Pylori Testing Research Articles

Campylobacter concisus gastritis masquerading as Helicobacter pylori on gastric biopsy.

Campylobacter concisus is a Gram-negative rod closely related to Helicobacter pylori. We sought to identify gastric biopsies positive for C. concisus that had been misdiagnosed as H. pylori gastritis in our routine surgical pathology practice. We performed a retrospective review of gastric biopsies in our regional microbiology and pathology electronic records to identify cases that were submitted for H. pylori testing in which C. consicus was identified on culture and how many had concurrent biopsies sent to pathology for histologic assessment over a two-year period (2017-2018). Pathologic findings in the gastric biopsies were reviewed and immunohistochemical staining for H. pylori was performed. 50 of 2191gastric biopsy specimens submitted to microbiology in 2017-18grew C. concisus (2.3%), compared to 168 in which H. pylori was identified (7.7%). Twenty-eight cases had concurrent histology. A total of four cases (three from 2017 and one from 2018) demonstrated organisms morphologically identical to H. pylori in the H&E sections, of which all were H. pylori immunoreactive. Our case series is the first to demonstrate that C. concisus can mimic H. pylori gastritis in routine biopsy pathology.

Helicobacter pylori infection and eradication outcomes among Vietnamese patients in the same households: Findings from a non-randomized study.

Familial transmission can possibly influence the infection and treatment of Helicobacter pylori. This study aimed to describe the prevalence of H. pylori infection and outcomes of eradication treatment among Vietnamese patients who live in the same households. We conducted a prospective cohort study of Vietnamese household members with upper gastrointestinal complaints. Participants received esophagogastroduodenoscopy and H. pylori testing. The H. pylori-positive patients were treated and asked to return for follow-up within 4 months. To explore factors associated with H. pylori infection at baseline, we performed multilevel logistic regression to account for the clustering effect of living in the same households. To explore factors associated with eradication failure, we used Poisson regression with robust variance estimation to estimate the risk ratio. The prevalence of H. pylori infection was 83.5% and highest among children <12 years old (92.2%) in 1,272 patients from 482 households. There were variations in H. pylori infection across households (intraclass correlation = 0.14, 95% confidence interval (CI) 0.05, 0.33). Children aged <12 years had higher odds of H. pylori infection (odds ratio = 3.41, 95%CI 2.11, 5.50). At follow-up, H. pylori was eradicated in 264 of 341 patients (77.4%). The risk of eradication failure was lower for the sequential regimen with tetracycline. H. pylori infection was common among people living in the same households. Eradication success for H. pylori was higher for the tetracycline sequential regimen. More research should be focused on how family factors influence H. pylori infection and on eradication treatment.

256 USE OF PROTON PUMP INHIBITORS ON SPECIALIST GERIATRICS UNITS

Abstract Background Proton Pump Inhibitors (PPIs) prescriptions have increased more than 100% in the past decade. Prior research estimates that only a third of PPI prescriptions are appropriate in older adults. Geriatric patients have increased rates of polypharmacy and adverse drug events. PPIs are associated with significant harms including a higher fracture risk, increased risk of infection and vitamin and electrolyte abnormalities. We aimed to examine the PPI prescribing practice in a Specialist Geriatric Unit (SGU), identify patterns of inappropriate use and reduce inappropriate prescriptions. Methods Medical records, kardexes and prescriptions were reviewed for 66 patients admitted in the Special Geriatric Units between April and May 2021. Variables included gender, age, ordinary residence (nursing home or home) and diagnosis on admission. PPI indication was grouped according to symptoms, OGD in the last year, H. Pylori testing in last year and reason/diagnosis leading to PPI prescription. Name and dose of PPI, route of administration and duration of treatment were noted. Results 38 patients (57.6%) were on a PPI. The mean age was 81.7 years. 79% of the patients were on the PPI at the time of hospital admission. Over 85% of the patients on PPI had no OGD or H. Pylori testing in the last year. Only 42% had a diagnosis justifying the use of PPI (only 25% of whom had their diagnosis confirmed by appropriate investigations). 90% of the patients were on PPI for more than a year. Conclusion Inappropriate use of PPIs remains common in the Specialist Geriatric Units. PPI prescriptions need to be optimized so as to reduce harmful effects on geriatric patients. Following a multifaceted PPI deprescribing intervention repeat audit is now planned.

