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Más Vita ; 3(4): 33-40, dic. 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1355015


La gastritis es una enfermedad con una alta morbilidad a nivel mundial, el principal factor de riesgo es la infección por Helicobacter pylori. Objetivo: Describir las características clínicas, histopatológica y endoscópicas en una población con gastritis crónica. Material y métodos: Se realizó un estudio observacional de tipo descriptivo, retrospectivo, se incluyeron 49 pacientes que acudieron a la consulta externa del área de gastroenterología, de 18 a 65 años, a quienes se realizó el estudio histopatológico y endoscópico en el Servicio de Gastroenterología en el Hospital General Quevedo, de Los Ríos-Ecuador, durante septiembre 2017 ­ septiembre 2018. Resultados: Se observó predominio del género masculino (65%); en mayores de 40 años (55%), la epigastralgía y la sensación de acidez estomacal, 39% y 35% respectivamente, fueron los síntomas más frecuentes, La positividad para Helicobacter pylori, alcanzó el 86%, y la lesión no erosiva un 73%, existió mayor presencia de la forma no atrófica (84%) sobre la atrófica. Conclusiones: La gastritis crónica predominó en el grupo etario mayor a 40 años y de género masculino, siendo los factores de riesgo de mayor prevalencia la infección por Helicobacter pylori y los asociados al consumo de antiinflamatorios no esteroideos, mala alimentación, alcohol y tabaco, los síntomas como epigastralgía y la sensación de acidez estomacal fueron los más frecuentes. El hallazgo endoscópico fue mayor para las formas no erosivas, y de acuerdo a la histopatología la gastritis no atrófica antral moderada fue la más frecuente(AU)

Gastritis is a disease with high morbidity worldwide, the main risk factor is Helicobacter pylori infection. Objective: To describe the clinical, histopathological and endoscopic characteristics in a population with chronic gastritis. Material and methods: An observational, descriptive, retrospective study was carried out, including 49 patients who attended the outpatient consultation of the gastroenterology area, aged 18 to 65 years, who underwent a histopathological and endoscopic study in the Gastroenterology Service at the Quevedo General Hospital, Los Ríos-Ecuador, during September 2017 - September 2018. Results: A predominance of the male gender was observed (65%); In people over 40 years of age (55%), epigastralgia and the sensation of heartburn, 39% and 35% spectively, were the most frequent symptoms, the positivity for Helicobacter pylori, reached 86%, and the non-erosive lesion 73 %, there was a greater presence of the non-atrophic form (84%) over the atrophic one. Conclusions: Chronic gastritis predominated in the age group over 40 years of age and male, the most prevalent risk factors being Helicobacter pylori infection and those associated with the consumption of non-steroidal anti-inflammatory drugs, poor diet, alcohol and tobacco. symptoms such as epigastric pain and the sensation of heartburn were the most frequent. The endoscopic finding was greater for non-erosive forms, and according to histopathology, moderate antral non-atrophic gastritis was the most frequent(AU)

Humans , Male , Female , Adult , Middle Aged , Anti-Inflammatory Agents, Non-Steroidal , Helicobacter pylori/drug effects , Dyspepsia/etiology , Gastric Mucosa/pathology , Gastritis/physiopathology , Peptic Ulcer , Signs and Symptoms , Biopsy , Pharmaceutical Preparations , Endoscopy, Gastrointestinal , Acidity , Gastroenterology
Med. leg. Costa Rica ; 37(1): 62-73, ene.-mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1098373


Resumen El carcinoma gástrico hoy en día es una de las principales causas de mortalidad a nivel mundial por neoplasias y especialmente en países como Costa Rica, que se cataloga como un país de alta incidencia. Existen múltiples factores de riesgo, siendo el primero y más importante la infección por Helicobacter pylori, que desencadena una cascada de diferentes lesiones, iniciando en atrofia gástrica, que puede llegar a finalizar en cáncer invasivo. Existen otros factores que pueden influir en un ambiente pro-carcinogénico tales como fumado, obesidad, la dieta, entre otros. Múltiples naciones han desarrollado diferentes guías de tamizaje para disminuir la mortalidad; sin embargo, en países con alta incidencia sigue siendo el estándar realizar estudios de imagen y endoscopia luego de determinada edad dependiendo de factores de riesgo.

