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Trabalhos Publicados em Fevereiro / 2018

RECORD  1

 

Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage  Therapy in the USA: A Real Life ExperienceTan B. Yang J.-C. Young C.L. Bishu S. Owyang S.Y. El-Zaatari M. Zhang M.  Grasberger H. Qian J.-M. Kao J.Y.Digestive Diseases and Sciences (2018) 63:2 (437-445). Date of Publication:  1 Feb 2018Background: The current practice guidelines recommend that Helicobacter  pylori (H. pylori) culture and antimicrobial susceptibility testing (AST) be  considered after patients failed the second course of H. pylori eradication  therapy. Aims: Here we report the real life experience of following this  recommendation in the USA. Methods: We established an in-house H. pylori  culture protocol for AST and identified retrospectively patients who  previously failed ≥ 2 courses of anti-H. pylori therapy and underwent  esophagogastroduodenoscopy with AST at University of Michigan from 2010 to  2017. We determined the rate of H. pylori antibiotic resistance, the success  rates of AST-guided tailored therapy, and the risk factors associated with  treatment failure. Results: Forty-seven patients were identified and 34  (72.3%) had successful cultures and AST. The most common antibiotic  resistance was to metronidazole (79.4%), followed by clarithromycin (70.6%)  and ciprofloxacin (42.9%). None of the patients were resistant to  amoxicillin or tetracycline. The overall success rate of AST-guided tailored  therapy was low (44.4%, 12/27). In patients infected with  metronidazole-resistant H. pylori, bismuth quadruple therapy appears to be  superior compared to non-bismuth quadruple therapy (6/8 or 75.0% vs. 3/14 or  21.4%, P = 0.03). High body mass index was significantly associated with  tailored therapy failure (OR 1.24, 95% CI 1.00–1.54, P = 0.049).  Conclusions: The success rate of AST-guided salvage therapy in the USA is  low particularly in those with high BMI. Bismuth-based therapy appears to be  better than non-bismuth-based regimens.                                                            

 

RECORD 2

 

Approach, attitudes, and knowledge of general practitioners in relation to  Helicobacter pylori is inadequate. There is much room for improvement!El abordaje, las actitudes y el conocimiento acerca de Helicobacter pylori  en médicos generales es deficiente. ¡Hay mucho que mejorar!Cano-Contreras A.D. Rascón O. Amieva-Balmori M. Ríos-Gálvez S. Maza Y.J.  Meixueiro-Daza A. Roesch-Dietlen F. Remes-Troche J.M.Revista de Gastroenterologia de Mexico (2018) 83:1 (16-24). Date of  Publication: 1 Jan 2018Background: Helicobacter pylori (Hp) infection is one of the most common  infections in humans. Due to its worldwide prevalence, a series of  guidelines and recommendations has been developed for the appropriate  screening, diagnosis, and management of patients with Hp infection. Aim: To  evaluate the approach, attitudes, and knowledge of a group of Mexican  general practitioners in relation to Hp. Materials and methods: A  cross-sectional study was conducted that evaluated the knowledge of Hp  diagnosis and treatment through the application of a questionnaire. Results:  From the total of 430 questionnaires delivered, information was obtained  from 411 (95% response rate). The most frequent indications for eradication  treatment were peptic ulcer (48.4%), gastroesophageal reflux disease  (41.8%), and dyspepsia (39.2%). Thirty-one percent of the physicians  surveyed used more than one test to look for Hp, and serology was the most  commonly employed method. The most widely used antibiotic regimen was  clarithromycin plus amoxicillin (63.8%), followed by metronidazole plus  tetracycline (16%). Ninety-two percent of the physicians confirmed  eradication through endoscopy for the histologic analysis and only 23%  utilized the breath test. Conclusions: Our results show the lack of  knowledge about the established diagnostic and treatment recommendations for  Hp infection. The implementation of workshops, courses, and conferences, or  the formulation of practical guidelines should be directed at primary care  physicians to strengthen the practice of medicine based on scientific  evidence.                                                            

 

RECORD 3

 

Eradication of helicobacter pylori in Iran: A reviewFakheri H. Firoozi M.S. Bari Z.Middle East Journal of Digestive Diseases (2018) 10:1 (5-17). Date of  Publication: 1 Jan 2018Helicobacter pylori (H. pylori) infection is one of the most common  bacterial infections, affecting almost half of the world’s population. It is  associated with peptic ulcer disease, gastric adenocarcinoma, and lymphoma.  In Iran, the prevalence of H. pylori infection has been reported to be  between 36% and 90% in different geographic regions. Several studies have  assessed the efficacy of different therapeutic options for first-line and  second-line H. pylori eradication in Iran; however, the results are  conflicting. Therefore, we conducted a review to evaluate different studies  in order to select the best options and to provide recommendations for H.  pylori eradication in Iran. Accordingly, we searched through PubMed to  obtain relevant randomized clinical trials published in English language up  to June 2017. According to our study, among first-line eradication regimens,  bismuth-based furazolidone- or clarithromycin-containing quadruple  therapies, hybrid regimen, and concomitant therapy seem to be appropriate  options. Also, 10- or 14-day clarithromycin-containing triple therapy can be  used if local H. pylori resistance to clarithromycin is known to be less  than 15%. For second-line H. pylori eradication, bismuth-based quadruple  therapies and 14-day levofloxacin-based triple therapy can be used, provided  that antibiotics other than those used in the first-line regimen are used.  Third-line H. pylori eradication regimens have not been addressed in Iranian  studies. However, most guidelines recommend treatment according to the  results of culture and susceptibility testing. Although we limited our  investigation to H. pylori eradication regimens in Iran, the results are  transferrable to any region as long as the patterns of antibiotic resistance  are the same.                                                            

 

RECORD 4

 

Telomere length in the gastric mucosa after Helicobacter pylori eradication  and its potential role in the gastric carcinogenesisTahara T. Tahara S. Tuskamoto T. Horiguchi N. Kawamura T. Okubo M. Ishizuka  T. Nagasaka M. Nakagawa Y. Shibata T. Kuroda M. Ohmiya N.Clinical and Experimental Medicine (2018) 18:1 (21-26). Date of Publication:  1 Feb 2018The molecular mechanisms of gastric carcinogenesis after Helicobacter pylori  (H. pylori) eradication remain unclear. We examined the telomere length of  gastric mucosa samples after successful H. pylori eradication in patients  without and those with gastric cancer. Telomere length was measured by the  real-time PCR among four different groups of biopsies: gastric body from  subjects without history of H. pylori infection (Hp-: n = 23), gastric body  from cancer-free subjects after H. pylori eradication (cancer-free body:  n = 24), gastric body from early gastric cancer patients diagnosed after H.  pylori eradication (EGC body: n = 35) and its paired samples from adjacent  mucosa of cancerous area (EGC ADJ: n = 35). The Hp-group presented the  longest telomeres among the all groups (Hp- vs. all others, all P < 0.05).  Samples from EGC body group showed shorter telomere length than the samples  from cancer-free body groups (P < 0.05). Conversely, samples from EGC ADJ  group showed rather longer telomere length compared to the EGC body group  (P < 0.05), which was also confirmed by the comparison of 35 matched samples  (P = 0.0007). Among the samples after H. pylori eradication, shorter  telomere length was associated with higher expression of IL-1B and NF-kB  (P < 0.0001, 0.0006, respectively). Longer telomere length was also  associated with higher expression of TNF-A (P = 0.01). Telomere shortening  seems to be important initial steps in gastric cancer predisposition after  H. pylori eradication, while it might shift to lengthening to acquire more  aggressive pathway to develop cancer.                                                            

 

RECORD 5

 

Helicobacter pylori induces caudal-type homeobox protein 2 and  cyclooxygenase 2 expression by modulating microRNAs in esophageal epithelial  cellsTeng G. Dai Y. Chu Y. Li J. Zhang H. Wu T. Shuai X. Wang W.Cancer Science (2018) 109:2 (297-307). Date of Publication: 1 Feb 2018Dysregulation of microRNAs (miRNAs) has been linked to virulence factors of  Helicobacter pylori. The role of H. pylori in esophageal disease has not  been clearly defined. We previously reported that H. pylori esophageal  colonization promotes the incidence of Barrett's esophagus and esophageal  adenocarcinoma in vivo. Here, we studied the direct effects of H. pylori on  the transformation of esophageal epithelial cells, with particular focus on  whether H. pylori exerts its effects by modulating miRNAs and their  downstream target genes. The normal human esophageal cell line HET-1A was  chronically exposed to H. pylori extract and/or acidified deoxycholic acid  for up to 36 weeks. The miRNA profiles of the esophageal epithelial cells  associated with H. pylori infection were determined by microarray analysis.  We found that chronic H. pylori exposure promoted acidified deoxycholic  acid-induced morphological changes in HET-1A cells, along with aberrant  overexpression of intestinal metaplasia markers and tumorigenic factors,  including caudal-type homeobox protein 2 (CDX2), mucin 2, and cyclooxygenase  2 (COX2). Helicobacter pylori modified the miRNA profiles of esophageal  epithelial cells, particularly aberrant silencing of miR-212-3p and  miR-361-3p. Moreover, in biopsies from Barrett's esophagus patients,  esophageal H. pylori colonization was associated with a significant decrease  in miR-212-3p and miR-361-3p expression. Furthermore, we identified COX2 as  a target of miR-212-3p, and CDX2 as a target of miR-361-3p. Helicobacter  pylori infection of esophageal epithelial cells was associated with  miRNA-mediated upregulation of oncoprotein CDX2 and COX2. Our observations  provide new evidence about the molecular mechanisms underlying the  association between H. pylori infection and esophageal carcinogenesis.                                                            

 

RECORD 6

 

Is It a Protective Factor of Helicobacter pylori Infection in Overall  Survival of All Gastric Cancer? Evidence from Meta-AnalysisZheng F. Sun Z. Kan J. Yin J. Du F. Shen G. Wang Z. Ren D. Bao X. Zhao J.Journal of environmental pathology, toxicology and oncology : official organ  of the International Society for Environmental Toxicology and Cancer (2017)  36:4 (309-320). Date of Publication: 2017Purpose - We aimed to assess whether Helicobacter pylori infection  influences prognosis in gastric cancer patients (GC). Methods - We  systematically searched MEDLINE, PubMed, EBSCO, EMBASE, and the Cochrane  Library (CENTRAL) Register from inception to June 1, 2017. Overall survival  (mean OS) or disease-free survival (mean DFS) in GC patients were calculated  using the hazard ratio (HR) and 95% confidence intervals (95% CIs). Results  - In total, 19 articles with 4,321 GC patients were enrolled. Helicobacter  pylori infection is associated with longer OS (HR 0.73; 95% CI 0.60-0.89; P  < 0.001) and DFS (HR 0.75; 95% CI 0.53-1.07; P = 0.002) in GC patients  overall. For our subgroup analysis, the pooled HRs and 95% CIs were as  follows: China (OS: HR 0.95; 95% CI 0.63-1.42; P = 0.804 and DFS: HR 0.88;  95% CI 0.50-1.56; P = 0.658), Europe (OS: HR 0.69; 95% CI 0.52-0.92; P =  0.010 and DFS: HR 0.62; 95% CI 0.32-1.17; P = 0.141), United States (OS: HR  0.77: 95% CI 0.56-1.06; P = 0.105), Korea (OS: HR 0.45; 95% CI 0.27-0.75; P  = 0.002 and DFS: HR 0.45; 95% CI 0.24-0.83, P = 0.011), and Turkey (OS: HR  0.94; 95% CI 0.52-1.70; P = 0.839 and DFS: HR 0.95; 95% CI 0.53-1.71, P =  0.864). Moreover, for R0 or M0 patients, H. pylori infection is associated  with better OS and DFS (P all values < 0.05). Conclusions - Helicobacter  pylori infection has a better prognosis in GC patients from Korea and  Europe. Helicobacter pylori infection has no association with prognosis for  China, the United States, or Turkey. Also, H. pylori infection has a better  prognosis in R0 resection or M0 GC patients.                                                             

 

RECORD 7

 

The prevalence of helicobacter pylori virulence related genes (hpa and  babA2) in Iranian patients with gastrointestinal disordersHeidari K. Kazem Nezhad V. Noroozi A. Mehravar F.Jundishapur Journal of Microbiology (2017) 10:12 Article Number: e60947.  Date of Publication: 1 Dec 2017Background: The clinical result severity of Helicobacter pylori infection is  determined by a combination of environmental factors, host genetic  background, and H. pylori virulence factors. A number of genes containing  vacA, iceA, babA2, cagA, cagE, hsp60-70, and hpa have been identified to  enhance H. pylori pathogenicity by encoding virulent proteins. The babA and  hpa proteins are considered 2 major adhesion molecules, and thus they are  key agents in the initial step of H. pylori invasion. Objectives: This study  aimed at investigating the existence of babA2 and hpa virulence factors of  H. pylori in Iranian patients with gastrointestinal complications. The  relationship between these agents and clinical results was also  investigated. Methods: A total of 80 positive biopsies out of 156 samples  were studied to determine babA2 and hpa gene frequency by PCR. The positive  biopsies were collected from patients suffering from gastric cancer (n =18),  peptic ulcer (n = 26), and gastritis (n =36). Results: The babA2+ strains  were found in 51 (64%) patients and the hpa+ strains in 57 (71%) patients  were associated with sex (P = 0.02). However, the frequency of these factors  was not significant between gastric disease groups (P > 0.05). Conclusions:  Our results revealed different frequency of these virulence factors in Iran,  which emphasized the effects of geographical influences. Also, it was found  that male patients had higher rate of hpa than females, highlighting the  gender specific factors.                                                            

 

RECORD 8Detection and genotyping of Helicobacter pylori in saliva versus stool  samples from asymptomatic individuals in Northeastern Thailand reveals  intra-host tissue-specific H. pylori subtypesWongphutorn P. Chomvarin C. Sripa B. Namwat W. Faksri K.BMC Microbiology (2018) 18:1 Article Number: 10. Date of Publication: 30 Jan  2018Background: Two-thirds of the world's population is thought to be infected  by Helicobacter pylori. Although most people infected with H. pylori are  asymptomatic, this pathogen is associated with several gastric pathologies  including cancer. The risk factors for colonization are still unclear and  the genetic diversity within individual hosts has never been clearly  investigated. Result: This study determined the prevalence of, and explored  risk factors for, H. pylori infection directly from paired saliva (n = 110)  and stool (n = 110) samples from asymptomatic persons in Northeast Thailand.  Samples were subjected to indirect immunofluorescence assay (IFA), 16S  rRNA-based real-time PCR and vacA-based semi-nested PCR. Partial vacA gene  sequences of H. pylori were compared between saliva and stool samples. The  overall prevalence of H. pylori infection in our asymptomatic study  population was 64%. Age, gender, occupation and frequency of brushing teeth  were not found to be associated with H. pylori colonization. The vacA gene  was successfully sequenced from both saliva and stool samples of 12  individuals. For seven of these individuals, saliva and stool sequences fell  into different clusters on a phylogenetic tree, indicating intra-host  genetic variation of H. pylori. Conclusion: This study reports a high  prevalence of H. pylori infection in asymptomatic persons in this region of  Thailand and demonstrates that genotypes (vacA gene sequences) of H. pylori  may differ between the oral cavity and intestinal tract.                                                             

 

RECORD 9

 

