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Trabalhos Publicados em Março / 2018

RECORD 1

 

Seven-day genotypic resistance-guided triple Helicobacter pylori eradication  therapy can be highly effectivePapastergiou V. Mathou N. Licousi S. Evgenidi A. Paraskeva K.D.  Giannakopoulos A. Stavrou P.-Z. Platsouka E. Karagiannis J.A.Annals of Gastroenterology (2018) 31:2 (198-204). Date of Publication: 5 Mar  2018Background The efficacy and applicability of molecular testing to guide the  selection of antibiotics in triple Helicobacter pylori (H. pylori)  eradication regimens have not been reported. We tested a 7-day, genotypic  resistance-guided triple H. pylori eradication therapy in a high-resistance  setting. Methods Consecutive dyspeptic patients with H. pylori infection  were prospectively enrolled. Genotypic resistances to clarithromycin  (23SrRNA mutations) and fluoroquinolones (gyrA mutations) were determined  from gastric biopsy specimens using a commercially available molecular assay  (GenoType(â) HelicoDR). A tailored genotypic resistance-guided 7-day triple  therapy comprised esomeprazole, amoxicillin, and either clarithromycin  (wild-type 23SrRNA), levofloxacin (23SrRNA mutated/wild-type gyrA) or  rifabutin (both 23SrRNA/gyrA mutated). H. pylori eradication was confirmed  by(13)C-urea breath test. Results Of 148 subjects screened, 51 patients were  enrolled (male/female: 27/24, mean age: 50.7±11.4 years,  treatment-naïve/-experienced: 32/19). The molecular kit was easily  implemented, allowing for rapid (within 24 h) and relatively inexpensive  determination of H. pylori resistance (clarithromycin: 47.1%,  fluoroquinolones: 15.7%, dual clarithromycin/ fluoroquinolones: 7.8%). For  patients who received clarithromycin-, levofloxacin- and  rifabutin-containing triple therapy, the respective eradication rates were  24/27, 20/20, and 2/4 by intention-to-treat (ITT); and 24/24, 19/19 and 2/3  by per-protocol (PP) analysis. Overall eradication rates were 90.2% (95%  confidence interval [CI] 77.8-96.3%) by ITT and 97.8% (95%CI 87-99.8%) by PP  analysis, showing no significant difference between treatment-naïve and  -experienced patients (ITT: 87.5% vs. 94.7%, P=0.64; PP: 96.4% vs. 100%,  respectively, P=1.00). Conclusions Regardless of prior treatment history, a  genotypic resistance-guided 7-day triple therapy, based on a simple  molecular assay, achieved a high H. pylori eradication rate.                                                                

 

RECORD 2

 

rdxA, frxA, and efflux pump in metronidazole-resistant Helicobacter pylori:  Their relation to clinical outcomesLee S.M. Kim N. Kwon Y.H. Nam R.H. Kim J.M. Park J.Y. Lee Y.S. Lee D.H.Journal of Gastroenterology and Hepatology (Australia) (2018) 33:3  (681-688). Date of Publication: 1 Mar 2018Background and Aim: rdxA and frxA mutations and enhancement of efflux pump  have been suggested as the cause of metronidazole resistance in Helicobacter  pylori. This study was performed to investigate the resistance mechanisms  related to clinical eradication outcome, and to examine direct involvement  of hefA in metronidazole-resistant isolates with intact rdxA and frxA.  Methods: A total of 53 H. pylori-positive patients who were treated with  metronidazole-containing sequential or quadruple therapy from 2011 to 2015  were enrolled. The metronidazole susceptibility of H. pylori isolates was  examined by agar dilution test. Mutations in rdxA and frxA, were analyzed  with DNA sequencing, and impact of hefA on metronidazole resistance was  examined with quantitative real-time reverse transcription polymerase chain  reaction, knockout and genetic complementation test for hefA. Results: Seven  mutation types of rdxA and/or frxA were found in H. pylori isolated from  non-eradicated subjects. rdxA mutation was associated with eradication  failure (P = 0.002), and nonsense mutation in rdxA reduced eradication  efficacy (P = 0.009). hefA expression was significantly higher in resistant  isolates (P < 0.001), especially in rdxA(−)frxA(−) as compared to  rdxA(+)frxA(+) (P = 0.027). Resistant isolates with no mutation in rdxA and  frxA became susceptible after hefA knockout. Genetic complementation for  hefA recovered metronidazole resistance in all of three hefA knockout  mutants. Conclusions: These results suggest that rdxA mutations play a  critical role in metronidazole resistance as well as the outcomes of  eradication therapy. In addition, hefA seems to be directly involved in  metronidazole resistance, which explains the resistance in clinical isolates  with intact rdxA and frxA.                                                                 

 

RECORD 3

 

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.                                                                 

 

RECORD 4

 

Impact of amoxicillin resistance on the efficacy of amoxicillincontaining  regimens for Helicobacter pylori eradication: Analysis of five randomized  trialsChen M.-J. Wu M.-S. Chen C.-C. Chen C.-C. Fang Y.-J. Bair M.-J. Chang C.-Y.  Lee J.-Y. Hsu W.-F. Luo J.-C. Lin J.-T. Liou J.-M.Journal of Antimicrobial Chemotherapy (2017) 72:12 (3481-3489). Date of  Publication: 1 Dec 2017Background: The impact of amoxicillin resistance on the efficacy of regimens  containing amoxicillin for Helicobacter pylori eradication remains unknown.  Objectives: To investigate whether the efficacy of an amoxicillin-containing  regimen is affected by amoxicillin resistance and to identify the optimal  breakpoint for amoxicillin resistance. Methods: This was a pooled analysis  of five randomized trials conducted in Taiwan from 2007 to 2016. Patients  who received amoxicillin-containing regimens were recruited. MICs were  determined by agar dilution testing. Meta-analysis was performed to assess  the risk ratio of eradication failure in amoxicillin-resistant strains  compared with susceptible strains of seven different regimens. We performed  further the pooled analysis and logistic regression in patients treated with  clarithromycin triple therapy to identify the optimal breakpoint for  amoxicillin resistance. Results: A total of 2339 patients with available  amoxicillin MICs were enrolled. Meta-analysis showed that the presence of  amoxicillin resistance was consistently associated with increased risk of  treatment failure of amoxicillin-containing regimens at different  breakpoints (risk ratio: 1.41, 95% CI 1.12-1.78, P=0.004 when the cut-off  was 0.5 mg/L). The heterogeneity was low (I(2)=0%, P=0.615). Pooled analysis  also showed that amoxicillin resistance was an independent risk factor for  treatment failure of clarithromycin triple therapy at different breakpoints.  The best correlation was observed when the breakpoint of amoxicillin  resistance was ≥0.125 mg/L (kappa coefficient 0.298), at which the  resistance rate was 11.1% (110 of 990). Conclusions: The efficacies of  amoxicillin-containing regimens are affected by amoxicillin resistance and  the optimal breakpoint MIC is≥0.125 mg/L.                                                                 

 

RECORD 5

 

Genetic populations and virulence factors of Helicobacter pyloriKabamba E.T. Tuan V.P. Yamaoka Y.Infection, Genetics and Evolution (2018) 60 (109-116). Date of Publication:  1 Jun 2018Helicobacter pylori is a bacterium that has infected more than half of the  human population worldwide. This bacterium is closely associated with  serious human diseases, such as gastric cancer, and identifying and  understanding factors that predict bacterial virulence is a priority. In  addition, this pathogen shows high genetic diversity and co-evolution with  human hosts. H. pylori population genetics, therefore, has emerged as a tool  to track human demographic history. As the number of genome sequences  available is increasing, studies on the evolution and virulence of H. pylori  are gaining momentum. This review article summarizes the most recent  findings on H. pylori virulence factors and population genetics.                                                                

 

RECORD 6

 

Resistance mechanisms of Helicobacter pylori and its dual target precise  therapyGong Y. Yuan Y.Critical Reviews in Microbiology (2018) 44:3 (371-392). Date of Publication:  4 May 2018Helicobacter pylori drug resistance presents a significant challenge to the  successful eradication of this pathogen. To find strategies to improve the  eradication efficacy of H. pylori, it is necessary to clarify the resistance  mechanisms involved. The mechanisms of H. pylori drug resistance can be  investigated from two angles: the pathogen and the host. A comprehensive  understanding of the molecular mechanisms of H. pylori resistance based on  both pathogen and host would aid the implementation of precise therapy, or  ideally “dual target precise therapy” (bacteria and host-specific target  therapy). In recent years, with increased understanding of the mechanisms of  H. pylori resistance, the focus of eradication has shifted from  disease-specific to patient-specific treatment. The implementation of  “precision medicine” has also provided a new perspective on the treatment of  infectious diseases. In this article, we systematically review current  research on H. pylori drug resistance from the perspective of both the  pathogen and the host. We also review therapeutic strategies targeted to  pathogen and host factors that are aimed at achieving precise treatment of  H. pylori.                                                                

 

RECORD 7

 

Helicobacter pylori eradication: poor medical compliance from East to West  of the worldRibaldone D.G. Astegiano M. Pellicano R.Scandinavian Journal of Gastroenterology (2018) 53:3 (265). Date of  Publication: 4 Mar 2018                                                                

 

RECORD 8

 

Helicobacter pylori among patients with uninvestigated dyspepsia: Issues to  be rememberedPellicano R. Durazzo M.European Journal of Gastroenterology and Hepatology (2018) 30:3 (278-279).  Date of Publication: 2018                                                                 

 

RECORD 9

 

Protective effects of Helicobacter pylori for IBD are related to the  cagA-positive strainLord A.R. Simms L.A. Hanigan K. Sullivan R. Hobson P. Radford-Smith G.L.Gut (2018) 67:2 (393-394). Date of Publication: 1 Feb 2018                                                                 

 

RECORD 10

 

Editorial: the post-Helicobacter stomach—not the same for cohorts and  individuals. Authors’ replyKim N. Hwang Y.J.Alimentary Pharmacology and Therapeutics (2018) 47:6 (847-848). Date of  Publication: 1 Mar 2018                                                                

 

RECORD 11

 

Editorial: the post-Helicobacter stomach—not the same for cohorts and  individualsGenta R.M.Alimentary Pharmacology and Therapeutics (2018) 47:6 (846-847). Date of  Publication: 1 Mar 2018                                                                

 

RECORD 12

 

Antimicrobial susceptibility of Helicobacter pylori strains isolated from  children in IsraelPastukh N. Peretz A. Brodsky D. Isakovich N. Azrad M. On A.Journal of Global Antimicrobial Resistance (2018) 12 (175-178). Date of  Publication: 1 Mar 2018Objectives: Helicobacter pylori is a bacterial pathogen causing inflammation  of the gastric mucosa that may lead to peptic ulcer, perforation or  malignancy. Children are at risk of contracting H. pylori and developing  subsequent morbidity. Diagnosis and management in children are difficult and  merit a different approach compared with adults. This study aimed to  describe the antimicrobial resistance rates of H. pylori to amoxicillin,  tetracycline, clarithromycin, metronidazole, levofloxacin and rifampicin.  Methods: Biopsies (n = 154) collected during endoscopic examinations were  cultivated for 10 days using a growth medium selective for H. pylori, of  which 89 were H. pylori-positive. Antimicrobial resistance of the strains  was assessed by Etest to establish minimum inhibitory concentrations (MICs)  according to British Society for Antimicrobial Chemotherapy guidelines.  Results: Resistance rates were most notable for amoxicillin and  clarithromycin at 12% and 35% with MICs of 0.74 μg/mL and 2.51 μg/mL,  respectively. Resistance rates to tetracycline and levofloxacin were 8% and  2% with MICs of 2.57 μg/mL and 2.0 μg/mL, respectively. Resistance rates to  rifampicin and metronidazole were 3% and 8% with MICs of 2.0 μg/mL and 9.71  μg/mL, respectively. Conclusion: Current rising antibiotic resistance rates  for H. pylori are of concern. Performance of culture enables determination  of the susceptibility profile, which may lead to a better choice of, and  perhaps narrower spectrum, antibiotic agent. In light of these findings, we  suggest that optimising the choice of antibiotic agent in children with H.  pylori infection remains a challenge for clinicians and thus requires  further investigation in randomised clinical trials.                                                                

 

RECORD 13

 

Helicobacter pylori-induced modulation of the promoter methylation of Wnt  antagonist genes in gastric carcinogenesisYang H.-J. Kim S.G. Lim J.H. Choi J.M. Kim W.H. Jung H.C.Gastric Cancer (2018) 21:2 (237-248). Date of Publication: 1 Mar 2018Background: This study aimed to investigate the changes in the promoter  methylation and gene expression of multiple Wnt antagonists between the  chronic infection and eradication of Helicobacter pylori (H. pylori) in  gastric carcinogenesis. Methods: The levels of methylation and corresponding  mRNA expression of seven Wnt antagonist genes (SFRP1, -2, -5, DKK1, -2, -3,  WIF1) were compared among the patients with H. pylori-positive gastric  cancers (GCs), and H. pylori-positive and H. pylori-negative controls, by  quantitative MethyLight assay and real-time reverse transcription  (RT)-polymerase chain reaction (PCR), respectively. The changes of the  methylation and expression levels of the genes were also compared between  the H. pylori eradication and H. pylori-persistent groups 1 year after  endoscopic resection of GCs. Results: The methylation levels of SFRP and DKK  family genes were significantly increased in the patients with H.  pylori-positive GCs and followed by H. pylori-positive controls compared  with H. pylori-negative controls (P OpenSPiltSPi 0.001). SFRP1, -2, and DKK3  gene expression was stepwise downregulated from H. pylori-negative controls,  H. pylori-positive controls, and to H. pylori-positive GCs  (P OpenSPiltSPi 0.05). Among the Wnt antagonists, only the degrees of  methylation and downregulation of DKK3 were significantly reduced after H.  pylori eradication (P OpenSPiltSPi 0.05). Conclusion: Epigenetic silencing  of SFRP and DKK family genes may facilitate the formation of an epigenetic  field during H. pylori-associated gastric carcinogenesis. The epigenetic  field may not be reversed even after H. pylori eradication except by DKK3  methylation.                                                                

 

RECORD 14

 

Helicobacter pylori in dyspepsia: Phenotypic and genotypic methods of  diagnosisShetty V. Ballal M. Balaraju G. Shetty S. Pai G.C. Lingadakai R.Journal of Global Infectious Diseases (2017) 9:4 (131-134). Date of  Publication: 1 Oct 2017Background: Helicobacter pylori affects almost half of the world's  population and therefore is one of the most frequent and persistent  bacterial infections worldwide. H. pylori is associated with chronic  gastritis, ulcer disease (gastric and duodenal), mucosa-associated lymphoid  tissue lymphoma, and gastric cancer. Several diagnostic methods exist to  detect infection and the option of one method or another depends on various  genes, such as availability, advantages and disadvantages of each method,  monetary value, and the age of patients. Materials and Methods: Patients  with complaints of abdominal pain, discomfort, acidity, and loss of appetite  were chosen for endoscopy, detailed history was contained, and a physical  examination was conducted before endoscopy. Biopsies (antrum + body) were  received from each patient and subjected to rapid urease test (RUT),  histopathological examination (HPE), polymerase chain reaction (PCR), and  culture. Results: Of the total 223 biopsy specimens obtained from dyspeptic  patients, 122 (54.7%) were positive for H. pylori for HPE, 109 (48.9%) by  RUT, 65 (29.1%) by culture, and 117 (52.5%) by PCR. The specificity and  sensitivity were as follows: RUT (99% and 88.5%), phosphoglucosamine mutase  PCR assay (100% and 95.9%), and culture (100% and 53.3%), respectively.  Conclusion: In this study, we compared the various diagnostic methods used  to identify H. pylori infection indicating that, in comparison with  histology as gold standard for detection of H. pylori infection, culture and  PCR showed 100% specificity whereas RUT and PCR showed 99% and 100%  sensitivity, respectively.                                                                 

 

RECORD 15

 

Genetic polymorphisms in TLR1, TLR2, TLR4, and TLR10 of Helicobacter pylori-  associated gastritis: A prospective cross-sectional study in ThailandTongtawee T. Bartpho T. Kaewpitoon S. Kaewpitoon N. Dechsukhum C.  Leeanansaksiri W. Loyd R.A. Talabnin K. Matrakool L. Panpimanmas S.European Journal of Cancer Prevention (2018) 27:2 (118-123). Date of  Publication: 2018The toll-like receptors (TLRs) mediate the recognition of Helicobacter  pylori and initiate the innate immune response to infection. We hypothesized  those genetic polymorphisms in the TLR1, TLR2, TLR4, and TLR10 influence  bacterial infection, affecting susceptibility H. pylori to disease outcomes.  Genomic DNA was extracted and genotypes of TLR1 (rs4833095), TLR2 (rs3804099  and rs3804100), TLR4 (rs10759932), and TLR10 (rs10004195) polymorphism were  detected by the TagMan single-nucleotide epolymorphisms genotyping assay  using the real-time PCR hybridization probe method. The TLR1 (rs4833095), C  allele and the TLR10 (rs10004195), A allele frequency was significantly  increased risk in the H. pylori infection group (odds ratio=1.76, 95%  confidence interval=1.84-2.15, P=0.01 and odds ratio=1.81, 95% confidence  interval=1.18-3.26, P=0.04, respectively). The TLR1 (rs4833095), C allele  and TLR10 (rs10004195), A allele are susceptible TLRs polymorphisms in the  Thai population. These findings suggest that TLR1 rs4833095 and TLR10  rs10004195 may play crucial roles in H. pylori susceptibility and gastric  pathogenesis.                                                                 

 

RECORD 16

 

Transfection of the helicobacter pylori CagA gene alters MUC5AC expression  in human gastric cancer cellsShi D. Liu Y. Wu D. Hu X.Oncology Letters (2018) 15:4 (5208-5212). Date of Publication: 1 Apr 2018Helicobacter pylori, the primary causative agent of stomach cancer, is known  to affect gastric mucin expression. However, the underlying molecular  mechanisms mediating this H. pylori-dependent effect remain unknown. In the  present study, the effect of exogenous expression of the H. pylori virulence  factor, CagA, on mucin 5AC oligomeric muscus/gel-forming (MUC5AC) expression  was investigated using an in vitro model of the gastric mucosa. AGS cells  were either untreated or transfected by a vector control (pCDNA3.1) or  heterologous DNA, which induced CagA overexpression (pCDNA3.1-CagA). The  expression and functionality of MUC5AC was analyzed using the reverse  transcription-quantitative polymerase chain reaction and immunofluorescence  assays. The expression of H. pylori-CagA in AGS cells was able to  significantly upregulate MUC5AC expression compared to the vector control.  In addition, immunofluorescence assays were able to validate increased  MUC5AC expression following exogenous expression of H. pylori-CagA. The  results of the present study revealed that the H. pylori-derived virulence  factor CagA was able to increase the expression of MUC5AC. As this mucin  constitutes an important ecological niche for H. pylori, this response may  be involved in H. pylori colonization of the stomach.                                                                

