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Trabalhos Publicados em Julho / 2017

RECORD 1

A Non-Inferiority Study: Modified Dual Therapy Consisting Higher Doses of Rabeprazole Is as Successful as Standard Quadruple Therapy in Eradication of Helicobacter pylori Sapmaz F. Kalkan I.H. Atasoy P. Basyigit S. Guliter S. American Journal of Therapeutics (2017) 24:4 (e393-e398). Date of Publication: 2017The aim is to compare high-dose rabeprazole and amoxicillin containing  modified dual therapy (MDT) with bismuth subcitrate containing standard  quadruple therapy (SQT) as the first-line Helicobacter pylori eradication  treatment in terms of efficacy, safety, and adherence to treatment. A total  of 200 consecutive patients diagnosed endoscopically with nonulcer dyspepsia  with H. pylori infection were randomly assigned into 2 groups, 1 treated  with amoxicillin 750 mg thrice daily plus rabeprazole 20 mg thrice daily  (MDT group) or rabeprazole 20 mg b.i.d., bismuth subcitrate 120 mg q.i.d.,  tetracycline 500 mg q.i.d., metronidazole 500 mg t.i.d. (SQT group).  Overall, 196 patients (98 in the MDT group and 98 in the SQT group)  completed the study. H. pylori eradication was achieved in 84.7% of patients  in the MDT group by intention to treat analysis and 84.9% by per-protocol  analysis, which were comparable with SQT group (87.8% and 88.8%,  respectively). Adverse events including nausea (P = 0.03), dysgeusia (P <  0.001), diarrhea (P = 0.001), black colored stool (P < 0.001), headache (P =  0.01), and abdominal pain (P = 0.05) were significantly higher in SQT group.  The MDT is an efficient and safe treatment choice that could be recommended  in the first-line eradication treatment of H. pylori.

 

RECORD 2

Hybrid therapy versus sequential therapy for eradication of Helicobacter  pylori: A randomized controlled trial Ashokkumar S. Agrawal S. Mandal J. Sureshkumar S. Sreenath G.S. Kate V.  Journal of Pharmacology and Pharmacotherapeutics (2017) 8:2 (62-67). Date of  Publication: 1 Apr 2017 Objective: To compare the sequential therapy (ST) with the hybrid therapy  (HT) for the eradication of Helicobacter pylori. Materials and Methods:  Patients with peptic ulcer disease and gastritis found to be H. pylori  positive were randomized to HT group who received omeprazole (20 mg bid) and  amoxicillin (1 g bid) for 7 days followed by omeprazole (20 mg bid),  amoxicillin (1 g bid), clarithromycin (500 mg bid), and metronidazole (400  mg tid) for the next 7 days and ST group who received omeprazole and  amoxicillin for 5 days followed by omeprazole, clarithromycin, and  metronidazole for the next 5 days. Eradication rate, compliance, and  complications were compared. Results: A total of 120 patients were included,  sixty in each group. H. pylori eradication rate was significantly higher in  HT group on intention-to-treat analysis (88.3% [confidence interval (CI)  78.3%-94.8%] vs.   showed higher eradication rate with HT (93% [CI 83.9%-93.7%] vs. 81.5% [CI  69.5%-90.2%]; P= 0.068); however, the difference was insignificant.  Compliance and side effects were similar. A complete course of HT costs  $10.77, while ST costs only $6.347. Conclusions: HT achieves significantly  higher H. pylori eradication rate than ST with comparable patient compliance  and side effects but at an higher price. However, it can be used in places  where ST is ineffective.

 

RECORD 3

An audit of endoscopic RUT and treatment for helicobacter pylori in clinical  practice  Mohanty R. Swain M. Kar S.K. Singh S.P. Rout N. Journal of Pure and Applied Microbiology (2017) 11:2 (941-948). Date of Publication: 1 Jun 2017 Helicobacter pylori infection is ubiquitous. Endoscopic Rapid urease test [RUT] is sensitive and specific for diagnosing H. pylori organism during endoscopy. Retrospective analysis of the pattern of RUT performance by endoscopists in Southeast Bengal region in patients evaluated for upper gastrointestinal disorders was performed. The gastroscopy reports of consecutive patients from South-eastern Bengal attending a gastroenterology clinic were studied. The data along with relevant treatment history were entered into a questionnaire and the data was analyzed. Data of 151 patients were analyzed. 16 patients with reflux oesophagitis and growth in duodenum were excluded. Out of 135 patients, 47.4 % and 52.6% had peptic ulcers and non ulcer dyspepsia [NUD] respectively. Rapid urease test (RUT) was positive in 40.62% and 33.80% of peptic ulcer and NUD patients respectively (p = 0.477). However 32.45% patients on "premedication" and 62% without "premedication"were RUT positive, which was statistically significant (p= 0.014). There is also no difference (P >0.05) in endoscopic diagnosis or result of RUT performed by gastroenterologists or nongastroenterologists. 81.25% of RUT positive NUD patients who received Triple therapy for H. pylori did not respond; but all [100%] responded to antidepressants. RUT was performed routinely in all patients undergoing gastroscopy irrespective of diagnosis. The RUT was routinely performed without cognizance of pre-endoscopy treatment. "Pre-treatment" results in erroneous underestimation of H. pylori infection. Antidepressants were superior to triple therapy for NUD even in H. pylori infected patients.

 

RECORD 4

Helicobacter pylori Seropositivity and Childhood Neurodevelopment, the Rhea  Birth Cohort in Crete, Greece Karachaliou M. Chatzi L. Michel A. Kyriklaki A. Kampouri M. Koutra K.  Roumeliotaki T. Chalkiadaki G. Stiakaki E. Pawlita M. Waterboer T. Kogevinas  M. de Sanjose S. Paediatric and Perinatal Epidemiology (2017) 31:4 (374-384). Date of  Publication: 1 Jul 2017 Background: Limited evidence exists on the association between exposure to Helicobacter pylori infection early in life, including fetal life, and  neurodevelopment in childhood. Methods: We used prospective data on 352  mother–child pairs and cross sectional data on 674 children to assess the  association of maternal and child's H. pylori seropositivity correspondingly  on child's neurodevelopment at age four in the Rhea birth cohort in Crete,  Greece. Blood levels of immunoglobulin G antibodies to 12 H. pylori proteins  were measured using multiplex serology. Child's neurodevelopment at age four  was assessed using the McCarthy Scales of Children's Abilities. Linear  regression models were used to explore the associations after adjusting for  potential confounders. Results: Helicobacter pylori seroprevalence (95% CI)  in cord blood, representing maternal status, was 41.5% (36.3%, 46.8%) and in  4 years old children was 6.5% (95% CI 4.8%, 8.7%). Children of H. pylori  seropositive mothers had lower score in the general cognitive (−3.87, 95% CI  −7.02, −0.72), verbal (−2.96, 95% CI −6.08, 0.15), perceptual performance

(−3.37, 95% CI −6.60, −0.15), quantitative (−2.85, 95% CI −6.28, 0.58), and  memory scale (−3.37, 95% CI −6.67, −0.07) compared to those of seronegative  mothers. Seropositivity in cord blood specifically to GroEl and NapA – two  of the 12 H. pylori proteins investigated – was associated with lower scores  in almost all scales. At age four, H. pylori seropositive children performed  worst in neurodevelopment assessment compared to their seronegative  counterparts although no association reached statistically significant  level. Conclusions: Helicobacter pylori infection in early life may be an  important but preventable risk factor for poor neurodevelopment

 

RECORD 5

First-line therapies for Helicobacter pylori eradication: A critical  reappraisal of updated guidelines  De Francesco V. Bellesia A. Ridola L. Manta R. Zullo A. Annals of Gastroenterology (2017) 30:4 (373-379). Date of Publication: 2017 Helicobacter pylori (H. pylori) treatment remains a challenge for the  clinician, as no available therapy is able to cure the infection in all  treated patients. In the last two decades, several antibiotic combinations  have been proposed, including triple therapies, bismuth-free therapies  (sequential, concomitant, hybrid regimens), and bismuth-based quadruple  therapy. Some national and international guidelines on H. pylori management  have recently been updated, recommending or discouraging the use of each of  these therapeutic approaches, based mainly on the presumed pattern of  primary antibiotic resistance in different geographic areas. We examined the  recommendations on first-line therapies in the most recently updated  guidelines worldwide, taking into account other data affecting the efficacy  of a therapy regimen beyond the primary resistance pattern. Although several  guidelines highlighted that the results achieved by an eradication therapy  are populationspecific and not directly transferable, it emerged that some  therapy regimens are recommended or discouraged with no mention of the vital

need for national data.

 

RECORD 6

Association between Gastric Cancer Risk and Serum Helicobacter pylori  Antibody Titer z Shuto M. Fujioka T. Matsunari O. Okamoto K. Mizukami K. Okimoto T. Kodama M.  Takigami S. Seguchi C. Nonaka Y. Sato R. Yamaoka Y. Murakami K.  Gastroenterology Research and Practice (2017) 2017 Article Number: 1286198. Date of Publication: 2017 Background/Aims. It is difficult to confirm the accurate cutoff value to  diagnose Helicobacter pylori (Hp) infection using commercial serology kits.  It is reported that there were many cases with present/past infection that  even the serum Hp-IgG antibody (HpAb) titers were below the cutoff value  (e.g., 10 U/mL for E-Plate®), suggesting that we might overlook many gastric cancer (GC). We investigated an association between gastric cancer risk and  serum Helicobacter pylori antibody titers. Methods. We conducted a primary  screening between 2014 and 2015. We performed gastroendoscopy if HpAb titers  were ≥3.0 U/mL (i.e., more than measurable limit, E-Plate). These patients  were divided into two groups: HpAb = 3.0-9.9 U/mL ("negative-high" group)  and HpAb ≥ 10 U/mL; cutoff value ("over-10 U/mL" group). Hp infection status was investigated, and the number of GC patients was counted. Results. Among the 3321 subjects in the primary screening, 56.9% (1891/3321) showed HpAb

titers ≥3.0 U/mL; 1314 patients underwent gastroendoscopy. Ten were GC. 421 patients were "negative-high" group; two were GC. After evaluating 381 patients for Hp infection, 22.6%/60.6% was with present/past infection among the "negative-high" group. Conclusion. We also found a correlation between HpAb titers and Hp infection status. "Negative-high" group has a risk of GC.

 

RECORD 7

Relationship between histopathological status of the Helicobacter pylori  infected patients and proteases of H. pylori in isolates carrying diverse  virulence genotypes Gharibi S. Falsafi T. Alebouyeh M. Farzi N. Vaziri F. Zali M.R. Microbial Pathogenesis (2017) 110 (100-106). Date of Publication: 1 Sep 2017 Helicobacter pylori is the main cause of several gastroduodenal diseases in Humans. Among various virulence factors of H. pylori, proteases may also be  involved in its pathogenicity. In this study, relationship between proteolytic activity of H. pylori strains and histopathological changes of  the stomach was investigated in the patients infected with strains carrying  diverse virulence factors. H. pylori strains were isolated from the biopsies  of 116 patients who referred to hospital for their gastroduodenal disorders,  in Tehran, Iran. Biopsies were sent to microbiology and pathology  laboratories for further analysis. All the suspected grown colonies were  characterized by both biochemical tests and polymerase chain reaction (PCR).  Presence of seven protease genes, htrA, clpP, hp0169, hp1012, hp0382, hp1350  and hp1435, and distinct allelic variants of H. pylori virulence factors,  cagA, vacA, iceA, babA2 and sabA, were analyzed in each strain. Protease  activity of the strains was assessed using spectrophotometric assay.  Furthermore, association between diversity in protease genes and virulence  genes, protease activity, as well as pathological changes was estimated  statistically. Proteases genes, htrA, clpP, hp0169, hp1012, hp0382, hp1350,  hp1435, were detected among 100%, 100%, 98%, 98%, 98%, 98%, and 8% of fifty  H. pylori strains isolated from the patients, respectively. Status of cagA,  vacA s1, vacA s2, vacA m1, vacA m2, iceA1, iceA2, babA2 and sabA genes in  isolates were 64%, 68%, 30%, 26%, 74%, 48%, 52%, 100%, and 96%,  respectively. Predominant (84%) combined status for protease genes was:  htrA/clpP/hp0169/hp1012/hp0382/hP1350/hp1435, while the prevalent combined  status (16%) for virulence genes was: cagA+/vacA  s1m2/iceA1(+)/sabA(+)/babA2(+). Although most of the strains (91.4%)  presented moderate protease activity in vitro, lowest activity was measured  in strains isolated from the patients with chronic gastritis (4.25%).  Present study provide the new data on diversity of protease genes in H.  pylori, as well as the proteolytic activity of these genes in H. pylori  strains from the sick patients. Presence of significant association between lower protease activity of the strains and mildness of the pathological  changes propose involvement of these proteases in the pathogenesis of H.  pylori in vivo.

 

RECORD 8

Sensitivity of Helicobacter pylori detection by Giemsa staining is poor in comparison with immunohistochemistry and fluorescent in situ hybridization and strongly depends on inflammatory activity Kocsmár É. Szirtes I. Kramer Z. Szijártó A. Bene L. Buzás G.M. Kenessey I.  Bronsert P. Csanadi A. Lutz L. Werner M. Wellner U.F. Kiss A. Schaff Z. Lotz  G. Helicobacter (2017) 22:4 Article Number: e12387. Date of Publication: 1 Aug  2017 Background: Conventional stainings (including H&E and special stains like  Giemsa) are the most widely applied histopathologic detection methods of  Helicobacter pylori (HP). Materials and Methods: We aimed to compare the  diagnostic performance of Giemsa staining with immunohistochemistry (IHC)  and fluorescent in situ hybridization (FISH) on a monocentric cohort of 2896  gastric biopsies and relate results to histologic alterations in order to find such histopathologic subgroups in which these methods underperform. All  cases were categorized regarding presence or absence of chronic gastritis, inflammatory activity, and mucosal structural alterations. Results: Giemsa  revealed 687 cases (23.7%), IHC 795 cases (27.5%), and FISH 788 cases  (27.2%) as being HP positive. Giemsa showed significantly lower overall  sensitivity (83.3%) compared to IHC (98.8%) and FISH (98.0%). Moreover, the  sensitivity of Giemsa dramatically dropped to 33.6% in the nonactive cases.  We found that sensitivity of Giemsa strongly depends on HP density and, accordingly, on the presence of activity. Structural alterations (intestinal metaplasia, atrophy, etc.) had only no or weak effect on sensitivity of the three stainings. Both IHC and FISH proved to be equally reliable HP detecting techniques whose diagnostic performance is minimally influenced by mucosal inflammatoryand structural alterations contrary to conventional stainings. Conclusions: Wehighly recommend immunohistochemistry for clinically susceptible, nonactive chronic gastritis cases, if the conventional stain-based HP detection is negative. Moreover, we recommend to use IHC more widely as basic HP stain. Helicobacter pylori FISH technique is  primarily recommended to determine bacterial clarithromycin resistance. Furthermore, it is another accurate diagnostic tool for HP.

 

RECORD 9

Eradication of Helicobacter pylori infection might improve clinical status  of patients with Parkinson's disease, especially on bradykinesia Liu H. Su W. Li S. Du W. Ma X. Jin Y. Li K. Chen H. Clinical Neurology and Neurosurgery (2017) 160 (101-104). Date of  Publication: 1 Sep 2017 Objectives Previous studies have shown that Helicobacter pylori infection  might make clinical status worse in patients with Parkinson's disease and Helicobacter pylori eradication might improve clinical status by modifying the pharmacokinetics of L-dopa. Here, we investigate whether Helicobacter pylori eradication could benefit idiopathic parkinsonism and Helicobacter pylori infection will effect which aspect of motor symptom significantly. Patientsand methods A cohort study involving idiopathic Parkinson's disease patients, screened for Helicobacter status by (13)C urea breath test. Clinical status was evaluated by using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr stage. If patients had motor complications, they were quantified at the “on” time. The Helicobacter pylori positive patients could choose to receive Helicobacter pylori eradication or not by themselves. Group 1 was Helicobacter pylori negative patients. Group 2 was Helicobacter pylori positive patients who didn't receive eradication treatment. Group 3 was Helicobacter pylori positive patients who received successful eradication treatment. Repeat clinical assessments and (13)C urea breath test was performed at 1 year later. Numerical data were expressed as mean ± standard deviation (SD) Results Ninety-four consecutive patients with Parkinson's disease were recruited and underwent the initial (13)C urea breath test, but onlyforty-eight patients successfully completed the total study. In Group 3, the UPDRS-III scores (=Motor Examination Section Scores) were significantly lower 1 year later compared to baseline (18.3 ± 8.38 vs. 25.9 ± 8.37, P = 0.007). The differences were main in UPDRS-23 (=Finger Taps) (1.7 ± 1.16 vs. 2.4 ± 1.51, P = 0.045), UPDRS-25 (Rapid Alternation Movements of Hands) (1.6 ± 1.35 vs. 2.4 ± 1.71, P = 0.031) and UPDRS-26 (=Leg Agility) (1.3 ± 1.25 vs.2.1 ± 0.99, P = 0.011). There was difference among three groups in the UPDRS-26(P = 0.040) of clinical status change of one year. Conclusion The eradication of Helicobacter might improve the clinical status of idiopathic parkinsonism, especially on bradykinesia.

