Correlation of Helicobacter pylori virulence genotype & severity of mucosal inflammation in gastric biopsies from two geographically diverse regions in India

Background: H. pylori-associated gastritis in patients from the high-altitude area of Ladakh showed severe gastritis, mucosal nodularity, atrophy, and cancer in comparison to those from North India. This study served to analyze if differences in the H. pylori virulence genotypes decide the extent of gastric mucosal inflammation. Methods: Fifty gastric biopsies each from patients with H. pylori-associated gastritis from Ladakh and a tertiary care center in North India were included. The presence of H. pylori strain was confirmed with Warthin starry stain and polymerase chain amplification of the H. pylori-specific 16S rRNA. The cagA, vacA s1, s2, and m1, m2 alleles, and dupA virulence genotypes were studied in all archival samples, followed by their histological correlations. Results: cagA (P 0.009) and vacAs1 m1 (P 0.009) genes were distinctly more in H. pylori strains colonizing the biopsies of North Indian patients. In contrast, the cagA -ve vacAs2 m2 strains were significantly more in H. pylori strain colonizing the biopsies from Ladakhi patients. dupA genotype was almost similarly present in strains from both regions. Among these, only cagA and dupA virulence genes were associated with severe mucosal neutrophilic activity and deep infiltration of H. pylori strains in North Indian patients. Conclusions: Differences in virulence genotypes of H. pylori in gastric biopsies from North Indian and Ladakhi patients were found not significant in deciding the severity of H. pylori-associated gastritis.

Diagnóstico de infección por Helicobacter pylori mediante test de aliento con urea C-14 en población ecuatoriana / Diagnosis of Helicobacter pylori infection by C-14 urea breath test in Ecuadorian population

siendo el test de aliento con urea carbono-14 (C-14) uno de los métodos de diagnóstico no invasivos; sin embar-go, no ha sido comprobada su utilidad en la población ecuatoriana.Objetivo: Evaluar la sensibilidad y especificidad del test de aliento con urea C-14 para predecir la infección por HP en la población ecuatoriana.Métodos: Estudio de Pruebas Diagnósticas realizado en pacientes que acudieron a la consulta externa del servicio de gastroenterología del Hospital Teófilo Dávila de la ciudad de Machala, en el periodo abril 2018 a marzo 2019. Los pacientes se sometieron a una endoscopia superior de luz blanca (ES) con toma de biopsias para investigar la infec-ción por HP; además, se realizó un test de aliento con urea C-14, para compararla con los resultados de las biopsias.Resultados: Se estudiaron 78 pacientes con una edad media de 33.76±11.2 años. El diagnóstico de gastritis se confirmó a través de la ES e histopatología en el 100% de los pacientes. El test de aliento con urea C-14 fue positi-va en 47/78 (60.3%) pacientes. Se demostró evidencia de infección por HP en biopsias gástricas de 50/78 (64.1%) pacientes. La sensibilidad, especificidad, VPP, VPN, observada y la concordancia entre evaluadores fue de 94%, 100%, 100%, 90%, 96% y 92% (P <0.001), respectivamente.Conclusiones: El test de aliento con urea C-14, es una herramienta útil para predecir infección por HP en la población ecuatoriana

Background: Early detection of Helicobacter pylori infection has become more relevant, with urea carbon-14 (C-14) breath test as one of the non-invasive diagnostic methods; however, it has not been proven in Ecuadorian population.Objective: To evaluate the sensitivity and specificity of the C-14 urea breath test to predict HP infection in the Ecuadorian population.Methods: : Study of diagnostic tests performed on patients who attended the outpatient gastroenterology service of the Hospital Teófilo Dávila in the city of Machala, in the period April 2018 to March 2019. The patients underwent an upper endoscopy of white light (WLE) with biopsies taken to investigate HP infection. In addition, a breath test with C-14 urea was performed to compare it with the biopsies results.Results: 78 patients with a mean age of 33.76±11.2 years were studied. The diagnosis of gastritis was confirmed through endoscopy and histopathology in 100% of the patients. The breath test with urea C-14 was positive in 47/78 (60.3%) patients. Evidence of HP infection was demonstrated in gastric biopsies from 50/78 (64.1%) pa-tients. Sensitivity, specificity, PPV, NPV, and inter-rater reliability were 94%, 100%, 100%, 90%, 96%, and 92% (P <0.001), respectively.Conclusions: The C-14 urea breath test is a useful tool for predicting HP infection in the Ecuadorian population

Infección por Helicobacter pylori en el municipio de Palma Soriano durante el período 2008-2014 / Helicobacter pylori infection in Palma Soriano during 2008-2014

