Evaluación gastrointestinal en los pacientes con fiebre mediterránea familiar con dolor abdominal crónico y tratados con colchicina: serie de casos / Gastrointestinal evaluation in colchicine-treated familial Mediterranean fever patients with chronic abdominal pain: Cases series

El objetivo de este estudio fue evaluar a los pacientes con fiebre mediterránea familiar (familial Mediterranean fever, FMF) y dolor abdominal crónico resistentes al tratamiento con colchicina. Se incluyó a 48 pacientes diagnosticados en nuestro consultorio de reumatología pediátrica que tenían dolor abdominal a pesar del tratamiento con colchicina. A todos los pacientes se los derivó a un gastroenterólogo pediátrico. Se registraron las características del dolor, tales como aparición, duración y frecuencia; se planificó una endoscopía digestiva para obtener un diagnóstico diferencial. Se determinó la presencia de una mutación del gen MEFV en 46 pacientes. La mediana de la duración del tratamiento fue de 2,8 años. Aproximadamente el 60% de los pacientes tenían dolor abdominal todos los días o de dos a tres veces a la semana; en el 73% de los casos, duró menos de tres horas. A 41 pacientes se les realizó una endoscopía digestiva alta. La gastroduodenitis es un hallazgo frecuente en los pacientes con FMF y dolor abdominal persistente a pesar del tratamiento. Los pacientes con los puntajes más altos de severidad de la enfermedad tenían inflamación digestiva grave.

The aim of the study to evaluate familial mediterranean fever (FMF) patients with chronic abdominal pain unresponsive to colchicine treatment. Forty-eight patients who diagnosed in our Pediatric Rheumatology clinics and suffering from abdominal pain despite colchicine treatment were include. All patients were referred to a pediatric gastroenterologist. The pain characteristics such as onset, duration and frequency were recorded; gastrointestinal (GI) endoscopy was planned for differential diagnosis. MEFV mutation was determined in 46 patients. The median duration of treatment was 2.8 years. Approximately 60% of the patients suffered from abdominal pain every day or 2-3 times a week, in 73% of the cases it lasted less than three hours. Forty-one patients underwent upper GI endoscopy. Gastroduodenitis is a common finding in persisting abdominal pain despite therapy of FMF patients. The patients with the highest disease severity scores had severe inflammation within the entire GI system.

Helicobacter spp. in domestic cats: identification and relationship with anatomical and histopathological gastric changes in animals of blood group A / Helicobacter spp. em gatos domésticos: identificação e relação com alterações gástricas anatômicas e histopatológicas em animais de sangue tipo A

The aim of this study was to evaluate the presence of gastric Helicobacter-like organisms and the endoscopic and histopathological changes in domestic cats with blood type A. Samples from the stomach antrum, body and fundus were collected from 32 mixed-breed stray domestic cats using gastroscopy. Urease testing and cytological analysis were performed in fresh samples. Tissue sections were processed and stained with hematoxylin and eosin (H&E) and the Warthin-Starry (WS) silver staining methods for histopathological examination. Helicobacter spp. were detected in 100% of samples subjected to silver staining and cytological analysis, and in 96.9% of samples subjected to urease testing. In 87.5% of the cats, mononuclear inflammatory-cell infiltrates were identified. The graduation and distribution of inflammatory infiltrates in these cats revealed mild (78.1%) to moderate (9.4%) inflammatory changes in at least one gastric region. These changes were independent of the colonization score. Hyperplasia of the lymphoid follicles was detected in three cats. Cats of blood group A are often colonized by Helicobacter spp. and the macroscopic and microscopic findings are consistent with studies in domestic cats reported to date, concluding that the most common blood group in cats is not associated with high susceptibility to symptomatic gastritis.(AU)

