Pylori-infected Peptic Ulcer Patients Research Articles

Detection Capacity of Helicobacter pylori Infection by Stool Antigen Test Comparing with Rapid Urease Test among Peptic Ulcer Disease Patients

Background: Rapid urease test and stool antigen test are both important diagnostic tools for the detection of Helicobacter pylori infection among peptic ulcer disease patients.
 Objective: The purpose of the present study was to compare the detection capacity of Helicobacter pylori infection with stool antigen test by comparing with rapid urease test among peptic ulcer disease patients.
 Methodology: This cross-sectional study was conducted in the Department of Clinical Pathology with the collaboration of Department of Gastroenterology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from October 2011 to September 2012 for a period of one year. All the clinically suspected Helicobactor pylori infected peptic ulcer patients attending in the Department of Gastroenterology at Bangabandhu Sheikh Mujib Medical University (BSMMU) for upper GI endoscopy were selected as study population. Stool antigen test for Helicobactor pylori specific antigen from stool sample was done with “ABON-One Step Helicobactor pylori antigen test device”. Endoscopy of upper GIT was performed in the Department of Gastroenterology. Biopsy taken during endoscopy for RUT. Rapid urease test (RUT) of endoscopic biopsy was performed.
 Result: A total 86 patients were recruited for this study. The mean (±SD) age was found 38.53(±10.40) years. Out of 86 patients 76 cases were SAT positive and 10 cases were negative. The sensitivity, specificity, positive predictive values and negative predictive values and accuracy of SAT with RUT are 85.53%, 90.0%, 98.48%, 45.0%, 86.05% respectively. The area under the curve was 0.283 with the lower and upper limits of 95% confidence interval of 0.133 and 0.432. This was statistically significant (p=0.003).
 Conclusion: In conclusion the stool antigen test is an effective method for the diagnosis of Helicobacter pylori infection.
 Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 161-164

Ginger Extract Modulates the Production of Chemokines CCL17, CCL20, CCL22, and CXCL10 and the Gene Expression of Their Receptors in Peripheral Blood Mononuclear Cells from Peptic Ulcer Patients Infected with Helicobacter pylori

Background: The imbalanced expression of chemokines plays critical role in the development of Helicobacter pylori-mediated complications. Objectives: Our aim was to determine ginger extract (GE) effects on the expression of chemokines CCL17, CCL20, CCL22, and CXCL10, as well as CCR4, CCR6, and CXCR3 receptors by peripheral blood mononuclear cells (PBMCs) from H. pylori -infected patients with peptic ulcer (PU). Methods: Peripheral blood mononuclear cells were obtained from 20 patients with H. pylori-associated PU, 20 H. pylori-infected asymptomatic subjects (HAS), and 20 non-infected healthy subjects (NHS). The PBMCs were stimulated by 10 µg/mL of H. pylori-derived crude extract (HPCE) in the presence of 0, 10, 20, and 30 µg/mL of GE. After 36 hours, the supernatant and the RNA extracted from the cells were tested for chemokine concentration and chemokine receptor expression using ELISA and real-time PCR techniques, respectively. Results: In PU patients, treating HPCE-stimulated PBMCs with 10, 20, or 30 µg/mL GE reduced the production of CXCL10 (1.47, 1.5, and 1.53 folds, respectively, P < 0.001 for all), CCL20 (1.44, 1.62, and 1.65 folds, respectively, P < 0.003), and treatment with 30 µg/mL GE increased CCL17 (1.28-fold, P < 0.001) and CCL22 (1.59-fold, P < 0.001) production compared with untreated HPCE-stimulated PBMCs. In PU patients, the HPCE-stimulated PBMCs treated with 10, 20, or 30 µg/mL GE expressed lower levels of CXCR3 (1.9, 3, and 3.5 folds, respectively, P < 0.001) and CCR6 (2.3, 2.7, and 2.8 folds, respectively, P < 0.002) while treating with 10 µg/mL GE upregulated CCR4 (1.7 fold, P = 0.003) compared with untreated HPCE-stimulated PBMCs. Conclusions: Ginger extract modulated the expression of chemokines and their receptors in the PBMCs derived from H. pylori-infected PU patients. The therapeutic potentials of ginger for treating HP-related complications need to be further explored.

