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Trabalhos Publicados em Novembro / 2017

RECORD 1

 

Comparison of 10-day levofloxacin bismuth-based quadruple therapy and levofloxacin-based triple therapy for Helicobacter pyloriWu T.-S. Hsu P.-I. Kuo C.-H. Hu H.-M. Wu I.-C. Wang S.S.W. Chen Y.-H. Wu D.-C. Su W.-W. Kuo F.-C.Journal of Digestive Diseases (2017) 18:9 (537-542). Date of Publication: 1 Sep 2017OBJECTIVE: This was a prospective study aiming to investigate whether levofloxacin plus bismuth-based quadruple therapy was more effective than levofloxacin-based triple therapy after failed first-line eradication therapies for Helicobacter pylori (H. pylori) infection. METHODS: Sixty-seven patients infected with H. pylori were randomly assigned to two groups; the levofloxacin plus bismuth-based quadruple therapy group (RBAL [n = 33]; rabeprazole 20 mg twice daily, bismuth subcitrate 120 mg four times daily, amoxicillin 1 g twice daily and levofloxacin 500 mg once daily, for 10 days) and the levofloxacin-based triple therapy group (RAL [n = 34]; rabeprazole 20 mg twice daily, amoxicillin 1 g twice daily and levofloxacin 500 mg once daily, for 10 days). Endoscopy was performed 4–8 weeks after H. pylori eradication to assess treatment response. We followed up patient response and compliance and checked their resistance to antibiotics. RESULTS: Intention-to-treat analysis revealed that both groups had similar eradication rates (RBAL vs RAL: 84.8% [95% confidence interval {CI} 72.6–97.1%] vs 67.6% [95% CI 51.9–83.4%], P = 0.0987). No significant differences in compliance or adverse events were found (P = 0.9829 and 0.0720). Epsilometer test showed that most eradication failure cases were levofloxacin-resistant. CONCLUSIONS: Adding bismuth subcitrate to levofloxacin-based triple therapy was not more effective than not doing so, but no further side effects were noted. Both eradication therapies were equally safe and patients had the same tolerance to both regimens. Resistance rate to levofloxacin may be important when choosing second-line therapy.

 

RECORD 2

 

Is Helicobacter pylori associated functional dyspepsia correlated with dysbiosis?Kim Y.-J. Chung W.C. Kim B.W. Kim S.S. Kim J.I. Kim N.J. Yoo J. Kim S.H.Journal of Neurogastroenterology and Motility (2017) 23:4 (504-516). Date of Publication: 2017Background/Aims To assess the long-term effect of Helicobacter pylori eradication on symptomatic improvement according to the type of antibiotic and the duration of treatment in H. pylori-associated functional dyspepsia. Methods We searched Pubmed, Embase, CINAHL, and the Cochrane library databases for randomized controlled trials written in English and undertaken up to August 2016 that met our eligibility criteria. The search methodology used combinations of the following keywords: Helicobacter pylori OR H. pylori OR HP; dyspepsia OR functional dyspepsia OR non-ulcer dyspepsia; eradication OR cure OR treatment. The study outcome was the summary odds ratio (OR) for symptomatic improvement in H. pylori-associated functional dyspepsia with successful eradication therapy. Subgroup analyses were performed based on the type of antibiotic, and the duration of treatment, whether or not patients had symptoms of irritable bowel syndrome, and on race. Results Sixteen randomized controlled trials met the inclusion criteria. The summary OR for symptomatic improvement in patients in our eradication group was 1.33 (95% confidence interval [CI], 1.16-1.54; P < 0.01). In a subgroup analysis on type of antibiotic, symptomatic improvement with metronidazole-containing regimen (OR, 1.87; 95% CI, 1.26-2.77) was better than treatment with clarithromycin (OR, 1.29; 95% CI, 1.11-1.50). H. pylori eradication therapy given for 10-14 days was the more effective for symptom improvement than 7-day therapy. When the studies excluding irritable bowel syndrome cases were analyzed, there were no therapeutic effects of H. pylori eradication on symptomatic improvement. Conclusions In the clinical setting, the most effective H. pylori eradication regimen for functional dyspepsia to provide relief of symptoms is a metronidazole-based treatment regimen for at least 10 days. The explanation for this is that H. pylori-associated functional dyspepsia could be associated with dysbiosis.

 

RECORD 3

 

Helicobacter pylori among patients with cirrhosis: Incidence or prevalence?Pellicano R.European Journal of Gastroenterology and Hepatology (2017) 29:11 (1315). Date of Publication: 2017

 

RECORD 4

 

In vivo analysis of the viable microbiota and Helicobacter pylori transcriptome in gastric infection and early stages of carcinogenesisThorell K. Bengtsson-Palme J. Liu O.H.-F. Gonzales R.V.P. Nookaew I. Rabeneck L. Paszat L. Graham D.Y. Nielsen J. Lundin S.B. Sjöling Å.Infection and Immunity (2017) 85:10 Article Number: e00031-17. Date of Publication: 2017Emerging evidence shows that the human microbiota plays a larger role in disease progression and health than previously anticipated. Helicobacter pylori, the causative agent of gastric cancer and duodenal and gastric ulcers, was early associated with gastric disease, but it has also been proposed that the accompanying microbiota in Helicobacter pylori-infected individuals might affect disease progression and gastric cancer development. In this study, the composition of the transcriptionally active microbial community and H. pylori gene expression were determined using metatranscriptomic RNA sequencing of stomach biopsy specimens from individuals with different H. pylori infection statuses and premalignant tissue changes. The results show that H. pylori completely dominates the microbiota not only in infected individuals but also in most individuals classified as H. pylori uninfected using conventional methods. Furthermore, H. pylori abundance is positively correlated with the presence of Campylobacter, Deinococcus, and Sulfurospirillum. Finally, we quantified the expression of a large number of Helicobacter pylori genes and found high expression of genes involved in pH regulation and nickel transport. Our study is the first to dissect the viable microbiota of the human stomach by metatranscriptomic analysis, and it shows that metatranscriptomic analysis of the gastric microbiota is feasible and can provide new insights into how bacteria respond in vivo to variations in the stomach microenvironment and at different stages of disease progression.

 

RECORD 5

 

Possible role of helicobacter pylori in diseases of dermatological interestGuarneri C. Lotti J. Fioranelli M. Roccia M.G. Lotti T. Guarneri F.Journal of Biological Regulators and Homeostatic Agents (2017) 31:2, Supplement 2 (57-77). Date of Publication: 1 Jun 2017Helicobacter pylori is a gram-negative, flagellate, microaerophilic bacterium identified for the first time about 30 years ago, as a pathogenic factor of gastritis and peptic ulcer. Soon after, it was linked to several gastrointestinal and extra-gastrointestinal diseases (hematological, cardiovascular, neurological, pulmonary and ocular diseases, obesity, diabetes mellitus, growth retardation and extragastric MALT lymphoma). Association and possible cause-effect correlation with H. pylori infection were suggested in diseases of dermatological interest such as chronic urticaria, rosacea, Henoch-Schoenlein's purpura, idiopathic thrombocytopenic purpura, cutaneous and oral lichen planus, atopic dermatitis, recurrent aphthous stomatitis, systemic sclerosis, psoriasis, Sjögren's syndrome, Behçet's disease, pruritus, alopecia areata, primary cutaneous marginal zone B-cell lymphomas, vitiligo, chronic prurigo, multiformis, prurigo nodularis, leukocytoclastic vasculitis, prurigo pigmentosa, eczema nummulare, primary cutaneous MALT-Type lymphoma, sublamina densa-Type linear IgA bullous dermatosis, Sweet's syndrome, cutaneous T-cell pseudolymphoma and pemphigus vulgaris. A critical review of the literature up to May 2017 shows clear evidence of H. pylori involvement only for some of the above purported associations, while in the majority of cases data appear contrasting and/or obtained on a not adequately large study population. Further clinical and laboratory research, with more adequate methodological and statistical basis, is required to assess the actual existence and relevance of many purported associations, as well as the possible role of H. pylori and the underlying pathogenic mechanisms.

 

RECORD 6

 

The relationship between recurrent aphthous stomatitis, and periodontal disease and Helicobacter Pylori infectionGülseren D. Karaduman A. Kutsal D. Nohutcu R.M.Clinical oral investigations (2016) 20:8 (2055-2060). Date of Publication: 1 Nov 2016OBJECTIVE: Recurrent aphthous stomatitis (RAS) is a common oral mucosal disease with unknown etiology. This cross-sectional study aimed to test the hypothesis that Helicobacter pylori and periodontal disease might play an etiological role in RAS.METHODS: Dental plaque samples obtained from 38 patients with RAS and 43 healthy individuals via periodontal examinations were examined for H. pylori colonization. H. pylori was identified using the rapid urease test (RUT). The periodontal status of the patients and controls was based on the following periodontal parameters: periodontal pocket depth (PPD), the plaque index (PI), the gingival index (GI), and clinical attachment loss (CAL).RESULTS: RUT results were positive in 34 (89.5 %) of the 38 patients and 24 (55.8 %) of the 43 controls (P = 0.002). There were not any significant differences in mean PPD, PI, GI, or CAL between the patient and control groups (P > 0.05). Mean PPD, PI, GI, and CAL were higher in the RUT-positive RAS patients than in the RUT-negative patients (P > 0.05, for all).CONCLUSIONS: The present findings show that H. pylori might have played an etiological role in RAS and might have caused periodontal disease, but RAS was not associated with any of the periodontal parameters examined in this study.CLINICAL RELEVANCE: The present study indicates that H. pylori plays a role in the development of RAS, but periodontal diseases have no effect on it. Eradicating H. pylori might be useful to prevent RAS.

 

RECORD 7

 

Association of Mannose-Binding Lectin rs1800450 and Tumor Necrotic Factor-α rs1800620 Polymorphism with Helicobacter pylori in Type II Diabetes MellitusMortazavi E. Eslami B. Aghahosseini P. Ahron F. Amininejad A. Mahmoodi S. Satarpour H. Radmanesh N. Rassi H.Monoclonal Antibodies in Immunodiagnosis and Immunotherapy (2017) 36:5 (236-241). Date of Publication: 1 Oct 2017Type II diabetes mellitus (T2DM) is the prevalent type of diabetes, including 90% of the cases world-wide. Helicobacter pylori plays a pathogenic role in the development of T2DM. The host genetic factors have a significant impact on the clinical outcome and anatomical distribution of H. pylori infection and polymorphisms in several genes such as tumor necrotic factor (TNF)-α and mannose-binding lectin (MBL) and are considered to increase the risk for the development of T2DM. In this study, we investigate the prevalence rate of H. pylori infection and its relationship to MBL rs1800450 and TNF-α rs1800620 polymorphism in T2DM. In this case-control study, 174 patients with type II diabetes and 185 healthy controls were studied. Also, demographics, physical, and biochemical parameters were performed in all patients. The DNA extracted from blood specimens was amplified by H. pylori cagA-specific primers. The MBL rs1800450 and TNF-α rs1800620 genotyping were detected by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). The results show that H. pylori cagA positivity was detected in 42.82% of the diabetic patients and in 22.16% of the control group, and H. pylori infection was closely correlated with MBL rs1800450 AA genotype and TNF-α rs1800620 GG genotype when compared with healthy controls. Furthermore, these two genotypes were strongly associated with H. pylori cagA(+) samples when compared with cagA(-) samples. In addition, the presence of H. pylori cagA(+) infection was significantly associated with the elevated serum levels of total cholesterol and low-density lipoprotein cholesterol. In general, it can be concluded that molecular analysis of MBL rs1800450 AA genotype and TNF-α rs1800620 AA genotype is important in the early detection and treatment of T2DM with H. pylori cagA(+) infection.

 

RECORD 8

 

Bismuth-based quadruple therapy following H. Pylori eradication failures: A multicenter study in clinical practiceZullo A. De Francesco V. Bellesia A. Vassallo R. D’Angelo A. Scaccianoce G. Sacco R. Bresci G. Eramo A. Tanzilli A. Ridola L. Alvaro D. Londoni C. Brambilla G. Manta R. Di Ciaula A. Portincasa P.Journal of Gastrointestinal and Liver Diseases (2017) 26:3 (225-229). Date of Publication: 1 Sep 2017Background & Aims: Helicobacter pylori (H. pylori) eradication in patients who failed one or more therapeutic attempts remains challenging. This study aimed to assess the efficacy of three-in-one capsules bismuth-based quadruple therapy (Pylera®) in these patients managed in clinical practice. Methods: This was a prospective, open-label, multicenter study enrolling consecutive, adult patients with persistent H. pylori infection following at least one standard therapy. All patients received a rescue quadruple therapy with Pylera (3 capsules four times daily) and esomeprazole 20 mg (1 tablet twice daily) for 10 days. H. pylori eradication was assessed by using Urea Breath Test 4-6 weeks following therapy ending. H. pylori eradication rates, compliance, and side-effects were calculated. Results: A total of 208 patients in the 9 participating centres were enrolled. Overall, 180 patients were successfully cured from the infection, accounting for 86.5% (95% CI 81.9-91.2) and 92.3% (95% CI 88.6-96.1) eradication rates at intention-to-treat analysis and at per protocol analysis, respectively. Cure rates were similar across patients who failed one to three previous therapy attempts, but the success rate fell to 67% after 4 or more therapy failures. Compliance to therapy was good in 198 (95.2%) patients, whilst in 7 (5.3%) cases the therapy was interrupted within 5 days due to side effects. A total of 97 (46.6%) patients complained of at least one side effect; nausea, diarrhea and vomiting were the most frequently reported. Conclusions: Our study found that this bismuth-based quadruple therapy is highly effective as second-line and rescue therapy for H. pylori eradication in clinical practice.

 

RECORD 9

 

Prevalence of helicobacter pylori infection among children living in a rural setting in Sub-Saharan AfricaAwuku Y.A. Simpong D.L. Alhassan I.K. Tuoyire D.A. Afaa T. Adu P.BMC public health (2017) 17:1 (360). Date of Publication: 24 Apr 2017BACKGROUND: Helicobacter pylori infection affects more than half of the world's population. It is generally acquired during childhood with no symptoms but has long- term clinical sequelae. This study estimated the prevalence of H. pylori infection amongst children in a rural environment in Africa.METHODS: We conducted a cross-sectional study over a four (4)-month period within two rural communities. 240 asymptomatic children were tested using lateral flow immunochromatographic assay for the qualitative detection of H. pylori antigen in a fecal specimen. Statistical analysis and processing was done using Stata version 11.RESULTS: The mean age of the participants was 10.5 ± 2.7 years with the predominant age range being 8-10 years (34.6%), and a mean household size of 7.1 ± 1.7. The study population showed a female preponderance of 57.1%. 88% of the H. pylori positive children lacked pipe and borehole drinking water. All of the positive H. pylori children practiced open-air defecation. The overall prevalence of H. pylori infection among children in this study was at least 14.2%.CONCLUSION: Our study demonstrated a high prevalence of H. pylori infection among children in a rural setting. Educational status of parents did not affect H. pylori prevalence but increasing household numbers, female gender, source of drinking water other than pipe and borehole, open-air defecation and younger age were associated with a higher H. pylori prevalence.