 

RECORD 10

Neither 10- nor 14-Day Sequential Treatment is better than Standard Triple Therapy for Helicobacter Pylori Eradication Warrington E. López-Román O. Tirado Montijo R. Urbina R. Cruz-Correa M. Toro D.H. Puerto Rico health sciences journal (2016) 35:4 (203-208). Date of  Publication: 1 Dec 2016 OBJECTIVE: Helicobacter pylori is a bacterial pathogen associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric  mucosa associated lymphoid tissue lymphoma. Current treatment guidelines  support a 7- to 14-day, triple-drug protocol consisting of a proton-pump  inhibitor (PPI), clarithromycin, and either amoxicillin or an imidazole. The initial eradication rates for this regimen were 80 to 90%. Nevertheless its  effectiveness has declined as the antibiotic resistance to clarithromycin  and metronidazole has emerged. In Puerto Rico the reported resistance of H.  pylori to clarithromycin is 16% and to metronidazole, 3.7%. Sequential therapy for H. pylori eradication, 5 days of treatment with a PPI and  amoxicillin followed by 5 days of treatment with the PPI and 2 other  antibiotics (clarithromycin and an imidazole), was introduced as an  effective alternate regimen. This is a prospective clinical trial intended  to compare the efficacy of first-line, standard 10-day tripledrug therapy  with those of both 10- and 14-day sequential therapy in eradicating H.  pylori at the San Juan Veterans Affairs Hospital in a population that is  naïve to previous treatment.METHODS: This was a prospective, open-label,  randomized clinical trial.RESULTS: Based on the intention-to-treat analysis, the eradication rate was 83.7% (72 of 86 patients) in the standard  triple-therapy group, 80.0% (68/85) in the 10- day sequential-therapy group,  and 79.1% (68/86) in the 14-day sequential-therapy group. There were no  significant statistical differences between the eradication rates among  therapies.CONCLUSION: Sequential-therapy treatment regimens are not better  than standard triple therapy for the eradication of H. pylori infection,  regardless of the treatment duration.

 

RECORD 11

Association of heterogenicity of Helicobacter pylori cag pathogenicity  island with peptic ulcer diseases and gastric cancer Khatoon J. Prasad K.N. Prakash Rai R. Ghoshal U.C. Krishnani N. British Journal of Biomedical Science (2017) 74:3 (121-126). Date of  Publication: 3 Jul 2017 Objective: To investigate the frequency and integrity of certain cag  pathogenicity island genes (cagPAI) in Helicobacter pylori strains and their  association with peptic ulcer disease (PUD) and gastric cancer. Material and  Methods: We enrolled 240 adult patients [120 with functional dyspepsia (FD),  50 with PUD and 70 with gastric cancer] undergoing upper gastrointestinal endoscopy. H. pylori infection was diagnosed when either culture or any two of the three tests (rapid urease test, histopathology and specific ureA PCR) were positive. DNA extracted from H. pylori isolates and positive gastric tissues were tested by PCR for the presence of different genes of cagPAI using specific primers. Results: A total of 122 (51%) patients were H. pylori positive. Frequencies of cagPAI genes cagA, cagE, cagT and cagM in H. pylori strains from different groups of patients were as follows: functional dyspepsia 73, 83, 76 and 60%, PUD 70, 94, 91, 70% and gastric cancer 75, 95, 90 and 70%, respectively. Risk associated for the presence of PUD and gastric cancer with cagPAI genes cagE, cagT and cagM was 5.0-, 4.6- and 4.1- and 3.0-, 2.8- and 2.5-folds, respectively. Prevalence of intact cagPAI was significantly higher in PUD and gastric cancer compared to functional dyspepsia (PUD vs. functional dyspepsia, 71% vs. 38%, P = 0.01; gastric cancer vs. functional dyspepsia, 75% vs. 38%, P < 0.01). Intact cagPAI was associated with increased risk for the presence of PUD (odds ratio 5.2, 95% CI 2.4–11.3) and for the presence of gastric cancer (odds ratio 4.5, 95% CI 2.3–7.1). Conclusions:cagPAI integrity and its different genes are linked to different forms of gastric disease and so may have a role in pathogenesis, diagnosis and management.

 

RECORD 12

Validation of a Novel Immunoline Assay for Patient Stratification according  to Virulence of the Infecting Helicobacter pylori Strain and Eradication Status Formichella L. Romberg L. Meyer H. Bolz C. Vieth M. Geppert M. Göttner G. Nölting C. Schepp W. Schneider A. Ulm K. Wolf P. Holster I.L. Kuipers E.J. Birkner B. Soutschek E. Gerhard M. Journal of Immunology Research (2017) 2017 Article Number: 8394593. Date of  Publication: 2017 Helicobacter pylori infection shows a worldwide prevalence of around 50%. However, only a minority of infected individuals develop clinical symptoms  or diseases. The presence of H. pylori virulence factors, such as CagA and  VacA, has been associated with disease development, but assessment of  virulence factor presence requires gastric biopsies. Here, we evaluate the  H. pylori recomLine test for risk stratification of infected patients by comparing the test score and immune recognition of type I or type II strains defined by the virulence factors CagA, VacA, GroEL, UreA, HcpC, and gGT with patient's disease status according to histology. Moreover, the immune responses of eradicated individuals from two different populations were analysed. Their immune response frequencies and intensities against all antigens except CagA declined below the detection limit. CagA was particularly long lasting in both independent populations. An isolated CagA band often represents past eradication with a likelihood of 88.7%. In addition, a high recomLine score was significantly associated with high-grade gastritis, atrophy, intestinal metaplasia, and gastric cancer. Thus, the recomLine is a sensitive and specific noninvasive test for detecting serum responses against H. pylori in actively infected and eradicated individuals. Moreover, it allows stratifying patients according  to their disease state.

 

RECORD 13

The contribution of Helicobacter pylori to excess gastric cancer in  Indigenous and Pacific men: a birth cohort estimate eng A.M. Blakely T. Baker M.G. Sarfati D. Gastric Cancer (2017) 20:4 (752-755). Date of Publication: 1 Jul 2017 Background: The reasons for higher gastric cancer incidence rates in  indigenous populations are debated. Methods: We quantify the role of  Helicobacter pylori in excess gastric cancer incidence in Māori and Pacific  men in New Zealand. Age-standardized gastric cancer rate ratios for  1981–2004 were calculated in Māori and Pacific men compared with  European/other men born in 1926–1940 and in 1941–1955. Rate ratios were then  compared with those restricted to H. pylori prevalent populations. Results:  H. pylori contributed substantially to excess gastric cancer incidence in  Māori men (50%, 61%) and Pacific men (71%, 82%) in both cohorts.  Conclusions: Policy should focus on reducing the acquisition and prevalence  of H. pylori infection in these populations.

 

RECORD 1

Influence of Dietary Factors on Helicobacter pylori and CagA Seroprevalence  in Bulgaria Yordanov D. Boyanova L. Markovska R. Ilieva J. Andreev N. Gergova G. Mitov I. Gastroenterology Research and Practice (2017) 2017 Article Number: 9212143.  Date of Publication: 2017 The aim of this study was to assess the association between some dietary  factors and prevalence of H. pylori infection or strain virulence in 294  adult asymptomatic blood donors. Methods. Seroprevalence was evaluated using  ELISA. Logistic regression was used. Results. Anti-H. pylori IgG prevalence was 72.4%, and CagA IgG seroprevalence was 49.3%. In the multivariate  analyses, the frequent (>5 days per week) honey consumption was associated with both reduced H. pylori seroprevalence OR, 0.68 with 95% confidence  interval (CI), 0.473-0.967 and reduced CagA IgG seroprevalence OR, 0.65 with  95% CI, 0.486-0859. Frequent (>5 days per week) yoghurt consumption also was  associated with lower H. pylori virulence of the strains (CagA IgG OR, 0.56  with 95% CI, 0.341-0.921). Smoking and consumption of the other dietary  factors resulted in no significant differences in the prevalence of H.  pylori IgG and CagA IgG within the subject groups. Conclusion. To the best  of our knowledge, this is the first report revealing reverse associations between honey or yoghurt consumption and CagA IgG prevalence as well as between frequent honey consumption and lower prevalence of the H. pylori infection. Regular honey and yoghurt consumption can be of value as a supplement in the control of H. pylori therapy.

 

RECORD 15

Rate of isolation of helicobacter pylori from different clinical samples in patients suffering from gastritis attending tertiary care hospital Hajare V. Anandkumar H. Rajeshwari R.S. Journal of Pure and Applied Microbiology (2017) 11:2 (903-906). Date of  Publication: 1 Jun 2017 H.pylori is one of the most common infections in the world. It causes  dyspepsia, chronic gastritis and gastric carcinoma. Spread of the infection from person to person is by oral-oral or faeco-oral route. The aim of the study is to determine the rate of isolation of H.pylori infection from different sites like gastric biopsy, gastric aspirate, saliva and faeces. Patients were selected based on the clinical findings like early satiation, epigastric pain, epigastric burning, bloating, belching and endoscopic findings. Four types of samples-Gastric biopsy, Gastric aspirate, Saliva and Faeces were collected and all the four samples were subjected to Direct Gram Stain, Rapid Urease Test and Culture. Culture was done by inoculating samples onto Skirrows media with cefsulodin and amphotericin B and incubated at 35°C for 3-5 days under microaerophilic conditions. Identification of organism was done based on Gram stain of the colony, oxidase, catalase and urease test. Out of 96 clinically suspected cases of gastritis, H.pylori was isolated in 34(35.41%) patients from Gastric biopsy, 18 (18.75%) patients from Gastric aspirate, 8 (8.33%) patients from saliva and 4 (4.16%) patients from faeces. Among the 96 patients selected 59 were male participants and 37 were female participants with age between 20-60 years. In the present study, we found that H.pylori can be cultured from biopsy, gastric aspirate, saliva and faeces. There are several invasive and non invasive techniques to diagnose H.pylori, each having its own advantages and disadvantages. Non-invasive tests on saliva and faeces sample can play an important role in the diagnosis of H.pylori infection, but has the disadvantage of low sensitivity, whereas invasive tests like gastric biopsy and gastric aspirate are more sensitive.

 

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Morphologic characterization of residual DNA methylation in the gastric mucosa after Helicobacter pylori eradication Tahara S. Tahara T. Tuskamoto T. Horiguchi N. Kawamura T. Okubo M. Ishizuka T. Nagasaka M. Nakagawa Y. Shibata T. Kuroda M. Ohmiya N. Cancer Medicine (2017) 6:7 (1730-1737). Date of Publication: 1 Jul 2017 Residual DNA methylation in the gastric mucosa after Helicobacter pylori H. pylori) eradication may have a role in gastric carcinogenesis. We  examined the association between morphologic features and promoter  methylation status of non-neoplastic gastric mucosa especially after  H. pylori eradication. A total of 140 gastric specimens from 99 participants who had at least 6 months of post-eradication period were examined. The magnifying narrow-band imaging (NBI) endoscopic feature of gastric mucosa was divided into two types: restored-small, round pits, accompanied with honeycomb-like subepithelial capillary networks; atrophic-well-demarcated oval or tubulovillous pits with clearly visible coiled or wavy vessels. Methylation status of five candidate genes (MYOD1, SLC16A12, IGF2, RORA, and PRDM5) were examined by bisulfite pyrosequencing. The atrophic type, informative endoscopic features of intestinal metaplasia, demonstrated higher methylation levels in all five genes compared to the restored type (all P < 0.0001). In the restored type, methylation levels were significantly lower among the samples with longer post-eradication period (for all genes, P < 0.0001), which was not observed in atrophic type (for all genes, P > 0.1). Multivariate analysis demonstrated that atrophic type or presence of intestinal held an independent factor for hyper methylation (odds ratio: 24.69, 95% confidence interval: 6.95–87.76, P < 0.0001). The atrophic type by the magnifying NBI and presence of intestinal metaplasia are the morphologic characteristics of residual DNA methylation of after H. pylori eradication, regardless of the post-eradication period and it might be considered as the epigenetic irreversible point with H. pylori

eradication.

 

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Immunopathological alterations on gastric mucosa and gastric secretions induced by toxigenic H.pylori among Iraqi patients Al-Ezzy A.I.A. Research Journal of Pharmaceutical, Biological and Chemical Sciences (2017) 8:4 (133-145). Date of Publication: 2017 To determine the correlation between toxigenic H.pylori, H.pylori specific IgG; gastric secretions;status of gastric mucosa and inflammatory activity in different gastroduodenal disorders. Gastroduodenal biopsies were taken from patients for histopathology and H.pylori diagnosis. Serum samples were used for evaluation of pepsinogen I (PGI);(PGII); gastrin-17 (G-17) and H pylori specific IgG antibodies. H.pylori Cag A gene expression was detected by In Situ Hybridization. H.pylori IgG antibodies detected in (88.8%) .According to Cag A positivity, Significant difference (P value < 0.05) in PG I ;PGII, PG I/ PG II among different gastric disorders . G-17 negatively correlated with Cag A (P value=0.04). Significant correlation between H.pylori IgG and PG I; PG II ; G-17 . Serum levels of PG I; PG II ; PG I / PG II ; G-17 correlated with PMNs grade and Status of H.pylori Infected gastroduodenal mucosa. Lymphocyte grades differs significantly without correlation with histopathological changes in mucosa (P value =0.002) among different disorders according to H.pylori IgG. Significant difference in serum level of PG I; PG II; PG I / PG II; G-17 according to PMN and lymphocyte grades(P value < 0.01) . PMNs grades correlated with Cag A expression; H.pylori IgG ; PG II; G-17 levels. PG I; PG I/ PG II correlated with lymphocyte grades (P value < 0.05) ; while PGII have negative correlation (P value =0.039) . The level of gastrin secretion does not affected by Cag A expression. The levels of Pepsinogens and gastrin-17 correlated directly with gastric infiltration of PMNs & lymphocytes and serum level of H.pylori IgG. Status of gastroduodenal mucosa significantly correlated with serum levels of pepsinogens and gastrin-17 .H.pylori have the ability to modulate gastric secretions through CagA dependent and independent manner, which subsequently affects the disease progression pattern and final clinical outcome.

 

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Effectiveness of Helicobacter pylori eradication in pregnant women with idiopathic thrombocytopenic purpura Ono Y. Shiozaki A. Yoneda N. Yoneda S. Yoshino O. Saito S. Journal of Obstetrics and Gynaecology Research (2017) 43:7 (1212-1216). Date of Publication: 1 Jul 2017 Platelet counts increase after eradication of Helicobacter pylori (Hp) infection in non-pregnant patients with Hp-associated idiopathic thrombocytopenic purpura (ITP); however, improvement in pregnant patients has not yet been reported. We treated four pregnant women for Hp-positive ITP after Hp eradication. In three of four cases, platelet counts increased to levels exceeding 10 × 10(9)/L two weeks after eradication, and these levels were maintained until delivery. Vaginal deliveries were uncomplicated, and no excessive blood loss occurred in any of the cases. There were no remarkable side effects of Hp eradication in pregnant women or fetuses. In pregnant women with Hp-associated ITP, Hp eradication might be worthwhile prior to considering steroid administration.

 

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Lectin binding patterns in normal, dysplastic and helicobacter pylori infected gastric mucosa Vernygorodskyi S. Shkolnikov V. Suhan D. Experimental Oncology (2017) 39:2 (138-140). Date of Publication: 1 Jun 2017 Aim: To analyze the glycoprotein binding sites of the gastric mucosa and its secreted mucus using lectin histochemistry in patients with chronic non-atrophic gastritis (CNAG) associated or not-associated with Helicobacter pylori infection with or without dysplasia. Materials and Methods: In order to identify the areas with glycoconjugates expression in gastric mucosa, 6 lectins (Canavalia ensiformis agglutinin - Con A, Sambucus nigra agglutinin - SNA, wheat germ agglutinin - WGA, soybean agglutinin - SBA, Helix pomatia agglutinin - HPA, peanut agglutinin - PNA) were used. Carbohydrate determinants were visualized according to the lectin-peroxidase-diaminobenzidine staining protocol. Biopsy material was obtained and processed by conventional histological methods. The samples from 84 patients (54 with CNAG) with low (n = 34) and high grade (n = 20) dysplasia, 38 patients were H. pylori-infected and 26 patients - H. pylori-noninfected) were used. The comparison group included 30 persons with CNAG without dysplasia (16 patients H. pylori-infected and 14 - noninfected). Results: In comparison to normal gastric mucosa, a low affinity of Con A was shown in 80% of patients with non-infected CNAG and 90% of H. pylori associated CNAG. In 70% of H. pylori-infected patients with CNAG and low grade dysplasia there was an increase of SNA expression compared with noninfected patients (p < 0.05). Regarding SBA labeling no differences were detected in the studied groups (p < 0.05). In H. pylori infected patients with CNAG and low grade dysplasia, WGA, HPA and PNA showed a strong reactivity with the gastric mucosa cells in 80; 75%, and 60% of patients, respectively. Conclusion: We suggest that a set of lectins in reaction with gastric epithelial and glandular cells can be used as a tool to obtain information about the dysplastic changes of the gastric mucosa and may offer new insight into gastric carcinogenesis and precancerous lesions treatment.

