Pylori Positivity Research Articles

Is it Necessary to Send the Sleeve Gastrectomy Specimens to Pathology?

Laparoscopic sleeve gastrectomy (LSG) has become more popular among other bariatric procedures. The histopathologic changes in the sleeve gastrectomy specimens have not been widely investigated among the Turkish population. The purpose of this study was to delineate these histopathologic findings of the LSG specimens of morbidly obese patients from a single center. A prospective database of all patients who have undergone LSG at a single center was reviewed. Demographic parameters, that is, sex, age, and body mass index were examined. The incidence of Helicobacter pylori, and other pathologic findings in the specimens were studied. In total, 253 patients who had undergone LSG between the period spanning from April 2012 to January 2017 were included in the study. The 183 patients were female individuals and 70 patients were male individuals. The mean age at the time of operation was 38.5 years (range, 18 to 65 y). The mean body mass index was 47.7 kg/m. The pathologic findings were H. pylori positivity in 69 patients (27%), chronic active gastritis in 52 patients (20.5%), chronic gastritis in 135 patients (53.4%), and intestinal metaplasia in 5 patients (2%), whereas normal histopathologic findings were observed in 65 patients (25.7%). As regards surgical complications, the mortality rate was 0%, the staple-line leak was observed in 2 patients (0.8%), and intra-abdominal hemorrhage occurred in 2 patients (0.8%). The majority of patients who underwent LSG had pathologic findings in the resected specimens. With regard to the high incidence of pathologic findings in this study, we conclude that it is essential to send the gastrectomy materials for pathologic investigation after sleeve gastrectomy.

The role of E-cadherin expression and E-cadherin gene promoter hypermethylation in gastric carcinoma

Background Gastric cancer is the third fatal cancers worldwide after lung cancer and liver cancer. Various studies have been launched to detect the markers helping predict the prognosis of different forms of this disease, thus, modifying the treatment regimen accordingly. The aim of this study was to define the role of the E-cadherin protein in such an important issue. Patients and methods Sixty-four patients with gastric carcinoma were included in this study. For each case, representative sections from the tumor tissue and the adjacent noncancerous tissue were assessed for E-cadherin protein expression by immunohistochemistry and promoter methylation by the methylation-specific PCR analysis technique. The results were correlated with Helicobacter pylori positivity and other clinicopathological variables. Result The frequencies of reduced E-cadherin expression and E-cadherin gene methylation were significantly higher in diffuse than intestinal-type gastric carcinoma. However, no significant relationship was found when being correlated to the T-stage and the N-stage of the corresponding lesions. Conclusion Reduced E-cadherin expression and E-cadherin methylation are common alterations in gastric cancer. These gene alternations facilitate cell invasion and metastatic spread with no significant correlation to the T-stage nor the N-stage of the tumor.

Helicobacter pylori infection: association with dietary habits and socioeconomic conditions

Few studies have investigated factors possibly related to the source of Helicobacter pylori infection in humans. This was a retrospective study including a population of 201 H.pylori positive patients and 259 H. pylori negative subjects observed at a tertiary referral center in Apulia. The H. pylori status was assessed by urea breath test. Data on socio-demographic characteristics and the consumption of different foods and beverages in the last year were collected by a questionnaire. No significant relationship was found between H. pylori infection and gender or age, type of employment, working in direct contact with the public, residence, level of education or exposure to pets. No association between H.pylori status and the consumption of fish, fruits, legumes, honey, spices, meats, milk and milk products including some typical product of our area was found. The same was true for the consumption of several kind of beverage including green tea and wine. Cigarette smoking and living in the same house with H.pylori positive relatives were significantly associated with H. pylori positivity. The intake of uncooked seafood (mussels and other molluscs) as well as some uncooked vegetables such as tomatos,pepper,and chicory,municipal water and the number of cups of coffee consumed per week correlated significantly with H. pylori status. The consumption of raw vegetables purchased from street vendors and the consumption of meals outside home were also associated with H.pylori infection. Foods may represent an important route in the transmission of H. pylori among humans.

