Úlcera gastroduodenal isquémica como complicación de la quimioembolización transarterial hepática de hepatocarcinoma / Ischemic gastroduodenal ulcer as a complication of hepatic hepatocarcinoma transarterial chemoembolization

La quimioembolización transarterial hepática es uno de los tratamientos del carcinoma hepatocelular irresecable en el que se han descrito de forma infrecuente lesiones isquémicas asociadas. Ante la aparición de sintomatología gastrointestinal alta inusual o que exceda el denominado síndrome postquimiembolización tras el procedimiento debe valorarse la realización de una gastroscopia para descartar la aparición de dichas complicaciones. Las variantes anatómicas con origen común de arterias gástricas y hepáticas pueden favorecer la migración de las microesferas hacia territorio gástrico obligando a valorar la eventual modificación de la técnica para prevenirlo.

Transarterial hepatic chemoembolization is one of the treatments of unresectable hepatocellular carcinoma in which associated ischemic lesions have been described infrequently. When unusual upper gastrointestinal symptoms or exceeding the so-called post-chemoembolization syndrome after the procedure, the performance of a gastroscopy should be assessed to rule out the occurrence of these complications. The anatomical variants with common origin of gastric and hepatic arteries can favor the migration of the microspheres into gastric territory, forcing the possible modification of the technique to prevent it.

Tratamiento endoscópico del sangrado digestivo alto por úlcera péptica / Endoscopic treatment of the high digestive bleeding by peptic ulcer

RESUMEN Introducción: la hemorragia digestiva alta ocurre por una lesión sangrante localizada entre el esfínter esofágico superior y el ángulo de Treitz. Objetivo: determinar el comportamiento del tratamiento endoscópico del sangrado digestivo alto por úlcera péptica, en el departamento de Gastroenterología del Hospital Universitario Comandante "Faustino Pérez". Materiales y métodos: se realizó un estudio descriptivo, prospectivo para evaluar el resultado del tratamiento endoscópico en el sangrado digestivo alto por úlcera péptica en el Hospital Universitario Comandante "Faustino Pérez" de Matanzas, de enero del 2016 a febrero del 2018. El tratamiento endoscópico fue la inyectoterapia con epinefrina al 1:10000. Se analizaron las variables: grupo de edades, sexo, resultado del tratamiento endoscópico, estigmas endoscópicos de sangrado, recidiva hemorrágica, mortalidad directa, necesidad de cirugía, estadía hospitalaria y cantidad de unidades transfusionales. Resultados: se constató un predominio de pacientes masculinos (87.5 %), menores de 60 años (70%). Prevalecieron los pacientes con estigmas endoscópicos de sangrado activo venoso (45%). La terapia endoscópica tuvo un resultado satisfactorio (92.5%) en su mayoría. La ocurrencia de resangrado (45%), mortalidad directa por hemorragia digestiva, promedio de estadía hospitalaria, cantidad de unidades transfusionales y necesidad de intervención quirúrgica de urgencia (17.5%), resultó similar a los estudios reportados, demostrando que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas. Conclusiones: la mayoría de los casos tratados con inyectoterapia endoscópica tuvieron un sangrado activo venoso o Forrest IB que fue satisfactoria. La inyectoterapia no satisfactoria fue en pacientes con sangrado activo. La mortalidad directa relacionada con el sangrado fue infrecuente y en relación con el sangrado arterial. Se demostró que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas (AU).

SUMMARY Introduction: high digestive bleeding happens due to a bleeding lesion located between the upper anatomical sphincter of the esophagus and the angle of Treitz. Objective: to determine the endoscopic treatment behavior of high digestive bleeding caused by peptic ulcer, in the department of Gastroenterology of the University Hospital "Comandante Faustino Perez". Materials and methods: a prospective descriptive study was carried out to evaluate the result of the endoscopic treatment in high digestive bleeding caused by peptic ulcer in the University Hospital "Comandante Faustino Perez", of Matanzas, from January 2016 to February 2018. The endoscopic treatment was injecto-therapy with epinephrine at 1:10000. The analyzed variables were: age group, sex, result of the endoscopic treatment, bleeding endoscopic stigma, hemorrhagic relapse, direct mortality, surgery necessity, hospital staying, and quantity of transfusion units. Results: male patients (87.5 %), aged less than 60 years predominated. Patients with endoscopic stigma of venous active bleeding (45 %) prevailed. In most of cases, endoscopic therapy achieved satisfactory results (92.5 %). The authors found that bleeding relapse (45 %), direct mortality by digestive hemorrhage, average hospital staying, quantity of transfusion units and necessity of urgent surgeries (17.5 %) were similar to those reported in other studies. Conclusions: most cases treated with endoscopic injectotherapy had active venous or Forrest IB bleeding and treatment was satisfactory. Therapy was unsatisfactory in patients with active bleeding. The direct mortality related to bleeding was infrequent, and related to arterial bleeding. It was showed that endoscopic injectotherapy is still an efficacious option if other endoscopic therapies are not available (AU).

