Incidence and management of acid peptic disorders in sickle cell disease patients in Western Odisha

Background: Sickle cell disease (SCD) is a chronic hemolytic disorder characterized by the presence of crescent-shaped red blood cells. Abdominal pain is the common presenting symptom in adults with SCD. Among the patients who are not in crisis, it is estimated that one third of patients with homozygous SCD with chronic recurrent epigastric pain has endoscopic evidence of peptic ulcer disease. Aims and Objectives: This study was undertaken with an aim to analyze the incidence and management of acid peptic disorders among SCD patients in Western Odisha. Materials and Methods: A prospective study was done considering 88 homozygous SCD patients. All the patients underwent upper gastrointestinal endoscopy (UGIE) with gastric antral biopsy and rapid urease test (RUT). Cases with Helicobacter pylori were administered a 14 days course of three drug regimen of anti H. pylori drugs and followed-up to 6 weeks of beginning the treatment with repeat UGIE and RUT. Results: Out of 88 cases, 19 cases had duodenal ulcer (21.6%) which was significantly high than patients with gastric ulcer (13.6%). Other findings were gastroesophageal reflux disease and gastritis. About 93.5% of patients became RUT negative after taking anti H. pylori medication. Conclusion: SCD patients with acid peptic disorder constitute a sizeable proportion of patients attending surgical outpatient department and indoor department of surgery. Conservative treatment with life style modification can effectively improve the symptoms of acid peptic disease.

Detection of helicobacter pylori infection by helicobacter pylori IgG serology test in pediatric patients at the Philippine General Hospital

Objective@#To determine the validity of serum H. pylori IgG in the detection of H. pylori-associated gastroduodenitis in patients with gastrointestinal symptoms. @*Methods@#Cross-sectional study which included consecutive patients 1-18 years old with upper gastrointestinal symptoms who underwent esophagogastroduodenoscopy. H. pylori infection was diagnosed by positive tests for both rapid urease test (RUT) and Giemsa stain of gastric biopsies. H. pylori IgG (ELISA) serology was also performed.@*Results@#Twenty-five patients [Mean (SD) age: 12 (4.5) years, 68% females] were included. Majority presented with epigastric pain (64%) and had endoscopic gastritis (84%). Four patients had ulcers (1 antral, 3 duodenal). Giemsa stain was positive in 16 (64%) patients and RUT in one. Prevalence of H. pylori infection was 4%. Serum H. pylori IgG test was positive in two; borderline in three with a 100% sensitivity, 80% specificity, and a positive and negative likelihood ratio of 10.9 and 0.6.@*Conclusion@#The present study showed a low prevalence of H. pylori infection, thus, the validity of the H. pylori serology could not be adequately evaluated. We presently could not recommend the serum IgG in the detection of H. pylori gastroduodenitis in our setting.

Combined rapid urease test and histology for the diagnosis of helicobacter pylori infection

Significance@#Accurate detection of Helicobacter pylori (HP) is essential for the diagnosis of HP infection. The use of antibiotics and proton pump inhibitors (PPI) may result in false-negative rapid urease test (RUT) results. We aimed to determine the sensitivity and specificity of RUT compared with histology and assess the detection rate of combined RUT and histology for HP infection. @*Methodology@#Retrospective data collection was performed on 192 patients who were tested for both RUT and histology at the time of upper endoscopy from 2017 to 2018. At least two gastric biopsies (1 from corpus, 1 from antrum) were taken each for RUT and histology. The endoscopy was performed by a single gastroenterologist and a single pathologist was responsible for interpreting the histology with hematoxylin and eosin (H&E) and Giemsa stain. The gold standard test for the diagnosis of HP infection was histology. Demographic profile, RUT and histology results were reviewed. Tests for diagnostic accuracy were computed using SPSSv23. @*Results@#192 patients were tested for RUT and histology. 52(27.1%) were males and 140(72.9%) were females with a mean age of 54±17 years. Epigastric pain was the most common indication (42.7%). 24(12.5%) patients tested positive for HP infection. Among these; 16(8.3%) tested positive for both RUT and histology(true-positive), while 8(4.2%) tested negative for RUT but had positive histology(false-negative). 6 out of 8(75%) patients with false negative results had PPI use. The sensitivity and specificity of RUT for the diagnosis of HP infection were 66.7 and 98.2%, respectively. While the positive and negative likelihood ratio were 37.3 and 0.34, respectively with a diagnostic odds ratio of 110. @*Conclusion@#The HP detection rate of RUT combined with histology increased by 33% compared with RUT alone. RUT is a highly specific test for diagnosing HP infection. Given its modest sensitivity, histology plays an important role in the diagnosis of HP infection, especially in patients taking PPIs. We recommend doing histology when RUT is negative to increase the HP detection rate.

Helicobacter spp. and gastric lesions association in minipigs / Associação entre Helicobacter spp. e lesões gástricas em minipigs

ABSTRACT: Due to their similarity to humans, studies regarding gastric ulcers in pigs have become of great interest. It is known that Helicobacter spp. is related to the occurrence of these ulcers, as they possess a high prevalence in pigs. This study aimed to associate gastric lesions findings naturally occurring in minipigs related to or not related to the presence of Helicobacter spp., through the ultra-rapid urease test and immunohistochemical analysis, reaffirming the disease in swine as a natural biomedical model for human cases. For this, samples of formalin-fixed paraffin-embedded gastric tissues from 40 minipigs were obtained at the Laboratório de Morfologia e Patologia Animal (LMPA) in the Universidade Estadual do Norte Fluminense (UENF). Regarding the ultra-rapid urease test, no animal was positive in all regions. However, 18 were positive in at least one: six (15%) were positive in the aglandular region, eight (20%) in the antrum region, 13 (32.5%) in the region of the cardiac gland, and one (2.5%) in the region of the fundic gland. Regarding immunohistochemical analysis, only one animal was positive in all regions, and 32 animals were positive in at least one: four (10%) were positive in the aglandular region, 10 (25%) in the antrum region, 23 (57.5%) in the region of the cardiac gland, and three (7.5%) in the region of the fundic gland. The gastric lesion findings showed a close relationship with Helicobacter spp., enriching the laboratory animal pathologies list. The immunostaining of the bacteria not associated with gastric lesions in certain regions demonstrated the saprophytic and opportunisitic nature of Helicobacter.

