To evaluate of the effect of adding licorice to the standard treatment regimen of Helicobacter pylori

ABSTRACT Objective: The aim of this study was to evaluate the effect of licorice in H. pylori eradication in patients suffering from dyspepsia either with peptic ulcer disease (PUD) or non-ulcer dyspepsia (NUD) in comparison to the clarithromycin-based standard triple regimen. Methods: In this randomized controlled clinical trial, 120 patients who had positive rapid urease test were included and assigned to two treatment groups: control group that received a clarithromycin-based triple regimen, and study group that received licorice in addition to the clarithromycin-based regimen for two weeks. H. pylori eradication was assessed six weeks after therapy. Data was analyzed by chi-square and t-test with SPSS 16 software. Results: Mean ages and SD were 38.8 ± 10.9 and 40.1 ± 10.4 for the study and control groups, respectively, statistically similar. Peptic ulcer was found in 30% of both groups. Response to treatment was 83.3% and 62.5% in the study and control groups, respectively. This difference was statistically significant. Conclusion: Addition of licorice to the triple clarithromycin-based regimen increases H. pylori eradication, especially in the presence of peptic ulcer disease.

Peptic ulcer frqquency differences related to h. pylori or aines / Diferentes frequências da úlcera péptica relacionadas com H. pylori ou AINES

Background Peptic ulcer etiology has been changing because of H. pylori decline. Objectives To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal anti-inflammatory drugs. Methods Records assessment in two periods: A (1997-2000) and B (2007-2010), searching for peptic ulcer, H. pylori infection and non-steroidal anti-inflammatory drugs use. Results Peptic ulcer occurred in 30.35% in A and in 20.19% in B. H. pylori infection occurred in 73.3% cases in A and in 46.4% in B. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000), increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000) and idiopathic peptic ulcer (P=0.002). The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002). Rates of gastric ulcer were higher and duodenal ulcer lower in the second period. Conclusions After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased. There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer. .

Contexto A etiologia da úcera péptica vem apresentando mudanças devido à redução da infecção pelo H. pylori. Objetivos Estimar a prevalência da úlcera péptica em dois períodos com intervalo de 10 anos e comparar a associação com a infecção pelo H. pylori com o uso de anti-inflamatórios não esteroides. Métodos Revisão de prontuários em dois períodos: A (1997-2000) e B (2007-2010), com busca por úlcera péptica, H. pylori e uso de anti-inflamatórios não esteroides (AINE). Resultados Úcera péptica apresentou frequência de 30,35% em A e 20,19% em B. Infecção por H. pylori ocorreu em 73,3% em A e em 46,4% em B. Uso de anti-inflamatórios não esteroides ocorreu em 3,5% em A e em 13,3% em B. Nenhuma dessas condições esteve associada em 10,4% e 20,5% das úlceras em A e B, respectivamente. Comparando os dois períodos, houve redução da úlcera péptica associada à H. pylori (P=0,000), aumento das úlceras associadas ao uso de anti-inflamatórios não esteroides (P=0,000) e aumento de úlceras idiopáticas (P=0,002). A associação concomitante de H. pylori e anti-inflamatórios não esteroides foi também mais alta em B (P=0,002). Úlceras gástricas aumentaram e úlceras duodenais diminuíram em B. Conclusões No intervalo de 10 anos, a prevalência de úlcera péptica diminuiu assim como as úlceras relacionadas com H. pylori e houve um aumento das úlceras associadas ao uso de anti-inflamatórios não esteroides. Houve inversão na frequência das lesões gástricas e duodenais e aumento da prevalência da úlcera idiopática. .

An overview of malaria transmission from the perspective of Amazon Anopheles vectors

In the Americas, areas with a high risk of malaria transmission are mainly located in the Amazon Forest, which extends across nine countries. One keystone step to understanding the Plasmodium life cycle in Anopheles species from the Amazon Region is to obtain experimentally infected mosquito vectors. Several attempts to colonise Ano- pheles species have been conducted, but with only short-lived success or no success at all. In this review, we review the literature on malaria transmission from the perspective of its Amazon vectors. Currently, it is possible to develop experimental Plasmodium vivax infection of the colonised and field-captured vectors in laboratories located close to Amazonian endemic areas. We are also reviewing studies related to the immune response to P. vivax infection of Anopheles aquasalis, a coastal mosquito species. Finally, we discuss the importance of the modulation of Plasmodium infection by the vector microbiota and also consider the anopheline genomes. The establishment of experimental mosquito infections with Plasmodium falciparum, Plasmodium yoelii and Plasmodium berghei parasites that could provide interesting models for studying malaria in the Amazonian scenario is important. Understanding the molecular mechanisms involved in the development of the parasites in New World vectors is crucial in order to better determine the interaction process and vectorial competence.