ETIOPATHOGENESIS OF PEPTIC ULCER: back to the past? / Etiopatogenia da úlcera péptica: de volta ao passado?

Objectives To review some aspects of the etiopathogenesis of peptic ulcerous disease especially on the basis of studies on its correlation with Helicobacter pylori (H. pylori). Methods A search was made in the data bases MEDLINE, LILACS and PubMed, and in Brazilian and foreign books, referring to the incidence and prevalence of infection by H. pylori and of peptic ulcerous disease in various populations of different countries. Results It was observed that the prevalence of H. pylori infection is similar in individuals with peptic ulcerous disease and the general population. There are differences between countries with respect to the prevalence of infection and of gastric or duodenal peptic ulcers. In many countries the prevalence of infection by H. pylori shows stability while the prevalence of peptic ulcerous disease is declining. The prevalence of peptic ulcerous disease without H. pylori infection varies between 20% and 56% in occidental countries. Discussion The observations might be suggestive of H. pylori being only one more factor to be summed together with other aggressive components in the genesis of peptic ulcerous disease. We would therewith be returning to the classic concept that peptic gastric and duodenal ulcers have multifactorial etiology and would result from imbalance between aggressive and defensive factors. The focus of studies should be enriched with the identification of the defensive factors and of other aggressive factors besides the well known H. pylori and non-steroidal anti-inflammatory drugs, since these two aggressors do not exhaust the full causal spectrum. .

Objetivos Revisar a etiopatogenia da doença ulcerosa péptica com base em revisão de estudos sobre a correlação entre Helicobacter pylori (H. pylori) e doença ulcerosa péptica. Métodos Foi realizada busca nas bases de dados MEDLINE, LILACS e PubMed, e em livros brasileiros e estrangeiros referentes à incidência e prevalência de infecção pelo H. pylori e de doença ulcerosa péptica em várias populações de diferentes países. Resultados Observamos que a prevalência da infecção pelo H. pylori é semelhante em indivíduos com doença ulcerosa péptica e a população geral; que existem diferenças entre países no que tange as prevalências de infecção e a de úlceras péptica gástrica e duodenal e que, em muitos países, a prevalência de infecção pelo H. pylori se mantém estável, enquanto a prevalência de doença ulcerosa péptica está em queda. A prevalência de doença ulcerosa péptica na ausência de infecção pelo H. pylori varia de 20% a 56% nos países ocidentais. Discussão As observações sugerem que o H. pylori constituiria somente mais um fator a ser somado ao rol dos agressores na gênese da doença ulcerosa péptica. Assim, estaríamos retornando ao conceito de que as úlceras pépticas, gástrica e duodenal, têm etiologia multifatorial e decorreriam, como era admitido no passado, do desequilíbrio entre fatores agressivos e defensivos da mucosa. O foco dos estudos deveria ser redirecionado à identificação dos fatores defensivos e de outros fatores agressivos além dos bem conhecidos H. pylori e medicamentos anti-inflamatórios não-esteróides, desde que esses dois agentes não cobrem todo o espectro ...

Helicobacter pylori Infection in Nonsteroidal Anti-inflammatory Drug Users / 대한소화기학회지

NSAID-induced upper gastrointestinal (GI) damage occurs easily in people with a prior history of complicated or uncomplicated ulcers. Many recent clinical studies have proved the benefit of Helicobacter pylori eradication in NSAID users; however, the exact pathophysiologic relationship between concomitant H. pylori infection and NSAID use has not yet been fully elucidated. Testing and eradication of H. pylori are generally recommended in patients who are at a high risk for NSAID-induced GI damage. However, in high-risk patients, ulcer prophylaxis with proton pump inhibitor or misoprostol is needed even if H. pylori has been successfully eradicated. In low-risk patients, it is still questionable whether or not eradication of H. pylori can reduce upper GI damage. However, in western countries, due to its cost effectiveness, testing and eradication of H. pylori is recommended before starting aspirin or NSAID irrespective of the risk level. In regions with a high prevalence of H. pylori infection (>20%), the usefulness of testing and eradication of H. pylori has not yet been determined.

