Asociación entre zonas altitudinales de residencia y diagnóstico clínico de gastritis crónica en pacientes ambulatorios de Perú: estudio transversal analítico / The altitude of residential areas and clinical diagnosis of chronic gastritis in ambulatory patients of Peru: A cross-sectional analytic study

INTRODUCCIÓN: La gastritis crónica es unas de las enfermedades más comunes en la población y varía por regiones. Existen diversos factores que influyen en su aparición. Sin embargo, no se ha estudiado a profundidad el efecto de la altura. OBJETIVOS: Determinar la asociación entre la zona altitudinal de residencia y gastritis crónica en pacientes ambulatorios de Perú. MÉTODOS: Estudio transversal analítico. Se realizó a través del análisis secundario de datos. La variable dependiente fue gastritis crónica, tomada del reporte del paciente y verificado en la historia clínica, según antecedentes patológicos mencionados durante consulta médica. La variable independiente fue la zona altitudinal de residencia (divida en baja altitud, altitud intermedia, elevada y muy elevada). Las covariables secundarias fueron edad, sexo y tiempo viviendo en altura. Se realizaron modelos lineales generalizados para estimar razones de prevalencias, usando familia Poisson y ciudad como clúster. RESULTADOS: De los 4263 pacientes estudiados, 63% fue del sexo femenino; la mediana de la edad fue de 42 años. La prevalencia global de gastritis crónica fue 12,9%. Hubo asociación con gastritis crónica y altura de residencia a nivel intermedio, elevado, pero no con muy elevado, con una razón de prevalencia ajustada de 1,52 (intervalo de confianza 95%: 1,03 a 2,23); 2,01 (1,55 a 2,60) y 1,12 (0,84 a 1,48), respectivamente. CONCLUSIONES: Se encontró una asociación significativa entre gastritis crónica y altitud intermedia y elevada, pero no en muy elevada. Esto se explicaría por la hipoxia hipobárica en alturas, que podría conllevar lesiones en la pared gástrica, la adaptación de los peruanos a las alturas y por otras variables sociodemográficas.

INTRODUCTION: Chronic gastritis is one of the most common diseases in the population. Several factors influence its appearance; however, the effect of high altitude has not been studied thoroughly. OBJECTIVE: To determine the association between the altitude of the residential area and chronic gastritis in outpatients of Peru. METHODS: Observational, analytical, and cross-sectional study. Secondary data analysis was conducted. The dependent variable was chronic gastritis, obtained from patient references, and verified in the medical history according to the pathological history mentioned during medical consultation. The independent variable was the altitude of the residential areas (categorized into low altitude, intermediate altitude, high and very high), and the secondary co-variables were age, sex, and time living at altitude. Generalized linear models were used to estimate prevalence ratios using Poisson family and city as a cluster. RESULTS: Of the 4263 patients studied, 63% were female; the median age was 42 years. The overall prevalence of chronic gastritis was 12,9%. There was an association with chronic gastritis and altitude of residence at the intermediate and high levels, but not at the very high; with an adjusted prevalence ratio of 1.52 (95% confidence interval, 1.03 to 2.23); 2.01 (1.55 to 2.60) and 1.12 (0.84 to 1.48), respectively. CONCLUSIONS: We found a significant association between chronic gastritis and intermediate and high altitude but not at very high, which could be explained by hypobaric hypoxia in altitude that could lead to gastric wall lesions and other socio-demographic variables.

Mutaciones del gen ARN ribosómico 23S de Helicobacter pylori asociadas con resistencia a claritromicina en pacientes atendidos en una unidad de endoscopia de Medellín, Colombia / Mutations in the Helicobacter pylori 23S rRNA gene associated with clarithromycin resistance in patients at an endoscopy unit in Medellín, Colombia

Resumen Introducción. La claritromicina es el antibiótico de primera línea para el tratamiento de la infección por Helicobacter pylori. La resistencia bacteriana se produce principalmente por mutaciones puntuales del gen ARN ribosómico 23S (ARNr 23S). Objetivo. Determinar la frecuencia de las mutaciones puntuales A2143G y A2142G del gen ARNr 23S asociadas con la resistencia de H. pylori a la claritromicina en muestras de pacientes con manifestaciones dispépticas en Medellín, región noroccidental de Colombia. Materiales y métodos. Se extrajo ADN a partir de muestras de biopsia gástrica obtenidas de pacientes con manifestaciones dispépticas atendidos en una unidad de endoscopia entre el 2016 y el 2017. Mediante reacción en cadena de la polimerasa (PCR), se amplificaron las regiones s y m del gen vacA y una región del gen ARNr 23S bacteriano. La presencia de las mutaciones A2142G y A2143G se determinó por la técnica de polimorfismos de longitud de fragmentos de restricción (RFLP) con las enzimas BbsI y BsaI, respectivamente. Resultados. Se encontró una prevalencia de infección de 44,2 % (175/396), según el informe de histopatología. En 143 de estas 175 muestras positivas se amplificaron las tres regiones del genoma bacteriano. Se identificaron las mutaciones A2143G y A2142G en 27 muestras (18,8 %; 27/143), la mutación más frecuente fue la A2143G (81,5 %; 22/27). Conclusiones. Hubo una gran prevalencia de mutaciones asociadas con la resistencia de H. pylori a la claritromicina en la población de estudio. Se requieren estudios adicionales para establecer la resistencia bacteriana en la población colombiana y, así, determinar los tratamientos de primera línea y de rescate.