Prevalence of Helicobacter pylori infection in patients with gastric ulcer perforation admitted in a tertiary care centre

Background: Gastric ulcers are one of the most prevalent gastro intestinal diseases. Perforation of gastric ulcer is most common and dreaded complication of a gastric ulcer. Causes of gastric ulcer include Helicobacter Pylori, the NSAID, smoking and alcohol. Helicobacter Pylori infection is a curable cause of gastric ulcer. As prevalence of H. pylori differ in populations, prevalence of H. pylori in our population need to be assessed for determining treatment strategy for gastric ulcer.Methods: Cross sectional study conducted in patients operated for perforation peritonitis and diagnosed to have gastric ulcer perforation in a tertiary care centre. Full thickness biopsy was taken from gastric ulcer perforation edge during the surgery for perforation peritonitis. The biopsy was stained with Giemsa stain and looked for the presence of H. pylori.Results: Helicobacter pylori prevalence was 48.8% in our study. 8 females (out of 16) and 51 males (out of 105) had H. pylori positivity. 43 had history of smoking. Among them 20 were diagnosed to be having H. pylori positive. 26 persons had history of pan chewing. Among pan chewers 17 were H. pylori positive. Among 50 patients with history of alcoholism, 24 got H. pylori positivity. Among 40 patients with history of NSAIDs, 14 were positive for H. pylori.Conclusions: Prevalence of Helicobacter pylori in gastric ulcer perforation in present study is 48.8%. Helicobacter Pylori eradication should be added in treatment protocols for perforated gastric ulcers.

The need for a patient-tailored Helicobacter pylori eradication protocol prior to bariatric surgery.

ObjectiveHigh-quality data indicating the advantages of preoperative Helicobacter pylori screening and eradication as well the clinical outcomes of patients with and without H. pylori after bariatric surgery are lacking.MethodsIn total, 96 morbidly obese patients with H. pylori preparing for bariatric surgery were retrospectively reviewed.ResultsOf 96 biopsy specimens, 73 (76%) were positive for H. pylori on initial Giemsa staining. These patients were treated with the standard 7-day antibiotic treatment protocol corrected by the individual patient’s creatinine clearance rate and body mass index and received a 30% higher dose because of their H. pylori positivity. A linear correlation was found between the effective antibiotic dose and the BMI with a recurrence rate of only 2.1% (2/96 patients). The preoperative percent estimated weight loss before surgery (17%) and in the first year of follow-up (68%–88%) was statistically equal between H. pylori-positive and -negative patients. Two early postoperative infectious complications and two postoperative surgical complications occurred in the preoperatively H. pylori-positive patients.ConclusionsA patient-tailored H. pylori eradication protocol prior to bariatric surgery is mandatory to improve the eradication rate and reduce the incidence of postoperative complications in mostly asymptomatic H. pylori-positive bariatric candidates.

Significance of histologic grading using visual analogue scale in chronic gastritis

Introduction: Helicobacter Pylori and its association with carcinogenesis has significantly changed the field, establishing new guidelines for the detection of it. Carcinogenicity of H. Pylori necessitates grading the variables with visual analogue scale in accordance to Sydney system classification. The objectives of this study is to assess chronic gastritis and grade with visual analogue scale of Sydney classification. Methods: This is a prospective study of 3 years in which 50 gastric endoscopic mucosal biopsies were included in the study. Grading of the variables were done with reference to Sydney classification. Morphological changes in all cases were studied with special reference to atrophy, dysplasia, metaplasia, neutrophilic infiltration, lymphoid follicle formation, plasma cell infiltration & malignant changes along with identification of H. pylori. Results: Of the 50 cases studied for gastritis, 20 cases (44.4%) had Chronic H. pyloric gastritis followed by 18 cases (38.6%) of chronic gastritis with nonspecific features. Evaluation for graded variables showed 41 cases of gastritis with chronic inflammation of which 22 cases showed H. Pylori positivity. Of the 20 cases of gastritis showed inflammatory activity, 11 showed H. Pylori positivity. H. pylori was seen in 21 cases which could be graded. Of the 15 cases of gastritis showing surface epithelial damage, 9 cases showed H. pylori positivity. Chronic inflammation was most commonly observed and 22 of the 41 cases with chronic inflammation showed H.pylori positivity. Presence of H.pylori was an useful indicator in grading of gastritis. Conclusion: Visual analogue scale is an useful indicator to histologically grade chronic gastritis and detection of H. Pylori and helps in better evaluation of patient in preventing the further progression of the disease.

