that explains the relationship between the infection and this disease. Studies evaluating the functional impact of this relationship are needed.

Immunoinformatic prediction of potential immunodominant epitopes from cagW in order to investigate protection against Helicobacter pylori infection based on experimental consequences.

Helicobacter pylori is a leading cause of stomach cancer and peptic ulcers. Thus, identifying epitopes in H. pylori antigens is important for disease etiology, immunological surveillance, enhancing early detection tests, and developing optimal epitope-based vaccines. We used immunoinformatic and computational methods to create a potential CagW epitope candidate for H. pylori protection. The cagW gene of H. pylori was amplified and cloned into pcDNA3.1 (+) for injection into the muscles of healthy BALB/c mice to assess the impact of the DNA vaccine on interleukin levels. The results will be compared to a control group of mice that received PBS or cagW-pcDNA3.1 (+) vaccinations. An analysis of CagW protein antigens revealed 8 CTL and 7 HTL epitopes linked with AYY and GPGPG, which were enhanced by adding B-defensins to the N-terminus. The vaccine's immunogenicity, allergenicity, and physiochemistry were validated, and its strong activation of TLRs (1, 2, 3, 4, and 10) suggests it is antigenic. An in-silico cloning and immune response model confirmed the vaccine's expression efficiency and predicted its impact on the immune system. An immunofluorescence experiment showed stable and bioactive cagW gene expression in HDF cells after cloning the whole genome into pcDNA3.1 (+). In vivo vaccination showed that pcDNA3.1 (+)-cagW-immunized mice had stronger immune responses and a longer plasmid DNA release window than control-plasmid-immunized mice. After that, bioinformatics methods predicted, developed, and validated the three-dimensional structure. Many online services docked it with Toll-like receptors. The vaccine was refined using allergenicity, antigenicity, solubility, physicochemical properties, and molecular docking scores. Virtual-reality immune system simulations showed an impressive reaction. Codon optimization and in-silico cloning produced E. coli-expressed vaccines. This study suggests a CagW epitopes-protected H. pylori infection. These studies show that the proposed immunization may elicit particular immune responses against H. pylori, but laboratory confirmation is needed to verify its safety and immunogenicity.

Helicobacter pylori multiplex serology and risk of non-cardia and cardia gastric cancer: a case-cohort study and meta-analysis.

Helicobacter pylori infection is a major cause of non-cardia gastric cancer (NCGC), but uncertainty remains about the associations between sero-positivity to different H. pylori antigens and risk of NCGC and cardia gastric cancer (CGC) in different populations. A case-cohort study in China included ∼500 each of incident NCGC and CGC cases and ∼2000 subcohort participants. Sero-positivity to 12 H. pylori antigens was measured in baseline plasma samples using a multiplex assay. Hazard ratios (HRs) of NCGC and CGC for each marker were estimated using Cox regression. These were further meta-analysed with studies using same assay. In the subcohort, sero-positivity for 12 H. pylori antigens varied from 11.4% (HpaA) to 70.8% (CagA). Overall, 10 antigens showed significant associations with risk of NCGC (adjusted HRs: 1.33 to 4.15), and four antigens with CGC (HRs: 1.50 to 2.34). After simultaneous adjustment for other antigens, positive associations remained significant for NCGC (CagA, HP1564, HP0305) and CGC (CagA, HP1564, HyuA). Compared with CagA sero-positive only individuals, those who were positive for all three antigens had an adjusted HR of 5.59 (95% CI 4.68-6.66) for NCGC and 2.17 (95% CI 1.54-3.05) for CGC. In the meta-analysis of NCGC, the pooled relative risk for CagA was 2.96 (95% CI 2.58-3.41) [Europeans: 5.32 (95% CI 4.05-6.99); Asians: 2.41 (95% CI 2.05-2.83); Pheterogeneity<0.0001]. Similar pronounced population differences were also evident for GroEL, HP1564, HcpC and HP0305. In meta-analyses of CGC, two antigens (CagA, HP1564) were significantly associated with a higher risk in Asians but not Europeans. Sero-positivity to several H. pylori antigens was significantly associated with an increased risk of NCGC and CGC, with varying effects between Asian and European populations.