Comportamiento higiénico-sanitario de pacientes con diagnóstico de úlcera gastroduodenal por Helicobacter pylori / Hygienic-sanitary behavior of patients diagnosed with gastroduodenal ulcer caused Helicobacter pylori

Introducción: actualmente la infección por Helicobacter pylori constituye la infección crónica más extensamente difundida en la especie humana, la cual puede cursar como síndrome dispéptico funcional u orgánico, gastritis, úlcera gastroduodenal y con síntomas subjetivos de cáncer gástrico. Diferentes estudios epidemiológicos cifran prácticamente en el 95 por ciento de los casos la asociación entre úlcera duodenal e infección por Helicobacter pylori. Objetivo: describir el comportamiento de algunas variables higiénicas-sanitarias en pacientes con úlceras gastroduodenales por Helicobacter pylori. Métodos: se realizó un estudio descriptivo y prospectivo de corte transversal a 908 pacientes con diagnóstico de úlcera péptica y positiva al test rápido de ureasa, en el período comprendido desde enero de 2007 hasta diciembre de 2008, en el Centro de Diagnóstico Integral del municipio Rafael Urdaneta, estado Miranda, República Bolivariana de Venezuela. Resultados: predominaron los pacientes que mantenían una higiene alimentaria inadecuada; los que no hervían el agua para tomar; y los que compartían los cubiertos sin previo lavado, elementos que pueden favorecer la infección por Helicobacter pylori. Conclusiones: hay estrecha relación entre la infección por Helicobacter pylori y el hábito higiénico, siendo más frecuente en los pacientes con hábito higiénico inadecuado...

Introduction: the present infection caused by Helicobacter pylori is the most spread chronic infection in the human species, which could also appear as functional or organic dyspeptic syndrome, gastritis, gastroduodenal ulcer and subjective symptoms of gastric cancer. Several epidemiological studies reveal that practically 95 percent of cases are associated to duodenal ulcer and H.pylori infection. Objective: to describe the behavior of some hygienic-sanitary variables in patients suffering H.pylori gastroduodenal ulcers. Methods: a prospective cross-sectional and descriptive study was conducted in 908 patients diagnosed with peptic ulcer after positive rapid urease test in the period of January 2007 through December 2008 at the Integral Diagnosis Center of Rafael Urdaneta municipality in Miranda state, Bolivarian Republic of Venezuela. Results: the patients who exhibited poor food hygiene, who did not boil drinking water and who shared unwashed cutlery prevailed. Those elements may favor H.pylori infection. Conclusions: close association between H. pylori infection and hygienic habits was found, being more frequent in patients with bad hygienic habits...

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)

Tratamientos convencionales y medicina alternativa de la úlcera péptica / Conventional treatment and herbal medicine for peptic ulcer

Entre las enfermedades que afectan al hombre y provocan alteraciones en su vida individual y social se encuentra la úlcera péptica, muy frecuente en casi todos los países del mundo. La úlcera péptica viene asociada generalmente al consumo de antiinflamatorios no esteroidales o a la infección por Helicobacter pylori, por lo que el tratamiento farmacológico difiere entre un caso u otro. Se tienen en cuenta varios aspectos como: la posibilidad de los fármacos antiulcerosos de interaccionar con otros principios activos y alimentos, además de los efectos no deseados que se presentan; los tratamientos de triples y cuádruples terapias que constituyen una limitante para el paciente por el gran número de medicamentos a administrar; y por último, el actual incremento de la resistencia antibiótica, se hace necesario la búsqueda de otras alternativas para el control de esta enfermedad. Un nuevo camino que brinda grandes posibilidades es la medicina alternativa, es decir, los fitofármacos

Peptic ulcer is one of the diseases affecting humans and causing changes in their individual and social life. It is very common in almost every country in the world. Peptic ulcer is usually associated to the consumption of non-steroidal anti-inflammatory or to Helicobacter pylori infection; hence, the drug treatment differs from one case to another. Various aspects such as the possibility of anti-ulcer drugs to interact with other active ingredients and foodstuffs, the adverse effects, the application of three or four therapies that bother the patient because of the the large number of drugs to be taken, and finally the current increased antibiotic resistance were taken into consideration. It is necessary to search for alternatives to control this disease. The alternative medicine, i.e. the herbal medicine offers new possibilities of treatment

Effect of Zinc Salts on Acid Secretion and Peptic Ulceration in Albino Rats.