Abstract Introduction: Clarithromycin is the first-line antibiotic for the treatment of Helicobacter pylori infection. Bacterial resistance is mainly due to the presence of specific mutations in the 23S ribosomal RNA (rRNA) gene. Objective: To determine the frequency of A2143G and A2142G specific mutations in the 23S rRNA gene associated with clarithromycin resistance of H. pylori in samples from patients with dyspeptic manifestations in Medellín, northwestern Colombia. Materials and methods: DNA was extracted from gastric biopsy samples of patients with dyspeptic manifestations seen at an endoscopy unit in Medellín between 2016 and 2017. PCR was performed to amplify the bacterial s and m vacA regions, and a region in the 23S rRNA gene. The presence of the A2142G and A2143G mutations was determined using the restriction fragment length polymorphism (RFLP) technique with the BbsI and BsaI enzymes, respectively. Results: The prevalence of infection was 44.2% (175/396), according to the histopathology report. The positive samples were analyzed and the three regions of the bacterial genome were amplified in 143 of the 175 samples. The A2143G and A2142G mutations were identified in 27 samples (18.8%, 27/143). The most frequent mutation was A2143G (81.5%, 22/27). Conclusions: We found a high prevalence of H. pylori mutations associated with clarithromycin resistance in the study population. Further studies are required to determine the bacterial resistance in the Colombian population in order to define first line and rescue treatments.

La microbiota según la topografía gástrica en pacientes con bajo y con alto riesgo de cáncer gástrico en Nariño, Colombia / Microbiota according to gastric topography in patients with low or high risk of gastric cancer in Nariño, Colombia

Resumen Introducción. La inflamación del antro gástrico por Helicobacter pylori aumenta el riesgo de úlcera duodenal, y la del cuerpo gástrico puede producir gastritis atrófica e incrementar la probabilidad de cáncer gástrico. Estas reacciones inflamatorias diferenciadas según su localización, podrían explicarse por la composición de la microbiota gástrica asociada con H. pylori. Objetivo. Identificar y comparar la microbiota del antro y del cuerpo del estómago en individuos de dos poblaciones: una con alto riesgo y otra con bajo riesgo de cáncer gástrico en Nariño, Colombia. Materiales y métodos. Se incluyeron biopsias del cuerpo y el antro gástrico de pacientes con gastritis no atrófica o con gastritis atrófica y metaplasia. La microbiota se definió por secuenciación de la región V3-V4 del gen 16S del ARNr de H. pylori (illumina-MiSeq™). Las unidades taxonómicas operativas se clasificaron utilizando las bases de datos BLASTn y RDPII. Las diferencias entre las poblaciones microbianas del antro y del cuerpo gástrico se evaluaron mediante el análisis de varianza multivariado con base en permutaciones (Permutational Multivariate Analysis of Variance, PERMANOVA) y análisis multivariados. Resultados. La clase Epsilonproteobacteria representada por H. pylori fue más abundante en las biopsias del antro y del cuerpo de los individuos con gastritis no atrófica (>50 %), en tanto que, en los individuos con gastritis no atrófica, esta clase correspondió al 20 % con una mayor diversidad metagenómica. La infección por H. pylori disminuyó significativamente la diversidad metagenómica del antro (p=0,005), en comparación con la del cuerpo gástrico. Conclusiones. Los grupos bacterianos involucrados en la disbacteriosis pueden colonizar ambas regiones topográficas del estómago, independientemente de las reacciones sectorizadas de inflamación. La infección por H. pylori asociada con la microbiota gástrica está relacionada con su localización en el estómago, el tipo de lesión y el mayor o menor riesgo de cáncer gástrico, lo que sugiere su importancia en la disbacteriosis y la de esta en la enfermedad gástrica.

Abstract Introduction: Inflammation in the gastric antrum caused by Helicobacter pylori increases the risk of duodenal ulcer while inflammation in the body generates atrophic gastritis and increased risk of gastric cancer. These inflammatory responses according to gastric topography could be explained by the composition of the gastric microbiota associated with H. pylori. Objective: To identify and compare the microbiota of the gastric antrum and body of individuals from two populations, one with high risk and one with low risk of gastric cancer from Nariño, Colombia. Materials and methods: Biopsies of the gastric antrum and body of patients with non-atrophic gastritis or metaplastic atrophic gastritis were included. The microbiota was defined by sequencing the 16S rRNA gene, V3-V4 region, (illumina-MiSeq™). The operational taxonomic units were classified using the BLASTn and RDPII databases. The differences among microbial populations were evaluated with the PERMANOVA and multivariate analyses. Results: The Epsilonproteobacteria class represented by H. pylori was more abundant in the antrum and body biopsies of individuals with metaplastic atrophic gastritis (>50%) while in individuals with non-atrophic gastritis it was 20 % and had greater metagenomic diversity. Helicobacter pylori infection significantly decreases the metagenomic diversity of the gastric antrum (p=0.005) compared to that of the body. Conclusions: The bacterial groups involved in the dysbiosis can colonize both topographic regions of the stomach, regardless of the sectorized inflammation responses. Helicobacter pylori infection associated with the gastric microbiota is related to its localization in the stomach, the type of lesion, and the population at risk of gastric cancer, which suggests its importance in microbial dysbiosis and gastric disease.