Influence of Helicobacter pylori virulence factors CagA and VacA on  pathogenesis of gastrointestinal disordersNejati S. Karkhah A. Darvish H. Validi M. Ebarhimpour S. Nouri H.R.Microbial Pathogenesis (2018) 117 (43-48). Date of Publication: 1 Apr 2018Helicobacter Pylori (H. pylori) is a gram-negative bacteria infecting  numerous people all over the world. It has been established that H. pylori  play an important role in pathogenesis of gastritis, peptic ulcer and  gastric cancer. Pathogenic features of this bacterium are mainly attributes  to the existence of pathogenic islands (PAI) genes. The most known genes in  these islands are cytotoxin-associated gene A (CagA) and vacuolating  cytotoxin gene (VacA). Most studies demonstrated various frequency of CagA  and VacA in patient with peptic ulcer or gastritis in different countries.  This variation in CagA and VacA frequency may be due to the capability of  this bacterium to be genetically versatile and can alter the expression of  these genes with geographic diversity. Although H. pylori infection is not  usually associated with any clinical symptoms, but sometimes leads to  inflammation in gastrointestinal system and resulted in peptic ulcer and  gastric cancer. In this regard, this review will illustrate the importance  of Helicobacter pylori in pathogenesis of gastrointestinal disorders with  focusing on CagA and VacA virulence factors.                                                             

 

RECORD 10

 

Gastroprotective effects of Hwanglyeonhaedok-tang against Helicobacter  pylori-induced gastric cell injuryPark H.-S. Wijerathne C.U.B. Jeong H.-Y. Seo C.-S. Ha H. Kwun H.-J.Journal of Ethnopharmacology (2018) 216 (239-250). Date of Publication: 24  Apr 2018Ethnopharmacological relevance: Helicobacter pylori, which is found in the  stomachs of approximately half of the world's population, has been  associated with the development of chronic gastritis and gastric cancer.  Hwanglyeonhaedok-tang (HHT) is a popular traditional medicine for the  therapies of gastric ulcers and gastritis. Aim of the study: The emerging  resistance of H. pylori to antibiotics arouses requirement on alternative  nonantibiotic-based therapies. In the present study, we investigated the  anti-inflammatory activity and anti-microbial activity of HHT against H.  pylori in vitro and in an H. pylori-infected mouse model. Materials and  methods: H. pylori were treated with various concentrations of HHT and then  incubated with human gastric carcinoma AGS cells. For the in vivo study,  mice were orally infected with H. pylori three times over the course of 1  week, and then subjected to daily administration of HHT (120 or 600 mg/kg)  for 4 weeks or standard triple therapy for 1 week. At the scheduled  termination of the experiment, all mice were killed and their stomachs were  collected for histological examination, quantitative real-time PCR, and  Western blot analysis. Results: Our in vitro studies showed that HHT  treatment inhibited the adhesion of H. pylori to AGS cells and suppressed  the H. pylori-induced increases of inflammatory regulators, such as  interleukin (IL)-8, cyclooxygenase 2 (COX-2), and inducible nitric oxide  synthase (iNOS). In the mouse model, HHT treatment significantly reduced H.  pylori colonization, inflammation, and the levels of IL-1β, IL-6, C-X-C  motif chemokine ligand 1 (CXCL1), tumor necrosis factor alpha (TNF-α),  COX-2, and iNOS in gastric mucosa. Further investigation showed that HHT  treatment reduced the H. pylori-induced phosphorylations of p38  mitogen-activated protein kinase (MAPK), extracellular signal-regulated  kinases 1/2 (ERK1/2), c-Jun N-terminal protein kinase (JNK), and nuclear  factor-kappa B (NF-κB). Conclusions: Our findings collectively suggest that  HHT has anti-inflammatory activity and antibacterial activity against H.  pylori and could be an alternative to antibiotics for preventing H. pylori  infection.                                                             

 

RECORD 11

 

Interleukin-12 and interferon-γ acting on damp-heat of spleenstomach  syndrome triggered by helicobacter pyloriChen W. Hu L. Li H. Luo Q. Fan D. Zhang Y.Journal of Traditional Chinese Medicine (2017) 37:6 (827-834). Date of  Publication: 15 Dec 2017OBJECTIVE: To investigate the expression of and interleukin-12 (IL-12) and  interferon-γ (IFN-γ) in relation to the pathology of damp-heat of  spleen-stomach syndrome (DHSS) induced by Helicobacter pylori (H. pylori)  infection. METHODS: In total, 114 individual gastric mucosal specimens  including 83 DHSS, 19 spleen-qi deficiency syndrome (SQD) and 12 from  healthy volunteers (CON) were collected by gastroscopy. To explore the  relationship between the two syndromes and H. pylori infection, individual  samples were tested using rapid urease and methylene blue tests. Hematoxylin  and eosin stained sections were examined to grade for the degree of  inflammation and inflammatory activity, and expression of IL-12 and IFN-γ  was investigated by immunohistochemistry. RESULTS: Statistically significant  differences in the degree of inflammation and inflammatory activity were  observed between the groups of specimens: DHSS, SQD and CON (P < 0.05).  Additionally, greater intestinal metaplasia (IM) and dysplasia were observed  in the DHSS group, especially those with H. pylori infection. Expression of  both IFN-γ and IL-12 was higher in DHSS samples infected with H. pylori than  in uninfected samples and in the CON (P < 0.05) but not in the SQD (P >  0.05) groups. Intriguingly, in gastric specimens exhibiting IM and  dysplasia, IL-12 translocated from the nucleus into the cytoplasm.  CONCLUSION: Our findings suggest that IL-12 and IFN-γ are involved in DHSS  pathology, but not in SQD, acting as healthy-Qi. DHSS is not just the  consequence of those two cytokines but results from the cross-talk between a  number of cytokines and/or other proteins, which may warrant further  investigation in DHSS patients infected with H. pylori.                                                            

 

RECORD 12

 

Visual diagnostic of Helicobacter pylori based on a cascade amplification of  PCR and G-quadruplex DNAzyme as a color labelLiu Z. Yao C. Wang Y. Zheng W.Journal of Microbiological Methods (2018) 146 (46-50). Date of Publication:  1 Mar 2018Helicobacter pylori is a spiral-shaped, Gram-negative, microaerophilic and  fastidious bacterium. It is the main cause of chronic gastritis as well as  gastric and duodenal ulcers. The diagnosis of H. pylori infection is  significant for the selection of therapy and for the follow up of  eradication success. A simple and robust strategy based on the cascade of  PCR and DNAzyme catalyzed reaction was utilized to detect H. pylori. The  design of the primer pair would enable PCR to synthesize aptamer of DNAzyme  at the 3′ end of PCR products. G-quadruplex DNAzyme as a color label can  exhibit peroxidase-like activity to amplify the specific signal and  demonstrate a colorimetric signal to indicate the diagnostic result. This  assay can detect genomic DNA of H. pylori specifically with as low as 100  pg/reaction by the naked eye. This is a powerful demonstration of  G-quadruplex DNAzyme to be used for PCR-based assay with significant  advantages of high sensitivity, low cost and simple manipulation over  existing approaches and offers the potential opportunity for clinical  application.                                                            

 

RECORD 13

 

Gastric bacterial Flora in patients Harbouring Helicobacter pylori with or  without chronic dyspepsia: Analysis with matrix-assisted laser desorption  ionization time-of-flight mass spectroscopyPereira V. Abraham P. Nallapeta S. Shetty A.BMC Gastroenterology (2018) 18:1 Article Number: 20. Date of Publication: 26  Jan 2018Background: The gastric microbiota has recently been implicated in the  causation of organic/structural gastroduodenal diseases (gastric and  duodenal ulcers, gastric cancer) in patients with Helicobacter pylori (H.  pylori) infection. We aimed to ascertain, in patients harbouring H. pylori,  the role of the gastric microbiota in the causation of symptoms (chronic  dyspepsia) in the absence of organic disease. Methods: Seventy-four gastric  biopsy samples obtained at endoscopy from patients with (n=21) or without  (n=53) chronic dyspepsia, and that tested positive by the bedside rapid  urease test for H. pylori infection, were cultured for detection of H.  pylori and non-H. pylori organisms. The cultured organisms were identified  by matrix-assisted laser desorption ionization time-of-flight mass  spectroscopy (MALDI-TOF MS). Results: A total of 106 non-H. pylori isolates  were obtained from 74 patients' samples. This included 33 isolates (median  2, range 1-2 per patient) from dyspeptic and 73 (median 2, range 1-2 per  patient) from non-dyspeptic patients. These were identified from the Bruker  Biotyper 2 database as Staphylococcus spp., Streptococcus spp.,  Lactobacillus spp., Micrococcus spp., Enterococcus spp., Pseudomonas spp.,  Escherichia spp., Klebsiella spp. and Bacillus spp., Staphylococcus and  Lactobacillus were identified significantly more commonly in dyspeptics and  Streptococcus, Pseudomonas, Escherichia coli and Klebsiella pneumoniae in  non-dyspeptics. All identified organisms belonged to the phyla Firmicutes  and Proteobacteria. Conclusions: There is a qualitative difference in the  gastric microbial spectrum between patients harbouring H. pylori with and  without chronic dyspepsia. Whether these organisms have an independent role  in the development or prevention of dyspepsia or act in concurrence with H.  pylori needs study.                                                            

 

RECORD 14

 

Helicobacter pylori induces direct activation of the lymphotoxin beta  receptor and non-canonical nuclear factor-kappa B signalingFeige M.H. Vieth M. Sokolova O. Täger C. Naumann M.Biochimica et Biophysica Acta - Molecular Cell Research (2018) 1865:4  (545-550). Date of Publication: 1 Apr 2018The pathogen Helicobacter pylori, which infects half of the world's  population, is a major risk factor for the development of gastric diseases  including chronic gastritis and gastric cancer. Among H. pylori's virulence  factors is the cytotoxin-associated gene pathogenicity island (cagPAI),  which encodes for a type IV secretion system (T4SS). The T4SS induces fast  canonical nuclear factor-kappa B (NF-κB) signaling, a major factor  increasing inflammation, supressing apoptotic cell death and thereby  promoting the development of neoplasia. However, H. pylori's capability to  mediate fast non-canonical NF-κB signaling is unresolved, despite a  contribution of non-canonical NF-κB signaling to gastric cancer has been  suggested. We analyzed signaling elements within non-canonical NF-κB in  response to H. pylori in epithelial cell lines by immunoprecipitation,  immunoblot, electrophoretic mobility shift assay and RNA interference  knockdown. In addition, tissue samples of H. pylori-infected patients were  investigated by immunohistochemistry. Here, we provide evidence for a  T4SS-dependent direct activation of non-canonical NF-κB signaling. We  identified the lymphotoxin beta receptor (LTβR) to elicit the fast release  of NF-κB inducing kinase (NIK) from the receptor complex leading to  non-canonical NF-κB signaling. Further, NIK expression was increased in  human biopsies of H. pylori-associated gastritis. Thus, NIK could represent  a novel target to reduce Helicobacter pylori-induced gastric inflammation  and pathology.                                                            

 

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Helicobacter pylori type IV secretion system and its adhesin subunit, CagL,  mediate potent inflammatory responses in primary human endothelial cellsTafreshi M. Guan J. Gorrell R.J. Chew N. Xin Y. Deswaerte V. Rohde M. Daly  R.J. Peek R.M. Jenkins B.J. Davies E.M. Kwok T.Frontiers in Cellular and Infection Microbiology (2018) 8:FEB Article  Number: 22. Date of Publication: 6 Feb 2018The Gram-negative bacterium, Helicobacter pylori, causes chronic gastritis,  peptic ulcers, and gastric cancer in humans. Although the gastric epithelium  is the primary site of H. pylori colonization, H. pylori can gain access to  deeper tissues. Concurring with this notion, H. pylori has been found in the  vicinity of endothelial cells in gastric submucosa. Endothelial cells play  crucial roles in innate immune response, wound healing and tumorigenesis.  This study examines the molecular mechanisms by which H. pylori interacts  with and triggers inflammatory responses in endothelial cells. We observed  that H. pylori infection of primary human endothelial cells stimulated  secretion of the key inflammatory cytokines, interleukin-6 (IL-6) and  interleukin-8 (IL-8). In particular, IL-8, a potent chemokine and angiogenic  factor, was secreted by H. pylori-infected endothelial cells to levels ~10-  to 20-fold higher than that typically observed in H. pylori-infected gastric  epithelial cells. These inflammatory responses were triggered by the H.  pylori type IV secretion system (T4SS) and the T4SS-associated adhesin CagL,  but not the translocation substrate CagA. Moreover, in contrast to integrin  α(5)β(1) playing an essential role in IL-8 induction by H. pylori upon  infection of gastric epithelial cells, both integrin α(5)β(1) and integrin  α(v)β(3) were dispensable for IL-8 induction in H. pylori-infected  endothelial cells. However, epidermal growth factor receptor (EGFR) is  crucial for mediating the potent H. pylori-induced IL-8 response in  endothelial cells. This study reveals a novel mechanism by which the H.  pylori T4SS and its adhesin subunit, CagL, may contribute to H. pylori  pathogenesis by stimulating the endothelial innate immune responses, while  highlighting EGFR as a potential therapeutic target for controlling H.  pylori-induced inflammation.                                                            

 

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Recurrence of infection and diversity of Helicobacter pylori strains in an  adult population in Mexico treated with empirical standard triple therapyRecurrencia de infección y diversidad de cepas de Helicobacter pylori en  adultos tratados con terapia triple estándar empírica en una población de  MéxicoSánchez-Cuén J.A. Irineo-Cabrales A.B. León-Sicairos N.M. Calderón-Zamora L.  Monroy-Higuera L. Canizalez-Román V.A.Revista Espanola de Enfermedades Digestivas (2017) 109:11 (749-756). Date of  Publication: 1 Nov 2017Background: After eradication treatment for Helicobacter pylori (H. pylori),  infection could recur due to recrudescence or re-infection. The objective of  this study was to determine the recurrence of H. pylori infection and  identify virulent H. pylori strains one year after eradication with standard  triple therapy. Material and methods: A quasi-experimental study was  performed that included a patient population with digestive diseases  associated with H. pylori who had received standard triple therapy. Cultures  and polymerase chain reaction (PCR) was performed on gastric biopsies for  strain identification in all patients prior to eradication treatment and  those with a positive carbon-14 breath test one year after eradication  treatment. Statistical analysis was performed using the Student’s t-test and  Fisher’s exact test; statistical significance was set at 0.05. Results: One  hundred and twenty-eight patients were studied, 51 (39.8%) were male and 77  (60.2%) were female with an average age of 54.8 years (DE 13.8). There was  an annual recurrence of H. pylori infection in 12 (9.3%) patients. An annual  re-infection and recrudescence occurred in nine (7%) and three (2.3%)  patients respectively. The recrudescence rate for antigenic protein (cagA)  was 1/30 (3.3%) patients and 2/112 (1.8%) patients for vacuolating cytotoxin  (vacA). The re-infection rate for cagA was 3/30 (10%) patients and 6/112  (5.3%) patients for vacA. Conclusions: The recurrence of infection in this  study was higher than that                                                            RECORDed in developed countries with a low  prevalence of H. pylori and lower than that                                                            RECORDed in developing countries  with a higher prevalence of H. pylori. The cagA or vacA s2/m2 strains were  isolated after re-infection and recrudescence.                                                            

 