Increased risk of subsequent benign prostatic hyperplasia in non-Helicobacter pylori-infected peptic ulcer patients: a population-based cohort study

The vagus nerve plays an essential role in homeostasis and inflammation. Clinically, peptic ulcer patients without helicobacter pylori (HP) infection may provide a population for studying the effect of vagal hyperactivity. There were interests in the association of gastrointestinal disease and urogenital disorders. Herein, we try to investigate subsequent risk of benign prostatic hyperplasia (BPH) in non-HP infected peptic ulcer patients. We identified 17,672 peptic ulcer admission male patients newly diagnosed in 1998–2007 from Taiwan Health Insurance Database, and 17,672 male comparison without peptic ulcer, frequency matched by age, and index-year. We assessed subsequent incidence of BPH in each cohort by the end of 2013, and then compared the risk of developing BPH between individuals with and without peptic ulcer. In addition, peptic ulcer patients underwent surgery were also examined. There were 2954 peptic ulcer patients and 2291 comparisons noted with the occurrence of BPH (25.35 and 16.70 per 1000 person-years, respectively). Compared to comparisons, peptic ulcer patients had a 1.45- and 1.26-fold BPH risk in multivariable Cox model and Fine and Gray model (95% CI 1.37–1.54 and 1.19–1.34). In age-stratified analysis, the highest risk of BPH was in 45–59 years (interaction p < 0.05). Regarding surgery types, peptic ulcer patients who underwent simple suture surgery (i.e.: with integrated vagus nerve) had a significant higher BPH risk than comparison (HR 1.50 and 95% CI 1.33–1.74; SHR 1.26 and 95% CI 1.07–1.48), while patients underwent truncal vagotomy/pyloroplasty showed a lower incidence of BPH. In this study, non-HP-infected male peptic ulcer patients were found to have an increased risk of subsequent BPH. Indicating that there might be a role of vagus nerve. Based on the limitations of retrospective nature, further studies are required.

CLINICAL EVALUATION OF TRIPLE AND QUADRUPLE HELICOBACTER PYLORI ERADICATION THERAPY IN PEPTIC ULCER PATIENTS WITH DIFFERENT ABO BLOOD GROUP PHENOTYPES

Objective: This study aimed to examine the pathological changes in gastric mucosa of Helicobacter pylori-infected peptic ulcer patients carrying different ABO phenotypes and to study the response to the 14 days’ standard triple therapy and 10 days’ quadruple therapy in peptic ulcer patients according to their ABO phenotypes.Methods: Interventional prospective randomized-controlled open-label study was performed on newly diagnosed patients with PUD. The H. pylori-positive patients were allocated into two major study groups in which they are subdivided according to ABO blood group phenotypes: Group 1 received standard H. pylori eradication triple therapy and Group 2 received standard H. pylori eradication quadruple regimen. Patients were monitored after 2 months for successful H. pylori eradication.Results: Chronic active gastritis was significantly high in patients carrying blood Group O phenotype (81.25%), while the atrophic gastritis and intestinal metaplasia were significantly high in patients carrying blood Group A phenotype (25.00% and 16.67%), respectively. 14 days’ triple therapy showed significantly lower eradication rate in H. pylori-infected peptic ulcer patients carrying blood Group O phenotype (p&lt;0.01), meanwhile higher response was found among patients with blood Group B. 10 days’ quadruple therapy produced a significant high eradication rate in H. pylori-infected patients carrying blood Group O than those with blood Group A (p&lt;0.01), but still both showed lower response compared to that in patients carrying blood Group B and AB phenotypes. Elderly patients showed significantly less healing efficacy than younger patients (p&lt;0.01), and the least healing rate was noticed in female patients after both regimens.Conclusion: Lower eradication rate in H. pylori-infected was noticed in peptic ulcer patients carrying blood Group O mainly than those with other blood groups and particularly those with duodenal Ulceri. 10 days’ quadruple therapy showed significant higher eradication rate in H. pylori infection and a better ulcer healing efficacy.