 

RECORD 17

 

Characterizing antigenic determinants in Helicobacter pylori CagA capable of  detecting serum antibodies in childrenShin M.-K. Jun J.-S. Kwon S.-W. Lee D.-H. Ha J.-H. Park J.-S. Kang H.L. Baik  S.C. Park J.S. Seo J.-H. Youn H.-S. Cho M.J. Lee W.K.Pathogens and Disease (2017) 75:8 Article Number: ftx103. Date of  Publication: 1 Nov 2017Helicobacter pylori can persistently colonize the mucosa of the human  stomach, resulting in gastric disorders. Endoscopic biopsy for rapid urease  test and histopathologic examination are considered as the most accurate  diagnostic methods for H. pylori infection. Serological methods are  recommended for children because of invasiveness of the diagnosis mentioned  above. Here, the cytotoxin-associated gene A protein (Cag A), as an  immunodominant antigen, was subdivided to determine which regions harbor  antigenicity for humans. CagA was divided into 17 overlapping fragments of  ~400 bp, which were used for the analysis of antigenic determinants. The  partial proteins were subjected to immunoblot analysis using pooled serum  samples from children with gastric symptoms. A partial recombinant CagA  protein containing epitope regions (683-749 amino acids), which were  identified in this study, was produced and used for the detection of  anti-CagA antibodies and further investigated its serodiagnostic value for  determination of H. pylori infection in children. The serum IgG reactivities  from children with gastric symptoms were significantly three times more than  that of serum samples from children with non-gastric symptoms (P < 0.005).  Moreover, the serum IgG reactivities from children showing strong urease  activity of gastric biopsies were significantly higher than those with  moderate and weak urease activities (P < 0.05). Hence, the partial CagA is a  candidate antigen for diagnosis of H. pylori infection.                                                                 

 

RECORD 18

 

Molecular epidemiology of helicobacter pylori infection in a minor ethnic  group of Vietnam: A multiethnic, population-based studyBinh T.T. Tuan V.P. Dung H.D.Q. Tung P.H. Tri T.D. Thuan N.P.M. Tam L.Q. Nam  B.C. Giang D.A. Hoan P.Q. Uchida T. Trang T.T.H. Van Khien V. Yamaoka Y.International Journal of Molecular Sciences (2018) 19:3 Article Number: 708.  Date of Publication: 1 Mar 2018The Helicobacter pylori-induced burden of gastric cancer varies based on  geographical regions and ethnic grouping. Vietnam is a multiethnic country  with the highest incidence of gastric cancer in Southeast Asia, but previous  studies focused only on the Kinh ethnic group. A population-based  cross-sectional study was conducted using 494 volunteers (18–78 years old),  from 13 ethnic groups in Daklak and Lao Cai provinces, Vietnam. H. pylori  status was determined by multiple tests (rapid urease test, culture,  histology, and serology). cagA and vacA genotypes were determined by  PCR-based sequencing. The overall H. pylori infection rate was 38.1%.  Multivariate analysis showed that variations in geographical region, age,  and ethnicity were independent factors associated with the risk of H. pylori  acquisition. Therefore, multicenter, multiethnic, population based study is  essential to assess the H. pylori prevalence and its burden in the general  population. Only the E De ethnicity carried strains with Western-type CagA  (82%) and exhibited significantly lower gastric mucosal inflammation  compared to other ethnic groups. However, the histological scores  ofWestern-type CagA and East-Asian-type CagA within the E De group showed no  significant differences. Thus, in addition to bacterial virulence factors,  host factors are likely to be important determinants for gastric mucosal  inflammation and contribute to the Asian enigma.                                                                

 

RECORD 19

 

Illusions regarding Helicobacter pylori clinical trials and treatment  guidelinesGraham D.Y.Gut (2017) 66:12 (2043-2046). Date of Publication: 1 Dec 2017While the details of therapy are important (drugs, doses, duration, etc),  the most important detail is to ensure that the organism is susceptible to  the antibiotics used. Most comparative studies and meta-analyses report  illusions of reliable data, based on trials in which antimicrobial  resistance is present but not taken into account which make the results  trial specific and useless for informing clinical decisions. Comparisons  among trials where differences are dependent on the presence of antibiotic  resistance populations are invalid. Because study-specific results cannot be  generalised, they should not be published, quoted nor used for  meta-analyses. Both the recent ACG and Toronto treatment guidelines are  largely based on Hp-shmeta-analyses. The Maastricht guidelines are the least  flawed, more nuanced and provide more data related to the effects of  resistance. Illusions arose because gastroenterologists have attempted to  develop treatments in the absence of susceptibility data. In 'My Fair Lady',  Henry Higgins asked "Why can a woman not be more like a man?", we ask "Why  can gastroenterologists not be more like infectious disease doctors? ".                                                                 

 

RECORD 20

 

The active bacterial assemblages of the upper GI tract in individuals with  and without Helicobacter infectionSchulz C. Schütte K. Koch N. Vilchez-Vargas R. Wos-Oxley M.L. Oxley A.P.A.  Vital M. Malfertheiner P. Pieper D.H.Gut (2018) 67:2 (216-225). Date of Publication: 1 Feb 2018OBJECTIVE: Patients infected with Helicobacter pylori develop chronic  gastritis with a subgroup progressing to further complications. The role of  microbiota from the oral cavity swallowed with saliva and either transiting  the stomach or persisting in the gastric mucosa is uncertain. It is also not  known whether the bacterial community differs in luminal and mucosal niches.  A key question is whether H. pylori influences the bacterial communities of  gastroduodenal niches.DESIGN: Saliva, gastric and duodenal aspirates as well  as gastric and duodenal biopsies were collected during  oesophagogastroduodenoscopy from 24 patients (m:9, f:15, mean age 52.2±SD  14.5 years). RNA was extracted and the V1-V2 region of the retrotranscribed  bacterial 16S rRNA amplified and sequenced on the Illumina MiSeq  platform.RESULTS: Overall, 687 bacterial phylotypes that belonged to 95  genera and 11 phyla were observed. Each individual comprised a unique  microbiota composition that was consistent across the different niches.  However, the stomach fluid enriched for specific microbiota components.  Helicobacter spp were shown to dominate the mucosa-associated community in  the stomach, and to significantly influence duodenal and oral  communities.CONCLUSIONS: The detailed analysis of the active global  bacterial communities from the five distinct sites of the upper GI tract  allowed for the first time the differentiation between host effects and the  influence of sampling region on the bacterial community. The influence of  Helicobacter spp on the global community structures is striking.                                                                

 

RECORD 21

 

MiR-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.                                                                

 

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World trends for H. pylori eradication therapy and gastric cancer prevention  strategy by H. pylori test-and-treatSuzuki H. Mori H.Journal of Gastroenterology (2018) 53:3 (354-361). Date of Publication: 1  Mar 2018Helicobacter pylori-associated gastritis leads to the development of gastric  cancer. Kyoto global consensus report on H. pylori gastritis recommended H.  pylori eradication therapy to prevent gastric cancer. To manage H. pylori  infection, it is important to choose the appropriate regimen considering  regional differences in resistance to clarithromycin and metronidazole.  Quinolones and rifabutin-containing regimens are useful as third- and  fourth-line rescue therapies.                                                                

 

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Gastric adenocarcinoma of the fundic gland type after endoscopic therapy for  metachronous gastric cancerKino H. Nakano M. Kanamori A. Suzuki T. Kaneko Y. Tsuchida C. Tsuchida K.  Tominaga K. Sasai T. Yamagishi H. Imai Y. Hiraishi H.Internal Medicine (2018) 57:6 (795-800). Date of Publication: 2018A 78-year-old man underwent endoscopic submucosal dissection (ESD) for early  gastric adenocarcinoma twice in 2009 and 2014. Between the procedures, he  successfully completed Helicobacter pylori eradication therapy. In May 2015,  upper endoscopy screening showed two elevated lesions on the gastric fundus,  and en bloc resection by ESD was performed. We histopathologically diagnosed  the patient to have gastric adenocarcinoma of the fundic gland type. In this  case, the two lesions of gastric adenocarcinoma of the fundic gland type  multifocally developed after ESD for metachronous gastric tubular  adenocarcinoma. Furthermore, they appeared in the gastric fundus, where  atrophy had been improved due to eradication therapy.                                                                

 

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New Medical Approach to Functional Dyspepsia, from Core Symposium 3, Japan  Gastroenterological Association 2015-2017Suzuki H.Digestion (2018) 97:1 (6-12). Date of Publication: 1 Mar 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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NAFLD, Helicobacter species and the intestinal microbiomeCastaño-Rodríguez N. Mitchell H.M. Kaakoush N.O.Best Practice and Research: Clinical Gastroenterology (2017) 31:6 (657-668).  Date of Publication: 1 Dec 2017Gut Microbiome in Health and Disease, Book Series Title:Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic  liver disease worldwide. It is well-accepted that gut dysbiosis is  associated with NAFLD, however, there is some conflicting evidence regarding  the nature of these alterations. Infection with Helicobacter species, mainly  H. pylori, has also been associated with increased NAFLD risk, however, some  studies have failed to reproduce this finding. Further studies including  large study samples and standardised procedures for microbiota analyses, H.  pylori detection and NAFLD diagnostic criteria, are required. The mechanisms  involving Helicobacter species and the intestinal microbiome in NAFLD  pathogenesis appear to be part of the multiple-hit theory, in which  increased intestinal permeability, inflammatory responses, altered choline,  bile acids and carbohydrate metabolism, production of short-chain fatty  acids, urea cycle and urea transport systems, altered maintenance of hepatic  γδT-17 cells, insulin resistance, hormones secreted by the adipose tissue,  metabolic hormones, bacterial metabolites and Helicobacter toxins, are all  implicated.                                                                 

 

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Muc5ac gastric mucin glycosylation is shaped by FUT2 activity and  functionally impacts Helicobacter pylori bindingMagalhães A. Rossez Y. Robbe-Masselot C. Maes E. Gomes J. Shevtsova A.  Bugaytsova J. Borén T. Reis C.A.Scientific reports (2016) 6 (25575). Date of Publication: 10 May 2016The gastrointestinal tract is lined by a thick and complex layer of mucus  that protects the mucosal epithelium from biochemical and mechanical  aggressions. This mucus barrier confers protection against pathogens but  also serves as a binding site that supports a sheltered niche of microbial  adherence. The carcinogenic bacteria Helicobacter pylori colonize the  stomach through binding to host glycans present in the glycocalyx of  epithelial cells and extracellular mucus. The secreted MUC5AC mucin is the  main component of the gastric mucus layer, and BabA-mediated binding of H.  pylori to MUC5AC confers increased risk for overt disease. In this study we  unraveled the O-glycosylation profile of Muc5ac from glycoengineered mice  models lacking the FUT2 enzyme and therefore mimicking a non-secretor human  phenotype. Our results demonstrated that the FUT2 determines the  O-glycosylation pattern of Muc5ac, with Fut2 knock-out leading to a marked  decrease in α1,2-fucosylated structures and increased expression of the  terminal type 1 glycan structure Lewis-a. Importantly, for the first time,  we structurally validated the expression of Lewis-a in murine gastric  mucosa. Finally, we demonstrated that loss of mucin FUT2-mediated  fucosylation impairs gastric mucosal binding of H. pylori BabA adhesin,  which is a recognized feature of pathogenicity.                                                                

 

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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) 47:7 (868-876). Date of  Publication: 1 Apr 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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Unde venis? Geographic profiling for the prevention of gastric cancerGenta R.M. Sonnenberg A.Gastrointestinal Endoscopy (2018) 87:4 (1029-1030). Date of Publication: 1  Apr 2018                                                                

 

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A review of the association between coronary artery disease and infectionKoroner arter hastalığı ile enfeksiyon arasındaki ilişki üzerine bir derlemeOnk A. Kahraman Ü. Aksoy E.Journal of Clinical and Analytical Medicine (2016) 7:4 (581-584). Date of  Publication: 1 Jul 2016Atherosclerotic involvement of the coronary arteries and its association  with various inflammatory processes such as chronic inflammation-repair  cascades have long been considered. There has been a growing body of  evidence regarding the role of certain inflammatory pathways in the  development of atherosclerosis in humans. The causal relationship between  infection and coronary artery disease has drawn less attention. A number of  infectious agents including chlamydia pneumoniae, helicobacter pylori,  herpes simplex virus, and cytomegalovirus (CMV) have increasingly been  reported as having significant causal relationships with the development and  severity of coronary artery disease. Despite experimental and autopsy  studies of the association between infection and certain microorganisms and  atherosclerosis, it is still unclear whether infectious etiology plays a  crucial role in the development of coronary artery disease. Current data  particularly indicate the causal relationship of C. pneumoniae with  atherosclerosis and there has also been convincing evidence that H. pylori  and herpesviruses may be responsible for disease progression or severity.                                                                

 

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Gastrointestinal lymphomas: French Intergroup clinical practice  recommendations for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR,  UNICANCER, SFCD, SFED, SFRO, SFH)Matysiak-Budnik T. Fabiani B. Hennequin C. Thieblemont C. Malamut G. Cadiot  G. Bouché O. Ruskoné-Fourmestraux A.Digestive and Liver Disease (2018) 50:2 (124-131). Date of Publication: 1  Feb 2018Introduction: This document is a summary of the French Intergroup guidelines  on the management of gastro-intestinal lymphomas, available on the web-site  of the French Society of Gastroenterology, SNFGE (www.tncd.org), updated in  September 2017. Methods: This collaborative work was realised under the  auspices of several French medical societies and involved clinicians with  specific expertise in the field of gastrointestinal lymphomas, including  gastroenterologists, haematologists, pathologists, and radiation oncologist,  representing the major French or European clinical trial groups. It  summarises their consensus on the management of gastrointestinal lymphomas,  based on the recent literature data, previous published guidelines and the  expert opinions. Results: The clinical management, and especially the  therapeutic strategies of the gastro-intestinal lymphomas are specific to  their histological subtypes and to their locations in the digestive tract,  with the particularity of gastric MALT lymphomas which are the most frequent  and usually related to gastritis induced by Helicobacter pylori. Conclusion:  Lymphomas are much less common than epithelial tumours of gastro-intestinal  digestive tract. Their different histological subtypes determine their  management and prognosis. Each individual case should be discussed within  the expert multidisciplinary team.                                                                

 

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Role of Age and Race in the Risk of Hepatocellular CarcinomaPonzetto A. Pérez-Pérez G.I. Figura N.Clinical Gastroenterology and Hepatology (2018) 16:4 (595-596). Date of  Publication: 1 Apr 2018                                                                

 

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Feasibility Study of Using Breath Ammonia Analysis Based on Off-Axis  Cavity-Enhanced Absorption Spectroscopy with External Cavity Diode Laser for  Noninvasive Real-Time Diagnosis of Helicobacter PyloriBayrakli I. Turkmen A. Cem Kockar M.Applied spectroscopy (2016) 70:8 (1269-1277). Date of Publication: 1 Aug  2016The purpose of this study is to assess the feasibility of using breath  ammonia analysis based on off-axis cavity-enhanced absorption spectroscopy  (OA-CEAS) with an external-cavity diode laser (ECL) for noninvasive,  real-time diagnosis of Helicobacter pylori (HP) infection. Analyses are  performed for the breath of 15 healthy volunteers, and eight children and 19  adults with HP infection. The range of ammonia levels for healthy  participants is determined to be between 178 and 610 ppb, whereas the ranges  for child and adult patients with HP infection are measured to be 457-2470  ppb and 450-2990 ppb, respectively. The ammonia concentrations for patients  with HP infection are significantly higher than the concentrations for  healthy volunteers. However, no sharp boundary between the ammonia  concentrations in the breath of patients with HP infection and healthy  volunteers is observed. No correlation between breath ammonia and either  body mass index (BMI) or age is found. The reported results suggest that our  breath ammonia measurement system has the potential for future use in easy,  noninvasive diagnosis of HP infection.                                                                

 

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Prospective multicentre clinical study on inter- and intrapatient genetic  variability for antimicrobial resistance of Helicobacter pyloriBilgilier C. Stadlmann A. Makristathis A. Thannesberger J. Kastner M.-T.  Knoflach P. Steiner P. Schöniger-Hekele M. Högenauer C. Blesl A. Datz C.  Huber-Schönauer U. Schöfl R. Wewalka F. Püspök A. Mitrovits N. Leiner J.  Tilg H. Effenberger M. Moser M. Siebert F. Hinterberger I. Wurzer H.  Stupnicki T. Watzinger N. Gombotz G. Hubmann R. Klimpel S. Biowski-Frotz S.  Schrutka-Kölbl C. Graziadei I. Ludwiczek O. Kundi M. Hirschl A.M. Steininger  C.Clinical Microbiology and Infection (2018) 24:3 (289-294). Date of  Publication: 1 Mar 2018Objectives: We report on a large prospective, multicentre clinical  investigation on inter- and intrapatient genetic variability for  antimicrobial resistance of Helicobacter pylori. Methods: Therapy-naive  patients (n = 2004) who had undergone routine diagnostic gastroscopy were  prospectively included from all geographic regions of Austria. Gastric  biopsy samples were collected separately from antrum and corpus. Samples  were analysed by histopathology and real-time PCR for genotypic resistance  to clarithromycin and quinolones. Clinical and demographic information was  analysed in relation to resistance patterns. Results: H. pylori infection  was detected in 514 (26%) of 2004 patients by histopathology and confirmed  in 465 (90%) of 514 patients by real-time PCR. PCR results were discordant  for antrum and corpus in 27 (5%) of 514 patients, indicating inhomogeneous  infections. Clarithromycin resistance rates were 17% (77/448) and 19%  (84/455), and quinolone resistance rates were 12% (37/310) and 10% (32/334)  in antrum and corpus samples, respectively. Combination of test results per  patient yielded resistance rates of 21% (98/465) and 13% (50/383) for  clarithromycin and quinolones, respectively. Overall, infection with both  sensitive and resistant H. pylori was detected in 65 (14%) of 465 patients.  Conclusions: Anatomically inhomogeneous infection with different, multiple  H. pylori strains is common. Prospective clinical study design, collection  of samples from multiple sites and microbiologic methods that allow the  detection of coinfections are mandatory for collection of reliable data on  antimicrobial resistance patterns in representative patient populations.  (ClinicalTrials.gov identifier: NCT02925091).                                                                

 