 

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Dynamic Expansion and Contraction of cagA Copy Number in Helicobacter pylori Impact Development of Gastric Disease Jang S. Su H. Blum F.C. Bae S. Choi Y.H. Kim A. Hong Y.A. Kim J. Kim J.-H. Gunawardhana N. Jeon Y.-E. Yoo Y.-J. Merrell D.S. Ge L. Cha J.-H. mBio (2017) 8:1. Date of Publication: 21 Feb 2017 Infection with Helicobacter pylori is a major risk factor for development of  gastric disease, including gastric cancer. Patients infected with H. pylori  strains that express CagA are at even greater risk of gastric carcinoma.  Given the importance of CagA, this report describes a new molecular  mechanism by which the cagA copy number dynamically expands and contracts in  H. pylori Analysis of strain PMSS1 revealed a heterogeneous population in  terms of numbers of cagA copies; strains carried from zero to four copies of  cagA that were arranged as direct repeats within the chromosome. Each of the multiple copies of cagA was expressed and encoded functional CagA; strains  with more cagA repeats exhibited higher levels of CagA expression and  increased levels of delivery and phosphorylation of CagA within host cells.  This concomitantly resulted in more virulent phenotypes as measured by cell  elongation and interleukin-8 (IL-8) induction. Sequence analysis of the  repeat region revealed three cagA homologous areas (CHAs) within the cagA  repeats. Of these, CHA-ud flanked each of the cagA copies and is likely  important for the dynamic variation of cagA copy numbers. Analysis of a  large panel of clinical isolates showed that 7.5% of H. pylori strains  isolated in the United States harbored multiple cagA repeats, while none of  the tested Korean isolates carried more than one copy of cagA Finally,  H. pylori strains carrying multiple cagA copies were differentially  associated with gastric disease. Thus, the dynamic expansion and contraction  of cagA copy numbers may serve as a novel mechanism by which H. pylori  modulates gastric disease development.IMPORTANCE Severity of  H. pylori-associated disease is directly associated with carriage of the  CagA toxin. Though the sequences of the CagA protein can differ across  strains, previous analyses showed that virtually all H. pylori strains carry  one or no copies of cagA This study showed that H. pylori can carry multiple  tandem copies of cagA that can change dynamically. Isolates harboring more  cagA copies produced more CagA, thus enhancing toxicity to host cells.  Analysis of 314 H. pylori clinical strains isolated from patients in South  Korea and the United States showed that 7.5% of clinical strains in the  United States carried multiple cagA copies whereas none of the South Korean  strains did. This study demonstrated a novel molecular mechanism by which  H. pylori dynamically modulates cagA copy number, which affects CagA  expression and activity and may impact downstream development of gastric disease.

 

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Helicobacter pylori infection status had no influence on upper gastrointestinal symptoms: a cross-sectional analysis of 3,005 Japanese subjects without upper gastrointestinal lesions undergoing medical health checkups Yoshioka T. Takeshita E. Sakata Y. Hara M. Akutagawa K. Sakata N. Endo H.  Ohyama T. Matsunaga K. Tanaka Y. Shirai S. Ito Y. Tsuruoka N. Iwakiri R. Kusano M. Fujimoto K. Esophagus (2017) 14:3 (249-253). Date of Publication: 1 Jul 2017 Background: This study aimed to evaluate the influence of Helicobacter  pylori infection and its eradication on the upper gastrointestinal symptoms  of relatively healthy Japanese subjects. Methods: A total of 3,005 subjects (male/female: 1,549/1,456) undergoing medical health checkups were enrolled in the present study, at five hospitals in Saga, Japan, from January to December 2013. They had no significant findings following upper gastrointestinal endoscopy. All subjects completed a questionnaire that addressed a frequency scale for symptoms of gastroesophageal reflux disease. The questionnaire comprised seven questions regarding reflux symptoms and seven regarding acid-related dyspepsia, which were answered with a score based on the frequency of symptoms. Helicobacter pylori infection was identified by a rapid urease test and/or H. pylori antibody titer, and an eradication history was confirmed by the subjects’ medical records. Results: Helicobacter pylori infection was positive in 894 subjects out of 3,005 (29.8%). Eradication of Helicobacter pylori was successfully achieved in 440 subjects of 458 treated. Helicobacter pylori infection had no influence on the acid-related dyspepsia evaluated by the questionnaire, whereas the mean reflux score was relatively high in the Helicobacter pylori native negative subjects compared to Helicobacter pylori native positive. Eradication of Helicobacter pylori and time span after the eradication had no effect on the upper gastrointestinal symptoms evaluated by the questionnaire. Conclusion: Helicobacter pylori infection and history of eradication did not affect acid-related dyspepsia symptoms in Japanese healthy subjects.

 

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Vonoprazan fumarate for the management of acid-related diseases Martinucci I. Blandizzi C. Bodini G. Marabotto E. Savarino V. Marchi S. de  Bortoli N. Savarino E. Expert Opinion on Pharmacotherapy (2017) 18:11 (1145-1152). Date of  Publication: 24 Jul 2017 Introduction: Proton pump inhibitors (PPIs) display a number of limitations and unmet clinical needs that have prompted the development of novel drugs to improve the outcomes of acid-related diseases, including the eradication of H. pylori. In this context, a new synthesized potassium-competitive acid blocker (P-CAB), vonoprazan, showed higher suppression of gastric acid secretion. Areas covered: This review discusses the current knowledge regarding the efficacy of vonoprazan in the treatment of acid-related

diseases, with a particular focus on its use in Helicobacter pylori eradication. Expert opinion: Vonoprazan showed some advantages over PPIs in terms of the pharmacokinetic and pharmacodynamic profile: fast onset of action without requiring acid activation and specific administration timing, more potent and prolonged inhibition of acid secretion, including a better nighttime acid control, and a less antisecretory variability. Recent evidence suggests that vonoprazan can be preferred to PPIs as maintenance therapy for reflux esophagitis and eradication of Helicobacter pylori owing to its stronger antisecretory effect. Moreover, vonoprazan displays favorable safety and tolerability profiles, even though long-term studies on the effects of vonoprazan are required.

 

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Pylera(®) (bismuth subcitrate potassium/metronidazole/tetracycline hydrochloride) in the eradication of Helicobacter pylori infection: a profile of its use in EuropeLyseng-Williamson K.A.Drugs and Therapy Perspectives (2017) 33:7 (311-320). Date of Publication: 1 Jul 2017 Pylera(®) comprises three (bismuth substrate potassium + metronidazole + tetracycline hydrochloride) of four components of bismuth-based quadruple therapy for the eradication of Helicobacter pylori (H. pylori) in a single capsule. The 10-day regimen consists of the relatively convenient administration of Pylera(®) four times daily + twice-daily administration of the proton pump inhibitor omeprazole. This regimen provides an effective, well tolerated and relatively convenient option for administering bismuth-based quadruple therapy, which a recommended first- and second-line treatment for H. pylori eradication. The Pylera(®) regimen effectively eradicated H. pylori, regardless of the treatment line, the resistance of the bacterial strain to metronidazole and/or clarithromycin, the type of gastric disease and the country of treatment. The regimen is well tolerated, with a tolerability profile that is consistent with those of the individual components taken separately.

 

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Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort Levenstein S. Jacobsen R.K. Rosenstock S. Jørgensen T. Scandinavian Journal of Gastroenterology (2017) 52:9 (954-961). Date of  Publication: 2 Sep 2017 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.

 

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Managing Helicobacter pylori in college health, with special considerations for international students Hillard J.R. Kashup S. Journal of American college health : J of ACH (2016) 64:5 (404-408). Date of  Publication: 1 Jul 2016 OBJECTIVE: Helicobacter pylori infection is the major cause of dyspepsia, peptic ulcer disease, and gastric cancer. This paper will make specific recommendations for a diagnostic and treatment strategy tailored to the international student population.PARTICIPANTS/METHODS: This paper is a case report and narrative review based on recent international epidemiologic studies and consensus conference recommendations identified in MEDLINE.RESULTS: In the nations (mostly Asian) that send the largest number of students to the United States, the prevalence of H. pylori is generally 60% to 80%, whereas the prevalence in the United States is about 25%. The patterns of antibiotic resistance in those countries are also different than that in the general US population.CONCLUSIONS: Health care providers should have a higher index of suspicion for Helicobacter infection among international students with dyspepsia and need to use a different treatment regimen than is standard for the general US population.

 

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N-acetylcysteine prevents the development of gastritis induced by Helicobacter pylori infection Jang S. Bak E.-J. Cha J.-H. Journal of microbiology (Seoul, Korea) (2017) 55:5 (396-402). Date of  Publication: 1 May 2017 Helicobacter pylori (H. pylori) is a human gastric pathogen, causing various  gastric diseases ranging from gastritis to gastric adenocarcinoma. It has been reported that combining N-acetylcysteine (NAC) with conventional antibiotic therapy increases the success rate of H. pylori eradication. We evaluated the effect of NAC itself on the growth and colonization of H. pylori, and development of gastritis, using in vitro liquid culture system and in vivo animal models. H. pylori growth was evaluated in broth culture containing NAC. The H. pylori load and histopathological scores of stomachs were measured in Mongolian gerbils infected with H. pylori strain 7.13, and fed with NAC-containing diet. In liquid culture, NAC inhibited H. pylori growth in a concentration-dependent manner. In the animal model, 3-day administration of NAC after 1 week from infection reduced the H. pylori load; 6-week administration of NAC after 1 week from infection prevented the development of gastritis and reduced H. pylori colonization. However, no reduction in the bacterial load or degree of gastritis was observed with a 6-week administration of NAC following 6-week infection period. Our results indicate that NAC may exert a beneficial effect on reduction of bacterial colonization, and prevents the development of severe inflammation, in people with initial asymptomatic or mild H. pylori infection.

 

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Association of Helicobacter pylori with Chronic Kidney Diseases: A Meta-AnalysisWijarnpreecha K. Thongprayoon C. Nissaisorakarn P. Jaruvongvanich V. Nakkala  K. Rajapakse R. Cheungpasitporn W.Digestive Diseases and Sciences (2017) 62:8 (2045-2052). Date of  Publication: 1 Aug 2017 Background/Objectives: The reported risk of chronic kidney disease (CKD) in  patients with Helicobacter pylori infection is conflicting. This  meta-analysis was conducted to summarize all available data and to estimate  the prevalence and association between H. pylori and kidney disease and CKD. Methods: Comprehensive literature review was conducted using MEDLINE and EMBASE database through October 2016 to identify studies that reported the prevalence or the association between H. pylori infection and non-dialysis-dependent kidney diseases or CKD. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results: Of 4546 studies, nine cross-sectional studies met the eligibility criteria and were included in the meta-analysis. The estimated prevalence of H. pylori infection among subjects with kidney disease was 53% (95% CI 45–61%). The pooled OR of H. pylori in patients with non-dialysis-dependent kidney diseases was 1.20 (95% CI 0.73–1.97) when compared with the patients without kidney diseases. The meta-analysis was then limited to only studies evaluating the risk of H. pylori in CKD; the pooled OR of H. pylori in patients with CKD was 1.00 (95% CI 0.58–1.71). Conclusions: The estimated prevalence of H. pylori in patients with non-dialysis-dependent kidney diseases is 53%. This study does not support the association between H. pylori infection and non-dialysis-dependent kidney diseases nor CKD.

 

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Relationship between Helicobacter pylori infection and vomiting induced by gastrointestinal cancer chemotherapy Yao Y. Ji C. He Y. Pan Y. Internal Medicine Journal (2017) 47:7 (792-797). Date of Publication: 1 Jul 2017 Background: Nausea and vomiting are the most common adverse reactions to chemotherapy. Aim: To discuss the relationship between Helicobacter pylori and chemotherapy-induced nausea and vomiting (CINV). Methods: A total of 112 patients with malignant tumours of the gastrointestinal tract was selected. Based on the 14C-urea breath test results, the patients were divided into H. pylori-positive (n = 59) and H. pylori-negative (n = 53) groups. Both groups received prophylactic antiemetic treatment during chemotherapy. The incidence of nausea and vomiting and their effects on the patients’ life functions was recorded using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemetic Tool (MAT) and the Functional Living Index Emesis (FLIE) from 0–120 h after chemotherapy. Records of the H. pylori-positive and H. pylori-negative groups were compared. Results: The rates of nausea and vomiting remission were higher in the H. pylori -negative group than in the H. pylori -positive group. The proportions of no effect in daily life (NIDL) patients in the nausea and vomiting section were 73.4 and 75.5% in the H. pylori -negative group respectively. There was a higher proportion of NIDL patients in the H. pylori -negative group than in the H. pylori -positive group (P < 0.001, P = 0.046). A multivariate unconditional logistic regression analysis was performed, and the results showed that H. pylori infection was a factor affecting the nausea scores on the FLIE (odds ratio = 0.757, 95% confidence interval 0.597–0.960, P = 0.021). Conclusion: H. pylori infection in patients with cancer may be a factor that increases CINV.

 

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Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study Kassem E. Naamna M. Mawassy K. Beer-Davidson G. Muhsen K. European Journal of Pediatrics (2017) 176:8 (1099-1105). Date of  Publication: 1 Aug 2017 The significance of Helicobacter pylori (H. pylori) infection in pediatric  abdominal pain remains poorly recognized. We examined associations of H.  pylori infection and serum pepsinogens (PGs), as non-invasive markers of  gastritis, with pediatric abdominal pain. A case-control study was conducted among 99 children aged 5–17 years admitted to one hospital for abdominal pain(cases) without an apparent organic reason. Using enzyme-linked immunosorbent assays, sera were tested and compared with 179 controls for anti-H. pylori immunoglobulin G (IgG) antibodies and PGI and PGII levels. Multivariable analysis was performed to adjust for potential confounders. H. pylori IgG sero-positivity was 34.3 and 36.3% in cases and controls, respectively, P = 0.7. H. pylori-infected children had higher median PGI and PGII levels and a lower PGI/PGII ratio than uninfected children. Cases infected with H. pylori had a higher median PGII level (P < 0.001) and lower PGI/PGII ratio (P = 0.036) than controls infected with H. pylori. The percentage of cases with PGII ≥7.5 μg/L, as indication for antral inflammation, was higher than in controls: 58.6 versus 44.7%, P = 0.027. Children with PGII levels ≥7.5 μg/L had increased risk for abdominal pain: adjusted prevalence ratio 1.73 [95% confidence intervals 1.02, 2.93], P = 0.039. Conclusion: Children with increased serum PGII levels, as an indication of gastritis, are more likely to have abdominal pain. Serum PGs can be a useful non-invasive marker for gastritis, in evaluating children with severe abdominal pain with no apparent organic reason.What is Known:• The significance of Helicobacter pylori infection in pediatric abdominal pain remains debated.• Serum pepsinogens (PGs), non-invasive markers of gastric inflammation, were rarely utilized in assessing the association between H. pylori in pediatric abdominal pain of unknown origin.What is New:• High serum PGII level, as an indication of gastritis, rather than H. pylori infection itself, was associated with increased risk for abdominal pain.• Serum PGs can be a useful biomarker for gastritis in evaluating children with severe abdominal pain with no apparent organic reason.

 

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The effects of synbiotic " Bifidobacterium lactis B94 plus Inulin" addition on standard triple therapy of helicobacter pylori eradication in children Ustundag G.H. Altuntas H. Soysal Y.D. Kokturk F. Canadian Journal of Gastroenterology and Hepatology (2017) 2017 Article  Number: 8130596. Date of Publication: 2017 Aim. The aim of this study is to evaluate the effects of the synbiotic  Bifidobacterium lactis B94 plus inulin addition to the standard triple therapy on Helicobacter pylori (H. pylori) infection eradication rates. Methods. Children aged 6-16 years who had biopsy proven H. pylori infection were randomly classified into two groups. The first group received the standard triple therapy consisting of amoxicillin + clarithromycin + omeprazole. The second group was treated with the standard triple therapy and Bifidobacterium lactis B94 (5 × 10(9) CFU/dose) plus inulin (900 mg) for 14 days, concurrently. Eradication was determined by (14)C-urea breath test 4-6 weeks after therapy discontinuation. Results. From a total of 69 H. pylori infected children (F/M = 36/33; mean ± SD = 11.2 ± 3.0 years), eradication was achieved in 20/34 participants in the standard therapy group and 27/35 participants in the synbiotic group. The eradication rates were not significantly different between the standard therapy and the synbiotic groups [intent-to-treat, 58.8% and 77.1%, resp., p = 0.16; per-protocol, 64.5% and 81.8%, resp., p = 0.19]. There was no difference between the groups in terms of symptom relief (p = 0.193). The reported side effects were ignorable. Conclusion. Considering the eradication rates, synbiotic addition to therapy showed no superiority over the standard triple therapy conducted alone. This trial is registered with NCT03165253.

