Pylori Era Research Articles

Time series analysis of gastric acid secretion over a 20-year period in normal Japanese men.

The gastric acid secretion level is an important determinant for the manifestation of the gastroesophageal reflux disease spectrum, finally leading to the development of esophageal adenocarcinoma (EAC). Although the incidence of EAC has remained low in Asia, understanding the recent trend in gastric acid secretion should be helpful in estimating future incidences of EAC in that area. We investigated the latest chronological change (1995-2014) in gastric acid secretion in normal Japanese patients. A total of 307 asymptomatic Japanese men who attended the clinic for annual endoscopic checkups from 1995 to 2014 were enrolled in this analysis. Gastrin-stimulated gastric acid secretion was estimated with the endoscopic gastrin test. The association between gastric acid secretion and chronological period was assessed with a multivariate linear regression analysis. Overall gastric acid secretion gradually increased over the 20-year period in the entire cohort in the unadjusted analysis (p < 0.05). However, the apparent increase was largely related to the relative decreasing rate of H. pylori infection, which profoundly inhibited gastric acid secretion. Gastric acid secretion did not change over the 20-year period in H. pylori-negative subjects, and it showed only a mild increase during this period in H. pylori-positive subjects. Considering that gastric acid secretion remained unchanged in H. pylori-negative Japanese men over a 20-year period at a level much lower than that in Occidental subjects, upper gastrointestinal disease profiles in the Japanese population will differ from those in Western countries in the post-H. pylori era.

Sofalcone, a gastroprotective drug, promotes gastric ulcer healing following eradication therapy for Helicobacter pylori: A randomized controlled comparative trial with cimetidine, an H2‐receptor antagonist

According to reports in Japanese patients, 1 week of Helicobacter pylori eradication therapy alone is not adequate for healing of gastric ulcers; 7-8 weeks of anti-ulcer therapy are subsequently required. We compared a gastroprotective drug, sofalcone, and an H(2)-receptor antagonist, cimetidine, in terms of promoting ulcer healing after 7 weeks of administration following 1 week of eradication therapy. Eradication therapy was administered to 64 patients with H. pylori-positive active gastric ulcer at least 10 mm in diameter, after which 32 patients each received 7 weeks of ulcer treatment with sofalcone (300 mg/day) or cimetidine (800 mg/day). The H. pylori eradication rate was 81.3% (intention-to-treat: ITT) and 81.3% (per protocol: PP) in the sofalcone group, and 62.5% (ITT) and 64.5% (PP) in the cimetidine group. The ulcer healing rate after 8 weeks was 71.9% (ITT) and 71.9% (PP) in the sofalcone group, and 71.9% (ITT) and 71.0% (PP) in the cimetidine group. The rate of a flat pattern of scarred mucosa was 43.5% (ITT) and 43.5% (PP) in the sofalcone group, and 47.8% (ITT) and 50.0% (PP) in the cimetidine group. No significant differences were seen between the two groups in terms of H. pylori eradication rate, ulcer healing rate and flat pattern rate. Sofalcone promoted gastric ulcer healing during 7 weeks of treatment following 1 week of eradication therapy, and the healing rate was equivalent to that of cimetidine. Symptom disappearance rates were significantly better in the sofalcone group than in the cimetidine group. This may be a useful way of using a gastroprotective drug in the H. pylori era.

Gastric tubes as vectors of Helicobacter pylori transmission

Peptic ulcer was a rare disease before 1850. The prevalence of peptic ulcer increased gradually in persons born between 1870 and 1900. A similar decay in opposite direction of the prevalence occurred after the 1960–1970s. Although the pathogenesis of peptic ulcer is readily explained by the Helicobacter pylori infection, the bacterium occurred many thousands years ago and followed the migrations of human populations; consequently, its presence does not explain the increase in peptic ulcer prevalence. Gastric tubes for secretory testing were introduced from 1871 and their use was extended gradually in the then growing departments of gastroenterology, becoming a very popular, though unpleasant method. There is circumstantial evidence from the pre- H. pylori era that gastric/enteral infections could be transmitted though contaminated gastric tubes/electrodes. The author’s hypothesis is based on the temporary overlap of the increased peptic ulcer prevalence and the extensive use of gastric secretory testing. The use of contaminated gastric tubes in sick persons harbouring pathogenic strains of the bacterium could have led to the transmission of the infection by gastro-oral route to the patients’ ward-mates and on, to their family members: years later, new ulcer or dyspeptic patients may have come from such groups. The current decay in peptic ulcer prevalence could be due to the decreased use of secretory testing and implementation of rigorous disinfection rules.