Helicobacter pylori infection is positively associated with an increased BMI, irrespective of socioeconomic status and other confounders: a cohort study.

Data on the association of Helicobacter pylori infection and BMI are conflicting. The fact that both H. pylori infection and BMI are associated with low socioeconomic status (SES) makes this relationship difficult to characterize. We aimed to evaluate the association between BMI and H. pylori infection after adjusting for multiple covariates. We analyzed a cohort of 235 107 individuals aged 18 years or older, who performed a C urease breath test (C-UBT), from 2007 to 2014. Data on BMI, age, sex, SES, ethnicity, and medications were extracted from a nationwide population-based database. BMIs were classified according to the WHO recommendations: underweight (<18.5 kg/m), normal weight (18.5-24.9 kg/m), overweight (25-29.9 kg/m), obese class I (30-34.9 kg/m), and obese class II or more (>35 kg/m). The positivity rate for H. pylori among underweight, normal weight, overweight, and obese class I and class II or more was 55.6, 58.5, 63.0, 64.5, and 65.5%, respectively (P<0.001, Plinear trend 0.007). The association between BMI and H. pylori infection was significant across all SES, sex, ethnicity, and age categories. After adjusting for age, sex, ethnicity, and SES, being overweight and obese class I and class II or more were associated significantly with H. pylori positivity: odds ratio 1.13 [95% confidence interval (CI): 1.11-1.15], 1.14 (95% CI: 1.11-1.17), and 1.15 (95% CI: 1.11-1.19), respectively, P value less than 0.001 for all. Among individuals who were referred to a C-UBT by primary care physician, after adjusting for multiple covariates including SES, we found a positive association between H. pylori infection and an increased BMI.

Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy.

In this study, we aimed to describe the findings associated with gastric pathology and to identify the prevalence of Helicobacter pylori (H. pylori) in patients undergoing laparoscopic sleeve gastrectomy (LSG). Gastric specimens of a total of 291 patients (225 females, 66 males; mean age: 42 years; range: 18 to 60 years) who underwent LSG for the treatment of morbid obesity were analyzed. Histopathologic diagnoses and their relation with body mass index (BMI), age and gender were evaluated. In the histopathological examination of sleeve specimens, 58 patients (19.93%) had chronic gastritis, 102 patients (35.05%) had chronic active gastritis, 27 patients (9.27%) had follicular gastritis, 47 patients (16.15%) had active follicular gastritis, one patient (0.34%) had a glomus tumor, and one patient (0.34%) had a gastrointestinal stromal tumor. The gastric mucosa was normal in 55 patients (18.90%). Intestinal metaplasia was detected in eight patients (2.74%). The H. pylori test result was positive in 126 patients (43.29%). There was no statistically significant difference between the pathological diagnoses and age and sex of the patient. Our study results suggest that the prevalence of chronic active gastritis and H. pylori positivity is high in morbidly obese Turkish patient population. No significant difference was found between the pathological diagnosis in obese patients with LSG operation in terms of age and sex.

Comparison of the Prevalence of Helicobacter pylori Infection Between the Exclusively Breastfed and Formula- or Mixed-Fed Infants in the First Six Months of Life

