The effect of Helicobacter pylori infection on duodenal bulbar microbiota in children with duodenal ulcer / 中华儿科杂志

Objective: To investigate the characteristics of duodenal bulbar microbiota in children with duodenal ulcer and Helicobacter pylori (Hp) infection. Methods: This prospective cohort study enrolled 23 children with duodenal ulcers diagnosed by gastroscopy who were admitted to the Children's Hospital of Zhejiang University School of Medicine due to abdominal pain, abdominal distension, and vomiting from January 2018 to August 2018. They were divided into Hp-positive and Hp-negative groups according to the presence or absence of Hp infection. Duodenal bulbar mucosa was sampled to detect the bacterial DNA by high-throughput sequencing. The statistical difference in α diversity and β diversity, and the relative abundance in taxonomic level between the two groups were compared. Microbial functions were predicted using the software PICRUSt. T-test, Rank sum test or χ2 test were used for comparison between the two groups. Results: A total of 23 children diagnosed with duodenal ulcer were enrolled in this study, including 15 cases with Hp infection ((11.2±3.3) years of age, 11 males and 4 females) and 8 cases without Hp infection ((10.1±4.4) years of age, 6 males and 2 females). Compared with Hp-negative group, the Hp-positive group had higher Helicobacter abundance (0.551% (0.258%, 5.368%) vs. 0.143% (0.039%, 0.762%), Z=2.00, P=0.045) and lower abundance of Fusobacterium, Streptococcus and unclassified- Comamonadaceae (0.010% (0.001%, 0.031%) vs. 0.049% (0.011%, 0.310%), Z=-2.24, P=0.025; 0.031% (0.015%, 0.092%) vs. 0.118% (0.046%, 0.410%), Z=-2.10, P=0.036; 0.046% (0.036%, 0.062%) vs. 0.110% (0.045%, 0.176%), Z=-2.01, P=0.045). Linear discriminant analysis (LDA) effect sized showed that at the genus level, only Helicobacter was significantly enriched in Hp-positive group (LDA=4.89, P=0.045), while Streptococcus and Fusobacterium significantly enriched in Hp-negative group (LDA=3.28, 3.11;P=0.036,0.025, respectively). PICRUSt microbial function prediction showed that the expression of oxidative phosphorylation and disease-related pathways (pathways in cancer, renal cell carcinoma, amoebiasis, type 1 diabetes mellitus) in Hp-positive group were significantly higher than that in Hp-negative group (all P<0.05), while the expression of pathways such as energy metabolism and phosphotransferase system pathways were significantly lower than that in Hp-negative group (all P<0.05). Conclusion: In children with Hp-infected duodenal ulcers, the mucosal microbiota of the duodenal bulb is altered, characterized by an increased abundance of Helicobacter and a decreased abundance of Clostridium and Streptococcus, and possibly alters the biological function of the commensal microbiota through specific metabolic pathways.

Infección por Helicobacter pylori y factores asociados en adultos con sospecha clínica de úlcera duodenal / Helicobacter pylori infection and associated factors in adults with a clinical suspicion of duodenal ulcer

RESUMEN Introducción: la infección por Helicobacter pylori es la enfermedad bacteriana crónica que afecta con mayor prevalencia al ser humano. Objetivo: identificar la frecuencia de infección por Helicobacter pylori y su relación con variables consideradas factores de riesgo de esta infección. Materiales y métodos: estudio de corte transversal realizado en el Policlínico Docente Camilo Cienfuegos, del municipio Habana del Este, durante el año 2018, en un universo de 42 pacientes con 18 años y más de edad, con sospecha clínica y hallazgo endoscópico de úlcera duodenal e informe del resultado de estudio histológico para el diagnóstico de la infección. Se confeccionó una planilla de recolección de datos que incluyó variables como hacinamiento, agua de consumo, lugar de nacimiento, estancia en una institución, contacto con animales y antecedentes familiares. Se determinó relación entre variables con la prueba de chi cuadrado (c2) con significación estadística ɒ = 0,05, y se identificaron variables cuyos coeficientes fueron significativamente diferentes de 0 (p < 0,05). La fuerza de asociación se determinó mediante odds ratio. Resultados: la prevalencia fue de 59,5 %. Se encontró asociación estadística y constituyeron factores de riesgo de infección por Helicobacter pylori, el hacinamiento (c2 = 4,37; OR = 3,89), el agua de consumo (c2 = 4,92; OR = 3,43), el contacto con animales (c2 = 7,41; OR = 6,17) y los antecedentes familiares (c2 = 13,18; OR = 13). Conclusiones: el estudio permitió determinar la prevalencia de infección por Helicobacter pylori y las principales variables asociadas, coincidiendo con otros estudios revisados que tratan el tema (AU).