RESUMO: Por sua semelhança com a da espécie humana, a úlcera gástrica nos suínos tem despertado muito interesse. Sabe-se que o Helicobacter spp. está relacionado à ocorrência dessas úlceras, apresentando alta prevalência. Este estudo teve como objetivo associar as lesões gástricas, de ocorrência natural em miniporcos, à presença, ou não, de Helicobacter spp., por meio do teste ultra-rápido da urease e da análise imunohistoquímica, reafirmando a enfermidade em suínos como modelo biomédico natural para os casos em humanos. Para este fim, foram utilizados histossetes de tecido gástrico de 40 minipigs obtidos no Laboratório de Morfologia e Patologia Animal (LMPA) da Universidade Estadual do Norte Fluminense (UENF). Em relação ao teste ultra-rápido da urease, nenhum animal foi positivo em todas as regiões, entretanto, 18 foram positivos em pelo menos uma: seis foram positivos na região aglandular, oito na região do antro, 13 na região das glândulas cárdicas e um na região das glândulas fúndicas. Em relação à análise imuno-histoquímica, somente um animal foi positivo em todas as regiões e 32 animais foram positivos em pelo menos uma: quatro foram positivos na região aglandular, 10 na região do antro, 23 na região das glândulas cárdicas e três na região das glândulas fúndicas. As lesões gástricas demonstraram estreita relação com o Helicobacter spp. em miniporcos, enriquecendo a lista de patologias de animais de laboratório. A imunomarcação da bactéria não associada à lesão, em certas regiões gástricas, demonstra seu caráter saprofítico e oportunista.

Adaptación a la realidad de Latinoamérica de la Guía Clínica NASPGHAN/ESPGHAN 2016 sobre Diagnóstico, Prevención y Tratamiento de Infección por Helicobacter pylori en Pediatría / Adaptation to the reality of Latin America of the NASPGHAN/ESPGHAN 2016 Guidelines on the Diagnosis, Prevention and Treatment of Helicobacter pylori Infection in Pediatrics

Resumen: Introducción: Las últimas guías clínicas conjuntas de NASPGHAN y ESPGHAN en relación a la infección por H. pylori publicadas el año 2016, contienen 20 afirmaciones que han sido cuestionadas en la práctica respecto a su aplicabilidad en Latinoamérica (LA); en particular en relación a la preven ción del cáncer gástrico. Métodos: Se realizó un análisis crítico de la literatura, con especial énfasis en datos de LA y se estableció el nivel de evidencia y nivel de recomendación de las afirmaciones mas controversiales de las Guías Conjuntas. Se realizaron 2 rondas de votación de acuerdo a la técnica Delfi de consenso y se utilizó escala de Likert (de 0 a 4) para establecer el "grado de acuerdo" entre un grupo de expertos de SLAGHNP. Resultados: Existen pocos estudios en relación a diagnóstico, efectividad de tratamiento y susceptibilidad a antibióticos de H. pylori en pacientes pediátricos de LA. En base a estos estudios, extrapolaciones de estudios de adultos y la experiencia clínica del panel de expertos participantes, se realizan las siguientes recomendaciones. Recomendamos la toma de biopsias para test rápido de ureasa e histología (y muestras para cultivo o técnicas moleculares, cuando estén disponibles) durante la endoscopia digestiva alta sólo si en caso de confirmar la infección por H. pylori, se indicará tratamiento de erradicación. Recomendamos que centros regionales seleccio nados realicen estudios de sensibilidad/resistencia antimicrobiana para H. pylori y así actúen como centros de referencia para toda LA. En caso de falla de erradicación de H. pylori con tratamiento de primera línea, recomendamos tratamiento empírico con terapia cuádruple con inhibidor de bomba de protones, amoxicilina, metronidazol y bismuto por 14 días. En caso de falla de erradicación con el esquema de segunda línea, se recomienda indicar un tratamiento individualizado considerando la edad del paciente, el esquema indicado previamente y la sensibilidad antibiótica de la cepa, lo que implica realizar una nueva endoscopía con extracción de muestra para cultivo y antibiograma o es tudio molecular de resistencia. En niños sintomáticos referidos a endoscopía que tengan antecedente de familiar de primer o segundo grado con cáncer gástrico, se recomienda considerar la búsqueda de H. pylori mediante técnica directa durante la endoscopia (y erradicarlo cuando es detectado). Con clusiones: La evidencia apoya mayoritariamente los conceptos generales de las Guías NASPGHAN/ ESPGHAN 2016, pero es necesario adaptarlas a la realidad de LA, con énfasis en el desarrollo de centros regionales para el estudio de sensibilidad a antibióticos y mejorar la correcta selección del tratamiento de erradicación. En niños sintomáticos con antecedente familiar de primer o segundo grado de cáncer gástrico, se debe considerar la búsqueda y erradicación de H. pylori.