The Relationship between Helicobacter Pylori and Intestinal Parasites in Patients with Peptic Ulcer

Aim: This study aimed to evaluate the frequency of Helicobacter pylori (H. pylori), risk factors, and co-infection with intestinal parasites in adult patients presenting gastrointestinal complaints. Materials and Methods: The working group of the study consisted of 385 patients with gastrointestinal complaints. A questionnaire including questions aiming to canvass the socio-demographic features, lifestyles, and complaints of the patients was administered to the study population. Cellophane slide method, native-lugol, sedimentation and Modified kinyoun acid-fast methods were used for the diagnosis of parasites in stool, under microscope. The H. pylori antigen was studied in the stool sample taken for the diagnosis of H. pylori.Results: H. pylori positivity was found to be 27.79% in the patients included in the study. 76.6% of those who are positive for H. pylori are women, and the positivity rate was found to be higher at the age of 40 and over (75.7%). The majority of patients with H. pylori positivity expressed being married (73.8%), having middle / low-income (89.7%), having a low educational background (82.2%), living in a village (55.1%), and in a nuclear family (72.2%) (p&amp;lt;0.001). H. pylori positivity was higher in those who used tap water (40.2%) and those who had a vegetable-based diet (75.7%) (p&amp;lt;0.001). The study found a statistically significant correlation between Entamoeba histoloytica and Enterobius vermicularis positivity and H. pylori positivity (p&amp;lt;0.05 p&amp;lt;0.001, respectively). The calculated odds ratio showed that H. pylori positivity was 1.19 times higher in Entamoeba histoloytica positivity and 11.27 times higher in Enterobius vermicularis positivity. Conclusion: Larger and more comprehensive studies should be performed to understand better the epidemiology, clinical effects, treatment, and control of H. pylori co-infection.

Gastrointestinal manifestations of allergy in the presence of &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection

Association of Helicobacter pylori infection with gastrointestinal tract disorders is one of the most common problems in the modern medicine. There are conflicting data in the literature on the role of H. pylori infection in development of allergic diseases and its effect on the course of gastrointestinal disorders in allergic conditions. There is currently no conclusive evidence about the role of H. pylori in etiology and pathogenesis of allergic states. Hence, the studies of gastrointestinal disorders in allergic conditions in the presence of H. pylori infection are of sufficient relevance. Our aim was to study the features of sensitization spectrum and clinical course of gastrointestinal manifestations in allergic disorders in the children infected with H. pylori.&#x0D; We have carried out a retrospective analysis of medical histories of the children with gastrointestinal manifestations of allergies (n = 29) aged from 1 to 18 years (middle age, 110.7 years), living in Eastern Siberia. The presence of H. pylori infection was determined with enzyme immunoassay technique, by measuring concentrations of total antibodies to the CagA H. pylori antigen. Depending on the carriage of H. pylori infection, 2 groups were discerned: HP-infected (n = 8), and HP-non-infected patients (n = 21). The spectrum of sensitization was determined by evaluating skin-prick tests for the non-infectious allergens. Gastrointestinal tract evaluation was based on the results of anamnesis, complaints, objective examination and data of esophagogastroduodenoscopy.&#x0D; It was found that, in most cases, gastrointestinal manifestations of allergy were combined with dermatorespiratory syndrome (41.3% of total group). The incidence of H. pylori infection in the patients with gastrointestinal manifestations of allergies was 27.5% of the group. Among the gastrointestinal manifestations of allergies, inflammatory diseases of the esophagus, stomach, and intestines, e.g., gastroesophageal reflux, gastritis, and duodenitis were most common. In the group of HP-infected children the incompetence of cardia was more often, being statistically significant. In the group of HP-noninfected children, esophagitis, bulbitis, erosive lesions of the stomach and duodenum were more common, however, the difference did not reach statistical significance. The spectrum of sensitization in the patients with gastrointestinal manifestations of allergies showed some features depending on the presence of HP infection. E.g., sensitization to birch and meadow grass mixture was found to be significantly more often in the group of HP-infected children, Among the HP-noninfected children, sensitization to house dust mite, cat wool, and dog wool was more often detected. Hence, when examining children with gastrointestinal manifestations of allergies it is necessary to exclude the presence of H. pylori infection, which can modify the course of a genuine allergic pathology.