O objetivo deste estudo foi avaliar a presença de organismos semelhantes a Helicobacter e as alterações endoscópicas e histopatológicas em estômago de gatos domésticos de sangue tipo A. Amostras de antro, corpo e fundo gástricos foram coletadas de 32 gatos, sem raça definida, não domiciliados através de gastroscopia. Teste de urease e análise citológica foram realizados em amostras frescas. Secções teciduais foram processadas e coradas com hematoxilina e eosina e pela prata pelo método de Warthin-Starry para avaliação histológica. Helicobacter spp. foi detectado em 100% das amostras submetidas às análises citológicas e coloração pela prata e em 96,9% das amostras submetidas ao teste de urease. Em 87,5% dos gatos foi identificado infiltrado inflamatório mononuclear. A graduação e distribuição do infiltrado inflamatório nestes gatos revelaram alterações leves (78,1%) a moderada (9,4%) em pelo menos uma região gástrica. Estas alterações eram independentes do escore de colonização. Hiperplasia de folículos linfoides foram detectadas em 3 gatos. Gatos do grupo sanguíneo A são frequentemente colonizados por Helicobacter spp. e os achados macro e microscópicos são consistentes com estudos em gatos domésticos realizados até a presente data. Conclui-se que o grupo sanguíneo mais comum em gatos não está associado com uma alta susceptibilidade a gastrite sintomática causada por Helicobacter spp.(AU)

Serum Antibodies against Helicobacter pylori Neutrophil Activating Protein in Carriers of IL-4 C-590T Genetic Polymorphism Amplify the Risk of Gastritis and Gastric Cancer

Background: Gastric cancer arises, mainly, on an inflammatory background. Helicobocter pylori neutrophil activating [HP-NAP] protein functions as a potent pro-inflammatory mediator. Similarly, IL-4 plays a critical role in the inflammation pathway, the levels of which are altered by C to T transition at position -590 in its promoter region. Here, we have aimed to assess the risk of gastritis and gastric cancer in the co-presence of these two inflammation modulating mediators

Methods: Gastritis [n=58] and gastric cancer [n=31] patients were evaluated and compared with H. py/or/-positive asymptomatic controls [n=46], for serum antibodies against recombinant HP-NAP and IL-4 C-590T single nucleotide polymorphism using immunoblotting and PCR-RFLP, respectively. Multivariable logistic regression, adjusting for age, gender and ethnicity, was used for data analysis

Results: In terms of susceptibility to gastritis, seropositivity to HP-NAP projected a risk impact of 4.62 fold [OR=4.62, 95% Cl=l.50-14.22], which when present in IL-4 -590 T carriers augmented the risk up to 9.7 fold [OR=9.70, 95% CI=2.06-45.69]

A similar pattern, but of a stronger magnitude, occurred for the risk of gastric cancer, which was estimated at 9.07 fold [OR=9.07, 95% Cl=1.99-42.0] for HP-NAP-seropositive subjects and was drastically amplified [OR=33.64, 95% 0=2.06-548.68], when double-positive [HP-NAP seropositive/IL-4 -590 T carrier] subjects were examined against double negatives [HP-NAP seronegative/IL-4 -590 CC]

Conclusion: Our preliminary data indicate that serum antibodies against HP-NAP represent a state of risk, which is further exacerbated in IL-4 -590 T carriers. These biomarkers, if validated in larger prospective studies, can be used to screen for gastric cancer susceptibility

Frequency of helicobacter pylori in histologically proven gastritis cases - a study of 100 cases

Objective: To determine the frequency of Helicobacter pylori [H. pylori] based on endoscopic of special stains in gastritis cases

Study Design: Prospective descriptive study

Place and Duration of Study: Histopathology department, Army Medical College Rawalpindi, from Oct 2016 to Mar 2017

Material and Methods: One hundred [100] cases were included in the study. Gastric biopsies of the patients histologically diagnosed as gastritis were included in the study, which were evaluated for the presence of H. pylori with the help of special stain [Modified Giemsa stain]

Results: Gastric biopsies of 100 patients, who were diagnosed as gastritis on histopathological examination were analyzed with the help of Giemsa stain for the presence or absence of H. pylori. Out of these 100 cases, 60 were males and 35 were females. Most patients were between the age group of 30-40 years. Histological examination and special stain analysis revealed presence of H. pylori in 30 cases [30%], while rest of the 70 cases [70%] showed no H. pylori. Out of 30 cases positive for H. pylori, 28 cases [93%] had chronic active gastritis, while 2 cases [7%] had no element of activity