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 ...

Higher serum levels of rheumatoid factor and anti-nuclear antibodies in helicobacter pylori-infected peptic ulcer patients

H. pylori infection has been associated with some autoimmune disorders. The aim of this study was to evaluate the serum concentrations of rheumatoid factor and anti-nuclear antibodies in H. pylori-infected peptic ulcer patients, H. pylori-infected asymptomatic carriers and a healthy control group. A Total of 100 H. pylori-infected peptic ulcer patients, 65 asymptomatic carriers and 30 healthy H. pylori-negative subjects [as a control group] were enrolled into study. Serum samples of participants tested for the levels of rheumatoid factor and anti-nuclear antibodies by use of ELISA. The mean serum levels of rheumatoid factor and anti-nuclear antibodies in peptic ulcer group was significantly higher in comparison to the control group [p<0.05]. Although, the mean serum levels of rheumatoid factor and anti-nuclear antibodies in the asymptomatic carriers group was higher than those in the control group, the difference was not statistically significant. No significant differences were observed between peptic ulcer patients and asymptomatic carriers groups regarding the mean serum levels of rheumatoid factor and anti-nuclear antibodies. The mean serum levels of rheumatoid factor in men with peptic ulcer was significantly higher compared to the group of healthy men [p<0.05]. Although in female of peptic ulcer patients or asymptomatic carriers groups, the mean serum levels of rheumatoid factor was higher than that in healthy women, but the differences were not statistically significant. Also, no significant differences were observed between men and women with peptic ulcer, asymptomatic carriers control groups based on the serum levels of anti-nuclear antibodies. The results showed higher serum levels of rheumatoid factor and anti-nuclear antibodies in H. pylori-infected patients with peptic ulcer disease which represent the H. pylori-related immune disturbance in these patients. Additional follow-up studies are necessary to clarify the clinical significance of these autoantibodies in patients with H. pylori infection

Helicobacter pylori vacA and cagA genotypes in patients from northeastern Brazil with upper gastrointestinal diseases

Helicobacter pylori causes chronic gastric inflammation and significantly increases the risk of duodenal and gastric ulcer disease and distal gastric carcinoma. In this study, we evaluated the Helicobacter pylori vacA and cagA genotypes in patients from a Brazilian region where there is a high prevalence of gastric cancer. Polymerase chain reaction (PCR) was used to investigate vacA mosaicism and cagA status in the gastric mucosa of 134 H. pylori-positive patients, including 76 with gastritis: 28 with peptic ulcer disease and 30 with gastric cancer. The s1m1 variant was the predominant vacA genotype observed, whereas the s1 allele was more frequently observed in patients with more severe diseases associated with H. pylori infection [p = 0.03, odds ratio (OR) = 5.72, 95% confidence interval (CI) = 1.15-38.60]. Furthermore, all of the s1 alleles were s1b. Mixed vacA m1/m2 strains were found more frequently in patients with gastric cancer and a cagA-positive status was significantly associated with gastric cancer (p = 0.016, OR = 10.36, 95% CI = 1.35-217.31). Patients with gastric cancer (21/21, 100%, p = 0.006) or peptic ulcers (20/21, 95%, p = 0.02) were more frequently colonised by more virulent H. pylori strains compared to gastritis patients (41/61, 67.2%). In conclusion, in the northeastern of Brazil, which is one of the regions with the highest prevalence of gastric cancer in the country, infection with the most virulent H. pylori strains, carrying the cagA gene and s1m1 vacA alleles, predominates and is correlated with more severe H. pylori-associated diseases.