Helicobacter pylori: resistencia múltiple en pacientes de Bogotá, Colombia / Helicobacter pylori: Multiple resistance in patients from Bogotá, Colombia

Resumen Introducción. La resistencia a los antibióticos es la principal causa del fracaso del tratamiento contra Helicobacter pylori; la claritromicina y el metronidazol son los antibióticos que generan mayor resistencia. En Colombia, la resistencia primaria a estos dos antibióticos y el uso excesivo de levofloxacina han alcanzado los límites aceptados (13,6, 83 y 16 %, respectivamente). A pesar de ello, se usa el tratamiento empírico combinando estos antibióticos en pacientes en los que ha fallado anteriormente. Objetivo. Determinar la resistencia a los antibióticos en pacientes previamente tratados para H. pylori en Bogotá, Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo en el que se evaluó mediante dilución en agar la resistencia a la amoxicilina, la claritromicina, la levofloxacina y el metronidazol en 10 aislamientos provenientes de 5 pacientes con tres o cuatro tratamientos fallidos para H. pylori. La resistencia a los antibióticos se confirmó mediante secuenciación de ADN (Magrogen, Korea). Resultados. Ocho de los aislamientos presentaron resistencia a dos o más antibióticos y todos fueron resistentes a la levofloxacina. Los patrones de sensibilidad de los aislamientos provenientes del antro pilórico y del cuerpo del estómago, fueron diferentes en tres de los pacientes. Conclusión. Hasta donde se sabe, esta es la primera evidencia de resistencia múltiple de H. pylori en Colombia en pacientes previamente tratados. Los resultados evidenciaron las consecuencias del uso de un esquema ineficaz de tratamiento antibiótico y la necesidad de evaluar la sensibilidad a los antibióticos en diferentes sitios anatómicos del estómago. La resistencia múltiple limita el número de antibióticos útiles para erradicar H. pylori.

Abstract Introduction: The main cause for Helicobacter pylori infection treatment failure is antibiotic resistance, where clarithromycin and metronidazole play the main role. In Colombia, primary resistance as a consequence of the use of these two antibiotics and excessive levofloxacin use is above the accepted limit (13.6%, 83%, and 16%, respectively). Despite this fact, empirical therapies that include the combination of these antibiotics are used in patients with previous therapeutic failure. Objective: To determine antibiotic resistance in patients previously treated for H. pylori in Bogotá, Colombia. Materials and methods: We conducted a descriptive study that included ten isolates obtained from five patients with three or four previous failed treatments for H. pylori. Antibiotic resistance to amoxicillin, clarithromycin, levofloxacin, and metronidazole was investigated by agar dilution and confirmed by DNA sequencing (Magrogen, Korea). Results: Eight isolates were resistant to two or more antibiotics. All isolates were resistant to levofloxacin. Susceptibility patterns in isolates from the gastric antrum and the body of the stomach were different in three patients. Conclusion: As far as we know, this is the first evidence of multiple H. pylori resistance in Colombia in previously treated patients. Results demonstrated the consequences of using an ineffective antibiotic scheme and the need to assess antibiotic susceptibility in different anatomical sites of the stomach. The consequences of multiple resistance decrease possible antibiotic effectiveness to eradicate H. pylori in the future.

Prevalencia de tipos histológicos de pólipos gástricos en pacientes adultos de un hospital público de Lima-Perú, en el periodo 2007 al 2016 / Prevalence of histological types of gastric polyps in adult patients from a public hospital in Lima-Peru (2007 - 2016)

Objetivos: Determinar la prevalencia de pólipos gástricos detectados mediante endoscopía digestiva alta, en pacientes mayores de 18 años del Hospital Cayetano Heredia, en el periodo 2007-2016. Materiales y métodos: Estudio retrospectivo de corte transversal, realizado con datos de biopsias gástricas de pacientes sometidos a endoscopía digestiva alta entre enero de 2007 y julio de 2016. Se evaluó cambios histológicos asociados, datos demográficos y características endoscópicas, las cuales fueron sometidas a análisis estadístico mediante STATA v14.2. Resultados: En una población de 16 552 endoscopías realizadas, se encontró 407 biopsias compatibles con pólipos gástricos, lo cual da una prevalencia de 2,5%. Los pólipos gástricos fueron más frecuentes en mujeres (62,38%). La mediana de edad fue de 61 años (52-71 años). El tipo histológico más frecuente fue el pólipo glandular fúndico (PGF) (44,85%), seguido de pólipo hiperplásico (38,48%) y adenomatoso (15,23%). La localización más frecuente fue en fondo/cuerpo (48,65%, p=0,001) Se detectó la presencia de Helicobacter pylori (Hp) en el 30,6% de las biopsias compatibles con pólipos. Conclusión: La prevalencia de pólipos gástricos es similar con otras regiones del mundo; los PGF e hiperplásicos son los más frecuentes. Los pólipos adenomatosos estuvieron en mayor relación a cambios como metaplasia y displasia.

Objectives: Establish the prevalence of gastric polyps detected by upper gastrointestinal endoscopy in patients older than 18 years old during the period from 2007 - 2016 in Cayetano Heredia Hospital. Materials and methods: Retrospective cross- sectional study, performed with data from the gastric biopsies reports of patients that have undergone upper gastrointestinal endoscopy between January 2007 and July 2016. Demographic data, endoscopic characteristics of the polyps and associated histological changes of the surrounding gastric mucosa were evaluated, which were subjected to statistical analysis using STATA v14.2. Results: In a population of 16 552 endoscopies, 407 gastric polyps biopsies were found. These results give a prevalence of 2.5% .Gastric polyps were detected predominantly in women (62.38%). The median age was 61 years (52-71 years). The most frequent histological type was the fundic gland polyp (FGP) (44.85%), followed by the hyperplastic (38.48%) and adenomatous (15.23%) polyp. The most frequent location was in the fundus / corpus (48.65%, p = 0.001). The presence of Hp was detected in 30.6% of the biopsies with polyps. Conclusion: The prevalence of gastric polyps is similar to other regions of the world; PGF and hyperplastic are the most frequent. Adenomatous polyps showed a greater relationship with and metaplasia and dysplasia.

Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori / Endoscopia digestiva alta aplicada em pediatria: hallazgos endoscópicos e histológicos incluyendo al Helicobacter pylory

Objective: To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. Material and methods: Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. Results: The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. Conclusion: pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications

Objetivo: Presentar y discutir los hallazgos endoscópicos e histológicos, así como la incidencia de Helicobacter pylori y otras enfermedades, indicaciones y características de endoscopia digestiva alta realizada en niños. Material y métodos: Fueron realizadas 225 endoscopias en niños de seis meses a 11 años (media de 7,69 años) a partir de febrero de 2013 hasta enero de 2016. En 200 pacientes, en las endoscopias diagnósticas se llevan a cabo biopsias seriadas (esófago, estómago y duodeno) en 120 de ellos. Resultados: La indicación de endoscopia fue diagnóstica en el 88,89% de los pacientes y en 26 pacientes se realizaron un procedimiento terapéutico. Los hallazgos endoscópicos más frecuentes fueron esofagitis en 49 pacientes, gastritis y duodenitis 84 y en 16 pacientes se diagnosticaron cuatro úlceras duodenales. En endoscopias terapéuticas fueron realizadas seis gastrostomías, catorce extracciones de cuerpos extraños, cinco pasajes de sonda nasogástrica y una dilatación esofágica. El estudio de H. pylori se realizó por el método histopatológico y fué positivo en 26 (13%) de 200 pacientes en los que se han buscado. Conclusión: La endoscopía pediátrica es un nicho importante de la endoscopía digestiva donde es importante enfatizar la relevancia de la estructura institucional que realiza estos procedimientos para conducirlos con seguridad y ser capaces de tratar las complicaciones posibles

Systemic diseases and other painful conditions in patients with temporomandibular disorders and migraine

Abstract Temporomandibular disorders (TMD) are a highly prevalent, painful musculoskeletal condition affecting the masticatory system, and are frequently associated with migraines (M) and other diseases. This study aimed to investigate the association between painful TMD and M with other painful conditions and systemic diseases, such as cervicalgia, body pain (BP), ear-nose-throat disorders, musculoskeletal disorders, diabetes, cardiopulmonary diseases and gastritis/peptic ulcer. Methods: This was a cross-sectional study conducted in a sample of 352 individuals. Participants were stratified into three groups according to the presence of painful TMD and M: controls [individuals free of TMD and any headache (HA)]; TMD only (presence of painful TMD, but free of any HA); and TMD+M (presence of painful TMD and M). TMD was classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I. Nonspecific physical symptoms (NSPS) were assessed by RDC/TMD - Axis II. The International Classification of Headache Disorders - II criteria, second edition, were applied to identify and classify primary HA. Other painful conditions and systemic diseases were assessed by volunteers' self-report. The prevalence of all assessed conditions was higher in the TMD+M group. Multiple regression models showed that cervicalgia was associated with the TMD only group (p<0.05), whereas gender (p<0.05), cervicalgia (p<0.05), BP (p<0.05) and NSPS (p<0.05) were significantly associated with the TMD+M group. Our results suggest that individuals with a comorbidity (TMD associated with M) have a more severe condition than those presenting only painful TMD.

Genotipificación de los factores de virulencia vacA y cagA de Helicobacter pylori en individuos de dos regiones de Colombia con riesgo opuesto de cáncer gástrico / Genotyping of Helicobacter pylori virulence factors vacA and cagA in individuals from two regions in Colombia with opposing risk for gastric cancer

Introducción. La prevalencia de infección por Helicobacter pylori es alta en Colombia; en la zona andina las tasas de cáncer gástrico son altas mientras que en las zonas costeras son bajas. Los genotipos de H. pylori cagA positivo y vacA s1 y m1 se asocian con un mayor riesgo de cáncer gástrico. Objetivo. Determinar las diferencias en las frecuencias de los genotipos de H. pylori asociados a virulencia en dos regiones de Colombia con riesgo opuesto de cáncer gástrico. Materiales y métodos. Se analizaron 401 biopsias del antro gástrico provenientes de 401 individuos con diagnóstico de gastritis no atrófica, gastritis atrófica o metaplasia intestinal; 256 se obtuvieron en la zona de alto riesgo (Tunja y Bogotá) y, 145, en la zona de bajo riesgo (Barranquilla, Santa Marta y Cartagena). La genotipificación de los genes de virulencia cagA y vacA se hizo mediante reacción en cadena de la polimerasa (PCR). Resultados. No se observó diferencia en la frecuencia de infección por H. pylori entre las dos zonas (77,3 Vs . 77,9 %, p=no significativo, ns). La presencia de cagA fue mayor en la zona de bajo riesgo (77,9 Vs . 69,2 %, p=ns). El alelo vacA s1 también fue más prevalente en la zona de bajo riesgo (61,8 Vs . 72,0 %, p=ns). El alelo vacA m1 presentó mayor prevalencia en la zona de alto riesgo (57,2 Vs . 42,8 %, p=ns). La combinación cagA positivo s1m1 también fue más frecuente en la zona de bajo riesgo (48,9 Vs . 38,9 %, p=ns). Conclusiones. Las diferencias en el riesgo de cáncer gástrico en estas dos zonas no pueden explicarse por las diferencias en la prevalencia de infección por H. pylori o en la virulencia de las cepas circulantes.