Conclusion: Among the cases of chronic gastritis, H. pylori negative gastritis was more common than H. pylori associated gastritis. A significantly decreased frequency of H. pylori in histologically gastritis cases in our population may be due to more frequent use of complete or incomplete therapies against H. pylori by general practitioners at some stage of disease

Unpleasant Journey from Helicobacter pylori-associated Gastritis to Gastric Cancer: Cancer Prevention by Taking a Detour / 대한소화기학회지

As a commensal or a pathogen, Helicobacter pylori can change the balance of a complex interaction that exists among gastric epithelial cells, microbes, and their environment. Therefore, unraveling this complex relationship of these mixtures can be expected to help prevent cancer as well as troublesome unmet medical needs of H. pylori infection. Though gastric carcinogenesis is a multi-step process, precancerous lesion can be reversible in the early phase of mucosal damage before reaching the stage of no return. However, biomarkers to predict rejuvenation of precancerous atrophic gastritis have not been identified yet and gastric cancer prevention is still regarded as an impregnable fortress. However, when we take the journey from H. pylori-associated gastritis to gastric cancer, it provides us with the clue for prevention since there are two main preventive strategies: eradication and anti-inflammation. The evidence supporting the former strategy is now ongoing in Japan through a nation-wide effort to eradicate H. pylori in patients with chronic gastritis, but suboptimal apprehension to increasing H. pylori resistance to antibiotics and patient non-compliance still exists. The latter strategy has been continued in the author's research center under siTRP (short-term intervention to revert premalignant lesion) strategy. By focusing on the role of inflammation in the development of H. pylori-associated gastric carcinogenesis, this review is intended to explain the connection between inflammation and gastric cancer. Strategies on H. pylori eradication, removal of inflammation, and reverting preneoplastic lesion will also be introduced. In the end, we expect to be able to prevent gastric cancer by take a detour from the unpleasant journey, i.e. from H. pylori-associated gastritis to gastric cancer.

Hallazgos histológicos gástricos en obesos mórbidos sometidos a gastrectomía vertical laparoscópica / Pathological findings in resected gastric segments after laparoscopic sleeve gastrectomy

Background: Laparoscopic sleeve gastrectomy (LSG) is used for the treatment of obesity and may provide gastric tissue for pathological studies. The association of obesity with dyslipidemias, diabetes and cardiovascular disease is of common knowledge. However its association with gastrointestinal diseases and gastritis is less well known. Aim: To analyze the pathological findings of the resected gastric segment during LSG. Material and Methods: Two hundred fifty patients aged 37 +/- 12 years and with a body mass index of 37.7 +/- 3.1 kg/m² (189 women), subjected to LSG, were included in a prospective protocol. Resected gastric segments were sent for a pathological study. Results: A gastric disease was identified in 220 (88 percent) cases. Chronic follicular gastritis was diagnosed in 117 patients (46.8 percent), chronic superficial gastritis in 76 (30.4 percent), chronic nonspecific gastritis in 38 (15.2 percent), intestinal metaplasia in 14 percent (5.6 percent) and in one case (0.4 percent) an early gastric carcinoma. Helicobacterpylori was present in 34 (13.6 percent) patients. Conclusions: This study shows a high prevalence of histopathological gastric lesions detected after the LSG, reaffirming the need for detection of these lesions before surgery.

Introducción: La gastrectomía vertical laparoscópica (GVL) es un procedimiento quirúrgico efectivo en el tratamiento de la obesidad. La obesidad está asociada con algunas comorbilidades como diabetes, dislipidemia y enfermedad cardiovascular, pero también se ha demostrado que tiene efectos potenciales sobre la gastritis y diversas enfermedades gastrointestinales. El objetivo de este estudio es determinar los hallazgos histológicos del segmento gástrico resecado durante la GVL realizada en una serie de pacientes obesos. Material y Método: Entre enero de 2006 y diciembre de 2008, 250 pacientes consecutivos a los que se realizó GVL, fueron incluídos en un protocolo prospectivo. La serie consistió en 189 mujeres (75,6 por ciento) y 61 hombres (24,4 por ciento), con edad promedio de 37,5 +/- 12,1 años. El Índice de Masa Corporal (IMC) promedio fue 37,7 +/- 3,1 kg/m². Resultados: Los resultados histológicos identificaron 220 casos (88 por ciento) con patología gástrica. Se diagnosticó gastritis crónica folicular en 117 pacientes (46,8 por ciento), gastritis crónica superficial en 76 (30,4 por ciento), gastritis crónica inespecífica en 38 (15,2 por ciento), metaplasia intestinal en 14 percent (5,6 por ciento) y en un caso (0,4 por ciento) adenocarcinoma in situ. Helicobacter pylori (HP) estuvo presente en 34 pacientes (13,6 por ciento). Conclusiones: Los hallazgos de este estudio, muestran una prevalencia incrementada de lesiones gástricas histopatológicas detectadas posterior a la GVL, reafirmando la necesidad de una detección de estas lesiones antes de la cirugía.