S3695 Collagenous Gastritis: A Rare Cause of Severe Iron Deficiency Anemia in a Basic Military Trainee

Introduction: Collagenous gastritis is a rare inflammatory disease characterized by deposition of a thick subepithelial band of collagen and associated inflammatory infiltrate. This disorder has a reported prevalence of 13 per 100,000 esophagogastroduodenoscopies (EGDs) with a female predominance. Two distinct clinical phenotypes have been described: adult-onset characterized by diffuse gastrointestinal involvement and diarrhea, and pediatric-onset manifesting with abdominal pain and anemia. We present an interesting case of pediatric-phenotype collagenous gastritis to highlight this poorly-recognized disorder. Case Description/Methods: A 19-year-old male basic military trainee was referred for evaluation of incidentally discovered iron deficiency anemia. He denied any symptoms, overt blood loss, or NSAIDs. Physical exam was unremarkable. Labs revealed hemoglobin of 9.3 g/dL, iron saturation 7% and ferritin 15 ng/mL. The patient underwent EGD and colonoscopy for further evaluation. EGD revealed a diffusely nodular appearance of the gastric mucosa with areas with suspected atrophy under narrow-band imaging (Figures 1A, B). Colonoscopy was normal. Biopsies returned with a non-specific chronic gastritis without H. pylori. Abdominal computed tomography and additional work up for autoimmune gastritis, fecal H. pylori antigen, syphilis, and heavy metals toxins were all normal. Decision was made to repeat EGD for additional tissue sampling, including cold snared samples. Repeat gastric biopsies with expert GI pathologist review revealed collagenous gastritis, characterized by subepithelial deposition of a thick (greater than 10 µm) collagen band and associated inflammatory infiltrate (Figures 1C, D). Patient was lost to follow up due to disqualification for military service. Discussion: Collagenous gastritis is an exceedingly rare heterogeneous disease process of poorly understood causes and pathogenesis, with autoimmune conditions, medication effects, and infections theorized to be responsible. Numerous treatments have been reported with variable effect, including antisecretory agents, corticosteroids, immunomodulators, and hypoallergenic diets, along with micronutrient supplementation. Due to its rarity, a high level of suspicion is required by gastroenterologists and pathologists based on clinical and endoscopic findings. Our case helps to bring awareness to collagenous gastritis, and emphasizes the potential value for repeat tissue sampling with expert pathologist review.Figure 1.: A: Diffusely nodular appearance of the gastric mucosa with areas. B: Narrow-band imaging reveals areas of suspected atrophy. C: Multiple fragments of gastric mucosa with a prominent lymphoplasmacytic infiltrate within the lamina propria and occasional foci of subepithelial collagen deposition (red arrows). [Hematoxylin & Eosin, 50× magnification]. D: On higher magnification a focus of subepithelial collagen deposition may be seen associated with epithelial injury indicated by loss of foveolar mucin and detachment of the surface epithelium. [Hematoxylin & Eosin, 200× magnification].

S3738 Agent Orange as a Possible Cause of Helicobacter pylori Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

Introduction: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma was first described in 1983 as the most common extranodal site of non-Hodgkin lymphoma. Helicobacter pylori (H. pylori) infection is implicated in 90% of all gastric MALT lymphoma cases. Agent Orange (AO), with traces of oncogenic 2,3,7,8-tetrachlorodibenzo-p-dioxin, has also been classified as a causative agent in non-Hodgkin lymphoma, which includes gastric MALT lymphoma. Here we report a case of H. pylori negative gastric MALT lymphoma in a patient with history of significant AO exposure. Case Description/Methods: A 75-year-old Caucasian male veteran who served in the Vietnam War with significant AO exposure, as well as history of chronic gastroesophageal reflux disease, was referred for endoscopy to evaluate a reported history of un-staged Barrett’s esophagus 5-years prior but with two subsequent normal endoscopies at an outside facility. He noted symptoms of burning chest pain and dyspepsia following large meals, all of which were worsened with spicy foods and improved with omeprazole. Family history was negative for a history of gastric cancer, and he had a 25-pack year smoking history but quit 20 years prior to presentation.Initial esophagogastroduodenoscopy (EGD) revealed abnormal folds in the gastric fundus and erythema in the gastric antrum, but otherwise normal exam including normal duodenum and esophagus. Random gastric biopsies and biopsies of the abnormal folds were consistent with gastric MALT lymphoma, negative for H. pylori and t(11;18)(q21;q21). Repeat EGD 1 month later for further sampling demonstrated identical findings (Figure 1A). Stool testing for H. pylori antigen was also negative. The patient was referred to oncology and after staging imaging was found to have stage IE gastric MALT lymphoma. He was treated with involved site radiation therapy and EGD 3 months later showed both endoscopic and pathologic resolution (Figure 1B). Discussion: The 10% of cases of H. pylori negative gastric MALT lymphoma have an unclear etiology, although dysregulation of nuclear factor-kappa B (NF-κB) principally via translocations t(11;18)(q21;q21) is thought to be a potentially causative genetic alteration. In this patient, neither H. pylori nor the common t(11,18) genetic alteration were present. Given AO is implicated in non-Hodgkin lymphoma and the most common site of extranodal non-Hodgkin lymphoma is the gastric mucosa, AO exposure should be considered a risk factor for development of gastric MALT lymphoma.Figure 1.: (A) EGD demonstrating abnormal gastric mucosa with prominent gastric fundus folds seen on retroflexion during EGD prior to ISRT (radiation) therapy. (B) Post-radiation EGD demonstrating resolution of the abnormalities seen with the pre-treatment EGD including disappearance of the prominent gastric fundus folds.