The present study was carried out to see the effect of two zinc salts i.e zinc sulphate and zinc chloride on gastric ulcers induced by stress, pylorus ligation and aspirin in albino rats. The rats were divided into two main groups (zinc sulphate 30, 60, 90 mg/kg i.p and zinc chloride 10 and 20mg/kg i.p). They were further sub-divided into three sub-groups dependant on ulcer model i.e stress, pylorus ligation and aspirin induced ulcers. It was found that zinc sulphate and zinc chloride had a dose dependant reduction in ulcer index in all three models of gastric ulceration. Also, both the salts had anti acid secretory effect, raised pH of gastric secretion and reduced total acidity significantly. Thus zinc salts prevent gastric ulceration. Probably this effect is mediated by anti acid secretory action.

Prevalence of H. pylori

Acid peptic disease is a world wide problem among all the age groups and both sexes. Duodenal ulcer is common as compared to gastric ulcer. Its prevalence being 4:1 in USA and UK and 5:1 in Pakistan. Etiology of peptic ulcer is almost certainly multi-factorial. Basic paradigm for ulcer disease is the imbalance between the digestive activity of acid and pepsin and the protective mechanism in place to resist mucosal digestion. Over the past few years a new line of thought has been evolved after isolating spiral campylobacter like organism from antral biopsy specimens. H pylori is now considered to be an important if not the only causative agent of gastritis and peptic ulcer disease. The dictum; No acid - No ulcer summarized the pathogenesis of peptic ulcer disease but new dictum seems to be; No H. pylori -No ulcer, as over 90% of Duodenal ulcer and 70% of Gastric ulcer patients are infected by H. Pylori. Aim of the study was to evaluate the prevalence of H. pylori among duodenal ulcer patients at Faisalabad District and its suburbs. Descriptive Study. From Mar 2008 to Oct 2008. 50 patients [40 males, 10 females] belonging to Faisalabad District and surrounding areas with upper gastrointestinal symptoms of acid peptic disease and endoscopy proved duodenal ulcer were subjected to gastric antral mucosal biopsies for evaluation of the H. Pylori status with the help of unease test and histological examination of biopsy specimen. Epigastric pain was the most frequent symptom 90%. [46 out of 50 patients]. 92% showed evidence of H. pylori infection. Maximum incidence of H. pylori was recorded in age group IV [46-55 years]. Maximum number of patients was skilled workers [35 out of 50] 70%. 80% of the patients belonged to lower and middle class. Percentage of H. pylori positivity was 89.1% and 84.34%. Acceptance of contributory role and high prevalence rate of H. pylori instigates us for addition of antimicrobial treatment to the conventional treatment with H2 Blockers and PPls which is cost effective and alter the course of the disease

Examination of Geographical, Clinical and Intrahost Variations in the 3' Repeat Region of CagA Gene in Helicobacter pylori

The size variation of the cytoxin-associated protein (cagA), which is dependent on the 3' repeat region (3'RR) of the cagA gene, is known to play a crucial role in the pathogenesis of Helicobacter pylori infection. The present study evaluated the relationship between the 3'RR variation and the geographic distribution, clinical manifestations, and locations of colonization in the stomach. We evaluated the 3'RR of H. pylori isolates from 78 patients with gastric cancer, peptic ulcer, and non-ulcer dyspepsia from Japan, Hong Kong, India, and the United States and assessed the variations of 3'RR according to the geographical and clinical characteristics. Sixty eight (87.2%) patients had the same 650 bp band without geographical differences. The frequency of polymorphisms in the 3'RR did not differ when compared to the clinical manifestations (P=0.868). The length of 3'RR did not differ by location of colonization. In conclusion, the 3'RR variation of cagA gene is not associated with the geographical and clinical characteristics of the patients studied.