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First-line treatment of Helicobacter pylori in Lebanon: Comparison of  bismuth-containing quadruple therapy versus 14-days sequential therapyTarhini M. Fayyad-Kazan M. Fayyad-Kazan H. Mokbel M. Nasreddine M. Badran B.  Kchour G.Microbial Pathogenesis (2018) 117 (23-26). Date of Publication: 1 Apr 2018Helicobacter Pylori (H. Pylori) is the most common cause of peptic ulcer  disease (PUD) and represents a strong risk factor for gastric cancer.  Treatment of H. Pylori is, therefore, a persistent need to avoid serious  medical complications. Resistance to antibiotics remains to be the major  challenge for H. Pylori eradication. In this study, we determined the  prevalence of H. pylori infection and evaluated H. pylori eradication  efficacy of bismuth-containing quadruple therapy (Pylera) versus 14-days  sequential therapy in treatment naïve-Lebanese patients. 1030 patients,  showing symptoms of peptic ulcer (PU) and gastritis, underwent (14)C-Urea  Breath Test and esophagogastroduodenoscopy to examine H. Pylori infection  and gastrointestinal disorders. Among the H. Pylori-positive patients 60  individuals were randomly selected, separated into two groups (each  consisting of 30 patients) and treated with either bismuth-containing  quadruple therapy or 14-days sequential therapy. We show that of the 1050  patients tested: 46.2% were H. pylori-positive, 55% had gastritis, 46.2% had  both gastritis and H. pylori infection, 8.8% had gastritis but no H. pylori  infection, 44.9% had neither gastritis nor H. pylori infection. Following  the 14-days sequential therapy, the eradication rate was significantly  higher than that obtained upon using bismuth-containing quadruple therapy  [80% (24/30) versus 50% (15/30), χ(2) = 5.93, P = 0.015]. In conclusion, we  determined H. pylori and gastritis prevalence among Lebanese PU-patients and  showed that 14-days sequential therapy is more efficient than  bismuth-containing quadruple therapy in terms of H. Pylori-eradication.                                                            

 

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First-Line Helicobacter pylori Eradication in Patients with Chronic Kidney  Diseases in TaiwanLiang C.-M. Chiu C.-H. Wang H.-M. Tai W.-C. Yao C.-C. Tsai C.-E. Kuo C.-M.  Chiu Y.-C. Wu K.-L. Lee C.-H. Tsai K.-L. Huang C.-F. Chuah S.-K.BioMed Research International (2017) 2017 Article Number: 3762194. Date of  Publication: 2017Aims. Patients with chronic kidney disease (CKD) and Helicobacter pylori (H.  pylori) infection have a higher incidence of gastroduodenal diseases and  therefore are recommended to receive eradication therapies. This study aimed  to assess the efficacy of a 7-day standard triple therapy in patients with  CKD (eGFR < 60 ml/min/1.73 m(2)) and to investigate the clinical factors  influencing the success of eradication. Methods. A total of 758 patients  with H. pylori infection receiving a 7-day standard first-line triple  therapy between January 1, 2013, and December 31, 2014, were recruited.  Patients were divided into two groups: CKD group ( = 130) and non-CKD group  ( = 628). Results. The eradication rates attained by the CKD and non-CKD  groups were 85.4% and 85.7%, respectively, in the per-protocol analysis ( =  0.933). The eradication rate in CKD stage 3 was 84.5% (82/97), in stage 4  was 88.2% (15/17), and in those who received hemodialysis was 87.5% (14/16).  There were no significant differences in the various stages of CKD ( =  0.982). The adverse events were similar between the two groups (3.1% versus  4.6%, = 0.433). Compliance between the two groups was good (100.0% versus  99.8%, = 0.649). There was no significant clinical factor influencing the H.  pylori eradication rate in the non-CKD and CKD groups. Conclusions. This  study suggests that the H. pylori eradication rate and adverse rate in  patients with CKD are comparable to those of non-CKD patients.                                                            

 

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Helicobacter pylori infection increases sirt2 gene expression in gastric  epithelial cells of gastritis patientsZandi S. Hedayati M.A. Mohammadi E. Sheikhesmaeili F.Microbial Pathogenesis (2018) 116 (120-123). Date of Publication: 1 Mar 2018Background: Helicobacter pylori Infection causes some clinical features of  the human stomach such as gastritis, duodenal ulcer, and gastric cancer. It  has been shown that Helicobacter pylori infection increases proinflammatory  cytokine gene expressions in Gastric Epithelial Cells by activation of NF-kB  signaling. Sirt1 and sirt2 as deacetylases play a certain role in the  progress of inflammation in arthritis and lung infection by impacting the  NF-kB. Aims: Sirt1 and sirt2 gene expressions in Gastric Epithelial cells of  gastritis patients were surveyed with and without Helicobacter pylori  infection and rate of prevalence of cagA and hopQ genes in Helicobacter  pylori strains were investigated. Methods: 25 biopsy samples of gastritis  patients with Helicobacter pylori infection and 25 biopsy samples of  gastritis patients without Helicobacter pylori infection were collected from  Tohid Hospital in the city of Sanandaj throughout the year 2016. CDNA was  made from total RNA extracted from biopsy samples (Qiagen(®) Kit). Sirt1 and  sirt2 gene expressions were determined using the Corbett machine (Rotor-Gene  6000 Software). CagA and hopQ genes of Helicobacter pylori strains were  determined by PCR using specific primers. Results: The sirt2 gene expression  was increased in Gastric Epithelial Cells of gastritis patients with  Helicobacter pylori infection. No significant relationship was found between  sirt1 and sirt2 gene expressions as well as cagA and hopQ as Helicobacter  pylori virulence genes. Conclusions: This study shows the Helicobacter  pylori infection duo to sirt2 gene up-expression. There is not a  statistically significance relationship between cagA and hopQ Helicobacter  pylori genotypes and sirt2 gene up-expression in Gastric Epithelial Cells of  gastritis patients.                                                             

 

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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 (2018) 74:1. Date of Publication:  1 Jan 2018Background: 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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The Effect of Psychological Stress on Mucosal IL-6 and Helicobacter pylori  Activity in Functional DyspepsiaDarwin E. Murni A.W. Nurdin A.E.Acta medica Indonesiana (2017) 49:2 (99-104). Date of Publication: 1 Apr  2017BACKGROUND: pathophysiology of functional dyspepsia remains poorly  understood. Many factors such as gastric motility disorder, visceral  hypersensitivity, Helicobacter pylori (Hp) infection, psychological stress  and excessive gastric acid secretion play roles in this symptom.  Psychological stress may promote peptic ulcer and has an effect on  ulcers-associated Hp. This study aimed to determine Helicobacter pylori  activity and expression of mucosal IL-6 and their association with  psychological stress.METHODS: a cross-sectional study was done among 40  outpatients with dyspeptic syndromes in M. Djamil General Hospital and  two-community health centers in Padang. The subjects were divided into two  groups, with and without psychological stress, which were identified using  DASS 42. Gastric biopsy specimens and peripheral blood samples were taken  while performing esophagogastroduodenoscopy. Immunohistochemistry methods  was used to determine the expression of IL-6 and Hp in gastric mucosa. The  correlation of each variable in the group experiencing psychological stress  and non-stress was analyzed using Chi-square test.RESULTS: there were 40  patients with functional dyspepsia with average age of 37.58(SD 11.82) years  old. The cortisol levels were significantly different between both groups  (non-stress vs. stress groups); moreover, morning cortisol level in  psychological stress group was higher beyond normal limit. Inter-Leukin-6  expression, as the evidence of inflammatory activity, seemed higher in  non-stress group than the group with psychological stress (8.25% vs. 7.25%).  Helicobacter pylori activity was seemed to be increased in the stress group  as characterized by higher numbers of invasion to the sub mucosa epithelium  compared to the non-stress group (11 vs. 7 subjects).CONCLUSION:  psychological stress seems to have no correlation with IL-6 in gastric  mucous of patients with functional dyspepsia; however, there is an evidence  of increasing activity of Helicobacter pylori.                                                             

 

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Protein profiling of infected human gastric epithelial cells with an Iranian  Helicobacter pylori clinical isolateFazeli Z. Alebouyeh M. Mansouri V. Malekpour H.Gastroenterology and Hepatology from Bed to Bench (2017) 10 Supplement 1  (S139-S145). Date of Publication: 2017Aim: The main objective of this study was to use high throughput approach to  characterize the response of human gastric epithelial cells to Helicobacter  pylori (H. pylori) infection at protein level. Background: Alteration of  host cell protein profiles occurs due to H. pylori infection. This  alteration seems to be strain specific. High throughput approaches, such as  proteomics, can describe changes that occurs at the protein levelin the  infected cells in response to H. pylori infection. In accordance with this  point of view, we used two dimensional electrophoresis (2-DE)/MS to  determine changes in proteome profile of gastric epithelial cells infected  with a clinical isolate of H. pylori from an Iranian patient. Methods: Human  gastric epithelial cells (AGS) were infected by an Iranian H. pylori isolate  (complete cagPAI, vacA s2m2, babA2, iceA1, sabA). The altered protein  patterns separated by 2-DE were identified by matrix-assisted laser  desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS)  analysis. Results: The results showed 40 spots with significantly different  intensities between the 2-DE gels. Protein SETSIP and Endoplasmic reticulum  resident protein 29 were identified by MALD-TOF and Mascot search. Proteomic  analysis for functional roles of these proteins showed that mechanisms to  deal with stress conditions and transcriptional activator related to cell  reprogramming are involved in H. pylori infection. Conclusion: Using high  throughput approaches, such as proteomics, we can provide further molecular  details about interaction of H. pylori strains with the infected cells at  protein level.                                                             

 

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Decreased MicroRNA miR-181c Expression Associated with Gastric CancerZabaglia L.M. Bartolomeu N.C. dos Santos M.P. Peruquetti R.L. Chen E. de  Arruda Cardoso Smith M. Payão S.L.M. Rasmussen L.T.Journal of Gastrointestinal Cancer (2018) 49:1 (97-101). Date of  Publication: 1 Mar 2018Purpose: This study investigated miRNA-181c expression in control patients  (healthy gastric mucosa), patients with gastritis, and patients with gastric  cancer. The presence of Helicobacter pylori was determined, and the  associations between H. pylori infection, levels of miRNA-181c expression,  and gastric disease were also analyzed. Methods: A total of 158 subjects  were included in the study, and the three groups were respectively composed  of 53 controls, 86 patients with gastritis, and 19 patients with gastric  cancer. miRNA-181c expression and H. pylori infection were determined by  quantitative real-time PCR and PCR, respectively. The subsequent target gene  analysis was performed using the bioinformatics approach to understand the  possible mechanisms of gastric cancer. Results: We determined significantly  lower miRNA-181c expression in the gastric cancer group when compared to the  control and gastritis groups, regardless of the presence of H. pylori. There  was no difference in miRNA-181c expression between the control group and  gastritis group, whether the presence of H. pylori was considered or not.  The bioinformatics approach identified several genes as possible targets for  miRNA-181c, including the X-linked inhibitor of apoptosis (XIAP) gene (which  encodes a protein that belongs to a family of apoptotic suppressor  proteins), the caspase 9 gene, and the caspase 3 gene. All target genes  identified may be involved in gastric cancer and apoptosis pathways.  Conclusion: The results suggest that the presence of H. pylori has no  influence on microRNA expression and that the downregulation of miR-181c may  play an important role in gastric cancer progression by controlling  important genes associated with apoptosis. Therefore, miRNA-181c may be a  potential marker of gastric cancer.                                                             

 

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Helicobacter pylori cagA gene polymorphism in patients with gastroduodenal  diseasesChowdhury M. Ahmed S. Khan A.M. Tarafdar S. Miah R.A.Bangladesh Medical Research Council Bulletin (2017) 43:1 (37-43). Date of  Publication: 2017Helicobacter pylori is a genetically diverse bacterial pathogen and its CagA  gene is a major virulence factor that plays an important role in  gastroduodenal pathologies. The biological function of cagA depends on  tyrosine phosphorylation within the EPIYA  (Glutamate-Proline-Isoleucine-Tyrosine-Alanine) motifs at the C-terminal  region of the protein. This region may undergo polymorphism to give  different types of EPIYA motifs. EPIYA motif diversity may provide a useful  tool for prediction of H. pylori pathogenic activity and accurate  determination of number and type of cagA EPIYA motifs could identify the  virulent H. pylori. The aim of this study was to detect H. pylori cagA gene  and its polymorphism in endoscopic gastroduodenal biopsy specimen from  patients with gastroduodenal diseases in Bangladesh. This cross sectional  study was carried out in the Department of Microbiology & Immunology,  Bangabandhu Sheikh Mujib Medical University and Center for Advanced Research  in Sciences, University of Dhaka during the period from March 2014 to  February 2015. Gastric biopsies were collected from 78 patients with  gastritis, duodenal ulcer, gastric ulcer and gastric carcinoma. H. pylori  was identified by rapid urease test and ureC gene PCR. Presence of cagA gene  and number and pattern of cagA EPIYA motif were determined by PCR. DNA  sequencing was carried out to confirm the PCR detection method of cagA EPIYA  motif and to analyse their peptide sequence. Among 31(39.7%) H. pylori  positive cases, 19 (61.3%) were cagA gene positive in 11(55%) gastritis,  4(66.7%) duodenal ulcer, 2(66.7%) gastric ulcer and 2(100%) gastric  carcinoma. A significant association was found between cagA gene and  duodenal ulcer (p=0.05). EPIYA motif of all H. pylori cagA positive cases  showed Western type cagA EPIYA ABC. No East Asian EPIYA ABD motif was found.  Majority of gastroduodenal cases (57.9%) had 3 copies of EPIYA (ABC type),  26.3% had 4 copies (ABCC type) while remaining 10.5% had AC and 5.2% AB type  EPIYA motif. EPIYA ABC was found in 75% of duodenal ulcer followed by 54.5%  of gastritis and 50% of both gastric ulcer and gastric carcinoma patients.  EPIYA ABCC motif was found in 50% of gastric ulcer and gastric carcinoma  patients. Most of the EPIYA motif was EPIYA ABC and some were ABCC which has  the risk of developing gastric carcinoma.                                                             

 

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Helicobacter pylori eradication may influence timing of endoscopic  surveillance for gastric cancer in patients with gastric precancerous  lesions: A retrospective studyDore M.P. Cipolli A. Ruggiu M.W. Manca A. Bassotti G. Pes G.M.Medicine (2018) 97:4 (e9734). Date of Publication: 1 Jan 2018Chronic atrophic gastritis and intestinal metaplasia related to Helicobacter  pylori infection, are major risk factors for gastric adenocarcinoma.  Eradication of H pylori and endoscopy surveillance of precancerous lesions  may reduce the risk and/or lead to early detection of gastric cancer  improving survival. In this study, the progression of precancerous lesions  after H pylori treatment was evaluated.Patients with incomplete or complete  intestinal metaplasia and/or gastric atrophy at the index endoscopy, were  examined for the extension/histological worsening of precancerous lesions at  the endoscopy surveillance for gastric cancer. Progression of lesions was  evaluated according to H pylori status, age, and sex. Cox proportional  hazard regression model and Kaplan-Meier curves were used to evaluate the  strength of predictors for lesions progression.Among 105 patients (61 women)  H pylori negative patients showed a milder worsening of gastric lesions  between index and surveillance endoscopy compared with patients positive for  the infection (log-rank test: P < .0001, P = .012, and P = .032 for antrum,  angulus, and corpus, respectively). The Cox regression model showed  persistence of H pylori infection (hazard ratio = 4.436; P < .0001) as the  only relevant factor for lesion progression, whereas age >65 years and sex  were not significant predictors.According to literature our results  demonstrate that H pylori eradication is the major factor able to delay  gastric precancerous lesions progression. Time interval for endoscopic  surveillance in patients negative for H pylori infection and with gastric  precancerous lesions may be extended.                                                             

 

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Autoimmunity and gastric cancerBizzaro N. Antico A. Villalta D.International Journal of Molecular Sciences (2018) 19:2 Article Number: 377.  Date of Publication: 1 Feb 2018Alterations in the immune response of patients with autoimmune diseases may  predispose to malignancies, and a link between chronic autoimmune gastritis  and gastric cancer has been reported in many studies. Intestinal metaplasia  with dysplasia of the gastric corpus-fundus mucosa and hyperplasia of  chromaffin cells, which are typical features of late-stage autoimmune  gastritis, are considered precursor lesions. Autoimmune gastritis has been  associated with the development of two types of gastric neoplasms:  intestinal type and type I gastric carcinoid. Here, we review the  association of autoimmune gastritis with gastric cancer and other autoimmune  features present in gastric neoplasms.                                                             

 