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Objective endoscopic analysis with linked color imaging regarding gastric  mucosal atrophy: A pilot studyMizukami K. Ogawa R. Okamoto K. Shuto M. Fukuda K. Sonoda A. Matsunari O.  Hirashita Y. Okimoto T. Kodama M. Murakami K.Gastroenterology Research and Practice (2017) 2017 Article Number: 5054237.  Date of Publication: 2017Objectives. We aimed to determine whether linked color imaging (LCI), a new  image-enhanced endoscopy that enhances subtle differences in mucosal colors,  can distinguish the border of endoscopic mucosal atrophy. Methods. This  study included 30 patients with atrophic gastritis. In endoscopy, we  continuously took images in the same composition with both LCI and white  light imaging (WLI). In each image, the color values of atrophic and  nonatrophic mucosae were quantified using the International Commission on  Illumination 1976 (L∗, a∗, b∗) color space. Color differences at the  atrophic border, defined as Euclidean distances of color values between the  atrophic and nonatrophic mucosae, were compared between WLI and LCI for the  overall cohort and separately for patients with Helicobacter pylori  infection status. Results. We found that the color difference became  significantly higher with LCI than with WLI in the overall samples of 90  points in 30 patients. LCI was 14.79 ± 6.68, and WLI was 11.06 ± 5.44  (P<0.00001). LCI was also more effective in both of the Helicobacter  pylori-infected group (P=0.00003) and the Helicobacter pylori-eradicated  group (P=0.00002). Conclusions. LCI allows clear endoscopic visualization of  the atrophic border under various conditions of gastritis, regardless of  Helicobacter pylori infection status.                                                                 

 

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The Progress of T Cell Immunity Related to Prognosis in Gastric CancerWei M. Shen D. Mulmi Shrestha S. Liu J. Zhang J. Yin Y.BioMed Research International (2018) 2018 Article Number: 3201940. Date of  Publication: 2018Gastric cancer is the fifth most common malignancy all over the world, and  the factors that can affect progress and prognosis of the gastric cancer  patients are various, such as TNM stages, invasive depth, and lymph node  metastasis ratio. T cell immunity is important component of human immunity  system and immunity responding to tumor and dysfunction or imbalance of T  cell immunity will lead to serious outcomes for body. T cell immunity  includes many different types of cells, CD4+ T cell, CD8+ T cell, memory  cell, and so on, and each of them has special function on antitumor response  or tumor immune escape which is revealed in lung cancer, colorectal cancer,  breast cancer, ovarian cancer, and so on. But its correlation with gastric  cancer is not clear. Our review was preformed to explore the relationship  between the progress and prognosis of gastric cancer (GC) and T cell  immunity. According to recent researches, T cell immunity may have an  important role in the progress and prognosis of GCs, but its function is  affected by location, category, related molecule, and interaction between  the cells, and some effects still are controversial. More researches are  needed to clarify this correlation.                                                                 

 

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Bismuth-Induced Inactivation of Ferric Uptake Regulator from Helicobacter  pyloriHe X. Liao X. Li H. Xia W. Sun H.Inorganic chemistry (2017) 56:24 (15041-15048). Date of Publication: 18 Dec  2017Ferric uptake regulator (Fur) of Helicobacter pylori is a global regulator  that is important for bacterial colonization and survival within the gastric  mucosa. H. pylori Fur (HpFur) is unique in its ability to regulate gene  expression in both metal-bound (holo-Fur) and metal-free (apo-Fur) forms.  Bismuth-based drugs are widely used for the treatment of H. pylori  infection. However, the mechanism of action of bismuth drug was not fully  understood. Recently, it has been reported that bismuth drugs could  interfere with the bacterial ferric uptake pathway and inhibit bacterial  growth, implying intrinsic correlation between bismuth drug and bacterial  iron metabolism. Herein, we demonstrate that Bi(III) binds to HpFur protein  specifically at the physiologically important S1 site, which further leads  to protein oligomerization and loss of DNA binding capability. The targeting  of HpFur by bismuth drugs significantly reduced transcription levels of its  regulated genes, which are crucial for bacterial physiology and metabolism.  Our studies present direct evidence that perturbation of iron metabolism in  H. pylori by bismuth might serve as one of the mechanisms for the  antimicrobial activity of bismuth drugs.                                                                 

 

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Natural 18O and 13C-urea in gastric juice: a new route for non-invasive  detection of ulcersMaity A. Pal M. Som S. Maithani S. Chaudhuri S. Pradhan M.Analytical and bioanalytical chemistry (2017) 409:1 (193-200). Date of  Publication: 1 Jan 2017The 13C-urea breath test (13C-UBT), developed a few decades ago, is widely  used as a non-invasive diagnostic method to detect only the presence of the  gastric pathogen Helicobacter pylori infection; however, the actual disease  state, i.e. whether the person harbouring H. pylori has peptic ulcer disease  (PUD) or non-ulcerous dyspepsia (NUD), is still poorly understood.  Nevertheless, the present 13C-UBT has numerous limitations, drawbacks and  pitfalls owing to the ingestion of 13C-labelled external urea. Here, we show  that H. pylori is able to utilize the natural 13C and 18O-urea inherently  present in the gastric juice in humans for its urease activity which has  never been explored before. In vitro measurements of isotopic fractionations  of gastric juice urea provide new insights into the actual state of the  infection of PUD or NUD. We also provide evidence of the unusual 13C and  18O-isotopic fractionations of breath CO2 that are distinctively altered in  individuals with PUD encompassing both gastric and duodenal ulcers as well  as with NUD by the enzymatic activity of H. pylori in the gastric niche  without oral administration of any 13C-enriched external urea. This deepens  our understanding of the UBT exploiting the natural 13C and 18O-gastric  juice urea in the pathogenesis of H. pylori infection, reveals the actual  disease state of PUD or NUD and thus offers novel opportunities for a  simple, robust, cost-effective and non-toxic global strategy devoid of any  13C-enriched urea for treating these common diseases by a single breath  test. Graphical Abstract Urea breath test without any external urea.                                                                

 

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Gastric microbial community profiling reveals a dysbiotic cancer-associated  microbiotaFerreira R.M. Pereira-Marques J. Pinto-Ribeiro I. Costa J.L. Carneiro F.  Machado J.C. Figueiredo C.Gut (2018) 67:2 (226-236). Date of Publication: 1 Feb 2018OBJECTIVE: Gastric carcinoma development is triggered by Helicobacter  pylori. Chronic H. pylori infection leads to reduced acid secretion, which  may allow the growth of a different gastric bacterial community. This change  in the microbiome may increase aggression to the gastric mucosa and  contribute to malignancy. Our aim was to evaluate the composition of the  gastric microbiota in chronic gastritis and in gastric carcinoma.DESIGN: The  gastric microbiota was retrospectively investigated in 54 patients with  gastric carcinoma and 81 patients with chronic gastritis by 16S rRNA gene  profiling, using next-generation sequencing. Differences in microbial  composition of the two patient groups were assessed using linear  discriminant analysis effect size. Associations between the most relevant  taxa and clinical diagnosis were validated by real-time quantitative PCR.  Predictive functional profiling of microbial communities was obtained with  PICRUSt.RESULTS: The gastric carcinoma microbiota was characterised by  reduced microbial diversity, by decreased abundance of Helicobacter and by  the enrichment of other bacterial genera, mostly represented by intestinal  commensals. The combination of these taxa into a microbial dysbiosis index  revealed that dysbiosis has excellent capacity to discriminate between  gastritis and gastric carcinoma. Analysis of the functional features of the  microbiota was compatible with the presence of a nitrosating microbial  community in carcinoma. The major observations were confirmed in validation  cohorts from different geographic origins.CONCLUSIONS: Detailed analysis of  the gastric microbiota revealed for the first time that patients with  gastric carcinoma exhibit a dysbiotic microbial community with genotoxic  potential, which is distinct from that of patients with chronic gastritis.                                                                 

 

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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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An Aggressive Form of MALT Lymphoma of the Stomach with Pancreas  InfiltrationMulalic E. Delibegovic S.Medical archives (Sarajevo, Bosnia and Herzegovina) (2016) 70:3 (235-237).  Date of Publication: 1 Jun 2016INTRODUCTION: MALT lymphoma accounts for 7-8% of all B-cell lymphomas and at  least 50% of primary gastric lymphoma, with the highest incidence at between  50 and 60 years of age. Aggressive forms are rare, as are indications for  multi-visceral resection.CASE STUDY: A patient, 33 years old, was admitted  to the tertiary hospital due to a biopsy at a small community hospital  confirming adenocarcinoma of the stomach. She was Helicobacter pylori  positive. CT showed thickening of the fundus and corpus wall, up to 2.7.  cm., with numerous lymph nodes, along the small curvature and in the  peripancreatic region, up to 1.5 cm in size. There was close contact between  the changed and tumorous posterior wall of the stomach and the anterior  surface of the pancreas. Neoplasm of the stomach was found that had  infiltrated the body and tail of the pancreas and spleen hilum. Infiltration  of the left crura of the diaphragm was also found, ex tempore biopsy showed  inflammatory infiltration without elements of neoplasm. Total gastrectomy  with omentectomy, and subtotal pancreatectomy and splenectomy were  performed. Definitive patho-histological diagnosis confirmed MALT lymphoma  of the stomach with pancreas infiltration, but no tumor cells were found on  the spleen. Additional staining and immunohistological examination of the  specimen from the community hospital showed that this was a misdiagnosis of  carcinoma, and the specimen also contained MALT lymphoma.DISCUSSION: MALT  lymphoma frequently occurs in the stomach. For patients with MALT,  systematic staging is indicated. If MALT is considered in the differential  diagnosis, multiple random systematic biopsies within the stomach wall are  needed to optimize diagnostic accuracy. Samples should be subject to immune  phenotype analysis6. The main tumor cells of MALT are: CD 20+, CD 5-, CD  10-, CD 23-, CD 43+-. It is obvious that this kind of analysis cannot be  accomplished in a small community hospital in a poor country such as Bosnia  and Herzegovina, and suspicion of MALT indicates referral to a tertiary  center. Although the long term risk of transformation of MALT lymphoma into  the aggressive form is low9, this case of the aggressive form of MALT  indicates the importance of systematic staging.                                                                

 

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Prevalence of upper gastrointestinal bleeding risk factors among the general  population and osteoarthritis patientsKim S.H. Yun J.M. Chang C.B. Piao H. Yu S.J. Shin D.W.World journal of gastroenterology (2016) 22:48 (10643-10652). Date of  Publication: 28 Dec 2016AIM: To assess the prevalence of possible risk factors of upper  gastrointestinal bleeding (UGIB) and their age-group specific trend among  the general population and osteoarthritis patients.METHODS: We utilized data  from the National Health Insurance Service that included claims data and  results of the national health check-up program. Comorbid conditions (peptic  ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal  reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol,  non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI),  personal habits (smoking, and alcohol consumption) were considered as  possible UGIB risk factors. We randomly imputed the prevalence of infection  in the data considering the age-specific prevalence of Helicobacter pylori  (H. pylori) infection in Korea. The prevalence of various UGIB risk factors  and the age-group specific trend of the prevalence were identified.  Prevalence was compared between osteoarthritis patients and others.RESULTS:  A total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above  were included. The prevalence of individual and concurrent multiple risk  factors became higher as the age increased. The prevalence of each comorbid  condition and concomitant drug were higher in osteoarthritis patients.  Thirty-five point zero two percent of the overall population and 68.50% of  osteoarthritis patients had at least one or more risk factors of UGIB. The  prevalence of individual and concurrent multiple risk factors in younger age  groups were also substantial. Furthermore, when personal habits (smoking,  and alcohol consumption) and H. pylori infection were included, the  prevalence of concurrent multiple risk factors increased greatly even in  younger age groups.CONCLUSION: Prevalence of UGIB risk factors was high in  elderly population, but was also considerable in younger population. Patient  with osteoarthritis was at higher UGIB risk than those without  osteoarthritis. Physicians should consider individualized risk assessment  regardless of age when prescribing drugs or performing procedures that may  increase the risk of UGIB, and take necessary measures to reduce modifiable  risk factors such as H. pylori eradication or lifestyle counseling.                                                                 

 

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The active bacterial assemblages of the upper Gi tract in individuals with  and without Helicobacter infectionSchulz C. Schütte K. Koch N. Vilchez-Vargas R. Wos-Oxley M.L. Oxley A.P.A.  Vital M. Malfertheiner P. Pieper D.H.Gut (2016) 67:2 (216-225). Date of Publication: 5 Dec 2016Objective: Patients infected with Helicobacter pylori develop chronic  gastritis with a subgroup progressing to further complications. The role of  microbiota from the oral cavity swallowed with saliva and either transiting  the stomach or persisting in the gastric mucosa is uncertain. It is also not  known whether the bacterial community differs in luminal and mucosal niches.  A key question is whether H. pylori influences the bacterial communities of  gastroduodenal niches. Design: Saliva, gastric and duodenal aspirates as  well as gastric and duodenal biopsies were collected during  oesophagogastroduodenoscopy from 24 patients (m:9, f:15, mean age 52.2±SD  14.5 years). RNA was extracted and the V1-V2 region of the retrotranscribed  bacterial 16S rRNA amplified and sequenced on the Illumina MiSeq platform.  Results: Overall, 687 bacterial phylotypes that belonged to 95 genera and 11  phyla were observed. Each individual comprised a unique microbiota  composition that was consistent across the different niches. However, the  stomach fluid enriched for specific microbiota components. Helicobacter spp  were shown to dominate the mucosa-associated community in the stomach, and  to significantly influence duodenal and oral communities. Conclusions: The  detailed analysis of the active global bacterial communities from the five  distinct sites of the upper GI tract allowed for the first time the  differentiation between host effects and the influence of sampling region on  the bacterial community. The influence of Helicobacter spp on the global  community structures is striking.                                                                

 

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Advantages of routine upper-gastrointestinal endoscopy in positive fecal  occult blood tests with negative colonoscopy resultsKrutsri C. Supsamutchai C. Hiranyatheb P. Singhatas P. Thampongsa T.  Jirasiritham J.Journal of the Medical Association of Thailand (2018) 101:1 (53-57). Date of  Publication: 1 Jan 2018Background: Fecal occult blood test [FOBT] is a popular use for colorectal  cancer screening. When positive results are found, colonoscopy is necessary  to find pathologic lesion. However, in many patients, nothing can be  identified in the colon or rectum. In this situation some surgeons prefer to  perform bidirectional endoscopy to search for the source of the bleeding.  Currently, there is no standard guideline or recommendation to support this,  nor is there evidence against it. Objective: To determine the predictive  value of upper gastrointestinal pathology and benefits of routine use of  esophagogastroduodenoscopy [EGD] after negative colonoscopy in positive  FOBT. Materials and Methods: A retrospective medical                                                                  RECORDs review between  January 1, 2015 and December 31, 2016. All patients who had FOBT for  screening colorectal cancer and positive results were included in the  present study. Patients had undergone colonoscopy and EGD on the same day in  the surgery unit and had negative finding in complete colonoscopy. The  exclusion criteria were active gastrointestinal bleeding, pre-existing  gastrointestinal disease, and previous gastrointestinal tract surgery.  Results: From the method, 185 patients with negative colonoscopy were  enrolled. The mean age was 62.57 years. There were 145 females (78.38%) and  40 males (21.62%). In 160 patients who had pathological lesion from EGD, we  found 117 cases (73.13%) with gastritis and no patients with gastric cancer.  In 160 patients, there were 25 cases (15.63%) with dyspepsia. Of the 25  dyspepsia patients, there were 18 cases (69.23%) who had Helicobacter pylori  infection. Conclusion: EGD has a higher yield for diagnosing benign lesions,  but not for gastric cancer, in FOBT-positive patients. Dual endoscopy may be  cost effective in terms of early treatment and the reduced chance of future  problems. In some patients, we diagnosed and eradicated H. pylori, therefore  reducing the risk of gastric cancer.                                                                

 

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Helicobacter pylori treatment results in Slovenia in the period 2013-2015 as  a part of European Registry on Helicobacter pylori ManagementTepes B. Kastelic M. Vujasinovic M. Lampic P. Seruga M. Jurecic N.B. Nyssen  O.P. Donday M.G. O'Morain C. Megraud F. McNicholl A.G. Gisbert J.P.Radiology and Oncology (2018) 52:1 (1-6). Date of Publication: 2018Helicobacter pylori (H. pylori) is the most common chronic bacterial  infection in the world affecting over 50% of the world's population. H.  pylori is a grade I carcinogen, responsible for the development of 89 % of  noncardia gastric cancers. In the present study we analyzed the data for H.  pylori eradication treatments in Slovenia. Slovenia is a part of the  European Registry on Helicobacter pylori Management from the beginning. In  seven medical institutions data for H. pylori eradication treatments was  collected for 1774 patients from April 16(th) 2013 to May 15(th) 2016. For  further modified intention to treat (mITT) analysis 1519 patients were  eligible and for per protocol (PP) analysis 1346 patients. Patients' dropout  was 11.4%. Eradication rate for 7 day triple therapy with proton pump  inhibitor (PPI) + Clarithromycin (C) + Amoxicillin (A) was 88.7% PP and  72.0% mITT; for PPI + C + Metronidazole (M) 85.2% PP and 84.4% mITT. Second  line 14 day therapy PPI + A + Levofloxacin had 92.3% eradication rate PP and  87.1% mITT. Ten to fourteen day Bismuth quadruple therapy was the therapy in  difficult to treat patients. At the end all patients that adhered to  prescribed regimens were cured of their H. pylori infection. High dropout  rate deserves further analysis. Slovenia is still a country with < 15% H.  pylori resistance to clarithromycin, triple therapy with PPI plus two  antibiotics reaches PP eradication rate > 85%, but mITT eradication rates  are suboptimal.                                                                

 

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Review of the health effects of berries and their phytochemicals on the  digestive and immune systemsGovers C. Kasikci M.B. van der Sluis A.A. Mes J.J.Nutrition Reviews (2018) 76:1 (29-46). Date of Publication: 1 Jan 2018Berries are generally considered beneficial to health. This health-promoting  potential has mainly been ascribed to berries' phytochemical and vitamin  content, and little attention has been paid to the potential benefits of  berries for the digestive tract, despite this being the first point of  contact. In vivo studies that described the health effects of berries on  individual parts of the digestive tract (ie, the mouth, esophagus, stomach,  small and large intestine, microbiome, and immune system) were reviewed.  Immune effects were included because a large part of the immune system is  located in the intestine. Beneficial health effects were mainly observed for  whole berry extracts, not individual berry components. These effects ranged  from support of the immune system and beneficial microbiota to reduction in  the number and size of premalignant and malignant lesions. These results  demonstrate the potency of berries and suggest berries can serve as a strong  adjuvant to established treatments or therapies for a variety of  gastrointestinal and immune-related illnesses.                                                                 