Helicobacter pylori– a Timeless Source of Lessons and Research Initiatives

The beginning of the H. pylori era was characterized by objections and even refusal to accept the new H. pylori-related theories. The shift from peptic ulcer disease as an acid-driven disease to a disease with an infectious etiology had to overcome major obstacles and the dogma of the stomach as a sterile organ. Strong effort and commitment of several medical disciplines with a large collection of scientific data gave decisive support to it. However what had started as a revolutionary and completely opposing concept to the one pre-existing evolved to a novel but integrative concept. The new theories were able to reconcile the new critical factor H. pylori with pre-existing knowledge carefully build up during several decades of intensive studies reserved to mechanisms regulating gastric physiology. On its way to full recognition and praise the difficult story of H. pylori has allowed the collection of many lessons which have allowed the medical and scientific profession to progress, and these lessons are also valuable for life beyond scientific boundaries.

Emerging Trends in Peptic Ulcer Disease and Damage Control Surgery in the H. Pylori Era

The prevalence of peptic ulcer disease (PUD) and the frequency of operation have been decreasing for decades. Immigration of patients harboring Helicobacter pylori may reverse these longstanding declines. The experience with a large public hospital population in an area of high immigration may portend future national trends. A 10-year retrospective study analyzed the changing demographics of PUD and the frequency and nature of surgical intervention. A total of 2,182 patients were diagnosed with PUD, 1,173 in the early period (1995-1999) and 1,009 in the recent period (2000-2004). The proportion of Hispanic patients increased from 39.3 per cent to 47.5 per cent (P = 0.017). The ratio of male to female patients decreased from 1.7:1 to 1.3:1 (P = 0.003). The PUD operation rate decreased from 6.7 per cent to 3.8 per cent (P = 0.004). Among operated patients, the frequency of H. pylori testing increased from 41.8 per cent to 81.6 per cent (P = 0.039). Acute perforation and bleeding necessitated the vast majority (87.2%) of operations. The use of acid-reducing operations declined from 50.6 per cent to 31.6 per cent in favor of nonacid-reducing "damage control" procedures. Contrary to historic trends, in the predominately immigrant public hospital patient population studied, 1) the incidence of PUD is decreasing only modestly, 2) male predominance is disappearing, 3) gastric ulcer (GU) is more prevalent than duodenal ulcer (DU), but DU requires operation more frequently than GU, and 4) there is a marked decrease in use of acid-reducing operations reflecting a new "damage control" surgical approach to acute PUD complications in the H. pylori era.

Hospital admission for gastrointestinal bleeding from peptic ulcer disease-before and after H. pylori era

Hospital admission for gastrointestinal bleeding from peptic ulcer disease-before and after H. pylori era

Hospital admission for gastrointestinal bleeding from peptic ulcer disease-before and after H. pylori era

Hospital admission for gastrointestinal bleeding from peptic ulcer disease-before and after H. pylori era

What causes gastric and duodenal ulcers in children in the H pylori era?

What causes gastric and duodenal ulcers in children in the H pylori era?

Alternative treatment strategies for patients with dyspepsia in the H. pylori ERA : [formula omitted], ME Chernew, RA Hirth, BS Bloom. University of Michigan, Ann Arbor, MI, and University of Pennsylvania, Philadelphia, PA, USA

Alternative treatment strategies for patients with dyspepsia in the H. pylori ERA : [formula omitted], ME Chernew, RA Hirth, BS Bloom. University of Michigan, Ann Arbor, MI, and University of Pennsylvania, Philadelphia, PA, USA