EPIYA motif patterns among Cuban Helicobacter pylori CagA positive strains / Patrón de los motivos EPIYA de cepas cubanas de Helicobacter pylori positivas para CagA

Introduction. It is known that polymorphisms in C-terminal region of CagA influence gastric disease development on Helicobacter pylori infection. Additionally, the geographic distribution of these polymorphisms has been associated with the appearance of more severe gastroduodenal pathologies. Objective. To determine the CagA phosphorylation motifs pattern (EPIYA pattern) in Cuban H. pylori isolates, and to study its association with patient´s pathologies. Materials and methods. DNAs from 95 H. pylori cagA-positive strains were used to amplify the 3´ variable region of cagA gene by PCR using two different strategies. Additionally, new primers were designed to identify either Western or Eastern CagAEPIYA motiftype by PCR. To confirm the PCR results, PCR products from 14 representative isolates were purified and sequenced Results. The distribution of the EPIYA motif found was: 2 AB (2.1 %), 1 AC (1.1 %), 1 BC (1.1 %), 70 ABC (73.6 %), 19 ABCC (20 %), and 2 ABCCC (2.1 %). Sequencing analysis confirmed the PCR classification in the 14 studied strains and showed three strains with unusual nucleotide sequences, not reported before. Distribution of the EPIYA-ABC pattern was equivalent in all pathologies (78.9 % in gastric ulcer, 72.5 % in duodenal ulcer and 72.2 % in non-ulcer dyspepsia). Conclusion. The PCR results using the new primers confirmed that all studied strains carried the Western CagA type. No specific EPIYA motif was associated with peptic ulcer. This is the first report that shows EPIYA motif distribution in H. pylori isolates from the Caribbean region.

Introducción. Se sabe que el polimorfismo en la región C-terminal de la citotoxina asociada al gen A (CagA) influye en el desarrollo de la enfermedad gástrica durante la infección por Helicobacter pylori. Objetivo. Determinar el número y el tipo de patrones de fosforilación de CagA (patrón EPIYA) en aislamientos cubanos de H. pylori, y estudiar su asociación con las enfermedades gástricas. Materiales y métodos. Se empleó el ADN de 95 cepas de H. pylori positivas paraCagA, para amplificar la región 3´ variable del gen cagA por PCR, mediante el empleo de diferentes estrategias. Además, se diseñaron nuevos cebadores para clasificar por PCR los aislamientos según el tipo de CagA, occidental o del este asiático. Los productos de PCR obtenidos de 14 aislamientos representativos se purificaron y secuenciaron para confirmar los resultados de la PCR. Resultados. La distribución de los patrones EPIYA encontrada, fue: 2 AB (2,1 %), 1 AC (1,1 %), 1 BC (1,1 %), 70 ABC (73,6 %), 19 ABCC (20 %), y 2 ABCCC (2,1 %). El análisis de la secuenciación confirmó las clasificaciones hechas por PCR en las 14 cepas estudiadas y demostró tres cepas con secuencias únicas de nucleótídos, no reportadas anteriormente. La distribución del patrón EPIYA-ABC fue equivalente en todas las enfermedades encontradas: 78,9 % en úlcera gástrica, 72,5 % en úlcera duodenal y 72,2 % en dispepsia no ulcerada. Conclusión. La mayoría de los aislamientos cubanos presentaron las combinaciones de motivos EPIYA menos virulentas (ABC). Los resultados del empleo de los nuevos cebadores y el análisis de la secuenciación, confirmaron que todas las cepas estudiadas portaban el gen cagA de tipo occidental. Ninguno de los patrones específicos de EPIYA se asoció con úlcera péptica. Este es el primer reporte que muestra la distribución de los motivos EPIYA en los aislamientos de H. pylori de la región del Caribe.

Epstein-Barr virus DNA load and its association with Helicobacter pylori infection in gastroduodenal diseases

Helicobacter pylori and Epstein-Barr virus (EBV) infections are common worldwide. Although H. pylori infection is a major factor in gastroduodenal diseases, its role in association with EBV infection is unknown. Objective: To study the association of H. pylori infection and EBV DNA load in patients with gastroduodenal diseases. Methods: Biopsy samples were collected from 200 adult patients [non-ulcer dyspepsia (NUD) 100, peptic ulcer disease (PUD) 50, gastric carcinoma (GC) 50] undergoing upper gastrointestinal endoscopy. H. pylori infection was diagnosed by rapid urease test, culture, histopathology, PCR and Q-PCR. EBV DNA was detected by non-polymorphic Epstein-Barr nuclear antigen-1 (EBNA-1) gene based Q-PCR. Results: In patients with GC and PUD, EBV DNA was detected more often than NUD (GC versus NUD = 90 percent versus 37 percent, p < 0.001; PUD versus NUD = 70 percent versus 37 percent, p < 0.001). The dual prevalence of H. pylori infection and EBV DNA was significantly higher in patients with GC and PUD than in those with NUD. Median copy number of EBV DNA was considerably higher in GC and PUD than NUD (p < 0.01). The copy number of EBV DNA was significantly higher in H. pylori infected patients (p = 0.015). The number of ureA gene copies was also found to be significantly higher in PUD and NUD with presence of EBV DNA. However, in GC no significant difference was seen between EBV positive and negative status. Conclusion: There was a trend for higher EBV DNA load in H. pylori positive individuals suggesting a probable role of H. pylori in modulating the conversion of EBV to its lytic phase.