Hemorragia digestiva alta: estado actual del diagnóstico y tratamiento / Upper gstrointestinal bleending: present status of the diagnosis and treatment

Se actualiza la metodología diagnóstica y la conducta y tratamiento más aceptados de las dos causas más frecuentes de hemorragia digestiva alta de carácter grave. En la úlcera péptica, gástrica o duodenal, después de la reposición inicial del primer y principal método diagnóstico y terapéutico es la endoscopía digestiva alta. La cirugía sólo está indicada cuando fracasa el intento de hemostasia endoscópica. En la hemorragia varicel las sustancias vasoactivas, en especial, la somastotatina o sus derivados, se emplean como tratamiento inicial mientras se realiza la reposición de la volemia. En la urgencia la hemostasia endoscópica con esclerosis o bandas elásticas es el tratamiento de primera línea y el más empleado para controlar la hemorragia y prevenir la recidiva. Controlado el episodio inicial, el alto riesgo de resangrado obliga a un tratamiento definitivo como profilaxis de la recidiva hemorrágica, puede ser endoscópico para erradicación de las várices, farmacológico con bloqueadores beta o quirúrgico, incluyendo el trasplante hepático.

Upper gastrointestinal (GI) bleending is a common clinical problem that requires frequent hospitalization, and sometimes originates a life-frequent hospitalization, and sometimes originates a life-threatening condition. The mortality rate, estimated to be 5 % to 10 %, has been relatively stable. In view of the aging population and the higher mortality of bleeding in the elderly, this may represent a slight improvement in mortality. In tis report, the authors describe the diagnostic methodology, the management and treatment most commonly accepted of the bleeding. For the peptic ulcer - gastric or duodenal - following the initial replacement of blood volumen, the first and main diagnostic and therapeutic procedure is the upper GI endoscopy. Surgery is only suggested when the endoscopic hemostasia fails. For variceal hemorrhages, vasoactive drugs, mainly somatostatin or their derivates, are employed as the initial treatment, meanwhile the transfusion requirements are used for restoration of blood volume. Continued bleeding or recurrent bleeding are indications for endoscopic therapy. Early surgical treatment should be considered for patients with persistent or recurrent bleending from ulcers that have failed endoscopic therapy. Variceal bleending has a high mortality. The patient's condition must be stabilized and requires replacement of blood volume. Acute bleending may be managed by endoscopic sclerotherapy, vasopressin infusion, compression of varices thanshepatically, or by emergency surgery. Once varice have stopped bleeding, a definitive procedure is in order to prevent recurrence of hemorrhage with the use of pharmacologic agents, B-andrenergic blockade or surgical, including liver transplantation. The indications for urgent surgery in GI bleending have remained essentially the same, except that now endoscopic therapy may be tried as the first approach.

Migraine headache and acid peptic diseases in children

Although there are some studies on correlation between migraine headache and GI symptoms, they did not significantly support the correlation between migraine headache and acid peptic diseases. This case control study aimed to find such a correlation. There were 70 patients [5-15 years old] who had endoscopic documented acid peptic diseases. The frequency of migraine headache in this group and also in a group consisting of a sample of normal population [300 individuals] without any GI problem in the past year was determined by a questionnaire. The frequency of migraine headache was determined in each kind of acid peptic disease in the patients, being 92.9%, 68.6%, 24.3%, 4.3%, and 4.3% among patients with gastritis, esophagitis, doudenitis, gastric ulcer, and duodenal ulcer, respectively. The frequencies of migraine headache among the normal population and acid peptic disease group were 11.3% and 22.9%, respectively. The difference was found to be statistically significant. Our findings showed a significant correlation between migraine headache and acid peptic diseases, especially esophagitis and gastritis. This result accords with that in some of the previous studies

The Changes in Prevalence and the Related Factors of Helicobacter pylori Infection in Korean Health Check-up Subjects during 8 Years / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to evaluate the changes in prevalence and the related factors of Helicobacter pylori (H. pylori) infection in Korean health check-up subjects during the period of 8 years. METHODS: Among 89,231 subjects who visited the Health Promotion Centers of Severance hospital or Chung-Ang University hospital from Jan. 1998 through Dec. 2005, a total of 10,553 subjects who received esophagogastroduodenoscopy (EGD) and H. pylori test were enrolled. H. pylori infection was assessed by histologic examination. Changes of the prevalence of H. pylori infection during 8 years, and infection-related factors such as demographic characteristics, body mass index, ABO blood types, endoscopic findings (presence of peptic ulcer diseases), educational level, economic status, smoking habits, and alcohol intake in year 2005 were analyzed. RESULTS: The mean age of 10,553 subjects (7,329 men, 3,224 women) was 49.7+/-10.4 years (range from 17 to 92 years). The prevalence of H. pylori infection at the first, second, third, fourth, fifth, sixth, seventh, and eighth year were 64.7%, 58.1%, 54.2%, 50.4%, 48.9%, 49.5%, 39.6%, and 40.0%, respectively, and these serial decreases in prevalence over 8 years were statistically significant (p<0.001). Regardless of sex, age or EGD findings, the prevalence of H. pylori infection was significantly decreased. In the analysis of the H. pylori infection-related factors in 2005, only age and EGD findings (peptic ulcer diseases) were significant factors. CONCLUSIONS: The prevalence of H. pylori infection was significantly decreased during 8-year period in Korean health check-up subjects. Age and peptic ulcer diseases were the two significant factors related to H. pylori infection in Korea.