Up-regulated Th17 cell function is associated with increased peptic ulcer disease in Helicobacter pylori-infection

BackgroundDuring Helicobacter pylori (H. pylori) infection CD4+ T cells in the gastric lamina propria are hyporesponsive and polarized by Th1/Th17 cell responses controlled by Treg cells. The objective of this study was to determine the number of Th17 cells in gastric mucosa of patients with gastritis and peptic ulcer and determined the relationship between main virulence factor of H. pylori and Th17 cells. Methods and materialsA total of 89 H. pylori-infected gastritis patients, 63 H. pylori-infected peptic ulcer patients and 48 H. pylori-negative non-ulcer dysplasia patients were enrolled in this study. The number of Th17 was determined by immunohistochemistry. IL-8 and IL-17A expressions were determined by real-time polymerase chain reaction (qPCR). Also, the grade of chronic and active inflammation was investigated for involvement according to the density of neutrophils and mononuclear in gastric mucosal crypts, from one to all crypts. ResultsThe number of Th17 cells and the expression of IL-8 and IL-17A in infected patients were significantly higher than uninfected subjects. The number of Th17 cells and the expression of IL-8 and IL-17A in infected patients with peptic ulcer were significantly higher than patients with gastritis. Additionally, the numbers of Th17 cells as well as the expression of IL-8 and IL-17A were positively correlated with the degree of H. pylori density in infected patients with peptic ulcer, while this correlation was negative in infected patients with gastritis. The numbers of Th17 cells as well as the expression of IL-8 and IL-17A were positively correlated with the degree of chronic inflammation. ConclusionThe predominant Th17 cell responses may play a role in the pathogenesis of peptic ulcers disease in infected patients.

Evaluation of H. pylori - Eradication Triple Therapy in Iraqi Peptic Ulcer Patients according to ABO Phenotypes: a New Study

Infection with H. pylori is an up growing public health problem that affects approximately 50% of people in industrialized nations, and up to 80% in developing countries. Helicobacter pylori (H. pylori) infection had been identified as the main causes of peptic ulcer disease (PUD). Blood group A phenotype was associated with gastric ulcer (GU) and gastric carcinoma, while blood group O phenotype found to be associated with duodenal ulcer DU predominantly; however, no explanation for this association was received. This study was conducted to, first, determine the relationship between ABO blood groups and H. pylori infection in peptic ulcer patients, and second, to study the response to the two weeks H. pylori eradication triple therapy in peptic ulcer patients carrying different blood groups. A total of 84 patients who presented with symptoms of PUD and showed positive endoscopic examination of PUD and evidence of H. pylori infection by histology and stool antigen test, were divided into four groups according to ABO blood group phenotype. All H. pylori infected patients received standard H. pylori eradication triple therapy for 14 days duration. Patients were followed up by re- endoscopic examination after 2 months of treatment course. The percentage of H. pylori infection in patients with peptic ulcer disease carrying blood group O was higher than other blood group phenotype. In H. pylori-infected peptic ulcer patients, higher incidence of gastric ulcer (GU) was noticed among blood group A carriers, while higher incidence of duodenal ulcer (DU) was found among blood group O carriers when compare with other blood group phenotypes. Fourteen days triple therapy showed lower eradication rate in H. pylori infected blood group O peptic ulcer patients, while a higher response to the standard H. pylori eradication triple therapy was found among patients with blood group B phenotype.