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Esophageal Squamous Papilloma in a Pediatric Patient With Helicobacter  pylori GastritisYang Q. Stefanovici C. Mujawar Q. El–Matary W.Pediatric and Developmental Pathology (2018) 21:1 (105-106). Date of  Publication: 1 Jan 2018                                                             

 

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Caveats in the work-up of iron deficiency anaemiaJolobe O.M.P.European Journal of Internal Medicine (2018) 48 (e38). Date of Publication:  1 Feb 2018                                                             

 

RECORD 29

 

Helicobacter pylori treatment: antibiotics or probioticsGoderska K. Agudo Pena S. Alarcon T.Applied Microbiology and Biotechnology (2018) 102:1. Date of Publication: 1  Jan 2018Treatment 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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Meta-analysis: High-dose vs. low-dose metronidazole-containing therapies for  Helicobacter pylori eradication treatmentJi Y. Lu H.PLoS ONE (2018) 13:1 Article Number: e0189888. Date of Publication: 1 Jan  2018Objective: The purpose of this study was to evaluate the efficacy of high  dose of metronidazole in the treatment of Helicobacter pylori (H. pylori)  infection. Methods Studies were identified from databases (Pubmed, Embase,  Cochrane Library, ClinicalTrials. gov) searched from January 1990 to  September 2017 using a battery of keywords. We included randomized  controlled trials (RCTs) of H. pylori treatment comparing the high-dose and  low-dose metronidazole-containing therapies (high-dose and low-dose  therapies). Two reviewers independently selected studies, extracted relevant  data and assessed study quality. A meta-analysis was performed by using  Review Manager 5.3. Dichotomous data were pooled to obtain the relative risk  (RR) of the eradication rate, with 95% confidence intervals (CIs). Results  Four randomized controlled trials, a total of 612 patients with a diagnosis  of H. pylori infection were included. Overall the meta-analysis showed that  both high-dose and low-dose therapies achieved similar efficacy of  intention-to-treat (ITT) eradication rate 82% vs. 76%, RR 1.12 (95%CI: 0.96  to 1.30), P = 0.15, and adherence 94% vs. 94%, RR 1.00 (95%CI: 0.97 to  1.04), P = 0.81, but side effects were more likely in high-dose therapies  [32% vs. 17%, RR 1.84 (95%CI: 1.17 to 2.88), P = 0.008]. In subgroup  analysis, increasing the dose of metronidazole enhanced eradication rates in  areas with high metronidazole resistance [74% vs 52%, RR 1.40 (95%CI: 1.08  to 1.82), P = 0.01] and in individuals with metronidazole-resistant strains  [71% vs. 46%, RR 1.50 (95%CI: 1.02 to 2.19), P = 0.04]. Conclusions Both  high-dose and low-dose therapies can achieve similar eradication rates and  adherence and generally low-dose therapies cause fewer side effects. In  populations with high metronidazole resistance, high dose of metronidazole  can increase the eradication rates of H. pylori infection.                                                             

 

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Inappropriate treatment in Helicobacter pylori eradication failure: a  retrospective studyLi H. Liang X. Chen Q. Zhang W. Lu H.Scandinavian Journal of Gastroenterology (2018) 53:2 (130-133). Date of  Publication: 1 Feb 2018Background: In recent years, success rates of empirical H. pylori therapies  have fallen in many countries. Although antibiotic resistance and poor  adherence are described as the main factors for treatment failure, in China,  iatrogenic factors also play an important role. Objective: To investigate  why patients experienced multiple failures, we performed a retrospective,  single center study using questionnaires to identify causes of treatment  failure other than antibiotic resistance. Methods: This study was conducted  from January 2016 to July 2017 in a general hospital. Patients with at least  two H. pylori treatment failures who completed the questionnaire were  entered. The survey covered characteristics of the study population,  regimens used, and adherence to therapy. Results: Two hundred and ninety  three patients were included in the final analysis. The top three most  antibiotic combinations as the first-line treatment were a PPI plus  clarithromycin–metronidazole (24.6%, 72/293), clarithromycin–levofloxacin  (23.5%, 69/293) and clarithromycin–amoxicillin (21.5%, 63/293).  Clarithromycin-containing regimens were repeatedly used in 178 patients  (60.8%) and levofloxacin-containing regimens repeatedly in 88 patients  (30.0%). Fifty patients (17.1%) had poor adherence per treatment history and  32 (10.9%) stopped treatment because of nonmedical reasons. Conclusions: In  order to increase the success of H. pylori eradication therapy, the effect  of prior therapies needs to be given more consideration. Patient education  to enhance adherence also needs to be improved.                                                             

 

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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 (2018) 28:3 (743-747). Date of Publication: 1 Mar 2018Aims 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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A real life study of Helicobacter pylori eradication with bismuth quadruple  therapy in naïve and previously treated patientsErradicación de helicobacter pylori con terapia cuádruple con bismuto en  pacientes naïve y fracasos previos: Experiencia en la práctica clínica realGómez-Rodríguez B.J. Castro-Laria L. Argüelles-Arias F. Castro-Márquez C.  Caunedo-Álvarez Á. Romero Gómez M.Revista Espanola de Enfermedades Digestivas (2017) 109:8 (552-558). Date of  Publication: 1 Aug 2017Objective: To evaluate the efficacy and safety of a quadruple regimen (BMTO)  of the “3-in-1 capsule” (containing bismuth subcitrate potassium,  metronidazole and tetracycline) plus omeprazole in naïve and previously  treated patients diagnosed with Helicobacter pylori (H. pylori) infection in  the clinical setting in Seville (Spain). Methods: This is a prospective  study carried out on consecutive patients with a confirmed H. pylori  infection and upper gastrointestinal symptoms. After providing their  informed consent, the patients were treated for ten days with a 3-in-1  capsule containing bismuth subcitrate potassium (140 mg), metronidazole (125  mg) and tetracycline (125 mg: Pylera®), three capsules four times daily,  plus omeprazole (20 or 40 mg) twice daily. Eradication of infection was  determined by a negative urea breath test at least 28 days after the end of  treatment. Results: A total of 58 consecutive patients were enrolled into  this study, two of whom withdrew early due to vomiting on days three and  five, respectively. In this cohort, 17 patients (29.3%) had a prior history  of medication to treat H. pylori. In the intent-to-treat population,  eradication was achieved in 97.6% (40/41) and 82.4% (14/17) of cases in  patients treated with BMTO as a first-line or rescue therapy, respectively.  At least one adverse event was reported by 28 (48%) patients, mostly mild  effects (86%). Conclusion: A ten day treatment with BMTO is an effective and  safe strategy to combat confirmed H. pylori infection in patients.                                                             

 

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Helicobacter pylori moderates the association between 5-MTHF concentration  and cognitive function in older adultsBerrett A.N. Gale S.D. Erickson L.D. Brown B.L. Hedges D.W.PLoS ONE (2018) 13:1 Article Number: e0190475. Date of Publication: 1 Jan  2018Objective To explore potential interactions between folate-cycle factors and  Helicobacter pylori seropositivity in the prediction of cognitive function.  Methods We used data obtained from the 1999–2000 continuous National Health  and Nutrition Examination Survey produced by the United States’ Centers for  Disease Control and Prevention. Using Ordinary Least Squares regression, we  tested for associations between multiple folate-cycle factors, Helicobacter  pylori seropositivity, and cognitive function assessed by the digit symbol  coding subtest of the Wechsler Adult Intelligence Scale-III. We then tested  for interactions between each of the folate-cycle factors and Helicobacter  pylori in the prediction of cognitive function. Results Although  Helicobacter pylori seropositivity, 5-methyltetrahydrofolate, vitamin B-12,  and homocysteine were not associated with performance on the digit symbol  coding task, Helicobacter pylori seropositivity interacted with  5-methyltetrahydrofolate concentration to predict performance on the digit  symbol coding task. The Helicobacter pylori seropositive group performed  worse on the digit symbol coding task as 5-methyltetrahydrofolate  concentration decreased. Conclusion The interaction between Helicobacter  pylori seropositivity and reduced folate-cycle factor  5-methyltetrahydrofolate might impair aspects of cognitive function.                                                             

 

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Construction and optimization of pH-sensitive nanoparticle delivery system  containing PLGA and UCCs-2 for targeted treatment of Helicobacter pyloriLuo M. Jia Y.-Y. Jing Z.-W. Li C. Zhou S.-Y. Mei Q.-B. Zhang B.-L.Colloids and Surfaces B: Biointerfaces (2018) 164 (11-19). Date of  Publication: 1 Apr 2018The acidic environment of the stomach is a threat to the curative effect of  antimicrobial drugs for the eradication of Helicobacter pylori (H. pylori)  in the infected area. The conventional clinical formulations of antibiotics  have low specificity to H. pylori, which disrupts the normal balance of  intestinal microbiomes. Therefore, oral drug delivery system with better  stability at low pH as well as higher specificity to target H. pylori would  provide more effective strategy to eradicate H. pylori and reduce the side  effect of antibiotics. Based on the construction of UreI-mediated targeted  drug delivery system developed by our group, in this work, using  urea-modified UCCs-2 as targeting moiety to the UreI channel protein which  is specifically expressed on H. pylori, pH-sensitive amoxicillin-loaded  AMX-PLGA/UCCs-2 nanoparticles produced by UCCs-2 and PLGA for targeted  treatment of H. pylori infection were established. The nanoparticles were  prepared by double emulsion-solvent evaporation method. To achieve a  promising drug delivery system with favorable pH-sensitive properties, we  adopted an orthogonal design to obtain the optimal formulation. The results  showed that the optimized AMX-PLGA/UCCs-2 nanoparticles were in a favorable  pH sensitive manner and exhibited low cytotoxicity, higher specificity and  better anti-H. pylori efficiency than amoxicillin and non-targeting  AMX-PLGA/Cs nanoparticle both in vitro and in vivo, which can protect the  antimicrobial drugs against acidic environment and deliver them to targeted  eradicate H. pylori in the infected location. The cellular uptake mechanism  showed that AMX-PLGA/UCCs-2 nanoparticles are an effective UreI-mediated  targeted drug delivery system for anti-H. pylori treatment, which can also  be used as promising nanocarriers for oral delivery of other therapeutic  drugs to targeted treat H. pylori.                                                             

 

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Analysis of the prevalence of helicobacter pylori in basan grande: A  medically underserved community in ecuadorHathaway B.A. Burchak A.Journal of Investigative Medicine (2018) 66:1 (188-189). Date of  Publication: 1 Jan 2018Purpose of study The aim of this study is to determine the prevalence of  Helicobacter pylori (H. pylori) in Basan Grande, a medically underserved  rural community in Ecuador, which is widely representative of the types of  rural communities in Ecuador that have little to no access to health care or  clean water and sanitation systems. Methods used This pilot study is an  observational, cross-sectional analysis of the prevalence of Helicobacter  pylori among residents of Basan Grande, Ecuador. An H. pylori blood-antibody  test was administered to consenting participants via a capillary stick to  obtain a positive or negative result. Participants included residents of  Basan Grande, in the Chimborazo Province of Ecuador, who visited the free  medical clinic and provided appropriate consent. Consenting residents of all  ages from Basan Grande were included. Patients residing outside the  Chimborazo Province were excluded from this study. Descriptive statistics  were run on collected data. Summary of results This study showed that the  prevalence of Helicobacter pylori was 59% among the residents of Basan  Grande, Ecuador. H. pylori was prevalent in 60.5% of female participants and  57.8% of male participants. H. pylori had the highest prevalence in  participants ages 26-50 years of age (67.4%) and was lowest in participants  ages 76-100 (11.1%). Stomach pain was a chief complaint in 25.6% of  participants (95% CI: 19.7% to 32.4%). Conclusions Notably, Helicobacter  pylori is prevalent in 59% of tested residents in rural Basan Grande,  Ecuador. Determining a causal relationship between H. pylori and the chief  complaint of 'stomach pain' requires further future investigative studies.  Programs directed at water sanitation are necessary in order to treat the  underlying source of H. pylori infection.                                                             

 

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First-Line Helicobacter pylori Eradication with Vonoprazan, Clarithromycin,  and Metronidazole in Patients Allergic to PenicillinSue S. Suzuki N. Shibata W. Sasaki T. Yamada H. Kaneko H. Tamura T. Ishii T.  Kondo M. Maeda S.Gastroenterology Research and Practice (2017) 2017 Article Number: 2019802.  Date of Publication: 2017Aim. To assess the efficacy of 7-day first-line Helicobacter pylori  eradication with vonoprazan (VPZ), clarithromycin (CAM), and metronidazole  (MNZ) in patients with penicillin allergy. Methods. Patients with penicillin  allergy, diagnosed with Helicobacter pylori infection and did not have  history of Helicobacter pylori eradication, were eligible for the study.  Twenty patients were prospectively treated with 20 mg VPZ twice daily, 200  or 400 mg CAM twice daily, and 250 mg MNZ twice daily for 7 days. We also  collected the data from 30 patients retrospectively treated with proton pump  inhibitor (PPI), CAM, and MNZ. Safety was evaluated in patients completing  an adverse effect questionnaire. Results. Both the intention-to-treat and  per-protocol effectiveness of VPZ-based eradication were 100% (95% CI:  86.1-100%; n=20). The eradication rates of PPI-based regimen were 83.3% (95%  CI: 65.3-94.4%) in the ITT and 82.7% (95% CI: 64.2-94.2%) in the PP  analyses. Abdominal fullness was more frequent in VCM compared to PCM.  However, all patients with VCM regimen had taken 100% of their course of  medication. Conclusion. Triple therapy with VPZ, CAM, and MNZ is well  tolerated and effective for eradicating Helicobacter pylori in patients  allergic to penicillin. This study was registered in the UMIN Clinical  Trials Registry as UMIN000016335.                                                             

 

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Vonoprazan: A Novel and Potent Alternative in the Treatment of Acid-Related  DiseasesYang X. Li Y. Sun Y. Zhang M. Guo C. Mirza I.A. Li Y.-Q.Digestive Diseases and Sciences (2018) 63:2 (302-311). Date of Publication:  1 Feb 2018Although proton pump inhibitors (PPIs) have been used widely, acid-related  diseases are still associated with a huge burden on the health care system.  Recently, the efficacy and safety of a new acid suppressant named vonoprazan  in the treatment of acid-related diseases have been evaluated by a series of  studies. As a novel potassium-competitive acid blocker, vonoprazan may  provide reversible acid suppression by preventing K(+) from binding to  gastric H(+)/K(+)-ATPase. It has been clinically used for the short-term  treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease  and Helicobacter pylori (H. pylori) infection in Japan. The healing rate of  GERD and gastric ulcers by vonoprazan is more than 95 and 90%, respectively;  also, it is effective in curing PPI-resistant GERD. It increases H. pylori  eradication rate to more than 88% as part of both first-line and second-line  therapy. It is also effective in the eradication of clarithromycin-resistant  H. pylori strains. All of these short-term studies show vonoprazan is safe  and well-tolerated. As a safe and effective acid inhibitor, vonoprazan might  be a novel alternative in the treatment of acid-related diseases.                                                             

 

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Functional Dyspepsia with Helicobacter pylori InfectionPribadi R.R. Syam A.F. Krisnuhoni E.Acta medica Indonesiana (2017) 49:2 (173-174). Date of Publication: 1 Apr  2017Helicobacter pylori infection is commonly found worldwide. In Indonesia, the  prevalence of H. pylori infection is 22.1%. The bacteria are responsible for  gastritis, peptic ulcer disease (PUD), and gastric cancer.Helicobacter  pylori may also has a role in functional dyspepsia. Diagnostic approach  consists of noninvasive and invasive examinations. One of the invasive  strategy is upper gastrointestinal (UGI) endoscopy and gastric mucosa  biopsy.                                                             

 