Virulence attributes of Helicobacter pylori isolates & their association with gastroduodenal disease.

Background & objectives Certain genotype(s) of Helicobacter pylori strains may play important role in the development of gastric cancer (GC) and peptic ulcer disease (PUD). This study was undertaken to investigate the association of cagA, cagA3/ region subtypes, babA2 and vacA genotypes of H. pylori with GC, PUD and non-ulcer dyspepsia (NUD) as there are no such studies from India. Methods A total of 348 consecutive adult patients (NUD 241, PUD 45, GC 62) undergoing upper gastrointestinal endoscopy between September 2002 and May 2007 in a tertiary referral centre at Lucknow, north India, were enrolled. H. pylori infection was diagnosed by rapid urease test, culture, histopathology and PCR. Genotyping for cagA, cagA3/ subtypes, babA2 and vacA was performed by PCR using sequence specific primers. Results H. pylori infection was higher in patients with PUD than with GC (80 vs. 56.5%, P < 0.01) and NUD (80 vs. 55.2%, P= 0.002). cagA positive H. pylori isolates were detected in 80 per cent in GC, 83.3 per cent in PUD and 76.7 per cent in NUD with no significant difference among them. Only A subtype of cagA3/ was detected and its distribution in GC, PUD and NUD was 68.8, 69.4 and 52.6 per cent respectively. Presence of babA2 genotype was 31.4 per cent and it had significant association with PUD when compared with NUD (52.8 vs. 26.3%, P<0.003). On univariate regression analysis, s1a allele was associated with GC (P<0.050) and s1a/m2 vacA genotype with both GC (P=0.014) and PUD (P=0.016). Interpretation & conclusions H. pylori infection was strongly associated with PUD with a very high proportion of patients with GC have s1a allele and s1a/m2 vacA genotype. Both s1a/m2 vacA genotype and babA2 are associated with PUD. The study shows that different virulence attributes of H. pylori are involved in different gastroduodenal disorders.

Duodenitis por strongyloides stercoralis simulando lesion polipoide de duodeno / Strongyloides stercoralis Duodenitis by simulating polypoid lesion of duodenum

La Strongyloidiasis es una parasitosis intestinal producida por un nematodo de distribución mundial, es endémica en zonas tropicales, el parasito penetra a través de los pies en forma de larva filariforme presente en suelos infectados. Puede presentar manifestaciones Dermatológicas, Respiratorias y Gastrointestinales, siendo estas ultimas de variado espectro, que van desde síntomas vagos e inespecíficos hasta Enteritis Invasiva. Los métodos convencionales de examen de heces seriados o radiología no son lo suficientemente sensibles ni específicos. La endoscopia ha aumentado la posibilidad de hacer mejores diagnósticos, así como la biopsia gástrica y duodenal; de hecho se considera a los hallazgos endoscópicos como marcadores de severidad de la infección. Presentamos el caso de un paciente con síntomas dispépticos y hallazgos endoscópicos e histológicos de Duodenitis por Strongyloides Stercoralis. El paciente recibió tratamiento con Ivermectina.

The intestinal strongyloidiasis is a parasitic disease caused by a global distribution nematode endemic in tropical areas, penetrates through the feet in the form of larvae present in infested soil filariform. May present with dermatological, respiratory and gastrointestinal tracts, the latter being varied spectrum of symptoms ranging from vague to invasive enteritis. Conventional methods of serial stool examination, radiology are not sensitive enough nor specific. Endoscopy has increased the possibility of better diagnosis, as well as gastric and duodenal biopsy, in fact considered the endoscopic findings as markers of severity of infection. We report the case of a patient with dyspeptic symptoms with endoscopic and histological findings of Duodenitis for Strongyloides Stercoralis. He was treated with Ivermectin.