Introduction: The overall prevalence of Helicobacter pylori infection is high in Colombia; however, in the country´s Andean region, gastric cancer rates far surpass those in coastal areas. Helicobacter pylori genotypes cagA positive and vacA s1 and m1 are associated with an increased risk of gastric cancer. Objective: To compare the distribution of H. pylori genotypes associated with virulence in two regions in Colombia with opposing risk for gastric cancer. Materials and methods: Four hundred and one gastric antral biopsies were obtained and analyzed from 401 individuals diagnosed with non-atrophic gastritis, atrophic gastritis and intestinal metaplasia: 256 came from the high-risk area cities of Tunja and Bogotá, and 145 from the low-risk area cities of Barranquilla, Santa Marta and Cartagena. Genotyping of virulence genes vacA and cagA was performed by PCR. Results: No difference was observed in the frequency of H. pylori infection between the two areas (77.3% vs 77.9 %, p=non significant, ns). The presence of cagA was higher in the low-risk area (77.9% vs. 69.2 %, p=ns). The vacA s1 allele was also more prevalent in the low-risk area (61.8 % vs 72.0 %, p=ns). The vacA m1 allele was more prevalent in the high-risk area (57.2 % vs 42.8 %, p=ns). The cagA positive s1m1 combination was also more frequent in the low-risk area (48.9% vs 38.9%, p=ns). Conclusions: The differences in the risk of gastric cancer in these two geographic areas cannot be explained by differences in the prevalence of infection by H. pylori or by differences in the virulence of circulating strains.

Determinación de mutaciones de un solo nucleótido en el gen 23S rRNA de Helicobacter pylori relacionadas con resistencia a claritromicina en una población del departamento del Cauca, Colombia / Determination of single nucleotide mutations in the 23S rRNA gene of Helicobacter pylori related to clarithromycin resistance in a population from Cauca, Colombia

Introducción. La terapia antibiótica combinada para la erradicación de Helicobacter pylori debería basarse en los patrones locales de resistencia. Objetivo. Determinar la resistencia de H. pylori a claritromicina en una población del departamento del Cauca mediante la identificación de mutaciones en el gen 23S r RNA en ADN obtenido de biopsias gástricas. Materiales y métodos. Se incluyeron en el estudio 162 pacientes con dispepsia funcional. El gen 23S rRNA se amplificó por PCR y el patrón de mutaciones se identificó por secuenciación directa. Resultados. La frecuencia de resistencia a claritromicina fue de 4 %. La mutación A2143G del gen se encontró en cuatro pacientes (2,46 %) y la mutación A2142G, en tres pacientes (1,85 %). Conclusiones. El estudio encontró que el genotipo más frecuente en los especímenes positivos para H. pylori fue 2143G, seguido por A2142G. La prevalencia observada de resistencia de H. pylori fue baja; por lo tanto, se considera que el tratamiento con claritromicina es una opción válida para la erradicación de H. pylori en la población objeto de estudio.

Introduction: Antibiotic combination therapy for the eradication of Helicobacter pylori should be based on local resistance patterns. Objective: To d etermine the resistance of H. pylori to clarithromycin in a population from Cauca province, through the identification of mutations in the 23S rRNA gene in DNA from gastric biopsies. Materials and methods: A total of 162 patients with functional dyspepsia were included in the study. The 23S rRNA gene and the DNA from 162 gastric specimens were amplified by PCR, and the mutation pattern was identified by direct sequencing. Results: The frequency of clarithromycin resistance was 4%. A2143G mutation was found in four patients (2.46%) and A2142G mutation was found in three patients (1.85%). Conclusions: Our study shows that the most frequent genotype in H. pylori -positive specimens was A2143G, followed by A2142G. The observed resistance prevalence of H. pylori was low; thus, we consider that clarithromycin treatment is a valid option for H. pylori eradication in the study population.

Detección molecular y genotipificación de Helicobacter pylori en biopsias gástricas de pacientes adultos sintomáticos de la ciudad de Santa Fe, Argentina / [Molecular detection and genotypification of Helicobacter pylori in gastric biopsies from symptomatic adult patients in Santa Fe, Argentina].

Our goals were: a) to detect Helicobacter pylori in gastric biopsies of symptomatic adults by PCR, b) to detect the presence of the cagA gene as well as of the allelic variants of the vacA gene, and c) to correlate genotypes with the endoscopic diagnoses. H. pylori was detected in 81

(39/48) of patients by nested PCR for hsp60. The presence of cagA was detected in 15/22 of samples and vacA s1 - m1 was the most frequent allelic combination (15/22). Gastritis, the most frequent diagnosis, was associated with genotype cagA+ in 10/13 of patients. In this group, 9/13 showed the allelic variant vacA s1- m1. The variant vacA s2 - m2 was detected in 3/3 of gastritis cases by H. pylori with the cagA- genotype. These results are the first reported in our region and provide data of epidemiological interest.

Relación entre la integridad del CagPAI y los polimorfismos en el gen CagA con la severidad de la gastritis en pacientes infectados con H. pylori CagA positivo / The Relation between CagPAI integrity and the polymorphisms in the CagA gene with the severity of gastritis in patients infected with CagA-positive H. pylori

Objetivos: Evaluar la histopatología gástrica en pacientes colombianos con gastritis infectados con Helicobacter pylori CagA-positivo y su asociación a la integridad del islote de patogenicidad Cag (CagPAI) y el número de motivos EPIYA-C presentes en la proteína CagA. Métodos: Se incluyó a 31 individuos con diagnóstico de gastritis. A partir de biopsias gástricas se aisló H. pylori CagA-positivo y se caracterizó, mediante secuencia, la composición de motivos EPIYA. La histopatología fue evaluada según el sistema Sidney actualizado. Los genes CagA, CagT, CagE y Cag10 fueron genotipificados mediante PCR y electroforesis en agarosa. Resultados: En total, 24 aislamientos (el 77% de los casos) portaban CagPAI íntegro. De los aislamientos negativos para uno o más genes del CagPAI, 7 de ellos (22%) fueron considerados como portadores de un CagPAI defectuoso. No se observaron diferencias significativas en los promedios de densidad de H. pylori, el grado de inflamación crónica ni la presencia de atrofia glandular o de metaplasia intestinal entre aislamientos con el CagPAI íntegro, en comparación con aislamientos con el CagPAI defectuoso. Tampoco se observaron diferencias significativas en los parámetros histopatológicos entre los aislamientos con un motivo EPIYA-C o más de un motivo EPIYA-C, ni en antro ni en cuerpo, excepto para la infiltración por neutrófilos, que fue significativamente mayor en cuerpo en aislamientos con más de un motivo EPIYA-C (p=0,018). Conclusiones: No se halló asociación entre la diversidad en los factores de virulencia CagPAI y CagA de aislamientos colombianos, y los hallazgos histopatológicos en la gastritis, otros factores del hospedero o ambientales podrían afectar las características histopatológicas de la gastritis.