 

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Anti-Helicobacter pylori Activity of Isocoumarin Paepalantine: Morphological and Molecular Docking Analysis Damasceno J.P.L. Rodrigues R.P. Gonçalves R.C.R. Kitagawa R.R. Molecules (Basel, Switzerland) (2017) 22:5. Date of Publication: 12 May 2017 The Helicobacterpylori bacterium is one of the main causes of chronic  gastritis, peptic ulcers, and even gastric cancer. It affects an average of  half of the world population. Its difficult eradication depends upon  multi-drug therapy. Since its classification as a group 1 carcinogenic by  International Agency for Research on Cancer (IARC), the importance of H.  pylori eradication has obtained a novel meaning. There is considerable  interest in alternative therapies for the eradication of H. pylori using  compounds from a wide range of natural products. In the present study, we  investigated the antibacterial property of the isocoumarin paepalantine  against H. pylori and it exhibited significant anti-H. pylori activity at a  minimum inhibitory concentration (MIC) of 128 μg/mL and at a minimum  bactericidal concentration (MBC) of 256 μg/mL. The scanning electron  microscopy (SEM) revealed significant morphological changes of the bacterial cell as a response to a sub-MIC of paepalantine, suggesting a  penicillin-binding protein (PBP) inhibition. Computational studies were carried out in order to study binding modes for paepalantine in PBP binding sites, exploring the active and allosteric sites. The data from the present study indicates that paepalantine exhibits significant anti-H. pylori activity, most likely by inhibiting membrane protein synthesis.

 

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Gastric juice-based real-time PCR for tailored Helicobacter Pylori treatment: A practical approachPeng X. Song Z. He L. Lin S. Gong Y. Sun L. Zhao F. Gu Y. You Y. Zhou L. Zhang J.nInternational Journal of Medical Sciences (2017) 14:6 (595-601). Date of Publication: 15 May 2017A gastric juice-based real-time polymerase chain reaction (PCR) assay was established to identify Helicobacter pylori infection, clarithromycin susceptibility and human CYP2C19 genotypes and to guide the choice of proton pump inhibitor (PPI), clarithromycin and amoxicillin treatment for tailored H. pylori eradication therapy. From January 2013 to November 2014, 178 consecutive dyspeptic patients were enrolled for collection of gastric biopsy samples and gastric juice by endoscopy at the Peking University Third Hospital; 105 and 73 H. pylori-positive and -negative patients, respectively, were included in this study. H. pylori infection was defined as samples with both a strongly positive rapid urease test (RUT) and positive H. pylori histology. A series of primers and probes were distributed into four reactions for identifying the H. pylori cagH gene coupled with an internal control (Rnase P gene), A2142G and A2143G mutants of the H. pylori 23S rRNA gene, and single-nucleotide polymorphisms (SNPs) G681A of CYP2C19*2 and G636A of CYP2C19*3. The E-test and DNA sequencing were used to evaluate the H. pylori clarithromycin susceptibility phenotype and genotype. The SNPs CYP2C19*2 and CYP2C19*3 were also evaluated by nucleotide sequencing. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this gastric juice-based real-time PCR assay were evaluated by comparing with the same measures obtained through gastric biopsy-based PCR and culture The H. pylori diagnostic sensitivities of the culture, PCR, and gastric biopsy- and gastric juice-based real-time PCR assays were 90.48% (95/105), 92.38% (97/105), 97.14% (102/105) and 100% (105/105), respectively; the specificities of the above methods were all 100%. Higher false-negative rates were found among the gastric biopsy samples assessed by culture (10.48%, 11/105), PCR (7.62%, 8/105) and real-time PCR (2.86%, 3/105) than in gastric juice by real-time PCR. Regarding clarithromycin susceptibility, a concordance of 82.98% (78/94) and discordance of 17.02% (16/94) were observed among the different methods, discrepancies that mainly represent differences between the H. pylori clarithromycin susceptibility phenotype and genotype. Three coinfections of susceptible and resistant strains were detected, with resistant-to-susceptible ratios of 1.16, 3.44, and 8.26. The CYP2C19 genotyping results from gastric juice by real-time PCR were completely in accordance with those obtained from biopsy samples by conventional PCR. This gastric juice-based real-time PCR assay is a more accurate method for detecting H. pylori infection, clarithromycin susceptibility and CYP2C19 polymorphisms. The method may be employed to inform the choice of proton pump inhibitor (PPI), clarithromycin and amoxicillin treatment for tailored H. pylori eradication therapy.

 

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Regulation of apoptosis is impaired in atrophic gastritis associated with gastric cancer Rosania R. Varbanova M. Wex T. Langner C. Bornschein J. Giorgio F. Ierardi E. Malfertheiner P. BMC Gastroenterology (2017) 17:1 Article Number: 84. Date of Publication: 29  Jun 2017 Background: Gastric premalignant conditions, atrophic gastritis (AG) and intestinal metaplasia(IM) are characterized by an increase of proliferation and a reduction of apoptosis in epithelial cells. The epithelial cell kinetics in AG and IM in gastric mucosa adjacent to gastric cancer is still unclear. The aim of this study was to evaluate the epithelial cell turnover and expression of proliferation and apoptosis-related genes in gastric cancer (GC) and adjacent mucosa with atrophic gastritis or intestinal metaplasia (AG/IM GC+), as well as in atrophic gastritis or intestinal metaplasia mucosa of patients without GC (AG/IM GC-) and in control biopsy samples of non-transformed gastric mucosa (Control). Methods: We selected 58 patients (M: F = 34:24; age range 20-84 years, median 61.06 years) with 4 well defined histological conditions: 20 controls with histological finding of non-transformed gastric mucosa, 20 patients with AG or IM (AG/IM GC-), and 18 patients with intestinal type gastric adenocarcinoma (GC) and AG or IM in the adjacent mucosa (3 cm from the macroscopic tumour margin, AG/IM GC+). We performed an immunohistochemical staining of Ki67 and TUNEL and quantitative RT-PCR to determine the expression of PCNA and Bax/Bcl-2. Results: The immunohistochemical expression of Ki67 and TUNEL in AG/IM GC- was significantly increased compared to not transformed gastric mucosa (p < 0.0001) but not compared to AG/IM in gastric mucosa adjacent to GC. Levels of Bcl-2 were reduced in GC and AG/IM GC- compared to controls as well as in AG/IM GC- compared to AG/IM in mucosa adjacent to GC+ (p < 0.05). Proliferation and apoptosis markers did not correlate with H.pylori status in our study population. Conclusions: In AG/IM associated with GC, no significant changes in the epithelial cell turnover were detected. Decreased Bcl-2 gene expression signified atrophic gastritis and IM in presence of cancer, as well as intestinal type gastric adenocarcinoma.

 

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High salt intake is associated with atrophic gastritis with intestinal Metaplasia Song J.H. Kim Y.S. Heo N.J. Lim J.H. Yang S.Y. Chung G.E. Kim J.S. Cancer Epidemiology Biomarkers and Prevention (2017) 26:7 (1133-1138). Date of Publication: 1 Jul 2017 Background: Although several studies have investigated excessive salt intake as a risk factor for gastric precancerous lesions, such as atrophic gastritis and intestinal metaplasia, the evidence is insufficient to make a conclusion. We evaluated the association between gastric precancerous lesions and salt intake. Methods: From 2008 to 2015, the medical records of 728 subjects who underwent upper gastrointestinal endoscopy and sodium excretion in 24-hour urine tests were retrospectively reviewed. Sixty-six subjects were excluded due to diuretics use (n55), diagnosis with a gastric neoplasm (n4), or the cases of intestinal metaplasia in the absence of atrophy (n 7), so 662 subjects were included. Atrophic gastritis and intestinal metaplasia were diagnosed by endoscopic findings. The subjects were grouped into three levels by tertiles of 24-hour urine sodium excretion. Results: A total of 192 (29.0%) had atrophic gastritis without  intestinal metaplasia and 112 (16.9%) had atrophic gastritis with intestinal metaplasia. A total of 276 subjects (61.5%) were infected with Helicobacter pylori (H. pylori). In multivariate analyses, H. pylori infection [OR 14.17; 95% confidence interval (CI), 7.12-28.22) was associated with atrophic gastritis without intestinal metaplasia. Highest levels of sodium excretion (OR 2.870; 95% CI, 1.34-6.14), heavy smoking (20 pack-years) (OR 2.75; 95% CI, 1.02-7.39), and H. pylori infection (OR 3.96; 95% CI, 2.02-7.76) were associated with atrophic gastritis with intestinal metaplasia. Conclusions: Our endoscopy-based study suggested that high salt intake could be associated with an increased risk of atrophic gastritis with intestinal metaplasia. Impact: Low salt diet might be helpful to prevent gastric carcinogenesis.

 

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Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination Safaan T. Bashah M. El Ansari W. Karam M. Obesity Surgery (2017) 27:7 (1741-1749). Date of Publication: 1 Jul 2017Background: Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history. Methods: Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011–July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes. Results: Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each). Conclusion: Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.

 

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A prospective evaluation of levofloxacin-based triple therapy for refractory Helicobacter pylori infection in Australia Katelaris P.H. Katelaris A.L. Internal Medicine Journal (2017) 47:7 (761-766). Date of Publication: 1 Jul 2017 Background: First-line Helicobacter pylori eradication failure is a common and challenging problem. Aim: To assess the efficacy of salvage levofloxacin-based triple therapy in Australia. Methods: Prospective patients referred after prior treatment failure(s) were prescribed esomeprazole 40 mg, amoxicillin 1 g and levofloxacin 500 mg each twice daily for 10 days. All patients received detailed written and verbal adherence support. Outcome assessment was by (13)C-urea breath test and/or histology and urease test. Results: In 150 consecutive, evaluable patients (66% female, mean age 54 ± 14 years; six smokers), the main indications for treatment were peptic ulcer disease (17%), increased gastric cancer risk (20%), symptoms (35%) and other risk reduction (28%). The median number of previous treatments was 2 (range 1–7). Eradication of H. pylori was achieved in 90% (intention to treat (ITT)) and 91% (per-protocol (PP)) of patients. The eradication rate did not differ according to the type or number of prior treatments: 93% when ≤2 (n = 107) compared with 84% after three or more prior treatments (n = 43; P = 0.13) or with age, ethnicity or indication for treatment but it was higher in females (ITT 94 vs 82%, P = 0.04). Adherence was excellent (95%). No serious adverse effects were observed; mild adverse effects were reported in 11%. No primary levofloxacin resistance was observed in 20 concurrent cases. Conclusion: The efficacy and safety of this levofloxacin-based triple therapysuggests it should be used as a salvage regimen in this region. Randomised comparative trials are unlikely to be done but these data compare favourably with local data for other salvage therapies.

 

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Improving the standard sequential treatment of Helicobacter pylori with either extended treatment or by adding bismuth Akpinar Z. Akay S. Unsal B. Arab Journal of Gastroenterology (2017) 18:2 (58-61). Date of Publication: 1 Jun 2017 Background and study aims Standard sequential treatment for Helicobacter pylori (H. pylori) eradication has less success because of increasing clarithromycin resistance. Extended treatment and bismuth containing regimens were, therefore, investigated. Patients and methods Consecutive H. pylori-positive patients with dyspepsia were randomly allocated to one of the three sequential regimens: The first group was given lansoprazole 30 mg b.i.d. plus amoxicillin 1 g b.i.d. for the first 5 days, followed by lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg t.i.d. for the second 5 days (standard sequential, SS). The second group was given the same regimen but for 7 + 7 days instead of 5 + 5 days (extended sequential, ES). In the third group, colloidal bismuth 600 mg b.i.d. was added to the second regimen for 14 days (extended sequential + bismuth subcitrate, ES + B). Urea breath test or histology was performed before enrolment and 6 weeks after the end of treatment to detect H. pylori. Results A total of 280 patients were included in the study. Per-protocol eradication rates were 62% (56/90), 72% (56/78), and 75% (54/72) in patients who received SS, ES, and ES + B regimens, respectively. Moreover, intention-to-treat eradication rates were 53% (56/104), 62% (56/90) and 62% (54/86), respectively. The differences in eradication rates between the groups were not statistically significant. Conclusion Although prolonging of the sequential treatment to 14 days may be considered, addition of bismuth to the regimen is of no avail.

 

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The GPX1 Pro(198)Leu polymorphism in gastric cancer patients with and without Helicobacter pylori infection Moradi M.-T. Yari K. Rahimi Z. Genes and Genomics (2017) (1-5). Date of Publication: 12 Jul 2017 Helicobacter pylori infection could induce oxidative stress. Oxidative stress is involved in the pathogenesis of gastric diseases. Glutathione peroxidase 1 (GPX1), is part of the enzymatic antioxidant defense, preventing oxidative damage. The aim of the present study was to assess the association of GPX1 Pro(198)Leu genotypes with gastric cancer in patients  with and without H. pylori infection in a population of Northern Iran. The present case-control study consisted of 50 patients with gastric cancer and 78 cancer-free subjects as controls. Extraction of DNA was performed on bioptic samples and the GPX1 genotypes were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The frequencies of GPX1 Pro/Pro, Pro/Leu and Leu/Leu genotypes in controls were 21.8, 71.8 and 6.4%, respectively. However, in gastric cancer patients, the frequencies of 34, 56 and 10% were observed for Pro/Pro, Pro/Leu and Leu/Leugenotypes, respectively (p = 0.185). In 38 (76%) patients infected with H. pylori, the frequencies of Pro and Leu alleles were 94.7 and 3.3%, respectively. There was a higher frequency of combined genotype of Pro/Leu + Leu/Leu (94.7%) in H. pylori positive patients than that in patients without H. pylori infection (75%, p = 0.047). The presence of this genotype tended to increase the risk of H. pylori related gastric cancer by 5.88–fold (p = 0.069) in our population. Our findings indicated the absence of association between the GPX1Pro(198)Leu polymorphism and the risk of gastric cancer in an Iranian population. However, we detected an association between H. pylori related gastric cancer with GPX1 Pro/Leu + Leu/Leu genotype.

 

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Association of Helicobacter pylori infection with olfactory function using smell identification screening test Üstün Bezgin S. Çakabay T. Irak K. Koçyiğit M. Serin Keskineğe B. Cevizci R. Bayazıt Y.A. European Archives of Oto-Rhino-Laryngology (2017) (1-3). Date of Publication: 26 Jun 2017 The aim of the present study is to investigate the role of Helicobacter pylori in olfactory function. Thirty-six patients (mean age 38.5) aged between 18 and 55 years who were diagnosed with H. pylori by gastric biopsies and age- and sex-matched 30 healthy adults (mean age 33.6) were included in the study. All participants underwent a detailed ear–nose–throat examination including endoscopic examination of the nasal cavity and laryngeal area, and olfactory tests were performed using the Sniffin’ Sticks, a 12-item screening test (Sniffin’Sticks; Burghart, Wedel, Germany) and odor scores were recorded. The mean odor score was 7.9 ± 1.7 (range 2–10) in the patient group and 10.3 ± 1.4 (range 6–12) in the control group. There were significant lower scores in the patient group compared to the control group (p < 0.05). In conclusion, it is apparent that there is an association of H. pylori infection with olfactory dysfunction. H. pylori infection should be considered as possible etiological factorsin patients with olfactory dysfunction.

 

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Efficacy and safety of probiotic-supplemented triple therapy for eradication f Helicobacter pylori in children: a systematic review and network meta-analysis Feng J.-R. Wang F. Qiu X. McFarland L.V. Chen P.-F. Zhou R. Liu J. Zhao Q.  Li J.European Journal of Clinical Pharmacology (2017) (1-10). Date of  Publication: 5 Jul 2017 Aim: The aim of this study was to identify the best probiotic supplementation in triple therapy for pediatric population with Helicobacter pylori infection. Methods: Eligible trials were identified by comprehensive searches. Relative risks with 95% confidence intervals and relative ranks with P scores were assessed. Results: Twenty-nine trials (3122 participants) involving 17 probiotic regimens were identified. Compared with placebo, probiotic-supplemented triple therapy significantly increased H.pylori eradication rates (relative ratio (RR) 1.19, 95% CI 1.13–1.25) and reduced the incidence of total side effects (RR 0.49, 95% CI 0.38–0.65). Furthermore, to supplementedtriple therapy, Lactobacillus casei was identified the best for H. pylori eradication rates (P score = 0.84), and multi-strain of Lactobacillus acidophilus and Lactobacillus rhamnosus for total side effects (P score = 0.93). As for the subtypes of side effects, multi-strain of Bifidobacterium infantis, Bifidobacterium longum, L. acidophilus, L. casei, Lactobacillus plantarum, Lactobacillus reuteri, L. rhamnosus, Lactobacillus salivarius, Lactobacillus sporogenes, and Streptococcus thermophilus was the best to reduce the incidence of diarrhea; multi-strain of Bacillus mesentericus, Clostridium butyricum, and Streptococcus faecalis for loss of appetite; multi-strain of B. longum, Lactobacillus bulgaricus, and S. thermophilus for constipation; multi-strain of Bifidobacterium bifidum, B. infantis, L. acidophilus, L. bulgaricus, L. casei, L. reuteri, and Streptococcus for taste disturbance; Saccharomyces boulardii for bloating; and multi-strain of Bifidobacterium breve, B. infantis, L. acidophilus, L. bulgaricus, L. casei, L. rhamnosus, and S. thermophilus for nausea/vomiting. Conclusions: Probiotics are recommended to supplement triple therapy in pediatrics, and the effectiveness of triple therapy is associated with specific probiotic supplementation.