ABSTRACT Introduction: the infection by Helicobacter pylori is the chronic bacterial disease that affects the human being with greater prevalence. Objective: to identify the frequency of the infection by Helicobacter pylori and its relationship with variables considered risk factors for this infection. Materials and methods: a cross-sectional study was carried out in the teaching Polyclinic Camilo Cienfuegos, municipality Habana del Este, during 2018. In a universe of 42 patients aged 18 years and over, with clinical suspicion and endoscopic diagnosis of duodenal ulcer and histological study report for the diagnosis of the infection. A data collection form was made, which included variables such as: overcrowding, consumption water, place of birth, staying in an institution, contact with animals, and family history. The relationship within variables was found using the chi-square test (c2) with statistical significance ɒ = 0.05, and there were identified variables significantly different from 0 (p < 0.05). The association strength was determined through odds ratio. Results: the prevalence was 59.5%. Statistical association was found and overcrowding (c2 = 4.37, OR = 3.89), consumption water (c2 = 4.92; OR = 3.43), contact with animals (c2 = 7.41, OR = 6.17) and family history (c2 = 13.18, OR = 13) were found risk factors for Helicobacter pylori infection. Conclusions: the study allowed to determine the prevalence of Helicobacter pylori infection and the main associated variables, coinciding with other reviewed studies dealing with the subject (AU).

Risk factors of helicobacter pylori infection in an urban community in northeast Brazil and the relationship between the infection and gastric diseases

Abstract INTRODUCTION: Helicobacter pylori, a water contaminant, is the primary pathogenic agent associated with gastric diseases in humans. Exposure to H. pylori is more likely higher in developing countries. This study aimed to evaluate the risk factors associated with H. pylori infection in patients undergoing endoscopy to validate the cause of dyspeptic symptoms in an urban population in northeast Brazil and to compare the urease test and polymerase chain reaction assay results with the histopathological findings. METHODS: We evaluated 200 of 759 individuals with dyspeptic complaints from Campina Grande, State of Paraiba, northeast Brazil. Patients underwent endoscopy, followed by gastric biopsies. Logistic regression analysis was performed to adjust for confounders and to determine significant risk factors of dyspeptic disorders. RESULTS: Women accounted for 72.5% (145/200) of the participants. Approximately 59.8% (120/200) of the samples tested positive for H. pylori based on histological examinations. The specificity of polymerase chain reaction assay was higher than that of the urease test (77% vs. 64%, p=0.034). City drinking water [odds ratio (OR): 2.6; 95% confidence interval (CI): 1.3-5.21; p=0.004] and smoking (OR: 4.0; 95% CI: 1.13-14.5; p=0.031) were the risk factors of H. pylori infection. Belching was the most common symptom associated with H. pylori infection (p=0.05). CONCLUSIONS: The increased risk of H. pylori infection associated with non-treated water consumption indicates the need for improvements in public water treatment and better sanitary conditions because these can be a source of not only H. pylori infections but also other water-borne pathogen infections.

Pneumomediastinum, pneumothorax, and subcutaneous emphysema due to duodenal ulcer

The presence of pneumothorax, pneumomediastinum, or cervical subcutaneous emphysema due to perforated duodenal ulcer is a rare presentation. We report a 23-year man who showed bilateral cervical subcutaneous emphysema, pneumomediastinum, and pneumothorax with no respiratory abnormality. He was found to have active duodenal ulcers, but no detectable pneumoperitoneum or duodenal leal. A sealed perforation from the duodenal ulcers was suspected, and he fully improved after conservative management

¿Píloro doble o fístula antral? / Double pylorus or antral fistula?

