Risk Of Peptic Ulcer Research Articles

Helicobacter pylori and low-dose aspirin ulcer risk: A meta-analysis.

Owing to wide-spread use, low-dose aspirin (LDA) produces a substantial amount of peptic ulcer disease. Current guidelines are ambivalent about the need for Helicobacter pylori eradication to protect against LDA ulcers. This study aimed to determine, through meta-analysis, if (and by how much) infection alters the baseline risk of peptic ulcers during LDA therapy. Literature screening was performed in MEDLINE and EMBASE from inception to May 2018. Original studies reporting prevalence or incidence of uncomplicated ulcers in LDA users were included. Ulcer endpoints needed to be specified separately, according to H.pylori infection status. Meta-analysis was performed in MIX 2.0 Pro. Ten cross-sectional studies and seven randomized controlled trials were included (n=5964). The pooled odds ratios with 95% confidence intervals (CI) for the risk of LDA ulcers in H.pylori-positive versus H.pylori-negative individuals were 1.68 (95%CI 1.40-2.02) and 1.65 (95%CI 1.29-2.08) under fixed-effects and random-effects models, respectively. Heterogeneity among studies was minimal (I2 =26.9%). After adjusting for the protective effects of antisecretory drugs, the odds ratios increased to 1.94 (95%CI 1.54-2.46). This analysis suggests that H.pylori increases the risk of LDA ulcers by almost 70% in a population where some were taking proton pump inhibitors and/or other acid suppressants. Without antisecretory drugs, the risk almost doubles. Clinically, these findings may support the use of a test-and-treat approach to H.pylori in LDA users, particularly those already at higher risk of developing peptic ulcers.

Increased risk of peptic ulcer in patients with early-onset cataracts: A nationwide population-based study.

Early-onset cataracts (EOC) are associated with an increased inflammatory response; therefore, a potential risk of other inflammatory diseases, like peptic ulcer, may be related. This study investigated the risk of peptic ulcer after being diagnosed with EOC. Retrospective claims data from the Taiwan National Health Insurance Research Database were analyzed. Study subjects comprised patients with EOC (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9- CM] codes 366.00, 366.01, 366.02, 366.03, 366.04, 366.09, 366.17 and 366.18), aged 20–55 years and newly diagnosed between 2000 and 2010 (n = 1910), and a comparison cohort without the disease (n = 7515). Both cohorts were followed up until 2010 to estimate the incidences of peptic ulcer. We used the Poisson regression model to compare incidence rate ratios and the 95% confidence interval (CI). Cox proportional hazards regression was used to assess the hazard ratio (HR) of peptic ulcer associated with EOC. The overall incidence rate of peptic ulcer was higher in the EOC cohort than in the comparison cohort (10.3 vs 7.68 per 1000 person-years) with an adjusted HR of 1.33 (95% CI = 1.05, 1.69). The present study suggests that patients with EOC are at an increased risk of being diagnosed with peptic ulcer in subsequent years.

Diminished circulating concentration of interleukin-35 in Helicobacter pylori-infected patients with peptic ulcer: Its association with FOXP3 gene polymorphism, bacterial virulence factor CagA, and gender of patients.

IL-35 modulates immune and inflammatory responses during infections. Here, we investigated IL-35 levels and a single nucleotide polymorphism, rs3761548, in FOXP3 gene in Helicobacter pylori-infected patients with peptic ulcer (PU), to clarify possible associations. This study includes 100 H.pylori-infected PU patients, 100 H.pylori-infected asymptomatic subjects (AS), and 100 noninfected healthy subjects (NHSs). Serum IL-35 levels and the genotyping were determined using ELISA and RFLP-PCR methods, respectively. In PU patients, the IL-35 levels were lower than AS and NHS groups (P<.001). The IL-35 levels in CagA+ H.pylori-infected participants from PU and AS groups were lower than individuals infected with CagA- strains (P<.02 and P<.04, respectively). Women had higher IL-35 levels than men among PU, AS, and NHS groups (P<.0001). In PU patients, AA genotype and A allele at rs3761548 were more frequent than total healthy subjects (AS + NHS groups) and associated with an increased PU risk (AA genotype: OR = 5.51, P<.0001; A allele: OR = 3.857, P<.002). In PU and AS groups, IL-35 levels were lower in subjects displaying AA genotype or A allele than subjects displaying CC genotype or C allele, respectively (P<.0001 and P<.03 for PU patients; P<.001 and P<.02 for AS group, respectively). Decreased IL-35 levels could be involved in PU development in H.pylori-infected individuals. IL-35 levels are affected by CagA status of H.pylori, participants gender, and genetic variations at rs3761548. The AA genotype and A allele at rs3761548 could represent a risk factor for PU development.