 

RECORD 10

 

Detection of Helicobacter pylori vacA, cagA and iceA1 virulence genes associated with gastric diseases in Egyptian patientsEl-Shenawy A. Diab M. Shemis M. El-Ghannam M. Salem D. Abdelnasser M. Shahin M. Abdel-Hady M. El-Sherbini E. Saber M.Egyptian Journal of Medical Human Genetics (2017) 18:4 (365-371). Date of Publication: 1 Oct 2017Background Helicobactor pylori (H. pylori) virulence markers would be useful to predict peptic ulcer disease (PUD) or gastric cancer. Aim In Egypt, since inadequate data are present regarding H. pylori virulence–related genes in different age group patients with gastro-duodenal diseases, it becomes crucial to study the clinical status of cagA, vacA and iceA1 genotypes of H. pylori strains recovered from patients with dyspepsia. Subjects and methods The study included 113 dyspeptic patients who were exposed to upper gastrointestinal endoscopic examination. Four antral biopsies were obtained from each patient for the analysis of H. pylori infection by rapid urease test and detection of 16S rRNA. Results Sixty (53.1%) patients were confirmed to be infected with H. pylori. Upon endoscopy, gastritis was revealed in 27 patients (45%) and10 patients (16.7%) had PUD. Of the 60 H. pylori strains, 39 (65%) had at least one virulence gene. Six different genotypic forms were recognized; vacA (9/60), iceA1 (1/60), vacA/cagA (7/60), vacA/iceA1 (13/60), vacA/cagA/iceA1 (8/60) only one of cagA/iceA type and we could not detect cagA. The overall vacA, iceA1and cagA genes identified were 61.6%, 38.8%, 26.6% respectively, by PCR-based molecular testing. The vacA gene status was highly significant related to gastritis patient (P ≤ 0.036). The vacA s1m1 and s2m2 alleles were significantly found in 50% of H. pylori infected patients with PUD and with gastritis 57.1% respectively (P ≤ 0.01). Conclusion In conclusion, the main genotype combinations in the studied Egyptian patients were; vacAs2m2/iceA1, vacAs1m1/cagA, mostly associated with gastritis, and vacAs1/cagA/icA, mainly in PUD. The less virulent (s2, s2m2) H. pylori genotypes were found in patients aged over 43 years.

 

RECORD 11

 

Group 2 Innate Lymphoid Cells Are Involved in Skewed Type 2 Immunity of Gastric Diseases Induced by Helicobacter pylori InfectionLi R. Jiang X.-X. Zhang L.-F. Liu X.-M. Hu T.-Z. Xia X.-J. Li M. Xu C.-X.Mediators of Inflammation (2017) 2017 Article Number: 4927964. Date of Publication: 2017H. pylori induces a complicated local and systematic immune response and contributes to the carcinogenesis of gastric cancer. A primary type 1 immune response is evoked by H. pylori since its occurrence. However, it is not unusual that an inhibitory immunity is dominant in H. pylori-associated diseases, which are promoted by the formation of immunosuppressive microenvironment. But whether group 2 innate lymphoid cells (ILC2s) plays a critical role in H. pylori-induced skewed type 2 immunity is still unclear. In the present study, firstly, we confirmed that type 1 immunity was inhibited and type 2 immunity were undisturbed or promoted after H. pylori infection in vitro and in vivo. Secondly, GATA-3 was firstly found to be increased in the interstitial lymphocytes from H. pylori-associated gastric cancer, among them, Lin-GATA-3(+) cells and Lin(+)GATA-3(+) cells were also found to be enhanced, which indicated an important role for ILC2s in H. pylori infection. More importantly, ILC2s were found to be increased after H. pylori infection in clinical patients and animal models. In conclusion, our results indicated that ILC2-mediated innate immune response might play a potential role in dominant type 2 phenotype and immunosuppressive microenvironment in H. pylori infection.

 

RECORD 12

 

Identification of pathogenic microRNAs in Helicobacter pylori-associated gastric cancer using a combined approach of animal study and clinical sample analysisCho C.H. Yu J. Wu W.K.Hong Kong medical journal = Xianggang yi xue za zhi (2016) 22:6 Supplement 6 (13-18). Date of Publication: 1 Dec 2016

 

RECORD 13

 

Antibiotic resistance and gyrA mutation affect the efficacy of 10-day sitafloxacin-metronidazole-esomeprazole therapy for Helicobacter pylori in penicillin allergic patientsMori H. Suzuki H. Matsuzaki J. Masaoka T. Kanai T.United European Gastroenterology Journal (2017) 5:6 (796-804). Date of Publication: 1 Oct 2017Background and aim: Helicobacter pylori (H. pylori) eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10-day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy. Methods: Penicillin-allergic patients infected with H. pylori were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the gyrA mutation status of the H. pylori strains were determined before treatment. The cut-off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [(13)C] urea breath test or the H. pylori stool antigen test. Results: Fifty-seven patients were analyzed, and the overall eradication rate was 89.5%. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0%, whereas for other combinations of resistance, this was above 90.0%. Finally, the eradication rate of gyrA mutation-negative strains was 96.2%, whereas for gyrA mutation-positive strains, it was 83.9%. Adverse events were reported in 31.6% of cases, all of which were mild and tolerable. Conclusion: Ten days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating H. pylori in penicillin-allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.

 

RECORD 14

 

L-glutamine eradicates helicobacter pylori gastritis: A novel case reportBalaji O. Amita P.Asian Journal of Pharmaceutical and Clinical Research (2017) 10:10 (13-14). Date of Publication: 1 Oct 2017Helicobacter pylori is the most common infection causing gastrointestinal diseases in the developing countries. It causes oxidative damage to gastric mucosal cells thereby altering the epithelial proliferation of these cells. With proton pump inhibitors and antibiotics being the mainstay in the management of symptoms, preclinical and clinical research is making inroads with novel therapeutic innovations to target the bacterium with the help of antioxidants. Hence, we report the first case of the treatment and eradication of H. pylori using L-glutamine, a sports medicine supplement with high antioxidant potential.

 

RECORD 15

 

Systematic review with meta-analysis: the global recurrence rate of Helicobacter pyloriHu Y. Wan J.-H. Li X.-Y. Zhu Y. Graham D.Y. Lu N.-H.Alimentary Pharmacology and Therapeutics (2017) 46:9 (773-779). Date of Publication: 1 Nov 2017Background: Up-to-date information regarding the recurrence rate of Helicobacter pylori (H. pylori) after eradication therapy is not available. Aim: To evaluate the global recurrence rate following H. pylori eradication therapy and confirm its association with socioeconomic and sanitary conditions. Methods: A systematic search of PubMed, EMBASE and the Cochrane library was performed to identify potentially relevant publications using the following keywords: “Helicobacter pylori” or “H. pylori” or “Hp” and “recurrence” or “recrudescence” or “reinfection” or “recurrent” or “recurred” or “re-infect*” or “relapse*.”. Results: A total of 132 studies (53 934 patient-years) were analysed. Each study was weighted according to the duration of patient-years. The global annual recurrence, reinfection and recrudescence rate of H. pylori were 4.3% (95% CI, 4-5), 3.1% (95% CI, 2-5) and 2.2% (95% CI, 1-3), respectively. The H. pylori recurrence rate was inversely related to the human development index (HDI) (ie, 3.1% [95% CI, 2-4], 6.2% [95% CI, 4-8] and 10.9% [95% CI, 6-18] in countries with a very high, high and medium or low HDI) (P <.01) and directly related to H. pylori prevalence (10.9% [95% CI, 7-16], 3.7% [95% CI, 3-5], 3.4% [95% CI, 2-5] and 1.6% [95% CI, 0.5-3] in countries with a very high, high, medium or low local H. pylori prevalence) (P <.01). Global recurrence rates remained relatively stable between 1990s, 2000s and 2010s but varied across different regions (P <.05). Conclusions: H. pylori recurrence remains a problem closely associated with socioeconomic and sanitary conditions. Methods to reduce recurrence in developing countries are needed.

 

RECORD 16

 

Clinicopathologic Correlates of Helicobacter pylori in Gastric MucosaWadhwa N. Gupta S. Aggarwal S. Mishra K.Applied Immunohistochemistry and Molecular Morphology (2017) 25:9 (e81-e82). Date of Publication: 2017

 

RECORD 17

 

Editorial: risk stratification for endoscopic surveillance of metachronous gastric cancer after endoscopic resectionFock K.M. Ang T.L.Alimentary Pharmacology and Therapeutics (2017) 46:10 (1014-1015). Date of Publication: 1 Nov 2017

 

RECORD 18

 

Physiologic, pathophysiologic, and pharmacologic regulation of gastric acid secretionSchubert M.L.Current Opinion in Gastroenterology (2017) 33:6 (430-438). Date of Publication: 1 Nov 2017Purpose of review The present review summarizes the past year's literature, both clinical and basic science, regarding physiologic and pharmacologic regulation of gastric acid secretion in health and disease. Recent findings Gastric acid kills microorganisms, assists digestion, and facilitates absorption of iron, calcium, and vitamin B 12. The main stimulants of acid secretion are the hormone gastrin, released from antral G cells; paracrine agent histamine, released from oxyntic enterochromaffin-like cells; and neuropeptide acetylcholine, released from antral and oxyntic intramural neurons. Gastrin is also a trophic hormone that participates in carcinogenesis. Helicobacter pylori may increase or decrease acid secretion depending upon the acuity and predominant anatomic focus of infection; most patients manifest hypochlorhydria. Despite the fact that proton pump inhibitors (PPIs) are amongst the most widely prescribed drugs, they are underutilized in patients at high risk for UGI bleeding. Although generally considered well tolerated, concerns have been raised regarding associations between PPI use and dementia, kidney disease, myocardial infarction, pneumonia, osteoporosis, dysbiosis, small bowel injury, micronutrient deficiency, and fundic gland polyps. Summary Our understanding of the physiologic, pathophysiologic, and pharmacologic regulation of gastric secretion continues to advance. Such knowledge is crucial for improved and safe management of acid-peptic disorders.

 

RECORD 19

 

Improvement of oral hygiene may be helped to gastric cancer reduction riskTavana A.M.Annals of Tropical Medicine and Public Health (2017) 10:4 (1091-1092). Date of Publication: 1 Jul 2017

 

RECORD 20

 

Enrichment of Helicobacter pylori mutant strains after eradication therapy analyzed by gastric wash-based quantitative pyrosequencingOikawa R. Watanabe Y. Miyamoto S. Sato Y. Ono S. Mabe K. Yamamoto H. Kato M. Itoh F.Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine (2017) 39:10 (1010428317734865). Date of Publication: 1 Oct 2017The eradication of Helicobacter pylori reduces the risk of gastric cancer. A clear understanding of the factors underlying mixed infection with multiple clarithromycin-susceptible and clarithromycin-resistant H. pylori strains is necessary to design more effective therapies against H. pylori. We aimed to assess how the abundance and prevalence of H. pylori strains vary after clarithromycin-based eradication therapy. Using gastric wash samples, which represent the entire stomach, we sequentially analyzed the abundance and prevalence of H. pylori DNA by 23S ribosomal RNA pyrosequencing before and 1, 2, and 3 years after eradication therapy. Low levels of H. pylori DNA were still detectable at the first-year follow-up in all samples with negative post-treatment urea breath test results. The abundance of H. pylori DNA decreased significantly until the 2-year follow-up, but it switched to an increase at the 3-year follow-up. Importantly, the ratio of the prevalence of mutant strains to the prevalence of wild-type strains had already increased at the first-year follow-up and continued to increase, suggesting the selection and growth of clarithromycin-resistant strains during the follow-up periods. Being sensitive and representative, our assay will be useful in effectively addressing gastric cancer development by enhancing the long-term success of intervention strategies and consecutive surveillance for H. pylori eradication.

 

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18F-FDG uptake in the stomach on screening PET/CT: value for predicting Helicobacter pylori infection and chronic atrophic gastritisKobayashi S. Ogura M. Suzawa N. Horiki N. Katsurahara M. Ogura T. Sakuma H.BMC medical imaging (2016) 16:1 (58). Date of Publication: 18 Oct 2016BACKGROUND: The aim of this study was to determine the value of 18F-FDG uptake on screening PET/CT images for the prediction of Helicobacter pylori (H. pylori) infection and chronic atrophic gastritis.METHODS: Among subjects who underwent 18F-FDG PET/CT for cancer screening from April 2005 to November 2015, PET/CT images were analyzed in 88 subjects who had gastrointestinal fiberscopy within 6 months. The volumes of interest (VOIs) were placed in the fornix, corpus and antrum of the stomach to determine maximal standardized uptake value (SUVmax) and mean SUV (SUVmean). Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic performance of SUV indicators in predicting H. pylori infection and chronic atrophic gastritis.RESULTS: SUV indicators of the stomach were significantly higher in subjects with H. pylori infection than those without (from P < 0.001 to P < 0.05). ROC analysis revealed that SUVmean had the highest performance in predicting H. pylori infection (AUC 0.807) and chronic atrophic gastritis (AUC 0.784). SUVmean exhibited the sensitivity of 86.5 % and the specificity of 70.6 % in predicting H. pylori infection, and the sensitivity of 75.0 % and 78.6 % in predicting chronic atrophic gastritis.CONCLUSION: Assessment of 18F-FDG uptake in the stomach reflecting active inflammation is useful in predicting patients with H. pylori infection and subsequent chronic atrophic gastritis which is closely associated with the risk of gastric neoplasms.

 

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Periodontal disease and Helicobacter pylori infection: a community-based study using serology and rapid urease testNisha K.J. Nandakumar K. Shenoy K.T. Janam P.Journal of investigative and clinical dentistry (2016) 7:1 (37-45). Date of Publication: 1 Feb 2016AIMS: The aims of the present study were to assess the prevalence of periodontal disease and Helicobacter pylori (H. pylori) infection and their associations within a predefined Indian population.METHODS: A community-based cross-sectional study of 500 selected individuals using a questionnaire, oral examination, rapid urease testing of dental plaque, and serological examination for immunoglobulin G antibody to H. pylori was carried out.RESULTS: Periodontal disease and H. pylori infection were prevalent in more than 50% of the population. Age, smoking, and diabetic status of the individuals were risk factors for periodontal disease after multivariate analysis, and a lack of proper sewage and waste disposal facilities were found to increase the risk of H. pylori infection. Although there was no association between periodontal disease and H. pylori seropositivity in the community, a highly-significant association was found between periodontal disease and colonization of H. pylori in dental plaque.CONCLUSIONS: Because periodontal disease is associated with the increased colonization of H. pylori, new treatment modalities, such as plaque control measures, should be employed for the complete management of H. pylori-associated gastric disease.

 

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Increasing antimicrobial resistance of Helicobacter pylori infection among Saudi patients undergoing upper gastrointestinal endoscopyAl-Eidan F.A.S. Alnaser M. Aljohani S.M. Al Johani M. El Hafi A. Al Jahdaly A. Al Khurmi A.Italian Journal of Medicine (2017) 11:3 (318-321). Date of Publication: 2017There is growing concern about Helicobacter pylori resistance strains being the main agent contributing to eradication failure. In this study, we evaluated the prevalence and antimicrobial susceptibility trends of H. pylori over a period of time. Over a period of seven years a total of 384 biopsy specimens were sent to the microbiology department and evaluated for culturing H. pylori and assess its susceptibility. Biopsy specimens that cultured and where bacterial susceptibility was determined were regarded as H. pylori positive, and specimens that failed to culture were considered H. pylori negative. A total of 221 patients with H. pylori positive were assessed and antimicrobial susceptibility was determined. The overall prevalence of H. pylori infections among Saudis undergoing upper gastrointestinal endoscopy, with indicated specimens, was 57.6%. Antimicrobial susceptibility was evaluated; overall clarithromycin resistance was found to be 4.5% and metronidazole resistance 52.5%. The number of clarithromycin resistant strains has increased significantly from 2.5% in 2008 to 10% in 2014 (P<0.0001), and metronidazole resistance strains from 47% in 2008 to 65% in 2014 (P<0.001). H. pylori infection is very common among Saudi patients with peptic ulcer disease. Resistance of H. pylori against clarithromycin and metronidazole has increased significantly over the seven-year period. This suggests a need to monitor the annual antimicrobial susceptibility pattern.