Clinical and Morphological Manifestations of Gastritis and Serum Cytokine Levels in Schoolchildren with Familial History of Gastric Cancer

Aim. A study of the clinical and morphological traits and cytokine profile of gastritis in schoolchildren with familial history of gastric cancer.Materials and methods. A cross-sectional questionnaire survey was conducted in Siberian regions (Tuva, Even-kiya, Aginskiy Buryat National District, Krasnoyarsk). A total of 3,343 schoolchildren aged 7–17 were surveyed for gastrointestinal complaints and history of gastric cancer in their 1st–2nd degree kindred. Oesophagogastroduo-denoscopy (OGDS) with gastric mucosa biopsy were performed in 463 respondents with complaints. Gastritis was graded in the Sydney classification. Serum cytokine levels (IL-2, IL-4, IL-8, IL-18, IL-1β, IFN-α, TNM-α) were obtained in enzyme immunoassays (ELISA).Results. Schoolchildren with gastritis and familial history of gastric cancer revealed a higher 59.8% rate of dyspeptic complaints vs. 40.8% in negative history (p = 0.001), as well as complaints of weekly heartburn in 14.2 and 8.3% cas-es (p = 0.019), respectively. In positive history and negative H. pylori tests, the cell immune response regulator IL-18 37 was revealed elevated in histology. In histologically verified H. pylori, no cross-cohort differences were observed in serum IL-18 by positive familial history of gastric cancer.Conclusion. Gastritis in schoolchildren with familial predisposition to gastric cancer more often associates with GERD and dyspepsia usually presented in postprandial distress syndrome. The cytokine regulation properties of gastritis in schoolchildren with familial history of gastric cancer have been reported.

Evaluation of the relationship between preeclampsia and positive rectovaginal culture of group B Streptococcus and Helicobacter pylori positive serology

Introduction: Identifying the incidence of pathogen colonizations in pregnant women with preeclampsia can be effective in providing proper treatment and reducing complications. Objectives: We evaluated the frequency and association between positive rectovaginal culture of group B Streptococcus (GBS) and positive Helicobacter pylori serology with preeclampsia in two groups of pregnant women (with and without preeclampsia). Patients and Methods: The present case-control study included pregnant women with preeclampsia and healthy pregnant controls during 2019-2020. Blood and rectovaginal samples were obtained and the data were statistically analyzed using SPSS software. Results: Fifty-four people were included in the study. The mean gestational age was 36 ± 3.4 months in the preeclampsia group and 37 ± 2.9 months in the control group. There was no significant relationship between preeclampsia and H. pylori-positive serology (P=0.84). Additionally, the association between positive H. pylori serology and the severity of preeclampsia was not significant (P=0.15). However, there was a significant relationship between positive H. pylori tests with early- and late-onset preeclampsia (P=0.04). However, there was no statistically significant relationship between the positive rectovaginal culture of GBS and preeclampsia, the severity of preeclampsia, the onset time, or the weight of newborns. Conclusion: There was a significant relationship between H. pylori infection and late-onset preeclampsia in preeclamptic mothers. H. pylori screening and eradication therapy before pregnancy can prevent preeclampsia and its serious consequences in both the mother and the fetus.