 

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Possible association between Helicobacter pylori infection and vocal fold  leukoplakiaChen M. Chen J. Yang Y. Cheng L. Wu H.-T.Head and Neck (2018). Date of Publication: 2018Background: Several studies have indicated the larynx as possible  Helicobacter pylori (H. pylori) reservoirs. This study explored the  association between H. pylori and vocal fold leukoplakia. Methods: The  case-control study involved 51 patients with vocal fold leukoplakia and 35  control patients with vocal polyps. Helicobacter pylori was detected in  tissues by the rapid urease test, nested polymerase chain reaction (PCR),  and single-step PCR. The H. pylori-specific immunoglobulin antibodies were  detected in plasma by enzyme-linked immunosorbent assay (ELISA). Results:  Helicobacter pylori-positive rate of vocal fold leukoplakia and vocal polyps  was 23.5% versus 11.4% (P = .157), 37.2% versus 14.3% (P = .020), 27.5%  versus 8.6% (P = .031), and 70.6% versus 68.6% (P = .841) detected by rapid  urease test, nested PCR, single-step PCR, and ELISA, respectively.  Regression analysis indicated that H. pylori infection (P = .044) was the  independent risk factor for vocal fold leukoplakia. Conclusion: Helicobacter  pylori infection exists in the larynx and may be associated with vocal fold  leukoplakia.                                                                

 

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The association between Helicobacter pylori infection and the risk of  advanced colorectal neoplasia may differ according to age and cigarette  smokingPark H. Park J.J. Park Y.M. Baik S.J. Lee H.J. Jung D.H. Kim J.-H. Youn Y.H.  Park H.Helicobacter (2018). Date of Publication: 2018Background: The association between Helicobacter pylori infection and  advanced colorectal neoplasia (ACN) remains controversial. This study aimed  to clarify the association between H. pylori infection and ACN according to  age groups. Methods: We retrospectively analyzed the association between H.  pylori infection and ACN in patients aged <50 and ≥50 years receiving a  health checkup that included colonoscopy. Helicobacter pylori positivity was  determined by the results of serum anti-H. pylori immunoglobulin G or rapid  urease test, if the anti-H. pylori immunoglobulin G was in the borderline  range. Results: Among the 19 337 patients who were included, 56.2% and 3.4%  were positive for H. pylori and ACN, respectively. Helicobacter pylori  infection independently increased the risk of ACN in patients aged <50 years  (odds ratio [OR], 1.602; 95% confidence intervals [CI], 1.194-2.150) but not  in patients aged ≥50 years (OR, 1.046; 95% CI, 0.863-1.268). The positive  association between H. pylori infection and ACN was affected by smoking  history. When stratified by age and smoking history, H. pylori infection  conferred an increased risk of ACN in patients aged <50 years with a history  of smoking (OR, 1.926; 95% CI, 1.336-2.775) but not in the other 3 groups  (3-way interaction test P = .023). Among patients aged <50 years with ACN,  ACN in the left colon was found more frequently in patients with H. pylori  infection and a history of smoking than in those without (69.3% vs 54.4%,  respectively; P = .031). Conclusions: Helicobacter pylori infection confers  an increased risk of ACN, but the association may differ according to age  and smoking history.                                                                

 

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Effect of modified Sanhuang Xiexin Tang plus additional herbs combined with  "standard triple therapy" on Helicobacter pylori eradicationYao X. Li Y.Journal of Traditional Chinese Medicine (2018) 38:1 (101-106). Date of  Publication: 15 Feb 2018To determine the effectiveness of modified Sanhuang Xiexin Tang (SHXXT) plus  additional herbs (MSAH) combined with "standard triple therapy" for  eradication of Helicobacter pylori (H. pylori) and amelioration of related  symptoms in comparison with standard triple and standard quadruple  therapies. From October 2015 to May 2016, we recruited patients with  dyspepsia symptoms confirmed to have H. pylori infection by the (13)C urea  breath test in our outpatient clinic. Patients were randomly divided into  three treatment groups: Nexium ® standard triple therapy (group A; EAC);  Nexium ® standard quadruple therapy (group B; EBAC); or Nexium® standard  triple therapy combined with MSAH (group C; EAC+MSAH). Comparisons of H.  pylori eradication and symptom amelioration rates were made among the three  groups at 2 or 6 weeks after group assignment. There was no difference in H.  pylori eradication rates between groups B (EBAC) and C (EAC+MSAH) (P=0.486),  and eradication rates in groups B and C were significantly higher than that  in group A (EAC) (P(A vs B)=0.001; P(A vs C)=0.003). There was no difference  in the total symptom score among the groups before treatment. In all groups,  the total symptom scores after treatment (2 or 6 weeks after group  assignment) were significantly lower than those before treatment (P < 0.001  for all). However, group C (EAC+MSAH) demonstrated superior total symptom  scores and symptom amelioration rates than groups A (EAC) and B (EBAC).  Group B also demonstrated better scores and rates than group A. There was no  difference in symptom amelioration rates at 2 and 6 weeks within each group.  There is no difference between MSAH combined with standard triple therapy  and standard quadruple therapy containing bismuth with regard to H. pylori  eradication rate. However, MSAH combined with standard triple therapy has a  higher symptom amelioration rate and therefore appears to be an ideal  treatment scheme for H. pylori eradication.                                                                

 

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Comparison of helicobacter pylori eradication rates of 2-week  levofloxacin-containing triple therapy, levofloxacin-containing bismuth  quadruple therapy, and standard bismuth quadruple therapy as a first-line  regimenKahramanoǧlu Aksoy E. Pirinçci Sapmaz F. Göktaş Z. Uzman M. Nazllgül Y.Medical Principles and Practice (2018) 26:6 (523-529). Date of Publication:  1 Feb 2018Objective: The aim of this study was to compare the efficacy and safety of  2-week levofloxacin-containing triple therapy, levofloxacin-containing  bismuth quadruple therapy, and standard bismuth-containing quadruple therapy  as a first-line regimen for the eradication of Helicobacter pylori.Methods:  A total of 329 patients with H. pylori infection were randomly divided into  3 groups to receive one of the following regimens: (a)  levofloxacin-containing bismuth quadruple therapy, RBAL (rabeprazole 20 mg,  b.i.d., bismuth subsalicylate 562 mg, b.i.d., amoxicillin 1 g, b.i.d,  levofloxacin 500 mg, once daily), (b) standard bismuth quadruple therapy,  RBMT (rabeprazole 20 mg, b.i.d, subsalicylate 562 mg, b.i.d., metronidazole  500 mg, t.i.d, tetracycline 500 mg, q.i.d), or (c) levofloxacin-containing  triple therapy, RAL (rabeprazole 20 mg, b.i.d., amoxicillin 1 g, b.i.d,  levofloxacin 500 mg, once daily). The primary outcome was the eradication  rate in the intention-To-Treat (ITT) and per protocol (PP) analysis.  Results: The eradication rates of the above 3 groups using ITT analysis were  RBAL 83.8%, RBMT 88.3%, and RAL 74.8% compared with 91.2, 92.5, and 79.2%,  respectively, using PP analysis. The eradication rate using RBMT was  significantly higher than that of RAL (p = 0.029 in ITT analysis and p =  0.017 in PP analysis). Several side effects occurred in 156 patients (54.1%)  in the RBAL group, 215 (52.3%) in the RBMT group, and 56 (26.2%) in the RAL  group (p > 0.05, RBAL vs. RBMT; p < 0.001, RBMT vs. RAL; p < 0.001, RBAL vs.  RAL). Conclusion: All bismuth-containing quadruple therapies had acceptable  eradication rates, but levofloxacin-containing triple therapy was not as  good as quadruple therapies. Hence, quadruple therapies should be considered  the preferred first-line therapy for H. pylori infections.     

                                                          

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Comparison of the efficacy and safety of hybrid and sequential therapies as  a first-line regimen for Helicobacter pylori infection in TurkeyKefeli A. Başyigit S. Yeniova A.O. Ozkan S. Nazligul Y.Archives of Medical Science (2018) 14:2 (276-280). Date of Publication: 1  Mar 2018Introduction: Helicobacter pylori infection is a common infection worldwide.  The most frequently recommended treatment for eradication of H. pylori  remains triple therapy. In this study, we compared sequential and hybrid  regimens for H. pylori eradication in a region of Turkey with high  resistance to clarithromycin. Material and methods: Three hundred and forty  H. pylori-positive patients were enrolled in the study. The subjects were  randomly divided into two groups. The first group (170 patients) received  rabeprazole (40 mg/b.i.d.) and amoxicillin (1000 mg/b.i.d.) for 2 weeks and  metronidazole and clarithromycin (500 mg/b.i.d.) during the second week in  the hybrid therapy group. The second group (170 patients) received  rabeprazole (40 mg/b.i.d.) for 14 days, amoxicillin (1000 mg/b.i.d.) for the  first 7 days, and metronidazole plus clarithromycin (each 500 mg/b.i.d.)  during the next 7 days in the sequential therapy group. Results: In the  per-protocol analysis, the eradication rate in the hybrid therapy group was  96.1% (147/153), and in the sequential therapy group it was 90.9% (140/154).  There was no significant difference between the two groups (p = 0.06).  Ninety-seven of those 340 patients reported minor adverse drug reactions.  The percentages of patients with adverse reactions were 30.6% in the hybrid  therapy group and 26.5% in the sequential therapy group (p = 0.74).  Conclusions: Both therapies are highly effective for eradication of H.  pylori, and could be recommended as a first-line therapy in regions with  high antibiotic resistance.                                                                 

 

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Association between Helicobacter pylori infection and gallbladder diseases:  A retrospective studyXu M.-Y. Ma J.-H. Yuan B.-S. Yin J. Liu L. Lu Q.-B.Journal of Gastroenterology and Hepatology (Australia) (2018). Date of  Publication: 2018Background and Aim: The association between Helicobacter pylori (H. pylori)  and gallbladder diseases is still unclear and is controversial. We conducted  a retrospective study to clarify the prevalence of gallbladder diseases and  factors related to gallbladder diseases and relationships between H. pylori  infection, gallstones, cholecystitis, and cholecystic polypus. Methods: The  retrospective study was performed at the Aerospace Center Hospital in  Beijing. The subjects in this study were a healthy population who underwent  health examinations at the hospital between 2012 and 2015. The logistic  regression models were used to explore the relationships between H. pylori  infection and gallbladder diseases. Results: There were 7803 (43.4%)  subjects with H. pylori infection, 995 (5.5%) with gallstones, 219 (1.2%)  with cholecystitis, and 1003 (5.6%) with cholecystic polypus amongst 17 971  subjects, respectively. In subjects aged 45 years or less, the prevalence of  gallstones in the H. pylori (+) group was lower than that in the H. pylori  (-) group (odds ratio = 0.653; 95% confidence interval: 0.468-0.911; P =  0.012). The prevalence of cholecystic polypus in the H. pylori (+) group was  significantly higher than that in the H. pylori (-) group (odds ratio =  1.160; 95% confidence interval: 1.012-1.328; P = 0.033). Conclusions:  Helicobacter pylori infection was related with cholecystic polypus and  gallstones in a Chinese population.                                                                 

 

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Helicobacter pylori infection in Egypt; a very common disease with low  evidence based clinical practiceAlboraie M. Elhossary W.Arab Journal of Gastroenterology (2018) 19:1 (49). Date of Publication: 1  Mar 2018                                                                 

 

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Update on the management of Helicobacter pylori infection. Position paper  from the Catalan Society of DigestologyActualización en el manejo de la infección por Helicobacter pylori.  Documento de posicionamiento de la Societat Catalana de DigestologiaSánchez Delgado J. García-Iglesias P. Titó L. Puig I. Planella M. Gené E.  Saló J. Martínez-Cerezo F. Molina-Infante J. Gisbert J.P. Calvet X.Gastroenterologia y Hepatologia (2018) 41:4 (272-280). Date of Publication:  1 Apr 2018More than 30 years after its discovery, Helicobacter pylori (H. pylori)  infection remains the most common cause of gastric and duodenal diseases. H.  pylori is the leading cause of chronic gastritis, peptic ulcer, gastric MALT  lymphoma and gastric adenocarcinoma. Several consensuses have recently been  published on the management of H. pylori infection. The general guidelines  of the Spanish consensus, the Toronto Consensus and the Maastricht V  Consensus of 2016 are similar but concrete recommendations can vary  significantly. In addition, the recommendations of some of these consensuses  are decidedly complex. This position paper from the Catalan Society of  Digestology is an update of evidence-based recommendations on the management  and treatment of H. pylori infection. The aim of this document is to review  this information in order to make recommendations for routine clinical  practice that are simple, specific and easily applied to our setting.                                                                 

 

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Comparison of Helicobacter pylori eradication regimens in patients with end  stage renal diseaseMajidi M.S. Pirayvatlou P.S. Rajabikashani M. Firoozabadi M. Seyed Majidi  S.A. Vafaeimanesh J.Gastroenterology and Hepatology from Bed to Bench (2018) 11:1 (15-19). Date  of Publication: 1 Dec 2018Aim: The aim of this study was to compare the Helicobacter pylori (HP)  eradication regimens in patients with end stage renal disease. Background:  In patients undergoing hemodialysis, the pathologic changes seen in the  stomach may be the result of high serum levels of gastrin, delayed gastric  emptying or HP infection. Methods: Our study was a randomized clinical trial  in which 120 patients with ESRD (Patients who undergo hemodialysis)  confirmed HP infection, were divided to four groups having 2-week  eradication regimens; Group I: LCA (lansoprazole 30 mg-BD, clarithromycin  250 mg-BD, amoxicillin 500 mg-BD), Group II: LCM (lansoprazole 30 mg-BD,  clarithromycin 250 mg-BD, metronidazole 500 mg-BD), Group III: LCAM  (lansoprazole 30 mg-BD, clarithromycin 250 mg-BD, amoxicillin 500 mg-BD,  metronidazole 500 mg-BD) and Group IV: Sequential (lansoprazole 30 mg-BDfor  two weeks; first week: amoxicillin 500 mg-BD and second week: clarithromycin  250 mg-BD, metronidazole 500 mg-BD).6 weeks after treatment, Urea Breath  Test (UBT) was performed for all patients. Results: The mean age of patients  was 43.1±11.2 years. 55.8% of patients were male. The success rates of HP  eradication in 4 groups were76.7%, 70%, 90% and 90%, respectively. HP  eradication rates were not statistically different among the regimens  (p=0.11). There were not significant differences among the groups regarding  demographic and anthropometric variables. Conclusion: The results showed  there was no significant difference between the success rates of HP  eradication regimens for ESRD patients. According to approved regimen for  90% eradication rate, with a lower number of medications and given the less  risk of side effects and drug interactions, the sequential regimen is the  best.                                                                

 

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Efficacy of reduced dosage of amoxicillin in an eradication therapy for  Helicobacter pylori infection in patients on hemodialysis: A randomized  controlled trialSahara S. Sugimoto M. Ichikawa H. Kagami T. Sakao Y. Ohashi N. Horio Y.  Sugimoto K. Kato A. Furuta T. Yasuda H.Digestion (2018) 97:2 (163-169). Date of Publication: 1 Feb 2018Background: An optimum Helicobacter pylori-eradication regimen for  hemodialysis patients is yet to be established because of different  pharmacokinetics of amoxicillin involved between hemodialysis patients and  healthy subjects. We investigated to establish appropriate doses of  amoxicillin for H. pylori infection eradication in hemodialysis patients.  Methods: Of 409 hemodialysis patients screened for H. pylori infection, 37  H. pylori-positive patients were randomized to different 1-week eradication  regimens: esomeprazole 20 mg twice a day (b.i.d.) and clarithromycin 200 mg  b.i.d., plus amoxicillin at either 750 mg b.i.d. (group A; conventional) or  250 mg b.i.d. (group B; experimental). Sixty-three patients with normal  renal function received the conventional regimen (group C). Successful  eradication was confirmed by urea breath testing. Results: Eradication rates  of group B (reduced amoxicillin-regimen) were 84.2% in intention-to-treat  analysis and 88.9% in per-protocol analysis, which were similar with group A  (77.8 and 77.8%) and group C (74.6 and 81.0%). However, the incidence of  adverse events in group A was significantly higher than that in group C  (22.2 vs. 5.1%, p = 0.027). Conclusions: In H. pylori-positive hemodialysis  patients, amoxicillin at 250 mg b.i.d. may be an appropriate scheme for  eradication with equivalent effects to the conventional therapy and safety  effects for adverse events.                                                                

 

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Rifabutin Triple Therapy is Effective in Patients with Multidrug-resistant  Strains of Helicobacter pyloriFiorini G. Zullo A. Vakil N. Saracino I.M. Ricci C. Castelli V. Gatta L.  Vaira D.Journal of Clinical Gastroenterology (2018) 52:2 (137-140). Date of  Publication: 2018Introduction: Eradicating Helicobacter pylori continues to be a challenge,  and no treatment regimen is uniformly successful in all treated patients.  Triple therapy with rifabutin and amoxicillin is a successful rescue therapy  after consecutive treatment failures. We designed this study to test the  efficacy of 12-day rifabutin-based triple therapy in patients infected with  multidrug-resistant strains. Methods: Consecutive patients with dyspeptic  symptoms after at least 1 antibiotic therapy course for H. pylori infection  harboring triple-resistant (clarithromycin, metronidazole, levofloxacin)  strains were enrolled. They received triple therapy with esomeprazole 40 mg  bid, amoxicillin 1 g bid, and rifabutin 150 mg od for 12 days. Patients who  failed rifabutin therapy were treated empirically on the basis of the  judgment of the treating physician. Results: A total of 254 out of 756  tested patients were found to be infected with a triple-resistant H. pylori  strains after at least 1 antibiotic therapy course. Overall, the infection  was eradicated in 213 patients, corresponding to a cure rate of 82.9% (95%  CI, 78.3-87.5) by intention-to-treat analysis and 88.7% (95% CI, 84.7-92.7)  at per-protocol analysis. In multivariate analysis, no factor was identified  as an independent predictor of bacterial eradication. Conclusions: There is  no current standard for the growing population of patients with  multidrug-resistant strains of H. pylori. The 12-day low-dose  rifabutin/high-dose proton pump inhibitor regimen is a safe and reliable  option for patients infected with triple-resistant strains.                                                                

 