Objectives: To evaluate gastric histopathology in Colombian patients infected with CagA-positive Helicobacter pylori and its association with the integrity of Cag (CagPAI) pathogenicity island and the number of EPIYA-C motifs present in the CagA protein. Methods: Thirty-one (31) individuals diagnosed with gastritis were included in the study. Using gastric biopsies, CagA-positive H.pylori was isolated and EPIYA motif makeup was characterized by sequencing. Histopathology was evaluated with updated Sydney system. The CagA, CagT, CagE and Cag10 genes were genotyped using PCR and agarose electrophoresis. Results: A total of 24 isolates (77% of cases) carried a complete CagPAI. Among the negative isolates for one or more genes with CagPAI, 7 (22%) were considered to be carriers of a defective CagPAI. No significant differences were observed in H. pylori density averages, degree of chronic inflammation, presence of glandular atrophy or intestinal metaplasia between isolates with complete CagPAI and isolates with defective CagPAI. No significant differences were observed in the histopathological parameters between isolates with one EPIYAC motif and those with more than one EPIYA-C motif, neither in antrum nor in body, except for infiltration by neutrophils which was significantly greater in bodies with isolates with more than one EPIYA-C motif (p=0.018). Conclusions: No association was found between the diversity of virulence CagPAI and CagA factors in Colombian isolates and the histopathological findings in gastritis, or in other host or environmental factors that could affect the histopathological characteristics of gastritis.

Gastritis y gastropatías: [revisión] / Gastritis and gastropathies: [review]

Se hace una revisión de los diferentes tipos de gastritis, incluyendo cuadros en los que el edema y eritema puede semejar el cuadro, pero sin la típica reacción inflamatoria que denominamos gastropatías. Se hace una descripción de diversos aspectos epidemiológicos, etiológicos, etiopatogénicos; se desarrolla diversas clasificaciones propuestas y se describe los métodos diagnósticos, tratamientos recomendados y el pronóstico de esta molestia tan común.

A review of the different types of gastritis, including features in which the edema and erythema can resemble the picture, but without the typical inflammatory reaction that is called gastropathy. A description of various epidemiological, aetiological, pathogenetic, are proposed. The review describes the diagnoses and treatment recommendations and prognosis of this common disorder.

Gastritis varioliforme y daño hepático crónico: Una inesperada asociación / Association between varioliform gastritis and cirrhosis

Background: Varioliform gastritis (VG) is found in approximately 0.3 to 2.8 percent of upper gastrointestinal endoscopies. Its etiology is not known. We have observed a higher frequency of VG in patients with liver cirrhosis. Aim: To confirm if there is an association between VG and liver cirrhosis. Patients and Methods: Two case-control studies were done. A retrospective study, reviewing the endoscopy database of a gastroenterological unit. A prospective study, identifying cases with the endoscopic diagnosis of VG among all patients referred for upper gastrointestinal endoscopies. The presence of liver cirrhosis, based on clinical, laboratory, ultrasonographic and endoscopic features was registered among patients with VG. Results: VG was found in 549 of 11.659 upper gastrointestinal endoscopies. Fourteen percent of patients with VG had cirrhosis compared to 5.6 percent in control patients (c² 29,8; p < 0.01). The odds ratio (OR) for having cirrhosis of patients with VG was 9.3 (95 percent confidence intervals 3.4-25.5, p < 0,01), according to a logistic regression analysis. In the prospective study, that included 1.498 upper gastrointestinal endoscopies, VG was also significantly more common among patients with liver cirrhosis. Conclusions: A higher frequency of VG was found among patients with liver cirrhosis. Therefore, the endoscopic finding of VG should alert physicians to look for the presence of a coexistent liver cirrhosis.

Caracterización del gen de la citotoxina vacuolizante de Helicobacter pylori a partir de biopsias gástricas de pacientes residentes en Tolima, Colombia / Characterization of the Helicobacter pylori vacuolating cytotoxin gene in gastric biopsy specimens from patients living in Tolima, Colombia

Helicobacter pylori es una bacteria que coloniza la mucosa gástrica de los humanos. Este microorganismo produce una citotoxina vacuolizante conocida como VacA y codificada por el gen vacA, el que se considera un factor de virulencia importante. Las cepas de H. pylori con diferentes alelos de vacA exhiben una gran variedad de fenotipos, algunos de los cuales han sido asociados con enfermedades gastroduodenales. El presente estudio pretende aportar datos sobre la prevalencia de H. pylori y de los genotipos de vacA en pacientes residentes en Tolima (Colombia), así como determinar la relación entre estos datos y el desarrollo de diferentes patologías gastroduodenales. Se incluyeron en este análisis 73 pacientes con diferentes patologías gástricas. Con el ADN total extraído de cada biopsia, se determinó la presencia de la bacteria mediante la amplificación de un fragmento específico del gen 16S ADNr. También se realizó la genotipificación del gen vacA por PCR. De las 50 muestras genotipificadas, el 52% mostró el alelo vacA s1m1, el 42% el alelo vacA s2m2, el 4% el s1m2 y el 2% los alelos s1,s2,m1,m2. Se evidenció una mayor sensibilidad en la detección de H. pylori por medio del gen vacA que por el gen 16S ADNr. En la población evaluada no se encontró asociación entre el genotipo de vacA y la presencia de las distintas patologías incluidas en este estudio.