S2345 A Rare Case of Bleeding Ulceration From the Excluded Stomach After Roux-en-Y Gastric Bypass Surgery

Introduction: Roux-en-Y gastric bypass (RYGB) is among the most common bariatric surgeries for treatment of morbid obesity, with >450,000 RYGB performed in the United States since 2011. Formation of an excluded stomach and duodenum that are difficult to access via conventional endoscopy can pose a unique challenge for diagnosis and treatment of gastrointestinal (GI) bleeding in post-RYGB patients. Case Description/Methods: A 60-year-old man with a history of morbid obesity and status post RYGB in 2017 presented in January 2021 with black tarry stools and a hemoglobin of 7.4 from a baseline of 13 g/dL without recent NSAID or tobacco use. He underwent upper endoscopy, colonoscopy, push enteroscopy and video capsule endoscopy without identification of a bleeding source. He was ultimately discharged home after stabilization and no further bleeding. Due to concern for an unidentified source of bleeding, further outpatient workup was pursued. CT enterography was unrevealing. Attempted endoscopic ultrasound (EUS)-guided gastrotomy to access the excluded stomach was unsuccessful due to inability to pass an Axios stent into the excluded stomach. Antegrade balloon enteroscopy failed to reach the jejuno-jejunal anastomosis. The patient was re-admitted in April 2021 for recurrent melena and a hemoglobin of 8.3 g/dL. Laparoscopic gastrotomy was performed with intraoperative transgastric endoscopy which revealed blood in the excluded stomach and duodenum. An ulcer in the excluded stomach was discovered and excised via subtotal gastrectomy. Pathology revealed focal transmural ulceration without dysplasia; H. pylori testing was negative. The patient was discharged home without recurrence of bleeding. Discussion: Alteration in GI anatomy after RYGB impedes access to excluded segments of the upper GI tract. Access to the excluded segments may be achieved by balloon enteroscopy depending on the length of the alimentary limb, EUS-assisted gastrotomy or laparoscopic formation of a temporary gastrotomy with transgastric endoscopy. A review of post-RYGB cases of excluded segment ulceration found that 93% of patients required surgery for definitive treatment. The most common interventions were remnant gastrectomy and oversewing of perforated ulcers with a 94% cure rate at short-term follow-up. Our case demonstrates that a high degree of suspicion for bleeding from the excluded gastric or small bowel segments should be maintained in patients with RYGB presenting with upper GI bleeding and initial negative GI tract evaluation.Figure 1.: Transmural ulceration in the remnant stomach status post subtotal gastrectomy

S685 H. pylori Testing in Patients Admitted for Upper GI Bleeding Due to Peptic Ulcer Disease: A Quality Improvement Project

S685 H. pylori Testing in Patients Admitted for Upper GI Bleeding Due to Peptic Ulcer Disease: A Quality Improvement Project

Changes of Gastric Juice Microenvironment in Patients with Fundic Gland Polyp and Hyperplastic Polyp

Introduction: The aim of this study was to study the relationship between the formation of gastric fundic gland polyp and gastric hyperplastic polyp (HP) and the changes of gastric juice microenvironment. Methods: The proton-pump inhibitor (PPI) applications to patients were recorded. Gastric juices and biopsy polyps were collected for pathological examination, H. pylori tests, biomarkers, and MUC1, MUC2, MUC5AC expression measurement. Results: Among 34,892 patients, the detection rate of gastric fundic gland polyps was significantly higher than that of gastric HPs (p < 0.01). The incidence rate of gastric fundic gland polyp and gastric HP in PPI users (n = 3,886) was higher than that of non-PPI users (p < 0.01). The occurrence of polyp was positively related to the duration of PPI application and the H. pylori-positive rate. The bile reflux rate between fundic gland polys group (17.61%) and HPs (28.67%) was significantly different (p < 0.01). The levels of gastric juice Gastrin-17, epidermal growth factor (EGF) and MUC₂ from patients with gastric fundic gland polyps and gastric HPs were higher than those in the control group (p < 0.01). However, patients with gastric fundic gland polyps and HPs had significantly lower gastric juice PGE₂ and MUC5AC (p < 0.01). Conclusion: PPI application, H. pylori infection, and bile reflux are the potential risk factors for formation of fundic gland polyps and HPs. The potential mechanism of polyps’ formation can be related to the levels of Gastrin-17, EGF, MUC₂, PGE₂, and MUC5AC in gastric juice.