 

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Bifidobacteria and Their Health-Promoting EffectsHidalgo-Cantabrana C. Delgado S. Ruiz L. Ruas-Madiedo P. Sánchez B. Margolles A.Microbiology spectrum (2017) 5:3. Date of Publication: 1 Jun 2017Bifidobacteria are members of the intestinal microbiota of mammals and other animals, and some strains are able to exert health-promoting effects. The genus Bifidobacterium belongs to the Actinobacteria phylum. Firmicutes, Bacteroidetes, and Actinobacteria constitute the most abundant phyla in the human intestinal microbiota, Firmicutes and Bacteroidetes being predominant in adults, and Actinobacteria in breast-fed infants, where bifidobacteria can reach levels higher than 90% of the total bacterial population. They are among the first microbial colonizers of the intestines of newborns, and play key roles in the development of their physiology, including maturation of the immune system and use of dietary components. Indeed, some nutrients, such as human milk oligosaccharides, are important drivers of bifidobacterial development. Some Bifidobacterium strains are considered probiotic microorganisms because of their beneficial effects, and they have been included as bioactive ingredients in functional foods, mainly dairy products, as well as in food supplements and pharma products, alone, or together with, other microbes or microbial substrates. Well-documented scientific evidence of their activities is currently available for bifidobacteria-containing preparations in some intestinal and extraintestinal pathologies. In this review, we focus on the role of bifidobacteria as members of the human intestinal microbiota and their use as probiotics in the prevention and treatment of disease.

 

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Gastric TFF1 expression from acute to chronic Helicobacter infectionEsposito R. Morello S. Vllahu M. Eletto D. Porta A. Tosco A.Frontiers in Cellular and Infection Microbiology (2017) 7:OCT Article Number: 434. Date of Publication: 9 Oct 2017TFF1, a mucin-associated secreted peptide of gastric mucous cells, is known as a protective agent for stomach epithelium under different stimuli, but its role upon Helicobacter infection is still not clear. In this paper we characterized TFFs expression, with particular attention to TFF1, under Helicobacter infection in gastric cell lines. A mouse model was used to distinguish TFF1 mRNA expression between acute and chronic stages of Helicobacter infection. Our results show that TFF1 expression is induced in infected cells; in addition, the inflammatory response upon Helicobacter infection is inversely associated to pre-existing TFF1 protein levels. In infected mice, TFF1 is initially upregulated in gastric antrum in the acute phase of infection, along with IL-1β and IL-6. Then, expression of TFF1 is gradually silenced when the infection becomes chronic and IFN-γ, CXCL5, and CXCL15 reach higher levels. Our data suggest that TFF1 might help cells to counteract bacteria colonization and the development of a chronic inflammation.

 

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Evaluation of diagnostic accuracy of two rapid stool antigen tests using an immunochromatographic assay to detect Helicobacter pylorida Silva-Etto J.M.K. Mattar R. Villares-Lopes C.A. Marques S.B. Carrilho F.J.Clinical Biochemistry (2017) 50:16-17 (959-962). Date of Publication: 1 Nov 2017Objectives The stool antigen assay for H. pylori infection diagnosis with monoclonal antibodies is a simple and recommended technique by the Maastricht V/Florence consensus report. Recently, Pylori K-Set K-1219 (Coris Bioconcept Sprl, Belgium) and HP-F23 (Symbiosys, Brazil) have been made commercially available in Brazil. Thus, the aim of this study was to evaluate the diagnostic accuracies of these two rapid stool antigen tests by immunochromatographic assays (index tests) for the clinical practice. Design and methods A total of 98 patients who underwent upper gastrointestinal endoscopy and (13)C-urea breath test entered the study. H. pylori infection status was defined by the combination of the rapid urease test and the (13)C-urea breath test (reference standard). Two observers who were aware of H. pylori status performed the reading of index tests. Diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value with 95% confidence intervals, positive likelihood ratio, negative likelihood ratio and kappa index measure of agreement) were determined. Results The index tests where in perfect agreement with the H. pylori status with kappa values of 0.87 for Pylori K-Set K-1219 and 0.92 for HP-F23. The sensitivity of HP-F23 was 97.9% (IC95%: 87.5–100) and specificity was 93.8% (IC95%; 84–97.2).The positive likelihood ratio was 15.8, and the negative likelihood ratio was 0.02. The Pylori K-Set K-1219 had a sensitivity of 87.7% (IC95%: 74.5–94.9) and a specificity of 100% (IC95%: 91.6–100); the positive likelihood ratio was ∞, and the negative likelihood ratio was 0.1. The test line on the cassette device of HP-F23 was stronger than of the Pylori K-Set K-1219. Conclusion The HP-F23 test performed better in clinical practice. Nonetheless, the (13)C-urea breath test is more reliable technique. Moreover, caution must be paid to the trace or clear pale test line readings that were observed in false positive and false negative results, leading to incorrect management of the patient.

 

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The impact of pathogen burden on leukocyte telomere length in the Multi-Ethnic Study of AtherosclerosisAiello A.E. Jayabalasingham B. Simanek A.M. Diez-Roux A. Feinstein L. Meier H.C.S. Needham B.L. Dowd J.B.Epidemiology and infection (2017) 145:14 (3076-3084). Date of Publication: 1 Oct 2017Several infections have been linked to telomere shortening and in some cases these associations have varied by sex. We assessed the association between seropositivity to four persistent pathogens (cytomegalovirus (CMV), herpes simplex virus-1, Helicobacter pylori, Chlamydia pneumoniae), and total pathogen burden on leukocyte telomere length in a diverse US sample. Data came from the Multi-Ethnic Study of Atherosclerosis, a population-based cohort study. We utilized cross-sectional survey data, and biological samples from participants tested for pathogens and telomere length (N = 163). Linear regression was used to examine the association between seropositivity for individual pathogens as well as total pathogen burden and telomere length, adjusting for various confounders. CMV seropositivity and increased total pathogen burden level were significantly associated with shorter telomere length among females (β = -0·1204 (standard error (s.e.) 0·06), P = 0·044) and (β = -0·1057 (s.e. = 0·05), P = 0·033), respectively. There was no statistically significant association among males. Our findings suggest that prevention or treatment of persistent pathogens, in particular CMV, may play an important role in reducing telomere shortening over the life course among women. Future research is needed to confirm these novel findings in larger longitudinal samples.

 

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Aminophosphinates against Helicobacter pylori ureolysis-Biochemical and whole-cell inhibition characteristicsMacegoniuk K. Grela E. Biernat M. Psurski M. Gościniak G. Dziełak A. Mucha A. Wietrzyk J. Berlicki Ł. Grabowiecka A.PloS one (2017) 12:8 (e0182437). Date of Publication: 2017Urease is an important virulence factor from Helicobacter pylori that enables bacterial colonization of human gastric mucosa. Specific inhibition of urease activity can be regarded as a promising adjuvant strategy for eradication of this pathogen. A group of organophosphorus inhibitors of urease, namely, aminophosphinic acid and aminophosphonic acid derivatives, were evaluated in vitro against H. pylori urease. The kinetic characteristics of recombinant enzyme activity demonstrated a competitive reversible mode of inhibition with Ki values ranging from 0.294 to 878 μM. N-n-Hexylaminomethyl-P-aminomethylphosphinic acid and N-methylaminomethyl-P-hydroxymethylphosphinic acid were the most effective inhibitors (Ki = 0.294 μM and 1.032 μM, respectively, compared to Ki = 23 μM for the established urease inhibitor acetohydroxamic acid). The biological relevance of the inhibitors was verified in vitro against a ureolytically active Escherichia coli Rosetta host that expressed H. pylori urease and against a reference strain, H. pylori J99 (CagA+/VacA+). The majority of the studied compounds exhibited urease-inhibiting activity in these whole-cell systems. Bis(N-methylaminomethyl)phosphinic acid was found to be the most effective inhibitor in the susceptibility profile studies of H. pylori J99. The cytotoxicity of nine structurally varied inhibitors was evaluated against four normal human cell lines and was found to be negligible.

 

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Detection of P53 and bax genes associated with helicobacter pylori infectionAl-Sabary A.H. Abdul Razzaq M.S. Wtwt M.A.Pakistan Journal of Biotechnology (2017) 14:3 (383-388). Date of Publication: 2017H. pylori is considered one of the most common human pathogen worldwide, with infection rates much higher in developing countries than in developed nations. The aim of this study is the investigation of some candidate genes include P53 and Bax genes mutation associated with H. pylori infection and study the role of H. pylori virulence genes on the induction of P53 and Bax genes mutation. The results show a total of 92 gastric biopsies gave positive results for the presence of H. pylori diagnosed by molecular technique. Only (49) cag a positive H. pylori strains obtain from gastric biopsy of patient suffering from H. pylori infection which also harboring cag E and vacA genes. Single Strand Conformation Polymorphism (PCR-SSCP) technique used to identify mutations in the p53 gene in several exons. Where 16 alterations in exon E5A, 19 alterations in exon E5B6A, 17 alterations in exon E7 and only two in exon E6B; but no alteration was appeared in exon E8 of P53 gene. In the same way, PCR-SSCP analysis detected alterations in Bax gene where only 14 positive samples gave alteration in the sequence of Bax gene in exons E1, E4 and E6. Regarding to exon 1 of Bax gene, it was appeared that only 10 samples gave positive gene locus mutation. This may attribute to H. pylori which stimulate Bax mutation through its ability to produce cag A protein which has the ability to cause changing in gene sequence and function. It is concluded that p53 and Bax genes mutation is important tool in the screening of genetic alteration associated with H. pylori infections.

 

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Subtypes of chronic gastritis in patients with celiac disease before and after gluten-free dietGabrieli D. Ciccone F. Capannolo A. Viscido A. Valerii G. Serva D. Necozione S. Coletti G. Calvisi G. Melideo D. Frieri G. Latella G.United European Gastroenterology Journal (2017) 5:6 (805-810). Date of Publication: 1 Oct 2017Background: Celiac disease (CD) often manifests with dyspeptic symptoms and chronic gastritis is a common finding. Aim: To evaluate the frequency of lymphocytic gastritis (LG), chronic active gastritis (CAG), and chronic inactive gastritis (CIG) in patients with CD, before and after gluten-free diet (GFD). Methods: A five-year prospective study including all consecutive patients with a new diagnosis of CD was conducted. Gastric and duodenal biopsy specimens taken both at the time of the CD diagnosis and at the first endoscopic control after 18–24 months on GFD were evaluated. Results: 213 patients with CD were enrolled. At the time of the diagnosis, 42 patients (19.7%) showed normal gastric mucosa, 34 (15.9%) LG, 67 (31.5%) CAG, and 70 (32.9%) CIG. Out of the 34 patients with LG, all were Helicobacter pylori negative and the majority of them showed an improvement both of gastritis (94.1%) and duodenal lesions (82.3%) after GFD. GFD did not show significant effects on CAG and CIG. Conclusions: LG is present in 16% of CD patients, it is not associated with H. pylori infection, and it improves after GFD. Both CAG and CIG are also frequently associated with CD, but fail to respond to a GFD.

 

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Interpretation of ACG clinical guideline: Treatment of Helicobacter pylori Infection (Version 2017)Dong H. Jin S.-L. Miao D.-L.Journal of International Translational Medicine (2017) 5:3 (160-166). Date of Publication: 1 Sep 2017Helicobacter pylori (H. pylori) infection is still one of the most common chronic bacterial infections that impacts human health. Great achievements have been made in the treatment of H. pylori infection since the publication of clinical guidelines of American College of Gastroenterology (ACG) in 2007. H. pylori infection is often acquired in childhood, with unclear infectious pathways. High-risk infection factors include low social and economic status, more brothers and sisters, and parents with H. pylori infection (especially mothers involved). Before this guideline was compiled, a seminar on H. pylori infection related PICO was conducted, and methodologies in McMaster University were cooperated to collect high-quality literatures. This paper mainly interpreted the indications, treatment and rescue therapies for patients with H. pylori infection briefly, so as to provide the latest and the most optimal therapeutic regimens for clinical treatment of H. pylori infection.

 

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Efficacy and safety of sequential versus quadruple therapy as second-line treatment for helicobacter pylori infection - A randomized controlled trialMunteanu D. Etzion O. Ben-Yakov G. Halperin D. Eidelman L. Schwartz D. Novack V. Abufreha N. Krugliak P. Rozenthal A. Gaspar N. Moshkalo A. Dizingof V. Fich A.PLoS ONE (2017) 12:9 Article Number: e0183302. Date of Publication: 1 Sep 2017Background and aims: Quadruple therapy is recommended as second-line treatment for Helicobacter pylori eradication failure. However, high cost, multiple side effects, and low adherence rates are major drawbacks to its routine use. Our aim was to compare the efficacy and safety of sequential versus quadruple regimens as second line treatment for persistent Helicobacter pylori infection. Methods: Prospective, randomized, open label trial was conducted at a large academic, tertiary care center in Israel. Patients who previously failed a standard triple treatment eradication course were randomly assigned (1:1) to receive a 10-day sequential therapy course, or a 14-day quadruple regimen. Compliance and adverse events were evaluated by telephone questionnaires. The primary endpoint for analysis was the rate of Helicobacter pylori eradication as defined by either a negative 13C-urea breath-test, or stool antigen test, 4–16 weeks after treatment assessed under the non-inferiority hypothesis. The trial was terminated prematurely due to low recruitment rates. See S1 Checklist for CONSORT checklist. Results: One hundred and one patients were randomized. Per modified intention-to-treat analysis, eradication rate was 49% in the sequential versus 42.5% in the quadruple regimen group (p-value for non-inferiority 0.02). Forty-two (84.0%) versus 33 (64.7%) patients completed treatment in the sequential and quadruple groups respectively (p 0.027). Gastrointestinal side effects were more common in the quadruple regimen group. Conclusion: Sequential treatment when used as a second line regimen, was non-inferior to the standard of care quadruple regimen in achieving Helicobacter pylori eradication, and was associated with better compliance and fewer adverse effects. Both treatment protocols failed to show an adequate eradication rate in the population of Southern Israel. Trial registration: ClinicalTrials.gov NCT01481844.

 

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30th International Workshop on Helicobacter and Microbiota in Inflammation and CancerHelicobacter (2017) 22 Supplement 1. Date of Publication: 1 Sep 2017The proceedings contain 343 papers. The topics discussed include: first-line tailored treatment of helicobacter pylori in a country with increasing resistance rates; treatment of helicobacter pylori infection: 2017 recommendations for practice by the French National Authority For Health and the French National Council Of Gastroenterologists; the efficacy and safety of vonoprazan in the therapy of helicobacter pylori infection: a meta-analysis; the role of gastric dysbiosis in gastric carcinogenesis; characterization of the gastric cancer-associated microbiota; and bacteriome and mycobiome analysis underscore the role of fungal dysbiosis in non-alcoholic steatohepatitis: fusarium genus as a novel player?.