Helicobacter pylori: rol del agua y los alimentos en su transmisión / Role of water and foods in helicobacter pylori transmission

Helicobacter pylori es una bacteria Gram negativa, microaerofílica, que coloniza eficientemente la mucosa gástrica humana. Fue aislada por primera vez en el año 1982 y actualmente se considera como un importante patógeno humano que causa diversas enfermedades gastrointestinales y además se reconoce como agente carcinógeno. Se habla de una alta prevalencia en el mundo, con un mayor porcentaje en los países en vías de desarrollo, esto probablemente relacionado con las condiciones de vida. De esta manera, el estatus socio-económico es el determinante más importante para el desarrollo de la infección por H. pylori, siendo las clases sociales más bajas las que exhiben mayor prevalencia. A la fecha, las rutas de transmisión de este microorganismo no se encuentran totalmente esclarecidas. Sobre la base de diversas evidencias epidemiológicas y microbiológicas se han propuesto varias vías. Dentro de estas se incluye al agua y a los alimentos como posibles vectores, a pesar de la compleja detección de esta bacteria en muestras distintas al tejido gástrico. H. pylori puede pasar a un estado viable no cultivable (VNC) bajo condiciones de estrés. No obstante, se han llevado a cabo diversos estudios para evaluar la prevalencia y supervivencia de esta bacteria en diversas fuentes de agua y muestras de alimentos, cuyos resultados indican la posibilidad de que los mismos actúen como un reservorio en su transmisión. Por esta razón, el presente artículo de revisión se enfoca en las evidencias que apoyan la transmisión de H. pylori a través del agua y los alimentos(AU)

Helicobacter pylori is a Gram-negative, microaerophilic, which efficiently colonizes the human gastric mucosa. It was first isolated in 1982 and is now considered an important human pathogen that causes various gastrointestinal diseases and is also recognized as a carcinogen. There is a high prevalence worldwide, with a higher percentage in developing countries, probably related to living conditions. Thus, the socio-economic status is the most important determinant for the development of the infection by H. pylori, being lower social classes exhibiting the highest prevalence. To date, the routes of transmission of this organism are not fully elucidated. Based on numerous epidemiological and microbiological evidences, several transmission paths have been suggested. Among them water and food are included as potential vectors, although the detection of these bacteria is complex in distinct samples to gastric tissue. H. pylori can happen to a viable but non-culturable state (VBNC) under conditions of stress. However, there have been several studies to assess the prevalence and survival of the bacteria in various water sources and food samples. Results indicate the possibility that they act as a reservoir for transmission. For this reason, this review article focuses on the evidence supporting the transmission of H. pylori through water and food(AU)

Fatores associados com a gastrite crônica em pacientes com presença ou ausência do Helicobacter pylori / Factors associated with chronic gastritis in patients with presence and absence of Helicobacter pylori