 

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Cytokine expression associated with Helicobacter pylori and Epstein-Barr virus infection in gastric carcinogenesis  Kim J.Y. Bae B.-N. Kang G. Kim H.-J. Park K.APMIS (2017). Date of Publication: 2017 Helicobacter pylori and Epstein-Barr virus (EBV) infection, and associated cytokines are involved in gastric carcinogenesis. We investigated the expression of these cytokines and their relationship with clinicopathological characteristics. The study included specimens from 207 patients with gastric adenocarcinoma, 56 with chronic gastritis, 32 with metaplasia, and 30 with low-grade epithelial dysplasia. Tissue microarrays were constructed and immunohistochemical staining for IL-1β, IL-6, IL-10, IL-17, p16, p21, TNF-α, and TNFR1 was performed. EBV and H. pylori infection status was determined. IL-1β, IL-6, IL-17, p16, and p21 protein expression was significantly higher in adenocarcinoma cases than in the other cases (p < 0.05). EBV was only noted in adenocarcinoma (13 cases, 6.3%). The H. pylori infection rate in adenocarcinoma was significantly higher than that in the other cases (p < 0.005). IL-6 expression was associated with improved survival (p < 0.05), whereas IL-17 expression was associated with decreased survival (p < 0.05). IL-6 expression was inversely associated with angioinvasion, and disease stage (p < 0.05), whereas IL-17 expression was associated with disease stage (p < 0.05). IL-10 expression was correlated with IL-1β and TNF-α expression, and p16 expression was correlated with IL-17 and EBV status. Our results indicate that IL-6 and IL-17 are associated with gastric carcinogenesis and may be considered prognostic factors. APMIS

 

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Double strain probiotic effect on Helicobacter pylori infection treatment: A double-blinded randomized controlled trial Haghdoost M. Taghizadeh S. Montazer M. Poorshahverdi P. Ramouz A. Fakour S. Caspian Journal of Internal Medicine (2017) 8:3 (165-171). Date of  Publication: 2017 Background: A decreased rate of successful helicobacter pylori (H.pylori) infection treatment has revealed serious demand for more effective regimens to eradicate infection. Therefore, probiotics have recently been considered to increase the rate of antibiotic regimens efficacy in H. pylori infections. In current randomized controlled trial, we evaluated the effect of double strain probiotic combination with standard triple therapy (STT), in the eradication rate of H. pylori infection. Methods: In current randomized placebo-control study, all patients (176 subjects) underwent the STT for 10 days. However, the study group received triple therapy for the eradication of H. pylori with supplement of Lactobacillus probiotic for 4 weeks and placebo was administered to control group, as well. Adverse  effects of the antibiotic regimen were recorded for all patients. Six weeks after the cessation of probiotic intake, all patients underwent H. Pylori with fecal antigen of test, followed by a recurrence evaluation six months later. Results: There was no significant difference in demographic data and presenting symptoms between the study groups. The eradication rate of H. pylori infection was significantly higher in probiotic group (78.4%), compared to that of placebo group (64.8%) (P=0.033). In addition, adverse events were significantly less prevalent in patients that received probiotic (P=0.047). Nonetheless, there was no significant difference in terms of infection recurrence during a 6-month follow-up (P=0.07). Conclusion: Double strain probiotic in combination with STT increased the eradication rate of H. pylori infection, while the adverse events due to antibiotic therapy decreased.

 

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Randomized trial comparing esomeprazole and rabeprazole in first-line  eradication therapy for Helicobacter pylori infection based on the serum levels of pepsinogens Shimoyama T. Chinda D. Sawada Y. Komai K. Chiba H. Saito Y. Sasaki Y.  Matsuzaka M. Fukuda S.Internal Medicine (2017) 56:13 (1621-1627). Date of Publication: 2017 Objective CYP2C19 metabolic activity influences the efficacy of Helicobacter pylori eradication therapies comprising PPIs. Rabeprazole (RPZ) and esomeprazole (EPZ) are PPIs not extensively metabolized by CYP2C19. The aim of this study was to elucidate whether or not first-line triple therapies using RPZ or EPZ are equally effective in Japanese patients with different CYP2C19 genotypes. Methods Two-hundred patients infected with H. pylori were randomized to receive one of the following regimens: amoxicillin (750 mg), clarithromycin (200 mg), and either esomeprazole (20 mg) (EAC group) or rabeprazole (10 mg) (RAC group), twice a day for one week. The CYP2C19 polymorphisms were determined by polymerase chain reaction and the serum levelofpepsinogens was measured. Results The eradication rates of the EAC and RAC regimens were 79.8% (95% confidential interval: 71.7-89.0%) and  74.7% (66.0 83.4%), respectively, in a per protocol (PP) analysis (p=0.488). The eradication rates of the EAC and RAC regimens were not significantly different between patients with the homo EM genotype (p=0.999) or hetero IM or PM genotypes (p=0.286). A lower PG I/II ratio was associated with lower eradication rates (p=0.025). Conclusion Although the eradication rate was less than 80%, the EAC and RAC regimens were equally effective in each CYP2C19 genotype group. The PG I/II ratio was associated with the results of EAC and RAC therapy in this series of patients.

 

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Eradication rate of Helicobacter Pylori infection is directly influenced by adherence to therapy in children Kotilea K. Mekhael J. Salame A. Mahler T. Miendje-Deyi V.Y. Cadranel S. Bontems P. Helicobacter (2017) 22:4 Article Number: e12383. Date of Publication: 1 Aug  2017 Background: Current commonly accepted strategies to eradicate Helicobacter pylori inchildren are a 10-day sequential treatment or a triple therapy for 7-14 days. To avoid further expensive and possibly risky investigations as well as induction of secondary antimicrobial resistance, a success rate of elimination strategies over 90% in a per-protocol analysis is the target goal but rates observed in clinical trials are lower. Antimicrobial resistance is a well-recognized risk factor for treatment failure; therefore, only a treatment tailored to susceptibility testing should be recommended. Adherence to therapy is also a risk factor for treatment failure but that has been poorly studied. The purpose of this study was to evaluate the influence of adherence to therapy on the elimination rates obtained with different treatment regimens. Methods: Cohort study analysis of children, aged 2-17 years, treated forHelicobacter pylori infection between October 2011 and December 2013. As a routine clinical practice, children infected with a strain susceptible to clarithromycin and to metronidazole received either a sequential regimen or a 10-day triple therapy while childreninfected with a strain resistant to clarithromycin or metronidazole received a 10-day triple regimen tailored to antimicrobial susceptibility. The eradication rate was assessed by a negative (13)C-urea breath test performed at least 8 weeks after the end of the treatment and adherence evaluated using a diary. Results: One hundred forty-five children (67 girls/78 boys, median age 9.7 years) fulfilled the inclusion criteria, 118 being infected with a strain susceptible to both clarithromycin and metronidazole, 10 with a clarithromycin resistant, and 17 with a metronidazole resistant strain. A sequential regimen was prescribed in 44, a triple therapy containing clarithromycin in 84 and containing metronidazole in 17. Follow-up data were available for 130/145 and clearance of the infection observed in 105 of them. A concordance of more than 90% between the prescribed and the ingested drugs was observed in 109 children, between 50 and 90% in eight, less than 50% in 11 while these data were unknown for 2/130. A successful eradication was achieved for 89.9% of patients that received at least 90% of the prescribed drugs, whereas the eradication rate for nonadherent patients was 36.6%. Adherence above 90% was significantly higher in the absence of chronic concomitant disease, in the absence of adverse event and results in a significantly higher eradication rate. With the proposed strategy and an adherence higher than 90%, eradication was obtained in 98/109 children, the rate being only significantly superior to 90% with the sequential regimen. Conclusion: Adherence to therapy is a very important factor for the outcome and has to be assessed when evaluating the outcome of an H. pylori eradication regimen in order to understand the reasons of treatment failure. As we treated only after evaluation of the resistance of the H. Pylori strains, we were expecting to reach the given objective of 90% successful treatment. Children with adherence to treatment above 90% had a successful outcome of 89,9%, whereas nonadherent had a successful outcome of 36,8%. This is the first time that adherence has been assessed accurately.

 

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The corpus-predominant gastritis index can be an early and reversible marker  to identify the gastric cancer risk of Helicobacter pylori-infected nonulcer  dyspepsia Cheng H.-C. Tsai Y.-C. Yang H.-B. Yeh Y.-C. Chang W.-L. Kuo H.-Y. Lu C.-C.  Sheu B.-S. Helicobacter (2017) 22:4 Article Number: e12385. Date of Publication: 1 Aug  2017 Background: Corpus-predominant gastritis index (CGI) is an early histological marker to identify Helicobacter pylori-infected gastric cancer relatives at risk of cancer. This study validated whether CGI is more prevalent in H. pylori-infected nonulcer dyspepsia (NUD) subjects than in duodenal ulcer (DU) controls and whether it is reversible after H. pylori eradication or is correlated with noninvasive biomarkers. Materials and Methods: In this longitudinal cohort study, 573 H. pylori-infected subjects were enrolled, including 349 NUD and 224 DU. Gastric specimens were provided to assess CGI, spasmolyic polypeptide-expressing metaplasia (SPEM), and Operative Link on Gastric Intestinal Metaplasia assessment (OLGIM). Serum pepsinogen I and II levels were assessed using enzyme-linked immunosorbent assay. CGI subjected were followed up at least 1 year after H. pylori eradication. Results: NUD subjects had higher prevalence rates of CGI (47.0% vs 29.9%, P<.001) and OLGIM stages III-IV (24.1% vs 15.2%, P=.01) than controls. CGI was highly prevalent in NUD subjects after the age of 40, which was 10 years earlier than atrophic gastritis and intestinal metaplasia. NUD subjects with CGI had higher risk of SPEM (OR 2.86, P<.001) and lower serum pepsinogen I/II ratios (P<.001) than those without CGI. Serum pepsinogen I/II ratios <9 could predict CGI modestly (AUROC 0.69, 95% CI: 0.63-0.74). CGI was regressed after eradication (P<.001). Conclusions: CGI was more prevalent in H. pylori-infected NUD subjects than in controls, was correlated with SPEM, and may serve as a marker earlier than OLGIM to indicate risk of gastric cancer. Moreover, CGI could be regressed after eradication.

 

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A Decrease of Histone Deacetylase 6 Expression Caused by Helicobacter Pylori Infection is Associated with Oncogenic Transformation in Gastric Cancer He Q. Li G. Wang X. Wang S. Hu J. Yang L. He Y. Pan Y. Yu D. Wu Y. Cellular Physiology and Biochemistry (2017) (1326-1335). Date of  Publication: 13 Jul 2017 Background: Histone deacetylase 6 (HDAC6) plays a role in the progression of many tumors. However, the relationship between the level of HDAC6 expression and gastric tumorigenesis is still unclear. Here, we illustrate the potentialcorrelation between Helicobacter pylori (HP) infection and the variation of HDAC6 expression in different gastric lesions, as well as the clinical significance of HDAC6 expression in gastric cancer (GC) patients. Materials and Methods: Between 2011 and 2016, 364 patients with different types of gastric lesions were enrolled in Baotou City Central Hospital. Immunostaining of HDAC6 expression and HP infection were performed in the following cohort including 21 normal tissues (Normal); 40 samples with chronic superficial gastritis (CSG); 106 with chronic atrophic gastritis (CAG); 94 with intestinal metaplasia (IM); 64 with dysplasia (DYS) and 39 with gastric cancer (GC). Survival analysis was performed in another 80 GC patients using the Kaplan-Meier method and multivariate Cox regression analyses. The level of HDAC6 expression was determined by Real-time PCR, Western blotting and IHC staining in gastric cell lines and tissues. Furthermore, the correlation between HDAC6 expression and clinicopathological features and prognosis was analyzed in the GC cohort. HP strains were lavaged into Kunming mice to investigate the effects of HP infection on the expression of different HDAC members in this mouse model. Results: Higher levels of HDAC6 expression were detected in normal and premalignant lesions than in the GC tissues (p<0.01), and decreased HDAC6 expression was associated with HP infection and TNM stage (p<0.01 and p=0.048, respectively). Multivariate analysis revealed that HDAC6 expression was an independent predictor of the outcome of GC patients (p=0.04). HP mediated HDAC6 expression in the cell lines and KM mice. HP infection could promote HDAC1 and HDAC4 expression as determined by Western blotting. Conclusions: HDAC6 is a promising biomarker for early diagnosis and prognosis during the oncogenic transformation of gastric cancer.

 

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Potential Association of IL1B Polymorphism with Iron Deficiency Risk in  Childhood Helicobacter pylori Infection Chen S.-T. Ni Y.-H. Liu S.-H. Journal of Pediatric Gastroenterology and Nutrition (2017). Date of  Publication: 19 Jul 2017 OBJECTIVE:: Helicobacter pylori (H. pylori) infection occurs predominantly in childhood. Host immune response gene polymorphism is reported to affect the susceptibility to H. pylori infection and the outcome of H. pylori-related gastric cancer. However, not all H. pylori-infected patients exhibit iron deficiency. The relationship between host genetic polymorphisms and iron deficiency mediated by H. pylori infection is not well understood. METHODS:: Subjects (n?=?644) from the general population aged 10 to 18 years were divided into two groups based on serology testing for anti-H. pylori IgG: (1) seropositive study group; (2) seronegative control group. Five single nucleotide polymorphisms (SNPs) in IL1B (rs1143627 and rs16944), IL8 (rs4073), IL10 (rs1800896), and ABO (rs505922), were genotyped and the iron status of the two groups was compared. RESULTS:: The seroprevalence rate for H. pylori was 10.7% in this study. Infected subjects were significantly older and had lower serum iron levels than uninfected subjects (P?=?0.0195 and 0.0059, respectively). Multivariate analysis revealed a significantly higher frequency of the T allele of rs505922 (OR?=?6.128; P?<?0.001) and lower frequency of the T allele of rs1143627 (OR?=?0.846; P?=?0.014) in seropositive subjects. Among 59 seropositive subjects, the T allele frequency of rs1143627 was significantly higher in those with iron deficiency (OR?=?3.156; P?=?0.043), compared to thosewithout iron deficiency. CONCLUSIONS:: ABO (rs505922) and IL1B (rs1143627) may affect H. pylori infection susceptibility, and IL1B (rs1143627) may also influence iron deficiency risk in infected children.

 

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Helicobacter pylori infection among patients with liver cirrhosis Pogorzelska J. Łapińska M. Kalinowska A. Łapiński T.W. Flisiak R. European Journal of Gastroenterology and Hepatology (2017). Date of  Publication: 11 Jul 2017 BACKGROUND AND AIM: Inflammatory changes in the stomach caused by Helicobacter pylori indirectly and directly affect liver function. Moreover,the bacteria may worsen the course of the liver cirrhosis. The study aimed at evaluating the incidence of H. pylori infection among patients with liver cirrhosis, depending on the etiology and injury stage, scored according to Child–Pugh classification. Stage of esophageal varices and endoscopic inflammatory lesions in the stomach were evaluated, depending on the presence of H. pylori infection. PATIENTS AND METHODS: The study included 147 patients with liver cirrhosis: 42 were infected with hepatitis C virus, 31 were infected with hepatitis B virus, 56 had alcoholic liver cirrhosis, and 18 had primary biliary cirrhosis. Diagnosis of H. pylori infection was performed based on the presence of immunoglobulin G antibodies in serum. RESULTS: H. pylori infection was found in 46.9% of patients. The incidence of H. pylori infection among patients with postinflammatory liver cirrhosis was significantly higher (P=0.001), as compared with patients with alcoholic liver cirrhosis. Ammonia concentration was significantly higher in patients infected with H. pylori, compared with noninfected individuals (129 vs. 112 μmol/l; P=0.002). Incidence of H. pylori infection in patients without esophageal varices was significantly lower compared with patients with esophageal varices (14 vs. 60%; P<0.001). CONCLUSION: H. pylori infection is significantly more frequent among patients with postinflammatory liver cirrhosis (infected with hepatitis C virus or hepatitis B virus) than in patients with alcoholic liver cirrhosis or primary biliary cirrhosis. H. pylori infection correlates with elevated concentration of blood ammonia and the incidence of esophageal varices.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-NoDerivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

 

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An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay Dacoll C. Sánchez-Delgado J. Balter H. Pazos X. Di Pace M. Sandoya G. Cohen  H. Calvet X. Gastroenterologia y Hepatologia (2017) 40:7 (447-454). Date of Publication: 1 Aug 2017 Background Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of  amoxicillinplus metronidazole at full doses has been shown to overcome metronidazoleresistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme. Aims The aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole. Methods Patients from the Clínica de Gastroenterología of the Hospital de Clínicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazole 500 mg, both three times a day. H. pylori cure was assessed by UBT. Results Forty-one patients were enrolled. Mean age was 53.3 ± 13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4–92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI 79.2–99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache). Conclusions Cure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT.

