Pylori-specific IgG Research Articles

Comparison of enzyme immunoassays detecting Helicobacter pylori specific IgG in serum and saliva with endoscopic and biopsy findings in patients with dyspepsia

Purpose: To compare the performance of two indirect enzyme-linked immunosorbent assays (ELISA) detecting Helicobacter pylori (HP)-specific IgG antibodies in serum and saliva with endoscopic observations and histologic findings of biopsies from dyspeptic patients, in an area of high HP prevalence. Materials and Methods: Sera, saliva and antral biopsies were obtained from 55 dyspeptic patients. IgG antibodies against HP were assayed in sera and saliva utilizing two indirect ELISAs. Biopsies were processed according to standard procedures in order to detect histological changes and the presence or absence of Helicobacter pylori. Laboratory data thus obtained were compared and statistically analyzed. Results: Forty-two (76.36%) biopsies were positive for HP. The organisms were detected in 4 of 16 (25%) cases with normal endoscopic findings, in all 16 cases of gastritis and in 22 of the 23 (95.6%) cases of duodenal ulcers (DU). Serum and saliva HP-specific IgG antibodies were detected in 4 normal cases with positive biopsies, in 12 and 14 cases of gastritis, respectively, and in all 22 (100%) biopsy positive cases of DU. The sensitivities of the serum and saliva tests were 90.5% and 95%, respectively, while the specificities were 84.5% and 70%, respectively. Conclusion: Due to their high sensitivity and specificity in diagnosing HP-associated DU and gastritis, serum and saliva antibody testing seems to offer a valuable alternative to invasive procedures especially in areas of high HP prevalence such as ours; saliva antibody testing is simple and practical especially in children and in difficult patients who resent venipuncture.

The Effect of Helicobacter Pylori and Economic Status on Growth Parameters and Leptin, Ghrelin, and Insulin-Like Growth Factor (IGF)-I Concentrations in Children

It was suggested that gastric colonization with Helicobacter pylori (H. pylori) was associated with suboptimal nutrition and growth in childhood. Furthermore, several studies indicated a relationship between H. pylori colonization and alterations in the circulating levels of growth-related molecules (GRM). Accordingly, in this study, we investigate the effect of H. pylori infection on GRMs and on the growth of healthy school children, taking into consideration the effect of their economic status (ES) and anthropometric indices of their parents. To acquire sociodemographic and anthropometric nutritional parameters and to detect H. pylori-specific serum IgG antibodies and growth-related molecules, we evaluated a total of 473 children attending four different primary and secondary schools in Istanbul. Subsequently, we assessed the effect of H. pylori on growth-related parameters (weight for age SDS, height for age SDS, BMI SDS, TSF, and waist-to-hip ratio) and on GRMs (leptin, ghrelin, and insulin-like growth factor-1 (IGF-1)), controlling for age, gender, family income, household crowding (HC), breastfeeding, maternal and paternal BMI SDS, and midparental height SDS with complex statistical models. Of the 473 children (275 F/198 M, age 6-15 years; mean: 10.3 ± 0.1 years), 161 (34%) were H. pylori-positive. The prevalence of H. pylori was significantly higher in lower economic status (ES) groups, in children living in crowded houses, and in older age groups. Using simple statistical models, we did not find any significant associations between H. pylori infection and the growth parameters. However, in complex models for height for age SDS and for weight for age SDS, there was a significant interaction between H. pylori infection status and ES. Whereas in H. pylori-positive subjects, mid-income family children were both taller and heavier than the low-income group, there was no such an association in H. pylori-negative subjects. Among biochemical parameters, only ghrelin levels were associated with H. pylori infection in all models. Leptin levels were associated with HC in girls, whereas none of the parameters was significantly associated with leptin levels in boys. For IGF-1 levels, for boys, age and maternal BMI, and for girls, age and HC were significantly associated with IGF-1 levels. We suggest that H. pylori may impair growth significantly only in susceptible children where unfavorable socioeconomic conditions facilitate its action, probably through mechanisms, at least in part, involving growth-related molecules.