 

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Efficacy and tolerability of culture-guided treatment for Helicobacter pylori infectionCosta S. Soares J.-B. Goncąlves R.European Journal of Gastroenterology and Hepatology (2017) 29:11 (1258-1263). Date of Publication: 2017Objective The aim of this study was to evaluate the efficacy/tolerability of a culture-guided approach in the eradication of Helicobacter pylori and identify factors associated with antibiotic resistance/treatment failure. Patients and methods This retrospective single-center study included patients who underwent culture-guided treatment for H. pylori infection, after two ineffective eradication attempts, between October 2012 and December 2016. We assessed the following demographic and clinical data of the patients: Sex, age, BMI, alcohol and tobacco consumption, history of dyspepsia, peptic ulceration and first-degree relatives with gastric cancer, antibiotic susceptibility results, treatment composition, tolerability, and success. The treatment success was confirmed by a monoclonal stool antigen test. Results Culture-guided treatment was performed in 42 patients (57% women, mean age±SD: 48.9±11.4 years). The rates of antibiotic resistance were as follows: Clarithromycin 86%, metronidazole 67%; levofloxacin 52%, tetracycline 2%, and amoxicillin and rifampicin 0%. Double resistance to clarithromycin and metronidazole was found in 59.5% of the patients. Most patients showed resistance to less than three antibiotics, but 31% were resistant to three or more. Intention-to-treat and per-protocol eradication rates were 59.5 and 61.5%. Adverse events occurred in 15 (35.7%) patients, but only two (4.8%) patients did not complete treatment because of adverse events. Only age more than 50 years was associated with resistance to three or more antibiotics. Having a first-degree relative with gastric cancer was associated with treatment failure and having a BMI of at least 25 kg/m 2 protected from failure. Conclusion Third-line culture-guided treatment often fails to eradicate H. pylori infection. We need to find factors other than in-vitro antibiotic resistance to explain these suboptimal results.

 

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2016 International Digestive Disease Forum, IDDF 2016Clinical Gastroenterology and Hepatology (2017) 15:1. Date of Publication: 1 Jan 2017The proceedings contain 103 papers. The topics discussed include: pancreas divisum increases the risk of idiopathic recurrent acute pancreatitis in the presence of cathepsin B L26V polymorphism; high efficacy of I-scan endoscopy in the diagnosis of helicobacter pylori infection; usefulness of hepatobiliary scintigraphy for detecting biliary leak in living donor liver transplant recipients; influence of n-acetyl cysteine on early graft outcome of recipient in live donor liver transplantation: a double blind randomized controlled trial; 10-days concomitant therapy, 10-day bismuth quadruple therapy, and 14-day triple therapy in the first line treatment of helicobacter pylori infection - a multicenter randomized trial; are metal implants a contraindication to radiofrequency ablation of liver tumors? a case report; and initial experience with nitinol wire based highly flexible magnetic device for endoscopy assisted ferromagnetic foreign body removal.

 

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Peptic ulcer diseaseLanas A. Chan F.K.L.The Lancet (2017) 390:10094 (613-624). Date of Publication: 5 Aug 2017The rapidly declining prevalence of Helicobacter pylori infection and widespread use of potent anti-secretory drugs means peptic ulcer disease has become substantially less prevalent than it was two decades ago. Management has, however, become more challenging than ever because of the threat of increasing antimicrobial resistance worldwide and widespread use of complex anti-thrombotic therapy in the ageing population. Peptic ulcers not associated with H pylori infection or the use of non-steroidal anti-inflammatory drugs are now also imposing substantial diagnostic and therapeutic challenges. This Seminar aims to provide a balanced overview of the latest advances in the pathogenetic mechanisms of peptic ulcers, guidelines on therapies targeting H pylori infection, approaches to treatment of peptic ulcer complications associated with anti-inflammatory analgesics and anti-thrombotic agents, and the unmet needs in terms of our knowledge and management of this increasingly challenging condition.

 

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Cumulative Helicobacter Pylori Eradication Rates by Adopting First- and Second- Line Regimens Proposed by the Maastricht IV Consensus in Obese Patients Undergoing Gastric Bypass SurgeryCerqueira R.M. Correia M. Vilar H. Manso M.C.Obesity Surgery (2017) (1-5). Date of Publication: 26 Oct 2017Aims and Methods: Our aim was to assess, in obese patients undergoing Roux-en-Y gastric bypass (RYGB) surgery, the cumulative Helicobacter pylori (HP) eradication rates by adopting Maastricht IV guidelines in areas of high clarithromycin resistance rates (CLT)—14 days concomitant first-line therapy with proton-pump inhibitor (PPI) bid, CLT 500 mg bid, metronidazole (MTZ) 500 bid, and amoxicillin (AMX) 1000 mg bid and 14 days second-line therapy with PPI bid, AMX 1000 mg bid and levofloxacin (LVF) 500 mg od. Single-center prospective study was over 4 years. Endoscopy and HP assessment (by histology or C13 urea breath test) were performed at baseline and post-treatment HP status was assessed by C13 urea breath test 4–6 weeks after the end of therapy. Results: Seven hundred seventy-seven consecutive HP-positive patients completed concomitant first-line treatment: 636 (81.9%) female, age 41.1 (± 10.2) years. HP was eradicated in 556 patients—71.56% (95% CI: 68.28–74.62%). In the remaining 221 patients, second-line LVF-based regimens eradicated HP in 121 patients—54.75% (95% CI: 48.16–61.18%). These results give 87.13% (95% CI: 84.58–89.31%) ITT and 89.43% (95% CI: 87.03–91.44%) PP cumulative eradication rates. Eradication rates were not significantly different by gender, age, endoscopy findings, and smoking habits. Conclusions: By adopting Maastricht IV consensus quadruple concomitant first-line treatment and second-line LVF-based therapy, high cumulative HP eradication rates are achieved but still leaves around 10.6% of obese patients undergoing RYGB in need of the culture and susceptibility testing prior to third-line treatment.

 

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Sequential versus concomitant therapy for treatment of Helicobacter pylori infection: an updated systematic review and meta-analysisWang Y. Zhao R. Wang B. Zhao Q. Li Z. Zhu-ge L. Yin W. Xie Y.European Journal of Clinical Pharmacology (2017) (1-13). Date of Publication: 8 Oct 2017Background: Sequential and concomitant therapies are two innovative therapies for Helicobacter pylori (H. pylori) eradication. However, the comparative efficacy and safety of these treatments are controversial. Therefore, we aimed to conduct an updated systematic review and meta-analysis of studies that compared these two treatments. Methods: A search of PubMed, Embase, the Cochrane Library, and Web of Science was carried out. Randomized controlled trials (RCTs) that compared sequential with concomitant therapies were selected for meta-analysis. Results: Twenty RCTs were included in the analysis. The eradication rate of 10-day sequential therapy was superior to that of 5-day concomitant therapy (82.09 versus 77.79%, relative risk (RR) 1.052 (95% confidence interval (CI) 1.004–1.103), P = 0.035)), similar to that of 7-day concomitant therapy (82.40 versus 86.99%, RR 0.959 (95% CI 0.874–1.053), P = 0.382), and inferior to that of 10-day concomitant therapy (78.39 versus 83.32%, RR 0.945 (95% CI 0.907–0.984, P = 0.006); the occurrence of diarrhea was higher in 10-day concomitant therapy than that in 10-day sequential therapy. Compared with the eradication rate of sequential therapy, that of concomitant therapy was higher in metronidazole-resistant strains (RR 0.912 (95% CI 0.844–0.986, P = 0.020)) and strains resistant to metronidazole and clarithromycin (RR 0.542 (95% CI 0.308–0.956, P = 0.035)). Conclusion: The efficacy of concomitant therapy was duration dependent, and 10-day concomitant therapy was superior to 10-day sequential therapy. Compared to sequential therapy, concomitant therapy was more efficacious for metronidazole-resistant strains and metronidazole plus clarithromycin-resistant strains. However, diarrhea was more frequent with concomitant therapy than with sequential therapy.

 

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Diagnostic accuracy of PCR-based detection tests for Helicobacter Pylori in stool samples: A systematic review and meta-analysisKhadangi F. Yassi M. Kerachian M.A.Helicobacter (2017). Date of Publication: 2017Background: Although different methods have been established to detect Helicobacter pylori (H. pylori) infection, identifying infected patients is an ongoing challenge. The aim of this meta-analysis was to provide pooled diagnostic accuracy measures for stool PCR test in the diagnosis of H. pylori infection. Methods: In this study, a systematic review and meta-analysis were carried out on various sources, including MEDLINE, Web of Sciences, and the Cochrane Library from April 1, 1999, to May 1, 2016. This meta-analysis adheres to the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses report (PRISMA Statement). The clinical value of DNA stool PCR test was based on the pooled false positive, false negative, true positive, and true negative of different genes. Results: Twenty-six of 328 studies identified met the eligibility criteria. Stool PCR test had a performance of 71% (95% CI: 68-73) sensitivity, 96% (95% CI: 94-97) specificity, and 65.6 (95% CI: 30.2-142.5) diagnostic odds ratio (DOR) in diagnosis of H. pylori. The DOR of genes which showed the highest performance of stool PCR tests was as follows: 23S rRNA 152.5 (95% CI: 55.5-418.9), 16S rRNA 67.9 (95%CI: 6.4-714.3), and glmM 68.1 (95%CI: 20.1-231.7). Conclusions: The sensitivity and specificity of stool PCR test are relatively in the same spectrum of other diagnostic methods for the detection of H. pylori infection. In descending order of significance, the most diagnostic candidate genes using PCR detection were 23S rRNA, 16S rRNA, and glmM. PCR for 23S rRNA gene which has the highest performance could be applicable to detect H. pylori infection.

 

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Application of Convolutional Neural Networks in the Diagnosis of Helicobacter pylori Infection Based on Endoscopic ImagesShichijo S. Nomura S. Aoyama K. Nishikawa Y. Miura M. Shinagawa T. Takiyama H. Tanimoto T. Ishihara S. Matsuo K. Tada T.EBioMedicine (2017). Date of Publication: 2017Background and aims: The role of artificial intelligence in the diagnosis of Helicobacter pylori gastritis based on endoscopic images has not been evaluated. We constructed a convolutional neural network (CNN), and evaluated its ability to diagnose H. pylori infection. Methods: A 22-layer, deep CNN was pre-trained and fine-tuned on a dataset of 32,208 images either positive or negative for H. pylori (first CNN). Another CNN was trained using images classified according to 8 anatomical locations (secondary CNN). A separate test data set (11,481 images from 397 patients) was evaluated by the CNN, and 23 endoscopists, independently. Results: The sensitivity, specificity, accuracy, and diagnostic time were 81.9%, 83.4%, 83.1%, and 198. s, respectively, for the first CNN, and 88.9%, 87.4%, 87.7%, and 194. s, respectively, for the secondary CNN. These values for the 23 endoscopists were 79.0%, 83.2%, 82.4%, and 230. ±. 65. min (85.2%, 89.3%, 88.6%, and 253. ±. 92. min by 6 board-certified endoscopists), respectively. The secondary CNN had a significantly higher accuracy than endoscopists (by 5.3%; 95% CI, 0.3-10.2). Conclusion: H. pylori gastritis could be diagnosed based on endoscopic images using CNN with higher accuracy and in a considerably shorter time compared to manual diagnosis by endoscopists.

 

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Duodenal pathologies in children: A single-center experienceAkbulut U.E. Fidan S. Emeksiz H.C. Ors O.P.Jornal de Pediatria (2017). Date of Publication: 2017Objective: Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. Method: Patients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. Results: Out of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p = 0.002, OR: 3.91, 95% CI: 1.59-9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%). Conclusion: Duodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.

 

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Helicobacter pylori treatment: antibiotics or probioticsGoderska K. Agudo Pena S. Alarcon T.Applied Microbiology and Biotechnology (2017) (1-7). Date of Publication: 26 Oct 2017Treatment of Helicobacter pylori infection is important for the management of gastrointestinal disorders such as peptic ulcer and gastric cancer. Due to the increase in the prevalence of H. pylori resistance to antibiotics, triple therapy with clarithromycin is no longer the best treatment for H. pylori, especially in some areas where the local resistance to this antibiotic is higher than 20%. Alternative treatments have been proposed for the eradication of H. pylori. Some of them including novel antibiotics or classical ones in different combinations; these treatments are being used in the regular clinical practice as novel and more effective treatments. Others therapies are using probiotics associated to antibiotics to treat this infection. The present article is a revision of H. pylori eradication treatment, focusing on emerging approaches to avoid the treatment failure, using new therapies with antimicrobials or with probiotics.

 

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Pathology and histology of the oesophagus and stomachWoods Y.L. Carey F.A.Surgery (United Kingdom) (2017). Date of Publication: 2017The presenting symptoms of dysphagia and dyspepsia can be caused by gastro-oesophageal reflux disease, malignancy or, less commonly, disorders of dysfunctional motility, such as achalasia. Most neoplasms of the oesophagus and stomach are epithelial in nature. Benign epithelial neoplasms usually take the form of polypoid lesions, such as oesophageal squamous papillomas, gastric adenomas, hyperplastic and fundic gland polyps. Malignant epithelial neoplasms of the oesophagus are divided into squamous cell carcinoma and adenocarcinoma, whereas malignant gastric neoplasms are predominantly adenocarcinomas. Each tends to develop in the context of dysplastic epithelial changes. Gastric carcinomas and lymphomas are associated with Helicobacter pylori infection. Stromal tumours of the stomach are important in that they have a distinctive molecular pathology and linked targeted therapy. This educational article provides an overview of the incidences, aetiologies and histological features of some of the most common mechanical, inflammatory and neoplastic pathologies encountered in the oesophagus and stomach. The emphasis is on clinical application.

 

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Recurrent anaemia in a patient with lymphocytic gastritis and vitamin B(12) deficiencyThereza-Filho M.A. Bansho E.T.O. Tonon D. I-Ching L. Dantas-Corrêa E.B. Cunha V.J.L. Schiavon L.L. Narciso-Schiavon J.L.Arab Journal of Gastroenterology (2017) 18:3 (165-168). Date of Publication: 1 Sep 2017Lymphocytic gastritis is an idiopathic disease, characterized by intraepithelial infiltration of large numbers of T lymphocytes and often described in association with coeliac disease and Helicobacter pylori infection. Although usually associated with iron deficiency anaemia, there is no description on the association between lymphocytic gastritis and secondary vitamin B(12) deficiency anaemia. We describe a rare case of recurrent anaemia in a patient with lymphocytic gastritis reversed with vitamin B(12) replacement.

 

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Regulation and functions of inflammasome-mediated cytokines in Helicobacter pylori infectionTran L.S. Chonwerawong M. Ferrero R.L.Microbes and Infection (2017) 19:9-10 (449-458). Date of Publication: 1 Sep 2017Persistent stomach infection with Helicobacter pylori causes chronic mucosal inflammation (gastritis), which is widely recognized as an essential precursor to gastric cancer. The IL-1 interleukin family cytokines IL-1β and IL-18 have emerged as central mediators of mucosal inflammation. Here, we review the regulation and functions of these cytokines in H. pylori-induced inflammation and carcinogenesis.

 

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Recent advances in the management of peptic ulcer bleedingBeales I.F1000Research (2017) 6 Article Number: 1763. Date of Publication: 2017Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/l. Comparative studies have confirmed that the Glasgow-Blatchford score remains the most useful score for predicting the need for intervention as well as for identifying the lowest-risk patients suitable for outpatient management. New scores, including the AIMS65 and Progetto Nazionale Emorragia Digestiva score, may be more accurate in predicting mortality. Pre-endoscopy erythromycin appears to improve outcomes and is probably underused. High-dose oral proton pump inhibition (PPI) for 11 days after PPI infusion is advantageous in those with a Rockall score of 6 or more. Oral is as effective as parenteral iron at restoring haemoglobin levels after a peptic ulcer bleed and both are superior to placebo in this respect. Within endoscopic techniques, haemostatic powders and over-the-scope clips can be used when other methods have failed. A disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Non- Helicobacter pylori, non-aspirin/non-steroidal anti-inflammatory drug ulcers contribute an increasing percentage of bleeding peptic ulcers and are associated with a poor prognosis and high rebleeding rate. The optimal management of these ulcers remains to be determined.