Background: Helicobacter pylori is a common gastrointestinal pathogen in human. The mechanism of its acquisition and transmission is unclear, although the most likely mode of transmission is fecal-oral or oral-oral. Most of infections occur in childhood. The current cohort assessed the prevalence of infection in infants with different feeding strategies (exclusive breastfeeding, formula, or mixed feeding). Methods: The current study was carried out in Vali-Asr hospital of Imam Khomeini hospital complex, Tehran, Iran, from 2012 to 2015.The study population included infants born in this hospital and registered in breastfeeding research center during the first 6 months of life. They were compared in 2 groups; exclusively breastfed, and formula or mixed fed. Mothers’ H. pylori infection was checked serologically using the enzyme-linked immunosorbent assay (ELISA) technique and those of infants by monoclonal antibody test using ELISA technique on stool samples at 1st and 6th month of life. Results: A total of 102 infants in 2 groups (54 exclusively breastfed and 48 formula or mixed fed) completed the study. Mothers’ serological assessments were positive in 68% of exclusively breast-fed subjects and 60% of formula or mixed fed subjects. All 1-month-old infants were negative for the infection and in the 6-month-old infants 10 cases (18.5%) were positive, 1 case was at borderline in the exclusively breastfed, and 13 cases (27%) were positive in formula- or mixed-fed subjects. This difference was not statistically significant (P = 0.302). The Mantel-Hanzel test was used to find a relationship in H. pylori positivity in mothers and infants during the first 6-month of life in each of the 2 groups. It was found that out of 37 serologically positive mothers in the breastfed group, 8 infants (22%) were H. pylori positive and in the formula and mixed-fed group, of 29 serologically positive mothers 10 infants (34%) were also H. pylori positive, but the difference between the groups was not statistically significant (P = 0.727). It meant that the prevalence of infantile H. pylori infection was similar in the 2 groups. Conclusions: The current study findings showed that exclusive breastfeeding had no role in protection or facilitation of H. pylori infection.

Helicobacter pylori colonization and obesity \u2013 a Mendelian randomization study

Obesity is associated with substantial morbidity, costs, and decreased life expectancy, and continues to rise worldwide. While etiological understanding is needed for prevention, epidemiological studies indicated that colonization with Helicobacter pylori (H. pylori) may affect body mass index (BMI), but with inconsistent results. Here, we examine the relationship between H. pylori colonization and BMI/obesity. Cross-sectional analyses were performed in two independent population-based cohorts of elderly from the Netherlands and Germany (n = 13,044). Genetic risk scores were conducted based on genetic loci associated with either H. pylori colonization or BMI/obesity. We performed a bi-directional Mendelian randomization. Meta-analysis of cross-sectional data revealed no association between anti-H. pylori IgG titer and BMI, nor of H. pylori positivity and BMI. Anti-H. pylori IgG titer was negatively associated with obesity (OR 0.99972; 95% CI 0.99946-0.99997, p = 0.03) and with obesity classes (Beta −6.91 •10−5; 95% CI −1.38•10−4, −5.49•10−7, p = 0.048), but the magnitude of these effects was limited. Mendelian randomization showed no causal relation between H. pylori genetic risk score and BMI/obesity, nor between BMI or obesity genetic risk scores and H. pylori positivity. This study provides no evidence for a clinically relevant association between H. pylori and BMI/obesity.

The Relationship Among Helicobacter pylori Positivity, Acute Phase Reactants, Blood Groups and Tumor Markers in Urea Breathe Test

Objective: In this study, positivity of Helicobacter pylori which is very common health problem for human, was examined by C 14 urine breath test and in this group also blood samples, acute phase reactants, tumor markers were examined for the specific correlation Methods: Blood samples of 130 patients which was examined by C 14 urine breath test, were drawn. In order to perform the urea breath test, which was the basis of our study, the patient was starved for at least 6 hours before the test and did not use antibiotics 1 month before and active acid inhibitors 1 week before. Following a 6-hour hunger period, 37 kBg of 14 C-urea capsules 50 mL water were given. Breath samples were collected at 10 minutes with a dry cartridge system (BREATHCARD). In this group also blood samples, acute phase reactants (crp, aso, sedim, rf), tumor markers (CEA, CA 19-9, CA 15-3) were examined for the specific correlation. Results: Test results for 57 of 130 patients were found to be positive (43.84%) while it was found to be negative (56.16%) in 73 patients. Reference ranges for blood parameters were 13.6-17.2 for HGB, 39.5-50.3 for HCT, 5.2-12.4 for WBC, 0-200 for ASO, 3.02 for CRP, 0-15 for RF, 0-3 for CEA, 0-35 for CA 19-9, 0-31.3 for CA 15-3 The mean age of patients with negative H. pylori infection was 39.41 and the positive was 39.03. 35 of the 57 H. pylori positive patients in the total 130 patients were female (61.4%), 22 were male (38.6%); Of 73 negative patients, 44 were female (60.3%) and 29 were male (39.7%). There was no sex-related collagen of H. pylori . 22 persons (38.6%) of the positive H. pylori blood group were found in the blood group A, 9 (15.8%) were in the blood group B, 11 (19.3%) were in the group AB and 15 (26.3%) were in the group O. It was observed that 21 patients (28.8%) in negatives of H. pylori were blood group A, 17 patients (23.3%) were blood group B, 14 patients (19.2%) were blood group AB and 21 patients (28.8%) were group O. No significant difference was observed between blood groups and H. pylori infection with Rh factor, and no linkage was detected. Conclusion: As a result, there were no significant correlation were found between acute phase reactants, tumor markers and ABO/ Rh blood groups for H. pylori positives.