The chemokine receptor CXCR5 is pivotal for ectopic mucosa-associated lymphoid tissue neogenesis in chronic Helicobacter pylori-induced inflammation

Ectopic lymphoid follicles are a key feature of chronic inflammatory autoimmune and infectious diseases, such as rheumatoid arthritis, Sjögren's syndrome, and Helicobacter pylori-induced gastritis. Homeostatic chemokines are considered to be involved in the formation of such tertiary lymphoid tissue. High expression of CXCL13 and its receptor, CXCR5, has been associated with the formation of ectopic lymphoid follicles in chronic infectious diseases. Here, we defined the role of CXCR5 in the development of mucosal tertiary lymphoid tissue and gastric inflammation in a mouse model of chronic H. pylori infection. CXCR5-deficient mice failed to develop organized gastric lymphoid follicles despite similar bacterial colonization density as infected wild-type mice. CXCR5 deficiency altered Th17 responses but not Th1-type cellular immune responses to H. pylori infection. Furthermore, CXCR5-deficient mice exhibited lower H. pylori-specific serum IgG and IgA levels and an overall decrease in chronic gastric immune responses. In conclusion, the development of mucosal tertiary ectopic follicles during chronic H. pylori infection is strongly dependent on the CXCL13/CXCR5 signaling axis, and lack of de novo lymphoid tissue formation attenuates chronic immune responses.

Sublingual Immunization Protects against Helicobacter pylori Infection and Induces T and B Cell Responses in the Stomach

Sublingual (SL) immunization has been described as an effective novel way to induce mucosal immune responses in the respiratory and genital tracts. We examined the potential of SL immunization against Helicobacter pylori to stimulate immune responses in the gastrointestinal mucosa and protect against H. pylori infection. Mice received two SL immunizations with H. pylori lysate antigens and cholera toxin as an adjuvant, and after challenge with live H. pylori bacteria, their immune responses and protection were evaluated, as were immune responses prior to challenge. SL immunization induced enhanced proliferative responses to H. pylori antigens in cervicomandibular lymph nodes and provided at least the same level of immune responses and protection as corresponding intragastric immunization. Protection in SL-immunized mice was associated with strong H. pylori-specific serum IgG and IgA antibody responses in the stomach and intestine, with strong proliferation and gamma interferon (IFN-γ) and interleukin-17 (IL-17) production by spleen and mesenteric lymph node T cells stimulated with H. pylori antigens in vitro, and with increased IFN-γ and IL-17 gene expression in the stomach compared to levels in infected unimmunized mice. Immunohistochemical studies showed enhanced infiltration of CD4(+) T cells and CD19(+) B cells into the H. pylori-infected stomach mucosa of SL-immunized but not unimmunized H. pylori-infected mice, which coincided with increased expression of the mucosal addressin cell adhesion molecule (MAdCAM-1) and T and B cell-attracting chemokines CXCL10 and CCL28. We conclude that, in mice, SL immunization can effectively induce protection against H. pylori infection in association with strong T and B cell infiltration into the stomach.

Helicobacter pylori infection is associated with decreased serum levels of high density lipoprotein, but not with the severity of coronary atherosclerosis

ObjectiveThe objective of this survey was to study the association between Helicobacter pylori infection and the severity of coronary atherosclerosis.MethodsThe study population consisted of 961 consecutive patients (711 males and 250 females) who underwent coronary angiography for suspected or known coronary atherosclerosis. The patients' body mass index, blood pressure, the blood lipid, blood glucose, leukocyte count (109/L), neutrophil count (109/L), and Helicobacter pylori-specific IgG antibodies were performed. Coronary angiograms were scored according to vessel score and Gensini's score.ResultsA significant association between H. pylori infection and coronary atherosclerosis as well as its severity was not find in this cross section study (p = 0.858). And, the level distribution of vessel score (p = 0.906) and Gensini's score (p = 0.905) were similar in the seropositivity group and seronegativity group of Helicobacter pylori infection. However, the level of fasting high-density lipoprotein cholesterol (mmol/L) (p = 0.013) was significantly lower in the seropositivity group than that in the seronegativity group of Helicobacter pylori infection.ConclusionsIn conclusion, in the present study, a significantly correlation between Helicobacter pylori seropositivity and angiographically evaluated severity of atherosclerosis was not find. And, the present study showed a good correlation between Helicobacter pylori infection and decreased HDL cholesterol. However, the exact mechanisms need further study.