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Hybrid therapy as first-line regimen for Helicobacter pylori eradication in  a high clarithromycin resistance area: A prospective open-label trialGeorgopoulos S.D. Papastergiou V. Martinez-Gonzalez B. Xirouchakis E.  Familias I. Sgouras D. Mentis A. Karatapanis S.Annals of Gastroenterology (2018) 31:2 (205-210). Date of Publication: 5 Mar  2018Background Hybrid therapy is a promising first-line regimen for Helicobacter  pylori (H. pylori) eradication. We evaluated a hybrid therapy, assessing the  impact of antibiotic resistance on eradication outcome. Methods This was a  prospective study that included 155 treatment-naïve patients diagnosed with  H. pylori infection by positive CLO-test, confirmed with histology and/or  culture. The hybrid therapy consisted of 40 mg esomeprazole and 1 g  amoxicillin for 14 days, with the addition of 500 mg clarithromycin and 500  mg metronidazole for the final 7 days (all b.i.d.). Eradication was defined  by negative(13)C-urea breath test or histology. Results The eradication  rates were 85.8% (133/155; 95% confidence interval [CI] 79.4-90.5%) by  intention-to-treat and 90.2% (129/143; 95%CI 84.1-94.2%) by per-protocol  analysis in a setting of high antibiotic resistance (clarithromycin 25.9%,  metronidazole 31.1%, dual resistance 8.9%). Adverse events occurred in 29.7%  and 1.3% discontinued treatment because of adverse events. Adherence >90%  was achieved in 96.6%. The eradication rate in patients with dual  clarithromycin/ metronidazole resistance (50%) was markedly lower compared  to those with single clarithromycin resistance (91.4%), single metronidazole  resistance (90.5%) or dual susceptibility (97.8%). Dual resistance was the  only factor to correlate with the failure of hybrid therapy (odds ratio  14.4, 95%CI 3.8-54.9, P=0.0003). Conclusions Hybrid therapy is an effective  and safe first-line regimen in populations with relatively high rates of  antibiotic resistance. However, dual clarithromycin/metronidazole resistance  may significantly compromise its efficacy.                                                                

 

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Helicobacter pylori infection is positively associated with an increased  BMI, irrespective of socioeconomic status and other confounders: A cohort  studySuki M. Leibovici Weissman Y. Boltin D. Itskoviz D. Tsadok Perets T.  Comaneshter D. Cohen A. Niv Y. Dotan I. Leibovitzh H. Levi Z.European Journal of Gastroenterology and Hepatology (2018) 30:2 (143-148).  Date of Publication: 2018Background Data on the association of Helicobacter pylori infection and BMI  are conflicting. The fact that both H. pylori infection and BMI are  associated with low socioeconomic status (SES) makes this relationship  difficult to characterize. Materials and methods We aimed to evaluate the  association between BMI and H. pylori infection after adjusting for multiple  covariates. We analyzed a cohort of 235 107 individuals aged 18 years or  older, who performed a 13 C urease breath test (13 C-UBT), from 2007 to  2014. Data on BMI, age, sex, SES, ethnicity, and medications were extracted  from a nationwide population-based database. BMIs were classified according  to the WHO recommendations: underweight (<18.5 kg/m 2), normal weight  (18.5-24.9 kg/m 2), overweight (25-29.9 kg/m 2), obese class I (30-34.9 kg/m  2), and obese class II or more (>35 kg/m 2). Study results The positivity  rate for H. pylori among underweight, normal weight, overweight, and obese  class I and class II or more was 55.6, 58.5, 63.0, 64.5, and 65.5%,  respectively (P<0.001, P linear trend 0.007). The association between BMI  and H. pylori infection was significant across all SES, sex, ethnicity, and  age categories. After adjusting for age, sex, ethnicity, and SES, being  overweight and obese class I and class II or more were associated  significantly with H. pylori positivity: odds ratio 1.13 [95% confidence  interval (CI): 1.11-1.15], 1.14 (95% CI: 1.11-1.17), and 1.15 (95% CI:  1.11-1.19), respectively, P value less than 0.001 for all. Conclusion Among  individuals who were referred to a 13 C-UBT by primary care physician, after  adjusting for multiple covariates including SES, we found a positive  association between H. pylori infection and an increased BMI.                                                                

 

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Hepcidin correlates with interleukin-1β and interleukin-6 but not iron  deficiency in children with Helicobacter pylori infectionChen S.-T. Ni Y.-H. Li C.-C. Liu S.-H.Pediatrics and Neonatology (2018). Date of Publication: 2018Background: Helicobacter pylori infection is associated with iron deficiency  (ID) in children. Inflammatory cytokine reactions could influence the  consequences of H. pylori infection. Hepcidin is an important regulator in  iron homeostasis and could be induced by chronic inflammation. The  relationship between hepcidin and cytokine levels in children infected with  H. pylori remains controversial. Methods: Based on serology testing for  anti-H. pylori IgG, participants (43 seropositive and 43 seronegative) aged  10-18 years were enrolled. Serum hepcidin levels and iron profiles,  including iron, ferritin, and total iron-binding capacity, were measured. ID  is defined as iron saturation less than 15%. Seropositive children were  divided into low hepcidin (n = 22) and high hepcidin (n = 21) groups. IL-1β,  IL-6, and IL-8 serum levels were compared. Results: Serum IL-1β and IL-6  levels were comparable between H. pylori seropositive and seronegative  children, as were the median serum hepcidin levels (6.5 ng/mL versus 8.6  ng/mL; P = 0.1318). Median levels of serum iron, ferritin, and iron  saturation were significantly lower in seropositive children with low  hepcidin than in those with high hepcidin (P = 0.0123, P = 0.0001, and P =  0.0004, respectively). The prevalence of ID was significantly higher in  those with low serum hepcidin levels (33.3% versus 4.5%; P = 0.015).  Compared to the high hepcidin seropositive group, the low hepcidin group had  significantly lower median serum levels of cytokines IL-1β and IL-6, but not  IL-8 (P = 0.0151 and P = 0.0015, respectively). Conclusions: Inflammatory  cytokines IL-1β and IL-6, but not IL-8, might be associated with increased  hepcidin levels among H. pylori-seropositive children. Further studies are  needed to clarify the role of hepcidin.                                                                

 

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Ethnic and racial difference in Helicobacter pylori infection in patients  with immune thrombocytopenia treated at a major urban medical centerO’Neill C.M. Weitz I.C. O’Connell C. Liebman H.A.Platelets (2018) (1-5). Date of Publication: 24 Mar 2018Immune thrombocytopenia (ITP) is an autoimmune disorder with a complex  immunopathology and pathogenesis characterized by thrombocytopenia and  bleeding manifestations. The disorder is separated into primary (idiopathic)  ITP and secondary ITP, when associated with other immune or  lymphoproliferative disorders and certain chronic infections. Helicobacter  pylori (H. pylori) is a recognized bacterial cause of ITP. In regions with  high prevalence of infection, bacterial eradication has resulted in  improvement in platelet count. However, the prevalence of H. pylori  infection and response to antimicrobial therapy in North American ITP  patients is reportedly low. We evaluated the prevalence of H. pylori  infection in ITP patients diagnosed and treated at a large urban medical  center. Eighty-two patients were screened for H. pylori, by stool antigen  (n = 54), H. pylori breath test (n = 11), and H. pylori antibodies (n = 16),  of which 15 (18.3%) were white non-Hispanic (WNH), 55 (67%) Hispanic (H), 8  (9.8%) Asian (A), and 4 (4.9%) African-American (AA). Of the screened  patients, 36/82 (43.9%) tested positive for H. pylori. The prevalence of H.  pylori infection within the represented ethnic groups was 2/15 (13%) WNH,  29/55 (52.7%) H, 3/8 (37.5%) A, and 2/4 (50%) AA. There was a significant  difference in prevalence of infection comparing WNH and H patients  (p = 0.007). There were 36 treated patients, with H. pylori eradication  documented in 26 patients. Fifteen of the 26 patients were evaluable for  response with 8 of 15 (53%) having clinical responses, 6 complete responses,  and 2 partial responses. Our study demonstrates an increased prevalence of  H. pylori infection in the Hispanic ITP population with a reasonable  platelet response among patients with H. pylori eradication.                                                                

 

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Helicobacter pylori Infection: an Update for the Internist in the Age of  Increasing Global Antibiotic ResistanceSiddique O. Ovalle A. Siddique A.S. Moss S.F.American Journal of Medicine (2018). Date of Publication: 2018Helicobacter pylori infects approximately half the world's population and is  especially prevalent in the developing world. H. pylori is an important  cause of global ill health due to its known etiological role in peptic ulcer  disease, dyspepsia, gastric cancer, lymphoma, and more recently, recognized  in iron deficiency anemia and idiopathic thrombocytopenic purpura. Increased  antibiotic usage worldwide has led to antibiotic resistance among many  bacteria, including H. pylori, resulting in falling success rates of  first-line anti-H. pylori therapies. Eradication failures are principally  due to resistance to clarithromycin, levofloxacin, and metronidazole.  Several new treatment options or modifications of established regimens are  now recommended by updated practice guidelines for primary or secondary  therapy. Because these updated recommendations were published in the  gastroenterological literature, internists and primary care physicians, who  commonly manage H. pylori, may be unaware of these advances. In this review,  we outline the changing epidemiology of H. pylori, advise on diagnostic test  selection for patients not undergoing endoscopy, and highlight current  management options in this era of growing antibacterial resistance.                                                                 

 

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3rd World Congress of Health ResearchAtencion Primaria (2016) 48 Supplement C. Date of Publication: 1 Sep 2016The proceedings contain 477 papers. The topics discussed include: the  importance of videodefecography in defecatory disorders in order to improve  the quality of life of patients; effectiveness of compression therapy of  short traction on venous leg ulcers treatment; nonsteroidal  anti-inflammatory drugs: use in higher education students; screening program  of colorectal carcinoma: a practice report of a health unit family;  correlation between antidiabetic medication adherence and type 2 diabetes  control in ambulatory patients; correlation between beliefs about medication  and type 2 diabetes control in ambulatory patients; communication skills: an  ignored health indicator in university settings?; diabetes mellitus: therapy  adherence and new therapeutic approach with incretin mimetics in northeast  Portugal; characterization of potential drug-drug interactions with vitamin  k antagonists and its influence on blood clotting; interpreting drawings by  children and adolescents undergoing cancer treatment; helicobacter pylori  infection in a community sample of Portuguese adults - a public health  issue; overweight and obesity in adolescents - analysis of associated  factors; breastfeeding difficulties after discharge in newborns hospitalized  in intensive care units; time-trends in infant mortality rates in the  southern Europe; intrinsic and extrinsic motivation to breastfeed scale -  Portuguese version: analyze the dimensions of motivation; and baby-led  weaning: a valid alternative to traditional introduction to complementary  food?.                                                                

 

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Levofloxacin based vs clarithromycin based sequential therapy in  Helicobacter pylori eradication; a randomized clinical trialMoradniani M. Mirbeik-Sabzevari Z. Jaferian S. Shafiezadeh S. Ardakani  M.J.E. Roozbahany M.M. Azadbakht S. Sherkatolabbasieh H.Gastroenterology and Hepatology from Bed to Bench (2018) 11:1 (20-26). Date  of Publication: 1 Dec 2018Aim: This study was aimed to evaluating the efficacy of levofloxacin based  sequential therapy vs clarithromycin based sequential therapy in h.pylori  (HP) eradication. Background: Several therapeutic regimen were investigated  to treat HP infection. Sequential therapy is an alternative to classic  triple therapy. Methods: In this randomized clinical trial, 200 HP infected  patients randomly divided into two therapeutic groups .1-Levofloxacin based  sequential regimen (group A); omeprazole and amoxicillin for 7days followed  by omeprazole, amoxicillin and levofloxacin for 7days. 2-clarithromycin  based sequential regimen (group B): omeprazole and amoxicillin for 7days  followed by omeprazole, amoxicillin and clarithromycin for 7days. HP  eradication was evaluated with urea breath test with carbon 13 (UBT) 6 weeks  after the end of treatment. Results: Per protocol eradication rates of group  A and B were 87.6% and 76% respectively. By intention to treat analysis,  eradication rate of group A and B groups were 85.1% and 73% respectively.  Levofloxacin based sequential regimen was more effective than clarithromycin  based sequential regimen (Pv=0.028). Adverse events were seen in 19.6% and  15.6% in group A and B respectively. Drug compliance was 97% in group A and  96% in group B. There was no significant difference between two groups in  term of adverse events (p=0.470) and compliance (p=0.651). Conclusion:  Levofluxacin based sequential therapy was more effective than Clarithromycin  based sequential therapy in HP eradication. The suggested Levofluxacin based  sequential therapy could be an alternative therapy in area with high  clarithromycin resistance. Further studies are needed to confirm these  findings.                                                                

 

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Impact of primary antibiotic resistance on the effectiveness of sequential  therapy for Helicobacter pylori infection: Lessons from a 5-year study on a  large number of strainsGatta L. Scarpignato C. Fiorini G. Belsey J. Saracino I.M. Ricci C. Vaira D.Alimentary Pharmacology and Therapeutics (2018). Date of Publication: 2018Background: The increasing prevalence of strains resistant to antimicrobial  agents is a critical issue in the management of Helicobacter pylori (H.  pylori) infection. Aims: (1) To evaluate the prevalence of primary  resistance to clarithromycin, metronidazole and levofloxacin (2) to assess  the effectiveness of sequential therapy on resistant strains (3) to identify  the minimum number of subjects to enrol for evaluating the effectiveness of  an eradication regimen in patients harbouring resistant strains. Methods:  Consecutive 1682 treatment naïve H. pylori-positive patients referred for  upper GI endoscopy between 2010 and 2015 were studied and resistances  assessed by E-test. Sequential therapy was offered, effectiveness evaluated  and analysed. Results: H. pylori-primary resistance to antimicrobials tested  was high, and increased between 2010 and 2015. Eradication rates were  (estimates and 95% CIs): 97.3% (95.6-98.4) in strains susceptible to  clarithromycin and metronidazole; 96.1% (91.7-98.2) in strains resistant to  metronidazole but susceptible to clarithromycin; 93.4% (88.2-96.4) in  strains resistant to clarithromycin but susceptible to metronidazole; 83.1%  (77.7-87.3) in strains resistant to clarithromycin and metronidazole. For  any treatment with a 75%-85% eradication rate, some 98-144 patients with  resistant strains need to be studied to get reliable information on  effectiveness in these patients. Conclusions: H. pylori-primary resistance  is increasing and represents the most critical factor affecting  effectiveness. Sequential therapy eradicated 83% of strains resistant to  clarithromycin and metronidazole. Reliable estimates of the effectiveness of  a given regimen in patients harbouring resistant strains can be obtained  only by assessing a large number of strains.                                                                 

 

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Helicobacter pylori infection does not protect against eosinophilic  esophagitis: results from a large multicenter case-control studyMolina-Infante J. Gutierrez-Junquera C. Savarino E. Penagini R. Modolell I.  Bartolo O. Prieto-García A. Mauro A. Alcedo J. Perelló A. Guarner-Argente C.  Alcaide N. Vegas A.M. Barros-García P. Murzi-Pulgar M. Perona M. Gisbert  J.P. Lucendo A.J. de Bortoli N. Costa V.A. Dominguez-Jimenez J.L.  Garcia-Romero R. Jimeno C. Marabotto E. Pajares-Diaz J.A. Perez-Aisa A.  Tolone S. Ortiz V. Zerbib F. Galera A.P.American Journal of Gastroenterology (2018) (1-8). Date of Publication: 15  Mar 2018Objectives: Rising trends in eosinophilic esophagitis (EoE) have been  repeatedly linked to declining Helicobacter pylori (H. pylori) infection,  mostly in retrospective studies. We aimed to prospectively evaluate this  inverse association. Methods: Prospective case-control study conducted in 23  centers. Children and adults naïve to eradication therapy for H. pylori were  included. Cases were EoE patients, whereas controls were defined by  esophageal symptoms and <5 eos/HPF on esophageal biopsies. H. pylori status  was diagnosed by non-invasive (excluding serology) or invasive testing off  proton pump inhibitor (PPI) therapy for 2 weeks. Atopy was defined by the  presence of IgE-mediated conditions diagnosed by an allergist. Results: 808  individuals, including 404 cases and 404 controls (170 children) were  enrolled. Overall H. pylori prevalence was 38% (45% children vs. 37% adults,  p 0.009) and was not different between cases and controls (37% vs. 40%, p  0.3; odds ratio (OR) 0.97; 95% confidence interval (CI) 0.73–1.30), neither  in children (42% vs. 46%, p 0.1) nor in adults (36% vs. 38%, p 0.4). Atopy  (OR 0.85; 95%CI 0.75–0.98) and allergic rhinitis (OR 0.81; 95%CI 0.68–0.98)  showed a borderline inverse association with H. pylori infection in EoE  patients. This trend was not confirmed for asthma or food allergy.  Conclusions: H. pylori infection was not inversely associated with EoE,  neither in children nor in adults. A borderline inverse association was  confirmed for atopy and allergic rhinitis, but not asthma of food allergy.  Our findings question a true protective role of H. pylori infection against  allergic disorders, including EoE.                                                                

 

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Helicobacter pylori infection promotes Aquaporin 3 expression via the  ROS–HIF-1α–AQP3–ROS loop in stomach mucosa: a potential novel mechanism for  cancer pathogenesisWen J. Wang Y. Gao C. Zhang G. You Q. Zhang W. Zhang Z. Wang S. Peng G. Shen  L.Oncogene (2018) (1-13). Date of Publication: 22 Mar 2018Helicobacter pylori (H. pylori) is the major stomach carcinogen, but the  molecular mechanism responsible for the pathogenesis of cancer development  mediated by H. pylori infection is still unclear. Aquaporin 3 (AQP3),  overexpressed in gastric carcinoma, has a crucial role in gastric  carcinogenesis and progression. However, the triggers and precise  regulations for AQP3 upregulation during gastric carcinogens also remain  unknown. Here we report that H. pylori infection-mediated carcinogenesis may  be mechanistically depended on the upregulation of AQP3 expression via  reactive oxygen species (ROS) pathway activation in the stomach. The  retrospective analyses of clinical samples from patients with gastric  carcinoma and other different stages of gastric diseases indicated that AQP3  expression was positively associated with gastric mucosal disease  progression and H. pylori infection status as well. Furthermore, H. pylori  infection significantly upregulated AQP3 and HIF-1α expression and increased  ROS amount in human gastric epithelial AGS and GES-1 cells. Blockage of ROS  with inhibitors, NAC and DPI, markedly decreased the expression of AQP3 and  HIF-1α in both AGS and GES-1 cells simultaneously. Furthermore, the  increased AQP3 in cells was mechanistically due to the transcriptional  regulation by HIF-1α. In addition, H. pylori infection exerted production of  proinflammatory cytokines IL-6, IL-8, and TNF depending on AQP3 level.  Importantly, these in vitro novel findings were further investigated in vivo  in a mouse H. pylori infectious model. Our current studies identify the  mechanistic link between H. pylori infection and AQP3 upregulation in the  pathogenesis of gastric carcinoma, which involves the activation of the  ROS–HIF-1α axis and the exacerbated ROS–HIF-1α–AQP3–ROS loop.                                                                