Prevalence of Helicobacter pylori among medical workers in Moscow and Kazan according to ¹³С-urease breath test

Rationale: The relevance of the problem is related to the lack of data on Helicobacter pylori (HP) prevalence in Russia, which is associated with the risk of peptic ulcer and gastric cancer, and also, on the other hand, to the non-adherence of the doctors to the existing expert guidelines on diagnosis of this infection and HP eradication therapy. Aim: To assess the prevalence of HP among medical workers and their willingness to undergo eradication therapy. Materials and methods: A total of 315 medical workers (61 men and 254 women) aged 18 to 76 years were examined, among them 221 in Moscow and 94 in Kazan. To assess the HP contamination rate, all participants performed a ¹³С-urease breath test with the “HELICARB” test kit according to the “four-point” technique. All participants were asked to complete the questionnaires to access the impact of social and occupational factors on the prevalence of HP. Results: HP was identified in 54.9% of the examined subjects, including 45.9% of men and 57.1% of women. The prevalence of HP in Moscow was substantially lower (49.8%) than in Kazan (67%). The proportion of HP-positive subjects increased with age from 41.8% in those below 25 years of age to 76.9% in those above their 60s. 60.2% of married participants and 49% of the singles were HP-positive. Among doctors, HP prevalence rate was the largest in the endoscopy specialists (61.5%) and internists (60.9%). Only 61.4% of HP-positive medical workers expressed their willingness to undergo eradication therapy. Conclusion: The study showed a high prevalence of HР in medical workers increasing with age. It is presumably related to hygiene habits and conditions during childhood of each generation; however, one cannot exclude their potential contamination during their occupational activities.

Gastroduodenal Ulcers and ABO Blood Group: the Japan Nurses’ Health Study (JNHS)

BackgroundAlthough several studies have shown that blood type O is associated with increased risk of peptic ulcer, few studies have investigated these associations in Japan. We sought to investigate the association between the ABO blood group and risk of gastroduodenal ulcers (GDU) using combined analysis of both retrospective and prospective data from a large cohort study of Japanese women, the Japan Nurses’ Health Study (JNHS; n = 15,019).MethodsThe impact of the ABO blood group on GDU risk was examined using Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CI), with adjustment for potential confounders.ResultsCompared with women with non-O blood types (A, B, and AB), women with blood type O had a significantly increased risk of GDU from birth (multivariable-adjusted HR 1.18; 95% CI, 1.04–1.34). Moreover, the highest cumulative incidence of GDU was observed in women born pre-1956 with blood type O. In a subgroup analysis stratified by birth year (pre-1956 or post-1955), the multivariable-adjusted HR of women with blood type O was 1.22 (95% CI, 1.00–1.49) and 1.15 (95% CI, 0.98–1.35) in the pre-1956 and post-1955 groups, respectively.ConclusionIn this large, combined, ambispective cohort study of Japanese women, older women with blood type O had a higher risk of developing GDU than those with other blood types.

Time latencies of Helicobacter pylori eradication after peptic ulcer and risk of recurrent ulcer, ulcer adverse events, and gastric cancer: a population-based cohort study