Se expone el caso de un paciente de 79 años de edad, con antecedentes de úlcera duodenal y crisis frecuentes de epigastralgia y acidez. El estudio endoscópico reveló la existencia de 2 orificios en el antro, que se comunicaban con el bulbo duodenal y fueron considerados como píloros. La evolución clínica resultó satisfactoria con el tratamiento antiulceroso indicado.

The case of a 79 year-old patient, with a history of duodenal ulcer and frequent crisis of epigastralgia and acidity is exposed. The endoscopic examination revealed the existence of 2 holes in the antrum which communicated with the duodenal bulb and they were considered as pyloruses. The clinical course was satisfactory with the precise antiulcerous treatment.

Upper gastrointestinal bleeding in children in southern Iran.

Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.

Comparison of Clinical Characteristics and Outcomes between Geriatric and Non-geriatric Patients in Peptic Ulcer Bleeding / 대한소화기학회지

BACKGROUND/AIMS: In geriatric patients with peptic ulcer, the use of NSAID and prevalence of chronic illness have been increased, but the Helicobacter pylori (H. pylori) infected portion decreased. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with peptic ulcer bleeding and compare with non-geriatric patients (less than 65 years old). METHODS: We conducted a retrospective study of 88 patients with peptic ulcer bleeding treated with therapeutic endoscopy from January 2006 to December 2006. We compared the clinical characteristics and outcomes of geriatric patients (n=34, 38.6%) with those of non-geriatric patients (n=54, 61.4%). RESULTS: Hypertension (52.9% vs. 24.1%), cardiovascular disease (35.3% vs. 13.0%), and chronic obstructive pulmonary disease (20.6% vs. 3.7%) were more prevalent in the geriatric group, compared with the non-geriatric group (p0.05). The amount of transfusion length of ICU stay, rebleeding rate, operation rate and mortality were not different between the two groups. The length of hospital stay in the geriatric patients was significantly longer than the non-geriatric group (12.3+/-10.6 vs. 7.2+/-5.9 days, p<0.05). In multiple regression analysis, old age was a significant risk factor for longer hospital stay (p<0.05). CONCLUSIONS: The geriatric patients with bleeding peptic ulcer had longer hospital stay than the non-geriatric patients in our study. The important emerging etiologies such as ulcerogenic drug and associated chronic illness should be checked and treated in these patients.

A Case of CD56+ Extranodal NK/T-cell Lymphoma, Nasal Type, Presenting as a Duodenal Ulcer Bleeding / 대한소화기학회지

Extranodal NK/T-cell lymphoma is a recently recognized distinct entity within the World Health Organization classification of lymphoid tumors. It is relatively prevalent in Asian and South American populations. It most commonly occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. Among these, extranodal NK/T-cell lymphoma of the gastrointestinal tract has shown an aggressive clinical course. We report a case of CD56+ extranodal NK/T-cell lymphoma presenting as a duodenal ulcer bleeding. A 62-year-old male patient presented with melena and abdominal pain. Endoscopic examination of the upper gastrointestinal tract showed the duodenal ulcer covered by blood clot. Pathologic examination revealed the diffuse infiltration of atypical lymphocytes with an angiocentric growth pattern, which was positive for CD3, CD56, and granzyme. The patient showed rapid deteriorating clinical course and died on day 14 after admission. Thus, we report this case with the review of literatures.

Divertículo duodenal en la tercera porción del duodeno como causa de sangrado del tubo digestivo alto y dolor crónico abdominal: informe de un caso y revisión de la literatura / Duodenal diverticulum in the third portion of duodenum as a cause of upper gastrointestinal bleeding and chronic abdominal pain: case report and literature review