S3519 A Rare Case of Epigastric Pain Caused by Duodenal Metastatic Cervical Cancer

Introduction: Cervical cancer was previously one of the most common causes of death for women in the United States but survival has since improved with the use of screening and the HPV vaccine. Metastatic cervical cancer spread to the duodenum is rare and presents a diagnostic challenge due to vague symptoms. We present a case of epigastric pain caused by invasive squamous cell cervical cancer with duodenal metastasis. Case Description/Methods: A 59-year-old female with a history of GERD and treated cervical cancer (2 years prior) and currently on pembrolizumab presented to clinic for 3 months of progressive upper abdominal pain and dyspepsia. Last upper endoscopy a year ago was normal. Physical exam was notable for epigastric tenderness without guarding. Laboratory data was remarkable for downtrending hemoglobin, normal liver function tests, normal lipase, and negative stool H pylori antigen. She was referred for EGD. A contrasted CT of the abdomen and pelvis performed revealed multiple enlarged lymph nodes of the mesentery. Upper endoscopy revealed thickened folds of the second portion of the duodenum and multiple biopsies taken of this site. It was an otherwise normal upper endoscopy. The duodenal biopsies were positive for metastatic squamous cancer of the cervix. The patient was transitioned to treatment with gemcitabine and carboplatin due to progressive disease on pembrolizumab. She unfortunately succumbed to her disease six months later. (Figure) Discussion: There is an estimated 7.5 per 100,000 new cases of cervical cancer per year with death rate of 2.2 per 100,000 in the United States. Cervical cancer is usually locally invasive and spreads by lymphatics or hematogenously with most common metastatic sites of lungs, liver, and bone. In a previous review, liver metastases was in up to 12.5% of patients but did not mention a single case of luminal disease. It is very rare for most cancers to metastasize to the gastrointestinal tract, but when present, metastasis has a predilection for the stomach and duodenum. Few case reports are available for cervical cancer metastasis to the GI tract specifically, with about 16 identified. These patients generally presented with gastrointestinal bleeding, bowel perforation, nonspecific abdominal pain or obstructive symptoms. In conclusion, duodenal metastasis of cervical cancer is rare and can be frequently missed. A high degree of suspicion can expedite referral for upper endoscopy to diagnose and allow for treatment to extend patients’ quality of life.Figure 1.: Thickened folds in the second portion of duodenum.

Interleukin -17, Interleukin-23 and Alkalinephosphatase Levels in Patients with Helicobacter pylori Infection

The study was carried out to detection of H.pylori in (218) patients who attended two teaching hospitals in Baghdad. The diagnosis is done by Immunochromatography methods. Stools and blood samples were taken from each patient as well as other (30) healthy control matching in age. The study included measurement the Levels of Interleukin-17, Interleukin-23, and Alkaline phosphatase in sera of patients and control .The result indicated presence of H pylori antigen in 115 cases 59 cases of males and 51 of females , Also, the result indicated increasing levels of IL-17 and IL-23 and Alkaline phosphatase in patients sera in comparison with healthy control.