RACIONAL - A gastrite crônica é inflamação da mucosa do estômago, que tem como principal fator etiológico o Helicobacter pylori. OBJETIVO - Verificar fatores associados com a gastrite crônica em pacientes com presença e ausência do H. pylori, visando obter maior conhecimento sobre os fatores etiológicos, manifestações clínicas, hábitos alimentares e de vida nesses pacientes. MÉTODOS - Trata-se de um estudo descritivo, retrospectivo com dados de prontuário de pacientes com gastrite crônica atendidos em ambulatório. A pesquisa foi realizada por meio de um questionário que investigava fatores etiológicos da gastrite crônica, bem como as manifestações clínicas das doenças, os hábitos alimentares e de vida, entre outros. Endoscopia digestiva e pesquisa do H. pylori foi a forma de diagnóstico da gastrite crônica. Para análise estatística foi utilizado o teste qui-quadrado. RESULTADOS - Dos 94 pacientes avaliados a maioria era sintomático, apresentando pirose, eructações, dor epigástrica, plenitude gástrica e náuseas. Em 56,6% (n=54) dos individuos foi detectada a presença da bactéria e em 43,6% (n=40) não foi achado fator etiológico específico. Os resultados que se mostraram significativos foram em relação à distensão abdominal e refluxo gastroesofágico, observando-se aumento desses fatores em pacientes que tinham a bactéria. Além disso, tornou-se evidente que além do H. pylori outros fatores estão relacionados com a gastrite crônica como: utilização de medicamentos, tabaco, álcool e pacientes que apresentavam hábitos alimentares com alimentação inadequada, realização de refeições rápidas, e dialogar durante as refeições. Também foram verificados estarem relacionados ansiedade, estresse e doenças associadas que pudessem aumentar a secreção ácida. CONCLUSÃO - Vários fatores etiológicos oriundos de hábitos alimentares e estilo de vida, como tabagismo, alcoolismo, ansiedade, estresse, doenças associadas e nutrição inadequada, interagem para o início das manifestações clínicas, e a presença ou ausência de H. pylori não mostrou diferenças significativas no estado clínico dos pacientes.

BACKGROUND - Chronic gastritis is an inflammation of the stomach mucosa, which is considered its main etiological factor the Helicobacter pylori. AIM - To observe the differences in patients with chronic gastritis as well as the presence and absence of H. pylori, to obtain a better understanding of the etiological factors, clinical, dietary and lifestyle habits and associated diseases. METHODS - This was a descriptive study, retrospective medical records of patients with chronic gastritis treated as outpatients. Endoscopy and research of H. pylori was used in the diagnosis of chronic gastritis. The survey was conducted through a questionnaire to ascertain the risk factors for chronic gastritis and the clinical manifestations of disease, dietary and lifestyle habits, family history of the disease, weight changes and medications. For statistical analysis was used Spearman coefficient. Data were considered statistically significant p<0.05. RESULTS - Of the 94 patients evaluated were symptomatic with heartburn, belching, epigastric pain, fullness and nausea. In 56.6% (n = 54) of individuals was detected the presence of bacteria and in 43.6% (n = 40) was not found any specific etiologic factor. Was performed chi-square statistical test of clinical manifestations and factors such as stress and anxiety, leading to positive correlation. It became evident that the risk factors for disease are diverse, including the use of drugs, alcoholism, eating quickly, talking during meals, with significant relation to abdominal distension and reflux. The patients with the bacteria, had a higher risk of experiencing these symptoms. CONCLUSION - Various etiological factors in eating habits and lifestyle, as smoking, alcoholism, anxiety, stress, associated diseases and inadequate nutrition, interact to the onset of clinical manifestations, and the presence and absence of H. pylori did not show significant changes in patient clinical status.

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.

Mesenteritis esclerosante: presentación de tres casos y revisión de la literatura / Sclerosing mesenteritis: presentation of three cases and review of the literature

Sclerosing mesenteritis or panniculitis is a rare condition characterized by inflammation of the mesentery ranging from an acute to a chronic fibrotic process that can resemble an intestinal malignant neoplasm even though it is benign. Its etiology is unknown, although it is thought to be the result of a nonspecific inflammatory response of the mesentery to an allergic, chemical, thermal, infectious, autoimmune or surgical stimulus. Its natural history is benign and in most cases is self-limited. Surgery is reserved only for those cases where there is intestinal obstruction. We report three cases of sclerosing mesenteritis that occurred after abdominal surgery and we present a review of the literature.