BACKGROUND: Duodenal diverticulum is a little-known pathology. The duodenum represents second place in frequency for the presence of diverticula in the digestive tract after the colon. Duodenal diverticulum as a cause of hemorrhage of the upper gastrointestinal (GI) tract has been described as an infrequent complication, although it must be considered in patients with digestive hemorrhage without evident cause at the esophagogastric level. Localization of diverticula in the third or fourth portions of the duodenum is rare and the diverticula are asymptomatic in 90% of cases. Diagnosis is made by endoscopy, contrast X-rays of the upper GI tract, selective arteriography and as a transoperative finding. The objective of this study was to identify and analyze the clinical presentation of duodenal diverticulum to familiarize surgeons and gastroenterologists when there is suspicion of the diagnosis. CLINICAL CASE: We report the case of an 85-year-old female presenting with massive upper GI tract hemorrhage and chronic abdominal pain due to a duodenal diverticulum located in the third portion of the duodenum. Diagnosis was made with upper GI barium series because visualization of the diverticulum was not possible by endoscopy. Other therapeutic options are described in the literature. A successful simple diverticulectomy, manually opened with a two-plane transversal incision, was performed on the patient. After >12 months of follow-up, the patient is completely asymptomatic. DISCUSSION: Clinical diagnosis presents difficulty because a classic presentation does not exist. Symptoms are generally vague, <10% of the duodenal diverticulum are frankly symptomatic, and <1 to 2% will require surgical resolution. CONCLUSIONS: Hemorrhage of the upper GI tract and chronic abdominal pain secondary to duodenal diverticulum present with recurrence and may be associated with the presence of duodenal diverticulum when other sources of bleeding are not found.

Emergency operations for bleeding duodenal ulcer: a simple option to consider: Case report

We report a 46 years-old man who had severe bleeding from a posterior duodenal ulcer [DU] that was diagnosed but could not be treated endoscopically in another health facility. He went into shock as he was being admitted to the casualty at Khartoum North Teaching Hospital [KNTH]. His haemoglobin [Hb] dropped to five gram/dl. He required resuscitation and transfusion of six units of blood overnight. Emergency surgery was performed. Over sewing [OS] of the ulcer was done and the stenosed first part of duodenum was closed transversely [pyloroplasty]. No acid-reducing procedure [ARP] was done. The patient received anti- helicobacter therapy via the intravenous route preoperatively and continued postoperatively. This was later given orally after he started taking by mouth. He made an uneventful recovery with no recurrence of bleeding and was discharged home one week latter. Endoscopy was done at KNTH six weeks later. This showed complete healing of the ulcer with no evidence of Helicobacter pylori in the biopsies taken. We found simple OS of the bleeding DU together with anti-helicobacter therapy safe, efficient, and not associated with re-bleeding. We discuss the rationale of this simple treatment. We propose the need for a randomized controlled study comparing it with acid-reducing procedure [ARP] as options in the surgical treatment of bleeding DU

Redução da prevalência de úlcera duodenal: um estudo brasileiro (análise retrospectiva na última década: 1996-2005) / Prevalence reduction of duodenal ulcer: a Brazilian study. (retrospective analysis in tha last decade: 1996-2005)

RACIONAL: A úlcera duodenal sempre representou uma doença muito prevalente entre as enfermidades digestivas, em qualquer parte do mundo. A prevalência média era de aproximadamente 10 por cento da população mundial. A partir do início dos anos 90, a literatura, tanto européia como norte-americana, passou a demonstrar sua redução gradativa entre seus países. OBJETIVO: Demonstrar, através de análise retrospectiva, a prevalência anual da úlcera duodenal nos últimos 10 anos em um Serviço de Endoscopia Digestiva que é referência para o sistema público de saúde da cidade de Porto Alegre, municípios da Grande Porto Alegre e outras cidades vizinhas da mesma. Os dados analisados são de março de 1996 até dezembro de 2005. MÉTODOS: Estudo retrospectivo transversal, com análise documental de diagnósticos endoscópicos efetuados em endoscopia digestiva alta, no referido Serviço. Foi feita a análise retrospectiva de diagnósticos endoscópicos efetuados em 13.130 pacientes submetidos a endoscopia digestiva alta no período de março de 1996 a dezembro de 2005. A classificação de Sakita foi utilizada para o estádio do grau evolutivo da úlcera duodenal e foi considerado por ela acometido o paciente com a lesão no estágio A1, até o estágio S1, inclusive. Observou-se também a prevalência nos dois sexos, na raça, o percentual médio total nos 10 anos, além da prevalência anual. Para verificar se houve significância estatística dos resultados observados nos diferentes períodos, foi aplicado um teste de regressão linear ("linear regression model"). RESULTADOS: Observou-se decréscimo gradativo dos percentuais de prevalência da úlcera duodenal, ano após ano, iniciando-se em 1996 com 8,6 por cento e se encerrando no final de 2005, com 3,3 por cento. A exceção do período foi observada no ano de 2003 quando houve um acréscimo, comparando-se com o decréscimo gradativo dos 6 anos anteriores. Mas já, a partir do período seguinte (2004), a queda gradativa voltou a ser observada...