 

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Eradication of Helicobacter pylori infection with a new bismuth-based  quadruple therapy in clinical practiceErradicación de la infección por Helicobacter pylori con una nueva terapia  cuádruple basada en bismuto en la práctica clínicaPérez-Arellano E. Rodriguez-Garcia M.I. Galera Rodenas A.B. de la  Morena-Madrigal E.Gastroenterologia y Hepatologia (2018) 41:3 (145-152). Date of Publication:  1 Mar 2018Introduction: The eradication of Helicobacter pylori infection represents a  clinical challenge. Objective: To evaluate the efficacy and safety of  quadruple therapy with esomeprazole plus a 3-in-1 capsule containing bismuth  subcitrate, metronidazole and tetracycline, plus probiotics in patients  diagnosed with H. pylori infection in routine clinical practice. Methods: A  prospective, interventional, single-centre and open-label study in  consecutive patients with a confirmed indication for eradication of H.  pylori infection. Patients were treated with three capsules of Pylera(®)  four times a day (breakfast, lunch, afternoon snack and dinner), plus 40 mg  of esomeprazole twice daily for 10 days (30 min before breakfast and dinner)  and probiotics for 30 days. Eradication of H. pylori infection was confirmed  by labelled urea breath test performed at least 28 days after the end of  treatment. Results: A total of 100 patients were consecutively enrolled.  Twenty-five patients (25.0%) had a prior history of treatment for their H.  pylori infection. In the intention-to-treat population, eradication rates  were 90.7% (68/75) and 80.0% (20/25) in patients treated with Pylera(®) as  the first line or as rescue therapy, respectively. Eighteen patients (18%)  had at least one adverse event, most of which (89%) were mild. Conclusion:  Ten days of treatment with a quadruple regimen of bismuth, metronidazole and  tetracycline plus esomeprazole and probiotics is an effective and safe  strategy in patients with H. pylori infection.                                                                

 

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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 (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.                                                                

 

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Study the relation between persistent chronic cough and helicobacter pylori  infection in pediatrics age groupEl-Sayed S.A.M. Shehab M.M. Ahmady M.M. Baraka A.International Journal of Pharmaceutical and Phytopharmacological Research  (2018) 8:1 (10-15). Date of Publication: 1 Feb 2018Introduction: Helicobacter pylori infection is most commonly a cause of  gastritis causing symptoms outside gastro intestinal tract. Cough is one of  the most common persistent problems in infant and children especially  chronic cough with confusing cause. H.p. gastritis spread to nasopharyngeal  cavity in case of gastro-esophageal reflux. Aims: To study the correlation  in-between Helicobacter pylori gastritis and persistent chronic cough in  infant and children. Materials and methods: 2 groups of patients sharing in  the study, study group (81) of patients complaining of persistent chronic  cough without known cause and control group (41) of patients with persistent  chronic cough due to nonspecific laryngeal and pharyngeal infection.  Results: Active infection with Helicobacter pylori was found in 88.8 %  (72/81) of children of our study group with persistent chronic cough But was  26.8 % (11/41) of our controlled group, supported by presence of the antigen  of Helicobacter in the children stool. The difference was apparent  significantly shown (p, < 00.001). After treatment by using the proper  management for H Pylori there was a significant improving of the persistent  chronic cough of 92.8% (65/70) of children (p, 00.001). Conclusions:  Persistent chronic cough without recognized cause most commonly due to  infection by Helicobacter pylori that leading to laryngeal and pharyngeal  inflammation, several manifestations especially persistent chronic cough.                                                                

 

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The emerging role of helicobacter pylori-induced metabolic gastrointestinal  dysmotility and neurodegenerationKountouras J. Boziki M. Polyzos S.A. Katsinelos P. Gavalas E. Zeglinas C.  Tzivras D. Romiopoulos I. Giorgakis N. Anastasiadou K. Vardaka E. Kountouras  C. Kazakos E. Giartza-Taxidou E. Deretzi G. Dardiotis E. Kotronis G.  Doulberis M.Current Molecular Medicine (2017) 17:6 (389-404). Date of Publication: 1 Jul  2017Helicobacter pylori infection (Hp-I) is a prevalent disorder identified in  themajority of the population in many countries around the world and is  responsible for substantial gastrointestinal morbidity. Likewise,  neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s  diseases, multiple sclerosis or glaucoma defined as ocular Alzheimer’s  disease, are associated with a large public health burden and are among the  leading causes of disability. Emerging evidences suggest that Hp-I may be  associated with neurodegenerative conditions. Moreover, Hp-I could be a  predictor of metabolic syndrome (MetS). Hp-I and its related MetS may induce  gastrointestinal tract dys-motility disorders with systemic complications  possibly including central nervous system neurodegenerative pathologies. We  hereby explore the emerging role of Hprelated metabolic gastrointestinal  dys-motilities on the molecular pathophysiology of Hprelated  neurodegenerative and gastrointestinal disorders. Improving understanding of  such Hp-I pathophysiology in brain pathologies may offer benefits by  application of new relative therapeutic strategies including novel  opportunities toward enhancing Hp eradication.                                                                

 

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Furazolidone treatment for Helicobacter Pylori infection: A systematic  review and meta-analysisZhuge L. Wang Y. Wu S. Zhao R.-L. Li Z. Xie Y.Helicobacter (2018) 23:2 Article Number: e12468. Date of Publication: 1 Apr  2018Antibiotic resistance is a major cause of Helicobacter pylori (H. pylori)  treatment failures. Because the resistance rate of H. pylori to furazolidone  is low, we aimed to assess the efficacy and safety of furazolidone. We  searched the PubMed, Web of Science, Cochrane Library, and Embase databases  and included randomized controlled trials (RCT) that either compared  furazolidone to other antibiotics or changed the administered dose of  furazolidone. A total of 18 articles were included in the meta-analysis.  According to the intention-to-treat (ITT) analysis, the total eradication  rates of furazolidone-containing therapy were superior to those of other  antibiotic-containing therapies (relative risk [RR] 1.07, 95% confidence  interval [CI] 1.01-1.14) (13 RCTs). Specifically, the eradication rates of  furazolidone-containing therapy were better than those for  metronidazole-containing therapy (RR 1.10, 95% CI: 1.01-1.21 for ITT). The  eradication rate of furazolidone-containing bismuth-containing quadruple  therapy was 92.9% (95% CI: 90.7%-95.1%) (PP). In addition, a higher daily  dose of furazolidone increased the eradication rate (RR 1.17, 95% CI:  1.05-1.31). And the incidence of some adverse effects, such as fever and  anorexia, was higher in the furazolidone group than in the control group,  the overall incidences of total side effects and severe side effects showed  no significant differences between the groups. Furazolidone-containing  treatments could achieve satisfactory eradication rates and did not increase  the incidence of total or severe adverse effects, but the incidence of  milder side effects, such as fever and anorexia, should be considered when  prescribing furazolidone-containing treatments to patients.                                                                

 

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Non-invasive diagnostic tests for Helicobacter pylori infectionBest L.M.J. Takwoingi Y. Siddique S. Selladurai A. Gandhi A. Low B. Yaghoobi  M. Gurusamy K.S.Cochrane Database of Systematic Reviews (2018) 2018:3 Article Number:  CD012080. Date of Publication: 15 Mar 2018Background: Helicobacter pylori (H pylori) infection has been implicated in  a number of malignancies and non-malignant conditions including peptic  ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained  iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and  colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic  biopsy, followed by histopathological examination using haemotoxylin and  eosin (H & E) stain or special stains such as Giemsa stain and  Warthin-Starry stain. Special stains are more accurate than H & E stain.  There is significant uncertainty about the diagnostic accuracy of  non-invasive tests for diagnosis of H pylori. Objectives: To compare the  diagnostic accuracy of urea breath test, serology, and stool antigen test,  used alone or in combination, for diagnosis of H pylori infection in  symptomatic and asymptomatic people, so that eradication therapy for H  pylori can be started. Search methods: We searched MEDLINE, Embase, the  Science Citation Index and the National Institute for Health Research Health  Technology Assessment Database on 4 March 2016. We screened references in  the included studies to identify additional studies. We also conducted  citation searches of relevant studies, most recently on 4 December 2016. We  did not restrict studies by language or publication status, or whether data  were collected prospectively or retrospectively. Selection criteria: We  included diagnostic accuracy studies that evaluated at least one of the  index tests (urea breath test using isotopes such as (13)C or (14)C,  serology and stool antigen test) against the reference standard  (histopathological examination using H & E stain, special stains or  immunohistochemical stain) in people suspected of having H pylori infection.  Data collection and analysis: Two review authors independently screened the  references to identify relevant studies and independently extracted data. We  assessed the methodological quality of studies using the QUADAS-2 tool. We  performed meta-analysis by using the hierarchical summary receiver operating  characteristic (HSROC) model to estimate and compare SROC curves. Where  appropriate, we used bivariate or univariate logistic regression models to  estimate summary sensitivities and specificities. Main results: We included  101 studies involving 11,003 participants, of which 5839 participants  (53.1%) had H pylori infection. The prevalence of H pylori infection in the  studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7%  (interquartile range 42.0% to 66.5%). Most of the studies (57%) included  participants with dyspepsia and 53 studies excluded participants who  recently had proton pump inhibitors or antibiotics.There was at least an  unclear risk of bias or unclear applicability concern for each study. Of the  101 studies, 15 compared the accuracy of two index tests and two studies  compared the accuracy of three index tests. Thirty-four studies (4242  participants) evaluated serology; 29 studies (2988 participants) evaluated  stool antigen test; 34 studies (3139 participants) evaluated urea breath  test-(13)C; 21 studies (1810 participants) evaluated urea breath test-(14)C;  and two studies (127 participants) evaluated urea breath test but did not  report the isotope used. The thresholds used to define test positivity and  the staining techniques used for histopathological examination (reference  standard) varied between studies. Due to sparse data for each threshold  reported, it was not possible to identify the best threshold for each test.  Using data from 99 studies in an indirect test comparison, there was  statistical evidence of a difference in diagnostic accuracy between urea  breath test-(13)C, urea breath test-(14)C, serology and stool antigen test  (P = 0.024). The diagnostic odds ratios for urea breath test-(13)C, urea  breath test-(14)C, serology, and stool antigen test were 153 (95% confidence  interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to  88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at  a fixed specificity of 0.90 (median from studies across the four tests), was  0.94 (95% CI 0.89 to 0.97) for urea breath test-(13)C, 0.92 (95% CI 0.89 to  0.94) for urea breath test-(14)C, 0.84 (95% CI 0.74 to 0.91) for serology,  and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on  average, given a specificity of 0.90 and prevalence of 53.7% (median  specificity and prevalence in the studies), out of 1000 people tested for H  pylori infection, there will be 46 false positives (people without H pylori  infection who will be diagnosed as having H pylori infection). In this  hypothetical cohort, urea breath test-(13)C, urea breath test-(14)C,  serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI  30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives  respectively (people with H pylori infection for whom the diagnosis of H  pylori will be missed). Direct comparisons were based on few head-to-head  studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12  to 3.70; P = 0.56) for urea breath test-(13)C versus serology (seven  studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath  test-(13)C versus stool antigen test (seven studies). The 95% CIs of these  estimates overlap with those of the ratios of DORs from the indirect  comparison. Data were limited or unavailable for meta-analysis of other  direct comparisons. Authors' conclusions: In people without a history of  gastrectomy and those who have not recently had antibiotics or proton ,pump  inhibitors, urea breath tests had high diagnostic accuracy while serology  and stool antigen tests were less accurate for diagnosis of Helicobacter  pylori infection.This is based on an indirect test comparison (with  potential for bias due to confounding), as evidence from direct comparisons  was limited or unavailable. The thresholds used for these tests were highly  variable and we were unable to identify specific thresholds that might be  useful in clinical practice. We need further comparative studies of high  methodological quality to obtain more reliable evidence of relative accuracy  between the tests. Such studies should be conducted prospectively in a  representative spectrum of participants and clearly reported to ensure low  risk of bias. Most importantly, studies should prespecify and clearly report  thresholds used, and should avoid inappropriate exclusions.                                                                

 

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Rapidity of diagnosis and management of H. Pylori in the endoscopy unit at  mater dei hospitalZammit D. Xerri T. Ellul P.Malta Medical Journal (2017) 29:3 (6-14). Date of Publication: 2017Introduction: H.pylori infection has been associated with various gastric  pathologies and its prevalence varies between different countries.  Furthermore, there is an increasing antibiotic resistance and the  eradication rates have declined. There is clinical and administrative  pressure as to provide the Rapid Urease Test (RUT) result as quickly as  possible and ideally prior to discharge from the endoscopy unit. Results: A  total of 542 patients fulfilled the inclusion criteria. The patient’s mean  age was 54.6 years and 52.4% were female. The main clinical indications for  an Oesophago-Gastro-Duodenoscopy (OGD) were dyspepsia (44.7%) and GORD  (24.5%). The overall positivity rate was 15% of which 8.7% were early  positive and 6.3% were late positive. Analysis of patients’ age with RUT  positivity revealed that patients above the age of 60 years were more likely  to have a positive result (p=0.013). There was no statistical significance  between the H.pylori results and smoking (p=0.6). In this study, there was a  variety of 10 different eradication regimes prescribed, the most popular  being the use of a PPI 20mg BD + Amoxicillin 1g BD + Clarithromycin 500mg BD  for 10 days (total of 27 cases) versus 14 days (23 cases). Conclusion: This  study demonstrates the importance of checking the RUT taken at endoscopy at  24 hours as this has given a 42% increase in the yield for H.pylori. It also  demonstrates that various regimens are used in clinical practice. In view of  the relatively low prevalence of H.pylori, especially amongst young  patients, maybe it is prime time that treatment of H.pylori is specifically  managed by culture and sensitivity to avoid worsening  clarithromycin-resistance.                                                                

 

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Definition, Pathogenesis, and Management of That Cursed DyspepsiaKoduru P. Irani M. Quigley E.M.M.Clinical Gastroenterology and Hepatology (2018) 16:4 (467-479). Date of  Publication: 1 Apr 2018Dyspepsia is an umbrella term used to encompass a number of symptoms thought  to originate from the upper gastrointestinal tract. These symptoms are  relatively nonspecific; not surprisingly, therefore, a myriad of conditions  may present with any one or a combination of these symptoms. Therein lays  the clinician's first challenge: detecting the minority who may have a  potentially life-threatening disorder, such as gastric cancer, from a  population whose symptoms are, for the most part, considered functional in  origin. The second challenge lies in the definition and management of those  individuals with functional dyspepsia (FD); the major focus of this review.  The Rome process has addressed the issue of FD definition and a look back at  the evolution of Rome criteria for this disorder illustrates the  complexities that have so frustrated us. There has been no shortage of  hypotheses to explain symptom pathogenesis in FD; initially focused on  gastric sensorimotor dysfunction, these have now strayed well into the  duodenum and have come to entertain such factors as immune responses and the  microbiome. FD has proven to be an equally challenging area for  therapeutics; while the staple approaches of acid suppression and  eradication of Helicobacter pylori have some limited efficacy in select  populations, strategies to ameliorate symptoms in the majority of sufferers  based on presumed pathophysiology have largely foundered. Lacking a  validated biomarker(s) FD continues to be an elusive target and is likely to  remain so until we can better define the various phenotypes that it must  surely contain.                                                                

 

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Outlook on epigenetic therapeutic approaches for treatment of gastric cancerHudler P.Current Cancer Drug Targets (2018) 18:1 (65-88). Date of Publication: 1 Jan  2018The incidence of gastric cancer has been declining globally in the last  decades. Despite the improvements in the diagnostic procedures, most cases  are still detected at advanced stages due to lack of specific symptoms  associated with early phases of tumour development. Consequently, gastric  cancer poses a major health burden worldwide due to high mortality rates.  Continuing advances in high-throughput technologies are revealing an  intricate network of genetic and epigenetic changes associated with  carcinogenesis. In addition, several risk factors, both environmental and  genetic, have been recognized, which promote accumulation of diverse  alterations affecting the expression of oncogenes, tumour suppressor genes,  DNA repair genes, and other genes, implicated in normal gastric cell  functions. A plethora of aberrant molecular events found in patients with  this disease and intragenic heterogeneity of tumours from individuals are  delaying the development of targeted biological therapies. Frequent  occurrence of characteristic CpG island methylator phenotypes (CIMP  phenotypes) in gastric cancers, particularly in association with  Helicobacter pylori or EBV infection, could lead to introduction of  epigenetic modulators into standard treatment regimens used against early  and advanced forms of adenocarcinomas. This review highlights aberrant DNA  methylation events in the development of gastric tumours and addresses the  different aspects associated with the application of therapeutic epigenetic  modulation in the management of the disease.                                                                

 

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Old and New Gut Hormone, Gastrin and Acid Suppressive TherapyHaruma K. Kamada T. Manabe N. Suehiro M. Kawamoto H. Shiotani A.Digestion (2018) (340-344). Date of Publication: 27 Mar 2018Gastrin acts physiologically as a gut hormone to stimulate acid secretion  after meal and as a cell-growth factor of oxyntic mucosa. Increase in serum  gastrin level happens under various conditions including Zollinger-Ellison  syndrome, antral G cell hyperplasia, autoimmune gastritis, atrophic  gastritis, renal failure, vagotomy, Helicobacter pylori infection and acid  suppressive therapy. As acid suppressive therapy causes hypergastrinemia,  the association between acid suppressive therapy and gastric neuroendocrine  cell tumor (NET) has been discussed during the past 30 years. In this review  article, the definition of hypergastrinemia and the related disorders  including acid suppressive therapy and gastric NET are discussed.                                                                

 