Abstract: Introduction: The latest joint H. pylori NASPGHAN and ESPGHAN clinical guidelines published in 2016, contain 20 statements that have been questioned in practice regarding their applicability in Latin America (LA); in particular in relation to gastric cancer prevention. Methods: We conduc ted a critical analysis of the literature, with special emphasis on LA data and established the level of evidence and level of recommendation of the most controversial claims in the Joint Guidelines. Two rounds of voting were conducted according to the Delphi consensus technique and a Likert scale (from 0 to 4) was used to establish the "degree of agreement" among a panel of SLAGHNP ex perts. Results: There are few studies regarding diagnosis, treatment effectiveness and susceptibility to antibiotics of H. pylori in pediatric patients of LA. Based on these studies, extrapolations from adult studies, and the clinical experience of the participating expert panel, the following recom mendations are made. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, when available) during upper endoscopy only if in case of confirmed H. pylori infection, eradication treatment will be indicated. We recommend that selected regional centers conduct antimicrobial sensitivity/resistance studies for H. pylori and thus act as reference centers for all LA. In case of failure to eradicate H. pylori with first-line treatment, we recommend empirical treatment with quadruple therapy with proton pump inhibitor, amoxi cillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second line scheme, it is recommended to indicate an individualized treatment considering the age of the pa tient, the previously indicated scheme and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with sample extraction for culture and antibiogram or molecular resistance study. In symptomatic children referred to endoscopy who have a history of first or se cond degree family members with gastric cancer, it is recommended to consider the search for H. pylori by direct technique during endoscopy (and eradicate it when detected). Conclusions: The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivity and to improve the correct selection of the eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H. pylori should be considered.

Prevalence of Helicobacter pylori infection in dyspeptic patients undergoing upper gastrointestinal endoscopy in a tertiary-care teaching hospital

Background: Helicobacter pylori infection is widely prevalent in the world especially in the developing countries. The common clinical presentation of this disease includes peptic and duodenal ulcer. A major post-infection complication of this disease is gastric carcinoma. The scope of this study was to determine the prevalence of active H. pylori infection in the local population by retrospective review of patient records, which can give a better picture of the current situation and estimate the at-risk population of gastric carcinoma. Objective of the study was to determine the prevalence of H. pylori infection in biopsy specimens obtained from upper gastrointestinal endoscopy performed in dyspeptic patients in a tertiary-care hospital.Methods: The study was performed as a retrospective review of biopsy reports of 262 dyspeptic patients with previously unknown H. pylori status who underwent upper gastrointestinal endoscopy during the months of January 2018 to May 2018. Biopsy obtained from stomach was evaluated for the presence of H. pylori infection by Rapid Urease Test (RUT) or histopathological examination.Results: The prevalence of H. pylori infection in dyspeptic patients obtained from the above study was 44.7% and was found to be more common in males compared to females.Conclusions: H. pylori is a risk factor for gastric carcinoma. Determining the prevalence with early identification of active infections results in better treatment and post infection monitoring for malignancy.

Does H. pylori therapy augments the effect of iron therapy among children with iron deficiency anemia?

Background: To assess beneficial effects of H. pylori therapy on children with pre-existing Iron Deficiency Anemia (IDA).Methods: A total of 218 consecutive patients with iron deficiency anemia (Hb 6-11 gm/dl) were invited to participate in the study. Patients underwent endoscopic biopsy and rapid urease test for H. pylori detection. A total of three groups were formed- Group I (n=13) - positive for H. pylori, underwent treatment for H. pylori therapy and IDA, Group II (n=16) - positive for H. pylori, underwent treatment for IDA only, Group III (n=101) - negative for H. pylori, underwent treatment for IDA only. All the patients were followed up after every 4 weeks till week 12. Change in haematological parameters and anaemic and iron status was assessed. Chi-square paired 't'-test and ANOVA were used using SPSS 21.0.Results: All the 3 groups showed a significant increase in S. Hb, Ferritin and iron levels and a decrease in S. TIBC levels. At 12 weeks, mean S. ferritin and S. iron levels were significantly higher in Groups I and III as compared to Group II while Mean S. TIBC levels were significantly higher in Group II as compared to that in Groups I and II. A total of 73.3% of Group III, 53.8% of Group I and 56.3% of Group II patients had hemoglobin levels >11 g/dl, but difference was not significant (p=0.175).Conclusions: The findings of study showed that H. pylori therapy augments the effect of iron therapy among H. pylori positive children with iron deficiency anemia.

Standardizing Diagnosis of Helicobacter pylori Infection to Improve Diagnostic Accuracy / 胃肠病学

Eradication of Helicobacter pylori (Hp) is important for the prevention and treatment of chronic gastritis, peptic ulcer and gastric cancer. The Chinese consensus on the management of Hp infection has taken "confirmed Hp infection" as an indication for eradication. The World Gastroenterology Organisation global guideline states the "test-and-treat strategy" for Hp infection. Accurate diagnosis of Hp infection is a prerequisite for standardized eradication. There are many methods to diagnose Hp infection. Each has its advantages and disadvantages. Different methods are suitable for different diseases and patients, and each method has strict requirements for reagents, equipment, testers and patients. Therefore, increasing the awareness of physicians and testers about the standardized diagnosis of Hp infection is essential to improve the diagnostic accuracy.

Prevalence of H. pylori in Immune Thrombocytopenic Purpura (ITP) in a tertiary care center, South India

Introduction: Immune thrombocytopenic purpura (ITP) has been linked with Helicobacter Pylori infection. Objectives: The objective of the present study was to determine the prevalence of H pylori infection in adult ITP patients in a tertiary care center in South India. Methods: 50 adult patients with ITP in the Department Hematology, Madras Medical College were recruited for a cross -sectional study over a period of 6 months. Biopsy from the antrum was subjected to Rapid urease test to detect H. pylori. A total of 50 patients participated in the study. Result: The prevalence of H. pylori infection in ITP patients was 36%. The majority of patients were male (78%). Conclusion: The diagnosis of H. pylori in ITP patients may be considered in high prevalent areas.