BACKGROUND: The duodenal ulcer always represented a very prevalent pathology among the gastrointestinal tract diseases worldwide. The average prevalence is approximately 10 percent of the world population. In the 90s the literature (both European and North American) begin to show a crescent reduction of this prevalence in many countries. AIM: To show through a retrospective analysis the annual prevalence of the duodenal ulcer in the last 10 years in a Digestive Endoscopy Service which is referred to public medical system in Porto Alegre and its suburban area and countryside of the State of Rio Grande do Sul, Brazil. The data analyzed is from March 1996 to December 2005. Specific data: transversal retrospective study with documented analysis of endoscopic diagnosis of upper gastrointestinal endoscopy. METHODS: A retrospective analysis of the diagnosis of the 13.130 procedures of upper gastrointestinal endoscopy between 1996 and 2005. The Sakita classification was used to verify the duodenal ulcer activity taking into consideration the patients who have lesions on A1 to S1 levels. To verify if there was a statistical significant results, a linear regression test was done (linear regression model). RESULTS: A gradate decrease of the prevalence percentuals was observed, year after year, it began with 8.3 percent of prevalence in 1996 and finished with 3.3 percent in the beginning of 2006. The average annual reduction of this prevalence was calculated following the regression test and it was placed in the 1.3 percent a year in the studied period of time. In 2003, in an isolated way, it was an exception in the decrease of the percentage because it presented a prevalence increase of (6.5 percent) comparing to the first 6 years of study. CONCLUSION: In this study it was observed a decrease of duodenal ulcer prevalence, 1.3 percent a year to be more accurate in 10 years of study, showing a statistical significance in the linear regression test.

Laparoscopic management of duodenal ulcer perforation: is it advantageous?

BACKGROUND: Surgery is the mainstay of treatment of patients with peptic duodenal perforation. With the advent of minimal access techniques, laparoscopy is being used for the treatment of this condition. METHODS: Retrospective analysis of 120 consecutive patients (mean age 44.5 years; 111 men) with duodenal ulcer perforation who had undergone laparoscopic surgery. RESULTS: 87 patients had history of tobacco consumption, 12 were chronic NSAID users, 72 had Helicobacter pylori infection and 36 had a co-morbid condition. The mean time to surgery from onset of symptoms was 28.4 hours. The median operating time was 46 minutes. All patients underwent laparoscopic closure of the perforation with Graham's patch omentopexy; 12 patients underwent additional definitive ulcer surgery. The morbidity rate was 7.5%; no patient needed conversion to open surgery or died. The mean postoperative hospital stay was 5.8 days. CONCLUSION: Results of laparoscopic management of perforated peptic ulcer are encouraging, with no conversion to open surgery, low morbidity and no mortality.

Úlcera péptica gastroduodenal e infecção pelo Helicobacter pylori na criança e adolescente / Gastroduodenal peptic ulcer and Helicobacter pylori infection in children and adolescents

OBJETIVO: Apresentar aspectos relevantes relativos à úlcera péptica gastroduodenal e à infecção pelo Helicobacter pylori na criança e adolescente. FONTES DOS DADOS : Livros técnicos e bases de dados MEDLINE e LILACS de 1966 a 2006. SíNTESE DOS DADOS : A úlcera péptica na criança e adolescente pode ser primária, associada à infecção pelo H. pylori, ou secundária, na qual os mecanismos etiopatogênicos dependem da doença de base. A infecção é adquirida predominantemente na infância, com taxas de prevalência que variam de 56,8 a 83,1 por cento nas crianças que vivem nas regiões mais pobres do Brasil e de aproximadamente 10 por cento nas crianças abaixo de 10 anos de idade nos países desenvolvidos. A infecção pode ser diagnosticada por métodos invasivos, que investigam a presença da bactéria, ou de DNA, RNA ou produtos bacterianos em fragmentos de biópsia da mucosa gástrica obtida à endoscopia; também pode ser diagnosticada através de métodos não-invasivos, que compreendem a pesquisa de anticorpos anti-H. pylori em amostras de soro, urina ou saliva, a pesquisa de antígenos da bactéria nas fezes e o teste respiratório com uréia marcada com carbono-13. O método de escolha para o diagnóstico da úlcera péptica é a endoscopia digestiva alta, com a vantagem adicional de, durante o procedimento, permitir a obtenção de fragmentos de mucosa gástrica para o diagnóstico da infecção e estudo histopatológico. CONCLUSÕES: A infecção por H. pylori é a principal causa de úlcera péptica na infância. A erradicação da bactéria com antimicrobiano é acompanhada de cura da doença, sendo, portanto, indicada em todas as crianças H. pylori-positivas com úlcera péptica em atividade, recorrente, cicatrizada ou complicada.