Gastritis crónica antral por Helicobacter pylori en la infancia / Chronic antral gastritis induced by Helicobacter pylori in children

Introducción. La investigación tiene como objetivos conocer la frecuencia de infección por Helicobacter pylori en los niños con gastritis crónica antral, estimar las diferencias en el comportamiento histológico de esta entidad en los niños con infección por Helicobacter pylori y sin ella, e identificar la posible relación entre la edad y las características histológicas de la gastritis crónica antral por Helicobacter pylori. Método. Se tomó como universo de estudio la totalidad de biopsias gástricas procesadas en el Hospital Pediátrico Provincial de Holguín, entre enero de 1991 y diciembre del 2004. Se determinó una muestra de 192 niños con diagnóstico histológico de gastritis crónica antral. Las biopsias fueron reevaluadas para detectar infección por Helicobacter pylori y su densidad de colonización junto a la actividad y la gravedad de las lesiones de la gastritis. Resultados. Se encontró infección por Helicobacter pylori en el 67,7 por ciento de los pacientes. Las formas activas predominaron en los casos con infección por Helicobacter pylori (116/130) a diferencia de quienes no tenían infección (5/62). Se identificó una relación estadísticamente significativa (p < 0,001) entre la infección por Helicobacter pylori y la gastritis crónica antral activa. Todas las formas graves (40/40) se ubicaron en el grupo de pacientes con Helicobacter pylori. Se identificó una relación estadísticamente significativa (p < 0,01) entre la gravedad de las lesiones y la infección por Helicobacter pylori. El grado de actividad no guardó relación estadística con la densidad de colonización. En cambio, en las formas abundantes de colonización por Helicobacter pylori, el estado grave (29/41) resultó el subconjunto mayoritario, mientras que en las escasas lo resultó la forma ligera (34/66). Se identificó una asociación...

Introduction. The objective of this investigation is to know the frequency of infection caused by Helicobacter pylori in children with chronic antral gastritis, to estimate the differences in the histological behavior of this entity in children with infection due to Helicobacter pylori and without it, and to identify the possible relation existing between age and the histgological characteristics of chronic antral gastritis caused by Helicobacter pylori. Methods. All the gastric biopsies processed in the Provincial Pediatric Hospital of Holguin from January 1991 to December 2004 were included in the study group. A sample of 192 children with histological diagnosis of chronic antral gastritis was determined. The biopsies were reevaluated to detect Helicobacter pylori infection and its colonization density together with the activity and severity of gastritis lesions. Results. Helicobacter pylori infection was found in 67.7 percent of the patients. The active forms predominated in the cases with infection due to Helicobacter pylori (116/130) compared with those without infection (5/62). A statistically significant relation (p < 0,001) was observed between the severity of the lesions and the Helicobacter pylori infection. The degree of activity did not have any statistical relation to the colonization density. However, in the abundant forms of colonization due to Helicobacter pylori, the severe state (29/41) was the greatest subgroup, whereas in the scarce, the mild form (34/66) was the largest. A significant association (p < 0.01) was found between the colonization density and the severity of the lesions of chronic antral gastritis. The age group 11-15 was the most affected (81/130), and a marked association between age and the severity of the lesions was observed (0,184886)...

[Determination of Helicobacter pylori immunogenes using two- dimensional gel electrophoresis and immunoblotting]

Helicobacter pylori is one of the most common infectious agents that colonizes in the mucus layer of stomach. This bacterium has been identified to be the etiologic agent of chronic active gastritis, peptic ulceration and gastric cancer. The present study was aimed to identify H. pylori immunogenes for clinical diagnisis of the infection in the above 3 groups of patients. H. pylori bacteria isolated from biopsy specimens of patients suffering from gastritis, peptic ulcer and gastric cancer were extracted in an extraction solution containing lysozyme, urea and CHAPS. Two-dimensional gel electrophoresis were performed. The resolved proteins were transferred to PVDF membrane using tank blotting and their reaction with purified IgG fraction of the patients. Sera were determined by immunoblotting. The bacterial extract showed several hundreds of silver-stained spots with molecular weights [MW] ranging from 10 to 100 KDa and isoelectric points [pI] ranging from 3.5 to 9.5. This pattern contained 6-7 major proteins, some of which as protein groups consisted of several spots. The results of immunoblots revealed that several protein spots with different MW and pI, were stained with all three groups of patients. sera but some proteins were stained only with one or two groups of sera. The protein spot with MW of 30 KDa reacted with sera of only two groups of patients; gastritis and gastric cancer; the protein with MW of 18 KDa reacted only with sera of gastritis patients. These proteins can be potential candidates for recognition of the type of gastric disorder. In addition, the results indicated that protein profiles of H. pylori, isolated from gastric cancer and peptic ulcer, are more similar to each other, comparing to that of gastritis patients

continuing dilemma of hyperinvasive strongyloidiasis syndrome: a case report and review of literature