Abstract Gastric carcinoma is nowadays one of the main causes of mortality worldwide due to neoplasms and especially in countries such as Costa Rica, which is classified as a high incidence country. There are multiple risk factors, starting with Helicobacter pylori infection being the most important one; after the infection a cascade with different lesions is triggered, first it begins with gastric atrophy and then eventually lead to an invasive cancer. There are other factors that can influence a pro-carcinogenic environment such as smoking, obesity, diet, among others. Multiple nations have developed different screening guidelines to reduce mortality, however in countries with high incidence it is still the gold-standard to perform imaging and endoscopy studies after a certain age and depending on risk factors.

Humans , Stomach Neoplasms/diagnosis , Helicobacter pylori/drug effects , Peptic Ulcer/complications , Gastritis, Atrophic/diagnosis , Metaplasia
Braz. arch. biol. technol ; 63: e20190408, 2020. tab
Article in English | LILACS | ID: biblio-1132168


Abstract Propolis is a resinous substance collected and processed by Apis mellifera from parts of plants, buds and exudates. In Minas Gerais (MG) state, Brazil, green propolis is produced from the collection of resinous substance found in shoot apices of Baccharis dracunculifolia. This paper aims to investigate the chemical composition and in vitro antioxidant, anti-Helicobacter pylori, antimycobacterial and antiproliferative activities of essential oil (EO) from Brazilian green propolis (BGP-EO). The oil showed high antibacterial activity against H. pylori (MIC = 6.25 µg/mL), Mycobacterium avium (MIC = 62.5 µg/mL) and M. tuberculosis (MIC = 64 µg/mL). Its antioxidant activity was evaluated in vitro by both DPPH (IC50 = 23.48 µg/mL) and ABTS (IC50 = 32.18 µg/mL) methods. The antiproliferative activity in normal (GM07492A, lung fibroblasts) and tumor cell lines (MCF-7, HeLa and M059J) was analyzed by the XTT assay. BGP-EO showed inhibition of normal cell growth at 68.93 ± 2.56 µg/mL. Antiproliferative activity was observed against human tumor cell lines, whose IC50 values were 56.17, 66.43 and -65.83 µg/mL for MCF-7, HeLa and M059J cells, respectively. Its major constituents, which were determined by GC-FID and GC-MS, were carvacrol (20.7 %), acetophenone (13.5 %), spathulenol (11.0 %), (E)-nerolidol (9.7 %) and β-caryophyllene (6.2 %). These results showed the effectiveness of BGP-EO as a natural product which has promising biological activities.

Propolis/chemistry , Anti-Infective Agents/pharmacology , Antioxidants/pharmacology , Brazil , Oils, Volatile/therapeutic use , Helicobacter pylori/drug effects , Mycobacterium avium/drug effects , Mycobacterium tuberculosis/drug effects
Arq. gastroenterol ; 56(4): 361-366, Oct.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1055160