Evolutionary dynamics of Helicobacter pylori cagA and vacA genes in Iran and their association with clinical outcomes

There is a relationship between specific genotypes of Helicobacter pylori cagA and vacA genes and the increased risk of peptic ulcer diseases and gastric cancer. These genes also possess strong patterns of geographical differentiation. The present study aims to determine the patterns of variation of the virulence genes in Iran and their association with clinical status. Sequence fragments for cagAand vacA were obtained from a total of 147 H. pylori isolates from diverse geographical and ethnic sources within Iran. We used phylogenetic methods to determine the patterns of allelic diversity, and the relationship between evolutionary lineages and clinical status. Phylogenetic analyses of Iranian cagA gene disclosed four lineages, whereas the vacA gene had two distinct lineages. The cagA lineage II showed extensive genetic diversity compared with lineage I. cagA lineages III and IV disclosed mixed ancestries with recombinant nucleotides that originated from lineages I and H Iranian strains with vac A lineage II genotype were significantly cagA+ [> 90%, p = 0.0] and correlated with a higher rate of peptic ulcers in infected individuals [p =0.003]. Most strains in the cagA lineage I showed a vacA lineage II genotype [p = 0.003] and significantly correlated with an increased risk of peptic ulcers in infected individuals [p = 0.022]. Strains with cagA lineage III genotype significantly correlated with gastritis [p = 0.0]. The increased level of allelic diversity in the virulence genes shows strong evolutionary dynamics, resulting in the emergence of new clonal genealogies of the cagA gene within Iran. Particular lineages of the Iranian cagA and vac A genes correlate with peptic ulcer diseases

Association between helicobacter pylori infection and autoimmune hypothyroidism in Egyptian population

Autoimmune hypothyroidism commonly affecting females is one of the commonest causes of thyroid disease in adults. Among the various autoantibody tests applied in research and clinical practice, the determination of thyroid microsomal antibodies [TPO] and thyroglobulin antibodies [TG Ab] still retains its strong value in the screening for thyroid autoimmunity. Helicobacter pylori [H. pylori] infection plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, MALT [Mucosa Associated lymphocyte T] Lymphoma and gastric cancer. The aim of this work was to study the relationship between H.pylori infection and autoimmune hypothyroidism in Egyptian population. This study was carried out on 147 Egyptian persons divided into 3 groups: Hypothyroid Group: Included 49 patients with autoimmune hypothyroidsm and positive antithyroid antibodies with no history of dyspeptic symptoms or peptic ulcer. H.pylori positive Group: Included 50 patients with dyspeptic symptoms or peptic ulcer with H.pylori positive antibodies with no history of any thyroid disease. Control Group: Included 48 apparently healthy persons serving as control. Serum Free T3, Free T4 and TSH were done for all subjects together with Antimicrosomal antibodies [TPO-Ab], Antithyroglobulin antibodies [TG-Ab] and Helicobacter Pylori antibodies [H. pylori Ab]. There was no significant difference between all groups as regards age. Also there was significant difference between Hypothyroid and H.pylori positive groups as regarding TSH and Free T3, TG-Ab, TPO-Ab and H. pylori Ab. There is also significant difference between Hypothyroid and control groups regarding TSH, free T3, TG-Ab, TPO-Ab, and H. pylori Ab. There is significant difference between H.pylori positive and control groups regarding FT3 and H. pylori AB. Hypothyroid Group was divided according to the presence of H. pylori Ab into ve and +ve H. pylori Ab subgroups. There was significant difference between the ve and +ve subgroups as regard TSH, free T4 and TG-Ab. H.pylori positive Group was divided according to the presence of TG Ab and TPO Ab into-ve and +ve subgroups. There was significant difference between the -ve and +ve cases in TSH, free T45 Free T3, and H.Pylori Antibody. Positive correlation was found between H pylori Ab titer and age, TSH, TG-Ab and TPO-Ab titers. There was also negative correlation between H. pylori Ab titer and free T4. There is no correlation between H. pylori Ab titer and free T3. [Correlation is referred to all subjects of the study = 147]. This study revealed that patients with positive TG and TPO antibodies, showed [+ve] H. pylori Ab, with significant high titer in their sera, The patients with positive H. Pylori Ab showed high serum titer of TG-Ab. In our study H. pylori-Ab correlates to thyroid function tests and thyroid antibodies