 

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Helicobacter pylori - Specific antigen tests in saliva to identify an oral  infection Yu Y. Zhao L. Wang S. Yee J.K.C. Annals of Clinical and Laboratory Science (2017) 47:3 (323-327). Date of  Publication: 1 May 2017 Goals. Over the past twenty years, the existence of oral Helicobacter pylori (H. pylori) infection has been controversial and is still disputed. It  proposes that living H. pylori do not exist in the oral cavity. However, the progressive loss of efficacy of standard eradication therapies has made the treatment of H. pylori more challenging than ever due to oral H. pylori infection. We conducted a study to explore the existence of oral H. pylori infection among 4321 adults. Procedures. A total 4321 adults (age range, 20-89 years old) comprising 2849 men and 1472 women were recruited by annual physical exam and evaluated using the saliva H. pylori antigen test (HPS) to diagnose oral H. pylori infection and the urea breath test (UBT) to diagnose stomach H. pylori infection. According to the classification on age grouping of World Health Organization, patients were divided into three age groups: A group, the young age subgroup (< 45 years); B group, the middle age subgroup (45 to 59 years); C group, the old age subgroup (60-74 years) and D group, the elder subgroup (75-89 years). Results. We found the positive rate of oral H. pylori was 59.59% in the 95% confidence interval (CI) ranges on A group. The lowest positive rate of H. pylori in D group was 25.48% in the 95% confidence interval CI ranges. There was a statistically significant difference (p < 0.001) between A, B, C, and D groups but no significant difference between men and women. Conclusion. HPS could identify oral H. pylori infection of individuals who have no risk for H. pylori gastric infection. The positive rate of oral H. pylori was 59.59% and this varies across different age groups. This information was not provided by UBT methods. It further identified that the prevalence of oral H. pylori infection is lower in the elder group that may be associated with fewer number of teeth.

 

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Studying the frequency of helicobacter pylori infection among women suffering from polycystic ovary resorting to hospital infertility center Darvishi M. Forootan M. Forootan M. Azmodeh O. Matinfar H. Biomedical and Pharmacology Journal (2017) 10:1 (75-80). Date of Publication: 2017 Polycystic ovary syndrome (PCOS) is in fact a chronic form of anovulation which is usually observed besides a large spectrum of clinical symptoms and signs. Helicobacter pylori is one of the most common infections that afflict humans. Considering the large prevalence of helicobacter pylori, particularly in developing countries, and the possibility of its effect on polycystic ovary syndrome (PCOS), the present research seeks to study the frequency of helicobacter pylori among women suffering from PCOS resorting to the infertility clinic of Mirza Kouchak Khan hospital from 2010 to 2011. A cross-sectional - descriptive research was conducted on 110 patients suffering from PCOS who had resorted to the infertility clinic of Mirza Kouchak Khan hospital from 2010 to 2011. As much as 5 cc blood was taken from the participants and after removing serum, blood samples were stored in a temperature of-20 !. Using ELISA test and in accordance with kit manufacturer's protocol (Trinity Biotech), IgG/IgA antibody titre was measured. The raw data was then analyzed using IBM SPSS Statistics v.15. The average and standard deviation of the age of those suffering from PCOS in this research was 26.55 ± 4.06 years old. The average and standard deviation of patients' BMI in this research was 26.77 ± 4.09. The results of categorizing age group and evaluation of antibody titre (IgA or IgG) showed that people aging 30 to 40 years old exhibited the highest rate in being identified with the positive titre of at least one antibody. The results of assessing IgG and IgA antibody titres by ELISA test showed that those people with a positive IgG titre are much more than those with positive IgA titre. Considering the results of this research and the scientific evidences presented here concerning complications of women's reproduction organs with helicobacter pylori, we may suggest that this bacteria acts as a risk factor in afflicting the patients with PCOS.

 

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Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate Shitomi Y. Nishida H. Kusaba T. Daa T. Yano S. Arakane M. Kondo Y. Nagai T. Abe T. Gamachi A. Murakami K. Etoh T. Shiraishi N. Inomata M. Yokoyama S. Pathology International (2017). Date of Publication: 2017 Lanthanum carbonate (LaC) is used to prevent hyperphosphatemia in dialysis patients. It is commonly believed that there is little LaC absorption from the intestines. However, La deposition in the gastric mucosa, which we coined "gastric lanthanosis", was recently reported. We describe here the clinicopathological features of and a possible mechanism for gastric lanthanosis. This study included 23 patients with definite gastric lanthanosis. We extracted characteristic clinicopathological features of gastric lanthanosis by computed tomography (CT) imaging and endoscopic, histologic, electron-microscopic, and element analysis examinations. The Helicobacter pylori infection rate in the lanthanosis group was much lower than that among the general population. The clinicopathological features characteristic of gastric lanthanosis were mucosal high-density linear appearance by CT, reflective bright-white spots (BWS) by gastroscopy, eosinophilic histiocytes occasionally phagocytizing foreign materials by histology, and numerous electron-dense particles in the histiocytes. The particles had burr-like skeletons resembling La crystals. Gastric lanthanosis is an under-reported, but not a rare lesion. It is characterized by endoscopic BWS and histologic eosinophilic histiocytes in dialysis patients treated with LaC. The proposed mechanism for gastric lanthanosis is that LaC is dissolved by gastric juice, crystallized within the mucosa and is phagocytized by histiocytes.

 

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Surveillance strategy according to age after endoscopic resection of early  gastric cancer Yang H.-J. Kim S.G. Lim J.H. Choi J.M. Oh S. Park J.Y. Han S.J. Kim J. Chung  H. Jung H.C. Surgical Endoscopy and Other Interventional Techniques (2017) (1-9). Date of  Publication: 21 Jul 201 Background: Whether surveillance strategy after curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) differs in young patients is unclear. This study aimed to evaluate the risk of metachronous and extragastric recurrence in young patients with EGC after curative ESD. Methods: We retrospectively enrolled 1237 consecutive patients who underwent curative ESD for EGC from 2005 to 2014 at a single tertiary hospital. The patients were divided into group 1 (<50 years of age, n = 86), group 2 (age 50–74, n = 985), or group 3 (≥75 years of age, n = 166). The clinical characteristics and outcomes were compared among the three age groups. Results: Group 1 had more frequent Helicobacter pylori infection (P < 0.001), less frequent intestinal metaplasia (P = 0.021), and more frequent undifferentiated tumors (P = 0.039). Although the 5-year risk of developing metachronous recurrence appeared to be lower in group 1 (2.7%) than in groups 2 (8.6%) or 3 (8.7%), the risk became quite similar at the 7-year follow-up (6.4, 12.7, and 8.7% for groups 1, 2, and 3, respectively; P = 0.409 by log-rank test). Extragastric recurrences developed in only 2 cases in group 2 (0.2%). Conclusions: Surveillance for metachronous and extragastric recurrence after curative ESD in patients <50 years of age should not be different from that in patients ≥50 years of age. Endoscopic surveillance for metachronous recurrence should be continued for longer than 5 years, even in young patients.

 

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The Effects of Switching to Vonoprazan, a Novel Potassium-Competitive Acid  Blocker, on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors Yamashita H. Kanamori A. Kano C. Hashimura H. Matsumoto K. Tsujimae M. Yoshizaki T. Momose K. Obata D. Eguchi T. Fujita M. Okada A. Digestion (2017) (52-59). Date of Publication: 30 Jun 2017Background/Aim: The effects of vonoprazan and proton pump inhibitors (PPIs) in patients with reflux esophagitis (RE) have not yet been compared using multichannel intraluminal impedance-pH (MII-pH). Methods: A total of 8 patients with persistent gastric mucosal injury, despite completing an 8-week standard PPI therapy, were enrolled in the study. While they were on standard PPI therapy, the baseline values of reflux parameters, holding time ratio (HTR) of gastric pH >4, and esophageal pH <4 were obtained by using 24 h MII-pH monitoring. They were re-evaluated after discontinuation of the therapy and 4 weeks of subsequent treatment with vonoprazan 20 mg/day. Results: The patients were found to be CYP2C19 extensive metabolizers and negative for Helicobacter pylori infection. In 7 patients (87.5%), the mucosal lesions had healed completely after vonoprazan therapy. A significant increase in gastric pH >4 HTR was observed, from 26.5 to 78.0% (p = 0.029). A reduction in esophageal pH <4 HTR was also observed but it was not statistically significant.Furthermore, acid clearance time and the total number of reflux events, including acid and proximal reflux events, were significantly reduced. Conclusion: Vonoprazan may be a better therapy for the treatment of patients with PPI-refractory RE.

 

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Helicobacter pylori vacA genotype is a predominant determinant of immune response to Helicobacter pylori Cag ALink A. Langner C. Schirrmeister W. Habendorf W. Weigt J. Venerito M. Tammer I. Schlüter D. Schlaermann P. Meyer T.F. Wex T. Malfertheiner P. World Journal of Gastroenterology (2017) 23:26 (4712-4723). Date of  Publication: 14 Jul 2017 AIM To evaluate the frequency of Helicobacter pylori (H. pylori ) CagA  antibodies in H. pylori infected subjects and to identify potential histopathological and bacterial factors related to H. pylori CagA-immune response. METHODS Systematic data to H. pylori isolates, blood samples, gastric biopsies for histological and molecular analyses were available from 99 prospectively recruited subjects. Serological profile (anti-H. pylori , anti-CagA) was correlated with H. pylori isolates (cagA , EPIYA, vacA s/m genotype), histology (Sydney classification) and mucosal interleukin-8 (IL-8) mRNA and protein expression. Selected H. pylori strains were assessed for H. pylori CagA protein expression and IL-8 induction in co-cultivation model with AGS cells. RESULTS Thirty point three percent of microbiologically confirmed H. pylori infected patients were seropositive for CagA. Majority of H. pylori isolates were cagA gene positive (93.9%) with following vacA polymorphisms: 42.4% vacA s1m1 , 23.2% s1m2 and 34.3% s2m2 . Anti-CagAIgG seropositivity was strongly associated with atrophic gastritis, increased mucosal inflammation according to the Sydney score, IL-8 and cagA mRNA expression. VacA s and m polymorphisms were the major determinants for positive (vacA s1m1) or negative (vacA s2m2) anti-CagA serological immune response, which also correlated with the in vitro inflammatory potential in AGS cells. In vitro co-cultivation of representative H. pylori strains with AGS cells confirmed functional CagA translocation, which showed only partial correlation with CagA seropositivity in patients, supporting vacA as major co-determinant of the immune response. CONCLUSION Serological immune response to H. pylori cagA + strain in H. pylori infected patients is strongly associated with vacA polymorphism, suggesting the crucial role of bacterial factors in immune and clinical phenotype of the infection.

 

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Lymphotoxin β receptor signalling executes Helicobacter pylori-driven gastric inflammation in a T4SS-dependent mannerMejías-Luque R. Zöller J. Anderl F. Loew-Gil E. Vieth M. Adler T. Engler D.B. Urban S. Browning J.L. Müller A. Gerhard M. Heikenwalder M. Gut (2017) 66:8 (1369-1381). Date of Publication: 1 Aug 2017 Objective Lymphotoxin β receptor (LTβR) signalling has been implicated in inflammation-Associated tumour development in different tissues. We have analysed the role of LTβR and alternative NF-? B signalling in Helicobacter pylori-mediated gastric inflammation and pathology. Design We analysed several ligands and receptors of the alternative NF-? B pathway, RelB, p52 nuclear translocation and target genes in tissue samples of H. pylori-infected patients with different degrees of gastritis or early gastric tumours by in situ hybridisation, immunohistochemistry, Western blot and real-Time PCR analyses. Molecular mechanisms involved in LTβR activation by H. pylori were assessed in vitro using human gastric cancer cell lines and distinct H. pylori isolates. The effects of blocking or agonistically activating LTβR on gastric pathology during challenge with a human pathogenic H. pylori strain were studied in a mouse model. Results Among the tested candidates, LT was significantly increased and activated alternative NF-? B signalling was observed in the gastric mucosa of H. pylori-infected patients. H. pyloriinduced LTβR-ligand expression in a type IV secretion system-dependent but CagA-independent manner, resulting in activation of the alternative NF-? B pathway, which was further enhanced by blocking canonical NF-? B during infection. Blocking LTβR signalling in vivo suppressed H. pylori-drivengastritis, whereas LTβR activation in gastric epithelial cells of infected mice induced a broadened pro-inflammatory chemokine milieu, resulting in exacerbated pathology. Conclusions LTβR-Triggered activation of alternative NF-? B signalling in gastric epithelial cells executes H. pylori-induced chronic gastritis, representing a novel target to restrict gastric inflammation and pathology elicited by H. pylori, while exclusively targeting canonical NF-? B may aggravate pathology by enhancing the alternative pathway.

 

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The correlation between tissue Helicobacter pylori severity and the increase in serum neutrophil/lymphocyte ratio in patients with active chronic gastritis Atayan Y. Hacisalihoglu P. Biomedical Research (India) (2017) 28:11 (4874-4877). Date of Publication:

2017 Introduction: Helicobacter pylori are a microaerophile gram-negative bacteria and the most frequent factor of chronic gastritis. Recently, there has been an inclination to various non-invasive tests to determine the severity of H. pylori infection in the gastric tissue. The serum neutrophils/lymphocytes rate (NLR) is a simple, safe, non-invasive and active inflammation reagent. The purpose of this study is examining the correlation between the increase in the positivity/severity of H. pylori infection and the increase in the NLR. Material and method: 149 patients were included into the study by considering the Sydney criteria in accordance with H. pylori severity degrees in 3 groups; Mild (n=49), Moderate-Severe (n=67) and Severe (n=33). A Control Group was also formed (n=22) with negative H. pylori by three experienced pathologists. Result: It has been determined that the severity has increased among the groups with H. pylori positive as regard to the increase in serum NLR (r: 0.295, p: 0.017), there has been a significant correlation has been determined between the Control Group and the Moderate-Severe patients (p:0.014), the Severe patients (p:0.002). Conclusion: It is suggested that the serum NLR, which can be used in order to predict the severity of the H. pylori Infection in patients with chronic gastritis, can be a practical, inexpensive and non-invasive test.

 

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Demographic and socioeconomic influences on Helicobacter pylori gastritis  and its pre-neoplastic lesions amongst US residents Genta R.M. Turner K.O. Sonnenberg A. Alimentary Pharmacology and Therapeutics (2017) 46:3 (322-330). Date of  Publication: 1 Aug 2017 Background: Gastric infection with Helicobacter pylori (Hp) can lead to chronic inactive gastritis, atrophy and intestinal metaplasia. Aims: To investigate in a cross-sectional study these changes among different socioeconomic and ethnic groups within the USA. Methods: We used the Miraca Life Sciences database, an electronic depository of clinicopathological records from patients distributed throughout the USA, to extract data from 487 587 patients who underwent oesophago-gastro-duodenoscopy with biopsy between 1/2008 and 12/2014. We then classified patients into ethnic and socioeconomic categories using previously validated algorithms, as well as ZIP code-based information derived from the 2011-2012 US Census. Results: The prevalence of Hp increased significantly until the age-group 40-49, before it leveled off and started a gradual decrease. The prevalence of chronic inactive gastritis, atrophy, and intestinal metaplasia increased significantly with age. The prevalence of Hp, chronic inactive gastritis, intestinal metaplasia, and atrophy decreased significantly with the percentage of Whites per ZIP code. The prevalence of all four diagnoses also decreased significantly with rising levels of income or college education. Hp, chronic inactive gastritis, atrophy and intestinal metaplasia were more common among Hispanics and the influence of income or college education less pronounced than in the entire population. Hp, chronic inactive gastritis, atrophy, and intestinal metaplasia were also more common among East-Asians, Hp and atrophy decreasing with rising income but remaining unaffected by levels of college education. Conclusion: Ethnicity and socioeconomic factors influence theoccurrence of Hp gastritis, and its progression to chronic inactive gastritis, atrophy or intestinal metaplasia.

 

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Natural Course of Helicobacter pylori Infection in Japanese Hemodialysis  Patients Sugimoto M. Sahara S. Ichikawa H. Sakao Y. Ohashi N. Sugimoto K. Yasuda H. Furuta T. Andoh A.Digestion (2017) 95:4 (302-309). Date of Publication: 1 Jul 2017 Helicobacter pylori (H. pylori) infection is one of the major risk factors for gastrointestinal morbidity in hemodialysis patients. Primary end point is to investigate H. pylori infection rate in hemodialysis patients. As secondary end point, we clarified whether pepsinogen (PG) level was related with H. pylori infection status in hemodialysis patients. Methods: Serum levels of PG I, II, and anti-H. pylori IgG antibody were assessed in 500 Japanese hemodialysis patients. Results:H. pylori infection rate was 15.0%(75/500; 95% CI 12.0-18.4). The duration of hemodialysis in H. pylori-positives was 4.6 ± 3.8 years, which was significantly shorter than in H. pylori-negatives (7.3 ± 6.9, p = 0.001). PG I levels positively correlated with the PG II level and PG I/II ratio (|R| = 0.661, p < 0.001, and |R| = 0.544, p <0.001, respectively). Using a cutoff value of 7.75, the sensitivity and specificity of PG I/II ratio for predicting H. pylori-negatives were 86.3 and 87.8%, respectively (area under the curve 0.930). Conclusions: In hemodialysis patients, infection rate with H. pylori was <20%, with lower rates in patients receiving hemodialysis for longer terms. A PG I/II ratio with a cutoff value of 7.75 may be useful for screening for H. pylori status.