Increased Cerebrospinal Fluid Helicobacter Pylori Antibody in Alzheimer’s Disease

Background: Helicobacter pylori (H. pylori) infection may play a role in Alzheimer's disease (AD). Aim: A prospective, nonrandomized, comparative study was car- ried out to examine the levels of anti-H. pylori-specific IgG antibodies in the cerebrospinal fluid (CSF) and serum of AD patients, compared with those of age-matched cognitively normal controls. Patients: CSF was aspirated from 27 AD patients and 27 age-matched cognitively normal patients with prostate hyperplasia or long-bone fractures necessitating surgery after epidural anesthesia. Serum samples were obtained from AD patients and the day before surgery from controls. Methods: CSF and serum anti-H. pylori IgG concentrations were measured by means of an enzyme-linked immunosorbent assay. Results: The mean concentration of anti-H. pylori-specific IgG was significantly greater in (a) the CSF of AD patients (10.53 ± 12.54 U/mL) than in controls (8.63 ± 8.01 U/mL, p = 0.047), and (b) the serum of AD patients (30.44 ± 33.94 U/mL) than in controls (16.24 ± 5.77 U/mL, p = 0.041). CSF anti-H. pylori IgG antibodies correlated with the degree of severity of the disease. Conclusion: H. pylori-specific IgG antibody levels are significantly increased in CSF and serum of AD; its titer in CSF might reflect the AD severity, thereby supporting a role for this common infection in the pathobiology of the disease.

Helicobacter pylori IgG Antibodies in Aqueous Humor and Serum of Subjects With Primary Open Angle and Pseudo-exfoliation Glaucoma in a South Indian Population

A prospective, nonrandomized, comparative study was carried out to investigate levels of anti-Helicobacter pylori-specific IgG antibodies in the aqueous humor and serum of patients with primary open angle glaucoma (POAG), exfoliation syndrome [pseudo-exfoliation glaucoma (PXFG)], and with normotensive cataract patients, who served as controls. Aqueous humor was aspirated at the beginning of glaucoma surgery from 50 eyes of 50 patients with POAG, with PXFG and at the beginning of phacoemulsification cataract surgery from controls. Serum samples were obtained. Anti-H. pylori IgG concentration in the aqueous humor and serum was measured by means of enzyme linked immunosorbent assay. Serum analysis of anti-H. pylori IgG antibodies revealed statistically significant difference between POAG and PXFG (52.26+/-52.51 vs. 25.22+/-35.27, P=0.01). Also, the difference between POAG and controls was statistically significant (54.05+/-55.04 vs. 33.83+/-41.73, P=0.04). However, on comparing PXFG with the control group, the difference was statistically insignificant (P=0.12). The mean concentration of anti-H. pylori IgG antibodies in aqueous humor of patients in POAG and controls were not statistically different (3.93+/-5.14 vs. 2.65+/-2.87, respectively, P=0.73). The mean concentration of anti-H. pylori IgG antibodies in aqueous humor of patients in PXFG and controls were not statistically different (8.87+/-30.25 vs. 2.65+/-2.87, respectively, P=0.83). There was also no statistical difference of IgG levels between POAG and PXFG (3.93+/-5.14 vs. 8.87+/-30.25, respectively, P=0.87). The levels of anti-H. pylori IgG titers in sera of individuals with POAG were significantly higher compared with PXFG and control groups. We support the hypothesis of the role of anti-H. pylori antibodies in causative mechanism for POAG. We could not find a significant link between the anti-H. pylori IgG antibodies and the PXFG.

Comparison of mucosal B- and T-cell responses inHelicobacter pylori-infected subjects in a developing and a developed country

Helicobacter pylori is highly endemic in developing countries, but comparatively little is known about mucosal immune responses to H. pylori in these settings. Therefore, we have compared B- and T-cell responses, with a focus on the gastrointestinal mucosa, in H. pylori-infected adults in a developing (Bangladesh) and a developed (Sweden) country. We found comparable numbers of CD19(+) B cells and CD4 (+)T cells and similar levels of H. pylori-specific IgA antibodies in gastric mucosa from Bangladeshi and Swedish volunteers. However, about threefold higher numbers of CD19(+) B cells and 12-fold increased levels of H. pylori-specific IgA antibodies were found in the duodenum of Bangladeshi subjects. The gastric and duodenal immune responses in Bangladeshi asymptomatic carriers and duodenal ulcer patients were comparable. Bangladeshi subjects had about twofold lower titers of H. pylori-specific IgA and IgG antibodies in the circulation compared with Swedish volunteers. In conclusion, our findings suggest that Bangladeshi individuals have comparable gastric immune responses, but lower systemic antibody responses to H. pylori, compared with Swedish volunteers. Increased inflammation is present in the duodenum of Bangladeshi volunteers, maybe as a result of frequent exposure to enteric infections in these individuals.