Infección por Helicobacter pylori en pacientes sintomáticos con patología gastroduodenal benigna: análisis de 5.664 pacientes / Helicobacter pylori infection in symptomatic patients with benign gastroduodenal diseases: analysis of 5.664 cases

Infection with Helicobacter pylori (H. pylori) is highly prevalent in Chile, but there are no systematic studies in patients with upper gastrointestinal symptoms. Aim: To determine the prevalence of H. pylori infection, according to age, gender and endoscopic pathology in a large sample of patients. Methods: We studied 7,893 symptomatic patients submitted to upper gastrointestinal endoscopy between July 1996 and December 2003 in the context of a screening program of gastric cancer in a high risk population. H. pylori infection was determined by rapid urease test (RUT) in antral mucosa. We excluded 158 patients with gastric cancer (2 percent) and 2,071 patients without RUT. Results: We included 5,664 patients, mean age 50.7 ± 13.9 years, women 72.1 percent. Endoscopic diagnoses were normal in 59.3 percent, erosive esophagitis in 20 percent, gastric ulcer (GU) in 8.1 percent, duodenal ulcer (DU) in 6.4 percent, and erosive gastropathy in 6.2 percent. RUT was positive in 78 percent of patients. After adjusting for age and sex and with respect to patients with normal endoscopy, frequency of H. pylori infection was 86.6 percent in DU (OR 2.1, 95 percent CI 1.5-2.8, p < 0.001); 81.4 percent in GU (OR 1.8, 95 percent CI 1.4-2.4; p < 0.001 ); 79.9 percent in erosive gastropathy (OR 1.4, 95 percent CI 1.03-1.8; p = 0.03) and 77.4 percent in erosive esophagitis (OR 1.1, 95 percent CI: 0.9-1.3; p = NS). The probability of H. pylori infection decreased significantly with age, more markedly in men with normal endoscopy. Conclusions: Prevalence of H. pylori infection is very high in symptomatic Chilean patients and even higher in those with gastroduodenal ulcer or erosions, while in patients with erosive esophagitis is similar to those with normal endoscopy. The frequency of infection decreases with age, probably as a consequence of rising frequency of gastric mucosal atrophy.

Neither genotype nor the gastric colonization site of Helicobacter pylori are predictive factors for the development of erosive esophagitis in patients with peptic ulcer disease, 1 year after eradication / O genótipo e o local no estômago de isolamento do Helicobacter pylori em pacientes com úlcera péptica não são fatores preditivos para o desenvolvimento de esofagite erosiva 1 ano após a erradicação da bactéria

CONTEXT: Whether Helicobacter pylori infection is a protective or predisposing factor for the development of gastroesophageal reflux disease remains controversial. The most virulent strains, such as those expressing the cytotoxin-associated gene A (CagA), and the site of gastric colonization have been correlated with the prevention or development of esophagitis. AIM: To determine the incidence of erosive esophagitis following eradication of H. pylori in patients with peptic ulcer disease and to evaluate the association of erosive esophagitis with virulent strains of H. pylori and the site of gastric colonization. METHODS: Triple therapy with lansoprazole, amoxicillin and clarithromycin was administered to 159 patients with peptic ulcer disease. Endoscopy, histopathology, urease and carbon-14 urea breath tests were performed prior to treatment, at 3 months and 1 year following treatment. Genotyping of H. pylori strains using polymerase chain reaction was performed separately on samples from the corpus and antrum. RESULTS: One year after treatment, 148 successfully treated patients were reevaluated. Twenty-eight patients (19 percent) had erosive esophagitis, classified as Los Angeles grade A in 24 and B in 4. The samples taken from the corpus were CagA-positive in 18 patients (64 percent), while the samples taken from the antrum were CagA-positive in 21 patients (75 percent). CONCLUSIONS: The incidence of erosive esophagitis in peptic ulcer patients who had their H. pylori eradicated was 19 percent. No correlation was found between the gastric site colonized by H. pylori or strains expressing CagA and the prevention or development of erosive esophagitis in patients with peptic ulcer disease, 1 year after infection eradication.