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Phenotypic heterogeneity of hereditary diffuse gastric cancer: report of a  family with early-onset diseaseGullo I. Devezas V. Baptista M. Garrido L. Castedo S. Morais R. Wen X. Rios  E. Pinheiro J. Pinto-Ribeiro I. Ferreira R.M. Preto J. Santos-Antunes J.  Marques M. Campos M. Almeida F. Espinheira M.D.C. Dias J.A. Figueiredo C.  Oliveira C. Trindade E. Carneiro F.Gastrointestinal Endoscopy (2018). Date of Publication: 2018Background and Aims: The time course for the development of clinically  significant hereditary diffuse gastric cancer (HDGC) is unpredictable.  Little is known about the progression from preclinical, indolent lesions to  widely invasive, aggressive phenotypes. Gastroendoscopy often fails to  detect early lesions, and risk-reducing/prophylactic total gastrectomy (PTG)  is the only curative approach. We present an HDGC family with early-onset  disease in which clinical and histologic findings provided insight into the  understanding of different HDGC phenotypes. Methods: The proband was  diagnosed at age 18 years with widely invasive, metastatic DGC. CDH1 genetic  testing identified a pathogenic, germline CDH1 variant (c.1901C>T,  p.Ala634Val). Thirty family members were tested, and 15 CDH1 carriers were  identified. Results: Six family members had PTG, with negative preoperative  workup. The proband's 14-year-old sister is the youngest patient, reported  to date, to have PTG after negative preoperative biopsy sampling.  Intramucosal HDGC foci were detected in all PTG specimens (1-33). In  contrast to the “indolent” phenotype of these foci, the aggressive DGC from  the proband showed pleomorphic cells, absent E-cadherin expression,  increased proliferation (Ki-67 index), and activation of oncogenic events  (p53, pSrc and pStat3 overexpression). All family members had Helicobacter  pylori gastritis. Cag-A–positive strains were detected in all specimens,  except in the proband's sister. Conclusions: HDGC is a heterogeneous disease  regarding clinical behavior, endoscopic findings, histopathologic features,  and immunophenotypic/molecular profile. The presence of bizarre, pleomorphic  cells in endoscopic biopsy specimens is suggestive of advanced disease and  should prompt clinical intervention. The involvement of a full  multidisciplinary team is essential for the management of these patients.                                                                

 

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Comparison of the prevalence of Helicobacter pylori infection between the  exclusively breastfed and formula- or mixed-fed infants in the first six  months of lifeAsgarshirazi M. Nayeri F. Shariat M. Dalili H. Abdollahi A. Ziaei S.Journal of Comprehensive Pediatrics (2017) 8:4 Article Number: e59992. Date  of Publication: 1 Nov 2017Background: Helicobacter pylori is a commongastrointestinal pathogen in  human. The mechanism of its acquisition and transmission is unclear,  although the most likely mode of transmission is fecal-oral or oral-oral.  Most of infections occur in childhood. The current cohort assessed the  prevalence of infection in infants with different feeding strategies  (exclusive breastfeeding, formula, or mixed feeding). Methods: The current  study was carried out in Vali-Asr hospital of Imam Khomeini hospital  complex, Tehran, Iran, from 2012 to 2015.The study population included  infants born in this hospital and registered in breastfeeding research  center during the first 6 months of life. They were compared in 2 groups;  exclusively breastfed, and formula or mixed fed. Mothers' H. pylori  infection was checked serologically using the enzyme-linked immunosorbent  assay (ELISA) technique and those of infants by monoclonal antibody test  using ELISA technique on stool samples at 1st and 6th month of life.  Results: A total of 102 infants in 2 groups (54 exclusively breastfed and 48  formula or mixed fed) completed the study. Mothers' serological  assessmentswerepositive in68% of exclusively breast-fed subjectsand60% of  formula ormixedfed subjects. All 1-monthold infants were negative for the  infection and in the 6-month-old infants 10 cases (18.5%) were positive, 1  case was at borderline in the exclusively breastfed, and 13 cases (27%) were  positive in formula- or mixed-fed subjects. This difference was not  statistically significant (P = 0.302). The Mantel-Hanzel test was used to  find a relationship in H. pylori positivity in mothers and infants during  the first 6-month of life in each of the 2 groups. It was found that out of  37 serologically positive mothers in the breastfed group, 8 infants (22%)  were H. pylori positive and in the formula and mixed-fed group, of 29  serologically positive mothers 10 infants (34%) were also H. pylori  positive, but the difference between the groups was not statistically  significant (P = 0.727). It meant that the prevalence of infantile H. pylori  infection was similar in the 2 groups. Conclusions: The current study  findings showed that exclusive breastfeeding had no role in protection or  facilitation of H. pylori infection.                                                                

 

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Fifth Chinese National Consensus Report on the management of Helicobacter  pylori infectionLiu W.Z. Xie Y. Lu H. Cheng H. Zeng Z.R. Zhou L.Y. Chen Y. Wang J.B. Du Y.Q.  Lu N.H.Helicobacter (2018) 23:2 Article Number: e12475. Date of Publication: 1 Apr  2018Background: Since the ‘Fourth Chinese National Consensus Report on the  management of H. pylori infection’ was published in 2012, three important  consensuses (Kyoto global consensus report on H. pylori gastritis, The  Toronto Consensus for the Treatment of H. pylori Infection in Adults and  Management of H. pylori infection—the Maastricht V/Florence Consensus  Report) have been published regarding the management of H. pylori infection.  Materials and Methods: A Delphi method was adopted to develop the consensus  of relevant ‘statements’. First, the established ‘statements’ were sent to  experts via email. Second, after undergoing two rounds of consultation, the  initial statements were discussed face to face and revised in the conference  item by item on 16 December 2016. Finally, 21 core members of conferees  participated in the final vote of statements. Voting for each statement was  performed using an electronic system with levels of agreements shown on the  screen in real time. Results: Consensus contents contained a total of 48  “statements” and related 6 parts, including indications for H. pylori  eradication, diagnosis, treatment, H. pylori and gastric cancer, H. pylori  infection in special populations, H. pylori and gastrointestinal microbiota.  Conclusions: Recommendations are provided on the basis of the best available  evidence.                                                                

 

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Exam 3: The Toronto Consensus for the Treatment of Helicobacter pylori  Infection in AdultsGastroenterology (2016) 151:1 (e25-e26). Date of Publication: 1 Jul 2016                                                                

 

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DEC205 mediates local and systemic immune responses to Helicobacter pylori  infection in humansKita M. Yokota K. Kageyama C. Take S. Goto K. Kawahara Y. Matsushita O.  Okada H.Oncotarget (2018) 9:22 (15828-15835). Date of Publication: 2018Helicobacter pylori infections cause gastritis and affect systemic immune  responses; however, no direct association between immune cells and stomach  bacteria has yet been reported. The present study investigated  DEC205-mediated phagocytosis of H. pylori and the role of DEC205-positive  macrophages in the human gastric mucosa. DEC205 mediated phagocytosis of H.  pylori was detected immunocytochemically in PMAstimulated macrophages  differentiated from NOMO1 cells. Expression of DEC205 mRNA in peripheral  blood mononuclear cells (PBMCs) from H. pylori-infected patients was  analyzed following stimulation with H. pylori cell lysate. We found that  anti-DEC205 antibodies inhibited phagocytosis of H. pylori. The number of  cells double-positive for DEC205 and CD14 in human gastric mucosa was higher  in H. pylori-infected patients. DEC205-positive macrophages invaded the  extracellular space between epithelial cells within gastric pits. In  addition, DEC205 mRNA expression was upregulated in human PBMCs stimulated  with H. pylori lysate. These findings suggest DEC205-expressing macrophages  are important for recognition of H. pylori in human gastric mucosa, which  affects systemic immunity.                                                                

 

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Helicobacter pylori serology in relation to hepatitis C virus infection and  IL28B single nucleotide polymorphismGutwerk A. Wex T. Stein K. Langner C. Canbay A. Malfertheiner P. Link A.Journal of Clinical Medicine (2018) 7:3 Article Number: 44. Date of  Publication: 5 Mar 2018The aim of the study was to evaluate the serological rate of Helicobacter  pylori (H. pylori) infection in patients with chronic hepatitis C virus  (HCV) infection and determine any correlations with liver damage and IL28B  single-nucleotide polymorphism (SNP). One hundred eighty-nine patients with  chronic HCV infection were included in the study, and H. pylori status was  defined based on anti-H. pylori-IgG or anti-CagA-IgG antibodies using  enzyme-linked immunosorbent assay (ELISA). Liver damage was assessed using  histology or transient elastography. IL28B C/T polymorphism (rs12979860) was  evaluated in circulating blood cells using a PCR-based restriction fragment  length polymorphism assay. Overall H. pylori serology was positive in 38.1%  of our HCV-infected subjects. Among those, the anti-CagA-IgG positivity rate  was 43.1% and was within the range of previously described populations of  the same region. Highest prevalence of H. pylori was found in patients  between 31 and 40 years compared to other age subgroups. The seropositivity  rate was higher in the non-cirrhotic group than the cirrhotic one (45.4% vs.  20.0%, p < 0.05). No difference was found in IL28B genotype between H.  pylori-positive and -negative cohorts. However, we observed a trend for the  lower anti-CagA-IgG expression level in relation to the IL28B T-allele. Our  results do not support an association between HCV and H. pylori infection.  Whether IL28B SNP has a functional role in modulation of serological  response to H. pylori CagA needs further investigation.                                                                

 

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Current helicobacter pylori infection is significantly associated with  subclinical coronary atherosclerosis in healthy subjects: Across-sectional  studyLee M. Baek H. Park J.S. Kim S. Kyung C. Baik S.J. Lee B.K. Kim J.-H. Ahn  C.W. Kim K.R. Kang S.PLoS ONE (2018) 13:3 Article Number: e0193646. Date of Publication: 1 Mar  2018Helicobacter pylori is a gastrointestinal pathogen known to be associated  with cardiovascular disease (CVD). However, most analyses about the effect  of H. pylori infection have been done in patients with a history of CVD but  not in healthy subjects. We evaluated the association between H. pylori  infection and subclinical atherosclerosis by using cardiac multidetector  computed tomography (MDCT) in healthy subjects without previous CVD. From  December 2007 to February 2014, 463 subjects who underwent the rapid urease  test (CLO test), pulse-wave velocity (PWV) measurement, and MDCT for a  self-referred health checkup were enrolled to this study. Helicobacter  pylori infection was defined on the basis of CLO test positivity on  endoscopic gastric biopsy. Significant coronary artery stenosis was defined  as >50% stenosis in any of the major epicardial coronary vessel on MDCT. The  CLO-positive subjects had a lower high-density lipoprotein-cholesterol  (HDL-cholesterol) level compared to the CLO-negative subjects. The incidence  of significant coronary stenosis was higher in the CLO-positive group (7.6%  vs. 2.9%, P= 0.01). Furthermore, the number of subjects with coronary artery  calcium score >0 and log{(number of segments with plaque)+1} were also  significantly higher in the CLO-positive group. However, there was no  statistical difference in the number of subjects with coronary artery  calcium score 7gt;100, the prevalence of any plaque nor the plaque  characteristics (calcified, mixed, or soft). Pulse-wave velocity (PWV) was  neither associated with CLO test positivity. The CLO-positive group was  3-fold more likely to have significant coronary artery stenosis even after  adjusting for confounding factors (adjusted odds ratio 2.813, 95% confidence  interval 1.051-7.528, P= 0.04). In a healthy population, current H. pylori  infection was associated with subclinical but significant coronary artery  stenosis. The causal relationship between H. pylori infection and  subclinical atherosclerosis in a "healthy" population remains to be  investigated in the future.                                                                

 

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Influence of intestinal indigenous microbiota on intrafamilial infection by  helicobacter pylori in JapanOsaki T. Zaman C. Yonezawa H. Lin Y. Okuda M. Nozaki E. Hojo F. Kurata S.  Hanawa T. Kikuchi S. Kamiya S.Frontiers in Immunology (2018) 9:FEB Article Number: 287. Date of  Publication: 21 Feb 2018Helicobacter pylori is a causative pathogen of chronic gastritis, gastric  ulcer disease, and gastric cancer. Humans are known to be a natural host for  H. pylori and tend to acquire the pathogen before the age of 5 years. The  infection may then persist lifelong if eradication therapy is not applied.  One of the modes of transmission of H. pylori is between family members, and  therefore, the presence of infected family members is an important risk  factor in children. However, other environmental factors have not been fully  analyzed. The present study was performed to clarify whether and to what  extent intestinal microbiota affect H. pylori intrafamilial infection. The  fecal specimens from H. pylori-infected infants and H. pylori-infected and  non-infected family members were collected in cohort studies conducted by  Sasayama City, Hyogo Prefecture from 2010 to 2013. In total, 18 fecal DNA  from 5 families were analyzed. Samples were amplified using 16S rRNA  universal primers, and the amplicons were sequenced using the Ion PGM  system. Principal-coordinate analysis demonstrated that there was no  difference in intestinal microbiota between H. pylori-positive and H.  pylori-negative groups. In intrafamilial comparison tests, the Manhattan  distance of intestinal microbiota between the H. pylori-infected infant  proband and H. pylori-negative mother was nearest in the family with low  intestinal microbial diversity. However, in the family with the highest  intestinal microbial diversity, the nearest Manhattan distance was shown  between the H. pylori-infected infant proband and H. pylori-infected mother.  The results in this study showed that the composition of the intestinal  microbiota was very similar between members of the same family, and as such,  colonization with organisms highly similar to the infected parent(s) may be  a risk factor for H. pylori infection in children.                                                                

 

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Clinicoepidemiologic features of chronic urticaria in patients with versus  without subclinical helicobacter pylori infection: A cross-sectional study  of 150 patientsKohli S. Mahajan V.K. Rana B.S. Mehta K.S. Raina R.K. Chauhan P.S. Sharma V.  Rawat R.International Archives of Allergy and Immunology (2018) 175:1-2 (114-120).  Date of Publication: 1 Feb 2018Background: The Helicobacter pylori infection is linked to chronic urticaria  in nearly 60% of patients. We studied clinicoepidemiologic features in  patients with chronic urticaria with and without H. pylori infection.  Methods: Endoscopic antral biopsy for the rapid urease test (RUT) and  histopathology, and serum IgG ELISA for H. pylori infection were performed  in 150 patients (male:female ratio 1: 2.4) of chronic urticaria aged 18-68  years. Clinicoepidemiologic features including age, gender, age of onset and  duration, frequency and distribution of wheals, urticaria severity score,  and systemic symptoms were analyzed in patients with and without H. pylori.  The results of serum IgG ELISA for H. pylori were compared with 106 age- and  gender-matched healthy adult controls. Results: The RUT in 84 patients  (56%), histopathology in 76 patients (50.6%), and H. pylori IgG ELISA in 94  patients (62.6%) were positive. H. pylori IgG ELISA was positive only in 35  (33%) controls, suggesting that chronic urticaria patients were more likely  to have asymptomatic H. pylori in- fection than normal controls. Although  not statistically significant, patients with H. pylori had a higher mean  urticaria severity score, number of urticaria/angioedema episodes per year,  and involvement of more body sites, particularly the scalp, palms, and  soles. The constitutional or gastrointestinal symptoms were statistically  higher in patients with H. pylori infection than those without it.  Conclusion: A subset of chronic urticaria patients appears to have  asymptomatic H. pylori infection. However, its implications in chronicity,  recurrences, the severity of urticaria, other systemic manifestations, and  management remains conjectural in view of 33% of controls also having  positive H. pylori ELISA and the endemicity of infection in developing  countries.                                                                

 

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Levels of malondialdehyde in the gastric juice: Its association with  Helicobacter pylori infection and stomach diseasesWang Y.-K. Chiang W.-C. Kuo F.-C. Wu M.-C. Shih H.-Y. Wang S.S.W. Liu C.-J.  Chen Y.-H. Wu D.-C. Su W.-W. Huang Y.-L.Helicobacter (2018) 23:2 Article Number: e12460. Date of Publication: 1 Apr  2018Background: Helicobacter pylori (H. pylori) infection causes elevation of  lipid peroxidation product malondialdehyde (MDA) and this association may be  due to the bacterium causing reactive oxygen species-mediated damage to DNA  in the gastric epithelium. The aim of this study was to investigate the  gastric juice MDA levels in relation to H. pylori infection and associated  gastric diseases. Methods: Gastric juice samples were obtained from 117  patients undergoing endoscopy, and gastric juice MDA levels were determined  by high-performance liquid chromatography (HPLC) system. We compared the MDA  levels between patients with and without H. pylori infection and assessed  the differences of MDA levels between chronic gastritis, gastric intestinal  metaplasia, and gastric cancer postsurgical resection. Results:  Malondialdehyde levels in gastric juice were significantly higher in chronic  gastritis patients with H. pylori infection than in those without H. pylori  infection (P <.0001). In patients without H. pylori infection, patients with  gastric intestinal metaplasia and gastric cancer postsurgical resection had  significantly higher gastric juice MDA level than patients with chronic  gastritis. As a whole, patients with gastric intestinal metaplasia and  gastric cancer postsurgical resection also had significantly higher MDA  levels in gastric juice as compared to patients with chronic gastritis  (P <.01). However, the difference of gastric juice MDA levels between  gastric intestinal metaplasia and gastric cancer postsurgical resection was  not significant. Conclusion: Malondialdehyde in gastric juice could be used  as a potential diagnostic biomarker for H. pylori infection and associated  gastric diseases. The gastric juice MDA levels increased proportionally with  the severity of gastric diseases.                                                                 

 

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Helicobacter pylori infection and occurrence of celiac disease in subjects  HLA-DQ2/DQ8 positive: A prospective studyDore M.P. Salis R. Loria M.F. Villanacci V. Bassotti G. Pes G.M.Helicobacter (2018) 23:2 Article Number: e12465. Date of Publication: 1 Apr  2018Background: Celiac disease (CD) occurs in subjects positive for HLA-DQ2  and/or DQ8 gene loci at any age following ingestion of gluten-containing  food. An increased permeability of the mucosa allows interactions between  gliadin macromolecules and genetic factors. It has been observed that  Helicobacter pylori has the ability to modulate the integrity of the  duodenal epithelium. We aimed to determine whether H. pylori infection may  enhance the occurrence of CD in genetically susceptible subjects. Materials  and Methods: This was a prospective observational study. Patients undergoing  upper endoscopy for any reason and positive for HLA-DQ2 and/or DQ8  haplotypes with or without CD were included. H. pylori infection was defined  as a positive gastric histopathology and/or 13C-urea breath test. Prevalence  of infection was compared between enrolled subjects with and without CD.  Multiple logistic regression analysis, adjusting odds ratios for patient  age, gender, smoking habit, residency, body mass index, and assumption of  nonsteroidal anti-inflammatory drugs (NSAIDs) and proton-pump inhibitors  (PPIs) were performed. Results: A total of 397 genetically susceptible  individuals (mean age: 37.7 ± 15.3 years; 86% women) were enrolled between  October 2014 and October 2017. There were 265 (68%) patients with a  diagnosis of CD. Overall, the prevalence of H. pylori infection was 33% and  was similar in patients with and without CD (32% vs 36%). Adjustment for all  covariates did not reveal any significant association, although adjusted  odds ratio (OR) for CD was higher in female (OR = 1.302), in patients H.  pylori positive (OR = 1.277), followed by use of NSAIDs (OR = 1.126),  respectively. The use of PPIs appeared to be mildly protective against CD  (OR = 0.644). Conclusion: Our study did not reveal any significant  relationship between H. pylori and CD risk, even taking into account other  confounders. More importantly, our findings do not support a “protective”  role of H. pylori infection against CD, as previously reported. Therefore,  there are no reasons to avoid eradication of H. pylori also in subject  genetically susceptible for CD.                                                                 