Helicobacter pylori successfully colonizes the gastric niche. These bacteria produce a vacuolating cytotoxin known as VacA, which is codified by the vacA gene. This protein represents an important virulence factor. H. pylori strains have different vacA alleles, which show a variety of phenotypes that have been associated with gastrointestinal diseases. The aim of this study was to generate data about the prevalence of H. pylori and the vacA genotype in Tolima (Colombia) residents, and to evaluate if there exists a relationship between these data and the development of different gastrointestinal pathologies. Seventy three patients with different pathologies were included. The DNA extracted from biopsy specimens was analyzed and the presence of bacteria was determined by amplifying a fragment of the 16 rDNA gene. The vacA genotype was also determined by PCR. Fifty-two percent out of the 50 genotyped samples showed vacA s1m1 allele, 42% vacA s2m2, 4% s1m2, and 2% s1,s2,m1,m2. A higher sensitivity for the detection of H. pylori was evidenced by amplifying the vacA gene rather than the 16S rDNA gene. No association was found between the vacA genotype and the gastrointestinal diseases included in the study.

The Clinical Usefulness of Focally Enhanced Gastritis in Korean Patients with Crohn's Disease / 대한소화기학회지

BACKGROUND/AIMS: Focally enhanced gastritis (FEG) has been suggested as a specific diagnostic marker for patients with Crohn's disease (CD). However, the usefulness of FEG for distinguishing CD from ulcerative colitis (UC) is uncertain and the incidence or prevalence of FEG for inflammatory bowel disease (IBD) patients in Korea has not been defined yet. In this study, we investigated the frequency of FEG and other gastric histological abnormalities in Korean patients with CD and UC. METHODS: We evaluated 37 patients with known CD, 43 patients with UC and 41 non-IBD control group; all underwent upper gastrointestinal endoscopy followed by biopsy from the antrum and the body. The pathology of the gastric biopsy specimens and the presence of Helicobacter pylori (H. pylori) were evaluated. FEG was characterized by a focal perifoveolar or periglandular inflammatory cell infiltrates. RESULTS: H. pylori positive gastritis was found in 10 of 37 (27.0%) of CD patients, in 16 of 43 (37.2%) of UC patients, and in 22 of 41 (53.7%) of non-IBD control group (p=0.054). In H. pylori-negative patients, FEG was found in 8 of 27 patients (29.6%) of CD patients, 6 of 27 (22.2%) patients with UC, and 2 of 9 (10.5%) of non-IBD control group (p=0.324). CONCLUSIONS: In H. pylori-negative patients, there was no statistically significant difference in the occurrence of FEG among CD, UC and control groups in Korea.

Presença de Helicobacter pylori na saliva de indivíduos com doenças gástricas superiores e doença periodontal / Presence of Helicobacter pylori in individuals with periodontal disease and upper gastric diseases

Helicobacter pylori (H. pylori) é um microorganismo Gram-negativo capaz de colonizar a mucosa gástrica e está associado a ulceras e câncer gástrico. Alguns estudos têm detectado esta bactéria na cavidade oral, sugerindo que esta funciona como um reservatório em potencial. O objetivo deste estudo foi analisar a prevalência do H. pylori na cavidade oral de indivíduos dispépticos sintomáticos (com queixa digestiva alta). Oitenta e nove pacientes com idade acima de 30 anos, com ou sem doença periodontal e com ou sem dispepsia gástrica, tiveram a saliva coletada e foram divididos em quatro grupos: Grupo A - Indivíduos com gastrite e doença periodontal; Grupo B - Indivíduos com gastrite e sem doença periodontal; Grupo C - Indivíduos sem gastrite e com doença periodontal; Grupo D - Indivíduos sem gastrite e sem doença periodontal.. As amostras foram analisadas através da PCR utilizando primers baseados no gene 16S rRNA, HPU1:5'- GCC-ATT-GGT-AAA-TTA-GTT-3' e HPU2:5'- CTC- CTT- AAT- TGT- TTT-TAC- 3' e visualizados por gel de agarose a 1% e luz ultravioleta. Os resultados demonstraram a presença do H. pylori em 22.2% (8/36) da saliva dos indivíduos do Grupo A; 18.7% (3/16) de indivíduos do Grupo B; e não foi detectado nos Grupos C e D. A diferença entre os Grupos A e B não foi estatisticamente significante (Fisher´s exact test, p< 0,05). No entanto quando analisados em conjunto, houve uma diferença significante na freqüência de H. pylori na saliva dos indivíduos com gastrite (A e B) quando comparados com os indivíduos sem gastrite (C e D). Os resultados deste estudo comprovam que o H. pylori está presente na cavidade oral de alguns indivíduos com gastrite e pode ser detectado na saliva.