Higher Serum Levels of Rheumatoid Factor and Anti-Nuclear Antibodies in Helicobacter Pylori-Infected Peptic Ulcer Patients

H. pylori infection has been associated with some autoimmune disorders. The aim of this study was to evaluate the serum concentrations of rheumatoid factor and anti-nuclear antibodies in H. pylori-infected peptic ulcer patients, H. pylori-infected asymptomatic carriers and a healthy control group. A Total of 100 H. pylori-infected peptic ulcer patients, 65 asymptomatic carriers and 30 healthy H. pylori-negative subjects (as a control group) were enrolled into study. Serum samples of participants tested for the levels of rheumatoid factor and anti-nuclear antibodies by use of ELISA. The mean serum levels of rheumatoid factor and anti-nuclear antibodies in peptic ulcer group was significantly higher in comparison to the control group (p<0.05). Although, the mean serum levels of rheumatoid factor and anti-nuclear antibodies in the asymptomatic carriers group was higher than those in the control group, the difference was not statistically significant. No significant differences were observed between peptic ulcer patients and asymptomatic carriers groups regarding the mean serum levels of rheumatoid factor and anti-nuclear antibodies. The mean serum levels of rheumatoid factor in men with peptic ulcer was significantly higher compared to the group of healthy men (p<0.05). Although in female of peptic ulcer patients or asymptomatic carriers groups, the mean serum levels of rheumatoid factor was higher than that in healthy women, but the differences were not statistically significant. Also, no significant differences were observed between men and women with peptic ulcer, asymptomatic carriers control groups based on the serum levels of anti-nuclear antibodies. The results showed higher serum levels of rheumatoid factor and anti-nuclear antibodies in H. pylori-infected patients with peptic ulcer disease which represent the H. pylori-related immune disturbance in these patients. Additional follow-up studies are necessary to clarify the clinical significance of these autoantibodies in patients with H. pylori infection.

Higher Circulating Levels of Anti-Phosphatidylserine Antibody in Peptic Ulcer Patients Infected with CagA-Positive Strains of Helicobacter pylori

The CagA-positive strains of H. pylori were associated with the higher risk of peptic ulcer (PU) diseases. The aim of this study was to evaluate the serum concentrations of anti-phosphatidylserine (anti-PS) and anti-cardiolipin (anti-CL) antibodies in H. pylori-infected PU patients, H. pylori-infected asymptomatic (AS) carriers, and a healthy non-infected group and also to determine their correlation with the bacterial virulence factor CagA. A total of 100 H. pylori-infected PU patients (80 patients were positive for anti-CagA antibody and 20 patients were negative for anti-CagA antibody), 65 H. pylori-infected AS carriers (40 subjects were positive for anti-CagA antibody and 25 subjects were negative for anti-CagA antibody) and 30 healthy H. pylori-negative subjects (as a control group) enrolled in the study. Serum samples of participants were tested for the levels of anti-PS and anti-CL antibodies by ELISA. The mean serum levels of anti-PS antibody in the PU group (13.46 +/- 2.90 RU/mL) was significantly higher than that observed in the H. pylori-infected AS group (1.57 +/- 0.38 RU/mL, p < 0.001) and healthy uninfected control group (0.77 +/- 0.32 RU/mL, p < 0.001). No significant difference was observed for the mean serum levels of anti-PS antibody between the AS group and uninfected control group. In the PU group, the mean serum levels of anti-PS antibody was significantly higher in patients with a positive test for anti-CagA antibody (16.46 +/- 3.55 RU/mL) in comparison to patients with a negative test for anti-CagA antibody (2.74 +/- 1.29 RU/mL; p < 0.01). The differences of the mean serum levels of anti-CL antibody were not significant between PU, AS, and control groups. These results showed higher serum levels of anti-PS antibody in patients with PU disease, especially in those infected with the CagA+ strains of H. pylori. Clinical significance of the anti-PS antibody in H. pylori-infected PU patients can be considered in additional follow up studies.