Clinical, endoscopic, pathologic and prognostic factors of primary gastric lymphoma

Objective To explore the clinical, endoscopic, pathologic and prognostic characteristics of primary gastric lymphoma (PGL) and to improve the level of diagnosis and treatment. Methods Sixty-three patients who were confirmed as PGL with operation and endoscopic biopsy pathology during January 2001 to December 2010 were retrospectively analyzed with respects of clinical, endoscopic and pathologic features. Survival analysis and prognosis were evaluated by kaplan-Meier and Cox proportional hazard model, respectively. Results In 63 PGL patients, the numbers of male and female were 40 and 23, respectively, and the average age was (59.8±13.3)years. The major symptoms were abdominal pain, abdominal distension, and gastrointestinal hemorrhage, accounting for 47.6%(30/63), 17.5%(11/63), and 17.5%(11/63), respectively. There were 39 (61.9%) PGL patients with endoscopic performance for ulcers, 34(54.0%) cases involved the gastric stomach antrum. The most immunohistochemistry analyses were diffuse large B-cell lymphoma (DLBCL) (71.4%, 45/63), followed by mucosa-associated lymphoid tissue (MALT) lymphoma (22.2%, 14/63). The frequency of Helicobacter pylori (H.pylori) positivity was lower in patients with DLBCL than that in patients with MALT lymphoma (37.8%(17/45) vs 10/14, χ2=4.872, P=0.027). The accumulate survival rates of one, three and five years were 74.6%, 63.5%, 55.6%, respectively, and the average survival time was (41.5±3.0) months (95% confidence interval (CI) 35.7 to 47.4 months) in PGL patients. There was no difference in the average survival time between DLBCL patients treated with surgery combined chemotherapy and those with surgery or chemotherapy alone (38.33±5.21) months vs (50.17±8.98) months vs (41.39±4.40) months, P>0.05). The patients diagnosed as DLBCL with H.pylori positive had longer average survival time than those with H.pylori negative ((51.90±4.30) months vs (33.30±4.50) months, t=-4.004, P<0.01). Conclusions Male patients with PGL are slightly more than female. Abdominal pain is the most frequent symptom. Ulcerative lesions are the most common endoscopic demonstrations mostly at stomach sinus. DLBCL is the most pathologic characteristic. There is no significant difference in the survival rate between patients treated with surgery combined with chemotherapy and those treated with surgery or chemotherapy alone. Key words: Gastric lymphoma; Lymphoma, large B-cell, diffuse; MALT lymphoma; Prognostic factor

Endoscopic gastric mucosal atrophy distinguishes the characteristics of superficial esophagogastric junction adenocarcinoma.

Western studies have suggested two distinct etiologies of esophagogastric junction (EGJ) cancer: Helicobacter pylori-associated atrophic gastritis and non-atrophic gastric mucosa resembling esophageal adenocarcinoma. The present study investigated whether endoscopic gastric mucosal atrophy can distinguish between these two types of EGJ adenocarcinoma. Data were collected from patients with Siewert type II, T1 EGJ adenocarcinoma who underwent endoscopic or surgical resection at eight Japanese institutions in 2010-2015. Clinicopathological characteristics of EGJ cancers with and without endoscopic gastric mucosal atrophy were compared. EGJ was defined as the lower end of the palisade vein and/or the top of the gastric folds. Of the 229 patients identified, 161 had endoscopic gastric mucosal atrophy and 68 did not. The latter group was younger (64 vs 70years, P=0.000); had a higher proportion of patients negative for H.pylori (90% vs 47%, P<0.0001); and had higher rates of gastroesophageal reflux disease symptoms (43% vs 12%, P=0.017), mucosal breaks (25% vs 15%, P=0.009), Barrett's esophagus (BE, 78% vs 42%, P<0.0001), and tumors above the EGJ (81% vs 19%, P<0.0001) and on the upper-right side (74% vs 38%, P<0.0001) than the former group. Multivariate analysis showed that H.pylori positivity (odds ratio [OR]=13.0, P<0.001), long-segment BE (OR=0.025, P=0.033), and longitudinal (OR=8.6, P=0.001) and circumferential (OR=4.7, P=0.006) tumor locations were independently associated with gastric mucosal atrophy. Two distinct types of EGJ cancer were identified, with and without endoscopic gastric mucosal atrophy. These types were associated with different tumor locations.