 

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New clinical paradigms for treating and preventing antiplatelet gastrointestinal bleedingAbraham N.S.Current Opinion in Gastroenterology (2017) 33:6 (467-472). Date of Publication: 1 Nov 2017Purpose of review To quantify antiplatelet-related gastrointestinal bleeding (GIB), characterize patients at greatest risk and summarize risk-management strategies emphasizing evolving knowledge in acute management of antiplatelet-related bleeding. Recent findings New paradigms for acute management of antiplatelet-related GIB exist in the domains of resuscitation and the transfusion of blood products, strategic use of proton pump therapy and identification and eradication of Helicobacter pylori. This review will also highlight the importance of prompt resumption of cardiac aspirin and dual antiplatelet therapy following endoscopic hemostasis to minimize the risk of future cardiac events. Summary This review will provide pragmatic strategies for the management of acute antiplatelet-related GIB. Emerging areas of clinical knowledge will be addressed and knowledge gaps requiring further research to inform clinical practice will be highlighted.

 

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Metaplasia in the stomach—precursor of gastric Cancer?Kinoshita H. Hayakawa Y. Koike K.International Journal of Molecular Sciences (2017) 18:10 Article Number: 2063. Date of Publication: 27 Sep 2017Despite a significant decrease in the incidence of gastric cancer inWestern countries over the past century, gastric cancer is still one of the leading causes of cancer-related deaths worldwide. Most human gastric cancers develop after long-term Helicobacter pylori infection via the Correa pathway: the progression is from gastritis, atrophy, intestinal metaplasia, dysplasia, to cancer. However, it remains unclear whether metaplasia is a direct precursor of gastric cancer or merely a marker of high cancer risk. Here, we review human studies on the relationship between metaplasia and cancer in the stomach, data from mouse models of metaplasia regarding the mechanism of metaplasia development, and the cellular responses induced by H. pylori infection.

 

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Comorbidities in rosacea: A systematic review and updateHaber R. El Gemayel M.Journal of the American Academy of Dermatology (2017). Date of Publication: 2017Background: Rosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients. Objective: To review available data regarding comorbidities associated with rosacea, discuss their pathogenesis, and highlight the evaluation of affected patients. Methods: We performed a complete and systematic literature review in PubMed/Medline, Embase, and the Cochrane Collaboration databases, searching for all articles on possible associated diseases that have been reported with rosacea, with no limits on publication date, participant age, sex, or nationality. Results: A total of 29 studies were included in this systematic review, including 14 case-control, 8 cross-sectional, and 7 cohort studies. Statistically significant association with rosacea has been mostly demonstrated with depression (n = 117,848 patients), hypertension (n = 18,176), cardiovascular diseases (n = 9739), anxiety disorder (n = 9079), dyslipidemia (n = 7004), diabetes mellitus (n = 6306), migraine (n = 6136), rheumatoid arthritis (n = 4192), Helicobacter pylori infection (n = 1722), ulcerative colitis (n = 1424), and dementia (n = 1194). Limitations: Limitations included the accuracy of the published data, potential patient selection, and possible confounding factors. The true nature of the drawn correlations is uncertain, and causality cannot be established. Conclusions: Rosacea is associated with a number of systemic disorders. Recognition of these conditions is critical to providing appropriate screening and management of affected patients.

 

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Mexican consensus on dyspepsiaCarmona-Sánchez R. Gómez-Escudero O. Zavala-Solares M. Bielsa-Fernández M.V. Coss-Adame E. Hernández-Guerrero A.I. Huerta-Iga F. Icaza-Chávez M.E. Lira-Pedrín M.A. Lizárraga-López J.A. López-Colombo A. Noble-Lugo A. Pérez-Manauta J. Raña-Garibay R.H. Remes-Troche J.M. Tamayo J.L. Uscanga L.F. Zamarripa-Dorsey F. Valdovinos Díaz M.A. Velarde-Ruiz Velasco J.A.Revista de Gastroenterologia de Mexico (2017) 82:4 (309-327). Date of Publication: 1 Oct 2017Since the publication of the 2007 dyspepsia guidelines of the Asociación Mexicana de Gastroenterología, there have been significant advances in the knowledge of this disease. A systematic search of the literature in PubMed (01/2007 to 06/2016) was carried out to review and update the 2007 guidelines and to provide new evidence-based recommendations. All high-quality articles in Spanish and English were included. Statements were formulated and voted upon using the Delphi method. The level of evidence and strength of recommendation of each statement were established according to the GRADE system. Thirty-one statements were formulated, voted upon, and graded. New definition, classification, epidemiology, and pathophysiology data were provided and include the following information: Endoscopy should be carried out in cases of uninvestigated dyspepsia when there are alarm symptoms or no response to treatment. Gastric and duodenal biopsies can confirm Helicobacter pylori infection and rule out celiac disease, respectively. Establishing a strong doctor-patient relationship, as well as dietary and lifestyle changes, are useful initial measures. H2-blockers, proton-pump inhibitors, prokinetics, and antidepressants are effective pharmacologic therapies. H. pylori eradication may be effective in a subgroup of patients. There is no evidence that complementary and alternative therapies are beneficial, with the exception of Iberogast and rikkunshito, nor is there evidence on the usefulness of prebiotics, probiotics, or psychologic therapies. The new consensus statements on dyspepsia provide guidelines based on up-to-date evidence. A discussion, level of evidence, and strength of recommendation are presented for each statement.

 

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Asymptomatic pyogenic liver abscesses secondary to Fusobacterium nucleatum and Streptococcus vestibularis in an immunocompetent patientHouston H. Kumar K. Sajid S.BMJ Case Reports (2017) 2017 Article Number: bcr-2017-221476. Date of Publication: 2017A 66-year-old male patient presented with symptoms and signs of L4/5 radiculopathy. He was found to be anaemic with elevated inflammatory markers and deranged hepatic enzymes. Imaging revealed lumbar canal stenosis and the presence of pyogenic liver abscesses from which Fusobacterium nucleatum and Streptococcus vestibularis were isolated. The hepatic abscesses were attributed to asymptomatic diverticular perforation. Multiple coexisting incidental infections were discovered, including oesophageal candidiasis, Helicobacter pylori, stool cultures positive for Strongyloides stercoralis, and sputum cultures positive for Enterobacter cloacae, Escherichia coli and Mycobacterium avium. Extensive investigations for possible underlying immunosuppression were negative.

 

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Helicobacter pylori affects the antigen presentation activity of macrophages modulating the expression of the immune receptor CD300E through miR-4270Pagliari M. Munari F. Toffoletto M. Lonardi S. Chemello F. Codolo G. Millino C. Bella C.D. Pacchioni B. Vermi W. Fassan M. de Bernard M. Cagnin S.Frontiers in Immunology (2017) 8:OCT Article Number: 1288. Date of Publication: 12 Oct 2017Helicobacter pylori (Hp) is a Gram-negative bacterium that infects the human gastric mucosa, leading to chronic inflammation. If not eradicated with antibiotic treatment, the bacterium persists in the human stomach for decades increasing the risk to develop chronic gastritis, gastroduodenal ulcer, and gastric adenocarcinoma. The lifelong persistence of Hp in the human stomach suggests that the host response fails to clear the infection. It has been recently shown that during Hp infection phagocytic cells promote high Hp loads rather than contributing to bacterial clearance. Within these cells Hp survives in "megasomes," large structures arising from homotypic fusion of phagosomes, but the mechanism that Hp employs to avoid phagocytic killing is not completely understood. Here, we show that Hp infection induces the downregulation of specific microRNAs involved in the regulation of transcripts codifying for inflammatory proteins. miR-4270 targets the most upregulated gene: the immune receptor CD300E, whose expression is strictly dependent on Hp infection. CD300E engagement enhances the pro-inflammatory potential of macrophages, but in parallel it affects their ability to express and expose MHC class II molecules on the plasma membrane, without altering phagocytosis. This effect compromises the possibility for effector T cells to recognize and activate the killing potential of macrophages, which, in turn would become a survival niche for the bacterium. Taken together, our data add another piece to the complicate puzzle represented by the long-life coexistence between Hp and the human host and contribute with new insights toward understanding the regulation and function of the immune receptor CD300E.

 

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Seroprevalence of Helicobacter pylori infection in adolescents and adults in BabolZamani M. Vahedi A. Zamani V. Bijani A. Shokri-Shirvani J.Journal of Babol University of Medical Sciences (2017) 19:7 (7-12). Date of Publication: 1 Jul 2017BACKGROUND AND OBJECTIVE: Helicobacter pylori is an important causative factor for chronic gastritis, peptic ulcer and gastric cancer. Based on the reports, about half of the world population are infected with this bacterium. The present study was designed with the purpose of investigation of H. pylori infection rate in adolescents and adults of Amirkola in Babol METHODS: This cross-sectional study was performed on individuals who referred to the health and treatment center of Amirkola, Babol, for the premarital counseling during December 2015 and January 2016. The blood sample of subjects was assessed for H. pylori status using enzyme-linked immunosorbent assay. The demographic data were collected. FINDINGS: Of 207 participants, 100 (48.3%) were male and others were female. The mean age was 25.35±5.82 (14-46) years. Rate of H. pylori was 43%, seen more frequently in the age group 21-25 years (37.2%). The infection rate was 49% and 37.4% in males and females, respectively, but the difference was not significant. The age group more than 30 was associated with increased risk of infection (odds ratio [OR]=5.25, 95% confidence interval [CI]: 1.86-14.78). There was also a significant correlation between the infection and level of education (p=0.041) and higher diploma was inversely associated with the infection (OR=0.4, 95% CI: 0.18-0.91). No significant relation was found between the infection and blood groups and residency. CONCLUSION: The results of study indicated a considerable rate of H. pylori infection in adolescents and adults of Amirkola. Also, it was determined that higher education can have a protective role against H. pylori infection.

 

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Postoperative helicobacter pylori infection as a prognostic factor for gastric cancer patients after curative resectionJung D.H. Lee Y.C. Kim J.-H. Chung H. Park J.C. Shin S.K. Lee S.K. Kim H.-I. Hyung W.J. Noh S.H.Gut and Liver (2017) 11:5 (635-641). Date of Publication: 1 Sep 2017Background/Aims: Few studies have evaluated the effect of Helicobacter pylori infection on the prognosis of patients diagnosed with gastric cancer (GC) after curative surgery. We investigated the association between the H. pylori infection status and clinical outcome after surgery. Methods: We assessed the H. pylori status of 314 patients who underwent curative resection for GC. The H. pylori status was examined using a rapid urease test 2 months after resection. Patients were followed for 10 years after surgery. Results: An H. pylori infection was observed in 128 of 314 patients. The median follow-up period was 93.5 months. A Kaplan-Meier analysis indicated that patients with H. pylori had a higher cumulative survival rate than those who were negative for H. pylori. Patients with stage II cancer who tested negative for H. pylori were associated with a poor outcome. In a multivariate analysis, H. pylori-negative status was a significant independent prognostic factor for poor overall survival. Conclusions: Having a negative H. pylori infection status seems to indicate poor prognosis for patients with GC who have undergone curative resection. Further prospective controlled studies are needed to evaluate the mechanism by which H. pylori affects GC patients after curative surgery in Korea.

 

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The clinical presentation, role of diagnostic modalities and sydney system in helicobacter pylori gastritis in childrenSaeed A. Assiri A. Zaidi Z. Aljaedi H. Ullah A.Pakistan Paediatric Journal (2016) 40:4 (221-225). Date of Publication: 1 Dec 2016Introduction: Helicobacter Pylori (H. pylori) is a gram negative, spiral gastro duodenal pathogen that infects 50% of the world population. Although infection is acquired during childhood but disease manifestations appear decades after the acquisition of infection and may lead to serious consequences like gastritis, ulcers and gastrointestinal malignancies. Presentation is variable but its association with recurrent abdominal pain, gastroesophageal reflux, iron deficiency anemia and asthma is still controversial. This study was aimed to review the characteristics of H. pylori gastritis including clinical presentation, diagnostic modalities and Sydney system classification of gastritis in children at a private center. Methods: It was a retrospective study conducted at pediatrics division of a private tertiary care hospital, Dr. Suleman Al-Habib Medical Group, Riyadh. Confirmed cases of H. pylori gastritis based on endoscopy and histopathology were included in a total of 202 children who underwent oesophago gastroduodenoscopy (OGD) from Jan 2009 to Jan 2014. Clinical profile of these patients including age at presentation, gender, socioeconomic status, clinical presentation, treatment prescribed, endoscopic and histopathological findings was reviewed. Results: Out of 202 patients who underwent upper gastrointestinal endoscopy, 49 (24%) were found to have H. pylori gastritis. Mean age of presentation was 10.5±2.53 years. Most of the patients were in the age range of 11-16 years (52%) and only 3% were less than 5 years. Females were 58%. Abdominal pain and heartburn were the major presentation in 84% and 28% respectively followed by vomiting and growth failure. Antral nodularity was the commonest feature on endoscopic examination. Reflux esophagitis was the feature in 14% (n=7). All patients had chronic active gastritis. Atrophic gastritis was a feature in few patients while most had non-atrophic gastritis. None of the patients showed metaplastic, dysplastic or malignant changes. Villous atrophy was found in 10%. All the patients were put on eradication therapy. 82% responded well to treatment. Conclusion: H. pylori infection is not an uncommon entity and an important cause of gastritis in Saudi children. The similarity of features of H. pylori in this private practice population suggests similarity in different subsets of the Saudi population. Prospective studies are needed to clarify risk factors in our community.

 

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High Serum Pepsinogen i and beta Helicobacter pylori Infection Are Risk Factors for Aspirin-Induced Gastroduodenal InjuryShan J. Lei H. Shi W. Sun X. Tang Y. Ren C.Digestive Diseases (2017) 36:1 (66-71). Date of Publication: 1 Oct 2017Background: Whether gastric hyperchlorhydria and Helicobacter pylori infection contribute to aspirin-induced gastroduodenal injury still lacks evidence. Because serum pepsinogens (PGs) and gastrin-17 (G17) can reflect gastric acid secretion, this study intended to elucidate whether serum PGs, serum G17, and H. pylori infection are associated with aspirin-induced gastrointestinal injury. Summary: A total of 60 patients taking low-dose aspirin for more than 1 month were enrolled in this study. Serum PG I, PG II, and G17 were determined using ELISA. A 14C-urea breath test was used for the detection of an H. pylori infection. The modified Lanza score was used to evaluate the degree of gastroduodenal injury under endoscopy. The median serum PG I level was significantly higher in the intensive gastroduodenal injury (IGI) group compared to that in the mild gastroduodenal injury group (155.0 vs. 116.6 ng/mL, p = 0.006). The H. pylori infection rate was significantly higher in the IGI group (73 vs. 40%, p = 0.037). Receiver operator characteristic curves analysis revealed that the cutoff value of PG I was 123 ng/mL, with 80% sensitivity and 61.4% specificity. H. pylori infection combined with PG I at >123 ng/mL had an OR (95% CI) of 15.8 (2.4 ± 104.5) for the prediction of aspirin-induced gastroduodenal injury. Key Messages: Serum PG I and H. pylori infection could be used to identify potential high-risk aspirin-induced gastroduodenal injury patients.