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Toll-like receptors are associated with helicobacter pylori infection and  gastric mucosa pathologySimawaranon T. Wattanawongdon W. Tongtawee T.Jundishapur Journal of Microbiology (2017) 10:12 Article Number: e58351.  Date of Publication: 1 Dec 2017Background: Toll-like receptors (TLRs) mediate recognition of Helicobacter  pylori and initiate the innate immune response to infection. Toll-like  receptors polymorphisms are thought to influence susceptibility to H. pylori  infection and H. pylori-related diseases. Objectives: To investigate the  association of TLR polymorphisms with the susceptibility to H. pylori  infection and various types of gastritis in Thai patients. Methods: The  single nucleotide polymorphisms (SNPs) TLR1 rs4833095, TLR2 rs3804099 and  rs3804100, TLR4 rs10759932 and TLR10 rs10004195 were analysed in 400  gastritis patients by real-time PCR using a TaqMan SNP Genotyping Assay. The  association between TLR polymorphisms and the risk of H. pylori infection  was investigated in 196 uninfected and 204 H. pylori-infected patients. The  associations between TLR genotypes and the risk of gastric pathology  changes, including chronic gastritis (N = 312 cases) and precancerous  gastric lesions/gastric cancer (GC) (N = 88 cases), were examined.  Univariate analysis was used to determine odds ratios (ORs) with confidence  intervals (95% CIs). Results: Patients with the CC -or TT homozygous  genotype for TLR1 rs4833095 had a significantly increased risk of H. pylori  susceptibility (OR = 2.28, 95% CI = 1.27 - 7.60, P = 0.02 andOR= 1.34, 95%  CI = 0.97-1.86, P = 0.04, respectively). Patients with the AA homozygous  genotype for TLR10 rs10004195 had a significantly increased risk of H.  pylori susceptibility (OR = 1.28, 95% CI = 0.98 - 1.76, P = 0.01) and  exhibited a significantly increased risk of precancerous gastric lesions/GC  (OR = 8.75, 95% CI = 2.78 - 14.24, P < 0.01). Conclusions: Our findings  suggest that the TLR1 rs4833095 and TLR10 rs10004195 polymorphisms are  potential genetic risk factors that modify the H. pylori infection  susceptibility and influence the clinical manifestation of chronic  gastritis, precancerous gastric lesions and GC in Thai patients.                                                             

 

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Modulation of quantum dots and clearance of Helicobacter pylori with synergy  of cell autophagyHuang Y. Deng X. Lang J. Liang X.Nanomedicine: Nanotechnology, Biology, and Medicine (2018) 14:3 (849-861).  Date of Publication: 1 Apr 2018Helicobacter pylori (Hp) is one type of Gram-negative pathogenic bacterium  that colonizes and causes a wide range of gastric diseases. Once Hp  penetrates into cells, the currently recognized triple or quadruple therapy  often loses effectiveness. Recent evidence suggests that autophagy is  closely associated with Hp infection, and can play an important role in the  eradication of Hp. More importantly, certain types of quantum dots (QDs) can  induce and modulate cellular autophagy, and can be developed into conjugates  making QDs potential candidates as new anti-Hp agents.                                                             

 

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A link between platelet to lymphocyte ratio and Helicobacter pylori  infectionFarah R. Hamza H. Khamisy-farah R.Journal of Clinical Laboratory Analysis (2018) 32:1 Article Number: e22222.  Date of Publication: 1 Jan 2018Purpose: Chronic Helicobacter pylori gastritis affects two-thirds of the  world's population and is one of the most common chronic inflammatory  disorders of humans, the infection clearly results in chronic mucosal  inflammation in the stomach and duodenum, which, in turn, might lead to  abnormalities in gastroduodenal motility and sensitivity and is the most  frequent cause of dyspepsia and peptic disease. Some studies showed that  there was a correlation between low-grade inflammation as CRP and HP  infection. The purpose of this study was to investigate the relationship  between the presence of HP infection and platelet/lymphocyte ratio (PLR).  Method: A total of 200 patients who met the HP criteria and 180 age- and  gender-matched control subjects were included in this randomized controlled  trial. Patients were diagnosed to have HP according stomach biopsy and urea  breath test, PLR was calculated from complete blood count at time of  diagnosis and before initiating the treatment. Results: Patients with HP  infection had significantly higher PLR compared to those without HP.  Moreover, the patients with symptomatic HP had higher PLR than those with  asymptomatic HP. While PLR increased as the severity of HP symptoms  increased (r=.452, P<.001). Conclusion: Our study indicated, for the first  time, a significant association between HP infection and symptoms based on  PLR, a simple and reliable indicator of inflammation. Furthermore, there an  increase in PLR as the severity of HP increases.                                                             

 

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Refractory gastric antral ulcers without Helicobacter pylori infection and  non-steroidal anti-inflammatory drugsNishie H. Kataoka H. Kato H. Suzuki T. Ichikawa H. Nojiri Y. Kitagawa M.  Inagaki Y. Iwasaki H. Tanaka M. Katano T. Okamoto Y. Ozeki K. Mizoshita T.  Shimura T. Kubota E. Tanida S. Joh T.Clinical Journal of Gastroenterology (2018) (1-6). Date of Publication: 16  Feb 2018Herein, we describe a rare case of refractory gastric antral ulcers. A woman  in her 50 s was admitted to Nagoya City University Hospital with epigastric  pain after being diagnosed with gastric antral submucosal tumor at another  hospital. Findings from esophagogastroduodenoscopy and endoscopic ultrasound  examination revealed that the lesion was a gastric ulcer. The patient had no  Helicobacter pylori infection and no recent history of using non-steroidal  anti-inflammatory drugs. On the basis of these findings, we diagnosed this  as a case of refractory gastric antral ulcer (RGAU). RGAU is considered a  new disease concept and detailed analyses are expected in the future.                                                             

 

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Management of multi-drug resistant Helicobacter pylori infection by  supplementary, complementary and alternative medicine; a reviewRezaeimanesh N. Farzi N. Pirmanesh S. Emami S. Yadegar A.Gastroenterology and Hepatology from Bed to Bench (2017) 10 Supplement 1  (S8-S14). Date of Publication: 2017Helicobacter pylori is recognized as the most common bacterial pathogens  colonizing the gastric epithelium of nearly half of the world's population.  This bacterium is the main etiological cause of gastroduodenal ulcers, and  more importantly as the substantial risk factor for development of gastric  cancer. The emergence and rapid increase in the prevalence of multi-drug  resistant phenotypes have posed major pitfalls in effectiveness of various  treatment regimens and eradication strategies against H. pylori infections.  Several natural products and supplementary food components have been  reported to have established anti-H. pylori activity. Herein, we review the  application and efficacy of some specific natural products and foodstuffs  such as milk, bee products (honey and propolis), fish oil, vitamins C and E,  and also a nickel free-diet used as anti-H. pylori alternative treatment  regimens.                                                             

 

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T cell subsets play an important role in the determination of the clinical  outcome of Helicobacter pylori infectionJafarzadeh A. Larussa T. Nemati M. Jalapour S.Microbial Pathogenesis (2018) 116 (227-236). Date of Publication: 1 Mar 2018Helicobacter pylori (H. pylori) is one of the most prevalent human pathogen  and a persistent infection with this bacterium causes common pathologies,  such as gastritis or peptic ulcers, and also less common but more serious  pathologies, such as gastric cancer or gastric mucosa-associated lymphoid  tissue (MALT) lymphoma. The clinical outcome of gastrointestinal infection  sustained by H. pylori is determined by the reciprocal interactions between  virulence factors of the bacterium and host factors, including immune  response genes. Although H. pylori induces a strong immune response, the  bacterium is not eliminated. The eradication failure could be attributed to  the bacterial capability to regulate helper T (Th) cell-related responses.  H. pylori specific CD4(+) T cells play a fundamental role in regulating host  immunity and immunopathologic events. It has been documented that Th1, Th2,  Th9, Th17, Th22 and T regulatory (Treg) cells, separately or in coordination  with each other, can affect the outcome of the infection sustained by of H.  pylori. Some studies indicated that both Th1 and Th17 cells may be  protective or pathogenic, whereas Treg and Th2 cells perform  anti-inflammatory impacts during H. pylori infection. This review gathers  recent information regarding the association of the CD4(+) T cells–mediated  immunological responses and the clinical consequence of H. pylori infection.                                                             

 

RECORD 46Decreased iron stores in patients with Helicobacter pylori infection is  improved by eradication without corresponding changes in the intake of iron  and vitamin CNakagawa S. Shimoyama T. Sato S. Chinda D. Nakaji S. Fukuda S.Cogent Medicine (2018) 5:1 Article Number: 1432539. Date of Publication: 1  Jan 2018Background: The relationship between Helicobacter pylori infection and iron  metabolism has not been well studied in Japan. We examined the association  of H. pylori infection and its eradication to iron metabolism. Methods: A  total of 654 adults who completed a health survey in 2012 were enrolled. H.  pylori stool antigen was tested and serum antibody titer and serum iron,  ferritin and pepsinogen levels were estimated. Subjects reported on their  daily intake of the diets to calculate daily intake of iron and vitamin C.  Among the H. pylori-infected patients surveyed in 2012, 177 patients  completed the same health survey in 2014. For these patients, the change of  daily intake of iron and vitamin C and serum iron and ferritin levels were  examined. Results: In 2012, 244 subjects (37.3%) were considered as infected  with H. pylori. In male subjects aged 35–64 years, serum level of ferritin  was 77.5 (SD 53.1) ng/mL in infected patients and 130.6 (114.3) ng/mL in  non-infected subjects (p < 0.05). In female subjects who received successful  eradication therapy, serum level of ferritin increased from 47.9 (35.2) to  61.0 (35.4) ng/mL (p < 0.05). The daily intake of iron and vitamin C was not  significantly different between H. pylori-infected and non-infected  subjects. Successful eradication did not change daily intake of iron and  vitamin C. Conclusions: Lower serum levels of ferritin were observed in  Japanese patients with H. pylori infection. Eradication of H. pylori  increased the serum level of ferritin without corresponding changes in the  intake of iron and vitamin C.                                                             

 

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Systematic review with meta-analysis: The worldwide prevalence of  Helicobacter pylori infectionZamani M. Ebrahimtabar F. Zamani V. Miller W.H. Alizadeh-Navaei R.  Shokri-Shirvani J. Derakhshan M.H.Alimentary Pharmacology and Therapeutics (2018). Date of Publication: 2018Background: The epidemiology of Helicobacter pylori infection is poorly  understood. Aim: To establish the reported regional and national prevalence  of H. pylori infection, stratified by age and gender. Methods: All relevant  English publications from 2000 to 2017 cited by PubMed and Scopus were  retrieved using comprehensive combinations of keywords. The overall  prevalence of H. pylori was estimated using both random effect and fixed  effect meta-analyses, and presented as prevalence rate (% and 95% CI). The  analyses were extended by separation into gender and age groups. Results: A  total of 14 056 RECORDs were obtained initially. After applying exclusion  criteria in several steps, 183 studies were selected. Analysis of 410 879  participants from 73 countries in six continents revealed an overall  prevalence of 44.3% (95% CI: 40.9-47.7) worldwide. This rate ranged from  50.8% (95% CI: 46.8-54.7) in developing countries compared with 34.7% (95%  CI: 30.2-39.3) in developed countries. The global H. pylori infection rate  was 42.7% (95% CI: 39-46.5) in females compared to 46.3% (95% CI: 42.1-50.5)  in males. The prevalence in adults (≥18 years) was significantly higher than  in children (48.6% [95% CI: 43.8-53.5] vs 32.6% [95% CI: 28.4-36.8],  respectively). There was a statistically nonsignificant decrease in the  prevalence in 2009-2016 compared with the 2000-2009 period. Conclusions: The  observed differences between countries appear to be due to economic and  social conditions. H. pylori infection can be a benchmark for the  socioeconomic and health status of a country. Further studies are suggested  to investigate the natural history of the acquisition of H. pylori infection  from childhood into adult life.                                                             

 

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New Medical Approach to Functional Dyspepsia, from Core Symposium 3, Japan  Gastroenterological Association 2015–2017Suzuki H.Digestion (2018) (6-12). Date of Publication: 1 Feb 2018In the annual meeting of the Japan Gastroenterological Association (JGA),  the scientific organizing committee selected the serial topics for the core  symposium. One of the core symposia held during 2015–2017 was entitled “New  medical approach to functional dyspepsia (FD).” In 2015, the subtitle of  this symposium was “Helicobacter pylori gastritis and FD.” In 2016, the  subtitle of this symposium was “overlap with other functional GI disorders.”  In 2017, the subtitle was “therapeutic approach to FD.” During these 3  years, a total of 24 presentations were included in Core Symposium 3 and  deep and intensive discussions were carried out.                                                             

 

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Development and validation of a novel line immunoassay for diagnosis of  Helicobacter pylori infectionNölting C. Reichhuber C. Formichella L. Meyer H. Boecher O. Soutschek E.  Gerhard M.Zeitschrift fur Gastroenterologie (2016) 54:8. Date of Publication: 1 Aug  2016Background: The infection with Helicobacter pylori (H. pylori) addects 50%  percent of the world population. By colonizing the human stomach, the  bacteria cause gastritis in all infected individuals. 10 -15% of H. pylori  positive individuals develop ulcer disease and 1 -2% gastric cancer. Both,  strain-specific virulence and host factors influence the course of disease.  While timely eradication of the pathogen is the most effective way to  prevent development of gastric cancer, it is uncertain which infected  individuals are at risk and require treatment. Material/methods: The novel  recomLine Helicobacter IgG, IgA 2.0 is a qualitative line immunoassay for  the detection of IgG and IgA antibodies against H. pylori in human serum or  plasma. The test principle allows the simultaneous identification of  multiple antibodies against 10 highly immunogenic recombinant H. pylori  antigens, which are immobilized in separate lines on a test stripe. The test  performance was evaluated with 236 clinically defined specimens from  patients undergoing routine endoscopy. The diagnostic sensitivity of  recomLine Helicobacter 2.0 was determined with 139 samples from H. pylori  infected individuals defined by histological analysis of gastric biopsies.  Pathological findings such as ulcer, premalignant changes and carcinoma were                                                             RECORDed. The diagnostic specificity was established with 97 specimens from  histologically-defined H. pylori negative individuals. In addition, the  relationship between antigen reactivity profile and disease stage was  evaluated as potential predictive risk marker for gastric disease in  infected individuals. Results: Using the histology findings as gold  standard, the diagnostic sensitivity of recomLine Helicobacter 2.0 IgG-test  to detect H. pylori infection is 99,3%. Additionally, 63,3% of H. pylori  infected individuals showed a specific IgA-immune response. The diagnostic  specificity evaluated with specimens of H. pylori negative patients is 100%.  Conclusions: The recomLine Helicobacter 2.0 represents a highly sensitive  and specific non-invasive diagnostic tool for the serological detection of  H. pylori infection. The high accuracy was confirmed by histological  findings.                                                             

 

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Overview of current concepts in gastric intestinal metaplasia and gastric  cancerJencks D.S. Adam J.D. Borum M.L. Koh J.M. Stephen S. Doman D.B.Gastroenterology and Hepatology (2018) 14:2 (92-101). Date of Publication: 1  Feb 2018Gastric intestinal metaplasia is a precancerous change of the mucosa of the  stomach with intestinal epithelium, and is associated with an increased risk  of dysplasia and cancer. The pathogenesis to gastric cancer is proposed by  the Correa hypothesis as the transition from normal gastric epithelium to  invasive cancer via inflammation followed by intramucosal cancer and  invasion. Multiple risk factors have been associated with the development of  gastric intestinal metaplasia interplay, including Helicobacter pylori  infection and associated genomics, host genetic factors, environmental  milieu, rheumatologic disorders, diet, and intestinal microbiota. Globally,  screening guidelines have been established in countries with high incidence.  In the United States, no such guidelines have been developed due to lower,  albeit increasing, incidence. The American Society for Gastrointestinal  Endoscopy recommends a case-by-case patient assessment based upon  epidemiology, genetics, and environmental risk factors. Studies have  examined the use of a serologic biopsy to stratify risk based upon factors  such as H pylori status and virulence factors, along with serologic markers  of chronic inflammation including pepsinogen I, pepsinogen II, and gastrin.  High-risk patients may then be advised to undergo endoscopic evaluation with  mapping biopsies from the antrum (greater curvature, lesser curvature),  incisura angularis, and corpus (greater curvature, lesser curvature).  Surveillance guidelines have not been firmly established for patients with  known gastric intestinal metaplasia, but include repeat endoscopy at  intervals according to the histologic risk for malignant transformation.                                                             