Efficacies of Reverse Hybrid Therapy in Eradication of Helicobacter pylori Infection

Introduction: Because the prevalence of antibiotic resistancemarkedly increases with time worldwide, anti-H. pyloritreatment is continuing to be a great challenge for physiciansin clinical practice. Eradication of H. pylori infection markedlychanges the natural history of peptic ulcer in patients withduodenal or gastric ulcer. Most peptic ulcers associated withH. pylori infection are curable. Aim of present study was tostudy the efficacies of 14 days ‘ Reverse Hybrid Therapy’ inH.pylori positive G.I.patients.Material and methods: 100 H.pylori positive patients withupper G.I. complaints who underwent upper GI endoscopywere included in the study. H.pylori infection was documentedby at least 2 positive results of Rapid Urease Test. Subjectswith any of the following criteria were excluded from thestudy. 1. Previous eradication therapy 2. Allergy to anyantibiotic used in study. 3. Co- existence of any serious illness.4. Pregnancy or lactating women 5. Previous gastrectomy6. Use of antibiotics within last 4 week. Detailed medicalhistory and demographic details of the patients were recorded.Routine haematogical tests and USG was done. Patients weregiven 14 days dual therapy ie quadruple regimen (proton pumpinhibitor + amoxicillin + clarithromycin + metronidazole) forfirst 7 days followed by dual regimen of PPI+ amoxicillin fornext 7 days. Patients were asked to report at 7, 14 days and at6 weeks interval.Results: Out of 97 patients 93 patients became negative forH.pylori after 6 week of Reverse Hybrid eradication therapy.It was observed that majority of patients enrolled in the studywere in the age group of 41–60 years (50%) followed bybelow 40 yrs (27%), above 60 yrs (23%). Out of them, 74%were male and 26% were female.Conclusion: Out of 97 patients 93 patients became negativefor H.pylori after 6 week of Reverse Hybrid eradicationtherapy. Hence, Reverse Hybrid Therapy is equally potenttherapy to Bismuth based therapy though the latter has a lotof side effects.

Utility of Anti-Helicobacter pylori IgG Estimation in the Diagnosis of Acid Peptic Diseases: A Comparison of Serum IgG Level with Rapid Urease Test

Introduction: The mode of treatment of APD is changedradically ever since the role of H.pylori is proved for thiscondition. The study was aimed to detect the utility of antiH.pylori IgG estimation in the diagnosis of acid pepticdiseases.Material and methods: Endoscopic examination of stomachfollowed by Rapid Urease Test on the biopsy material andthe anti-Helicobacter pylori IgG quantitative estimation weredone in 85 patients with history suggestive of acid pepticdisease.Results: 46 (100%) patients with gastritis showed positiveRapid Urease Test within 30 minutes and had serum IgG >30IU/ml. 10 patients with peptic ulcer, 12 patients with non ulcerdyspepsia and 2 patients with carcinoma stomach gave positiveRapid Urease Test after 30minutes and serum IgG level was< 30 IU/ml for these patients. Of the 70 Rapid Urease Testpositive in the study, 2 of the 12 non ulcer dyspepsia patientswere negative for antibody. Endoscopy findings in 15 subjectswere normal and negative for Rapid Urease Test and antiHelicobacter pylori IgG antibody.Conclusion: Estimation of Serum anti-Helicobacter pyloriIgG may be useful as a non invasive method in the diagnosisof gastritis.

Comparing Diagnostic Performance of Pronto Dry Rapid Urease® and Culture to Histopathology among Endoscopy Patients at the Aga Khan University Hospital, Nairobi-Kenya

Aim:This study sought to evaluate Pronto dry rapid urease® diagnostic test and compare its performance with culture.Study Design:Cross-sectional study.Place and Duration:From September 2017 to July 2018, across-sectional study was conducted at the Aga Khan University Hospital.Methodology:Patients attending endoscopy unit at the hospital were randomly sampled to provide gastric biopsy specimen. One specimen was tested for presence or absence of H. pylori using Pronto dry rapid urease® test and another specimen subjected to in vitro culturetest which were then compared with histology reference results. Test validity and reliability was determined using Graph Pad Prism v5.01. Results:Of 274 study specimens, 121(44%) were positive for histology. Ninety-one (33%) of the study specimen were positive for culture compared to 147(54%) for Pronto dry rapid urease®. Pronto dry rapid urease® test had sensitivity of 100% (97.5%-100%) against 73.6% (64.8%-81.3%) for culture. Specificity was 96.1% (91.1%-98.7%) for Pronto dry rapid urease® compared to 35.3% (95% CI 24.1%-47.8%) for culture. Positive predictive value was 96.7% (92.5-98.9%) for Pronto dry rapid urease® compared to 97.8% (92.3%-99.7%) for culture. Negative predictive value was 100% (97%-100%) for Pronto dry rapid urease® against 82.5% (76.2%-87.7%) for culture. There was significant difference between both Pronto dry rapid urease® and culture test performance with histology in all validity measures, P< 0.001. On the other hand, there was no significant difference between Pronto dry rapid urease® and culture in all validity measures due to overlapping confidence intervals.Conclusion:Pronto dry rapid urease® out-performed culture in sensitivity and NPV. It would be the method of choice in H. pylori detection where histology is untenable and antimicrobial profiling which require culturing the bacterium is needless

Incidence and profile of Helicobacter pylori infection among HIV positive patients