 

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L-ascorbic Acid-2-Glucoside inhibits Helicobacter pylori-induced apoptosis through mitochondrial pathway in Gastric Epithelial cellsChen X. Liu R. Liu X. Xu C. Wang X.Biomedicine and Pharmacotherapy (2018) 97 (75-81). Date of Publication: 1 Jan 2018Helicobacter pylori (H. pylori) infection is the major cause for gastritis, peptic ulcer, and gastric cancer. Elevated oxidative stress, mitochondrial dysfunction and apoptotic death of gastric epithelial cells are typical hallmarks of H. pylori infection. Ascorbic Acid 2-Glucoside (AA2G) is a stable version of Vitamin C, that binds glucose to conventional vitamin C. AA2G has free radical scavenging activities and anti-apoptotic abilities. However, the protective effect of AA2G against H. pylori-infection in gastric epithelial cells is yet unknown. In this study, we investigated the effects of AA2G in human H. pylori-infected gastric epithelial cells. AA2G could remarkably ameliorate H. pylori-induced oxidative stress, including the levels of intracellular reactive oxygen species (ROS) and 4-hydroxynonenal (4-HNE). Importantly, AA2G treatment also improved mitochondrial function by restoring the level of ATP and mitochondrial membrane potential (MMP). Furthermore, AA2G reduced apoptosis induced by H. pylori through modulation of mitochondria-dependent apoptotic pathways. Our findings suggest that AA2G has a protective effect against H. pylori infection in gastric epithelial cells.

 

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Lymphoid follicles in children with Helicobacter pylori-negative gastritisBroide E. Richter V. Mendlovic S. Shalem T. Eindor-Abarbanel A. Moss S.F. Shirin H.Clinical and Experimental Gastroenterology (2017) 10 (195-201). Date of Publication: 11 Aug 2017Purpose: The prevalence of Helicobacter pylori gastritis has been declining, whereas H. pylori-negative gastritis has become more common. We evaluated chronic gastritis in children with regard to H. pylori status and celiac disease (CD). Patients and methods: Demographic, clinical, endoscopic, and histologic features of children who underwent elective esophagogastroduodenoscopy were reviewed retrospectively. Gastric biopsies from the antrum and corpus of the stomach were graded using the Updated Sydney System. H. pylori presence was defined by hematoxylin and eosin, Giemsa, or immunohistochemical staining and urease testing. Results: A total of 184 children (61.9% female) met the study criteria with a mean age of 10 years. A total of 122 (66.3%) patients had chronic gastritis; 74 (60.7%) were H. pylorinegative. Children with H. pylori-negative gastritis were younger (p=0.003), were less likely to present with abdominal pain (p=0.02), and were mostly of non-Arabic origin (p=0.011). Nodular gastritis was found to be less prevalent in H. pylori-negative gastritis (6.8%) compared with H. pylori-positive gastritis (35.4%, p<0.001). The grade of mononuclear infiltrates and neutrophil density was more severe in the H. pylori-positive group (p<0.001). Pan-gastritis and lymphoid follicles were associated most commonly with H. pylori. Although less typical, lymphoid follicles were demonstrated in 51.3% of H. pylori-negative patients. The presence or absence of CD was not associated with histologic findings in H. pylori-negative gastritis. Conclusion: Our findings suggest that lymphoid follicles are a feature of H. pylori-negative gastritis in children independent of their CD status.

 

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Helicobacter pylori cagA+ Is associated with milder duodenal histological changes in chilean celiac patientsLucero Y. Oyarzún A. O'Ryan M. Quera R. Espinosa N. Valenzuela R. Simian D. Alcalde E. Arce C. Farfán M.J. Vergara A.F. Gajardo I. Mendez J. Carrasco J. Errázuriz G. Gonzalez M. Ossa J.C. Maiza E. Perez-Bravo F. Castro M. Araya M.Frontiers in Cellular and Infection Microbiology (2017) 7:AUG Article Number: 376. Date of Publication: 23 Aug 2017Background: Mechanisms underlying the high clinical and histological diversity of celiac disease (CD) remain elusive. Helicobacter pylori (Hp) chronically infects gastric and duodenal mucosa and has been associated with protection against some immune-mediated conditions, but its role (specifically of cagA+ strains) in CD is unclear. Objective: To assess the relationship between gastric Hp infection (cagA+ strains) and duodenal histological damage in patients with CD. Design: Case-control study including patients with active-CD, potential-CD and non-celiac individuals. Clinical presentation, HLA genotype, Hp/cagA gene detection in gastric mucosa, duodenal histology, Foxp3 positive cells and TGF-ß expression in duodenal lamina propria were analyzed. Results: We recruited 116 patients, 29 active-CD, 37 potential-CD, and 50 non-CD controls. Hp detection was similar in the three groups (~30-40%), but cagA+ strains were more common in infected potential-CD than in active-CD (10/11 vs. 4/10; p = 0.020) and non-CD (10/20; p = 0.025). Among active-CD patients, Foxp3 positivity was significantly higher in subjects with cagA+ Hp+ compared to cagA- Hp+ (p~0.01) and Hp- (p~0.01). In cagA+ Hp+ individuals, Foxp3 positivity was also higher comparing active- to potential-CD (p~0.01). TGF-ß expression in duodenum was similar in active-CD with cagA+ Hp+ compared to Hp- and was significantly downregulated in cagA+ potential-CD subjects compared to other groups. Conclusion: Hp infection rates were similar among individuals with/without CD, but infection with cagA+ strains was associated with milder histological damage in celiac patients infected by Hp, and in active-CD cases with higher expression of T-reg markers. Results suggest that infection by cagA+ Hp may be protective for CD progression, or conversely, that these strains are prone to colonize intestinal mucosa with less severe damage.

 

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Helicobacter pylori infection among patients with liver cirrhosisPogorzelska J. Łapińska M. Kalinowska A. Lapiński T.W. Flisiak R.European Journal of Gastroenterology and Hepatology (2017) 29:10 (1161-1165). Date of Publication: 2017Background 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.

 

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The study of memory and executive dysfunction in patients infected with Helicobacter pyloriRezvani F. Sayadnasiri M. Rezaei O.Neurological Research (2017) 39:11 (953-958). Date of Publication: 2 Nov 2017Background: Infectious agents are considered as potential causes of Alzheimer’s disease. Recently, evidence of a high prevalence of Helicobacter pylori (H. pylori) infection in patients with Alzheimer’s disease has been observed. The aim of this study was to investigate memory and executive function in H. pylori positive persons not suffering from Alzheimer’s or other marked cognitive disorders. Methods: This is a cross-sectional study. A total 140 participants were selected using purposive sampling from the patients within the age group of 18–60 years old at Fayyaz Bakhsh Hospital, Tehran in spring 2016. The participants were divided into two groups of H. pylori positive and negative according to results of the serologic tests to measure the levels of specific antibodies of IgA and IgG against H. pylori using ELISA method. They were subsequently assessed using two tests of Trail Making (TMT) part A and B and Wechsler Memory Scale–Third Edition. Data were analyzed using independent t-test and chi-square. The level of significance was considered P-value ≤ 0.05. Results: Out of 140 participants, there were 41 male (29.3%) and 99 female (70.7%) among which 84 patients (60%) suffered from H. pylori infection (seropositive) and 56 patients (40%) were not infected. Comparison of the results using independent t-test showed a significant difference (P = 0.006) between the memory scores of patients (M: 106, SD: 8.12) and healthy ones (M: 112, SD: 1.12). In addition, the executive function showed there is a significant difference in the executive ability of seropositive individuals in the two age groups of 20–50 years old (Part A: M: 1.36, SD: 7.11, and Part B: M: 8.8, SD: 8.25 p = 0.01) and over 50 years old (Part A: M: 55, SD: 8.20, and Part B: M: 106, SD: 7.22, p = 0.009). Conclusion: The results of this study showed that the infected patients have a lower cognitive performance in comparison to healthy individuals. In other words, H. pylori infection increases the prevalence of memory and executive dysfunction.

 

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Decrease of Estradiol and Several Lifestyle Factors, but Not Helicobacter pylori Infection, Are Significant Risks for Osteopenia in Japanese FemalesChinda D. Shimoyama T. Iino C. Matsuzaka M. Nakaji S. Fukuda S.Digestion (2017) 96:2 (103-109). Date of Publication: 1 Sep 2017Background: The primary cause of osteoporosis in women is increased bone resorption and decreased bone density associated with reduced estrogen secretion. Several studies have demonstrated a relationship between Helicobacter pylori infection and osteoporosis regardless of estrogen levels. This study examined the relationship between H. pylori infection and osteopenia together with estrogen levels, calcium intake, and several lifestyle factors. Methods: This study included 473 healthy women who underwent a general health examination. Multivariate analysis was performed, with age, body mass index (BMI), smoking habit, drinking habit, exercise habit, schooling duration, estradiol levels, birth history, calcium intake, schooling duration, smoking habit, drinking habit, exercise habit, and H. pylori infection as independent variables and the presence of osteopenia as a dependent variable. Results: The adjusted OR for osteopenia with H. pylori infection was 0.95 (95% CI 0.55-1.63, p = 0.84). In contrast, osteopenia was significantly associated with age, low BMI, lesser schooling period, low estradiol levels, and low calcium intake. Conclusions:H. pylori infection was not a significant risk for osteopenia by the multivariate analysis, which included the primary confounding factors. Significant factors, such as estradiol and calcium intake, should be assessed together to study the association of H. pylori infection and osteopenia.

 

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Association of Helicobacter pylori infection with metabolic parameters and dietary habits among medical undergraduate students in southeastern of IranEslami O. Shahraki M. Shahraki T. Ansari H.Journal of Research in Medical Sciences (2017) 22:1 Article Number: 12. Date of Publication: 2017Background: To date, there is still inconclusive evidence on the extra-gastric manifestations of Helicobacter pylori (H.pylori) infection. This study aimed to determine whether there is an association between H.pylori infection with metabolic syndrome and dietary habits among medical undergraduate students in south-eastern of Iran, Zahedan. Materials and Methods: This cross‑sectional study was done among 363 undergraduate students in Zahedan University of Medical Sciences during spring 2014. All subjects completed a questionnaire including demographic factors and dietary habits. Serum H. pylori‑specific IgG antibodies, total cholesterol (TC), triglycerides (TG), high‑density lipoprotein‑cholesterol (HDL‑C), low‑density lipoprotein‑cholesterol (LDL‑C), and fasting blood sugar (FBS) levels were measured after an overnight fast. Results: The seroprevalence of H. pylori infection was 45.7%. H. pylori‑positive subjects had lower mean levels of TC and TG and higher levels of HDL‑C compared to H. pylori‑negative subjects. In addition, lower levels of LDL‑C (P = 0.044) and FBS (P = 0.05) were observed among subjects with positive H pylori infection. Only rare consumption of raw vegetables (odds ratio [OR] =3.74, 95% confidence interval [CI] =1.37–5.24) as well as higher levels of FBS (OR = 1.031, 95% CI = 1.001–1.99) were significantly associated with higher odds of H. pylori infection in both the univariate and multiple logistic regression analysis. Conclusion: In a small population of young students in southeastern of Iran, H. pylori infection was associated with low consumption of raw vegetables and higher serum blood glucose.

 

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Comparison of two methods for the in-vivo diagnosis of Helicobacter pylori infection using a tablet of (13)C-ureaGilardi D. Fiorino G. Furfaro F. Al Fieri M.F. Orlandi I. Allocca M. Danese S.Minerva Gastroenterologica e Dietologica (2017) 63:4 (319-326). Date of Publication: 1 Dec 2017BACKGROUND: The urea Breath-test is a widely-used method to detect the presence of Helicobacter pylori (HP) infection. Recently, new technologies were introduced, to obtain an immediate test result by continuous breath samples analysis after labeled urea intake. The total test duration is shorter than 20 minutes. METHODS: The study compared two diagnostic methods requiring the administration of EXPIROBACTER® (Sofar SpA, Trezzano Rosa, Milan, Italy) 100 mg as a source of labeled urea. Subjects with clinical indication to urea breath test for H. pylori were enrolled. This study was designed to directly compare the accuracy of urea breath test performed with both the classic method and BreathID® (Exalenz Bioscience, Inc., Manasquan, NJ, USA). Each patient simultaneously underwent to both tests, to measure the concordance between the results (positive or negative test), minimizing the risks of differences related to the intra- and inter-individual variability. RESULTS: Forty-six subjects were enrolled. Forty-one patients (91.1%) were found negative with both methods and 5 (10.1%) were positive for H. pylori infection in both tests. Correlation between the two methods was excellent (κ=1.00). BreathID® was significantly preferred by patients, with a 7.83 (95% CI: 3.35 to 12.30, P=0.001) difference in mean patient satisfaction, measured by a Visual Analogue Scale (VAS). No adverse event was observed. CONCLUSIONS: Correlation between the two methods was excellent. Moreover, the patient satisfaction, measured by VAS, showed a significantly greater acceptance of BreathID® method. This study support the use of a product containing 13C-urea 100 mg and citric acid for immediate determination of HP infection by urea breath test performed with BreathID®.

 

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Helicobacter pylori modulates cyclooxygenase-2 and 15-hydroxy prostaglandin dehydrogenase in gastric cancerZhao J. Wen S. Wang X. Zhang Z.Oncology Letters (2017) 14:5 (5519-5525). Date of Publication: 1 Nov 2017Persistent infection with Helicobacter pylori may contribute to the carcinogenesis of gastric cancer through modulating local prostaglandin E(2) (PGE(2)) levels. Cyclooxygenase-2 (COX-2) and 15-hydroxy prostaglandin dehydrogenase (15-PGDH) are two key enzymes that regulate PGE(2) synthesis and inactivation, respectively. The present study was designed to investigate the expression of COX-2 and 15-PGDH in gastric cancer specimens (n=66) in comparison to that of control specimens (n=70) and, furthermore, to semi-quantitatively assess the level of COX-2 and 15-PGDH mRNA and protein in tissues with or without H. pylori infection by reverse transcription-polymerase chain reaction and immunohistochemistry, respectively. It was revealed that COX-2 was expressed in almost all gastric cancer specimens infected with H. pylori (32 out of 33 specimens), but it was also expressed in 2/3 gastric cancers without H. pylori infection (22 out of 33 specimens). By contrast, COX-2 was expressed in <1/6 control subjects regardless of H. pylori infection. Furthermore, 15-PGDH was expressed in control samples but significantly down regulated in gastric cancer specimens. H. pylori infection resulted in slight inhibition of 15-PGDH in control subjects, but significant inhibition of 15-PGDH mRNA expression and protein synthesis in the gastric cancer specimens. These findings indicated that COX-2 and 15-PGDH, the two enzymes that regulate PGE(2) levels, were significantly altered in gastric cancer, and that H. pylori may contribute to gastric carcinogenesis through modulating COX-2 and 15-PGDH mRNA expression and protein synthesis.