Helicobacter pylori infection: a predictor of vomiting severity in pregnancy and adverse birth outcome

BackgroundNausea and occasional vomiting in early pregnancy is common. Why some women experience severe nausea and occasional vomiting in early pregnancy is unknown. Causes are multifactorial and only symptomatic treatment options are available, although adverse birth outcomes have been described. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy.ObjectiveThe purpose of this study was to investigate the association of H pylori with vomiting severity in pregnancy and its effect on birth outcome.Study DesignWe assembled a population-based prospective cohort of pregnant women in The Netherlands. Enrolment took place between 2002 and 2006. H pylori serology was determined in mid gestation. Women reported whether they experienced vomiting in early, mid, and late gestation. Maternal weight was measured in the same time periods. Birth outcomes were obtained from medical records. Main outcome measures were vomiting frequency (no, occasional, daily) and duration (early, mid, late gestation), maternal weight gain, birthweight, small for gestational age, and prematurity. Data were analyzed with the use of multivariate regression.ResultsWe included 5549 Women, of whom 1932 (34.8%) reported occasional vomiting and 601 (10.8%) reported daily vomiting. Women who were H pylori-positive (n=2363) were more likely to report daily vomiting (adjusted odds ratio, 1.44; 95% confidence interval, 1.16-1.78). H pylori positivity was associated with a reduction of total weight gain in women with daily vomiting (adjusted difference, -2.1 kg; 95% confidence interval, -2.7 to -1.5); infants born to women with H pylori and daily vomiting had slightly reduced birthweight (adjusted difference -60g; 95% confidence interval, -109 - -12) and an increased risk of being small for gestational age (adjusted odds ratio, 1.49; 95% confidence interval, 1.04-2.14). H pylori and daily vomiting did not significantly affect prematurity rate.ConclusionThis study suggests that H pylori is an independent risk factor for vomiting in pregnancy. In women with daily vomiting, H pylori is also associated with low maternal weight gain, reduced birth weight, and small for gestational age. Because effective treatments for severe nausea and occasional vomiting in early pregnancy are currently lacking, the effect of H pylori eradication therapy on nausea and occasional vomiting in early pregnancy symptom severity should be the target of future studies.

VacA and CagA Status as Biomarker of Two Opposite End Outcomes of Helicobacter pylori Infection (Gastric Cancer and Duodenal Ulcer) in a Moroccan Population.

Helicobacter pylori (H. pylori) infection induces inflammation of the gastric mucosa, which may progress to precancerous lesions leading to gastric cancer. Pathological determinism is associated to some virulence genes of the bacterium, notably the vacA and cagA genes. The present study aimed to determine the H. pylori genotypes distribution and their association with sex, age and gastric diseases in a Moroccan population. Gastric biopsy was taken from 1079 consenting patients. The specimens were processed by PCR to identify H. pylori and to determine the genotypic profile by PCR characterizing vacA s, vacA m and vacA i regions directly from biopsies H. pylori positives. VacA genotyping revealed the predominance of vacA m2 (53.2%), vacA s2 (52.9%) and vacA i2 (52%). The most virulent vacA alleles (s1, i1 and m1) are more predominant in men (47.3%, 41.9% and 46.1% respectively) than in women (38.3%, 33.3% and 37% respectively). However, the association between vacA genotypes and age did not reach a statistical significant value. Logistic regression analysis results show that vacA i1m1 and vacA i1m2 genotypes were strongly associated with the risk of GC, the Odds Ratio (95% confidence interval) was 29.73 [5.08–173.73] and 9.17 [2.06–40.82] respectively, while vacAs1/cagA+ seems to be a risk factor for DU since it is inversely associated with GC (OR was 0.13 [0.02–0.75]. The results of this study suggest that vacA i1 genotype independently to vacAm status may be of a clinical usefulness and will help to identify patients at a high risk of GC development.