Helicobacter pylori is a Gram-negative microorganism which is able to colonize the gastric mucosa and is associated with gastric ulcer and cancer. Several studies have detected this bacterium in the oral cavity, suggesting it as a potential reservoir. The aim of this study was to investigate the presence of Helicobacter pylori in the oral cavity of individuals with periodontal and gastric diseases. Eighty and nine individuals, with mean age 42.3 yrs, from a suburb of Rio de Janeiro participated in the study. They were divided in four groups: Group A - With gastric diseases and periodontal disease; Group B - With gastric diseases and no periodontal disease; Group C - Without gastric diseases and periodontal disease; Group D - Without gastric diseases and without periodontal disease. Saliva samples were collected from all volunteers and prepared for polymerase chain reaction (PCR) analysis using specific primers. Fisher´s exact test was used for detecting statistical differences between groups. Helicobacter pylori was detected in saliva of 22.2% (8/36) of Group A, 18.7% (3/16) of Group B, 0 ( 0%) of Groups C and D. There was'nt a statistically difference of Helicobacter pylori in Groups A and B. Helicobacter pylori can be detected in saliva of individuals with gastric diseases The organism seems to be able to colonize oral cavity at least temporarily. Key words:

Associação entre a gastrite e a infecção gástrica pelo Helicobacter pylor / Association between gastritis and gastric infection caused by Helicobacter pylori

Introdução: Gastrite é qualquer processo inflamatório que envolve o estômago, sendo a infecção pelo Helicobacter pylori um importante fator etiológico. As informações sobre essa associação direta são escassas na literatura biomédica atual. Objetivo: Constatar a ocorrência de infecção gástrica pelo H. pylori nos casos de gastrite no Serviço de Endoscopia Digestiva da Faculdade de Medicina de Marília (FAMEMA). Métodos: Entre janeiro e maio de 2004, todos os pacientes submetidos ao exame de endoscopia digestiva alta (EDA) no Serviço de Endoscopia da FAMEMA que tinham indicação clínica de pesquisa de infecção gástrica pelo H. pylori e que assinaram o termo de consentimento foram in-cluídos no estudo, que foi aprovado pelo CEP (041/ 02). Nesses pacientes, foram coletados cinco frag-mentos de mucosa gástrica: um do antro para pesquisa do H. pylori por genotipagem através da técnica da polimerase chain reaction (PCR) e quatro fragmentos (dois do antro e dois do corpo) para análise histológica pelas colorações HE e Giemsa, que foram utilizados pelo patologista na busca da presença do H. pylori e determinação de reação inflamatória crônica na mucosa gástrica. Os dados encontrados na pesquisa de laboratório foram confrontados com o laudo endoscópico. Resultados:Das 251 endoscopias digestivas realizadas por ummesmo examinador, 88 pacientes foram incluídos no estudo. Nesses, a concordância do diagnóstico endoscópico e histológico de gastrite ocorreu em 50 casos, sendo 36 casos de gastrite associada ao H. pylori (casos "verdadeiro-positivos") e 14 casos de gastrite H. pylori negativo (gastrite não associada ao H. pylori). Conclusão: A ocorrência de infecção pelo H. pylori nos casos de gastrite no Serviço de Endoscopia Digestiva da FAMEMA é de 72.7.

Nodular Gastritis and Pathologic Findings in Children and Young Adults with Helicobacter pylori Infection

PURPOSE: The aim of this study was to investigate the pathologic characteristics of nodular gastritis in children and young adults infected with Helicobacter pylori (H. pylori). MATERIALS AND METHODS: A total of 328 patients were enrolled in this study, and the diagnosis of H. pylori infection was done with gastroduodenal endoscopy concomitant with a CLO

Gastrointestinal lesions and helicobacter pylori in patients with myeloproliferative disorders

The aim of this study is to investigate the endoscopic lesions, and Helicobacter pylori [H. pylori] positivity in patients with myeloproliferative disorders [MPD]. Thirty patients with MPD and 93 controls with functional dyspepsia were enrolled in this study after informed consent obtained between March 2000 and July 2003. The study was held at the Departments of Hematology and Gastroenterology, Adnan Menderes University Faculty of Medicine, Adnan, Turkey. Physical examination, hemogram, peripheral blood examination, upper endoscopic examinations were performed in all patients. Helicobacter pylori positivity was evaluated by rapid urease test, and by histopathological examination of the biopsies obtained from antrum and corpus. The H. pylori positivity was 46.7% in MPD and 19.4% in control group [p<0.05]. The prevalence of gastritis was much higher in MPD patients than control group [p<0.05]. There was no gastrointestinal bleeding in control group but 8 patients in MPD group [26.7%; p<0.05]. The higher susceptibility of H. pylori infection and high frequency of gastric lesions in patients with MPD suggests a surveillance of these patients. The eradication of H. pylori to avoid probable gastrointestinal problems is advised in MPD patients

Helicobacter pylori-associated gastritis and gastric cancer in Nigeria.

BACKGROUND: The etiology of gastric cancer has not been clearly delineated. There is some evidence of an association of gastric cancer with Helicobacter pylori-induced chronic gastritis, atrophic gastritis and intestinal metaplasia. Previous studies report a high rate of H. pylori infection and chronic gastritis among Nigerians. METHODS: We retrospectively reviewed 84 tissue specimens with gastric cancer seen in our department over an 18-year period for for the presence of H. pylori infection, chronic gastritis, atrophic gastritis, and intestinal metaplasia in the adjacent non-cancerous gastric mucosa. RESULTS: H. pylori infection was detected in 15 (17.9%) of 84 specimens. Moderate to severe gastritis was found in non-cancerous areas in 77 (91.7%) specimens, and was equally frequent in patients with 'intestinal' and 'diffuse' types of cancer. Atrophic gastritis and intestinal metaplasia were observed in 22 (26.2%) and 35 (41.7%) specimens, respectively, and were more common in 'intestinal' type of gastric cancer. CONCLUSION: Chronic gastritis was seen in the adjacent non-cancerous mucosa in most specimens with gastric cancer. However, its severity did not correlate with the histological subtype of gastric cancer.