ABSTRACT BACKGROUND: Helicobacter pylori infection in Chile remains as a public and private health-care system's challenge, with a prevalence of the infection over 70%. Nowadays, antibiotic treatment of the infection is mandatory to prevent the arising of severe associated diseases but failures in the eradication therapy mainly due to clarithromycin resistance has been observed worldwide and first line eradication therapy seems to be not effective anymore in several geographical areas. Thus, health-care systems are committed to maintain an epidemiological surveillance upon the evolution of the antibiotic resistance of this priority 2 pathogen. OBJECTIVE: This work reports a 10 years surveillance of the primary antibiotic resistance of H. pylori clinical isolates at the Biobío region-Chile, and the evolution of resistance toward amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline among the species. METHODS: H. pylori strains were investigated during the periods 2005-2007 (1435 patients analysed) and 2015-2017 (220 patients analysed) by inoculating a saline homogenate biopsy onto the surface of Columbia agar (Oxoid, Basingstoke, UK) - supplemented with 7% horse red blood cells plus DENT inhibitor (Oxoid, Basingstoke, UK) - following by incubation at 37ºC under 10% CO2 atmosphere for five days. Antibiotic resistance pattern of the isolates was assessed using the disk diffusion test in Müeller-Hinton agar supplemented with 7% horse red blood cells followed by incubation for further three days under 10% CO2 atmosphere. Statistical analysis was done using the SPSS v22 software and P values <0.05 were considered statistically significant. RESULTS: A total of 41% of 1435 patients were detected to be infected with H. pylori by bacteriological culture in 2005-2007 period, meanwhile 32.7% from 220 patients were also infected in 2015-2017 period. The clinical isolates of H. pylori are mostly susceptible to amoxicillin and tetracycline (both over 98% of strains), but less susceptible to levofloxacin in both periods analysed (over 79% of the strains). On the other hand, metronidazole continuous showing the highest score of resistant isolates (over 40% of resistant strains), although an 18% fewer resistant strains were observed in 2015-2017 period. Clarithromycin, the key antibiotic in eradication therapies, has an increased frequency of resistant strain isolated in the decade (22.5% in 2005-2007 and 29.2% in 2015-2017). Multidrug resistant strains (two, three and four antibiotics) were also detected in both periods with the highest scores for simultaneous resistance to clarithromycin-metronidazole (18%) and clarithromycin-metronidazole-levofloxacin (12.5%) resistant strains. According to gender, the isolates resistant to amoxicillin, clarithromycin and metronidazole were more frequent in female, with a specific increment in amoxicillin and clarithromycin resistance. CONCLUSION: The frequency of clarithromycin resistance (29.2%) detected in 2015-2017 suggests that conventional triple therapy is no longer effective in this region.

RESUMO CONTEXTO: A infecção por Helicobacter pylori no Chile permanece como um desafio do sistema de saúde público e privado, com prevalência da infecção acima de 70%. Hoje em dia, o tratamento antibiótico da infecção é obrigatório para prevenir o surgimento de graves doenças associadas, mas falhas na terapia de erradicação, principalmente devido à resistência à claritromicina, têm sido observadas em todo o mundo, e a terapia de erradicação de primeira linha parece não ser mais eficaz em várias áreas geográficas. Assim, os sistemas de saúde estão comprometidos em manter uma vigilância epidemiológica sobre a evolução da resistência aos antibióticos deste patógeno prioritário tipo 2. OBJETIVO: Este trabalho relata uma vigilância de 10 anos da resistência antibiótica primária de isolados clínicos de H. pylori na região do Biobío-Chile, e a evolução da resistência em relação à amoxicilina, claritromicina, levofloxacina, metronidazol e tetraciclina entre as espécies. MÉTODOS: As cepas de H. pylori foram investigadas durante os períodos 2005-2007 (1435 pacientes analisados) e 2015-2017 (220 pacientes analisados) inoculando uma biópsia de homogeneizado fisiológico na superfície do agar Columbia (Oxoid, Basingstoke, Reino Unido) - suplementado com 7% de glóbulos vermelhos do cavalo mais o inibidor de DENTE (Oxoid, Basingstoke, Reino Unido) - seguindo pela incubação em 37ºC a atmosfera de 10% de CO2 por cinco dias. O padrão de resistência aos antibióticos dos isolados foi avaliado utilizando-se o teste de difusão em disco em agar Müeller-Hinton suplementado com 7% de glóbulos vermelhos de cavalo seguidos de incubação por mais três dias a atmosfera de 10% de CO2. A análise estatística foi realizada utilizando-se o software SPSS V22 e os valores de P<0,5 foram considerados estatisticamente significantes. RESULTADOS: Um total de 41% dos 1435 pacientes foram detectados como contaminados por H. pylori pela cultura bacteriológica no período 2005-2007, ao mesmo tempo 32,7% de 220 pacientes foram contaminados igualmente no período 2015-2017. Os isolados clínicos de H. pylori são principalmente suscetíveis à amoxicilina e tetraciclina (tanto mais de 98% das cepas), mas menos suscetíveis à levofloxacina em ambos os períodos analisados (mais de 79% das cepas). Por outro lado, o metronidazol permaneceu mostrando a maior pontuação de resistentes isolados (mais de 40% de cepas resistentes), embora tenham sido observados 18% menos cepas resistentes no período de 2015-2017. A claritromicina, o antibiótico-chave em terapias de erradicação, tem uma frequência aumentada de cepa resistente isolada na década (22,5% em 2005-2007 e 29,2% em 2015-2017). Cepas multirresistentes (dois, três e quatro antibióticos) também foram detectadas em ambos os períodos com os maiores escores de resistência simultânea à claritromicina-metronidazol (18%) e claritromicina-metronidazol-levofloxacina (12,5%) cepas resistentes. De acordo com o sexo, os isolados resistentes à amoxicilina, claritromicina e metronidazol foram mais frequentes no sexo feminino, com incremento específico em amoxicilina e resistência à claritromicina. CONCLUSÃO: A frequência de resistência à claritromicina (29,2%) detectada em 2015-2017 sugere que a terapia tripla convencional não é mais efetiva nesta região.

Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Helicobacter pylori/drug effects , Anti-Bacterial Agents/pharmacology , Tetracycline/pharmacology , Population Surveillance , Helicobacter Infections/microbiology , Clarithromycin/pharmacology , Drug Resistance, Multiple, Bacterial , Disk Diffusion Antimicrobial Tests , Levofloxacin , Amoxicillin/pharmacology , Metronidazole/pharmacology , Middle Aged
Braz. arch. biol. technol ; 62: e19180285, 2019. tab, graf
Article in English | LILACS | ID: biblio-1055377


Abstract Helicobacter pylori is a bacterium that reaches half of the world population and it's recognized as the main cause of chronic gastritis and peptic ulcer. In this study, we evaluated the anti-H. pylori, antioxidant and immunomodulatory activities of the methanolic (MeOH) extract of Eugenia uniflora leaves and chemical profile. Anti-H. pylori activity was evaluated by spectrophotometric broth microdilution technique by determining the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), in addition to the evaluation of the effect on the urease enzyme. The antioxidant activity was evaluated by capturing O2 •-, HOCl e NO• radicals. The immunomodulatory effect was evaluated on the cytokines TNF-α, IL-6 and on nitric oxide through inhibition in LPS-stimulated macrophages. The chemical profile was performed by total phenolic, tannin and flavonoid contents and mass spectrometry analysis by ESI-FT-ICR MS. In the anti-H. pylori assay the extract showed MIC of 128 μg/mL, however it did not obtain MBC. The extract also showed ability to inhibit the urease enzyme about 20%. The antioxidant activity of the MeOH extract showed EC50 values of 29.77 µg/mL, 15.71 µg/mL and 442.10 µg/mL to O2 •-, HOCl and NO•, respectively. The extract also showed influence on the release of TNF-α, IL-6 and NO in LPS-stimulated macrophages, ranging from 39% to 97% inhibition. Flavonoids, phenylpropanoids, tannins, triterpenoids and carbohydrates were the major classes of compounds present in the MeOH extract as identified by (-)-ESI-FT-ICR MS. The results indicate important anti-H. pylori, antioxidant and immunomodulatory activities from Eugenia uniflora highlighting its importance in the prevention and treatment of diseases caused by H. pylori infection.

Humans , Helicobacter pylori/drug effects , Eugenia/drug effects , Antioxidants , Peptic Ulcer/drug therapy , Microbial Sensitivity Tests/instrumentation , Immunomodulation , Gastritis/drug therapy
Gastroenterol. latinoam ; 30(supl.1): S18-S25, 2019. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1116305


Helicobacter pylori (H. pylori) is a gram negative bacteria that survives in the gastric acid environment. The infection is acquired mainly during childhood. Fifty to 70% of adult population has the infection. However, in the last 10 year, a decrease in the prevalence of this infection has been observed in all age groups, in particular in pediatric population and elderly patients over 60 years old. The evolution of the infection depends on bacterial factors (virulence and toxins) and host immune response. People infected mainly develop gastrointestinal diseases such as gastritis, peptic ulcer and MALT lymphoma. H. pylori infection is the main risk factor of gastric cancer and for that reason, the eradication is recommended if H. pylori has been detected through invasive or non-invasive tests. Among children, eradication is not recommended unless there is a clinical manifestation that merits. H. pylori eradication is recommended in symptomatic adults and there is a controversy about massive eradication in asymptomatic population due to the risk of development of antibiotic resistance. Treatment is based on the use of proton pump inhibitors (PPI) associated to antibiotics, that should be chosen taking into account the increasing antibiotic resistance, and local availability. Clarithromycin (CLA) and levofloxacin resistance is increasingly high, and CLA-free quadruple therapy schemes are currently recommended for first-line therapy. H. pylori eradication must be confirmed with invasive or non-invasive tests. Second-line therapy based on antibiotics not previously used, PPI high doses and bismuth is recommended.