The Adjuvant Effect of CpG Oligodeoxynucleotide Linked to the Non‐Toxic B Subunit of Cholera Toxin for Induction of Immunity Against H. pylori in Mice

The present study was carried out to test the immunostimulatory and adjuvant effects of the non-toxic B subunit of cholera toxin (CTB), CpG oligodeoxynucleotide (ODN) and CpG ODN linked to CTB (CTB-CpG) for generation of immunity against H. pylori in mice. Herein, we showed that CTB-CpG induces more potent proinflammatory cytokine and chemokine responses in the cervical and the mesenteric lymph nodes (CLN and MLN, respectively) cells in vitro compared with those of CTB and CpG ODN. The adjuvant effects of these agents were examined following intranasal immunization of C57Bl/6 mice with H. pylori lysate in combination with CpG ODN, CTB or CTB-CpG. All three immunization regimes resulted in high H. pylori-specific IgG antibody responses; however, only the CTB-CpG and, to some extent, the CpG ODN immunized mice mounted a sustainable IgG2c antibody response. Importantly, mice immunized with H. pylori antigen and CTB-CpG or CpG ODN, but not CTB, developed strong H. pylori-specific proliferative and IFN-gamma responses in their MLN CD4+ T cells upon recall antigen stimulation in vitro. These mice also had significantly lower bacterial load compared with the control-infected mice. Furthermore, the CTB-CpG and the CpG ODN immunized mice developed increased specific IgA antibody responses in their gastrointestinal tracts following H. pylori challenge. These results imply that CTB-CpG and CpG ODN, but not CTB, could serve as nasal adjuvants for induction of a H. pylori-specific Th1 type immunity in MLN and also a specific mucosal IgA antibody response in the gastrointestinal tract upon H. pylori challenge.

Helicobacter pylori, Anemia, and Iron Deficiency

Attempts to understand determinants of anemia and iron deficiency have led researchers to examine the role of Helicobacter pylori infection. The current study assessed determinants of anemia and iron deficiency, including H. pylori, in Alaska Native children. In 1999, a population-based survey was conducted among 86 children (67% response rate), mean age of 43.7 months (standard deviation = 16.8 months). Samples of breath, stool, and venous blood were obtained from children for measures of anemia, iron deficiency, H. pylori, fecal blood loss, and current inflammation. Standardized interviews with parents provided information on demographics, illness, and intake of dietary iron, iron-absorption inhibitors, and enhancers. Of the 86 children studied, 17.4% were anemic and 38.6% were iron deficient. Forty-one percent of the cohort had H. pylori-specific IgG antibodies, 86% tested positive by the urea breath test (UBT), and 80% tested positive by the stool antigen test. Presence of H. pylori antibodies emerged as a significant risk factor for anemia and iron deficiency in adjusted analyses controlling for demographic factors, current inflammation, and antibiotic use. In contrast, children with positive UBT or stool antigen results were significantly less likely to have anemia or iron deficiency than those with negative results. Results from different measures of H. pylori may reflect different stages of infection. Relationships between H. pylori and anemia/iron deficiency may depend on the phase of infection measured, with serologic tests reflecting established H. pylori infection associated with anemia/iron deficiency, and UBT and stool antigen results reflecting an earlier stage of infection.

Aggravation of Anemia by Helico Bacter Pylori Infection in Maintenance Hemodialysis Patients