A 28-year-old man from Bangladesh was admitted to Al-Jahra Hospital in Kuwait with an Addison's crisis after suddenly stopping steroids prescribed for uveitis. His hospital stay was further complicated by severe gastritis, peritonitis and meningitis. Investigations revealed Strongyloides stercoralis in the sputum, stomach aspirate and duodenal mucosa. The patient died in spite of intensive treatment. The problem of hyperinvasive strongyloidiasis syndrome is reviewed

Endoscopic findings in children on non-steroidal anti-inflammatory drugs [NSAIDs]

Non-steroidal anti-inflammatory drugs [NSAIDs] remain as the initial approach to the pharmacologic management in juvenile rheumatoid arthritis [JRA]. Gastrointestinal [GI] damage associated with NSAIDs is common in adults, but there are few studies available in children. This study was performed to determine the GI complications due to the use of NSAIDs in a cohort of JRA patients by endoscopy. Twenty-one patients with JRA who were using NSAIDs for at least 3 months were assessed clinically and by endoscopy at Pediatric Immunology Clinic of Nemazee Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, southern Iran from June 1999 to June 2003. The mean age of the patients was 9.8 years [11 females], and the mean duration under NSAIDs management was 16 months. The most common NSAIDs used was diclofenac. GI symptoms were found in 42.9% of patients including 33.4% abdominal pain and 9.5% vomiting. There was no significant difference between the patients and symptoms free subjects in regard to mean duration of treatment. Macroscopic endoscopic lesions were found in 85.7% and infection of Helicobacter pylori [Hp] in 14.3% of cases. There was no significant relationship between endoscopic findings and duration of treatment or clinical symptoms. Our data showed that patients using NSAIDs had frequent GI damage without any relationship to the duration of treatment. There were also a high number of children with GI damage and without any clinical complaint. Furthermore, we found no significant relationship between the duration of drug use and the GI complaints, and no relation between duration and GI complaints to upper GI tract endoscopic lesions. The possibility of GI derangements with NSAIDs in pediatric age group is high. Close monitoring of symptoms and prevention measures are suggested

Immunological study of the serum complement and other serological parameters in correlation to histopathology in helicobacter pylori Infection

Nowadays, Helicobacter pylori is considered to be the most common human bacteria in the pathogenesis of chronic gastritis and peptic ulcer disease It causes systemic and local immune response, till now little references regarding the immune status and role of complement in H pylori infection have been reported. This study was designed to clarify any underlying role of the complement in the pathogenesis of H. pylori -chronic gastritis and peptic ulcer. From November 2003 to January 2005, 105 patients with gastritis and peptic ulcer, compared with control group of 25 patients, were underwent upper GIT endoscopy and biopsy. Histopathological examination of all gastric antral biopsies and serological tests [EIA] of serum samples for serum Anti H. Pylori antibody, C3, C4 complement components and total serum IgG essay were done. High serum level of complement component C3 and C4 has also been reported among the study group rather than control group [47.2% and 43.6% Vs 0%] and among H. pylori positive gastritis than H. pylori negative gastritis with a significant difference between two group [p<0.005]. Both C3 and C4 were well correlated to grade of gastritis, level of Anti-H pylori antibody and the density of H. pylori infection as well as the more severe clinical presentations. Conclusion: C3,C4 complement are well correlated to the level of Anti- H. pylori antibody in H. pylori positive gastritis patients and serum assay of C3 and C4 complement beside Anti- H. pylori antibody could be considered as screening tests for assessment of H. pylori infection. Lastly, these results confirmed the postulated role of C3 and C4 complements in the pathogenesis of H. pylori associated gastritis and peptic ulcer. Up to this time we didn't find any published paper concerned with the correlation of Complement and anti H. pylori infection in Iraq and surrounding areas