Helicobacter pylori (H. pylori) es una bacteria gramnegativa que sobrevive en el medio ácido gástrico. La infección se adquiere principalmente en la niñez. Un 50 a 70% de la población adulta es portadora, pero en los últimos 10 años, se ha observado una disminución en la prevalencia de infección en todos los grupos etarios, en particular en población pediátrica y mayores de 60 años. La evolución de la infección depende de factores propios de la bacteria (virulencia, toxinas) y de la respuesta inmune del huésped. Los individuos infectados desarrollan principalmente patologías gastrointestinales como gastritis, úlcera péptica y linfoma MALT. La infección por H. pylori es el principal factor de riesgo del cáncer gástrico por lo que se recomienda su erradicación en caso de haberse detectado mediante test invasivo o no invasivo. En niños, no es recomendable la erradicación a menos que exista una manifestación clínica que lo amerite. Se recomienda su erradicación en adultos sintomáticos y existe controversia respecto a la erradicación masiva en población asintomática debido al riesgo de desarrollar resistencia antibiótica. El tratamiento se basa en el uso de inhibidores de la bomba de protones asociado a antibióticos, los cuales deben ser escogidos teniendo en cuenta la tasa de resistencia antimicrobiana y disponibilidad local. La resistencia a claritromicina (CLA) y levofloxacino es creciente, por lo que se recomienda el uso de esquemas de cuadriterapia libre de CLA en esquemas de primera línea. Se recomienda confirmar su erradicación con test no invasivos y retratar con esquema de segunda línea con antibióticos no utilizados previamente, asociado a dosis altas de inhibidores de bomba de protones y sales de bismuto.

Humans , Child , Adult , Helicobacter Infections/drug therapy , Remission Induction , Helicobacter pylori/drug effects , Helicobacter pylori/pathogenicity , Helicobacter Infections/diagnosis , Helicobacter Infections/physiopathology , Age Factors , Clarithromycin/therapeutic use , Drug Resistance, Bacterial/drug effects , Drug Therapy, Combination , Proton Pump Inhibitors/therapeutic use , Levofloxacin/therapeutic use
Braz. j. microbiol ; 49(3): 544-551, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-951820


Abstract The epidemiology of Helicobacter pylori resistance to antibiotics is poorly documented in Africa and especially in Algeria. The aim of our study was to determine the antibiotic resistance rates, as well as its possible relationship with VacA and CagA virulence markers of isolates from Algerian patients. One hundred and fifty one H. pylori isolate were obtained between 2012 and 2015 from 200 patients with upper abdominal pain. Antimicrobial susceptibility testing was performed for amoxicillin, clarithromycin, metronidazole, ciprofloxacin, rifampicin and tetracycline. Molecular identification of H. pylori and the detection of vacA and cagA genes were performed using specific primers. We found that H. pylori was present in 83.5% of collected biopsies, 54.9% of the samples were cagA positive, 49.67% were vacA s1m1, 18.30% were vacA s1m2 and 25.49% were vacA s2m2. Isolates were characterized by no resistance to amoxicillin (0%), tetracycline (0%), rifampicin (0%), a high rate of resistance to metronidazole (61.1%) and a lower rate of resistance to clarithromycin (22.8%) and ciprofloxacin (16.8%). No statically significant relationship was found between vagA and cagA genotypes and antibiotic resistance results (p > 0.5) except for the metronidazole, which had relation with the presence of cagA genotype (p = 0.001).