[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

Studying of the helicobacter pylori vacA cytotoxin gene prevalence by PCR technique among the Iranian patients with gastroduodenal disorders

Helicobacter pylori is a major etiological agent in gastro-duodenal disorders, and has spread in the world. The prevalence of infection with H. pylori is more than 80% in some populations, but only 10% to 20% of them are infected with this organism. Also infection with this pathogen is associated with peptic ulcer disease [PUD], Gastritis [G], Duodenitis [Du], and non-ulcer dyspepsia [NUD]. The development of diseases depends on the virulence of the infecting H. pylori strain and the susceptibility of the host. The vacuolating cytotoxin and the cytotoxin associated protein, encoded by vacA and cagA genes are important virulence determinants of H. pylori which are divided into different pathogenic types, to cause varities of infections. This may be used as a marker of infection and could be used to distinguish between pathogenic and nonpathogenic strains of H. pylori in Iran. The aim of this study was to assess the prevalence of vacA genotype of H. pylori and its development of PUD, G, Du, and NUD from Iranian patients who were admitted to Hazrat Rasoul Akram [peace upon him] as an educational and research society, affiliated to Iran University of Medical Sciences and Health Services [IUMS] in Tehran, Iran. During this study specimen biopsies were collected from 180 patients who underwent routine gastrointestinal endoscopies to the internal medicine ward, Hazrat Rasoul Akram Hospita, LIUMS, Tehran, Iran. Positive H. pylori strains were identified by cultured isolates, standard biochemical methods, and molecular typing was performed by PCR technique to detect vacA gene and its alleles. In this study out of 180 samples of 93 H. pylori strains were isolated and identified by biochemical tests, the PUD, G, Du and NUD were 79%, 60%, 90% and 30% respectively. 87 [94%] strains contained vacA gene and the predominant genotypes are in the vacA gene. Also 59 [64%] strains had displayed the sl/m2 genotype. 57 [625] strains were classified as type 1, 31[33%] strains were type IV, 3 [3.26%] strains were type II, and 2[2.17% strains were type III. The significant difference [P<0.01] between type I and type IV isolated strains from PUD [62% type I] showed that type I strains are more pathogenic than type IV strains

Helicobacter pylori and peptic ulcer in cirrhotic patients

H.pylori infection increases the risk of peptic ulcer in cirrhotic patients. The role of H.pylori in inducing peptic ulcer disease in chronic liver disease patients remains controversial. The objective was to see if etiology of peptic ulcer in cirrhotic patients is related to H.pylori infection. Sixty cirrhotic patients were enrolled in the study. Peptic ulcer was detected in patients by means endoscope. Sera from patients were tested for Helicobacter pylori antibodies by a commercial ELISA kit. t student and fisher test was used for statistical analysis. Active peptic ulcer was detected in nine cirrhotic patients. Of the nine patients with peptic ulcer eight [88.9%] tested positive for Helicobacter pylori antibodies and of the remaining 51 patients, 31[60.8%] tested positive for Helicobacter pylori antibodies. Helicobacter pylori infections in our series of cirrhotic patients with peptic ulcer seems to show the same pattern as described in cirrhotic patients without peptic ulcer [P=0.078]. The suggestion that the etiology of the peptic ulcer in cirrhotic patients could be related to Helicobacter pylori infection was not confirmed by our study

Prevalence of helicobacter pylori Cag E genotypes, in patients with non-ulcer dyspepsia, peptic ulcer and gastric carcinoma