OBJECTIVE: To show important aspects of gastroduodenal peptic ulcer and of Helicobacter pylori infection in children and adolescents. SOURCES: Technical textbooks and MEDLINE and LILACS databases including publications between 1966 and 2006. SUMMARY OF THE FINDINGS : The etiology of peptic ulcer in children and adolescents may be primary, associated with H. pylori infection, or secondary, in which etiopathogenic mechanisms rely upon the underlying disease. The infection is acquired predominantly in childhood, with prevalence rates between 56.8 and 83.1 percent in children who live in the poorest Brazilian regions, amounting to nearly 10 percent in children aged less than 10 years in industrialized countries. The infection can be diagnosed by invasive methods, which investigate the presence of the bacterium, or of DNA, RNA or bacterial products in biopsy fragments of the gastric mucosa obtained at endoscopic examination; it can also be diagnosed through noninvasive methods, which include the detection of anti-H. pylori antibodies in serum, urine or saliva samples, detection of bacterial antigens in stool samples, and the carbon 13-labeled urea breath test. However, upper gastrointestinal endoscopy is the method of choice for the diagnosis of peptic ulcer, as it allows collecting fragments from the gastric mucosa during the procedure for the diagnosis of infection and for histopathological analysis. CONCLUSIONS: H. pylori infection is the major cause of peptic ulcer among children. Eradication of the bacterium with antimicrobial therapy results in the cure of the disease, and is therefore indicated for all children with H. pylori infection with an active, recurrent, healed, or complicated peptic ulcer.

Prevalencia de la infección por Helicobacter pylori en pacientes dispépticos / Histologic alterations of the gastric mucous and prevalence of Helicobacter pylori in dyspeptic patients

Un estudio en pacientes dispépticos puede permitirnos arrojar alguna claridad sobre aspectos epidemiológicos importantes relacionados con la infección por Helicobacter pylori en nuentro medio. Se realizó un estudio descriptivo, prospectivo, donde el universo estuvo constituido por pacientes con síntomas dispépticos, a los que se les indicó una endoscopia superior, durante el período comprendido entre marzo del 2000 y marzo del 2002. La muestra quedó constituida por 200 pacientes, 108 de sexo femenino y 92 de sexo masculino con promedio de edad de 52 años. Se tomaron muestras de biopsia gástrica para histología y para test de ureasa. En pacientes con úlcera duodenal se encontró una prevalencia de la infección por Helicobacter pylori de 99.0. En 22 pacientes con úlcera gástrica se encontró una prevalencia de 91.0. La prevalencia de la infección encontrada en los pacientes con gastritis crónica fue 94.0. En pacientes con histología normal la infección tuvo una prevalencia de 68.0

Aspectos clínicos e histológicos da úlcera duodenal em crianças e adolescentes / Clinical and histological features of duodenal ulcer in children and adolescents