 

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Helicobacter pylori infection is associated with reduced prevalence of colonic diverticular disease Bartels L.E. Jepsen P. Tøttrup A. Vilstrup H. Dahlerup J.F. Helicobacter (2017) 22:4 Article Number: e12384. Date of Publication: 1 Aug 2017 Background: Colonic diverticular disease is a common disorder with increasing incidence in Western societies. The intestinal microbiome may be among etiological factors. Helicobacter pylori may protect against some intestinal diseases, and incidence of H. pylori is decreasing in Western societies. Thus, we aimed to determine whether H. pylori is associated to decreased prevalence of registered colonic diverticular disease. Materials and Methods: In a historical cohort study, patients were enrolled from primary health care centers after urea breath test for H. pylori and then followed for a median of 6 years. The patient's diagnostic codes and country of birth were acquired from nationwide Danish administrative registries. We used logistic regression to compare prevalence and Cox regression to compare incidence of diverticular disease between H. pylori-positive and H. pylori-negative patients, adjusting for confounding variables. Results: Patients infected with H. pylori had lower prevalence of colonic diverticular disease (0.87% vs 1.14%, OR=0.62, 95% CI: 0.50-0.78). This phenomenon was observed whether we studied all registered diagnoses or only cases registered as primary diagnoses at discharge. After urea breath test, we observed no statistical difference in incidence rates of diverticular disease. Conclusion: H. pylori is associated with reduced prevalence of colonic diverticular disease. The inverse association was absent after the urea breath test. Thus, we speculate that H. pylori may provide protection from colonic diverticular disease. Alternatively, H. pylori is a marker for other factors affecting disease development.

 

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Effect of Helicobacter pylori infection on outcomes in resected gastric and gastroesophageal junction cancer Kolb J.M. Ozbek U. Harpaz N. Holcombe R.F. Ang C. Journal of Gastrointestinal Oncology (2017) 8:3 (583-588). Date of  Publication: 1 Jun 2017 Background: Helicobacter pylori (H pylori) infection is a known risk factor  for gastric cancer (GC) and has been linked with gastroesophageal junction (GEJ) cancer. Studies examining the relationship between H. pylori infection, GC characteristics and prognosis are limited and have yielded conflicting results. We report on the clinicopathologic characteristics and oncologic outcomes of gastric and GEJ cancer patients with and without a history of H. pylori treated at our institution. Methods: We retrospectively reviewed the medical records of patients over the age of 18 years who underwent curative resection for GEJ and GC at Mount Sinai Hospital between 2007 and 2012 who had histopathologic documentation of the presence or absence of H pylori infection. Demographic, clinical, pathologic, treatment characteristics and outcomes including recurrence-free survival (RFS) and overall survival (OS) were compared. Results: Ninety-five patients were identified. The majority of patients were male (61%), white (36%) or Asian (34%), with median age at diagnosis 64. Tumors were stage I (51%), stage II (23%), stage III (25%), and stage IV (1%). H pylori infection status was documented at the time of cancer diagnosis in 89 (94%) patients, and following cancer diagnosis and treatment in 6 (6%) patients. Younger age at diagnosis, Asian race and Lauren histologic classification were associated with H Pylori infection. H pylori positive patients exhibited higher 5-year OS and 5-year RFS compared to H pylori negative patients, though the difference was not statistically significant in either univariate or multivariate analyses. Conclusions: In this retrospective series of predominantly early stage GC and GEJ cancers, H. pylori positive patients were significantly younger at cancer diagnosis and were more frequently Asian compared to H. pylori negative patients. Other demographic and histologic classifications except for Lauren histologic classification were similar between the two groups. H pylori positive patients appeared to have improved outcomes compared to H. pylori negative patients

 

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Gastric expression of IL-17A and IFNγ in Helicobacter pylori infected  individuals is related to symptom Adamsson J. Ottsjö L.S. Lundin S.B. Svennerholm A.-M. Raghavan S. Cytokine (2017) 99 (30-34). Date of Publication: 1 Nov 2017 Background: Chronic infection with Helicobacter pylori leads to gastritis and in a subpopulation of infected individuals to ulcers and cancer. Bacterial virulence factors and host immune inflammatory responses are risk factors related to disease. CD4(+) T cells secrete cytokines that promote inflammation and an anti-bacterial response in the gastric mucosa during infection. The aim of the study was to investigate the pattern of expression of CD4(+) T cell derived cytokines, IL-17A and IFNγ in paired antrum and corpus biopsies and correlate it to H. pylori infection outcome. Methods: Gene and protein expression of IL-17A and IFNγ was analyzed in gastric biopsies from H. pylori infected subjects with non-ulcer dyspepsia (NUD) or gastric ulcer; and for comparison uninfected individuals. Results: Upregulation of IL-17A and IFNγ gene expression was seen in corpus and antrum biopsies of H. pylori infected individuals with NUD compared to in uninfected controls. The expression of these cytokines correlated significantly with each other. Immunofluorescence staining revealed increased frequencies of IL-17A(+) and IFNγ(+) cells in antrum biopsies of gastric ulcer patients compared to of H. pylori infected NUD individuals; positive cells were not detected in any of the biopsies of uninfected controls. The frequencies of IFNγ and IL-17A(+) cells correlated positively with inflammation in the antrum, but not the corpus, of H. pylori infected individuals. In the antrum, while there was no significant evidence of correlation between IFNγ and bacterial score, a positive correlation between bacterial score and IL-17A(+) cells was seen. Conclusions: In H. pylori infected individuals, the frequencies of IFNγ and IL-17A(+) cells were increased in the antrum, particularly in patients with H. pylori induced gastric ulcers. Even though H. pylori colonized both the corpus and antrum regions of the stomach, the cytokine responses and subsequent pathology were mainly detected in the antrum.

 

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Downregulated regulatory T cell function is associated with increased peptic ulcer in Helicobacter pylori-infection Bagheri N. Shirzad H. Elahi S. Azadegan-Dehkordi F. Rahimian G. Shafigh M.  Rashidii R. Sarafnejad A. Rafieian-Kopaei M. Faridani R. Tahmasbi K. Kheiri S. Razavi A. Microbial Pathogenesis (2017) 110 (165-175). Date of Publication: 1 Sep 2017Background Helicobacter pylori (H. pylori) chronically colonizes gastric/duodenal mucosa and induces gastroduodenal disease such as gastritis and peptic ulcer and induces vigorous innate and specific immune responses; however, the infection is not removed, a state of chronic active gastritis persists for life if untreated. The objective of this study was to determine the number of regulatory T cells (Tregs) in gastric mucosa of patients with gastritis and peptic ulcer and determined the relationship between main virulence factor of H. pylori and Tregs. Methods and materials A total of 89 patients with gastritis, 63 patients with peptic ulcer and 40 healthy, H. pylori-negative subjects were enrolled in this study. Expression of CD4 and Foxp3 was determined by immunohistochemistry. Antrum biopsy was obtained for detection of H. pylori, bacterial virulence factors and histopathological assessments. TGF-β1, IL-10 and FOXP3 expressions were determined by real-time polymerase chain reaction (qPCR). Results The numbers of CD4(+) and Foxp3(+) T cells as well as the expression of IL-10, TGF-β1, FOXP3, INF-γ and IL-17A in infected patients were significantly higher than the ones in uninfected patients. Also, the number of CD4(+) T cells was independent on the vacuolating cytotoxin A (vacA) and outer inflammatory protein A (oipA), but it was positively correlated with cytotoxin-associated gene A (cagA). Instead, the number of Foxp3(+) T cells was dependent on the vacA and oipA, but it was independent on cagA. The number of Foxp3(+) T cells and the expression of IL-10, TGF-β1 and FOXP3 in infected patients with gastritis were significantly higher than the ones in infected patients with peptic ulcer. Moreover, the number of CD4(+) T cells and the expression of IL-17A and INF-γ was the lowest in the gastritis patients, however, increased progressively in the peptic ulcer patients. Additionally, the numbers of CD4(+) and Foxp3(+) T cells as well as the expression of IL-10, TGF-β1, FOXP3 and INF-γ were positively correlated with the degree of H. pylori density and chronic inflammation. Conclusion Tregs are positively associated with vacA alleles and oipA status of H. pylori and histological grade but negatively associated with peptic ulcer disease.

 

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Evolution of correlation between Helicobacter pylori infection and  autoimmune liver disease Peng X.-G. Li Y.-Y. Chen H.-T. Zhou Y. Ma J.-G. Yin H.-M. Experimental and Therapeutic Medicine (2017) 14:2 (1487-1490). Date of  Publication: 1 Aug 2017 The present study was planned to evaluate correlation between Helicobacter pylori (HP) infection and autoimmune liver disease (AILD). A total of 60  patients diagnosed with AILD in Affiliated Hospital of Binzhou Medical College were continuously enrolled in the present study. HP infection was detected by 13C-urea breath test. The levels of anti-myeloperoxidase were tested by ELISA. The positive rate of anti-nuclear antibody (ANA), anti-mitochondrial antibody (AMA), anti-smooth muscle antibody (SMA) and anti-neutrophil cytoplasm antibody (ANCA) were tested by indirect immunofluorescence. The positive rates of anti-mitochondrial antibody (AMA-M2), anti-liver-kidney microsomal antibody (LKM-1), anti-liver cytoplasm antibody I (LC-1) and anti-soluble liver antigen/liver-pancreas antigen (SLA/LP) were tested by immunoblotting. Liver function indexes including alanine transaminase, aspartate transaminase, alkaline phosphatase and glutamyltransferase, were analyzed with a fully automatic biochemical analyzer. The levels of serum cytokine IFN-γ, interleukin-6 (IL-6), IL-10 and tumor necrosis factor-α (TNF-α) were tested by ELISA. A total of 37 patients (61.67%) were observed to be HP-positive. MPO-positive rate, positive rate of ANA, AMA, SMA and ANCA and positive rate of AMA-M2, LKM-1, LC-1 and SLA/LP in patients with positive HP infection were significantly higher than those of patients with negative HP infection. On the other hand, the levels of liver function indices did not showed any significant differences among HP-positive cases or HP-negative cases. However, the levels of IFN-γ, IL-6,IL-10 and TNF-α in patients with positive HP infection were significantly higher than those of patientswith negative HP infection. In conclusion, the positive infection rate of HP infection in patients with AILD is high and is closely associated with various positive immune antibodies as well as cytokine levels.

 

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Correlation between thrombospondin-1 expression in non-cancer tissue and gastric carcinogenesis Kashihara H. Shimada M. Yoshikawa K. Higashijima J. Tokunaga T. Nishi M.  Takasu C. Ishikawa D. Anticancer Research (2017) 37:7 (3547-3552). Date of Publication: 1 Jul 2017 Background/Aim: Thrombospondin-1 (TSP1) is correlated with carcinogenesis occurring in cases of intestinal inflammation. The aim of this study was to clarify the role of TSP1 in gastric carcinogenesiS. Materials and Methods: A total of 39 patients with gastric cancer who had undergone gastrectomy were enrolled. The expression of TSP1 mRNA in non-cancer tissues was determined. Furthermore, the expression of CD36, STAT3 and TGFR2 mRNA in non-cancer tissues in two expression groups, the TSP1 high-and lowexpression groups, were examined. Results: The expression of TSP1 was high in the mucosal-atrophy group and tended to be high in the Helicobacter pylori (H. pylori) (+) and multiple cancer groupS. The levels of CD36, STAT3 and TGFR2 mRNA were significantly higher in the TSP1-high group. TSP1 signaling pathway was induced in multiple cancer or atrophy (+) or H. pylori (+) compared to cases with single cancer, atrophy (-) and H. pylori (-). Expression of proteins involved in the TSP1 signaling pathway in non-cancer tissues with multiple gastric cancers were higher than that with single gastric cancer. Conclusion: Expression of TSP1 in non-cancer tissue correlated with gastric carcinogenesiS.

 

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Screening endoscopy finds high prevalence of Helicobacter pylori and  intestinal metaplasia in Korean American with limited access to health care Woo Y. Behrendt C.E. Trapp G. Hyun J.G. Gonda T. Fong Y. Wang T. ournal of Surgical Oncology (2017) 116:2 (172-176). Date of Publication: 1 Aug 2017 Background: Gastric cancer (GC) is the leading cause of cancer death among  Korean Americans. Prevention and early detection is improved by screening.  Methods: Between September 2013 and March 2015, ethnic Koreans age 40 or  older without history or symptoms of GC and without upper endoscopy (UE)  during previous 3 years were enrolled. Participants were offered screening with GC risk assessment followed by UE with biopsies. Results: Risk assessment was provided to 146 participants (age 55.6 ± 8.3 years; 52.1% female; 92.5% uninsured), of whom 99 (67.8%) returned for UE. Undergoing UE was independently associated with family history of GC (OR 12.33, 95% CI:1.52-100.17), being a former smoker (6.68,1.42-31.32), and Hp-negative status (0.25,0.11-0.57). Among UE recipients, half (49.5%) had intestinal metaplasia (IM) only (n = 24), Hp only (n = 12), or both (n = 13). No case of GC was found. Adjusted for age, IM was independently associated with male sex (2.89,1.12-7.42), current Hp (2.90,0.99-8.51), unmarried status (single or divorced) (4.23,1.23-14.56). Conclusions: High prevalence of risk factors associated with gastric carcinogenesis including Hp infection and IM exists in Korean Americans who underwent upper endoscopic screening. Acceptance of GC screening is informed by personal risk factors. These findings support the need to improve access to screening UE among KAs.

 

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Effectiveness of Endoscopic Hemostasis with Soft Coagulation for Non-Variceal Upper Gastrointestinal Bleeding over a 12-Year Period Yamaguchi D. Sakata Y. Yoshida H. Furukawa N.E. Tsuruoka N. Higuchi T.  Watanabe A. Shimoda R. Tsunada S. Iwakiri R. Fujimoto K.Digestion (2017) 95:4 (319-326). Date of Publication: 1 Jul 2017 In this study, investigations were carried out to ascertain whether soft coagulation hemostasis for non-variceal upper gastrointestinal bleeding (UGIB) has ever been performed in a time-dependent manner. Methods: Medical records of 502 patients who had undergone emergency endoscopic hemostasis for non-variceal UGIB from 2003 to 2014 were checked and the modalities were used to achieve hemostasis compared between the first period from 2003 to 2008 (197 patients) and the second period from 2009 to 2014 (305 patients). Results: Endoscopic hemostasis was successfully achieved in 96.0% of study patients. Peptic ulcers were the main cause of bleeding (89.4%). Endoscopic hemostasis was performed by soft coagulation significantly more frequently during the second (71.1%) thanthe first period (11.7%; p < 0.001). Endoscopic hemostasis was mainly achieved by trainees during the second period (76.1%); these trainees comprised a significantly greater proportion of endoscopists than during the first period (56.3%; p < 0.001). Endoscopic-related complications did not differ between the 2 periods. The only risk factorfor rebleeding after hemostasis was Helicobacter pylori infection; the use of soft coagulation and the fact that endoscopists were just trainees were not risk factors. Conclusion: Our findings suggest that using soft coagulation to achieve endoscopic hemostasis for non-variceal UGIB is safe and effective, even when it is performed by trainees.

 

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Global Prevalence of Helicobacter pylori Infection: Systematic Review and  Meta-Analysis Hooi J.K.Y. Lai W.Y. Ng W.K. Suen M.M.Y. Underwood F.E. Tanyingoh D.  Malfertheiner P. Graham D.Y. Wong V.W.S. Wu J.C.Y. Chan F.K.L. Sung J.J.Y.  Kaplan G.G. Ng S.C. Gastroenterology (2017) 153:2 (420-429). Date of Publication: 1 Aug 2017 Background & Aims The epidemiology of Helicobacter pylori infection has  changed with improvements in sanitation and methods of eradication. We  performed a systematic review and meta-analysis to evaluate changes in the  global prevalence of H pylori infection. Methods We performed a systematic  search of the MEDLINE and EMBASE databases for studies of the prevalence of H pylori infection published from January 1, 1970 through January 1, 2016.  We analyzed databased on United Nations geoscheme regions and individual countries. We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CIs), weighted by study size. We extrapolated 2015 prevalence estimates to obtain the estimated number of individuals with H pylori infection. Results Among 14,006 reports screened, we identified 263 full-text articles on the prevalence of H pylori infection; 184 were included in the final analysis, comprising data from 62 countries. Africa had the highest pooled prevalence of H pylori infection (70.1%; 95% CI, 62.6−77.7), whereas Oceania had the lowestprevalence (24.4%; 95% CI, 18.5−30.4). Among individual countries, the prevalence of H pylori infection varied from as low as 18.9% in Switzerland (95% CI, 13.1−24.7) to 87.7% in Nigeria (95% CI, 83.1−92.2). Based on regional prevalence estimates, there were approximately 4.4 billion individuals with H pylori infection worldwide in 2015. Conclusions In a systematic review and meta-analysis to assess the prevalence of H pylori infection worldwide, we observed large amounts of variation among regions—more than half the world's population is infected. These data can be used in development of customized strategies for the global eradication.

