ABSTRACT
Nodular gastritis is directly related to Helicobacter pylori (Hp) infection. Refractory Hp infection has significant impact on the treatment efficacy and prognosis of nodular gastritis. Aims: To analyze the spheroidization and antibiotic resistance of refractory Hp and PPI drug metabolic enzyme CYP2C19 gene polymorphism in patients with nodular gastritis, so as to promote the eradication rate of refractory Hp infection in patients with nodular gastritis. Methods: Refractory Hp infection patients with nodular gastritis from Oct. 2019 to Nov. 2020 at the Second Affiliated Hospital of Baotou Medical College were enrolled. Hp strains were cultured in microaerophilic environment. Immunohistochemistry was used to detect Hp spheroidization. Mutation sites of antibiotic resistance genes and host CYP2C19 gene polymorphism were detected by PCR. According to the results of genetic testing, individualized therapy was given and follow up was performed, the eradication rate of intention-to-treat was calculated. Results: A total of 42 patients with refractory Hp nodular gastritis were enrolled. Among them, lymphocyte accumulation was found in 33.3% patients. Hp spheroidization was found in 2 patients, and the spheroidization rates were 20% and 10%, respectively. There were 25 intensive metabolizer, 15 intermediate metabolizer and 2 poor metabolizer of CYP2C19. Antibiotic resistance gene detection showed that the drug resistance rate of amoxicillin, clarithromycin, levofloxacin, furazolidone, tetracycline, metronidazole were 4.8%, 38.1%, 35.7%, 47.6%, 42.9% and 61.9%, respectively. Twenty-two (52.4%) of the patients developed resistance to 3 or more antibiotics. The total eradication rate of intention-to-treat was 83.3%, of which high-dose dual therapy was 88.9%. Conclusions: Multi-antibiotic resistance and CYP2C19 may be the main reason for the failure of eradication of refractory Hp in nodular gastritis. Hp spheroidization has little effect on the efficacy of eradication therapy. The amoxicillin resistance rate is still significantly lower than that of other antibiotics, and high-dose dual therapy is a better option.
ABSTRACT
Background: There is still controversy whether the existence of esophageal heterotopic gastric mucosa (EHGM) and its histological type are related to the laryngopharyngeal symptoms. Aims: To analyze the clinical and histological characteristics of EHGM and its correlation with gastroesophageal reflux. Methods: A retrospective study was conducted in consecutive gastroscopy-proved EHGM cases from September 2018 to January 2020 at the Second Affiliated Hospital of Baotou Medical College. Besides clinical data review and questionnaire survey on reflux symptoms, histological typing of EHGM and immunohistochemistry were also performed in some cases. Results: A total of 1 229 cases of EHGM were recruited. The male-to-female ratio was 1.67:1, and middle-aged people were predominant. Most of the heterotopic mucosa were located 15-18 cm away from the incisors, and were mainly single. Two hundred and ninety-four cases (23.9%) were complicated with reflux esophagitis (RE), of which Los Angeles grade A and B accounted for 96.6%. Regurgitation/acid reflux (15.5 %) and heartburn (12.3%) were the most common esophageal symptoms, while extraesophageal symptoms were rare. Histological typing was obtained in 57 cases, of which, 37 (64.9%) were cardia-type, 18 (31.6%) were fundic-type, and 2 (3.5%) were mixed type. There were no significant differences in gender, age, location and number of EHGM, expression levels of H
ABSTRACT
Background: The incidence of alcoholic liver disease (ALD) is increasing year by year, and is lack of specific diagnostic indicators. Exploring the trend of molecular markers in different stages of ALD is of great significance for its diagnosis and treatment. Aims: To investigate the levels and diagnostic value of serum interleukin-12 (IL-12), carbohydrate-deficient transferrin (CDT), hepatocyte growth factor (HGF) and endotoxin in different stages of ALD. Methods: Nineteen patients with alcoholic cirrhosis (AC), 14 alcoholic hepatitis (AH), 16 alcoholic fatty liver (AFL), 16 subclinical patients from July 2017 to January 2018 at the Second Affiliated Hospital of Baotou Medical College were enrolled, and 15 healthy volunteers were served as healthy controls. Serum IL-12, CDT, HGF levels were detected by ELISA method, and serum endotoxin was detected by limulus test. Diagnostic value of IL-12, CDT for ALD was analyzed by ROC curve. Results: Serum IL-12, endotoxin were significantly increased in AC, AH groups than in AFL, subclinical patients, healthy controls (P<0.05); serum CDT level was significantly increased in AC, AH, AFL, subclinical patients than in healthy controls (P<0.05); serum HGF was significantly increased in AC patients than in AH, AFL, subclinical patients and healthy controls (P<0.05). Serum IL-12, CDT, HGF were positively correlated with serum endotoxin in ALD patients (P<0.05). When the cut-off value of serum IL-12, CDT were 55.06 pg/mL, 354.41 pg/mL, respectively, sensitivity for diagnosing ALD were 0.86, 0.67, respectively, specificity were 0.95, 0.88, respectively. Conclusions: Serum IL-12, CDT, HGF and endotoxin have a trend of change in different stages of ALD, and IL-12 and CDT have high sensitivity and specificity for diagnosing ALD, and can be used as markers for early diagnosis of ALD. Serum HGF and endotoxin are valuable for assessing the severity of ALD.