Serum Levels of High-Sensitivity C-Reactive Protein (hs-CRP) in Helicobacter pylori-Infected Peptic Ulcer Patients and Its Association with Bacterial CagA Virulence Factor

CRP is a marker of inflammation and infection of the gastric mucosa with Helicobacter pylori, which causes an inflammatory reaction. It has been reported that CagA(+) H. pylori strains induce more severe gastric inflammation and are also associated with higher risks of peptic ulcer and gastric cancer. The purpose of this study was to compare serum concentrations of hs-CRP in H. pylori-infected peptic ulcer (PU) patients, H. pylori infected asymptomatic (AS) carriers, and a healthy control group, and their association with bacterial virulence factor CagA. A total of 60 H. pylori infected PU patients (30 patients were positive for anti-CagA antibody and 30 were negative for anti-CagA antibody), 53 H. pylori-infected AS carriers (25 subjects were positive for anti-CagA antibody and 28 were negative for anti-CagA antibody), and 22 healthy H. pylori-negative subjects (as a control group) were enrolled in the study. Serum concentrations of hs-CRP were measured by use of an ELISA method. The mean serum level of hs-CRP in all PU patients (124.9±32.4 μg/dl) was significantly higher than that in all AS subjects (18.6±2.6 μg/dl; P<0.001) and the healthy uninfected control group (10.7±2.9 μg/dl; P<0.0001). Moreover, the mean serum level of hs-CRP in the AS group was significantly higher than that observed in the uninfected control group (P<0.04). No significant difference was observed between mean serum levels of hs-CRP of PU patients with positive test for anti-CagA antibody (132.6±49.4 μg/dl) and PU patients with negative test for anti-CagA antibody (117.1±42.9 μg/dl). Moreover, mean serum levels of hs-CRP were similar in AS subjects with positive test for anti-CagA (18.4±3.1 μg/dl) and in those who were negative for anti-CagA antibody (18.9±4.1 μg/dl). The results of this study showed that mean serum concentrations of hs-CRP in PU patients and in H. pylori infected AS carriers were higher than in a healthy control group. Although H. pylori infection is associated with higher serum levels of hs-CRP, serum concentrations of this inflammatory marker were not affected by expression of bacterial CagA virulence factor.

Enhanced levels of C-X-C chemokine, human GROalpha, in Helicobacter pylori-associated gastric disease.

C-X-C Chemokines play an important role for neutrophil extravasation through microvessels. Although the level of interleukin (IL)-8 is known to increase in the Helicobacter pylori-infected gastric mucosa, another C-X-C chemokine, GROalpha, has not been evaluated in the H. pylori-associated gastric mucosal injury. The present study was designed to investigate gastric contents of GROalpha in relation to those of IL-8 in the gastric mucosa of H. pylori-infected peptic ulcer patients. Thirty-eight patients with gastric ulcer and 41 with gastritis underwent endoscopy with informed consent and 49 were found to be H. pylori positive and 30 H. pylori negative. Biopsies from the gastric corpus were performed in each patient to examine the H. pylori colonization by bacterial culture, the rapid urease test and histological specimens as well as measurement of the contents of human GROalpha and IL-8. Helicobacter pylori infection was eradicated in 21 patients by triple therapy (lansoprazole 30 mg, amoxycillin 2.0 g, clarithromycin 600 mg; 2 weeks). The samples for GROalpha and IL-8 assay were homogenized in 0.02% aprotinin containing phosphate-buffered solution and the mucosal contents of GROalpha and IL-8 in the supernatants were quantified by sandwich enzyme immunoassay methods. The levels of GROalpha and IL-8 in H. pylori-positive gastric mucosa were significantly higher than those in the H. pylori-negative mucosa. There was a significant linear correlation between the levels of GROalpha and IL-8 (r = 0.798, P < 0.01). After the eradication of H. pylori by the triple therapy, the levels of GROalpha and IL-8 were significantly decreased. The GROalpha showed an increase in the H. pylori-positive gastric mucosa in a similar fashion as IL-8 contents, suggesting a pathogenetic role for GROalpha in H. pylori-associated gastric mucosal injury.