Prevalence of H. Pylori in Perforated Peptic Ulcer Disease at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Helicobacter Pylori is the most common cause of peptic ulcer disease with disputable association with perorated Peptic Ulcer disease (PPD). This study aims to determine magnitude of Helicobacter Pylori in PPD and the outcomes of treatment, at Saint Paul Hospital Millennium Medical College (SPHMMC). Between January 9, 2013 and February 7, 2018, all patients operated for PPD were recruited retrospectively. Data was extracted from patient's medical records using pretested questionnaire. Data analysis was done by SPSS version 20. During the 5 years, 46 patients fulfilling inclusion criteria were included in the study. H. Pylori test was positive for stool antigen in 10 (21.7%) and serology eleven (23.9 %) of patients. Overall, nineteen (41.3%) of patients had positive result regardless of the type of test used. Out of 46 patients, twenty-six (56.5%) patients were given eradication therapy and thirty-four (73.9%) patients were given PPI alone or as a part of eradication therapy. During their hospital stay, five (10.9%) patients developed deep and superficial surgical site infection and two (4.3%) of patients have died. The prevalence of H. Pylori among PPD patients in this study is lower compared to most studies. Further prospective studies should be conducted in the future to understand association with H. Pylori and provide recommendations on eradication treatment.

Prevalence of Helicobacter pylori Infection Among Rosacea and Chronic Spontaneous Urticaria Patients in a Tertiary Hospital in Riyadh, Saudi Arabia.

Background: The multifactorial nature of rosacea and chronic spontaneous urticaria (CSU) pathogenesis complicates the achievement of satisfactory treatment outcomes. 13C urea breath test (UBT) has been identified as an accurate, non-invasive, and quick procedure to detect the presence of Helicobacter pylori (H. pylori) with high sensitivity and specificity.Objective: In this study, we aim to assess the correlation between H. pylori infection and rosacea and CSU patients.Methods: A cross-sectional, observational study was conducted on patients with rosacea and CSU in the dermatology clinic at King Khalid University Hospital in Riyadh, Saudi Arabia. History and physical examination were performed by a dermatologist. H. pylori 13C-UBT detection was performed in all subjects.Results: In total, 114 patients were included in this current study, with 41 rosacea and 73 urticaria patients. The vast majority of our subjects were females (96.5%). The mean (±SD) age was 42.3 (±12.7). More than half (58.8%) of the examined samples were positive for 13C-UBT; however, positive results were significantly higher in the rosacea patients (73.2%) compared to the urticaria group (50.7%), with a p-value of 0.019.Conclusion: Our findings underline the significant association of H. pylori with rosacea and CSU regardless of the presence or absence of gastrointestinal symptoms. We thus recommend the inclusion of H. pylori testing in the routine workup of CSU and rosacea patients.

High Prevalence of Helicobacter pylori Infection in Special Needs Schools in Japan.

Background: Developmental disorders and high Helicobacter pylori (H. pylori) infection rates have been reported. This study aimed to examine the prevalence of H. pylori in a special needs school where all students had developmental disorders in Japan.Methods: In 2017, third-grade junior high school and second- and third-grade high school students attending a special needs school with developmental disorders were enrolled. Participants of Saga Prefecture's H. pylori test and treat project, which comprised third-grade junior high school students not from special needs school, were assigned to the control group.Results: In the control group, H. pylori positive results were 3.18% (228/7,164) students. Similarly, in developmental disorder group, H. pylori positive results were 6.80% (13/191) students. For the developmental disorder and control groups, this present examination sensitivity was 7.03% (13/185), specificity was 96.76% (6,815/7,043), positive predictive value was 5.39% (13/241), negative predictive value was 97.54% (6,815/6,987), Likelihood ratio of a positive result 2.17 and Odds ratio was 2.26 (95% confidence interval: 1.27–4.03, p = 0.005).Conclusion: The prevalence of H. pylori infection was significantly higher in adolescents with developmental disorders than in typically developing adolescents.