To elucidate whether and how in patients on maintenance hemodialysis (HD), infection of H. pylori intensifies the anemia, a cross-sectional study that was conducted on 39 patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis treatment who had various upper gastrointestinal complaints consisting of epigastric pain, epigastric burning, postprandial fullness, early satiety, bloating and belching. Mean ages of patients were 46(±18) years. The dialysis duration was 30±(35) months (median: 18 months). Mean±SD of hemoglobin and hematocrit level of all patients were 9±2 g/dl and 28±6. The value of serum helicobacter pylori (H. Pylori) specific IgG antibody titers of all patients was 7.6 (±9.9)u/ml (median:2 u/ml). In this study non significant difference of H. Pylori-IgG antibody level between males and females or diabetic and non-diabetic hemodialysis patients were seen, and a significant inverse correlation of H. Pylori-IgG antibody level with serum hemoglobin and hematocrit in male hemodialysis patients and a significant inverse correlation of H. Pylori-IgG antibody level with serum iron were found. Also non significant correlation of serum H. Pylori-IgG antibody level with Hgb, Hct and serum iron in all patients, female, non diabetics and diabetic HD groups were found. In hemodialysis patients an inverse correlation between H. pylori infection with hemoglobin and hematocrit level as well as with serum iron, implies more attention to H. pylori infection in these patients and aggravation of anemia with H. pylori infection needs aggressive treatment of H. pylori infection in these patients. © Asian Network for Scientific Information, 2006.

Correlation of Serum Leptin with Circulating Anti-Helico Bacter Pylori IgG Antibodies in End-Stage Renal Failure Patients on Regular Hemodialysis

Leptin is synthesized mainly by the adipose tissue. Leptin also is detected in gastric chief cells. To consider the association of serum leptin with helicobacter pylori- IgG antibodies as parameters of nutritional status, on a group of hemodialysis patients, serum Leptin and serum helicobacter pylori specific IgG (H. Pylori-IgG) antibody titer were measured. Total patients were 36. In all patients there were a significant positive correlation of serum leptin with BMI and a near significant positive correlation of serum leptin with age. In the diabetic HD group a significant inverse correlation of helicobacter pylori IgG antibody titer and serum leptin was seen. This is the first report of the association of serum leptin with pylori-IgG antibodies in hemodialysis patients which may explain nutritional problems that is frequently seen in diabetic hemodialysis patients .More research is needed regarding the clinical consequences of this association.

Helicobacter pylorieradication for the treatment of dyspeptic symptoms in chronic renal failure

From Clinical Hospital Split, *Department of Gastroenterology and Hepatology, †Department of Nephrology, ‡Department of Pathology, §Department of Microbiology, Split, CroatiaCorrespondence:Prof. Izet Hozo MD, PhDDepartment of Internal Medicine,Clinical Hospital Split, Soltanska 1, Split, CroatiaTel: 385-21-55-76-58Fax: 385-21-55-76-58Izet.Hozo@st.htnet.hrAccepted for publicationNovember 2004

Intestinal Helminthiasis in Colombian Children Promotes a Th2 Response to Helicobacter pylori: Possible Implications for Gastric Carcinogenesis

Colombians living in coastal Tumaco have a lower incidence of Helicobacter pylori-associated gastric cancer compared with residents of Pasto in the high Andes. Considering the risk for H. pylori disease seems affected by features of bacterial virulence and host polymorphisms, other poorly understood influences, such as concurrent helminthiasis, may also be important. Fecal samples from 211 children were tested for parasites and sera from another cohort of 159 children and 92 adults were tested for IgE and H. pylori-specific IgG. Most individuals (95%) from both areas were H. pylori seropositive, with a predominant response of IgG1 followed by IgG2 and low IgG3 and IgG4 antibodies. Compared with Pasto children, Tumaco children were more commonly infected with helminths (P = 0.000), had higher serum IgE levels (P < 0.03), and had higher Th2-associated IgG1 responses to H. pylori (P < 0.0002). Other IgG isotype responses all increased with age but were not significantly different between children and adults from either area. These results suggest that intestinal helminthiasis in children promotes Th2-polarizing responses to H. pylori and may decrease gastric cancer risk in these individuals later in life. Concurrent helminthiasis may alter inflammatory responses to H. pylori and thus affect the progression of gastritis to gastric atrophy, dysplasia, and cancer.