Background: People having HIV infection present with a number of symptoms related to gastrointestinal tract like dyspepsia. HIV itself as well as opportunistic infections is responsible for such symptoms. Notably is Helicobacter pylori infection causes variety of such symptoms. The objective of the present research was to study incidence and profile of Helicobacter pylori among HIV positive patients.Methods: A hospital based cross sectional study was carried out over a period of two years among 101 HIV positive patients in the Department of General Medicine, Madurai Medical College, Madurai in collaboration with Department of Medical Gastroenterology and also Department of Venereology and Leporology. Rapid urease test was done. HIV status was confirmed by ELISA test. Data was analysed with the help of EPI statistical software.Results: Majority (40.6%) had CD4 count of 200-500. It has been observed that incidence of Helicobacter pylori was low in groups with low CD4 count. It was also observed that those with higher CD4 count had higher incidence of RUT positivity. This association was found to be statistically significant. The incidence of Helicobacter pylori positivity was not significantly different among those patients who were on ART (18%) and those who were not on ART (21%).Conclusions: The incidence of Helicobacter pylori infection was less in HIV positive patients. Those with CD4 cell count less than 100 had lower incidence of Helicobacter pylori infection than those with CD 4 cell count more than 500. Incidence of Helicobacter pylori infection was not affected by ART.

Relación de anemia y talla baja con el diagnóstico de infección por Helicobacter pylori en niños de 6 a 14 años, de enero del 2014 a diciembre del 2016 en el Hospital del Niño Dr. José Renán Esquivel / Relationship of anemia and short stature with the diagnosis of Helicobacter pylori infection in children from 6 to 14 years old, from January 2014 to December 2016 at the Hospital del Niño Dr. José Renán Esquivel

Introducción: La infección por Helicobacter pylori es la enfermedad bacteriana crónica más extendida del mundo y afecta a más de la mitad de la población mundial, con una distribución vinculada con el grado de desarrollo económico de cada país. En la edad pediátrica no existe un cuadro clínico específico de esta infección, puede tener resultados clínicos diversos que incluye no sólo síntomas digestivos sino manifestaciones extradigestivas como anemia por deficiencia de hierro y retraso del crecimiento. La relación entre la infección por Helicobacter pylori, la anemia por déficit de hierro y talla baja ha sido confirmada en múltiples estudios, pero el tema sigue siendo controvertido. Debido a la escasez de estudios sobre esta asociación, particularmente en niños panameños, y el impacto de sus complicaciones a corto y largo plazo en una población tan vulnerable, es de extraordinaria importancia llevar a cabo estudios para mejorar nuestra comprensión de este tema. Material y Métodos: Se realizó un estudio analítico de casos y controles no pareados, retrospectivo. Se incluyeron 158 pacientes (79 casos y 79 controles) del Hospital del Niño Dr. José Renán Esquivel de Panamá, entre enero de 2014 a diciembre de 2016. Se hizo revisión de los expedientes clínicos con autorización del Comité de Bioética del hospital. Los datos demográficos generales y las variables de estudio seleccionadas se obtuvieron de los pacientes sometidos a endoscopia digestiva alta con biopsia gástrica que cumplían los criterios de inclusión. La existencia de una asociación estadística se evaluó con la prueba exacta de Fisher y el odds ratio.Resultados: La edad promedio de ambos grupos fue de 9.75 + 2.75 sin diferencia estadística entre las edades en los grupos. La infección fue más frecuente en el sexo femenino (63%). El dolor abdominal fue la principal indicación para realizar endoscopia. La frecuencia de anemia en los pacientes infectados fue de 31%, mayor a la reportada en países latinoamericanos, pero no se encontró asociación entre anemia e infección por Helicobacter pylori (p= 0.36) al igual que no se encontró asociación con talla baja (p= 0.74). El nivel socioeconómico fue más bajo en los pacientes enfermos (p= 0.01). El test de ureasa presentó especificidad de 100% en nuestro estudio. Conclusiones: No encontramos asociación entre anemia y talla baja con la infección por Helicobacter pylori, pero la frecuencia de anemia es elevada respecto a otros países de Latinoamérica; y el nivel socioeconómico es un factor influyente en el desarrollo de esta infección. Son necesarios estudios longitudinales que puedan evaluar a los pacientes en la evolución de la enfermedad y determinar las alteraciones en los parámetros hematológicos y velocidad de crecimiento.

Introduction: Helicobacter pylori infection is the most widespread chronic bacterial disease in the world and affects more than half of the world population, with a distribution linked to the degree of economic development of each country. In the pediatric age there is no specific clinical picture of this infection. In children, it can have diverse clinical outcomes that include not only digestive symptoms but extra-digestive manifestations such as iron deficiency anemia and growth retardation. The relationship between Helicobacter pylori infection, iron deficiency anemia and short stature has been confirmed in multiple studies, but the issue remains controversial. Due to the scarcity of studies on this association, particularly in Panamanian children, and the impact of its short and long term complications on such a vulnerable population, it is of extraordinary importance to carry out studies to improve our understanding of this topic. Material and Methods: It is a retrospective, analytical, unmatched case and control study involving a total of 158 patients (79 cases and 79 controls) from the Hospital del Niño Dr. José Renán Esquivel, Panamá, between January 2014 to December 2016. Patient records were examined with autorization from the hospital's bioethics committee. General demographic data and the selected study variables were obtained from patients who underwent upper digestive tract endoscopy with gastric biopsy that met the inclusion criteria. The existence of a statistical association was evaluated with Fisher's exact test and odds ratio. Results: The average age of both groups was 9.75 + 2.75 with no statistical difference between the ages in the groups. Infection was more frequent in females (63%). Abdominal pain was the main indication for endoscopy. The frequency of anemia in the infected patients was 31%, higher than that reported in Latin American countries, but no association was found between anemia and Helicobacter pylori infection (p= 0.36), as there was no association with growth retardatin (p= 0.74). The socioeconomic level was lower in the sick patients (p= 0.01). The urease test showed 100% specificity. Conclusions: We did not find an association between anemia and short stature with Helicobacter pylori infection, but the frequency of anemia is high compared to other Latin American countries, and the socioeconomic level is an influential factor in the development of this infection. Longitudinal studies are needed that can evaluate patients in the evolution of the disease and determine the alterations in the hematological parameters and growth rate.