Abstract 41: International Collaborative Rwanda Endoscopy Week Conferences Demonstrate Feasibility and identify H. pylori Testing as an Important Target for Capacity-Building Interventions

Abstract Purpose: Gastrointestinal (GI) endoscopy is a growing field in Rwanda, a country of 12.6 million with significant GI morbidity and mortality. Endoscopy alongside Helicobacter pylori identification and eradication aids in GI cancer prevention and diagnosis in this population. Our collaborative training-focused endoscopy conference provides preliminary data to focus future training and capacity building programs in Rwanda to improve oncologic outcomes. Methods: Since 2017, ‘Rwanda Endoscopy Week' (REW) is held annually at multiple hospitals throughout Rwanda. It consists of several days of didactic training in endoscopy, oncology and research, followed by a week of endoscopy procedures performed jointly by visiting and hosting endoscopists, and ending with a summary of results of didactic and endoscopic activity. Results: Four (4) hospitals performed 244 training endoscopies in 2017 and 448 cases in 2018. In 2019 this expanded to 668 endoscopies performed at 7 hospitals, including academic, district, and private hospitals. The case distribution remained similar over 3 years at 86.0% (1170/1360) upper endoscopies, 13.2% (180/1360) colonoscopies, and 0.7% (10/1360) endoscopic retrograde cholangiopancreatographies. Thirty-nine (5.8%, 39/668) patients had a tumor finding suspicious for gastric (4.0%, 27/668), colorectal (1.5%,10/668), ampullary (0.1%, 1/668), or gallbladder (0.1%, 1/668) malignancy. 54% of patients receiving endoscopy were tested for H. Pylori (367/669); 38% of those tested had inconclusive results (141/367) and 20% were positive (74). There were 2 non-serious bleeding events. Conclusions: Participation by Rwandan urban, district, public and private hospitals in a cooperative international GI training conference has experienced a nearly three-fold increase in patients and identified malignant pathology while maintaining safe endoscopic care over a three-year period. H. pylori, ubiquitous in this population, is an important risk factor for gastric cancer and gastric diseases. Necessary next steps include increased training and capacity-building interventions to improve the quality of the testing and surveillance of those treated. Citation Format: Nikitha Gangasani, Eric Rutaganda, Felcien Shikama, Steve Bensen, Vincent Dusabejambo, Mary Chamberlin. International Collaborative Rwanda Endoscopy Week Conferences Demonstrate Feasibility and identify H. pylori Testing as an Important Target for Capacity-Building Interventions [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 41.

English

Helicobacter pylori is the most common infection in the world, and the most main causes of dyspepsia are related to H. pylori infection. In that respect, several non-invasive methods for the diagnosis of H. pylori infection were utilized. The current study aimed to determine the prevalence of H. pylori infection and its associated variables among dyspeptic patients in Mukalla city, Hadhramout-Yemen during a period from February to September 2018. A cross-sectional descriptive study was conducted among 100 suspected dyspeptic patients. Data regarding to associated variables were collected using a structured questionnaire, and the samples of feces and serum were collected and screened for H. pylori by rapid diagnostic immunochromatographic assays for antigen and antibody. Data was analyzed using SPSS statistical software version 20 and a P value &lt;0.05 was taken statistically significant. Prevalence of H. pylori was found to be 15 and 18.5% using the antigen H. pylori test and serum anti-H. pylori test respectively. Prevalence using antigen H. pylori test was significantly associated to male sex (P=0.035). In those patients with H. pylori, a positive result with antigen test was significantly associated to drinking non-filtered water (COR = 3.67; 95%CI=1.436-9.363; P=0.007), symptoms of heartburn and regurgitation (COR=0.865, 95%CI=0.034-0.536, P=0.004) and antibiotics used (COR=0.312, 95%CI=0.125-0.780, P=0.013). The prevalence of H. pylori infection was frequent among the dyspeptic patients in the study area. H. pylori infection was related to non-filtered water source, symptoms of heartburn and regurgitation and antibiotics used are contributing factors. Moreover, further studies are needed to investigate other potential associated variables for H. pylori infection. &nbsp; Key words: Antibody, antigen, dyspepsia, Helicobacter pylori, laboratory diagnosis, prevalence.