CONTEXTO: É controverso se a infecção pelo Helicobacter pylori é um fator de proteção ou de predisposição para o desenvolvimento da doença de refluxo gastroesofágico. Cepas mais virulentas tais como as que expressam a citotoxina CagA e o local no estômago de infecção pela bactéria, podem estar correlacionados com a prevenção ou desenvolvimento de esofagite. OBJETIVOS: Determinar a incidência de esofagite erosiva após a erradicação do H. pylori em pacientes com úlcera péptica e a sua associação com a virulência das cepas da bactéria e o local no estômago de seu isolamento. MÉTODOS: Um tratamento tríplice com lansoprazol, amoxicilina e claritromicina foi administrado a 159 pacientes com úlcera péptica. Endoscopia digestiva alta, exame histológico, teste rápido da urease e o teste respiratório de uréia com carbono-14 foram realizados antes, 3 meses e 1 ano após o tratamento. A genotipagem das cepas do H. pylori por meio de PCR foi realizada separadamente em amostras obtidas da mucosa do corpo e do antro gástricos. RESULTADOS: Um ano após o tratamento, 148 pacientes curados da infecção foram avaliados: 28 (19 por cento) apresentavam esofagite erosiva, 24 com grau A da classificação de Los Angeles e 4 com grau B. Nas amostras obtidas da mucosa do corpo gástrico, a citotoxina CagA foi positiva em 18 (64 por cento) pacientes com esofagite erosiva, enquanto que nas amostras obtidas do antro gástrico, a citotoxina CagA foi positiva em 21 (75 por cento). CONCLUSÕES: A incidência de esofagite erosiva em pacientes com doença péptico-ulcerosa foi de 19 por cento. Não houve correlação entre o local de isolamento no estômago ou as cepas CagA-positivas do H. pylori e a proteção ou o desenvolvimento de esofagite erosiva, em pacientes com úlcera péptica, 1 ano depois da erradicação da bactéria.

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients / Estudo comparativo quanto à recidiva ulcerosa do tratamento cirúrgico de úlcera péptica perfurada entre pacientes H. Pylori positivos, após erradicação, e negativos

BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done.AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori.METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months.RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients.CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

RACIONAL: O tratamento cirúrgico da úlcera péptica perfurada é assunto discutível. Os cirurgiões, por muitos anos, fizeram suas opções entre procedimentos de redução ácida, somente fechamento da perfuração - porém com maior chance de recidiva ulcerosa. Desde a comprovada vinculação da úlcera péptica e suas complicações à infecção gastroduodenal causada pelo Helicobacter pylori, houve recomendação para mudança na atitude dos cirurgiões na volta à operação mais simples com erradicação da bactéria.OBJETIVO: Analisar a recidiva ulcerosa em pacientes com úlcera perfurada H. pylori positiva que foram submetidos à simples sutura da lesão e omentopexia com erradicação da bactéria e compará-la com H. pylori negativo submetido ao mesmo tratamento cirúrgico.MÉTODOS: Cento e quatorze pacientes com úlceras pré-pilóricas, pilóricas e duodenais perfuradas foram atendidos com fechamento simples. Trinta dias após a operação submeteram-se à endoscopia digestiva alta com biópsias para testes da urease e histopatológicos. Foram divididos em dois grupos de acordo com o resultado dos testes: positivo e negativo.Os positivos foram erradicados e, junto com o grupo negativo, foram seguidos com endoscopias semestrais e testes de detecção para H. pylori procurando por recidiva ulcerosa e reinfecção no grupo erradicado.RESULTADOS: O grupo positivo foi formado por 25 pacientes, dos quais dois foram considerados não erradicáveis segundo os critérios do protocolo. Os demais foram seguidos por período médio de 38,21 meses e detectadas recidivas em quatro pacientes (17,39%), metade deles (8,69%) foram reinfectados. O grupo negativo foi formado por 26 pacientes, seguido por período médio de 38,28 meses e oito (30,76%) apresentaram recidiva ulcerosa. Não foi evidenciada diferença estatisticamente significativa entre os grupos...