Antibiotic resistance in Helicobacter pylori: A mutational analysis from a tertiary care hospital in Kashmir, India

Background: Helicobacter pylori infection is recognised as type 1 carcinogen by the International Agency of Research on Cancer. Previous studies in our hospital have revealed high prevalence of H. pylori in our population with a high recurrence rate after completion of treatment. This prompted us to undertake this study. Aim: This study aimed to determine common gene mutations leading to resistance to clarithromycin, metronidazole, tetracycline and quinolones in H. pylori in patients attending our hospital. Settings and Design: This is a cross-sectional hospital-based study. The study was approved by the Institutional Ethics Committee. Materials and Methods: This study was conducted on 196 adult dyspeptic patients with an indication for upper gastrointestinal endoscopy. Gastric biopsies collected from them were subjected to histopathological examination, rapid urease test (RUT) and culture. Of the 196 patients, 95 met the inclusion criteria. Drug susceptibility testing (DST) by various polymerase chain reaction-based methods was done for 47 RUT-positive biopsies and 13 H. pylori isolates. Results: Maximum resistance was seen to metronidazole (81.66%) followed by clarithromycin (45%) and quinolones (3.33%). No high-level resistance was seen to tetracycline. In clarithromycin-resistant cases, A2142G mutation was more prevalent than A2143G mutation. Multidrug resistance (resistance to metronidazole and clarithromycin) was seen in 41.66% of patients. Conclusions: Tetracycline and quinolones could be the antibiotics of choice in the eradication of H. pylori in this region, while recurrence of the infection with H. pylori could be expected among patients receiving either metronidazole or clarithromycin, for eradication therapy. DST should be done on a routine basis utilising both phenotypic and genotypic methods to prevent further emergence of resistance in this region.

Comparação entre teste da urease e histopatologia na identificação do Helicobacter pylori / Comparison between urease test and histopathology in the identification of Helicobacter pylori

Introdução: o Helicobacter pylori (H. pylori) é uma bactéria gram-negativa capaz de colonizar a mucosa gástrica e predispor a diversas patologias. Para identificação do H. pylori, os testes invasivos ainda são os mais realizados, sendo que não há um teste padrão ouro aceito universalmente. A análise histológica e o teste da urease são dois dos principais métodos diagnósticos utilizados atualmente. Objetivo: o presente estudo tem como objetivo avaliar a positividade do teste da urease e da análise histopatológica, levando em consideração as variáveis como sexo, idade e patologias associadas. Métodos: trata-se de um estudo transversal de caráter quantitativo, tendo como base dados obtidos por meio de laudos de endoscopias realizadas no Hospital Universitário Santa Terezinha de Joaçaba ­ SC no período entre abril de 2014 e dezembro de 2015, assim como a partir de dados dos exames anatomopatológicos dos respectivos casos, fornecidos pelo Instituto de Patologia Joaçaba, de Joaçaba ­ SC. Os dados foram analisados e comparados através do software Microsoft Office Excel. Resultados: dos 313 pacientes que compunham a pesquisa, o teste da urease mostrou-se positivo para o H. pylori em 84 (26,83%) amostras e a avaliação histopatológica em 89 (28,43%) amostras. Em relação ao sexo, o teste da urease apresentou maior prevalência de casos positivos em homens, com 45 (53,57%) amostras. Já a histopatologia mostrou leve predominância de mulheres, com 45 (50,57%) amostras. No tocante à idade dos pacientes, ambos os métodos diagnósticos apresentaram maior frequência de positividade entre 41 e 50 anos e entre 61 e 70 anos. Quanto às lesões gástricas encontradas em pacientes com H. pylori positivo, no teste da urease, 54,76% das amostras apresentavam pangastrite enantematosa e, na avaliação histopatológica, 87,64% dos pacientes apresentavam gastrite crônica ativa. Conclusão: a comparação entre os dois métodos diagnósticos, teste da urease e histopatologia mostrou resultados equivalentes na detecção do H. pylori, sendo indicada a realização dos métodos concomitantemente. A gastrite foi a patologia mais evidenciada em ambos os métodos com H. pylori positivo; no entanto, muitos dos não acometidos também apresentavam tal patologia, o que sugere a presença de outros fatores envolvidos na gênese da afecção.