Gastric Polyps and Atrophic Gastritis

Aim. A study of atrophic gastritis severity and rate in patients with gastric polyps (GP).Materials and methods. The study enrolled 61 patients with hyperplastic (HGP) and 41 — with adenomatous GP (AGP). All patients had 24-h gastric pH-metry, control of the pepsinogen I, II and gastrin-17 levels, in addition to a general clinical, endoscopic, histological examination and testing for Helicobacter pylori.Results. GP patients had benign manifestations prevailed with epigastric heaviness and overflow, and a scarce history of H. pylori testing at no control of rendered eradication therapy. A symptomatic proton pump inhibitor treatment in GP was either prescribed or voluntary. Focal atrophic gastritis in endoscopy was revealed in 12 (19.7 %) HGP and 16 (39.0 %) AGP patients, diffused atrophic gastritis — in 49 (80.3 %) HGP and 25 (60.9 %) AGP patients. Low-grade chronic gastritis in histology prevailed in HGP, moderate — in AGP, and severe — in 21.9 % cases. Moderate (27.9 %) to severe (65.6 %) atrophy of gastric mucosa was registered in HGP, with 53.7 and 39.0 % respective AGP cases. Polyp dysplasia was detected in 20 % HGP and 75.6 % AGP cases. Pepsinogen I &lt;25 µg/L at a pepsinogen I/II ratio &gt;&lt;3 was observed in 38 (62.3 %) HGP and 18 (43.9 %) AGP patients. Hypo- and anacidic were 65.6 % HGP and 31.7 % AGP patients. &gt;H. pylori-positive were 52.5 % HGP and 70.7 % AGP cases.Conclusion. A largely similar aetiopathogenesis of gastric polyps and chronic atrophic gastritis warrants the H. pylori diagnosis and a more detailed patient control for chronic gastritis grading and staging, functional insufficiency of gastric mucosa and the severity of hyperplastic and dysplastic change. The H. pylori eradication, in contrast to anti-secretory therapy, allows the containment of chronic gastritis and is a critical measure in gastric cancer prevention.

Objective Visual Analog Scale for Biopsy Diagnosis of Helicobacter pylori Infection in Clinical Practice.

Historic and current pathology society guidelines recommend using visual gestalt to identify substantial inflammatory cell infiltrate in Helicobacter pylori gastritis, but these scales were subjectively designed. This study aims to objectively investigate the density of inflammation that justifies additional workup for H. pylori infection. We retrospectively identified 2 patient cohorts who had undergone endoscopy with gastric biopsies; 1 with H. pylori infection (n=66), confirmed with a positive stool antigen test and/or Campylobacter-like organism test, and 1 without infection (n=81). Antral and body biopsies were selected from each case, if available, and stained with MUM-1 to highlight mucosal plasma cells. Digital analysis was performed to calculate the number of plasma cells/mm2, termed the "inflammatory score" (IS). Patients with H. pylori infection had an average of 1289 plasma cells/mm2 in the antrum and 835 plasma cells/mm2 in the body, compared with 346 plasma cells/mm2 in the antrum and 178 plasma cells/mm2 in the body in patients without infection. IS cut-off values for a positive infection were 714 plasma cells/mm2 in the antrum and 316 plasma cells/mm2 in the body, with high sensitivities and specificities in both the antrum (92%, 92%) and body (85%, 84%), respectively. A visual analog scale was created to provide a histologic correlate of the observed IS ranges and cut-offs. This practical and objective scale is associated with a high sensitivity and specificity for diagnosing H. pylori infection and justifies moving away from upfront universal H. pylori testing in routine clinical practice.

The Association between Serum Vitamin D Levels and Helicobacter pylori Presence and Eradication.