 

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Deep learning analyzes Helicobacter pylori infection by upper  gastrointestinal endoscopy imagesItoh T. Kawahira H. Nakashima H. Yata N.Endoscopy International Open (2018) 6:2 (E139-E144). Date of Publication: 1  Feb 2018Background and study aims Helicobacter pylori (HP)-associated chronic  gastritis can cause mucosal atrophy and intestinal metaplasia, both of which  increase the risk of gastric cancer. The accurate diagnosis of HP infection  during routine medical checks is important. We aimed to develop a  convolutional neural network (CNN), which is a machine-learning algorithm  similar to deep learning, capable of recognizing specific features of  gastric endoscopy images. The goal behind developing such a system was to  detect HP infection early, thus preventing gastric cancer. Patients and  methods For the development of the CNN, we used 179 upper gastrointestinal  endoscopy images obtained from 139 patients (65 were HP-positive: ≥10 U/mL  and 74 were HP-negative: <3 U/mL on HP IgG antibody assessment). Of the 179  images, 149 were used as training images, and the remaining 30 (15 from  HP-negative patients and 15 from HP-positive patients) were set aside to be  used as test images. The 149 training images were subjected to data  augmentation, which yielded 596 images. We used the CNN to create a learning  tool that would recognize HP infection and assessed the decision accuracy of  the CNN with the 30 test images by calculating the sensitivity, specificity,  and area under the receiver operating characteristic (ROC) curve (AUC).  Results The sensitivity and specificity of the CNN for the detection of HP  infection were 86.7% and 86.7%, respectively, and the AUC was 0.956.  Conclusions CNN-aided diagnosis of HP infection seems feasible and is  expected to facilitate and improve diagnosis during health check-ups.                                                             

 

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Potential Association of IL1B Polymorphism With Iron Deficiency Risk in  Childhood Helicobacter pylori InfectionChen S.-T. Ni Y.-H. Liu S.-H.(2018) 66:2 (e36-e40). Date of Publication: 1 Feb 2018GamiFIN 2017 - Proceedings of the 1st International GamiFIN Conference, Book  Series Title:Objective: Helicobacter pylori infection occurs predominantly in childhood.  Host immune response gene polymorphism is reported to affect the  susceptibility to H pylori infection and the outcome of H pylori-related  gastric cancer. Not all H pylori-infected patients, however, exhibit iron  deficiency (ID). The relationship between host genetic polymorphisms and ID  mediated by H pylori infection is not well understood. Methods: Subjects (n  = 644) from the general population of age 10 to 18 years were divided into 2  groups based on serology testing for anti-H pylori IgG: seropositive study  group; and seronegative control group. Five single nucleotide polymorphisms  (SNPs) in IL1B (rs1143627 and rs16944), IL8 (rs4073), IL10 (rs1800896), and  ABO (rs505922), were genotyped and the iron status of the 2 groups was  compared. Results: The seroprevalence rate for H pylori was 10.7% in this  study. Infected subjects were significantly older and had lower serum iron  levels than uninfected subjects (P = 0.0195 and 0.0059, respectively).  Multivariate analysis revealed a significantly higher frequency of the T  allele of rs505922 (odds ratio [OR] = 6.128; P < 0.001) and lower frequency  of the T allele of rs1143627 (OR = 0.846; P = 0.014) in seropositive  subjects. Among 59 seropositive subjects, the T allele frequency of  rs1143627 was significantly higher in those with ID (OR = 3.156; P = 0.043),  compared with those without ID. Conclusions: ABO (rs505922) and IL1B  (rs1143627) may affect H pylori infection susceptibility, and IL1B  (rs1143627) may also influence ID risk in infected children.                                                             

 

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Obstructive sleep apnea in patients with helicobacter pylori infectionMaroufi A. Shams-Alizadeh N. Khalilian A. Biglarbegian K. Khazaie H. Ghaderi  E. Yazdanpanah K. Rahimi E.Sleep Medicine (2017) 40 Supplement 1 (e209). Date of Publication: 1 Dec  2017Introduction: Association of obstructive sleep apnea (OSA) with a variety of  diseases has been increasingly reported in recent years. The present study  aimed to investigate the prevalence and the risk for obstructive sleep apnea  in patients with Helicobacter Pylori (H. Pylori) infection. Materials and  methods: One hundred and sixty two patients with dyspepsia were recruited in  this case-control study at two general hospitals in Sanandaj and Hamedan in  west of Iran, from May 2014 to Jun 2015. Using enzyme-linked immunosurbent  assay IgG serologic test for H. Pylori diagnosis, we enrolled eighty one  patients with positive IgG and eighty one matched control patients with  negative IgG to the study. All the patients were invited to fill out the  Berlin Questionnaire in order to identify those who are at risk for the  sleep apnea syndrome. Results: Logistic regression analysis showed a greater  risk of OSA in patients with H. Pylori infection (OR = 2.123, p = 0.05).  Conclusions: Although the study does not disclose the causality, OSA may be  associated with H. Pylori infection and patients with a positive IgG  serologic test may be more susceptible to be in a group with higher risk for  OSA.                                                             

 

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Living conditions and helicobacter pylori in adultsAmaral O. Fernandes I. Veiga N. Pereira C. Chaves C. Nelas P. Silva D.BioMed Research International (2017) 2017 Article Number: 9082716. Date of  Publication: 2017Introduction. Infection by the bacterium Helicobacter pylori (H. pylori) is  transmissible and is considered a public health issue which affects people  of all ages. The objective of this study was to identify factors  (lifestyles, dietary factors, and hygiene conditions) related to the  prevalence of H. pylori infection. Methods. We carried out an observational  cross-sectional study with a community sample of adults from the  municipalities of Viseu and Sátão, Portugal. The final sample resulted in  166 adults. The data were collected through a self-Administered  questionnaire with questions regarding sociodemographic aspects and  lifestyles. H. pylori infection was identified using the 13C-urea breath  test. Results. No association was found between the prevalence of H. pylori  infection and the use of tobacco, alcohol, or coffee or dietary factors. The  prevalence of H. pylori infection was higher in adults who reported higher  consumption of fried food and lower consumption of vegetables and fruit. H.  pylori infection was significant for the variables of lower frequency of  handwashing before going to the bathroom (p=0.02) and well water consumption  (p=0.05). Conclusion. A significant association was found for H. pylori  infection with the lower frequency of handwashing before going to the  bathroom and the consumption of well water.                                                             

 

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Elevated circulating nitric oxide levels correlates with enhanced oxidative  stress in patients with hyperemesis gravidarumBeyazit F. Türkön H. Pek E. Ozturk F.H. Ünsal M.Journal of Obstetrics and Gynaecology (2018) (1-6). Date of Publication: 1  Feb 2018Since the biochemical and molecular mechanisms responsible for ongoing  oxidative stress in hyperemesis gravidarum (HEG) patients have not yet been  fully elucidated, the aim of this study was to evaluate the possible role of  nitric oxide (NO), malondialdehyde (MDA) and other oxidative stress markers  in the disease pathophysiology. Moreover, the relation between oxidative  stress markers and Helicobacter pylori (H. pylori) infection was also  investigated. Women with pregnancies complicated by HEG (n = 33) were  compared with pregnant women without HEG (n = 30) and with healthy  non-pregnant women (n = 31). Serum NO, MDA, total oxidant status (TOS),  total antioxidant status (TAS), oxidative stress index (OSI) and H. pylori  infection status were determined for each subject. Serum NO levels and OSI  index were found to be increased (p = .001 and .013, respectively) and TAS  levels were decreased (p < .001) in HEG patients compared with both controls  regardless of H. pylori infection status. Serum MDA and TOS levels were not  different between the study groups. Helicobacter pylori infection rates were  similar in each group. The reduced antioxidant activities, as well as the  increased OSI and NO levels in HEG patients indicate possible oxidative  stress conditions in HEG patients. Moreover, serum NO levels may be used as  an adjunctive marker to distinguish HEG patients from other causes of emesis  during pregnancy.Impact statementWhat is already known on this subject?  Current evidence suggests that oxidative stress is a significant factor  responsible for a number of complications during pregnancy.What do the  results of this study add? Hyperemesis gravidarum is an oxidative stress  condition, as reflected by increased nitric oxide (NO) and decreased total  antioxidant status activity, regardless of H. Pylori infection.What are the  implications for clinical practice and/or further research? Full disclosure  of the association between circulating NO and hyperemesis gravidarum would  shed light on underlying biological mechanisms and could help clinical  management of similar pregnancy-associated morbidity states.                                                             

 

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Choroidal Thickness of Helicobacter-Positive Patients without Central Serous  ChorioretinopathyHorozoglu F. Sever O. Celik E. Mete R. Sahin E.Current Eye Research (2018) 43:2 (262-265). Date of Publication: 1 Feb 2018Purpose: To evaluate the effect of Helicobacter pylori (H. pylori) infection  on subfoveal choroidal thickness (SFCT) in patients without clinical central  serous chorioretinopathy (CSC). Materials and Methods: This prospective  study included 50 patients with pathologically proven H. pylori infection  (H. pylori (+)) and 50 patients without H. pylori infection (H. pylori (−)).  All of the recruited patients were previously admitted to the  Gastroenterology Department of the Namik Kemal University School of Medicine  over the period of July 2014 to September 2015. All patients had 20/20  vision and underwent complete ophthalmological examination, macular optical  coherence tomography (OCT), and enhanced depth imaging OCT. Results: All  patients had 20/20 vision and similar macular thicknesses. The mean SFCT of  patients in the H. pylori (+) group was 309 ± 41.1 µm and 315 ± 18.2 µm in  the H. pylori (−) group (p = 0.174). The right and left eyes of patients in  the H. pylori (+) and (−) groups were not statistically significantly  different (p = 0.852, p = 0.937). The age, sex, and choroidal thicknesses of  patients in the H. pylori (+) and (−) groups were not correlated.  Conclusion: H. pylori infection does not have an effect on choroidal  thickness in patients without any ocular pathology.                                                             

 

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Association of TNF-α but not IL-1β levels with the presence of Helicobacter  pylori infection increased the risk of peptic ulcer developmentTourani M. Habibzadeh M. Karkhah A. Shokri-Shirvani J. Barari L. Nouri H.R.Cytokine (2018). Date of Publication: 2018Peptic ulcer is a lesion in the mucosa of the digestive tract affecting many  people all around the world. Recent investigations have indicated that  produced inflammatory cytokines such as TNF-α and IL-1β in response to  gastric infection by Helicobacter pylori play an important role in the  development of peptic ulcer. With regard to the significance of these  cytokines in peptic ulcer development and the high prevalence of this  disease in the developing countries, this study aimed to investigate the  association of TNF-α and IL-1β with peptic ulcer in the presence of H.  pylori. This case-control study enrolled 61 patients with peptic ulcer  disease (PUD) as cases and 59 people without peptic ulcer (NPUD) as  controls. Blood samples and endoscopic biopsies were collected. H. pylori  infection was confirmed by using rapid urease test (RUT), specific IgG  measurement and histopathological examination. Then, IL-1β and TNF-α levels  were evaluated using enzyme linked immunosorbent assay (ELISA). The  seropositivity of H. pylori was 62.5% in the studied population, while by  considering RUT and histopathological examination along with specific-IgG  antibody, H. pylori infection decreased to 56.7%. In addition, H. pylori  infection was significantly (OR = 0.37; 95% CI = 0.17-0.82; P = .02)  associated with peptic ulcer development. The TNF-α level in PUD and  infected H. pylori subjects was significantly higher than that of control  and un-infected H. pylori individuals. However, no significant difference of  IL1β level was observed between PUD and control groups as well as between H.  pylori infected and un-infected individuals. Interestingly, IL-1β level in  PUD patients without H. pylori infection was significantly higher than  infected ones. Moreover, a significant correlation between specific-IgG  antibody with TNF-α level was observed. Taken together, our results showed  that increased level of TNF-α could probably play pivotal role in  pathogenesis of peptic ulcer in the presence of H. pylori infection. These  findings also highlighted the importance of IL-1β in the absence of H.  pylori infection in peptic ulcer development.                                                             

 

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Association between Helicobacter pylori Infection and Nonalcoholic Fatty  Liver Disease: A Single-Center Clinical StudyCai O. Huang Z. Li M. Zhang C. Xi F. Tan S.Gastroenterology Research and Practice (2018) 2018 Article Number: 8040262.  Date of Publication: 2018Objective. To investigate the association between Helicobacter pylori (H.  pylori) infection and nonalcoholic fatty liver disease (NAFLD). Methods.  Data from 2051 participants who underwent (13)C urea breath test and  abdominal ultrasound examinations was collected. Participants were allocated  to NAFLD risk group and NAFLD nonrisk group based on definite risk factors  for NAFLD. The relationship between H. pylori infection and NAFLD was  analyzed. Results. No significant difference was found between rates of H.  pylori infection and NAFLD using the chi-square test (P=0.30) or regression  analysis (P=0.70). There was no significant difference between rates of H.  pylori infection with and without NAFLD (P=0.47) in the NAFLD risk group or  in the NAFLD nonrisk group (P=0.59). There was no significant difference  between rates of H. pylori infection in men (P=0.69) and in women (P=0.27)  or in participants aged 18-40 years (P=0.43), 41-65 years (P=0.14), and ≥66  years (P=0.66) with and without NAFLD in the NAFLD risk group or between the  same sex or age groups (P=0.82, P=0.66, P=0.24, P=0.53, and P=1.00, resp.)  in the NAFLD nonrisk group. Conclusions. H. pylori infection does not appear  to increase the NAFLD prevalence rate or to be associated with, or a risk  factor for, NAFLD.                                                            

 

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Distribution of gastric adenocarcinoma subtypes in different ethnicities in  Kuala Lumpur, MalaysiaSukri A. Hanafiah A. Kosai N.R. Taher M.M. Mohamed Rose I.Malaysian Journal of Pathology (2017) 39:3 (235-242). Date of Publication: 1  Dec 2017The multiracial population in Malaysia has lived together for almost a  century, however, the risk of gastric cancer among them varies. This study  aimed to determine the distribution of different gastric adenocarcinoma  subtypes and Helicobacter pylori infection status among gastric  adenocarcinoma patients. Patients with gastric adenocarcinoma were enrolled  from November 2013 to June 2015. Blood samples were collected for detection  of H. pylori using ELISA method. Gastric adenocarcinoma cases were more  prevalent in the Chinese (52.8%), followed by the Malays (41.7%) and least  prevalent in the Indians (5.6%). Gastric adenocarcinoma located in the  cardia was significantly more prevalent in the Malays (66.7%) compared to  the Chinese (26.3%), whereas non-cardia cancer was diagnosed more in the  Chinese (73.7%) compared to the Malays (33.3%) [P = 0.019; OR = 5.6, 95 CI:  1.27 to 24.64]. The Malays also had significantly higher prevalence of  gastric tumour located at the cardia or fundus than other gastric sites  compared to the Chinese (P = 0.002; OR: 11.2, 95% CI: 2.2 to 56.9). Among  the cardia gastric cancer patients, 55.6% of the Malays showed intestinal  histological subtype, whereas all the Chinese had the diffuse subtype. More  than half of the patients (55.3%) with gastric adenocarcinoma were positive  for H. pylori infection and among them, 66.7% were Chinese patients. The  risk of gastric adenocarcinoma in our population is different among  ethnicities. Further studies on host factors are needed as it might play an  important role in gastric cancer susceptibility in our population.                                                             