Helicobacter pylori is associated with peptic ulcer disease and gastric cancer. Therefore we wanted to test how various lengths of delays in H pylori eradication therapy influence the risk of recurrent peptic ulcer, ulcer adverse events, and gastric cancer. This population-based nationwide Swedish cohort study included 29,032 patients receiving H pylori eradication therapy after peptic ulcer disease in 2005 to 2013. Predefined time intervals between date of peptic ulcer diagnosis and date of eradication therapy were analyzed in relation to study outcomes. Cox regression provided hazard ratios (HRs) and 95% confidence intervals (95% CIs), adjusted for age, sex, comorbidity, history of ulcer disease, use of ulcerogenic drugs, and use of proton pump inhibitors (PPIs). Compared with eradication therapy within 7 days of peptic ulcer diagnosis, eradication therapy within 8 to 30, 31 to 60, 61 to 365, and >365 days corresponded with HRs of recurrent ulcer of 1.17 (95% CI, 1.08-1.25), 2.37 (95% CI, 2.16-2.59), 2.96 (95% CI, 2.76-3.16), and 3.55 (95% CI, 3.33-3.79), respectively. The corresponding HRs for complicated ulcer were 1.55 (95% CI, 1.35-1.78), 3.19 (95% CI, 2.69-3.78), 4.00 (95% CI, 3.51-4.55), and 6.14, (95% CI, 5.47-6.89), respectively. For gastric cancer the corresponding HRs were .85 (95% CI, .32-2.23), 1.31 (95% CI, .31-5.54), 3.64 (95% CI, 1.55-8.56), and 4.71 (95% CI, 2.36-9.38), respectively. Delays in H pylori eradication therapy after peptic ulcer diagnosis time-dependently increase the risk of recurrent ulcer, even more so for complicated ulcer, starting from delays of 8 to 30 days.

Peptic ulcer risk with antidepressants and NSAIDs

Although the selective serotonin reuptake inhibitors (SSRIs) have a very good safety profile, they have been associated with spontaneous bleeding in some patients. The risk could be further increased if patients are taking concurrent nonsteroidal anti‐inflammatory drugs (NSAIDs). Investigators recently conducted a retrospective analysis to evaluate the risk of peptic ulcer disease associated with concomitant use of both classes of drugs, as compared with use of antidepressants alone, as well as to examine the differential risk among the various classes of antidepressants and individual antidepressants.

The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis

ABSTRACTObjective: Systemic glucocorticoids (SGCs) are a treatment option for severe asthma but are associated with the development of adverse events (AEs). Evidence on the extent of SGC use and the relationship between SGC dose and AE risk in severe asthma is limited. Methods: Patients with severe asthma (Global Initiative for Asthma step 4/5), with no SGC use during the <6–12 months before severe asthma determination (index date) were identified in the UK-based Clinical Practice Research Datalink database (2004–2012). Patients were assessed for SGC exposure and an incident diagnosis of an SGC-related AE (cataracts, diabetes, myocardial infarction [MI], osteoporosis, peptic ulcer or stroke) during the 8-year observation phase. The dose-related risk of an SGC-related AE was determined using AE-specific Cox proportional hazards models. Results: Overall, 75% of 60,418 patients identified with severe asthma received SGC during the 8-year follow-up, with the majority receiving an average of >0–≤2.5 mg/day. The risk of diabetes (hazard ratio [HR]:1.20 [95% confidence interval (CI): 1.11, 1.30]), MI (HR: 1.25 [95% CI: 1.09, 1.43]) and osteoporosis (HR: 1.64 [95% CI: 1.51, 1.78]) was increased at low SGC doses (0–2.5 mg/day), with further risk increases at doses >2.5 mg/day versus no SGC use. Compared with no SGC use, SGC increased the risk of peptic ulcer in a non-dose-dependent manner, but the risk of stroke was unchanged. Conclusions: Most patients with severe asthma are exposed to SGC, which increases SGC-related AE risk. This suggests that SGC exposure should be minimized as recommended by asthma treatment guidelines.

TLR2 Arg677Trp but not TLR2 -196 to -174 ins/del and Arg753Gln polymorphism alter the risk of peptic ulcer in north of Iran