 

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The potential value of serum pepsinogen for the diagnosis of atrophic gastritis among the health check-up populations in China: A diagnostic clinical research Tong Y. Wu Y. Song Z. Yu Y. Yu X. BMC Gastroenterology (2017) 17:1 Article Number: 88. Date of Publication: 20  Jul 2017 Background: The aim of this study is to assess the validity of the measurement of pepsinogen as a screening test for chronic atrophic gastritis (AG) in health check-up populations in China. Methods: Patients from consecutive regular health check-up were enrolled from January 2014 to June 2015. Endoscopy, combined with monitoring the Helicobacter pylori (Hp) infections, and measuring the serum pepsinogen (PG) were used to determine the diagnostic accuracy of PG for the screening of atrophic gastritis. Histopathology was assessed by the Operative Link on Gastritis Assessment (OLGA) system. Statistical analysis was performed using SPSS statistical software. Results: The total Hp infection rate was 40%. Based on pathology, the 996 participants were divided into three groups: non-atrophic (NAG), mild-moderate atrophic (MAG): stage I and II of the OLGA classification, and severe atrophic (SAG): stage III and IV of the OLGA classification. Compared with NAG and MAG groups, PGR decreased significantly in SAG group (p < 0.05). PGI and PGII levels were significantly elevated in Hp-positive group, while the PGR was markedly decreased (p < 0.01). When MAG and SAG groups were combined and compared with NAG group, the best cutoff value for atrophy diagnosis was PGI ≤50.3 ng/ml; the cutoff value in Hp-negative group was absolutely higher than in Hp-positive group. When NAG and MAG groups were combined and compared with the SAG group, the best cutoff value for diagnosis of severe atrophy was at PGR ≤4.28. The cutoff values in Hp-negative and Hp-positive groups were calculated at PGR ≤6.28 and ≤4.28, respectively. Conclusions: Pepsinogens play an important role in the identification of patients with atrophic gastritis and severe AG. Use of different cutoff values of PG for Hp-negative and Hp-positive groups may offer greater efficacy in the diagnosis of AG.

 

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Gastric Ulcer Complications after the Introduction of Proton Pump Inhibitors into Clinical Routine: 20-Year Experience Eisner F. Hermann D. Bajaeifer K. Glatzle J. Königsrainer A. Küper M.A. Visceral Medicine (2017) 33:3 (221-226). Date of Publication: 1 Jun 2017 Background: The aim of this study was to analyze the admissions and the management of peptic ulcer disease (PUD) in a tertiary care surgical center. Methods: We evaluated the medical records of all patients admitted to the University Hospital of Tübingen, Germany, for treatment of PUD during 1989-2008. Patients were included into the study if the diagnosis was verified endoscopically or surgically. Annual number of admissions, length of hospitalization, mortality rate, age, rate of non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitor (PPI) medication, rate of Helicobacter pylori infection, and complications of PUD and surgery performed were recorded. Data were analyzed by descriptive analyses, Pearson's chi-square test, and regression analysis. Results: This study included 614 admissions. The number of annual admissions (31 ± 12), the length of hospitalization (9 ± 3 days), and the mortality rate (5 ± 4% per year) remained constant, whereas the age increased (1989: 52 ± 14 years vs. 2008: 67 ± 16 years). The rates of patients with H. pylori infection (47 ± 28% per year), NSAIDs treatment (29 ± 15% per year), and PPI treatment (31 ± 27% per year) remained constant. The most frequent PUD complication was hemorrhage (42 ± 16% per year), followed by perforation (9 ± 8% per year). During 1999-2008, more hemorrhages (125 vs. 121; p < 0.05) and perforations (40 vs. 21; p < 0.05) were registered than during 1989-1998. The rate of emergency surgery increased from 70% during 1989-1998 to 87% during 1999-2008. In contrast, elective surgery decreased from 21% during 1989-1998 to 7% during 1999-2008. Ulcer excision and oversewing was the most frequent surgical procedure performed (59%), with decreasing rates of acid-reducing surgery. Conclusion: Despite recent advances in PUD management, ulcer hemorrhage and perforation remain a significant health burden and a surgical disease.

 

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Cancers of the Esophagus and Stomach: Potential Mechanisms behind the Beneficial Influence of Physical Activity Shephard R.J Clinical Journal of Sport Medicine (2017) 27:4 (415-421). Date of Publication: 1 Jul 2017 Objective: To compare findings from several recent meta-analyses showing a reduced risk of gastric and esophageal cancers in physically active individuals, to assess the magnitude of this benefit, and to seek information on potential underlying mechanisms. Data Sources: A comprehensive search of Ovid/Medline from 1996 to February 2016, using the terms physical activity or exercise or training and esophageal or gastric cancer, and supplementing the articles identified by material from references lists and personal files. Main Results: Moderate-to-vigorous physical activity is associated with a 20% to 30% reduction in the risk of gastroesophageal adenocarcinomas, with a significant dose/response relationship. Benefit is greater in women than in men, and greater for noncardia than for cardia or esophageal tumors. Mechanisms could include a reduction of visceral fat (with a lesser production of cancer promoting hormones and reduced gastroesophageal reflux) and/or a lesser likelihood of smoking and excessive alcohol consumption. Physical activity does not protect against Helicobacter pylori infections or gastric ulceration, but mechanisms related to the impact of exercise on immune function, antioxidant mechanisms, and gastroesophageal reflux remain to be explored. Conclusions: Regular, moderate-to-vigorous physical activity is associated with a clinically significant reduction in the risk of gastroesophageal adenocarcinomas, but mechanisms are as yet unclear, and a causal relationship remains to be proven.

 

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Increased expression of deleted in malignant brain tumors (DMBT1) gene in precancerous gastric lesions: Findings from human and animal studies Garay J. Piazuelo M.B. Lopez-Carrillo L. Leal Y.A. Majumdar S. Li L.  Cruz-Rodriguez N. Serrano-Gomez S.J. Busso C.S. Schneider B.G. Delgado A.G.  Bravo L.E. Crist A.M. Meadows S.M. Constanza Camargo M. Wilson K.T. Correa  P. Zabaleta J Oncotarget (2017) 8:29 (47076-47089). Date of Publication: 2017 Helicobacter pylori infection triggers a cascade of inflammatory stages that may lead to the appearance of non-atrophic gastritis, multifocal atrophic, intestinal metaplasia, dysplasia, and cancer. Deleted in malignant brain tumors 1 (DMBT1) belongs to the group of secreted scavenger receptor cysteine-rich proteins and is considered to be involved in host defense by binding to pathogens. Initial studies showed its deletion and loss of expression in a variety of tumors but the role of this gene in tumor development is not completely understood. Here, we examined the role of DMBT1 in gastric precancerous lesions in Caucasian, African American and Hispanic individuals as well as in the development of gastric pathology in a mouse model of H. pylori infection. We found that in 3 different populations, mucosal DMBT1 expression was significantly increased (2.5 fold) in individuals with dysplasia compared to multifocal atrophic gastritis without intestinal metaplasia; the increase was also observed in individuals with advanced gastritis and positive H. pylori infection. In our animal model, H. pylori infection of Dmbt1-/- mice resulted in significantly higher levels of gastritis, more extensive mucous metaplasia and reduced Il33 expression levels in the gastric mucosa compared to H. pylori-infected wild type mice. Our data in the animal model suggest that in response to H. pylori infection DMBT1 may mediate mucosal protection reducing the risk of developing gastric precancerous lesions. However, the increased expression in human gastric precancerous lesions points to a more complex role of DMBT1 in gastric carcinogenesis.

 

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Prognostic significance of glutathione peroxidase 2 in gastric carcinoma Liu D. Sun L. Tong J. Chen X. Li H. Zhang Q. Tumor Biology (2017) 39:6. Date of Publication: 1 Jan 2017 Increasing evidence suggests that the glutathione peroxidase 2 may actually play important roles in tumorigenesis and progression in various human cancers such as colorectal carcinomas and lung adenocarcinomas. However, the role of glutathione peroxidase 2 in gastric carcinoma remains to be determined. In this study, the expression and prognostic significance of glutathione peroxidase 2 in gastric carcinoma were investigated and the well-known prognostic factor Ki-67 labeling index was also assessed as positive control. Glutathione peroxidase 2 expression levels in the tumor tissue specimens, the matched adjacent normaltissue specimens, and the lymph node metastases of 176 patients with gastric carcinoma were evaluated by quantitative polymerase chain reaction, western blotting, and immunohistochemical staining. The associations between glutathione peroxidase 2 expression levels, as determined by immunohistochemical staining, and multiple clinicopathological characteristics were determined by Pearson’s chi-square test and Spearman’s correlation analysis. The relationships between glutathione peroxidase 2 expression and other clinicopathological variables and patient prognoses were analyzed further by the Kaplan-Meier method, the log-rank test, and Cox multivariate regression. The quantitative polymerase chain reaction, western blotting, and immunohistochemical staining results showed that glutathione peroxidase 2 expression levels were upregulated in both the primary tumor foci and the lymph node metastases of patients with gastric carcinoma (all p values < 0.05). Furthermore, Pearson’s chi-square tests, as well as Spearman’s correlation analysis, revealed that glutathione peroxidase 2 expression  levels were strongly correlated with the Ki-67 labeling index, differentiation, histological patterns, Lauren classifications, lymph node metastasis, vascular invasion, tumor-node-metastasis stages, Helicobacter pylori infection, and overall survival (all p values < 0.05). Kaplan-Meier analysis, as well as the log-rank test and multivariate Cox regression analysis, showed that multiple clinicopathological risk factors and glutathione peroxidase 2 expression were novel independent prognostic factors for gastric carcinoma (all p values < 0.05). Glutathione peroxidase 2 expression is a novel independent prognostic biomarker for gastric carcinoma that may be used to devisepersonalized therapeutic regimens and precision treatments for this disease.

 

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Relationship between H. pylori infection and IL-1β polymorphism in pregnant Women Al-Thahab A.O. Lateef G.R. Research Journal of Pharmaceutical, Biological and Chemical Sciences (2017) 8:4 (858-866). Date of Publication: 2017 A study was performed on 100 pregnant women in the outpatient department of gynecology and obstetrics of Maternity and Children Hospital in Al-Diwaniya City during the period between (March to September 2016). One hundred blood samples (50 for patients and 50 for control) were collected under the supervision of the treating gynecologist. The detection of Helicobacter. pylori was done by the use of the serum antibody Rapid test. The results showed that 50(100%) were positive and 50(100%) were negative for H. pylori in above method. All blood of patients and control samples were used for the extraction of genomic DNA, where the 304 bp PCR product size. Genotyping of the IL-1β -511 (C/T) SNP was performed by restriction fragment length polymorphism PCR (RFLP-PCR). PCR products were digested with AvaI restriction enzyme. Individuals with the IL-1β-511(CC) homozygote produced digested DNA bands at 190 bp and114 bp. A heterozygous genotype of IL-1β-511 (CT) produced 304 bp, 190 bp, and 114bp bands. Individuals with the IL-1β-511(TT) homozygote genotype had no amplicon digested and generated only one band of 304 bp. There was a significant difference in the frequency of the (IL-1β -511) CC genotype between H. pylori positive group and H. pylori negative group (22%, 8% respectively). Also for CT genotype, there was a significant difference between H. pylori positive group and H. pylori negative group (44%, 66% respectively). Concerning the frequency of the (IL-1β -511) TT genotype between H. pylori positive group and H. pylori negative group, there was no significant difference between the two groups.

 

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Upper Gastrointestinal Endoscopy prior to Bariatric Surgery-Mandatory or  Expendable? An Analysis of 801 Cases Wolter S. Duprée A. Miro J. Schroeder C. Jansen M.-I. Schulze-zur-Wiesch C.  Groth S. Izbicki J. Mann O. Busch P. Obesity Surgery (2017) 27:8 (1938-1943). Date of Publication: 1 Aug 2017 Background: Upper gastrointestinal pathologies are common in bariatric patients. Preoperative esophagogastroduodenal endoscopy (EGD) should detect and treat pathologies that might alter the type of bariatric surgery. However, clinical consequences of these findings are often insignificant. The aim of this study was to assess the influence of preoperative endoscopy in our cohort and its clinical consequences. Methods: We conducted a retrospective analysis of endoscopic findings in patients under evaluation for bariatric surgery. Endoscopic findings were compared to preoperative risk factors as well as postoperative complications, and its clinical consequences were analyzed. Results: Data was available for 801 patients. Abnormal endoscopic findings were found in 65.7% of all patients. The most common conditions were gastritis (32.1%) and gastroesophageal reflux (24.8%). Malignancies were observed in 0.5% of all patients. We observed  early-stage adenocarcinoma of the esophagus in two patients through our routine preoperative evaluation. Helicobacter pylori infections were detected in preoperative biopsies in only 3.7% of all patients. Patients who reported reflux symptoms had a higher rate of pathological EGDs (74.2 vs. 64.9%, p.019). We did not find any other risk factors for a pathological endoscopy. The postoperative complication rate was 11.2%. Leakage rate was 1.1%. Mortality rate was 0.4%. We did not find any correlation between the incidence of postoperative complications and preoperative endoscopic findings. Conclusions: Relevant findings in routine preoperative endoscopy are rare but have significant influence on decision-making in bariatric patients and should be assessed as a necessary diagnostic tool.

 

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A novel method to quantify base substitution mutations at the 10(−6) per bp  level in DNA samples Yamashita S. Iida N. Takeshima H. Hattori N. Maeda M. Kishino T. Nagano R.  Shimazu T. Tsugane S. Ushijima T. Cancer Letters (2017) 403 (152-158). Date of Publication: 10 Sep 2017 Somatic base substitution mutations of frequencies at the 10(−6)/bp level are expected to be present in many biomedical samples, such as tissues exposed to carcinogenic factorsand exhausted stem cells. However, measurement of such rare mutations has been very difficultin human DNA samples. Here, we invented the use of 100 copies of genomic DNA as a template for amplicon deep sequencing so that a real mutation in a single DNA molecule would be detected at a variant allele frequency of 1% while sequencing errors have less frequency. In addition, we selected 15,552 error-resistant base positions whose mutation frequency was expected to reflect that of base positions that can drive carcinogenesis or potentially even of the entire genome. The validity of the method was first confirmed by the successful detection of mutations premixed at the frequency of 0.1%. Second, increasing mutation frequencies (4–60 × 10(−6)/bp) were successfully detected in cells treated with increasing doses of one of two mutagens, and their signature mutations were detected. The ratio of non-synonymous mutations to synonymous mutations time-dependently decreased after treatment with a mutagen, supporting the neutral theory of molecular evolution for somatic mutations.Importantly, gastric mucosae exposed to Helicobacter without. These results demonstrated that our new method can be used to measure rare base substitution mutations at the 10(−6)/bp level, and is now ready for a wide range of applications.

 

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Continuing use of antithrombotic medications for patients with bleeding  gastroduodenal ulcer requiring endoscopic hemostasis: a case–control study Kawasaki K. Nakamura S. Kurahara K. Nagasue T. Yanai S. Harada A. Yaita H. Fuchigami T. Matsumoto T. Scandinavian Journal of Gastroenterology (2017) 52:9 (948-953). Date of  Publication: 2 Sep 2017 Objective: The aim of this study was to compare clinical characteristics and outcomes of bleeding gastroduodenal ulcer between patients taking antithrombotic medications and those not taking antithrombotic medications. Methods: We performed a case–control study of 346 patients with endoscopically verified bleeding gastroduodenal ulcer, which included 173 cases taking antithrombotic medications throughout peri-bleeding period and 173 age- and sex-matched controls not taking antithrombotic medications. Results: The cases showed less frequent Helicobacter pylori (H. pylori) infections (45.1% versus 60.7%, p =.005), more frequent duodenal location (31.8% versus 19.1%, p =.009), and more frequent rebleeding (13.9% versus 5.8%, p =.02) than the controls. Multivariate analysis revealed that duodenal location (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.37–6.65) and use of antithrombotic medications (OR 2.47, 95% CI 1.13–5.77) were independent factors for rebleeding. However, there were no differences in clinical outcomes, including final successful endoscopic hemostasis, need for surgical intervention, and mortality between cases and controls. Thromboembolic events did not occur in any cases and controls during the periendoscopic period. Conclusions: Low prevalence of H. pylori infection, frequent duodenal location, and high rebleeding rate are characteristics of patients with bleeding gastroduodenal ulcer under antithrombotic medications. Continuation of antithromboticmedications can be accepted for bleeding gastroduodenal ulcer.

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