Background: The success of Helicobacter pylori (H. pylori) eradication depends on several host and treatment factors. Serum vitamin D levels may be associated with H. pylori infection and eradication rates. We investigated the association between vitamin D and H. pylori infection and eradication, using a large electronic database based on medical records from a population-based health maintenance organization. Methods: Data regarding adults who underwent H. pylori testing and had vitamin D measurements within one month of H. pylori testing were collected. H. pylori infection was ascertained using urea breath or stool antigen tests. A negative H. pylori test following a positive result implied eradication. Multivariate regression models were constructed to assess associations between H. pylori infection, eradication, and vitamin D. Results: Among 150,483 members who underwent H. pylori testing from 2009 to 2018, 27,077 (18%) had vitamin D measurements. Vitamin D levels were inversely associated with H. pylori infection, p < 0.001. The odds of a positive H. pylori test were 31% higher among patients with vitamin D levels <20 ng/mL, compared with those with levels ≥20 ng/mL (OR 1.31, 99% CI 1.22–1.4, p < 0.001). Purchase of vitamin D supplements was associated with a negative subsequent H. pylori test (p < 0.001). Mean vitamin D levels were moderately higher in those with successful vs. failed H. pylori eradication (19.34 ± 9.55 vs. 18.64 ± 9.61, p < 0.001). Conclusions: Vitamin D levels are associated with H. pylori infection. Increased vitamin D levels are associated with successful H. pylori eradication. Vitamin D may have a role in H. pylori eradication.

The relation between Helicobactor pylori gastrointestinal tract infection and central serous chorioretinopathy among patients in Al-Diwaniya province

PURPOSE:Central serous chorioretinopathy (CSR) is a serous detachment of the central retina. This condition usually affects young males. Its pathogenesis is not fully understood. Helicobactor pylori is the most prevalent stomach and gastrointestinal tract (GIT) infection worldwide, and a possible correlation between these two conditions was examined in this study.METHODS:Sixty-two patients with CSR (fifty-five males and seven females) were included in this study. All patients were examined by a senior ophthalmologist and fluorescein angiography was performed for each patient to confirm CSR, which has specific ophthalmic findings. It was found to be the first attack of CSR in 49 patients with the help of history and optical coherence tomography and an Amsler grid test, while in 13 patients it was shown to be recurrent disease. Diagnosis of H. pylori was done using the urea breath test at the GIT center in Diwaniya Teaching Hospital, Iraq. The control group contained 162 patients attending the GIT Department at Diwaniya Teaching Hospital with 79 patients with a positive H. pylori test and normal comprehensive eye examinations. Patients with any other ophthalmic diseases were excluded from the study.RESULTS:The rate of infection was significantly higher in patients than in control group (47/75.8% vs. 79/48.8%; P < 0.001). The odds ratio was 3.29 with 95% confidence interval of 1.71–6.36; therefore, patients with CSR are 3.29 times more susceptible to H. pylori infections than control subjects.CONCLUSION:A statistically significant relationship between the presence of H. pylori infections with CSR development among young patients was shown. More multi-center studies are needed to confirm this relationship.

Optimization of the diagnosis, management and treatment of patients with different types of Barrett’s esophagus. The results of our own observations