BackgroundMost polymorphisms that occur in TLR-2 are associated with gastrointestinal disorders such as peptic ulcer disease (PUD). Hence, in current study, association between TLR2-196 to -174 ins/del, Arg753Gln and Arg677Trp polymorphisms and risk of PUD development in north of Iran was evaluated. MethodsThis case-control study included 50 patients with PUD as cases and 50 people without peptic ulcer as control group. Blood and endoscopic biopsies were collected. Helicobacter pylori infection was screened by rapid urease test, specific IgG measurement and specific PCR for glmM gene. Then, TLR2-196 to -174 ins/del polymorphism was assessed by using allele-specific PCR. The Arg753Gln and Arg677Trp polymorphism in TLR2 gene were analyzed by the PCR-restriction fragment length polymorphism (RFLP). ResultsThere was no significant difference in the allele and genotype frequencies of polymorphisms in the TLR2-196 to -174 ins/ins and Arg753Gln genes between controls and patients, respectively. However, an association with increased risk for PUD was observed for polymorphism TLR-2 Arg677Trp (odds ratio [OR] = 7.9; 95% confidence interval [CI] = 0.94–67.5). Further analysis showed that H. pylori infection was associated with a significant difference in genotype and allele frequencies of TLR2-196 to -174 ins/ins and Arg753Gln polymorphism, respectively. Furthermore, there was no association between variant haplotypes and PUD development in H. pylori infected subjects. However, no association was detected between gender and genotypic frequencies of all polymorphisms in TLR2. ConclusionOur findings showed that TLR2 Arg677Trp polymorphism and H. pylori infection may play crucial roles in peptic ulcer development respectively in north of Iran.

Antiplatelet drug ticagrelor delays gastric ulcer healing in rats.

Adenosine diphosphate P2Y12 receptor antagonist clopidogrel is not sufficiently safe for the gastric mucosa in patients with high risk of peptic ulcer, since it may impair healing of gastric erosions. However, the safety of the novel P2Y12 receptor antagonist ticagrelor in the gastric mucosa has not been elucidated to date. The present study aimed to examine whether ticagrelor delays gastric ulcer healing and to elucidate the involved mechanisms. Gastric kissing ulcers were produced in rats by luminal application of acetic acid solution, and ticagrelor was administered at dose of 10 or 20 mg/kg/day orally for 7 days. On day 8 after ulcer induction, the ulcer size, mucosal epithelial cell proliferation of the ulcer margin, expression levels of epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF), and signal transduction pathways for cell proliferation and angiogenesis were measured and compared between the ticagrelor-treated and untreated model groups. The results revealed that the ulcer size was significantly greater in the ticagrelor-treated group compared with the model group, while the mucosal epithelial cell proliferation of the ulcer margin was significantly decreased in the ticagrelor-treated group. In addition, ticagrelor significantly decreased the ulcer-stimulated expression levels of EGF, VEGF, phosphorylated extracellular signal-regulated kinase (ERK), phosphorylated P38 mitogen-activated protein kinase and nuclear factor-κB P65 at the ulcer margin (P<0.05). These findings suggested that ticagrelor delayed gastric ulcer healing. Furthermore, the possible mechanisms underlying the effect of ticagrelor were associated with its functions of attenuating the expression levels of VEGF and EGF, as well as suppressing the phosphorylation activation of ERK1/2, P38 and nuclear factor-κB P65. Finally, the gastric epithelial cell proliferation and angiogenesis were also inhibited.

Association Between Alendronate Use and Hip Fracture Risk in Older Patients Using Oral Prednisolone

Oral glucocorticoid treatment increases fracture risk, and evidence is lacking regarding the efficacy of alendronate to protect against hip fracture in older patients using glucocorticoids. To investigate whether alendronate treatment in older patients using oral prednisolone is associated with decreased hip fracture risk and adverse effects. Retrospective cohort study using a national database (N = 433 195) of patients aged 65 years or older undergoing a health evaluation (baseline) at Swedish health care facilities; 1802 patients who were prescribed alendronate after at least 3 months of oral prednisolone treatment (≥5 mg/d) were identified. Propensity score matching was used to select 1802 patients without alendronate use from 6076 patients taking prednisolone with the same dose and treatment time criteria. Follow-up occurred between January 2008 and December 2014. Alendronate vs no alendronate use; no patients had previously taken alendronate at the time of prednisolone initiation. The primary outcome was incident hip fracture. Of the 3604 included patients, the mean age was 79.9 (SD, 7.5) years, and 2524 (70%) were women. After a median follow-up of 1.32 years (interquartile range, 0.57-2.34 years), there were 27 hip fractures in the alendronate group and 73 in the no-alendronate group, corresponding to incidence rates of 9.5 (95% CI, 6.5-13.9) and 27.2 (95% CI, 21.6-34.2) fractures per 1000 person-years, with an absolute rate difference of -17.6 (95% CI, -24.8 to -10.4). The use of alendronate was associated with a lower risk of hip fracture in a multivariable-adjusted Cox model (hazard ratio, 0.35; 95% CI, 0.22-0.54). Alendronate treatment was not associated with increased risk of mild upper gastrointestinal tract symptoms (alendronate vs no alendronate, 15.6 [95% CI, 11.6-21.0] vs 12.9 [95% CI, 9.3-18.0] per 1000 person-years; P = .40) or peptic ulcers (10.9 [95% CI, 7.7-15.5] vs 11.4 [95% CI, 8.0-16.2] per 1000 person-years; P = .86). There were no cases of incident drug-induced osteonecrosis and only 1 case of femoral shaft fracture in each group. Among older patients using medium to high doses of prednisolone, alendronate treatment was associated with a significantly lower risk of hip fracture over a median of 1.32 years. Although the findings are limited by the observational study design and the small number of events, these results support the use of alendronate in this patient group.

Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort

Objective: To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades.Materials and methods: A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30–60, in 1982–3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993–4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry.Results: Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4–2.8), Helicobacter pylori (HR 1.7, CI 1.2–2.3), smoking (HR 2.0, CI 1.3–3.1), heavy drinking (HR 1.6, CI 1.1–2.4), abstinence (HR 1.6, CI 1.1–2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5–3.0), and sedentary lifestyle (HR 1.9, CI 1.4–2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0–2.2, p = .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers.Conclusions: A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in ‘idiopathic’ and Helicobacter pylori-associated ulcers, and in acute surgical cases.

Helicobacter pylori cagL amino acid polymorphism D58E59 pave the way toward peptic ulcer disease while N58E59 is associated with gastric cancer in north of Iran.

The cagL protein of Helicobacter pylori involving in pathogenesis of gastroduodenal disorders. Therefore, the current study was conducted to determine the cagL amino acid polymorphisms in patients with gastric diseases. One hundred gastric biopsies were collected from gastritis, peptic ulcer (PUD) and gastric cancer (GC) patients and were screened for cagL using polymerase chain reaction (PCR). Also, sequence variations of the cagL were assessed via sequence translation. The cagL geneopositivity was 71.6% in patients were infected with H.pylori. The cagL from PUD indicated a higher rate of D58 amino acid sequence polymorphism than those of the GC and gastritis (P<0.05). The D58 polymorphism showed an increased risk of PUD up to 6.5-fold (95% CI: 1.2-35.7). This position was occupied with amino acid N58 in GC. The E59 polymorphism was more frequently found in PUD and GC than gastritis patients. Additionally, presence of Q62 and N122 significantly observed in PUD and GC, whereas I60 was detected in PUD patients. Our results demonstrated that presence of the D, I, Q and N at position 58, 60, 62 and 122, respectively increased the risk of peptic ulcer. However, amino acid N, M, Q and N at the same position alongside V134 increased the risk of gastric cancer.

Differential Risk of Peptic Ulcer Among Users of Antidepressants Combined With Nonsteroidal Anti-inflammatory Drugs.

Selective serotonin reuptake inhibitors (SSRIs) have been reported to have an increased risk of gastrointestinal adverse events, and the risk may be further increased by combined use of nonsteroidal anti-inflammatory drugs (NSAIDs). However, little has been known about the risk of peptic ulcer associated with other classes of antidepressants or individual antidepressants combined with NSAIDs. We conducted a retrospective cohort study to define the risk of peptic ulcer associated with combined use of antidepressants and NSAIDs, as compared with use of antidepressants alone. Using the Korean Health Insurance Review and Assessment Service database, we identified a total of 1,127,622 patients who began receiving antidepressants between 2009 and 2012. Propensity-based matching and Cox proportional hazards models were used to compare the risk of peptic ulcer between antidepressant users with NSAIDs and those without NSAIDs matched in a 1:1 ratio, for a total of 768,850 patients. The risk of peptic ulcer did not increase with combined use of overall antidepressants and NSAIDs, as compared with antidepressant use alone (hazard ratio [HR], 1.02; 95% confidence interval [CI], 0.99-1.06). A slightly increased risk was observed for combined use of NSAIDs with tricyclic antidepressants (HR, 1.15; 95% CI, 1.09-1.21) and with SSRIs (HR, 1.08; 95% CI, 1.01-1.16). We found that although concomitant use of NSAIDs and antidepressants was not associated with an increased risk of peptic ulcer for antidepressants in general, it was so for some specific classes including tricyclic antidepressants and SSRIs. However, we cannot rule out the possibility that the increased risk was solely due to NSAID use.