Se realizó un estudio descriptivo y retrospectivo de 989 pacientes con diagnóstico endoscópico de gastritis crónica, cuyas biopsias habían sido procesadas en el Departamento de Anatomía Patológica del municipio de Palma Soriano, en Santiago de Cuba, durante el período 2008-2014, con el objetivo de determinar la incidencia de la infección por Helicobacter pylori, para lo cual además se consideraron las variables: edad, sexo, tipos de gastritis, presencia del microorganismo y su asociación con neoplasias malignas. En la serie predominaron el grupo etario de 40-49 años (26,7 %) y el sexo femenino (69,0 %); asimismo, resultó más frecuente la gastritis superficial (57,8 %) y se halló la bacteria en 70,5 % de la muestra, donde solo 0,5 se asoció a neoplasias malignas

A descriptive and retrospective study of 989 patients with endoscopic diagnosis of chronic gastritis whose biopsies had been processed in the Pathology Department of Palma Soriano in Santiago de Cuba, was carried out during 2008-2014, aimed at determining the incidence of the infection due to Helicobacter pylori, for which the variables: age, sex, gastritis types, presence of the organism and its association with malignancies were also considered. In the series the 40-49 years age group (26,7 %) and female sex (69,0 %) prevailed; also, the superficial gastritis was more frequent (57,8 %) and the bacteria was found in 70,5 % of the sample, where only 0,5 was associated to malignancies

Clinical significance of various diagnostic techniques and emerging antimicrobial resistance pattern of Helicobacter Pylori from Gastric Biopsy Samples.

Background: There is no single technique that can meet the criteria in identification of Helicobacter pylori. The diagnosis is important asantimicrobial resistance is frequently observed and associated with treatment failure. The present study was conducted to evaluate diagnostic tests for identification of H pylori and to assess their antimicrobial resistance pattern. Materials and Methods: Biopsies of gastric tissue from 200 patients with disorders of the upper gastrointestinal tract were studied for detection of H pylori by various methods like culture, H and E staining and urease test. Antimicrobial susceptibility testing was carried out by Kirby Bauer’s disc diffusion method. Results: Out of 200 patients, H pylori was detected by rapid urease test, H and E staining and culture in 26.5%, 14.5% and 2.5% cases respectively. H and E was taken as the gold standard. Sensitivity of urease test was 76.6% and of culture 13.3%. Specificity of urease was 81.7% in comparison with culture which showed 99.4% specificity. Metronidazole (05) showed high level of resistance followed by amoxicillin (03) and norfloxacillin (03). Tetracycline, erythromycin, levofloxacin and cotrimoxazole showed one resistance each to H pylori. Conclusion: H and E is taken as the gold standard according to CDC. Urease test is a better screening procedure than culture. H pylori resistance to metronidazole in our zone was highest. This is due to general and extensive use of metronidazole for other infectious diseases. Our study suggests need for a systematic approach to determine antibiogram of the strains before considering the drug regimens.

Correlación entre síntomas gastrointestinales funcionales y la histopatología de la mucosa gástrica, incluyendo la infección por Helicobacter pylori, en Lima, Perú / Correlation between functional gastrointestinal disorders and gastric mucosa histopathology findings, including Helicobacter pylori infection, in Lima, Peru

This study aims to investigate the relationship between functional gastrointestinal disorders and histopathology characteristics, including H. pylori infection, of gastric mucosa, at Cayetano Heredia National Hospital, Lima-Peru, in 2013. Materials and methods: 112 patients were interviewed prospectively between June and July 2013 in the gastroenterology service. Dyspepsia, irritable bowel syndrome, and postprandial distress syndrome were characterized using the Rome III Survey. Results: Pathology results were determined by gastric biopsies obtained by endoscopy. Of the patients interviewed, biopsy results were obtained for 101. 22.8% had atrophy, 24.8% had intestinal metaplasia, 57.4% presented with H pylori. Conclusions: Using chisquare analysis, no statistically significant relationship could be identified between clinical presentation and biopsy results...

El objetivo de este estudio fue investigar la correlación que existe entre la presencia de síntomas gastrointestinales y los hallazgos histopatológicos de la biopsia gástrica incluyendo la presencia de la infección por Helicobacter pylori. Materiales y métodos: Este estudio prospectivo comprendió a 112 pacientes que se incluyeron entre junio y julio de 2013 en el Servicio de Gastroenterología del Hospital Nacional Cayetano Heredia, Lima-Perú a los que se les hizo endoscopía y biopsia gástrica. Los síntomas de dispepsia, síndrome de intestino irritable y síndrome de distrés post prandial fueron obtenidos usando las encuestas de Roma III. Resultados: De los pacientes a los que se les hizo la encuesta sólo en 101 se les evaluó la biopsia. 22,8% tuvo atrofia, 24,8% presentó metaplasia intestinal, y en 57,4% se reportó la infección por Helicobacter pylori. Conclusiones: Usando el análisis con chi-cuadrado no se pudo establecer ninguna correlación estadísticamente significativa entre la presentación clínica y los resultados de las biopsias...