 

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Association between infection with Helicobacter pylori and atopy in young Ethiopian children: A longitudinal studyTaye B. Enquselassie F. Tsegaye A. Amberbir A. Medhin G. Fogarty A. Robinson K. Davey G.Clinical and Experimental Allergy (2017) 47:10 (1299-1308). Date of Publication: 1 Oct 2017Background: Epidemiological evidence from developed countries indicates that Helicobacter pylori infection correlates with a reduced risk of atopy and allergic disorders; however, limited data are available from low-income countries. Objective: We examined associations between H. pylori infection in early childhood and atopy and reported allergic disorders at the age of 6.5 years in an Ethiopian birth cohort. Methods: A total of 856 children (85.1% of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half years. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Serum samples were analysed for total IgE levels and anti-H. pylori cytotoxin-associated gene A (CagA) IgG antibody using commercially available ELISA kits. Stool samples were analysed for H. pylori antigen using a rapid immunochromatographic test. The independent effects of H. pylori infection (measured at age of 3, 5 and 6.5 years) on prevalence and incidence of atopy and reported allergic disorders (measured at age of 6.5 years) were determined using multiple logistic regression. Results: In cross-sectional analysis, current H. pylori infection at age 6.5 years was inversely, though not significantly, related to prevalence of atopy and “any allergic condition” at age 6.5 years. However, detection of H. pylori infection at any point up to age 6.5 years was associated with a significantly reduced odds of both atopy and “any allergic condition” (adjusted OR AOR, 95% CI, 0.54; 0.32-0.92, P =.02, and.31; 0.10-0.94, P =.04, respectively). In longitudinal analyses, H. pylori infection at age 3 was inversely associated with incidence of atopy (AOR, 95% CI, 0.49; 0.27-0.89, P =.02). Furthermore, among H. pylori-infected children, those with a CagA+ strain had a more pronounced reduction in odds of atopy (AOR = 0.35 vs 0.63 for CagA+ vs CagA-), and this reduction reached borderline significance. Conclusion: These data are consistent with the hypothesis that early exposure to H. pylori is inversely associated with atopy and allergic conditions. A possible modest protective association against atopy was observed in those infected with a more virulent CagA+ strain of H. pylori.

 

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Correlation between H pylori infection, clinicopathological features and related digestive disorders among 5172 symptomatic patientsAmrani Hassani Joutei H. Zamiati S. Mahfoud W. Sadaoui I. Marchoudi N. Benomar H.Indian Journal of Public Health Research and Development (2017) 8:2 (187-192). Date of Publication: 1 Apr 2017Background: Rates of Helicobacter pylori infection appear to be higher in developing countries than in developed countries where they seem to be decreasing with improvements in hygiene practices. Few data are currently available on the prevalence of H. pylori infection in the Moroccan population. Objectives: We identified the medical records of 5172 symptomatic patients in order to determine the prevalence of H. pylori, and its association with the clinicopathological features and digestive disorders. Materiel and Method: This is a retrospective comparative and descriptive study. The data were collected from screening archives of patients, suffering from recurrent abdominal pain or other similar symptoms, recruited between 1(st) January 2003 to 31(st) December 2008 in CHU Averroes-Casablanca and Pasteur Institute-Morocco. The data were processed and analyzed by Epi-Info software. Results: In total, 4032 (82.45%) were H. pylori-positive. H. pylori infection was closely correlated to age but not gender. Chronic gastritis associated with H. pylori diagnosis was the most common (94%) and associated severe glandular atrophy and intestinal metaplasia were observed, respectively, in 6.5% and 13% of cases. As for the topography, the antral mucosa was most frequently colonized (64.5%). Conclusion: The Helicobacter infection may be considered as a significant risk factor for chronic gastritis, and the exact prevalence of H. pylori infection in gastric cancer patients in our studied population remains difficult to estimate, because infection can be lost from individuals with cancer. The very high frequency found in our population and generally in developing countries should incite us to make a systematic eradication, and to evaluate the interest of an annual screening of helicobacter pylori infection in our area.

 

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Interleukin-17C in human Helicobacter pylori gastritisTanaka S. Nagashima H. Cruz M. Uchida T. Uotani T. Abreu J.A.J. Mahachai V. Vilaichone R. Ratanachu-ek T. Tshering L. Graham D.Y. Yamaoka Y.Infection and Immunity (2017) 85:10 Article Number: e00389-17. Date of Publication: 2017The interleukin-17 (IL-17) family of cytokines (IL-17A to IL-17F) is involved in many inflammatory diseases. Although IL-17A is recognized as being involved in the pathophysiology of Helicobacter pylori-associated diseases, the role of other IL-17 cytokine family members remains unclear. Microarray analysis of IL-17 family cytokines was performed in H. pylori-infected and uninfected gastric biopsy specimens. IL-17C mRNA was upregulated approximately 4.5-fold in H. pylori-infected gastric biopsy specimens. This was confirmed by quantitative reverse transcriptase PCR in infected and uninfected gastric mucosa obtained from Bhutan and from the Dominican Republic. Immunohistochemical analysis showed that IL-17C expression in H. pylori-infected gastric biopsy specimens was predominantly localized to epithelial and chromogranin A-positive endocrine cells. IL-17C mRNA levels were also significantly greater among cagA-positive than cagA-negative H. pylori infections (P = 0.012). In vitro studies confirmed an increase in IL-17C mRNA and protein levels in cells infected with cagA-positive infections compared to cells infected with either cagA-negative or cag pathogenicity island (PAI) mutant. Chemical inhibition of IκB kinase (IKK), mitogen-activated protein extracellular signal-regulated kinase (MEK), and Jun N-terminal kinase (JNK) inhibited induction of IL-17C proteins in infected cells, whereas p38 inhibition had no effect on IL-17C protein secretion. In conclusion, H. pylori infection was associated with a significant increase in IL-17C expression in human gastric mucosa. The role of IL-17C in the pathogenesis of H. pyloriinduced diseases remains to be determined.

 

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Positive Helicobacter pylori status is associated with better overall survival for gastric cancer patients: Evidence from casecohort studiesFang X. Liu K. Cai J. Luo F. Yuan F. Chen P.Oncotarget (2017) 8:45 (79604-79617). Date of Publication: 2017Helicobacter pylori (H. pylori) infection increases the gastric cancer risk; however, the influences of H. pylori infection status on the outcomes for gastric cancer patients have not yet clearly defined. Herein, we systematically assessed the epidemiological studies regarding the associations between the H. pylori infection status at diagnosis and the prognosis for gastric cancer patients with the metaanalysis methods. Thirty-three eligibility studies with 8,199 participants that had determined the H.pylori infection status and the outcomes for gastric cancer patients were identified through searching the PubMed and MEDLINE databases updated to March 1(st), 2017. The random-effects model suggested that positive H. pylori infection was associated with better overall survival with the pooled hazard ratio (HR) was 0.79 [95% confidence interval (CI) = 0.66-0.93; Q = 134.86, df = 32, P-heterogeneity < 0.001; I(2) = 76.3%] compared to negative patients. The association was found to be more prominent in studies with higher quality, longer following-up time and more sensitive detection methods. An inverse but not statistically significant association between the H.pylori status and the disease-free survival of the patients (pooled HR = 0.84, 95% CI = 0.61-1.05;Q = 30.48, df = 11, P-heterogeneity = 0.001; I(2) = 63.9%) was found, while no significant association was noticed in any subgroup analyses. These results suggested that gastric cancer patients with positive H.pylori infection status at diagnosis have better overall survival compared to negative; however, more studies are warranted to confirm the results and elucidate the underlying mechanisms.

 

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Expression of c-met and hepatocyte growth factor in various gastric pathologies and its association with Helicobacter pylori infectionXie C. Yang Z. Hu Y. Cao X. Chen J. Zhu Y. Lu N.Oncology Letters (2017) 14:5 (6151-6155). Date of Publication: 1 Nov 2017Activation of the hepatocyte growth factor (HGF)/c-Met signaling pathway was identified to be associated with malignant tumors. The present study aimed at determining the expression of HGF and c-Met in gastric carcinogenesis and its association with Helicobacter pylori infection. Gastric biopsies were obtained from 160 H. pylori-negative and -positive patients, including those with chronic gastritis, intestinal metaplasia, dysplasia and gastric cancer (GC). Proteins were extracted from GES-1, gastric epithelial, and AGS, gastric adenocarcinoma, cells following co-culture with H. pylori in vitro. The expression of HGF and c‑Met in gastric tissues or cells was determined using immunohistochemistry and western blot analysis. The expression of c-Met increased in GC tissues (72.5%) compared with that in pre-cancerous lesions (17.5, 17.5 and 30%). Additional analysis identified that the expression of HGF and c-Met was significantly increased in the presence of H. pylori infection in dysplasia and gastric cancer samples. Furthermore, H. pylori may activate the HGF/c-Met signaling pathway in vitro, which may contribute to gastric carcinogenesis.

 

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Helicobacter pylori infection in patients with portal hypertensive gastropathy owing to liver cirrhosis: Prevalence and relation with severity of gastropathyPuri S. Jain M. Narayan K. Pandey S. Nijhawan S.Journal of Digestive Endoscopy (2017) 8:3 (123-128). Date of Publication: 1 Jul 2017Background and Aim: Helicobacter pylori is a major human pathogen. Its role in the pathogenesis of portal hypertensive gastropathy (PHG) is debated. The aim of this study was to evaluate the prevalence of this infection in patients with portal hypertension due to liver cirrhosis and its relation with severity of gastropathy. Patients and Methods: Sixty consecutive patients with liver cirrhosis were enrolled in the study. All patients were subjected to an upper gastrointestinal endoscopy (UGIE), and rapid urease testing for H. pylori was performed. The diagnosis and severity of PHG was evaluated on UGIE. Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores were calculated to assess the severity of liver cirrhosis. Results: H. pylori infection was reported in 33 patients with overall prevalence 55%. The presence of H. pylori was observed in 26 (67%) cirrhotic patients with PHG compared to 7 (33%) cirrhotic patients without PHG. The risk estimate showed a significant association between H. pylori and PHG in cirrhotic patients (P = 0.0133, odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.298-12.325). Out of the 26 patients with PHG and H. pylori infection, 17 had severe PHG (65.3%) and 9 had mild PHG (34.6%) whereas 4 patients had severe PHG (30.8%) and 9 had mild PHG (69.2%%) in the group of H. pylori-negative patients. The difference was statistically significant (P = 0.04, OR: 4.25, 95% CI: 1.0188-17.729). Of the 39 patients with PHG, 21 (53.85%) had severe PHG and 18 (46.15%) had mild PHG. No significant relation was found between H. pylori infection and severity of liver cirrhosis as regards CTP score (P = 0.76) and MELD score (P = 0.56).Conclusion: Our results showed a significant association between H. pylori infection and the occurrence and also the severity of gastropathy in patients with liver cirrhosis. Yet, the severity of liver cirrhosis itself did not correlate with H. pylori or the severity of gastropathy.

 

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Comment on Helicobacter pylori seroprevalence and the occurrence and severity of psoriasisRibaldone D.G. Saracco G. Pellicano R.Anais Brasileiros de Dermatologia (2017) 92:4 (584). Date of Publication: 1 Jul 2017

 

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Helicobacter pylori prevalence and relation with obesityOzdemir S. Aksu C. Ozden E. Narman I. Varlik S. Aksu B. Kasimay O. Yagci A.Indian Journal of Pathology and Microbiology (2017) 60:3 (451-452). Date of Publication: 1 Jul 2017

 

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Could Helicobacter pylori cause an abnormal immune response?Sur G. Sur L. Girbovan A. Samasca G. Alexandru G. Carpa R. Lupan I.Gastroenterology and Hepatology from Bed to Bench (2017) 10:3 (242-243). Date of Publication: 2017

 

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Associations of Helicobacter pylori infection and chronic atrophic gastritis with accelerated epigenetic ageing in older adultsGao X. Zhang Y. Brenner H.British Journal of Cancer (2017) 117:8 (1211-1214). Date of Publication: 10 Oct 2017Background:Helicobacter pylori (HP) infection and chronic atrophic gastritis (CAG) have shown strong associations with the development of gastric cancer. This study aimed to examine whether both risk factors are associated with accelerated epigenetic ageing, as determined by the DNA methylation age', in a population-based study of older adults (n=1477).Methods:Serological measurements of HP antibodies and pepsinogen I and II for CAG definition were obtained by ELISA kits. Whole blood DNA methylation profiles were measured by Illumina Human Methylation450K Beadchip. DNA methylation ages were calculated by two algorithms proposed by Horvath and Hannum et al.Results:After adjusting for potential covariates in linear regression models, we found that HP infection, infection with virulent HP strains (CagA+) and severe CAG were significantly associated with an increase in DNA methylation age by 1/40.4, 0.6 and 1 year (all P-values <0.05), respectively.Conclusions:Our study indicates that both CagA+ HP infection and CAG go along with accelerated epigenetic ageing.

 

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The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapyNegovan A. Iancu M. Moldovan V. Sàrkàny K. Bataga S. Mocan S. Țilea I. Banescu C.European Journal of Internal Medicine (2017) 44 (62-66). Date of Publication: 1 Oct 2017Background Preventive strategies developed to avoid the complications of antiplatelet therapies recommend the evaluation of risk factors for gastrointestinal events and indicated gastroprotective strategies. Aim We aimed to assess the impact of predisposing factors - histological findings, concomitant drug consumption, comorbidities, symptoms, social habits, Helicobacter pylori infection - on severe gastro-duodenal lesions in patients with low-dose aspirin and concomitant protective therapy with proton pump inhibitors (PPI). Method We enrolled 237 patients with LDA and PPI therapy, referred for upper digestive endoscopy, divided into two groups according to the severity of their endoscopic lesions (172 patients with no or mild endoscopic lesions and 65 patients with severe endoscopic lesions). Results In the univariate logistic regression model, the factors associated with severe gastro-duodenal lesions were gender (OR = 1.87, 95% CI: 1.04–3.41), anticoagulants (OR = 2.40, 95% CI: 1.26–4.53), gastric atrophy and/or intestinal metaplasia (OR = 1.85, 95% CI: 1.04–3.32), congestive heart failure (OR = 2.59, 95% CI: 1.16–6.62), anaemia (OR = 3.01, 95% CI: 1.67–5.47) and smoking (OR = 4.29, 95% CI: 1.57–12.32). In the final model, anticoagulants (p = 0.041 < 0.05) and anaemia (p = 0.019 < 0.05) were risk factors for severe lesions via multivariate regression analysis, while for active/inactive chronic gastritis and smoking a positive dependency with a tendency towards statistical significance (p < 0.10) was noticed for severe gastric lesions. Conclusions In patients treated with low-dose aspirin and gastroprotective therapy with proton pump inhibitors we have enough evidence to consider co-treatment with anticoagulants and anaemia important predictors for severe endoscopic lesions, while other factors such as inflammation in gastric biopsies, congestive heart failure, co-treatment with clopidogrel and smoking tended to have a positive influence on risk for severe gastro-duodenal lesions.

 

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Time trend occurrence of duodenal intraepithelial lymphocytosis and celiac disease in an open access endoscopic populationGalli G. Purchiaroni F. Lahner E. Sacchi M.C. Pilozzi E. Corleto V.D. Di Giulio E. Annibale B.United European Gastroenterology Journal (2017) 5:6 (811-818). Date of Publication: 1 Oct 2017Background: Duodenal intraepithelial lymphocytosis (DIL) is a histological finding characterized by the increase of intraepithelial CD3T-lymphocytes over the normal value without villous atrophy, mostly associated to coeliac disease (CD), Helicobacter pylori (Hp) gastritis and autoimmune diseases. Objective: To assess the occurrence of DIL, CD and Hp gastritis in an endoscopic population over a 13 year period. Methods: From 2003 to 2015 we included adult patients who consecutively underwent oesophago-gastro-duodenoscopy (OGD) with duodenal biopsies assessing the overall and annual occurrence of DIL and CD and the prevalence of Hp gastritis. Results: 160 (2.3%) patients with DIL and 275 (3.9%) with CD were detected among 7001 patients. CD occurrence was higher from 2003 to 2011, while since 2012 DIL occurrence gradually increased significantly compared to CD (p = 0.03). DIL patients were more frequently female (p = 0.0006) and underwent OGD more frequently for dyspepsia (p = 0.002) and for indications not related to gastrointestinal symptoms than CD patients (p = 0.0003). Hp gastritis occurred similarly in CD and DIL patients but the latter had higher frequency of atrophic body gastritis (p = 0.005). Conclusions: DIL is a condition increasing in the general endoscopic population mainly diagnosed by chance. Concomitant gastric histological evaluation is able in one third of DIL patients to identify associated possible causes of DIL, such as Hp and atrophic gastritis.