Introduction: Helicobacter pylori (H. pylori) is a gram negative bacteria capable of colonizing the gastric mucosa and predispose to various diseases. For identification of H. pylori, invasive tests are still the most accomplished, and there is no gold standard universally accepted. Histological analysis and urease test are two of the main diagnostic methods currently used. Aims: this study aims to evaluate the test positive urease and histopathology, taking into account variables such as gender, age and associated pathologies. Methods: this is a cross-sectional study of quantitative approach, based on data obtained through endoscopies reports conducted at the University Hospital Santa Terezinha de Joaçaba - SC from April 2014 to December 2015, as well as from data pathological examination of their cases, provided by the Institute of Pathology Joaçaba, Joaçaba - SC. The data were analyzed and compared using the Microsoft Office Excel software. Results: of the 313 patients who comprised the study, the urease test positive proved to H. pylori in 84 (26.83%) samples and histopathological evaluation in 89 (28.43%) samples. Regarding gender, the urease test showed a higher prevalence of positive cases in men, with 45 (53.57%) samples. Already histopathology showed slight predominance of women with 45 (50.57%) samples. Regarding the age of the patients, both diagnostic methods showed a higher frequency of positivity between 41 and 50 years and between 61 and 70 years. As for gastric lesions found in patients with H. pylori positive, the urease test, 54.76% of the samples had enanthematous pangastritis, and in histopathology, 87.64% of patients had chronic active gastritis. Conclusion: the comparison between the two diagnostic methods, urease test and histopathology showed equivalent results in the detection of H. pylori is indicated performing the methods concurrently. Gastritis was more evident pathology in both methods with H. pylori positive, however, many unaffected also had such pathology, suggesting the presence of other factors involved in the pathogenesis of the disease.

Determinar la concordancia del test rápido de ureasa y de la histopatología para el diagnóstico de enfermedad gastroduodenal por Helicobacter pylori en pacientes pediátricos de 2 a 14 años atendidos en el Hospital del Niño de enero de 2001 a enero 2014 / Determine the concordance of the rapid urease test and the histopathology for the diagnosis of gastroduodenal disease by Helicobacter pylori in pediatric patients aged 2 to 14 years attended in the child's hospital from January 2001 to January 2014

Helicobacter pylori es una de las causas más frecuentes de infección bacteriana crónica. La epidemiología apunta a que la infección se adquiere en su gran mayoría durante la edad pediátrica. Métodos: Se realizó un estudio de concordancia de pruebas diagnósticas, analítico, ambispectivo, para evaluar la seguridad, validez y fuerza de concordancia del Test rápido de ureasa al compararlo con la histopatología para el diagnóstico de enfermedad gastroduodenal asociada a infección por Helicobacter pylori. Resultados: De un total de 93 pacientes se encontró que un 52 % eran de sexo masculino y 48 % de sexo femenino. De acuerdo a la edad 21% eran preescolares, 37% escolares y 42 % adolescentes. En un 89 % de los casos el dolor abdominal recurrente fue la indicación principal de endoscopía. De los pacientes participantes, 55 resultaron positivos por Enfermedad gastroduodenal por H. pylori (59.13 %) y 38 negativos (40.87 %).Con respecto a la concordancia entre la prueba de rápida de ureasa y la histopatología, κ = 0.502, considerada fuerza de concordancia moderada y p < 0.0001 indica que es estadísticamente significativa. Los escolares presentaron concordancia del Test de ureasa con la histopatología de 0.59 (moderada), p = 0.0003. La probabilidad diagnóstica aumenta a 9.29 (moderada), considerada una prueba buena en este grupo etario. En escolares y adolescentes, la nodularidad antral tiene una sensibilidad de 97.73% y un Valor predictivo negativo de 92.13%. Se observa que la concordancia es de 0.68, IC (0.49 ­ 0.86), p <0.0001 ) y 0.67 IC (0.45 ­ 0.88), p< 0.0001 en pacientes con densidad de colonización de moderada a severa (relación alta e incluso muy alta para los límites superiores de los intervalos de con anza).

Helicobacter pylori is one of the most common causes of chronic bacterial infection. Epidemiology suggests that the infection is acquired mostly during childhood. Methods:An agreement study of diagnostic, analytical, ambispective tests to assess the safety, validity and strength matching the rapid urease test when compared with histopathology for the diagnosis of gastroduodenal disease associated with infection by Helicobacter pylori was performed. Results: From a total of 93 patients found that 52% were male and 48% female. According to preschool age were 21%, 37% and 42% school adolescents. In 89% of cases recurrent abdominal pain was the main indication for endoscopy. Of the participating patients, 55 were positive for H. pylori peptic disease (59.13%) and 38 negative (40.87%). With regard to the correlation between rapid urease test and histopathology, κ = 0.502, considered force moderate concordance p <0.0001 indicates that it is statistically significant. School had urease test concordance with histopathology of 0.59 (moderate), p = 0.0003. The diagnostic probability increases to 9.29 (moderate), considered a good test in this age group. In children and adolescents, the antral nodularity has a sensitivity of 97.73% and a negative predictive value of 92.13%. It is observed that the correlation is 0.68, CI (0.49 to 0.86), p <0.0001) and CI 0.67 (from 0.45 to 0.88), p <0.0001 density in patients with moderate to severe colonization (high ratio too high for even the upper limits of the confidence intervals).

Prevalence of helicobacter pylori ten years ago compared to the current prevalence in patients undergoing upper endoscopy / Prevalência do helicobacter pylori há dez anos comparada com a atual em pacientes submetidos à endoscopia digestiva alta

ABSTRACT Background: Helicobacter pylori has been extensively studied since 1982 it is estimated that 50% of the world population is affected. The literature lacks studies that show the change of its prevalence in the same population over time. Aim: To compare the prevalence of H. pylori in 10 years interval in a population that was submitted to upper endoscopy in the same endoscopy service. Method: Observational, retrospective and cross-sectional study comparing the prevalence of H. pylori in two samples with 10 years apart (2004 and 2014) who underwent endoscopy with biopsy and urease. Patients were studied in three consecutive months of 2004, compared to three consecutive months of 2014. The total number of patients was 2536, and 1406 in 2004 and 1130 in 2014. Results: There were positive for H. pylori in 17 % of the sample as a whole. There was a significant decrease in the prevalence from 19.3% in 2004 to 14.1% in 2014 (p<0.005). Conclusion: There was a 5.2% reduction in the prevalence of H. pylori comparing two periods of three consecutive months with 10 years apart in two equivalent population samples.