The Development of Urease Inhibitors: What Opportunities Exist for Better Treatment of Helicobacter pylori Infection in Children?

Stomach infection with Helicobacter pylori (H. pylori) causes severe gastroduodenal diseases in a large number of patients worldwide. The H. pylori infection breaks up in early childhood, persists lifelong if not treated, and is associated with chronic gastritis and an increased risk of peptic ulcers and gastric cancer. In recent years, the problem of drug-resistant strains has become a global concern that makes the treatment more complicated and the infection persistent at higher levels when the antibiotic treatment is stopped. Such problems have led to the development of new strategies to eradicate an H. pylori infection. Currently, one of the most important strategies for the treatment of H. pylori infection is the use of urease inhibitors. Despite the fact that large numbers of molecules have been shown to exert potent inhibitory activity against H. pylori urease, most of them were prevented from being used in vivo and in clinical trials due to their hydrolytic instability, toxicity, and appearance of undesirable side effects. Therefore, it is crucial to focus attention on the available opportunities for the development of urease inhibitors with suitable pharmacokinetics, high hydrolytic stability, and free toxicological profiles. In this commentary, we aim to afford an outline on the current status of the use of urease inhibitors in the treatment of an H. pylori infection, and to discuss the possibility of their development as effective drugs in clinical trials.

Unsaturated Fatty Acid Synthesis in the Gastric Pathogen Helicobacter pylori Proceeds via a Backtracking Mechanism

Helicobacter pylori is a Gram-negative bacterium that inhabits the upper gastrointestinal tract in humans, and the presence of this pathogen in the gut microbiome increases the risk of peptic ulcers and stomach cancer. H.pylori depends on unsaturated fatty acid (UFA) biosynthesis for maintaining membrane structure and function. Although some of the H.pylori enzymes involved in UFA biosynthesis are functionally homologous with the enzymes found in Escherichia coli, we show here that an enzyme HP0773, now annotated as FabX, uses an unprecedented backtracking mechanism to not only dehydrogenate decanoyl-acyl carrier protein (ACP) in a reaction that parallels that of acyl-CoA dehydrogenase, the first enzyme of the fatty acid β-oxidation cycle, but also isomerizes trans-2-decenoyl-ACP to cis-3-decenoyl-ACP, the key UFA synthetic intermediate. Thus, FabX reverses the normal fatty acid synthesis cycle in H.pylori at the C10 stage. Overall, this unusual FabX activity may offer a broader explanation for how many bacteria that lack the canonical pathway enzymes produce UFA-containing phospholipids.

Newly arrived refugee children with Helicobacter pylori are thinner than their non-infected counterparts.

The hypothesis of this study was that those refugee children with Helicobacter pylori are thinner than their non-infected counterparts. This cross-sectional study investigated the height and weight of newly arrived refugee children up to age 19 years, who were screened for H. pylori using a stool antigen test at the Migrant Health Service in Adelaide between August 2010 and October 2013. Of 460 children, 21% were infected with H. pylori. After adjusting for vitamin B12 and iron levels, ethnicity, age and sex, the odds of being thin in the 10- to 19-year-old age group was 4.28-fold higher (95% CI 1.48-12.4) if they were H. pylori positive compared with those who were H. pylori negative. The difference between the two groups is statistically significant (P=0.01). Screening and treatment for H. pylori in the general population in developed countries is not recommended unless there are symptoms such as dyspepsia or risk of peptic ulcer, duodenal ulcer or gastric cancer. Given the findings of this study, a recommendation could be made that newly arrived refugee children who are thin should be tested for H. pylori. Thinness in children may influence their cognitive ability, school performance, physical endurance and hence their ability to successfully settle into their new country.

Increased Risk of Peptic Ulcers Following a Cholecystectomy for Gallstones.