Association between Helicobacter pylori infection and acute inflammatory demyelinating polyradiculoneuropathy

The aim of this study was to investigate a possible association between Helicobacter pylori infection and acute inflammatory demyelinating polyradiculoneuropathy (AIDP). Of 17 consecutive patients with Guillain-Barre syndrome (GBS), 13 patients (six females; mean age 50 +/- 24 years) with AIDP were investigated. Clinical status was evaluated according to Hughes' score, and electrophysiological tests were performed within 2 weeks from disease onset. Helicobacter pylori infection was detected histologically and serum H. pylori-specific IgG antibodies were analysed by ELISA. Twenty asymptomatic patients (12 females; mean age 63 +/- 8 years), undergoing upper gastrointestinal endoscopy for investigation of mild iron deficiency anaemia, served as controls. Helicobacter pylori was found in 12 of 13 AIDP patients (92%), and in 10 of 20 controls (50%), (P = 0.02). Electrophysiological studies showed demyelination in all AIDP patients. High levels of anti-H. pylori IgG antibodies correlated with advanced clinical status. Five of seven AIDP patients with high levels of anti-H. pylori IgG antibodies had delayed F-wave latencies, indicating affection of proximal segments of peripheral nerves. Helicobacter pylori infection seems to be more frequent in AIDP patients. Anti-H. pylori titre might reflect advanced clinical status. Anti-H. pylori IgG antibodies are also associated with involvement of the proximal parts of peripheral nerves in AIDP.

Augmentation of Helicobacter pylori urease activity by its specific IgG antibody: implications for bacterial colonization enhancement

Gastric colonization of Helicobacter pylori (H. pylori) occurs in a very early age via infected mothers having H. pylori-specific IgG antibodies that would be transplacentally transferred to infants. In addition, H. pylori urease-specific IgG was associated with chronic gastric atrophy and post-immunization gastritis is usually correlated with a strong local IgG response. These findings indicate that H. pylori-specific IgG antibodies, in particular its urease-specific IgG, may induce unfavorable influence on host resistance against H. pylori. Here, we show that we have found a unique H. pylori urease-specific IgG monoclonal antibody (MAb), termed S3, recognizing the conformational structure of the small subunit Ure-A, which enhanced the urease enzymatic activity. Such enhancement of the H. pylori urease activity induced by 1 microg of S3 was almost completely cancelled by simultaneously added the same amount of L2 MAb, which has a strong and specific inhibitory activity against H. pylori urease and recognizes a liner epitope of 8-mer peptide (F8: SIKEDVQF) within its large subunit Ure-B (Infect. Immun. 69: 6597, 2001). Intravenous pre-administration of purified S3 into BALB/c mice showed significant augmentation for gastric colonization with the susceptible strain Sydney Strain-1 (SS-1). To our knowledge, this is the first demonstration that a H. pylori urease-specific IgG MAb induced an augmentation of their gastric colonization in vivo.

Evaluation of anti‐Helicobacter pylori IgG2 antibody for the diagnosis of Helicobacter pylori infection in western and Chinese populations

The performance of commercial Helicobacter pylori diagnostic kits developed for particular geographic regions has often been found to be of poor diagnostic value when applied to other regions, possibly because of infections being caused by different H. pylori strains in different regions. To evaluate the performance of an IgG2 anti-H. pylori enzyme-linked immunoassay test (Helirad Alert) for detection of H. pylori infection in both Australian and Hong Kong (Chinese) subjects. Serum samples were tested for H. pylori specific IgG2 and IgG antibodies by enzyme-linked immunoassay kits using identical antigen preparation in 168 Australian and 160 Hong Kong (Chinese) subjects diagnosed with dyspepsia. Using a cut-off value determined by analysis of H. pylori-negative Australian samples, the sensitivity, specificity and accuracy of the IgG2 assay were 77.8, 97.4 and 91.1%, respectively, for the Australian samples and 96.3, 83.8 and 90% for Hong Kong samples. For the IgG assay, sensitivity, specificity and accuracy were 87.0, 99.1 and 95.2% for Australian samples and 97.5, 75 and 86.3% for Hong Kong samples respectively. Receiver-operating characteristic analysis showed better discrimination of H. pylori status when the IgG2 assay was applied to Hong Kong samples, while the IgG assay was better in the Australian samples. These data demonstrate that the Helirad Alert enzyme-linked immunoassay could provide a reliable method for screening H. pylori infection in both western and Chinese populations.