Objective — to optimize the diagnostic methods, concepts of definitions and treatment options in patients with different types of Barrett’s esophagus, as well as to standardize endoscopic observation intervals for these patients.Materials and methods. The material of the study was the results of instrumental studies and treatment data of 22 patients with Barrett’s esophagus without dysplasia, with «indefinite» for dysplasia, low‑grade dysplasia (LGD) and high‑grade dysplasia (HGD). The most part of patients (17 (77.3 %)) referred to the age group of 33 to 43 years (the mean age (38.5 ± 0.4) years). The diagnosis was verified on the basis of the data of instrumental and morphological investigations.Results. Among the 22 examined patients with diagnosed Barrett’s esophagus, 10 (45.5 %) patients were diagnosed with Barrett’s esophagus without dysplasia, in 7 patients (31.8 %) — Barrett’s esophagus with «indefinite» for dysplasia, in 4 patients (18, 2 %) — Barrett’s esophagus with LGD, in 1 patient (4.5 %) — Barrett’s esophagus with HGD. The H. pylori tests were negative in 13 patients. Other patients haв anamnesis of the successful eradication therapy. The unique algorithm of the management of patients with different EB types has been worked out.Conclusions. The absence of H. pylori infection or the successful completion of previous eradication therapy does not reduce the risk of dysplasia in the Barrett’s esophagus segment. Barrett’s esophagus is an endoscopic diagnosis, only if the examination is performed with a high‑resolution endoscope (HD endoscopy) with magnification and chromoscopy, which is further confirmed morphologically. Continuous administration of PPIs for Barrett’s esophagus without dysplasia, with a segment size of Barrett’s esophagus less than 3 cm, in asymptomatic patients and without a family history of cancer, probably requires revision.

Surgical referral for cholecystectomy in patients with atypical symptoms

BackgroundCholelithiasis referrals often present with concomitant or isolated atypical symptoms such as reflux, bloating, or epigastric pain. We sought to identify the impact of preoperative symptomatology of atypical or dyspepsia-type biliary colic on operative and non-operative clinical outcomes. MethodsA retrospective review of patients referred for gallstone disease from 2014 to 2018 at a single institution in Los Angeles County was performed. ResultsOf 746 patients evaluated for gallstone disease, 87.4% (n = 652) underwent cholecystectomy – 90.8% (n = 592) had symptom resolution postoperatively whereas 9.2% (n = 60) did not. Over half presented with concomitant atypical and/or dyspepsia symptoms (n = 411). Heartburn/reflux was significantly associated with unresolved symptoms postoperatively (OR 2.1,1.0–4.4, p = 0.04). Overall, 11.1% (n = 83) of all 746 patients and 20.2% of patients with atypical and/or dyspepsia symptoms improved with medical management of gastritis or Helicobacter pylori triple therapy pre/post-operatively. ConclusionAtypical biliary colic and/or dyspepsia is associated with unresolved symptoms following cholecystectomy. Such patients may benefit from H. pylori testing or PPI trial prior to cholecystectomy.

Correlation Analysis of Helicobacter pylori Infection and Digestive Tract Symptoms in Children and Related Factors of Infection.

Background:To analyze the correlation between Helicobacter pylori infection and digestive tract symptoms in children and other related factors, and to explore the risk factors of H. pylori infection in children and the expression of inflammatory factors in H. pylori-positive and H. pylori-negative children.Methods:Overall, 234 children with H. pylori test in Xuzhou Children’s Hospital, Xuzhou Medical University (Xuzhou, China) were enrolled. Among them, 73 children were H. pylori-positive and 161 were H. pylori-negative. The expression levels of cytokines interleukin-8 (IL-8), interleukin-18 (IL-18) and interferon-γ (IFN-γ) in H. pylori-positive and H. pylori-negative children were determined by ELISA. The correlation between H. pylori-positive and general data, digestive tract symptoms, other clinical symptoms, living habits, eating habits, family history and other related factors was statistically analyzed. Multivariate Logistic regression analysis was used to analyze the independent risk factors of H. pylori infection in children.Results:Family monthly income, inattentive eating, sharing toothbrushes and cups, gnawing fingers, eating fried food, drinking raw water, eating smoked and pickled food, father suffering from gastropathy and mother suffering from gastropathy were independent risk factors for H. pylori infection in children. The most common digestive tract symptoms of children with H. pylori infection were abdominal pain, accompanied by one or more clinical symptoms. The expression levels of IL-8, IL-18 and IFN-γ in H. pylori-positive children were significantly higher than those in H. pylori-negative children.Conclusion:Prevention of H. pylori infection in children is helpful for healthy growth of children, and cytokines IL-8, IL-18, IFN-γ have the potential to be used as biomarkers for diagnosis of H. pylori-positive children.