Helicobacter pylori Infection and Risk Factors in Relation to Allergy in Children.

PurposeTo analyze presence of Helicobacter pylori infection and environmental risk factors among children with and without allergy.MethodsParents of children at primary health care centres/kindergartens and allergologist consultation were asked to answer a questionnaire and to bring a faecal sample. H. pylori infection was detected by monoclonal stool antigen test. Prevalence of H. pylori infection and risk factors were compared between individuals with and without allergy using χ2 test, ANOVA test and parameters and logistic regression.ResultsAmong 220 children (mean age, 4.7 years; ±standard deviation 2.3 years) H. pylori positivity was non-significantly lower among patients with allergy (n=122) compared to individuals without allergy (n=98): 13.9% (17/122) vs. 22.4% (22/98); p=0.106. In logistic regression analysis presence of allergy was significantly associated with family history of allergy (odds ratio [OR], 8.038; 95% confidence interval [CI], 4.067–15.886; p<0.0001), delivery by Caesarean section (OR, 2.980; 95% CI, 1.300–6.831; p=0.009), exclusive breast feeding for five months (OR, 2.601; 95% CI, 1.316–5.142; p=0.006), antibacterial treatment during the previous year (OR, 2.381; 95% CI, 1.186–4.782; p=0.015).ConclusionPrevalence of H. pylori infection did not differ significantly between children with and without allergy. Significant association of allergy with delivery by Caesarean section and antibacterial therapy possibly suggests the role of gastrointestinal flora in the development of allergy, while association with family history of allergy indicates the importance of genetic factors in the arise of allergy.

Histomorphological Spectrum of Duodenal Pathology in Functional Dyspepsia Patients.

Functional Dyspepsia (FD) is one of the most common causes of gastrointestinal symptoms aetiology of which is poorly understood. To study duodenal histomorphological features and their relationship with Helicobacter pylori (H Pylori) infection in patients of FD. This case control study included 50 cases of FD patients selected according to Rome III criteria and 30 age and sex matched controls. These were subjected to oesophago-gastro-duodenoscopy, rapid urease test for detection of H. pylori on gastric antral biopsy and duodenal biopsy from second part of duodenum for histopathological evaluation by light microscopy. Ten antral urease positive cases of FD with highest Intraepithelial Lymphocyte Count (IEL) were subjected to Immunohistochemistry (IHC). Duodenal inflammation was an invariable feature noted in FD. Morphological spectrum consisted of increased IEL in 72%, increased duodenal eosinophils in 92%, presence of focal villous atrophy in 16%, lymphoid aggregates, colonic metaplasia, and duodenal H. pylori infection in 4% each. Gastric H. pylori positivity was noted in 48% cases of FD. Increased duodenal IEL count and duodenal eosinophilia was noted in 75%, 87.5% such cases. Same was noted respectively, with 61.5% and 95.15% cases with gastric H. pylori negativity. In cases of FD, duodenal IEL and eosinophil count in lamina propria showed statistically significant rise when compared with control and had positive correlation with gastric H pylori infection. On IHC, increased expression of CD 8 was noted in duodenal IEL and lymphocytes in lamina propria as compared to CD4. Our study provided some insight in pathogenesis of FD and role of H. pylori in its aetiology.