OBJETIVO: Avaliar as características clínicas e histológicas de crianças e adolescentes com úlcera duodenal. MÉTODOS: Foram avaliadas prospectiva e consecutivamente 43 pacientes com úlcera duodenal ao longo de 6 anos (7,2 pacientes por ano). A avaliação consistiu de questionário clínico de sintomas dispépticos, exame físico e endoscopia digestiva com biópsias gástricas para exame histológico e detecção do Helicobacter pylori. RESULTADOS: A idade no diagnóstico variou de 4 anos e 8 meses a 17 anos e 4 meses (mediana = 12 anos e 4 meses). O sintoma mais freqüente foi dor abdominal (39/43, 90,7 por cento): no epigástrio em 31/39, periumbilical em 7/39 e noturna em 27/39. Outros sintomas freqüentes foram: diminuição do apetite (32/43, 74,4 por cento), vômitos (30/43, 69,8 por cento), plenitude pós-prandial (23/43, 53,5 por cento), perda de peso (22/43, 51,2 por cento) e sensibilidade abdominal (19/43, 44,2 por cento). Hemorragia digestiva alta ocorreu em 19/43 pacientes (44,2 por cento), e anemia em 21/43 (48,8 por cento). H. pylori foi detectado em 41/43 (95,3 por cento), e todos esses pacientes apresentaram gastrite crônica ativa de antro, 92 por cento deles com predomínio do infiltrado linfomononuclear. A erradicação da bactéria ocorreu em 68,3 por cento dos pacientes infectados, mas houve cicatrização da lesão em 100 por cento dos pacientes erradicados e em 89 por cento dos não-erradicados. CONCLUSAO: Ulcera duodenal foi associada à gastrite crônica por H. pylori na grande maioria dos pacientes. Houve grande freqüência de complicações, especialmente hemorragia digestiva alta.

Helicobacter pylori en la patología gastroduodenal / Helicobacter pylori in the gastroduodenal pathology

Actualmente se acepta que helicobacter pylori, inicialmete denominado campylobacter pyloides, es la causa fundamental de gastritis crónica activa, y está presente en la mucosa gástrica de la totalidad de pacientes con la úlcera duodenal, aunque no se ha demostrado una relación casual directa con la enfermedad ulcerosa péptica. La asociación entre gastritis antral y ulcera duodenal, es un hecho conocido desde hace muchos años, y puede afirmarse que en todos los pacientes con este tipo de úlcera existe una inflamación de la mucosa gástrica, fundamentalmente a nivel del antro, de ahi que existen una serie de datos que apoyan el papel patogénico directo de helicobacter pylori en la gastritis crónica activa, entre lo que se destaca la estrecha relación entre la infección y la presencia de un infiltrado gastritis, pudiendo además desempeñar un posible papel patogénico en el cáncer gástrico. Es así que muchos estudios epidemiológicos realizados para conocer la prevalencia del helicobacter pylori en las patologías gastroduodenales en todo el mundo, motivo por el cual describiremos la prevalencia de la infección por helicobacter pylori en paciente diagnosticados de adenocarcinoma gástrico, comparándola con la observada en la gástritis crónica. Los resultados que obtuvimos fue que helicobacter pylori se detectó en el 67% de los pacientes con gastritis histológica, mientras que únicamente el 29% de los casos con adenocarcinoma gástrico fue considerado helicobacter pylori(+). De este modo se doncluyó que la prevalencia por la infección por helicobacter pylori diagnosticado por métodos microbiológicos e histológicos en pacientes con adenocarcinoma gástrico (29%) es significativamente inferior a la evidencia en los pacientes con gastritis crónica, considerando su lesíon precursora.

Diagnosis and eradication of helicobacter pylori in patients with duodenal ulceration in the community

To determine the value of Helicobacter pylori [Hp] serology in diagnosis of active Hp infection in patients with documented duodenal ulcer [DU] and to directly compare the efficacy and side-effects profiles of metronidazole or tinidazole in a triple therapy regimen to eradicate active Hp infection. Prospective, single-blinded, randomised trial. One hundred patients from General Practice with documented DU and Hp seropositivity had a C14 Urea Breath Test [UBT]. Those who tested positive were randomised to receive one-week, twice daily omeprazole 20 mgs and clarithromycin 250 mgs in combination with metronidazole 400 mgs [OCM] or tinidazole 500 mgs [OCT]. Eradication was confirmed by a repeat UBT. Eighty five sero-positive patients had a positive pre-treatment UBT. On intention to treat basis, OCT [100%] had a significantly better eradication rate than OCM [87.8%], p = 0.023. There was no difference in side effects. [1] Positive Hp serology in patients with DU does not always mean active infection and [2] for patients in the community with active Hp and DU disease OCT is significantly better than OCM for eradicating Hp