Histopathologic changes in patients with H. pylori positive chronic gastritis, before and after treatment

To evaluate histopathologic changes, between pre and post anti-Helicobacter pylori treatment using three different modalities, 108 patients with duodenal ulcer and H. pylori positive chronic gastritis were selected. Biopsies for histopathology and rapid urease test were taken from antrum and body and fundus regions, before and after treatment. Histopathologic evaluation was based on updated Sydney System. H. pylori in 45 of 108 patients [41.7%] became histologically eradicated, however rapid urease test was negative in 83 patients [76.8%]. The grade of gastritis and mean eosinophilic infiltration count were significantly decreased on post treatment biopsies in both eradicated and non eradicated patients [P value = 0.000,0.005 and 0.000,0.032 respectively]. Active inflammation was resolved in both eradicated and non eradicated groups [P Value = 0.000 and 0.002 respectively]. Density of H. pylori was significantly decreased in non eradicated group. Changes in atrophy and intestinal metaplasia were not statistically significant due to inadequate patients number, suffering from atrophy and/or intestinal metaplasia. Eradication of H. pylori is accompanied by significant histopathologic improvement. To evaluate reversibility of atrophy and intestinal metaplasia, larger study groups is needed. In comparison with histopathology, rapid urease test has low sensitivity

[Study of the CagA gene prevalence in helicobacter pylori strains isolated from patients with upper gastrointestinal disorders in Iran]

Helicobacter pylori commonly is associated with gastritis: but only sometimes it causes clinically significant diseases such as gastric and duodenal ulcer. The development of disease depends on the virulence of the infecting H. pylori strain, the susceptibility of the host, and environment co-factors. The cytotoxin associated protein encoded by cagA gene is an important virulence factor that is produced by some H. pylori strains, and has been used as virulence marker in some populations. The aim of the study was to examine the prevalence of cagA gene in the isolated strains of H. pylori from patients with dyspeptic disease and to investigate the association of cagA gene and the severity of H. pylori related diseases in Iran. In this study, biopsy specimens were obtained from the antrum of 180 patients. After isolation of H. pylori and its DNA by standard methods, polymerase chain reaction [PCR] technique was used for detection of cagA bacterial gene. 92 out of the 180 patients had H. pylori strains. 70% were cagA gene positive. All patients with peptic ulcer [100%] and 44 out of 72 [61%] patients with non-ulcer dyspepsia were cagA positive [p<0.01]. There was significant difference in frequency of cagA gene in peptic ulcer disease and non-ulcer dyspepsia [p<0.01]. It showed that the risk of PUD in patients with cagA+ H. pylori infection may be higher than in those with cagA- H. pylori infection

Study of helicobacter pylori infection in children and adolescents with recurrent abdominal pain

Recurrent abdominal pain [RAP] is a common pediatric diagnostic problem. An organic etiology can be found in only 10% of cases. Because infection with helicobacter pylori [H. pylori] in adults and children results in gastritis, a causative role for the organism has been postulated. The study was designed to compare the prevalence of H. pylori infection in children with RAP with healthy asymptomatic children and to investigate the related symptoms and some risk factors for acquisition of infection. Cases were 70 children presenting with RAP, controls were 20 healthy children. A standard questionnaire was used to gather social, demographic and full clinical information on each participant. The new non-invasive H. pylori antigen stool test was used to assess the infection status. Twenty seven [38.6%] children tested positive for H. pylori in the RAP group as compared to 30% in the controls [p=0.03] with no significant difference. Sixteen children were found to have other organic cause i.e giardiasis, amebiasis, worm infestation and urinary tract infection. No significant difference was detected comparing H. pylori positive children with the negative ones with respect to abdominal pain characteristics. Only nocturnal awakening was more common in H. pylori positive children. The presence of H. pylori was associated with both parents being born in a country with a high prevalence of infection, living in joint families with more family members and low social class. The study concluded that the prevalence of H. pylori infection in children with RAP is comparable to that of healthy children and it is not associated with RAP. No specific symptomatolgy could be attributed to H. pylori infection in children. Large compound families with overcrowding, bed sharing and low social level are risk factors for H. pylori infection