Isolation of Helicobacter pylori strains and analysis of CYP2C19 genetic polymorphisms with the same gastric biopsy samples / 中华微生物学和免疫学杂志

Objective To analyze the CYP2C19 genetic polymorphisms in patients suffering from gastric diseases in Beijing and Shandong, and to evaluate the possibility of using the same gastric biopsy samples for the isolation of Helicobacter pylori ( H.pylori) strains.Methods A total of 1649 gastric biopsy samples positive for rapid urease test ( RUT) were collected from patients with gastric diseases in Beijing and Shandong.Each sample was grinded and equally divided into two parts for the isolation of H.pylori strains and the analysis of CYP2C19 genetic polymorphisms, respectively.H.pylori strains were isolated from the samples and identified with catalase and urease.CYP2C19*2 and CYP2C19*3 specific primers were used for the PCR amplification of DNA extracts.The PCR products were analyzed by electrophoresis and nucleo-tide sequencing.The metabolic types of CYP2C19 were analyzed based on the results of nucleotide sequen-cing.Results Altogether 1415 (85.81%) H.pylori strains were isolated successfully from the 1649 gastric biopsy samples.The products of CYP2C19 specific PCR for all DNA extracts showed clear bands in electro-phoresis and were further confirmed with sequencing analysis.Statistical analysis revealed that there were no statistical differences with the percentages of CYP2C19 metabolic types between Beijing and Shandong, nor between males and females (P>0.05).Conclusion It showed the possibility of using the same gastric bi-opsy samples for the isolation of H.pylori strains and the analysis of CYP2C19 genetic polymorphisms.No significant differences with the percentages of CYP2C19 metabolic types were found between patients from Beijing and Shandong.

Frecuencia de Helicobacter pylori y características clínicas en niños con endoscopía digestiva alta de un hospital de Lambayeque / Clinical characteristics and frequency of Helicobacter pylori infection in child from and Hospital of Lambayeque: 2007 - 2010

Objetivo: Estimar la frecuencia del Helicobacter pylori y describir las características clínicas en menores de 18 años con endoscopía digestiva alta del Servicio de Gastroenterología del Hospital Nacional Almanzor Aguinaga Asenjo - EsSalud. 2007 - 2010.Material y métodos: estudio descriptivo- retrospectivo en el que se revisaron las historias clínicas y la hoja de endoscopía de 93 pacientes menores de 18 años con endoscopía digestiva alta. Se usó estadística descriptiva; el procesamiento fue mediante Microsoft Excel 2010 y STATA v 10.0. Resultados: Hubieron 93 pacientes de los cuales 60 fueron mujeres (64,52%) y 33 varones (35,48%). La media de edad fue de 12 +/-4 años. La frecuencia de Helicobacter pylori fue de 68,82%. En los pacientes con Helicobacter pylori, la principal indicación para endoscopía fue "gastritis": 50,54% seguido por "dolor abdominal inespecífico":24,73%. En los pacientes HP positivos el diagnóstico endoscópico más frecuente fue: Gastritis nodular: 31 pacientes (33,33%) y el principal hallazgo histopatológico fue Gastritis crónica folicular moderada: 55 pacientes (59,14%); se encontró asociación entre Gastritis nodular (p.0,044) y Gastritis crónica folicular moderada (p<0,001) con la presencia de Helicobacter pylori. Conclusiones:La frecuencia de la infección por Helicobacter pylori en niños fue elevada; la gastritis nodular y la gastritis crónica folicular moderada fueron los hallazgos endoscópico y de biopsia más frecuentes; se halló asociación entre éstos hallazgos y la presencia de Helicobacter pylori.(AU)