Association of medications for lifestyle-related diseases with reflux esophagitis

BackgroundBecause of a change in lifestyle, especially adoption of westernized eating habits, lifestyle-related diseases have become increasingly prevalent. The aim of this study was to investigate the association of medications for lifestyle-related diseases with reflux esophagitis (RE).MethodsWe conducted a hospital-based, cross-sectional retrospective study of consecutive outpatients who received an upper gastrointestinal endoscopy in our department from February 2008 to November 2014, which was performed by one specialist who was a member of the Japan Gastroenterological Endoscopy Society. We investigated the patient profile, Helicobacter pylori (H. pylori) infection status, medications for lifestyle-related diseases (including calcium channel blockers, statins, and bisphosphonates), and upper gastrointestinal endoscopic findings (RE, hiatal hernia, Barrett’s mucosa, and endoscopic gastric mucosal atrophy [EGA]). Patients with gastrectomy, peptic ulcer disease, gastric or esophageal malignant disease, and those who used proton pump inhibitors or histamine-2 receptor antagonists were excluded. We divided the subjects into a group without RE (RE(−)) and a RE (RE(+)) group as judged by endoscopy, and investigated the risk factors for RE.ResultsOf 1,744 consecutive cases, 590 cases (300 males and 290 females; mean age 60.5±13.2 years) were eligible. RE(−) and RE(+) cases numbered 507 and 83, respectively. Bivariate analysis showed significant positive associations of RE with male sex, body mass index (BMI), calcium channel blockers, Barrett’s mucosa, hiatal hernia and negative associations of RE with H. pylori positivity, EGA. Multivariate analysis showed significant positive associations of RE with BMI (odds ratio [OR]: 1.20, 95% confidence interval [95% CI]: 1.10–1.29), use of calcium channel blockers (OR: 2.12, 95% CI: 1.16–3.87), Barrett’s mucosa (OR: 2.97, 95% CI: 01.64–5.38), hiatal hernia (OR: 3.13, 95% CI: 1.79–5.47) and negative associations of RE with H. pylori positivity (OR: 0.20, 95% CI: 0.07–0.57), use of statins (OR: 0.42, 95% CI: 0.18–0.96), and EGA (OR: 0.83, 95% CI: 0.70–0.98).ConclusionCalcium channel blockers were positively associated with RE and statins were negatively associated with RE, while bisphosphonates were not associated with RE.

A Rare Case of Simultaneous Metastatic Disease of Renal Cell Carcinoma to the Stomach, Bone, and Lungs

79 year old male patient with past medical history of stage 4 renal cell carcinoma status post nephrectomy and radiation presented with melena. His vital signs were normal upon presentation. Physical exam was unremarkable except for mild left sided abdominal pain without guarding or rebound. He was found to have a hemoglobin of 5.9g/dL from a baseline of 9g/dL, 2 months ago. Upper endoscopy showed a non bleeding non ulcerated vessel in the second portion of the duodenal bulb. This was consistent with a Dieulafoy's lesion (figure 1). It was treated with epinephrine injection and one hemoclip. In stomach we noted two ulcerated friable masses (3 cm and 4 cm). Biopsy showed Clear Cell carcinoma consistent with renal origin. Antral biopsy was remarkable for gastritis with reactive changes and H. pylori positivity. Imaging was performed to rule out further metastatic disease. CT showed numerous pulmonary metastatic nodules, a lesion in the right kidney, a lesion in the acetabulum with large destructive metastasis, and multiple abdominal lymph nodes and small enhancing peritoneal nodules with concern for metastatic disease. The patient was discharged to rehabilitation in a stable condition with appropriate outpatient follow up. Three weeks later he returned with hypoxia and was found to have a pulmonary embolus initially treated with Enoxaparin however he again developed melena, requiring 2 units pRBCs and was discharged to rehab. Seventeen days later he returned with additional GI bleeding with Hb of 7.2g/dL requiring 2 uPRBCs and was enrolled in hospice care. Renal cell carcinoma can metastasize to multiple organs. The most common sites are the liver, brain, bones, and lung. Metastatic disease to the stomach is very rare (0.2-4%). Our patient had metastatic disease in both of these organs as well as bone and lungs. This shows that RCC remains unpredictable in its pattern of spread. Oncologists should anticipate any pattern of presentation of RCC metastasis, and this report emphasizes the importance of close follow- up and a high suspicion for odd areas of metastasis.Figure 1Figure 2Figure 3

The gastric acid pocket is attenuated in H. pylori infected subjects

ObjectiveGastric acid secretory capacity in different anatomical regions, including the postprandial acid pocket, was assessed in Helicobacter pylori positive and negative volunteers in a Western population.DesignWe studied 31 H. pylori...