 

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A multicenter prospective study on the diagnostic performance of a liquid  rapid urease test for the diagnosis of Helicobacter pylori infectionDolak W. Biligilier C. Stadlmann A. Leiner J. Püspök A. Plieschnegger W.  Siebert F. Wewalka F. Schöfl R. Huber-Schönauer U. Datz C. Bioski-Frotz S.  Högenauer C. Schrutka-Kölbl C. Makristathis A. Schöniger-Hekele M.  Steininger C.Zeitschrift fur Gastroenterologie (2016) 54:5. Date of Publication: 1 May  2016Background: Helicobacter pylori (H. pylori) causes a diversity of gastric  diseases including gastritis, MALT lymphoma, and gastric adenocarcinoma.  Rapid urease tests (RUT) are well established for the point-of-care,  invasive diagnosis of H. pylori infection. The study aimed to evaluate the  diagnostic performance of a liquid RUT, the preOx-HUT, within a prospective  cohort of treatment-naïve patients. Patients/Methods: The multicenter  prospective clinical trial was conducted at nine Austrian centers for  gastrointestinal endoscopy. Patients referred for a diagnostic upper  gastrointestinal endoscopy were screened to undergo gastric biopsy sampling  for routine histological evaluation, and in parallel, the preOx-HUT.  Histological evaluation served as reference standard to evaluate the  diagnostic performance of the preOx-HUT. Results: From January 2015 to  January 2016, a total of 183 consecutive patients (54 males and 129 females,  median age 50 years) were included in this study. Indications for  gastroscopy were mostly upper abdominal pain (38%) and reflux symptoms  (25%), followed by cancer screening (15%) and dysphagia (5%). Endoscopy  revealed pathological findings in 149/183 cases (81%), which were mostly  gastritis (59%) and gastro-esophageal reflux disease (27%). An ulcer was  found in 4%, a tumor in 2% of cases. H. pylori infection was detected by  histology in 41/183 (22%) cases. In relation to histology, the preOx-HUT had  a sensitivity of 85%, a specificity of 94%, a positive predictive value of  80% and a negative predictive value of 96%. Concomitant PPI-use (in 28/183  patients, 15%) had no statistically significant effect on the diagnostic  accuracy of the preOx-HUT according to logistic regression analysis.  Discussion: This was the first study evaluating the preOx-HUT in a  prospective, multicenter clinical setting. Thereby, a high diagnostic  accuracy was found for the point-of-care, invasive diagnosis of H. pylori  infection. Hence, this test may be a valuable diagnostic adjunct to the  clinical presentation of patients with suspected H. pylori infection.                                                            

 

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Detection of antimicrobial resistance genes of Helicobacter pylori strains  to clarithromycin, metronidazole, amoxicillin and tetracycline among  Egyptian patientsDiab M. El-Shenawy A. El-Ghannam M. Salem D. Abdelnasser M. Shaheen M.  Abdel-Hady M. El-Sherbini E. Saber M.Egyptian Journal of Medical Human Genetics (2018). Date of Publication: 2018Background: Antibiotic resistance of Helicobacter pylori (H. pylori)  treatment is on the rise, and is affecting the efficacy of current used  therapeutic regimens. Aim: We aimed to enhance the understanding of  antimicrobial resistance rates of H. pylori strains recovered from patients  at Theodor Bilharz Research Institute Hospital in Egypt, as a mandatory step  before starting treatment. Subjects and methods: Mutant genes conferring  metronidazole, amoxicillin, clarithromycin, and tetracycline resistance were  detected in 60 H. pylori strains recovered from patients who underwent upper  endoscopic examination. Patients were considered to be infected with H.  pylori when rapid urease test and detection of 16S rRNA in gastric biopsies                                                             RECORDed positive. Molecular detection of resistant genes to metronidazole  (rdx gene) and amoxicillin (pbp1A gene) was carried out by conventional PCR  followed by sequencing of PCR products. While detection of 23S rRNA gene  conferring clarithromycin resistance and detection of 16S rRNA mutation gene  conferring tetracycline resistance were carried out by real-time PCR.  Results: H. pylori resistance rates to metronidazole, and amoxicillin were  25% and 18.3% respectively. While for clarithromycin and tetracycline, point  mutations in 23S rRNA types A2142G and A2143G and in 16S rRNA of H. pylori  were assessed by real time PCR assay respectively. Resistance mutant genes  were found to be 6.7% of clarithromycin and 1.7% of tetracycline. Combined  resistance rates to metronidazole and amoxicillin was (11.6%) followed by  metronidazole and clarithromycin (5%), while patterns of clarithromycin and  amoxicillin (1.6%), metronidazole, clarithromycin and amoxicillin (1.6%)  were revealed. Conclusion: Data concerning antimicrobial resistance genes  play an important role in empiric treatment of H. pylori infection.  According to our results, H. pylori resistance to metronidazole and  amoxicillin was relatively high. Clarithromycin is still a good option for  first line anti-H. pylori treatment. Combined resistant strains are emerging  and may have an effect on the combination therapy.                                                            

 

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Chronic urticaria associated with helicobacter pylori infectionConsultant (2018) 58:2. Date of Publication: 1 Feb 2018                                                            

 

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First progress report on the Japan Endoscopy Database projectKodashima S. Tanaka K. Matsuda K. Fujishiro M. Saito Y. Ohtsuka K. Oda I.  Katada C. Kato M. Kida M. Kobayashi K. Hoteya S. Horimatsu T. Matsuda T.  Muto M. Yamamoto H. Ryozawa S. Iwakiri R. Kutsumi H. Miyata H. Kato M.  Haruma K. Fujimoto K. Uemura N. Kaminishi M. Tajiri H.Digestive Endoscopy (2018) 30:1 (20-28). Date of Publication: 1 Jan 2018Background and Aim: The Japan Endoscopy Database (JED) Project was started  to develop the world's largest endoscopic database, capture the actual  performance of endoscopic practice, and standardize the terminology and  fundamental items needed for a clinical and research registry. This paper  presents a progress report on the first phase of this project undertaken at  eight endoscopic centers in Japan. Methods: The list of data items to be  collected was drafted by the MSED-J (Minimal Standard Endoscopic Database)  subcommittee. These items were aggregated offline by integrating data from  two endoscopic filing systems between July 2015 and December 2015. The study  population included all patients who underwent esophagogastroduodenoscopy or  colonoscopy at all eight centers, patients who underwent enteroscopy at five  of the eight centers, and patients who underwent endoscopic retrograde  cholangiopancreatography (ERCP) at four of the eight centers. Results: Data  collected in this phase included 61 070 endoscopic procedures, of which 40  475 were esophagogastroduodenoscopies, 215 were enteroscopies, 19 204 were  colonoscopies, and 1176 were ERCPs. Frequencies of complications were 0.68%  for esophagogastroduodenoscopy, 0% for enteroscopy, 0.43% for colonoscopy,  and 13.34% for ERCP. In addition, we obtained various data including  Helicobacter pylori infection status, past history of endoscopy in patients  who underwent enteroscopy or colonoscopy, and degree of difficulty of ERCP,  although the frequencies of reporting were sometimes low, with some items  <20%. Conclusion: Results of the first phase suggest that the JED project  can provide vast quantities of useful data about endoscopic procedures.                                                             

 

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Effect of maternal Helicobacter pylor infection on gestational weight gain  in an urban community of ugandaWanyama R. Obai G. Odongo P. Kagawa M. Baingana R.Pan African Medical Journal (2017) 28 Article Number: 145. Date of  Publication: 16 Oct 2017Introduction: Maternal Helicobacter pylori (H. pylori) infection has been  associated with undesirable effects during pregnancy such as; hyperemesis  gravidarum, anemia, intrauterine fetal growth restriction and miscarriage.  Our aim was to document the effect of H. pylori infection on gestational  weight gain (GWG) in a low-income urban setting in Uganda. Methods: This was  a prospective cohort study conducted in Kampala between May 2012 and May  2013. The participants were HIV negative, H. pylori positive and H. pylori  negative primigravidae and secundigravidae. Recruitment was at gestation age  of eighteen or less weeks and follow up assessments were carried out at 26  and 36 weeks gestation age. H. pylori infection was determined using H.  pylori stool antigen test. Maternal weight and height were measured, and  body mass index (BMI) and rates of GWG were calculated. Results: The  participants’ mean±standard deviation (sd) age was 20.9±2.7 years.  Primigravidae were 68.8% (n = 132) and 57.3% (n = 110) of the participants  were positive for H. pylori infection. Low pre-pregnancy BMI (< 18.5  kg/m(2)) was RECORDed in 14.6% (n = 28). The mean±sd rate of GWG during  second and third trimesters was 300.5±79.7 grams/week. The mean±sd weight  gained by 36 weeks of gestation was 9.6±2.2 kg while gestation age at  delivery was 39.4±1.0 weeks. Factors independently associated with the rates  of GWG during the second and third trimesters were parity (P=0.023), H.  pylori infection (P = 0.006), pre-pregnancy BMI (P = 0.037), height (P =  0.022) and household income (P = 0.003). Conclusion: H. pylori infection is  associated with low rates of GWG among primigravidae and secundigravidae.                                                            

 

RECORD 65Neisseria flavescens: A Urease-Expressing Potential Pathogen Isolated from  Gastritis PatientsZeng B. Sun L. Chen Y. Qian Y. Cao Q. Zhang Z. Li Z.Current Microbiology (2018) 75:2 (186-193). Date of Publication: 1 Feb 2018Parasitic pathogens, such as H. pylori (Helicobacter pylori), are considered  as primary elements for causing stomach infection and leading to chronic  gastritis or ulcers. Here, an unreported urease- and oxidase-producing  Neisseria flavescens-like bacteria was isolated from the gastroscopic  biopsies of (14)C-UBT-positive gastritis patients. The isolate expressed the  activity of urease, which is a pathogenic factor and considered as a  reliable marker for diagnosis of H. pylori infection. However, the isolate  didn’t express the key functional genes of H. pylori including vacA and  hpaA, and also the morphological feature of isolate was significantly  different with H. pylori. Eventually, the 16S rDNA of isolate was sequenced  and its sequence shared about 99.8% similarity with the N. flavescens  standard strains, but about 20.8% similarity with the H. pylori. Further  study of antibiotics-resistance revealed the N. flavescens isolate is high  resistant to metronidazole, but highly sensitive to ampicillin sodium. To  summarize, a urease-expressing N. flavescens strain was isolated and  identified from Chinese gastritis patients; the encouraging results provides  an important reference for the further study of its pathogenicity and the  reasonable diagnosis and use of antibiotics clinically.                                                            

 

RECORD 66Effect of risk factors on expression of vascular endothelial growth factor  in precancerous lesions of gastric cancerLi T. Jin X. Dong J. Deng H.Biomedical Research (India) (2017) 28:21 (9438-9441). Date of Publication:  2017Objective: To investigate the relationship between the various risk factors  and Vascular Endothelial Growth Factor (VEGF) expression in the precancerous  lesions of gastric cancer. Methods: The patients with PLGC confirmed by  gastroscope and pathology results were collected. The expression of VEGF was  detected by immunohistochemical. The relationship of the expression of VEGF  with smoking, drinking, diet condition of patients, personal history, and  family history of Helicobacter pylori (H. pylori) infection was analysed.  Results: Single factor analysis showed that five risk factors (smoking, bile  reflux, tumor family history, personal history of chronic atrophic gastritis  and H. pylori infection) between VEGF positive group and VEGF negative group  had statistically significant (P<0.05), the multiple factors logistic  regression analysis showed that smoking (OR=3.386, 95% CI: 1.373~8.349),  bile reflux (OR=3.027, 95% CI: 1.176~7.795), H. pylori infection (OR=3.884,  95% CI: 1.345~11.212) had affection on VEGF expression in PLGC. Conclusion:  Smoking, bile reflux and H. pylori infection were influencing factors for  VEGF expression in PLGC.                                                             

 

RECORD 67Gastric cancer: Epidemiology, prevention, classification, and treatmentSitarz R. Skierucha M. Mielko J. Offerhaus G.J.A. Maciejewski R. Polkowski  W.P.Cancer Management and Research (2018) 10 (239-248). Date of Publication: 7  Feb 2018Gastric cancer is the second most common cause of cancer-related deaths in  the world, the epidemiology of which has changed within last decades. A  trend of steady decline in gastric cancer incidence rates is the effect of  the increased standards of hygiene, conscious nutrition, and Helicobacter  pylori eradication, which together constitute primary prevention. Avoidance  of gastric cancer remains a priority. However, patients with higher risk  should be screened for early detection and chemoprevention. Surgical  resection enhanced by standardized lymphadenectomy remains the gold standard  in gastric cancer therapy. This review briefly summarizes the most important  aspects of gastric cancers, which include epidemiology, risk factors,  classification, diagnosis, prevention, and treatment. The paper is mostly  addressed to physicians who are interested in updating the state of art  concerning gastric carcinoma from easily accessible and credible source.                                                             

 

RECORD 68MiR-22 sustains NLRP3 expression and attenuates H. Pyloriinduced gastric  carcinogenesisLi S. Liang X. Ma L. Shen L. Li T. Zheng L. Sun A. Shang W. Chen C. Zhao W.  Jia J.Oncogene (2018) 37:7 (884-896). Date of Publication: 15 Feb 2018Chronic inflammation is the primary cause of gastric cancer (GC). NLRP3, as  an important inflammasome component, has crucial roles in initiating  inflammation. However, the potential roles of NLRP3 in GC is unknown. Here,  we show that NLRP3 expression is markedly upregulated in GC, which promotes  NLRP3 inflammasome activation and interleukin-1β (IL-1β) secretion in  macrophages. In addition, NLRP3 binds to cyclin-D1 (CCND1) promoter and  promotes its transcription in gastric epithelial cells. Consequently, NLRP3  enhances epithelial cells proliferation and GC tumorigenesis. Furthermore,  we identify miR-22, which is constitutively expressed in gastric mucosa, as  a suppressor of NLRP3. MiR-22 directly targets NLRP3 and attenuates its  oncogenic effects in vitro and in vivo. However, Helicobacter pylori (H.  pylori) infection suppresses miR-22 expression, while enhances NLRP3  expression, and that triggers uncontrolled proliferation of epithelial cells  and the emergence of GC. Thus, our research describes a mechanism by which  miR-22 suppresses NLRP3 and maintains homeostasis of gastric  microenvironments and suggests miR-22 as a potential target for the  intervention of GC.                                                             

 

RECORD 69Postoperative bleeding risk after gastric endoscopic submucosal dissection  during antithrombotic drug therapyKono Y. Obayashi Y. Baba Y. Sakae H. Gotoda T. Miura K. Kanzaki H. Iwamuro  M. Kawano S. Kawahara Y. Tanaka T. Okada H.Journal of Gastroenterology and Hepatology (Australia) (2018) 33:2  (453-460). Date of Publication: 1 Feb 2018Background and Aim: The safety of gastric endoscopic submucosal dissection  (ESD) in the antithrombotic drug users remains controversial. Methods:  Patients who underwent gastric ESD at Okayama University Hospital between  March 2006 and February 2016 were enrolled. This study investigated the risk  of post-ESD bleeding according to the management of the antithrombotic  drugs. Results: One thousand twenty lesions (872 patients) were enrolled. In  a multivariate analysis, heparin replacement (odds ratio [OR] 5.0, 95%  confidence interval [CI] 1.8–14), multiple antithrombotic drug use (OR 2.9,  95% CI 1.1–6.9), a resected specimen of ≥ 33 mm in diameter (OR 2.7, 95% CI  1.5–5.4), Helicobacter pylori negativity (OR 2.2, 95% CI 1.3–3.7), and  tumors located in the lower third of the stomach (OR 1.7, 95% CI 1.0–2.9)  were significant risk factors for post-ESD bleeding, while the continuation  of aspirin or cilostazol was not (OR 2.6, 95% CI 0.72–7.8). The bleeding  rate of the continuation group was comparable with that of the all cessation  group among single antithrombotic drug users (4.5% vs 4.4%, P = 1.0);  however, the rate of the continuation group was significantly higher than  that of the all cessation group among multiple antithrombotic drug users  (67% vs 15%, P = 0.020). Conclusions: The risk of post-ESD bleeding differed  according to the management of the antithrombotic drugs. The gastric ESD  under the cessation or continuation of aspirin or cilostazol monotherapy was  acceptable. However, multiple antithrombotic drug use or heparin replacement  was associated with a higher risk of post-ESD bleeding.                                                             