Objetive: To determine the frequency of Helicobacter pylori infection and describe the clinical characteristics of children with upper endoscopy from the service of Gastroenterology - Hospital Nacional Almanzor Aguinaga Asenjo - ESSALUD: 2007 - 2010. Materials and Methods: Retrospective, descriptive study in which the medical records and the endoscopy sheet of 93 patients younger than 18 years, were reviewed. Descriptive statistics was used. The processing of data was using Microsoft Excel 2010 and 10.0th STATA version. Results: There were 93 patients of whom 60 were women (64.52%) and 33 males (35.48%). The mean age was 12 +/- 4 years. The frequency of Helicobacter pylori infection was 68.82%. In patients with Helicobacter pylori infection the primary indication for endoscopy was "gastritis" followed by nonspecific abdominal pain. In HP positive patients, the principal indication for endoscopic was "gastritis" 50.54%, follow with Abdominal recurrent pain with 24.73%. The most frequent endoscopic diagnosis in HP patients was nodular gastritis: 31 patients (33.33%), the main histopathological finding was moderate chronic follicular gastritis: 55 patients (59.14%). Association between Nodular gastritis (p.0,044) and Chronic folicular moderate Gastritis (p< 0,001) with the presence of Helicobacter pylori, was found. Conclusions: Helicobacter pylori infection in children under 18 years was very frequent, being Nodular gastritis and Chronic follicular moderate gastritis the endoscopic and biopsy findings, more frequently found. We found an association within Helicobacter pylori infection with Nodular gastritis and Chronic moderate follicular gastritis.(AU)

Microvillous Inclusion Disease Diagnosed by Gastric Biopsy.

Protracted diarrhea in neonates is uncommon and usually requires an intestinal biopsy for etiological diagnosis. Gastric biopsy has not been used in the routine diagnosis of this condition. We report the first documented patient with microvillous inclusion disease from India, where the diagnosis was established by a gastric biopsy.

Pathological diagnosis of high-grade intraepithelial neoplasia in gastric biopsy / 上海第二医科大学学报

Objective To investigate the pathological diagnosis of high-grade intraepithelial neoplasia in gastric biopsy.MethodsOne hundred and forty-three cases diagnosed by gastric biopsy as high-grade intraepithelial neoplasia were analyzed by light microscopy,and were compared with the pathological findings of surgical specimens in 60 cases and a second biopsy in 13 cases.Results Among the sixty cases treated surgically following the gastric biopsies,no carcinoma was found in 6,while the other 54 were diagnosed as gastric adenocarcinoma,27 in advanced stage and 27 in early stage,respectively.Fifteen cases were well-differentiated,24 moderately-differentiated,12 poorly-differentiated and 3 were of mucinous type.Four of the 13 cases with a second biopsy were diagnosed as well-differentiated adenocarcinoma,8 low-grade intraepithelial neoplasia and 1 chronic inflammation.The colorectal adenomas-like changes were morphologically found in 6 surgically-treated cases without carcinoma,5 of whom mucous muscles were not found by biopsy.Fibroblastic reactions were found in 9 cases,all of which were diagnosed as adenocarcinoma in surgical specimens.Conclusion Ninety percent of the cases who are diagnosed as high-grade intraepithelial neoplasia by biopsy may have already been complicated with adenocarcinoma.The location and depth of the specimen in gastric biopsy have a considerable influence on pathological diagnosis.The fibroblastic reaction may be considered as an important marker for gastric adenocarcinoma in pathological diagnosis of gastric biopsy.

Detection of Helicobacter pylori in Gastric Biopsy Specimens by Polymerase Chain Reaction / 대한내과학회지

OBJECTIVE: Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of chronic gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Histological examination and culture are considered to be the most specific tests, and rapid urease test and serological test are rapid but less specific tests. 'I he aim of this study was to investigate the efficiency of the polymerase chain reaction (PCR) assay as a procedure for the diagnosis of H, pylori infection in gastric biopsy specimens. METHODS: Biopsy specimens were obtained from the gastric antrum within 2cm from the pyloric channel of 42 patients during endoscopy and submitted for the histological examination, CLO test, and PCR assay. At the same time, another biopsy specimens were obtained from the lesion for the diagnosis of the diseases. Also, blood was sampled for the measure of the value of IgM and IgG. RESULTS: As the result of the histopathological examination, chronic gastritis was diagnosed in 13 patients, gastric ulcer in 11, duodenal ulcer in H, and gastric cancer in 10. By the histological examination of the antrum, H, pylori were found in 77% of chronic gastritis, 55% of gastric ulcer, 75% of duodenal ulcer, and 40% of gastric cancer. As a whole, the bacteria was identified in 62%, 60%, 88%, 90%, 69% of patients by histological test, CLD test, IgM, IgG, and P(;R respectively. The gold standard we used for the presence of bacteria was histological examination. Sensitivity, specificity, positive predictive value, ancl negative predictive value for PCR assay were 92%, 69%, 83% and 85% respectively. The results of other test were as follows. CLO test: 89%, 88%, 92%, 82%, IgM:92%, 19%, 65%, 60%, IgG:100%, 25%, 68%, 100%. CONCLUSION: CR is a very sensitive but some- what less specific test for the detection of H. pylori. This is mainly due to the contamination of H. pylori during endoscopy and biopsy. So, minimization of the contamination would make PCR clinically useful test.