RESUMO Racional: Helicobacter pylori vem sendo amplamente estudado desde 1982 estimando-se que 50% da população mundial esteja afetada. A literatura carece de estudos que mostrem a mudança de sua prevalência em uma mesma população ao longo do tempo. Objetivo: Comparar a prevalência do H.pylori no intervalo de 10 anos em população que realizou endoscopia digestiva alta no mesmo serviço de endoscopia. Método: Estudo observacional, retrospectivo e transversal, comparando a prevalência de H. pylori em duas amostras com intervalo de 10 anos (2004 e 2014) que realizaram endoscopia digestiva alta com biópsias e teste da urease para a pesquisa de H. pylori. Foram estudados pacientes em três meses consecutivos de 2004, comparados aos de três meses consecutivos de 2014. O número total de pacientes avaliados foi 2536, sendo 1406 em 2004 e 1130 em 2014. Resultados: Constatou-se resultado positivo para H.pylori em 17% da amostra como um todo. Houve queda significativa da prevalência de H.pylori de 19,3% em 2004 para 14,1% em 2014 (p<0.005). Conclusão: Houve redução de 5,2% da prevalência de H. pylori comparando-se dois períodos de três meses consecutivos com intervalo de 10 anos em duas amostras populacionais equivalentes.

Investigation of Helicobacter pylori antigen in stool samples of patients with upper gastrointestinal complaints

Abstract Helicobacter pylori infection is usually acquired in early childhood and it can persist throughout life without antibiotic treatment. This study aimed to compare the accuracy of the noninvasive H. pylori Stool Antigen Test-applied on the stool samples with the invasive gold standart Rapid Urease Test-applied on the gastric biopy samples of patients with upper gastrointestinal complaints. After endoscopy, biopsy and stool specimens were taken in 122 patients. The infection was detected with rapid urease test which is accepted as gold standart test. Rapid, one-step H. pylori card test was applied to all patients stool specimens. In this study 106 of the 122 patients (86.8%) were positive for H. pylori infection, while 16 of the 122 patients (13.2%) were negative. H. pylori card test was negative in 13 of the 16 patients and was positive in 98 of the 106. The sensitivity, specifity, positive and negative predictive values were 92.45%, 81.25%, 97.02%, and 61.90%, respectively. H. pylori card test is rapid, easy, noninvasive and inexpensive methods for detection H. pylori infection. This test showed high sensitivity and specificity. Additionally, it may be a good alternative to invasive tests for the detection of H. pylori infections especially in children.

Validación de Sensibacter pylori test® como prueba de ureasa para el diagnóstico de infección por Helicobacter pylori en Chile / Validation of Sensibacter pylori test ® as urease tests for the diagnosis of Helicobacter pylori infection in Chile

Introduction: Helicobacter pylori is a highly prevalent bacterium in Chile that causes various gastric pathologies including gastric cancer, which corresponds to the leading cause of cancer-related death in Chile in men. This is why early detection of an Helicobacter pylori infection is gaining importance, for tis purpose there are various diagnostic methods, including rapid urease tests (RUT) such as the Sensibacter pylori test®. Objectives: To validate the Sensibacter pylori test® in Chile, so that it may be used in healthcare centres in our country. Materials and Methods: Upper gastrointestinal endoscopies were performed on symptomatic patients in 3 healthcare centres and gastric mucosa samples were obtained following established protocols. These underwent the health centre ́s RUT and the Sensibacter pylori test®, and the results were compared to the gastric mucosa histology (gold standard) Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each test. Kappa test was used to assess agreement between the RUT’s and the turning time of each test was measured. Results: Sensibacter pylori test® showed a sensitivity of 82.6 percent, specificity 92.3 percent, PPV 95 percent and NPV 75 percent. The consistency with the other RUT’s was 0.958 (p < 0.001) and 0.872 (p < 0.001). The turning time was 15 min. Conclusion: Sensibacter pylori test® is a sensitive and specific method, similar to other tests used daily in Chile, which has the advantage of yielding results within a few minutes.

Introducción: Helicobacter pylori es una bacteria de gran prevalencia en Chile y es causante de variadas patologías gástricas, entre las cuales se encuentra el cáncer gástrico, que corresponde a la primera causa de muerte por cáncer en Chile en hombres. Por esto, cobra relevancia detectar a tiempo la existencia de Helicobacter pylori, para lo cual existen diversos métodos diagnósticos, entre los que se encuentran los test rápidos de ureasa (TRU) como Sensibacter pylori test®. Objetivos: Validar Sensibacter pylori test® en Chile, para poder ser utilizado en centros de salud de nuestro país. Materiales y Métodos:Se realizaron endoscopias digestivas altas a pacientes sintomáticos en tres centros de salud y se obtuvieron muestras de mucosa gástrica según protocolos establecidos. Estas se sometieron al TRU del centro de salud y a Sensibacter pylori test®, comparándose el resultado con histología de la mucosa gástrica (estándar de oro), calculándose sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Se utilizó test kappapara evaluar concordancia entre TRU y se midió el tiempo de viraje de cada test. Resultados: Sensibacter pylori test® demostró una sensibilidad de 82,6 por ciento, especificidad de 92,3 por ciento, VPP de 95 por ciento y VPN de 75 por ciento. La concordancia con los otros TRUs fue de 0,958 (p < 0,001) y 0,872 (p < 0,001). El tiempo de viraje fue de 15 min. Conclusión: Sensibacter pylori test® es un método sensible y específico comparable con otros test de uso diario en Chile, y tiene la ventaja de mostrar resultados en pocos minutos.