This retrospective cohort study examined the relationship between a cholecystectomy and the subsequent risk of peptic ulcers using a population-based database. Data for this study were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. This study included 5209 patients who had undergone a cholecystectomy for gallstones and 15,627 sex- and age-matched comparison patients. We individually tracked each patient for a 5-year period to identify those who subsequently received a diagnosis of peptic ulcers. We found that of the 20,836 sampled patients, 2033 patients (9.76%) received a diagnosis of peptic ulcers during the 5-year follow-up period: 674 from the study group (12.94% of the patients who underwent a cholecystectomy) and 1359 from the comparison group (8.70% of the comparison patients). The stratified Cox proportional hazard regressions showed that the adjusted hazard ratio (HR) for peptic ulcers during the 5-year follow-up period was 1.48 (95% CI = 1.34~1.64) for patients who underwent a cholecystectomy than comparison patients. Furthermore, the adjusted HRs of gastric ulcers and duodenal ulcers during the 5-year follow-up period were 1.70 and 1.71, respectively, for patients who underwent a cholecystectomy compared to comparison patients. This study demonstrated a relationship between a cholecystectomy and a subsequent diagnosis of peptic ulcers.

Diabetes increases morbidity and mortality rates in peptic ulcer bleeding: An updated systematic review and meta-analysis

To elucidate the relationship between diabetes mellitus (DM) and the risk of peptic ulcer complications. Fixed effects and random effects models were used for calculating pooled relative risks (RRs) and/or odds ratios (ORs). Subgroup and sensitivity analyses were also performed. Nineteen high-quality investigations were included in the present study. In an analysis of morbidity rates in primary peptic ulcer bleeding (PUB), we calculated a summary OR of 1.433 (95% CI=1.280-1.604) in the random effects model comparing incidence in diabetes patients and in those without diabetes. In addition, a meta-analysis using the fixed effects model indicated a higher 30-day mortality in PUB in DM patients (OR=1.442, 95% CI=1.245-1.671) than in patients without DM. Further subgroup analyses demonstrated that DM patients in prospective cohort studies had an increased risk of 30-day mortality in PUB (RR=1.407, 95% CI=1.177-1.681). A similar result was obtained in a retrospective cohort subgroup, in which DM significantly increased mortality rates in PUB (OR=1.521, 95% CI=1.171-1.976). We provided convincing evidence by a meta-analysis that DM was associated with a 43.3% increase in morbidity rates in PUB and a 44.2% increase in the risk of 30-day mortality in PUB patients.

Pathologies digestives hautes associées aux anti-inflammatoires non stéroïdiens

assess the pathology of the upper digestive tract associated with NSAIDs. it is a prospective study from June 2012 to July 2014 including, patients under treatment with nonsteroidal anti-inflammatory drug. They were seen in consultation for gastrointestinal symptoms (abdominal pain, dyspepsia, hematemesis, melena, vomiting), and had undergone upper endoscopy. NSAIDs were considered as the cause of endoscopic lesions if taken during the preceding two weeks. Gastric biopsy in search of Helicobacter pylori was not systematic. A total of 142 patients were recruited, among them 72 men (50.7%). The average age was 48.8 years. There were 45 patients with hypertension (31.7%), and 11with valvular disease (7.7%). Twenty-six patients had rheumatic disease, or 16.2%. NSAID use was resulting from self-medication in 34% of cases. Ibuprofen was the most antiinflammatory used (50%). The most frequent indication for endoscopy was epigastric pain (64%), followed by hematemesis and / or melena (29.6 %). The duration of NSAID use was more than 12 months in 29 patients (20.4%), between one and three months for 27 patients (19%) and one to 14 days in 52 patients (36.6%). Peptic ulcer disease was observed in 61 patients (42.9%). Twenty-six patients (18.3%) were taking two NSAIDs and 14 of them had a peptic ulcer (53.8%). The acid acetyl salicylic low dose (<300 mg) was used in 26 patients (18.3%), of which 12 presented a peptic ulcer (46.1%) and three gastrointestinal bleeding (11.5%). Dyspepsia was observed in 18 patients (12.7%). The risk of peptic ulcer was associated with male gender (OR = 1.4 95% CI: 0.7 to 2.7), more than 12 months NSAID taking (OR = 4.9 95% CI 1.3 to 10.9).