 

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Lanthanum deposition in the stomach in the absence of Helicobacter pylori  infectionIwamuro M. Urata H. Tanaka T. Kawano S. Kawahara Y. Kimoto K. Okada H.Internal Medicine (2018) 57:6 (801-806). Date of Publication: 2018In this case report, we describe two patients who showed a diffusely whitish  mucosa in the posterior wall and the lesser curvature of the gastric body.  The patients were serologically- and histopathologically-negative for  Helicobacter pylori. Random biopsy specimens from the stomach revealed no  regenerative changes, intestinal metaplasia, and/or foveolar hyperplasia in  either of the patients. Although lanthanum deposition in the gastric mucosa  has been reported to occur in close association with H. pylori-associated  gastritis, our patients tested negative for H. pylori. These cases suggest  that lanthanum deposition presents as whitish lesions in the gastric body in  H. pylori-negative patients.                                                                

 

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Toward early detection of Helicobacter pylori-associated gastric cancerWalker R. Poleszczuk J. Mejia J. Lee J.K. Pimiento J.M. Malafa M. Giuliano  A.R. Enderling H. Coppola D.Gastric Cancer (2018) 21:2 (196-203). Date of Publication: 1 Mar 2018Background: Gastric cancer is typically diagnosed at a late stage, leading  to poor prognoses. Helicobacter pylori is responsible for 70% of gastric  cancers globally, and patients with this bacterial infection often present  with early stages of the carcinogenic pathway such as inflammation or  gastritis. Although many patients continue to progress to advanced-stage  disease after antibacterial treatment, there are no follow-up screening  protocols for patients with a history of H. pylori. Methods: Several  biomarkers (Lgr5, CD133, CD44) become upregulated during gastric  carcinogenesis. A logistic regression model is developed using clinical data  from 59 patients at different stages of the carcinogenic pathway to identify  the likelihood of being at an advanced stage of disease for all combinations  of age, sex, and marker positivity. Using these likelihood distributions and  the observed rate of marker positivity increase, time to high likelihood  (probability CloseSPigtSPi0.8) of advanced disease for individual patients  is predicted. Results: A strong correlation between marker positivity and  disease stage was found for all three markers. Disease stage was accurately  classified by the respective regression models for more than 86% of  retrospective patients. Highly patient-specific predictions of time to onset  of dysplasia were made, allowing the classification of 17 patients initially  diagnosed with intestinal metaplasia into high-, intermediate-, or low-risk  categories. Conclusions: We present an approach designed to integrate  pathology, mathematics, and statistics for detection of the earliest  precancerous, treatable lesion. Given the simplicity and robustness of the  framework, such technique has the potential to guide personalized screening  schedules to minimize the risk of undetected malignant transformation.                                                                

 

RECORD 90

 

Can bacterial virulence factors predict antibiotic resistant helicobacter  pylori infection?Brennan D.E. Dowd C. O’Morain C. McNamara D. Smith S.M.World Journal of Gastroenterology (2018) 24:9 (971-981). Date of  Publication: 7 Mar 2018AIM To evaluate the association between virulence factor status and  antibiotic resistance in Helicobacter pylori (H. pylori )-infected patients  in Ireland. METHODS DNA was extracted from antral and corpus biopsies  obtained from 165 H. pylori -infected patients. Genotyping for  clarithromycin and fluoroquinolone-mediating mutations was performed using  the Genotype HelicoDR assay. cagA and vacA genotypes were investigated using  PCR. RESULTS Primary, secondary and overall resistance rates for  clarithromycin were 50.5% (n = 53/105), 78.3% (n = 47/60) and 60.6% (n =  100/165), respectively. Primary, secondary and overall resistance rates for  fluoroquinolones were 15.2% (n = 16/105) and 28.3% (n = 17/60) and 20% (n =  33/165), respectively. Resistance to both antibiotics was 12.4% (n = 13/105)  in treatment-naïve patients, 25% (n = 15/60) in those previously treated and  17% (n = 28/165) overall. A cagA -positive genotype was detected in 22.4% (n  = 37/165) of patient samples. The dominant vacA genotype was S1/M2 at 44.8%  (n = 74/165), followed by S2/M2 at 26.7% (n = 44/165), S1/M1 at 23.6% (n =  39/165) and S2/M1 at 4.8% (n = 8/165). Primary clarithromycin resistance was  significantly lower in cagA -positive strains than in cagA -negative strains  [32% (n = 8/25) vs 56.3% (n = 45/80) P = 0.03]. Similarly, in patients  infected with more virulent H. pylori strains bearing the vacA s1 genotype,  primary clarithromycin resistance was significantly lower than in those  infected with less virulent strains bearing the vacA s2 genotype, [41% (n =  32/78) vs 77.8% (n = 21/27) P = 0.0001]. No statistically significant  association was found between primary fluoroquinolone resistance and  virulence factor status. CONCLUSION Genotypic H. pylori clarithromycin  resistance is high and cagA -negative strains are dominant in our  population. Less virulent (cagA -negative and vacA S2-containing) strains of  H. pylori are associated with primary clarithromycin resistance.                                                                

 

RECORD 91

 

Relationship of vitamin D receptor gene polymorphisms in helicobacter pylori  gastric patientsMartins D.J. Matos G.C.B. Loiola R.S.P. D’Annibale V. Corvelo T.Clinical and Experimental Gastroenterology (2018) 11 (19-27). Date of  Publication: 2018Purpose: The present study aimed to investigate the association between the  human VDR gene and Helicobacter pylori infection. Patients and methods: A  cross-sectional study was conducted on 208 adult patients with upper  gastrointestinal symptoms. Gastric biopsy specimens were obtained from each  patient for molecular DNA and histological examination. Patients were  genotyped for VDR gene polymorphisms using polymerase chain reaction and  restriction fragment length polymorphism analysis. Results: The allelic and  genotypic distribution analyses of the FokI, ApaI and TaqI polymorphisms of  the VDR gene did not show distribution differences between H.  pylori-positive and -negative groups. The genotype distribution observed for  polymorphism BsmI deviated significantly from what was expected in a  Hardy–Weinberg equilibrium test in the H. pylori-positive group  (c(2)=29.048, p<0.001). The distribution of BsmI genotypes differed  significantly between the H. pylori-negative and H. pylori-positive groups  (p=0.0034), where the frequency of the bb genotype increased among H.  pylori-positive individuals compared with those without infection (63.25%  versus 50.55%, respectively). Conversely, the H. pylori-negative group  showed a Bb frequency that was 20.27% higher than in the infected group.  Conclusion: We identified a possible association between the BsmI  polymorphism and infection by H. pylori. However, further research is  required to clarify this relationship.                                                                

 

RECORD 92

 

Ethnic/racial differences in gastrointestinal symptoms and diagnosis  associated with the risk of Helicobacter pylori infection in the USHuerta-Franco M.-R. Banderas J.W. Allsworth J.E.Clinical and Experimental Gastroenterology (2018) 11 (39-49). Date of  Publication: 2018Background: In the US, neither the prevalence nor the gastrointestinal (GI)  diagnosis/symp-toms associated with Helicobacter pylori (HP) have been  examined in different racial/ethnic groups. Aim: To determine the  racial/ethnic differences in HP infection associated with GI diagnoses/  symptoms using the Cerner Health Facts® database. Methods: This  cross-sectional study collected data during the period of 2000–2015 from the  following ethnic/racial groups: 8,236,317 white, 2,085,389 black, 426,622  Hispanic, 293,156 Asian Pacific/Islander (APIs), and 89,179 Native  American/Alaskan Native (NA/AN) patients aged 21–65 years old; the data were  then analyzed. The primary dependent variable was a diagnosis of HP  (ICD-9-Clinical Modification/ICD-10 classification). SAS version 9.4 was  used for the statistical analysis. The statistical analysis was performed on  11,130,663 patients with GI symptoms, and of these, 152,086 patients were  positive for the infection. Results: Hispanics and NA/ANs had the highest  prevalence of HP associated with upper GI symptoms/diagnosis. Nevertheless,  blacks and APIs presented the highest relative risk (RR) of HP associated  with dyspepsia (RR [95% CI] =11.2 [10.7–11.9] and 14.2 [12.8–15.6]), peptic  ulcer (RR =13.8 [13.3–14.5] and 10.7 [9.3–12.3]), and atrophic gastritis (RR  =9 [8.5–9.6] and 7.4 [6.4–8.5]), respectively. In all racial/ethnic groups,  HP was also associated with inflammatory bowel diseases, liver diseases, and  celiac diseases. Conclusion: Black and API populations had the highest risk  of HP associated with upper GI symptoms/diagnosis. Black patients also had  the highest risk for HP associated with GI cancer.                                                                

 

RECORD 93

 

Acquisition of double mutation in gyrA caused high resistance to  sitafloxacin in Helicobacter pylori after unsuccessful eradication with  sitafloxacin-containing regimensMori H. Suzuki H. Matsuzaki J. Masaoka T. Kanai T.United European Gastroenterology Journal (2018) 6:3 (391-397). Date of  Publication: 1 Apr 2018Background and aim: Although sitafloxacin (STFX)-containing regimens are  effective rescue treatments for Helicobacter pylori infection, prevalence of  fluoroquinolone resistance in H. pylori has increased rapidly worldwide. The  change in resistance levels and gyrA mutations, a major cause of  fluoroquinolone resistance, after unsuccessful STFX-containing treatment has  not been investigated. Methods: We conducted a retrospective, non-randomized  study to compare the minimum inhibitory concentrations (MICs) of STFX and  the location of gyrA mutations in H. pylori before and after unsuccessful  eradication with STFX-containing regimens at Keio University Hospital  between December 2011 and March 2015. Results: A total of 266 patients  treated with STFX-containing regimens for third-line H. pylori eradication  were evaluated. Double mutations in gyrA were acquired by 20.8% of strains  that exhibited seven-fold increased STFX MICs, compared to pre-treatment  MICs. The STFX MICs did not increase, however, when the location of the gyrA  mutations did not change after treatment. Double mutations in gyrA developed  in 60.0% of the strains in which eradication failed, which exhibited a  baseline mutation at position D91, and in 11.1% of strains with baseline  mutations at position N87. Conclusion: Acquisition of double mutations in  gyrA evoked high-level resistance to STFX in H. pylori after unsuccessful  eradication with STFX-containing regimens.                                                                

 

RECORD 94

 

Up-regulated Th17 cell function is associated with increased peptic ulcer  disease in Helicobacter pylori-infectionBagheri N. Razavi A. Pourgheysari B. Azadegan-Dehkordi F. Rahimian G.  Pirayesh A. Shafigh M. Rafieian-Kopaei M. Fereidani R. Tahmasbi K. Shirzad  H.Infection, Genetics and Evolution (2018) 60 (117-125). Date of Publication:  1 Jun 2018Background: During Helicobacter pylori (H. pylori) infection CD4(+) T cells  in the gastric lamina propria are hyporesponsive and polarized by Th1/Th17  cell responses controlled by Treg cells. The objective of this study was to  determine the number of Th17 cells in gastric mucosa of patients with  gastritis and peptic ulcer and determined the relationship between main  virulence factor of H. pylori and Th17 cells. Methods and materials: A total  of 89 H. pylori-infected gastritis patients, 63 H. pylori-infected peptic  ulcer patients and 48 H. pylori-negative non-ulcer dysplasia patients were  enrolled in this study. The number of Th17 was determined by  immunohistochemistry. IL-8 and IL-17A expressions were determined by  real-time polymerase chain reaction (qPCR). Also, the grade of chronic and  active inflammation was investigated for involvement according to the  density of neutrophils and mononuclear in gastric mucosal crypts, from one  to all crypts. Results: The number of Th17 cells and the expression of IL-8  and IL-17A in infected patients were significantly higher than uninfected  subjects. The number of Th17 cells and the expression of IL-8 and IL-17A in  infected patients with peptic ulcer were significantly higher than patients  with gastritis. Additionally, the numbers of Th17 cells as well as the  expression of IL-8 and IL-17A were positively correlated with the degree of  H. pylori density in infected patients with peptic ulcer, while this  correlation was negative in infected patients with gastritis. The numbers of  Th17 cells as well as the expression of IL-8 and IL-17A were positively  correlated with the degree of chronic inflammation. Conclusion: The  predominant Th17 cell responses may play a role in the pathogenesis of  peptic ulcers disease in infected patients.                                                                

 

RECORD 95

 

Helicobacter pylori infection among patients with liver cirrhosisPonzetto A. Figura N.European Journal of Gastroenterology and Hepatology (2018) 30:4 (490). Date  of Publication: 2018                                                                

 

RECORD 96

 

Metformin and Helicobacter pylori Infection in Patients with Type 2 DiabetesTseng C.-H.Diabetes Care (2018) 41:4 (e42-e43). Date of Publication: 1 Apr 2018                                                                

 

RECORD 97

 

Age and gender may be the key points in hyperglycemic patients with  Helicobacter pylori infection combined colorectal adenomaKuo Y.-C. Shih S.-C. Yu L.-Y. Wu M.-S. Su T.-H. Liu C.-J. Hu K.-C.Helicobacter (2018) 23:2 Article Number: e12473. Date of Publication: 1 Apr  2018                                                                

 

RECORD 98

 

Long-term course of precancerous lesions arising in patients with gastric  MALT lymphomaRentien A.-L. Lévy M. Copie-Bergman C. Gagniere C. Dupuis J. Le Baleur Y.  Belhadj K. Sobhani I. Haioun C. Delchier J.-C. Amiot A.Digestive and Liver Disease (2018) 50:2 (181-188). Date of Publication: 1  Feb 2018Background and aims: To evaluate the prevalence and the long-term course of  gastric precancerous lesions in patients with GML. Patients and methods: In  this retrospective single-centre study, we included 179 patients with GML,  70 with gastric diffuse large B-cell lymphoma (GDLBCL) and 152 with  Helicobacter pylori-associated gastritis (HpG), from January 1995 to January  2014. The presence of atrophic gastritis, intestinal metaplasia and  neoplastic lesion has been assessed at baseline and during follow-up.  Results: Atrophic gastritis was more frequent in the GML group whereas there  was also a trend for intestinal metaplasia and gastric dysplasia. In  patients with GML, atrophic gastritis, intestinal metaplasia and gastric  dysplasia were more frequent in the GML area than in other part of the  stomach. During follow-up, the prevalence of atrophic gastritis remained  stable overtime whereas intestinal metaplasia and dysplasia tend to increase  overtime. In multivariate analysis, the occurrence of dysplasia or carcinoma  was associated with the presence of intestinal metaplasia at baseline and  male gender. Conclusion: GML is associated with gastric precancerous lesion  to a higher extent than GDLBCL and HpG. Those precancerous lesions do not  regress despite achievement of complete remission of GML and tend to  increase overtime.                                                                

 

RECORD 99

 

Incidence, clinical characteristics, and associated diseases in patients  with immune thrombocytopenia: A nationwide population-based study in TaiwanWu S.-R. Kuo H.-C. Huang W.-C. Huang Y.-F. Chiou Y.-H. Chang Y.-H. Nong  B.-R.Thrombosis Research (2018) 164 (90-95). Date of Publication: 1 Apr 2018Introduction: Immune thrombocytopenia (ITP) is an immune-mediated disease;  it has been reported to be associated with several diseases. The data on ITP  in patients with hepatitis B, tuberculosis, or thyroid diseases are  relatively scarce. In addition, these diseases are not rare in Taiwan,  together with hepatitis C and Helicobacter pylori which are also related to  ITP. Methods and materials: We identified 1223 ITP patients and  characterized these patients between 2000 and 2013 from the National Health  Insurance Research Database. The adult ITP patients were matched with  non-ITP patients. Results: The overall incidence of ITP was 2.59/100,000  person-years. The frequencies of hepatitis B and C in adult ITP patients  were much higher than those indicated in previous studies. The frequencies  of non-traumatic intracerebral hemorrhage and gastrointestinal bleeding  during hospitalization among ITP patients were low. The diseases associated  with increased risks of ITP included hepatitis B (OR = 18.70, 95% CI =  9.71–36.03), hepatitis C (OR = 54.43, 95% CI = 15.94–185.88), hepatitis B  and hepatitis C (OR = 7.02, 95% CI = 1.47–33.56), tuberculosis (OR = 5.37,  95% CI = 2.72–10.61), Helicobacter pylori infection (OR = 5.93, 95% CI =  3.16–11.10), hyperthyroidism (OR = 3.43, 95% CI = 2.09–5.64), hypothyroidism  (OR = 6.70, 95% CI = 2.35–19.13), and simple and unspecified goiter (OR =  2.68, 95% CI = 1.43–5.03). Conclusions: Surveying for the diseases which are  frequent and related to increased risks of ITP among patients with newly  diagnosed ITP should be considered.                                                                 

 

RECORD 100

 

Exploring current status of Helicobacter pylori infection in different age  groups of patients with dyspepsiaDutta A.K. Reddy V.D. Iyer V.H. Unnikrishnan L.S. Chacko A.Indian Journal of Gastroenterology (2017) 36:6 (509-513). Date of  Publication: 1 Nov 2017Recent data from Asian countries including India has shown a significant  decline in the frequency of peptic ulcer disease (PUD) compared to the past.  H. pylori is considered the most important risk factor for PUD, and we aimed  to explore the current frequency of H. pylori infection in different age  groups of patients with dyspepsia. Patients CloseSPigtSPi15 years of age  with dyspeptic symptoms were prospectively recruited in this study from 2010  to 2014 after obtaining informed consent. Patients were divided into three  age groups: 15–30 years, 31–50 years, and CloseSPigtSPi50 years, and the  minimum sample size required in the three groups with a power of 90% was  259, 256, and 188, respectively. All patients underwent upper  gastrointestinal endoscopy; rapid urease test was done on gastric mucosal  biopsy to detect H. pylori. The clinical, demographic features and  socioeconomic status were                                                                  

 

RECORDed. The institute review board approved the  study. We included 1000 patients with dyspepsia during the study period.  Their mean age was 40.0+13.3 years, and 69.3% were males. Infection with H.  pylori was detected in 419 (41.9%) patients. Among men, H. pylori was  present in 45.7% while the frequency of infection in women was lower at  33.2% (p OpenSPiltSPi 0.001). In the 15–30 years age group (n = 303), the  frequency of infection was 42.6% while it was 48.3% in the 31–50 years group  (n = 350) and 34.9% in the above 50 years group (n = 347). Male sex was a  significant risk factor for H. pylori infection (p OpenSPiltSPi 0.001). H.  pylori infection, an important risk factor for PUD, was detected in less  than half of the dyspeptic patients in the current study.

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