 

RECORD 70Proinflammatory Cytokine IL-17 Shows a Significant Association with  Helicobacter pylori Infection and Disease SeverityArachchi P.S. Fernando N. Weerasekera M.M. Senevirathna B. Weerasekera D.D.  Gunasekara C.P.Gastroenterology Research and Practice (2017) 2017 Article Number: 6265150.  Date of Publication: 2017Background. The pro-and anti-inflammatory cytokines play an important role  in the immune response against H. pylori infection. The proinflammatory  cytokines of Th17 cells have been suggested to play a major role in H.  pylori infection and resulting gastric inflammation. Objective. The  objective of this study was to compare the expression of selected  inflammatory cytokines (IL-10, IL-17, IL-21, IL-23, and TNF-α) in H.  pylori-infected patients and healthy controls and to understand their  association with H. pylori infection and disease severity. Results. The  expression levels of IL-17 and IL-23 were significantly higher in H.  pylori-infected patients. The expression of IL-21 was also higher in H.  pylori-positive patients but there was no significant association with  infection. IL-17 expression showed a significant increase with the severity  of chronic gastritis. Conclusion. The proinflammatory cytokine, IL-17, shows  a significant association with H. pylori infection and disease severity in a  Sri Lankan dyspeptic patient population.                                                            

 

RECORD 71

 

Infections, genetic and environmental factors in pathogenesis of autoimmune  thyroid diseasesShukla S.K. Singh G. Ahmad S. Pant P.Microbial Pathogenesis (2018) 116 (279-288). Date of Publication: 1 Mar 2018In Autoimmune disease a combination of infection, genetic and environmental  factors causes an autoimmune response to the thyroid gland (characterized by  lymphocytic infiltrations), thyroid stimulating hormone receptor (TSHR) and  different thyroid antigens. Graves' and Hashimoto disease are autoimmune  disorders with genetic predisposition. CD40 that stimulates the  proliferation and differentiation of lymphocytes is an essential  immunomodulatory component for follicular cells in the thyroid and the cell  that present the antigen. CD40, PTPN22 and thyroid-specific genes are  immunomodulating genes for the TSH receptor and thyroglobulin. CD40 used to  be associated with Graves's disease as positional candidate on the basis of  Graves' disease linkage study connecting with 20q11 genome chromosomal  region. The PTPN22 gene gives rise to a substantial risk of specific  autoimmune phenotypes and frequent disease mechanisms. Infections have been  implicated in the pathogenesis of AITD including Coxsackie virus, Yersinia  enterocolitica, Borrelia burgdorferi, Helicobacter pylori and retroviruses  (HTLV-1, HFV, HIV and SV40). Infectious hepatitis C agents are the strongest  proof supporting an affiliation with AITD. The essential environmental  triggers of AITD are iodine, drugs, infection, smoking and perhaps stress.  Autoimmune disease provide important facts on genetic mechanisms that  influence the prognosis and treatment of the disease and by recent molecular  techniques through gene expression study by quantitative Real Time-PCR and  microarray, we can identify novel genes which are responsible for Graves'  and Hashimoto disease.                                                             

 

RECORD 72

 

Helicobacter pylori infection and small intestinal bacterial overgrowthEnko D. Kriegshäuser G.Zeitschrift fur Gastroenterologie (2016) 54:5. Date of Publication: 1 May  2016Introduction: H. pylori is a remarkable bacterium, because it has one of the  highest urease activities of all known bacteria. Since H. pylori infection  may increase the intra-gastric pH due to the production of ammonia, this  bacterium may be a causative agent of small intestinal bacterial overgrowth  (SIBO). The purpose of the present study was to investigate the presence of  small intestinal bacterial overgrowth (SIBO) in patients with active H.  pylori infection assessed by functional breath testing. Patients and  Methods: All in all 109 patients with gastrointestinal complaints, who were  referred for the H. pylori 13C-urea breath test (13C-UBT) by general  practitioners and specialists, were also tested for the presence of SIBO by  the glucose hydrogen (H2)/methane (CH4) breath test (HMBT). The Fisher's  exact test was performed to compare 13C-UBT with glucose H2/CH4 breath test  results. A detailed anamnesis was carried out about the history of H.-pylori  infection, eradication therapies, proton pump inhibitor (PPI)-intake and  comorbidities. Results: In total, 36/109 (33.0%) patients had a positive H.  pylori 13C-UBT, and 35/109 (32.1%) patients had a positive glucose HMBT.  Interestingly, 19/36 (52.8%) individuals with a positive 13C-UBT also had a  positive glucose HMBT, whereas only 16/73 (21.9%) patients with a negative  13C-UBT showed a positive glucose HMBT (p = 0.002), respectively. Overall  13/38 (34.2%), 4/12 (33.3%), 1/2 (50.0%), and 1/2 (50.0%) patients, who had  completed one, two, three and four eradication therapies, were diagnosed  with SIBO by HMBT, respectively. Conclusions: In the present study active H.  pylori infection was found significantly associated with the presence of  SIBO as determined by functional breath testing. In addition SIBO rates  appeared to have increased after completed eradication therapies. However,  further longitudinal studies are warranted, to fully elucidate the  relationship and treatment modalities of coincident H. pylori infection and  SIBO.                                                             

 

RECORD 73

 

Species-specific role of gene-adjacent retroelements in human and mouse  gastric carcinogenesisRhyu M.-G. Oh J.-H. Hong S.-J.International Journal of Cancer (2018) 142:8 (1520-1527). Date of  Publication: 15 Apr 2018Helicobacter pylori (HP) infection promotes the recruitment of bone marrow  stem cells into chronic gastritis lesions. Some of these marrow stem cells  can differentiate into gastric epithelial cells and neoplastic cells. We  propose that HP-associated methylation could stabilize trans-differentiation  of marrow-derived stem cells and that an unstable methylation status is  associated with a risk of gastric cancer. Pathobiologic behavior of  experimental mouse gastric cancer is mild compared to invasive and  metastatic human gastric cancer. Differences in epigenetic stabilization of  adult cell phenotypes between humans and mice could provide a foundation to  explore the development of invasive and metastatic gastric cancer.  Retroelements are highly repetitive sequences that play an essential role in  the generation of species diversity. In this review, we analyzed  retroelements adjacent to human and mouse housekeeping genes and proposed a  possible epigenetic mechanism for HP-associated carcinogenesis.                                                             

 

RECORD 74

 

Accuracy of different rapid urease tests in comparison with histopathology  in patients with morphological signs of gastritis in endoscopyDechant F.X. Mayr R. Selgrad M. Weber F. Reischl U. Mueller M. Weigand K.Zeitschrift fur Gastroenterologie (2017) 55:5. Date of Publication: 1 May  2017Helicobacter pylori (HP) is a gram negative, microaerophilic bacterium that  was first discovered in 1982. It is one of the most important risks for  gastroduodenal ulcer disease and distal gastric cancer. In addition, HP is  an acknowledged oncogene for gastric MALT lymphoma, eradication of HP can  cure the majority of HP related diseases and offers the unique chance to  prevent gastric cancer. Corresponding to several guidelines different  invasive and non invasive tests are possible to detect a HP infection. In  detail invasive methods are HP culture, histological staining, rapid urease  tests (RUTs) and PCR methods. Non invasive methods are urea breath test, HP  stool antigen and serum IgG test. In our study we wanted to compare  different RUTs with histology findings to determine sensibility and  specificity of the different tests. In our study we tested all five in  Germany commercial available RUTs in comparison to histological staining in  150 real life patients with strong morphological signs of gastritis or  gastroduodenal ulcers even if proton pump inhibitors (PPIs) or antibiotics  were used. RUTs were checked after 30 min, 2h and 24hours. If the results of  the RUTs and the histological staining were different, a PCR test to detect  HP DNA was added. In 15 patients (10%) all five RUTs as well as histological  examination were positive. In one patient 3 of 5 RUTs, the histological  staining and the PCR test were positive. In one further patient 4 of 5 RUTs,  the histological staining and the PCR test were positive. In three patients  (2%) the results of histology and the RUTs were different. Although all five  RUTs were positive in one patient, the histological staining was negative.  Interestingly the PCR test showed a positive result for HP DNA in this  patient. In summary 20 patients (13%) had an infection with HP in our study  cohort. In two patients the RUTs did not detect an infection with HP,  whereas the histological staining showed a false positive result, since the  added PCR test showed a negative result. In 128 patients (85%) all five RUTs  as well the histological staining were negative. There was no significant  difference in sensitivity and specificity between the different RUTs. In  conclusion, rapid urease test is a cheap and high potential test for the  diagnosis of a HP infection with comparable sensitivity and specificity to  histological staining. In PPIs or antibiotic pretreated patients rapid  urease test may be even more sensitive compared to histology.                                                            

 

RECORD 75

 

Routine histological examination of laparoscopic sleeve gastrectomy  specimens-a worthwhile exercise? sleeve gastrectomyAdebibe M. Mansour O. Miu K. Lipszyc G. Lynn W. Goralczyk A. Ilczyszyn A.  Aguilo R. Agrawal S. Koak Y. Dixit A. Mannur K. Devalia K.Obesity Surgery (2017) 27:1 Supplement 1 (1000). Date of Publication: 1 Jul  2017Background: Laparoscopic Sleeve Gastrectomy (LSG) is the second most common  bariatric procedure in the UK. At present, Bariatric Surgery departments  differ in protocols for pre/post-operative investigation of gastric  pathology: pre-operative Gastroscopy is not universally routine and  histopathological examination of LSG specimens are performed routinely or  selectively. Introduction: Our practice is to perform selective gastroscopy  in patients with gastric symptoms and routine histopathology of LSG  specimens. Objectives: Here we present 10-year data on histopathology of SG  specimens. Methods: In this single-centre retrospective study, 866  consecutive LSG histopathology results were obtained by electronic medical RECORDs over 10-years (May 2006-November 2015) Results: 866 patients  underwent LSG procedures, of which histopathology results were available in  801 (92%): 281 (35%) specimens were normal, gastritis was found in 518 (64%)  and 15% (79/518) of these were associated with Helicobacter Pylori  infection. Incidental gastric tumours were found in 4 specimens only (0.5%):  2 Neuroendocrine tumours and 2 GastroIntestinal Stromal Tumours.  Pre-operative OGD was performed in 18 patients (2%). Conclusion: Gastritis  was the most common pathological abnormality identified however the rate of  tumour identification was only 0.5%. Whilst concerns may remain for missed  pathology, this study did not reveal any tumours in the residual specimen  that would have been missed on visual inspection. This compelling data will  change our practice to selective histological assessment of LSG specimens  and has already changed one surgeon's practice.                                                            

 

RECORD 76

 

Impact of SNP-SNP interactions of DNA repair gene ERCC5 and metabolic gene  GSTP1 on gastric cancer/atrophic gastritis risk in a Chinese populationSang L. Lv Z. Sun L.-P. Xu Q. Yuan Y.World Journal of Gastroenterology (2018) 24:5 (602-612). Date of  Publication: 7 Feb 2018AIM To investigate the interactions of the DNA repair gene excision repair  cross complementing group 5 (ERCC5 ) and the metabolic gene glutathione  S-transferase pi 1 (GSTP1 ) and their effects on atrophic gastritis (AG) and  gastric cancer (GC) risk.METHODS Seven ERCC5 single nucleotide polymorphisms  (SNPs) (rs1047768, rs2094258, rs2228959, rs4150291, rs4150383, rs751402, and  rs873601) and GSTP1 SNP rs1695 were detected using the Sequenom MassARRAY  platform in 450 GC patients, 634 AG cases, and 621 healthy control subjects  in a Chinese population. RESULTS Two pairwise combinations (ERCC5 rs2094258  and rs873601 with GSTP1 rs1695) influenced AG risk (P interaction = 0.008  and 0.043, respectively), and the ERCC5 rs2094258-GSTP1 rs1695 SNP pair  demonstrated an antagonistic effect, while ERCC5 rs873601- GSTP1 rs1695  showed a synergistic effect on AG risk OR = 0.51 and 1.79, respectively). No  pairwise combinations were observed in relation to GC risk. There were no  cumulative effects among the pairwise interactions (ERCC5 rs2094258 and  rs873601 with GSTP1 rs1695) on AG susceptibility (P trend > 0.05). When the  modification effect of Helicobacter pylori (H. pylori ) infection was  evaluated, the cumulative effect of one of the aforementioned pairwise  interactions (ERCC5 rs873601-GSTP1 rs1695) was associated with an increased  AG risk in the case of negative H. pylori status (P trend = 0.043).  CONCLUSION There is a multifarious interaction between the DNA repair gene  ERCC5 SNPs (rs2094258 and rs873601) and the metabolic gene GSTP1 rs1695,  which may form the basis for various inter-individual susceptibilities to  AG.                                                            

 

RECORD 77

 

Accuracy of different rapid urease tests in comparison with histopathology  in patients with morphological signs of gastritis in endoscopyDechant F.X. Mayr R. Selgrad M. Weber F. Reischl U. Mueller M. Weigand K.Zeitschrift fur Gastroenterologie (2017) 55:8. Date of Publication: 2017Helicobacter pylori (HP) is a gram negative, microaerophilic bacterium that  was first discovered in 1982. It is one of the most important risks for  gastroduodenal ulcer disease and distal gastric cancer. In addition, HP is  an acknowledged oncogene for gastric MALT lymphoma, eradication of HP can  cure the majority of HP related diseases and offers the unique chance to  prevent gastric cancer. In our study we wanted to compare different RUTs  with histology findings to determine sensibility and specificity of the  different tests. In our study we tested all five in Germany commercial  available RUTs in comparison to histological staining in 150 real life  patients with strong morphological signs of gastritis or gastroduodenal  ulcers even if proton pump inhibitors (PPIs) or antibiotics were used. RUTs  were checked after 30 min, 2h and 24hours. If the results of the RUTs and  the histological staining were different, a PCR test to detect HP DNA was  added. In 15 patients (10%) all five RUTs as well as histological  examination were positive. In one patient 3 of 5 RUTs, the histological  staining and the PCR test were positive. In one further patient 4 of 5 RUTs,  the histological staining and the PCR test were positive. In three patients  (2%) the results of histology and the RUTs were different. Although all five  RUTs were positive in one patient, the histological staining was negative.  Interestingly the PCR test showed a positive result for HP DNA in this  patient. In summary 20 patients (13%) had an infection with HP in our study  cohort. In two patients the RUTs did not detect an infection with HP,  whereas the histological staining showed a false positive result, since the  added PCR test showed a negative result. In 128 patients (85%) all five RUTs  as well the histological staining were negative. There was no significant  difference in sensitivity and specificity between the different RUTs. In  conclusion, rapid urease test is a cheap and high potential test for the  diagnosis of a HP infection with comparable sensitivity and specificity to  histological staining. In PPIs or antibiotic pretreated patients rapid  urease test may be even more sensitive compared to histology.

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