Preferential placental transfer of Helicobacter pylori specific IgG

Objective: To evaluate the placental transfer of Helicobacter pylori-specific IgG in Iranian mothers. Method: The antibodies were measured in sera of 156 mother/newborn pairs using a commercially available indirect Enzyme Linked Immunosorbent Assay (ELISA). The study population was among healthy pregnant women who attended to the Zeinabieh hospital of Shiraz University of Medical Sciences in 1999. Results: In total 74.7% of mothers were seropositive and more than 82% of seropositive mothers transferred Helicobacter pylori-specific IgG antibodies to their fetuses. The mean maternal Helicobacter pylori-specific IgG was significantly higher than that of the newborns (104.01 vs. 68.30 IU/ml, p < 0.001), however, there was a good correlation between maternal and neonatal antibodies. The level of maternal Helicobacter pylori-specific IgG was significantly lower in carriers of blood group B + compared to carriers of blood groups A + and O + . However, the cord/maternal ratio of Helicobacter pylori-specific IgG was significantly higher in blood group B + phenotype compared to blood group phenotypes A + and O + . Conclusion: The high rate of seropositivity among mothers highlights the risk of acquisition of Helicobacter pylori infection in early infancy for Iranian children. Our results also suggest that mothers having blood group B + are more likely to transfer Helicobacter pylori-specific IgG to their neonates.

Preferential placental transfer of Helicobacter pylori specific IgG

To evaluate the placental transfer of Helicobacter pylori-specific IgG in Iranian mothers. The antibodies were measured in sera of 156 mother/newborn pairs using a commercially available indirect Enzyme Linked Immunosorbent Assay (ELISA). The study population was among healthy pregnant women who attended to the Zeinabieh hospital of Shiraz University of Medical Sciences in 1999. In total 74.7% of mothers were seropositive and more than 82% of seropositive mothers transferred Helicobacter pylori-specific IgG antibodies to their fetuses. The mean maternal Helicobacter pylori-specific IgG was significantly higher than that of the newborns (104.01 vs. 68.30 IU/ml, p < 0.001), however, there was a good correlation between maternal and neonatal antibodies. The level of maternal Helicobacter pylori-specific IgG was significantly lower in carriers of blood group B + compared to carriers of blood groups A + and O + . However, the cord/maternal ratio of Helicobacter pylori-specific IgG was significantly higher in blood group B + phenotype compared to blood group phenotypes A + and O + . The high rate of seropositivity among mothers highlights the risk of acquisition of Helicobacter pylori infection in early infancy for Iranian children. Our results also suggest that mothers having blood group B + are more likely to transfer Helicobacter pylori-specific IgG to their neonates.

P0945 HELICOBACTER PYLORI INFECTION IN THE NEONATAL PERIOD AND COW MILK PROTEIN INTOLERANCE: IS THERE A RELATION?

Introduction: H. pylori is one of the most common infections worldwide, and especially in developing countries. It is generally accepted that H. pylori is most often acquired in childhood. However, under one year of age, infants rarely become infected with H. pylori, even when they are exposed to infected mothers. Many groups have reported a maternal transfer of H. pylori-specific IgG antibodies to the fetus. Spontaneous clearance followed by subsequent reacquisition of infection in young children also has been reported. Methods: The aim of this study is the retrospective analysis of 3 cases of H. pylori infection in neonates between 2001 and 2003, and to discuss the associated clinical presentation along with the need of eradication therapy in this age group. Results: The patients had 15, 17 and 18 days respectively. The first patient presented with excessive crying. The two others had symptoms of gastric outlet syndrome, with poor weight gain and malaise. Treatment for GERD (prokinetics and anti-acids) was initiated in patients 1 and 3, and patient 2 received only prokinetic therapy with hydrolysate formula, then amino-acid formula, with no clinical improvement in all patients. GI endoscopy revealed signs of congestive and edematous gastritis in patients 2 and 3, and hemorrhagic esogastroduodenitis in patient 1. Pathology confirmed this active gastritis with presence of H. pylori bodies. All patients were kept on anti-acids and prokinetics, and formula was changed to a hydrolysate one in patients 1 and 3. Patient 2 was kept on amino-acid formula, and was given antibiotic therapy (amoxicillin and clarithromycin). Significant improvement and resolution of all symptoms was obtained in all patients. Conclusion: H. pylori infection in neonates is very rare, and clinical presentation can vary from signs of minimal GER to those of gastritis and esophagitis. The role of H. pylori infection on the genesis of CMP intolerance has been reported, but there is no clear consensus on eradication treatment of HP in this age group. We think that combination therapy for both GERD and CMPA should be given when no clinical improvement is rapidly obtained, before deciding on eradication of H. pylori.