Helicobacter pylori are a bacterial pathogen evolved to chronically colonize the gastric epithelium and causes gastritis, peptic ulcers, and even gastric malignancies in few infected humans. More recently, a pathogenicity island has been identified within the H. pylori genome that contains a cluster of genes, including cagE. The aim of the current study was to investigate the prevalence of cagE genotypes of H. pylori isolates from patients with NUD[Non Ulcer Dyspepsia], peptic ulcer and cancer. 150 Gastric biopsy specimens obtained from patients were inoculated onto a Brucella Columbia Agar containing 5% sheep for 3 to 5 days at 37°C under micro aerobic conditions [5% O2, 5% CO2, and 90% N2]. After DNA extraction, genotyping of the cagE gene was performed by PCR amplification using the primers. PCR products were separated by 1% agarose gel electrophoresis and examined under UV illumination. Of 92 positive cultures, 34, 28, 20, and 10 isolations were obtained from patients with NUD, duodenal ulcers [DU], gastric ulcers [GU] and gastric cancer [GC], respectively. The frequency of cagE gene was 88/24%, 100%, 85%, 100% and within isolates of patients with NUD, DU, GU and GC, respectively. The presence of cagE in patients with Helicobacter pylori infection is not a marker for predicting or diagnosing the resultant diseases

Comportamiento de Úlcera Péptica en pacientes del Hospital Mario Muñoz / Peptic Ulcer behavior in patients from the Hospital Mario Muñoz Monroy

La patología ulcerosa péptica resulta frecuente en nuestro medio por lo que es causa común de consulta en los servicios de Cirugía y Gastroenterología y el conocimiento a fondo de su comportamiento es vital para su mejor diagnóstico y tratamiento, lo que nos motivó a realizar un estudio observacional descriptivo retrospectivo en los pacientes aquejados de tal afección atendidos en el hospital Mario Muñoz Monroy del municipio de Colón, provincia Matanzas, en el período comprendido desde febrero del 2002 hasta mayo del 2005. Las variables analizadas fueron edad, localización de la úlcera, forma de presentación del sangramiento digestivo alto y antecedentes patológicos personales, datos obtenidos de las historias clínicas y analizados por estadística descriptiva, siendo los principales resultados: La úlcera gástrica y la úlcera duodenal predominaron en el grupo etáreo de 46 a 60 años (17,1 por ciento y 23,1 por ciento). Se presentaron mayor cantidad de úlceras duodenales que gástricas (66,3 por ciento). Los antecedentes patológicos personales que con mayor frecuencia se asociaron a la presencia de úlcera péptica fueron en orden decreciente: historia de enfermedad ulcerosa péptica, consumo de alcohol, uso de anti-inflamatorios no esteroideos.

Peptic Ulcer pathology is frequent in our settings and a common cause of consultation in the Surgery and Gastroenterology services, because the deepest knowledge of its behavior is vital for its better diagnosis and treatment, which motivated us to carry out a descriptive, retrospective, observational study in patients suffering such affection at the hospital Mario Muñoz Monroy of the municipality of Colon, Matanzas, during the period from February 2002 to May 2005. The analyzed variables were: age, localization of the ulcer, presentation form of digestive high bleeding and personal pathological background , data obtained from clinical records and analyzed by descriptive statistics , being the main results: the gastric ulcer and the duodenal ulcer predominated in the age group from 46 to 60 years ( 17, 1% and 23, 1% ). There was more quantity of duodenal ulcers than gastric (66, 3%). The personal pathological backgrounds more frequently associated with the existence of peptic ulcer were, in diminishing order: history of ulcerous peptic illness, alcohol abuse and non-steroidal antinflammatory drugs´ use.

Anti-stress and anti-oxidant effects of roots of Chlorophytum borivilianum (Santa Pau & Fernandes).

The aqueous extract of C. borivilianum (250 mg/kg for 7 days) significantly reverted the elevated levels of plasma glucose, triglycerides, cholesterol and serum corticosterone and also reduced the ulcer index, adrenal gland weight more as effectively as the standard drug (diazepam) in rats. At 125 mg/kg po, it showed a mild anti-stress activity. Under in vitro 1,1-diphenyl-2-picrylhydrazyl (DPPH*) free radical scavenging assay and lipid peroxidation assay the extract considerably inhibited, in a dose-dependent manner, the levels of DPPH* free radicals and thiobarbituric acid reactive substances, respectively thus showing significant antioxidant property. The results suggested that it could be used for the treatment of oxidative stress-induced disorders.