Helicobacter pylori en pacientes con diferentes enfermedades gastroduodenales / Helicobacter pylori in patients with different gastroduodenal diseases

El papel que desempe±a Helicobacter pylori en el desarrollo de diferentes enfermedades digestivas ha sido ampliamente investigado y discutido. Se estudió la presencia de esta bacteria en muestras de biopsia obtenidas mediante endoscopia. Se tomaron 69 pacientes con úlcera duodenal, úlcera gástrica, gastritis crónica y dispepsia. Los diagnósticos de úlcera gástrica y gastritis crónica fueron confirmados histológicamente. Se analizaron 27 úlceras duodenales, 12 úlceras gástricas, 24 gastritis crónicas y 6 dispepsias. Se detectó la presencia de Helicobacter pylori a través de la amplificación de un fragmento del gen Ure A mediante la reacción en cadena de la polimerasa, en el 100 por ciento de las úlceras duodenales, en el 100 por ciento de las úlceras gástricas, en el 83 por ciento de las dispepsias y en el 92 por ciento de las gastritis crónicas, para una prevalencia total del 95,7 por ciento.

The role played by Helicobacter pylori in the development of different digestive diseases has been widely studied and discussed. The presence of this bacterium in biopsy samples obtained by endoscopy was studied. 69 patients with duodenal ulcer, gastric ulcer, chronic gastritis and dyspepsia were investigated. The diagnoses of gastric ulcer and chronic gastritis were histologically confirmed. 27 duodenal ulcers, 12 gastric ulcers, 24 chronic gastritis and 6 dyspepsias were analyzed. The presence of Helicobacter pylori was detected through the amplification of a fragment of the Ure A gene by polymerase chain reaction in 100 percent of the duodenal ulcers, in 100 percent of the gastric ulcers, in 83 percent of the dyspepsias and in 92 percent of chronic gastritis, for a total prevalence of 95.7 percent.

Estudio de test de ureasa en exámenes endoscópicos con patologías benignas: ¿algún cambio en diez años? / Positivity of urease tests: results of its application in an open-access unity after a decade is there any change?

Epidemiological studies have shown changes in upper digestive diagnosis in recent times. It has been observed especially in developed countries, consisting in a diminution of duodenal peptic ulcers and non cardial gastric cancer and an increase of symptoms and lesions attributable to gastroesophageal reflux. Both circumstances have been considered as a consequence of a reduction in the prevalence, of infection with Helicobacter pylori and its more aggressive strains. There is little information of Possible changes in our country, so we have studied our experience in years 1996 and 2006 observing the results of Helicohacter pylori presence through urease tests and biopsies in a 10 year period. Patients were assessed with endoscopy indicated for upper digestive symptoms in an open access University Endoscopy Center. The accuracy of the test compared with biopsies was similar in both years. We observed after a decade: increase in the number of examinations and urease tests similar percentages of normal endoscopies and those with esophagitis, gastritis, or ulcers. In patients studied for suspected gastroesophageal reflux, there were similar percentages of those with and without esophageal erosions. The Urease Test was positive in similar high percentage in duodenal ulcers, but showed decreased values in patients studied for reflux, both erosive and non erosive esophagitis and also in erosive gastritis. In conclusion, Helicobacter pylori infection is still important in duodenal ulcer, with reductions in other diagnosis, possibly as a consequence of differences in patients social status or the very common medication aiming at the eradication of the infection or control of gastroesophageal symptoms.

Estudios epidemiológicos han mostrado cambios en la incidencia de patologías digestivas consistentes en disminución de úlceras duodenales y cáncer gástrico y aumento de cuadros atribuidos a reflujo gastroesofágico. Ambas tendencias se han asociado a disminución de la tan difundida infección por Helicobacter pylori y sus cepas genéticamente más agresivas. El presente estudio tuvo come objeto revisar retrospectivamente los resultados de endoscopias en 1996 y 2006 para observar eventuales cambios en la patología de esófago y gastroduodenal. Los resultados en la última década indican: aumento del número de exámenes y de tests de ureasa; proporción similar, de: endoscopias normales, esofagitis erosiva, síntomas de reflujo no erosivo, gastritis erosiva, úlcera gástrica, úlcera duodenal; porcentaje similar de esofagitis erosiva y reflujo no erosivo en pacientes estudiados por síntomas sugerentes de reflujo gastroesofágico y disminución de la positividad del TU, significativamente en EE y GE. Pensamos que el Hp continúa siendo factor patogénico en UD y que la disminución de positividad en pacientes con RGE puede atribuirse a cambios en la composición de la población examinada y al uso de medicación que puede modificar su presencia en la mucosa de estómago, siendo similar la reducción en reflujo con y sin esofagitis erosiva.