 

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Helicobacter pylori infection is associated with an altered gastric microbiota in childrenBrawner K.M. Kumar R. Serrano C.A. Ptacek T. Lefkowitz E. Morrow C.D. Zhi D. Kyanam-Kabir-Baig K.R. Smythies L.E. Harris P.R. Smith P.D.Mucosal Immunology (2017) 10:5 (1169-1177). Date of Publication: 1 Sep 2017The intestinal microbiome in early life influences development of the mucosal immune system and predisposition to certain diseases. Because less is known about the microbiome in the stomach and its relationship to disease, we characterized the microbiota in the stomachs of 86 children and adults and the impact of Helicobacter pylori infection on the bacterial communities. The overall composition of the gastric microbiota in children and adults without H. pylori infection was similar, with minor differences in only low abundance taxa. However, the gastric microbiota in H. pylori-infected children, but not infected adults, differed significantly in the proportions of multiple high abundance taxa compared with their non-infected peers. The stomachs of H. pylori-infected children also harbored more diverse microbiota, smaller abundance of Firmicutes, and larger abundance of non-Helicobacter Proteobacteria and several lower taxonomic groups than stomachs of H. pylori-infected adults. Children with restructured gastric microbiota had higher levels of FOXP3, IL10, and TGFβ expression, consistent with increased T-regulatory cell responses, compared with non-infected children and H. pylori-infected adults. The gastric commensal bacteria in children are altered during H. pylori infection in parallel with more tolerogenic gastric mucosae, potentially contributing to the reduced gastric disease characteristic of H. pylori-infected children.

 

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Helicobacter pylori infection and serum leptin, obestatin, and ghrelin levels in Mexican schoolchildrenRomo-González C. Mendoza E. Mera R.M. Coria-Jiménez R. Chico-Aldama P. Gomez-Diaz R. Duque X.Pediatric Research (2017) 82:4 (607-613). Date of Publication: 1 Oct 2017Background: There is little information about the possible role of Helicobacter pylori infection on appetite-regulating peptides in children. This study evaluated the association between H. pylori infection and serum levels of ghrelin, leptin, and obestatin in schoolchildren. Methods One hundred seventy-eight schoolchildren, students at boarding schools in Mexico City, participated. H. pylori infection status was determined every 6 months for 1 year by a breath test using (13)C-urea; schoolchildren with consistently positive or negative results were selected to participate. Age, sex, and body mass index (BMI) were recorded. Serum concentrations of total ghrelin, leptin, and obestatin via specific enzyme-linked immunosorbent assays were determined. Results Schoolchildren with H. pylori infection had lower concentration of leptin, - 0.54 pg/ml (95% CI: - 0.98 to - 0.09), compared to the schoolchildren without infection, after adjustment by age, gender, and BMI. And the children with the infection had a median of obestatin lower in 0.99 ng/ml (95% CI: - 1.93 to - 0.06) compared with the uninfected children after adjustment by BMI. Conclusion Association was found between H. pylori infection and decreased serum concentrations of leptin and obestatin. These results suggest that in schoolchildren, H. pylori infection affects the levels of hormones implicated in regulating appetite and energy homeostasis.

 

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Helicobacter pylori and epstein–barr co-infection in gastric diseaseFasciana T. Capra G. Calà C. Zambuto S. Mascarella C. Colomba C. Di Carlo P. Giammanco A.Pharmacologyonline (2017) 1:Special Issue (73-82). Date of Publication: 1 Oct 2017The incidence of gastrointestinal diseases and in particular gastric cancer (GC) is high worldwide. Over the last few years, numerous studies have speculated that Helicobacter pylori (H. pylori) and Epstein-Barr virus (EBV) can be correlated with gastric cancerogenesis. Virulence factors of H. pylori can contribute to the variability of clinical outcomes: among the most important virulence factors is the pathogenicity island (CagPAI), vacA and oipA gene. EBV infection usually persists in B cells and induces an inflammatory reaction in cooperation with H. pylori. In Sicily, H. pylori and EBV infections are particularly prevalent, and to our knowledge no study has addressed this yet. The aim of our study was to examine the association of H. pylori and EBV infection in patients with gastric diseases in Sicily. Gastric biopsies were collected from 24 adult patients with chronic gastritis active (CGA) and from 24 adult patients without any gastric disease (NGD) who underwent upper gastrointestinal endoscopy. H. pylori infection was diagnosed by PCR for ureaseA gene while EBV-DNA was detected by Real time PCR for region Bam HI-W. Moreoever, we investigated the presence of CagPaI and the status of vacA and oipA genes. Percentage of resistance to Clarithromycin of H. pylori was evaluated also. We established that H. pylori and EBV infection was present in 42% of patients, while dual infection with H. pylori and EBV-DNA was present in 54% of the patients with CGA. In patients with NGD we found that H. pylori and EBV infection was present in 46% and in 21% of patients respectively, while co-infection was present in 33% of patients. CagPAI was present in only 20% of patients with GCA and in 9% of patients with NGD. As regards vacA alleles, s2i2m2 were predominant, present in 80% and 82% of patients with CGA and NGD respectively. The status “ON” of oipA gene was present in the same percentage. Finally, we found that 38% of patients positive for H. pylori infection showed resistance to Clarithromycin. In our study, there was a strong association between the simultaneous presence of H. pylori and EBV infection in patients with CGA compared to patients with NGD. Furthermore, our data confirmed the high percentage of resistance among H. pylori strains circulating in Sicily, underlining the importance of establishing a therapy that is effective in eradicating them and reducing the frequency of coinfections and evolution towards gastric cancerogenesis.

 

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Advances in the endoscopic management of gastric outflow disordersStorm A.C. Ryou M.Current Opinion in Gastroenterology (2017) 33:6 (455-460). Date of Publication: 1 Nov 2017Purpose of review Disorders of gastric outflow and outlet obstruction include a variety of benign and malignant disorders such as peptic strictures, foreign bodies, gastroparesis, and cancers of the stomach, duodenum, and pancreas. Historically, a majority of patients presenting with gastric outlet obstruction (GOO) were to the result of peptic ulcers and surgical management of peptic ulcer complications was a mainstay of general surgical training. Invasive surgery is being performed less frequently today due to realization of the role of Helicobacter pylori in peptic ulcer disease and the introduction of novel endoscopic techniques for management of GOO. Recent findings For malignant GOO, the introduction of lumen-apposing metal stents have opened the door for the development and performance of endoscopic ultrasound-guided gastric bypass procedures. For benign GOO, including gastroparesis and pyloric stenosis, endoscopic myotomy shows promise. Summary Endoscopic ultrasound-guided gastric bypass, per-oral endoscopic myotomy, and other novel techniques in the endoscopic management of GOO, are discussed in this review.

 

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Risk factors for gastric tumorigenesis in underlying gastric mucosal atrophySong J.H. Kim S.G. Jin E.H. Lim J.H. Yang S.Y.Gut and Liver (2017) 11:5 (612-619). Date of Publication: 1 Sep 2017Background/Aims: Atrophic gastritis is considered a premalignant lesion. We aimed to evaluate the risk factors for gastric tumorigenesis in underlying mucosal atrophy. Methods: A total of 10,185 subjects who underwent upper gastrointestinal endoscopy between 2003 and 2004 were enrolled in this retrospective cohort study. Follow-up endoscopy was performed between 2005 and 2014. Atrophic gastritis and intestinal metaplasia were assessed by endoscopy using the Kimura-Takemoto classification. Helicobacter pylori infection was evaluated based on serum immunoglobulin G antibody levels, the rapid urease test, or the urea breath test. Results: Atrophic gastritis was confirmed in 3,714 patients at baseline; 2,144 patients were followed up for 6.9 years, and 1,138 exhibited increased atrophy. A total of 69 subjects were diagnosed with gastric neoplasm during follow-up (35 adenoma and 34 carcinoma). Age ≥55 years (hazard ratio [HR], 1.234), alcohol consumption (HR, 1.001), and H. pylori infection (HR, 1.580) were associated with increased mucosal atrophy. The risk factors for gastric neoplasm in underlying mucosal atrophy were age ≥55 years (HR, 2.582), alcohol consumption (HR, 1.003), extent of mucosal atrophy (HR, 2.285 in C3-O1; HR, 4.187 in O2-O3), and intestinal metaplasia (HR, 2.655). Conclusions: Extent of atrophy, intestinal metaplasia, and alcohol consumption are significant risk factors for gastric neoplasm in underlying mucosal atrophy.

 

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Is the hygiene hypothesis relevant for the risk of multiple sclerosis?Wendel-Haga M. Celius E.G.Acta Neurologica Scandinavica (2017) 136 Supplement 201 (26-30). Date of Publication: 1 Nov 2017The hygiene hypothesis, suggesting that low exposure to pathogens early in life can increase the risk for immune-mediated diseases, has been proposed as an explanation for the increase in incidence of allergy and autoimmune diseases in industrialized countries during the last decades. Several aspects of the hygiene hypothesis have been related to MS. Already in 1966, the risk of MS was suggested to be higher in individuals with high hygienic standard during childhood. Further, an episode of infectious mononucleosis is an independent risk factor for MS and can be regarded as an indicator of low exposure to pathogens early in life, as infection with Epstein-Barr virus often is asymptomatic when it occurs in young children. Conflicting results have been reported regarding number of siblings, attendance in a day care center and exposure to animals during childhood in relation to MS risk, but common childhood infections and vaccinations do not seem to influence the risk of MS. In line with the hygiene hypothesis, two large meta-analyses have recently shown that infection with Helicobacter pylori is negatively correlated with MS. Moreover, a protective influence of helminth infection on MS has been observed in several, small clinical studies, but more knowledge is needed before a potential role of helminth-derived therapy in MS is determined. Also, it has been hypothesized that infection with the parasite Toxoplasma gondii could be protective against MS.

 

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PD-1 and PD-L1 co-expression predicts favorable prognosis in gastric cancerWu Y. Cao D. Qu L. Cao X. Jia Z. Zhao T. Wang Q. Jiang J.Oncotarget (2017) 8:38 (64066-64082). Date of Publication: 2017While the prognosis of gastric cancer (GC) remains poor, PD-1 and PD-L1/L2 are promising prognostic biomarkers. We evaluated PD-1 and PD-L1/L2 expression in tumor cells (TCs) and tumor-infiltrating immune cells (TIICs). We determined the Helicobacter pylori (Hp) and Epstein-Barr virus (EBV) infection status in a GC cohort (n=340), then analyzed the relationship between the expression of PD-1, PD-L1/ L2 and GC prognosis. We found that PD-1, PD-L1, and PD-L2 mRNA levels were upregulated in GC tissues, and were positively correlated with one another (P=0.043, P=0.008 and P=0.035). PD-1 protein expression in TIICs was observed in 22.6% of GC patients. The PD-L1 and PD-L2 positivity rates were 40.3% and 53.8% in TCs, respectively, and 60.0% and 60.9% in TIICs, respectively. PD-L1 was up-regulated in EBV-infected GC patients in both TCs (P=0.009) and TIICs (P=0.003). Hp status was not associated with PD-1 or PD-L1/PD-L2 expression. In TIICs, PD-L1 expression was independently associated with better GC prognosis (HR=0.72, 95%CI: 0.53- 0.99). Co-expression of PD-1 and PD-L1, but not PD-L2, was a favorable prognostic marker that indicated a dose effect on the mortality risk of GC patients (P-value for trend=0.005). Comprehensive evaluation of PD-1 and PD-L1 in TCs and TIICs could help predict the prognosis of gastric cancers, as well as reveal patients who might benefit from targeted treatment.

 

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The utility of routine esophagogastroduodenoscopy before laparoscopic Roux-en-Y gastric bypassSun W.Y.L. Dang J.T. Switzer N.J. de Gara C. Birch D.W. Karmali S.Surgery for Obesity and Related Diseases (2017) 13:10 (1717-1722). Date of Publication: 1 Oct 2017Background The routine use of esophagogastroduodenoscopy (EGD) before laparoscopic Roux-en-y gastric bypass (LRYGB) is debatable. Various studies have reported high diagnostic yield of routine EGD before LRYGB to detect pathologies that could alter surgical management. However, other studies have found that preoperative EGD did not identify significant pathologies that changed clinical management; therefore, it is not indicated in asymptomatic patients. Objectives We aimed to study the utility of routine EGD in patients before LRYGB. Setting Academic teaching hospital, (Royal Alexandra Hospital, Canada). Methods A retrospective review of patients undergoing LRYGB with 1 surgeon at our hospital from May 2014 to March 2016 was completed. EGD findings were compared with surgical gastrojejunal specimen pathology and postoperative complications. Results There were 116 patients who underwent EGD before LRYGB with 113 reported EGDs, of which 46.0% were normal, 40.7% had findings that did not result in a change of management, and 13.3% had findings resulting in a change of management. In the gastrojejunal specimen, 16 patients (14.2%) were found to have chronic gastritis. The relative risk of patients having gastrojejunal gastritis was 5.1 (P<.0005) for patients with gastritis on EGD and 5.1 (P<.0005) for patients with Helicobacter pylori infection on EGD. After surgery, 18 patients (15.9%) had complications. Preoperative EGD findings were not associated with postoperative complications. Conclusion Based on the findings from this study, we recommend using less invasive screening in the routine workup of patients awaiting LRYGB and reserving EGD for symptomatic patients.

 

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Serum pepsinogen and gastrin‑17 as potential biomarkers for pre‑malignant lesions in the gastric corpusLoong T.H. Soon N.C. Nik Mahmud N.R.K. Naidu J. Abdul Rani R. Abdul Hamid N. Hikmah Elias M. Rose I.M. Tamil A. Mokhtar N.M. Raja Ali R.A.Biomedical Reports (2017) 7:5 (460-468). Date of Publication: 1 Nov 2017Abstract. There is a lack of non‑invasive screening modalities to diagnose chronic atrophic gastritis (CAG) and intestinal metaplasia (IM). Thus, the aim of the present study was to determine the sensitivity and specificity of serum pepsinogen I (PGI), PGI:II, the PGI:II ratio and gastrin‑17 (G‑17) in diagnosing CAG and IM, and the correlations between these serum biomarkers and pre‑malignant gastric lesions. A cross‑sectional study of 72 patients (82% of the calculated sample size) who underwent oesophageal‑gastro‑duodenos-copy for dyspepsia was performed in the present study. The mean age of the participants was 56.2±16.2 years. Serum PGI:I, PGI:II, G‑17 and Helicobacter pylori antibody levels were measured by enzyme‑linked immunosorbent assay. Median levels of PGI:I, PGI:II, the PGI:II ratio and G‑17 for were 129.9 µg/l, 10.3 µg/l, 14.7 and 4.4 pmol/l, respectively. Subjects with corpus CAG/IM exhibited a significantly lower PGI:II ratio (7.2) compared with the control group (15.7; P<0.001). Histological CAG and IM correlated well with the serum PGI:II ratio (r=‑0.417; P<0.001). The cut‑off value of the PGI:II ratio of ≤10.0 demonstrated high sensitivity (83.3%), specificity (77.9%) and area under the receiver operating characteristic curve of 0.902 in detecting the two conditions. However, the sensitivity was particularly low at a ratio of ≤3.0. The serum PGI:II ratio is a sensitive and specific marker to diagnose corpus CAG/IM, but at a high cut‑off value. This ratio may potentially be used as an outpatient, non‑invasive biomarker for detecting corpus CAG/IM.

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