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Bacterial Proteins/genetics , Helicobacter pylori/drug effects , Helicobacter Infections/microbiology , Drug Resistance, Bacterial , Anti-Bacterial Agents/pharmacology , Antigens, Bacterial/genetics , Helicobacter pylori/isolation & purification , Helicobacter pylori/genetics , Helicobacter pylori/metabolism , Clarithromycin/pharmacology , Algeria , Amoxicillin/pharmacology
Braz. j. infect. dis ; 22(4): 311-316, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-974231


ABSTRACT Aim To analyze the influence of the -31 C/T polymorphism of the interleukin-1β gene on Helicobacter pylori eradication therapy success in patients with functional dyspepsia. Methods Functional dyspepsia was diagnosed according to the Rome III criteria. All patients underwent upper gastrointestinal endoscopy, and gastric biopsies were obtained at screening and 12 months after randomization (last follow-up visit). Urease test and histological examination were performed to define the H. pylori status. Patients received twice-daily amoxicillin, clarithromycin and omeprazole for 10 days. Genotyping of the interleukin-1beta -31 C/T polymorphism (rs1143627) was performed using polymerase chain reaction-restriction fragment length polymorphism. Results One hundred forty-nine patients received treatment with triple therapy for H. pylori eradication. Only one patient was lost to follow-up, and adherence to study medication was 94.6%. A total of 148 patients (mean age 46.08 ± 12.24 years; 81.8% women) were evaluated for the influence of the interleukin-1beta -31 C/T polymorphism on the outcome of H. pylori eradication therapy. After treatment, bacteria were eradicated in 87% of patients (129/148). Genotype frequencies of the polymorphism were as follows: CC, 38/148 (25.7%); CT, 71/148 (47.9%); and TT, 39/148 (26.4%). Successful eradication rate was 78.9%, 94.4% and 82.1% for the CC, CT and TT genotypes, respectively. The CT genotype was significantly associated with successful H. pylori eradication (p= 0.039). Conclusion This study suggests that the CT genotype of the interleukin-1beta -31 C/T polymorphism plays a role in the successful eradication of H. pylori among patients with functional dyspepsia.

Humans , Male , Female , Adult , Middle Aged , Polymorphism, Genetic , Helicobacter pylori/drug effects , Helicobacter Infections/drug therapy , Dyspepsia/drug therapy , Interleukin-1beta/genetics , Anti-Bacterial Agents/therapeutic use , Omeprazole/therapeutic use , Double-Blind Method , Follow-Up Studies , Helicobacter pylori/genetics , Treatment Outcome , Clarithromycin/therapeutic use , Dyspepsia/diagnosis , Genotype , Amoxicillin/therapeutic use , Anti-Ulcer Agents/therapeutic use
Cienc. tecnol. salud ; 5(1): 54-62, 2018. ilus 27 cm
Article in Spanish | LILACS | ID: biblio-965189


La infección por Helicobacter pylori es una de las infecciones crónicas más comunes a nivel mundial y causa importante de enfermedad péptica y cáncer gástrico. Infecta al 50% de la población adulta con mayor prevalencia en América Central/Sur y Asia y al menos dos veces mayor en poblaciones con alta incidencia de cáncer gástrico. Los objetivos de esta investigación fueron identificar la tasa de erradicación de H. pylori con terapia triple estándar y las posibles características asociadas a su erradicación. Se estudió a 119 pacientes con diagnóstico de infección por H. pylori, seleccionados en forma consecutiva de la consulta externa de Gastroenterología del Hospital General San Juan de Dios. Se realizó endoscopia diagnóstica y toma de biopsia gástrica. Se dio terapia triple estándar con lansoprazol, amoxicilina y claritromicina durante 10 días, seguido de 30 días con lansoprazol. Seis semanas después de completado el tratamiento se evaluó el antígeno de H. pylori en heces para determinar si hubo erradicación. La edad promedio de los participantes fue 49.0 años, 81.5% mujeres, 85.7% de área urbana, el síntoma más común fue dispepsia en 86.6%. En el examen post tratamiento el 89.9%, IC 95% [83.0, 94.7] presentó antígeno en heces negativo. No se encontró asociación entre las características de los pacientes con la respuesta al tratamiento. En conclusión, la respuesta a la terapia triple de primera línea se encuentra dentro del rango aceptable para continuar con ese esquema, pero debe mantenerse una evaluación constante por la presencia de posible resistencia.

Infection by Helicobacter pylori is one of the most common chronic infections worldwide and an important cause of peptic disease and gastric cancer. It infects 50% of the adult population with the highest prevalence in Central / South America and Asia and at least twice as high in populations with a high incidence of gastric cancer. The objectives of this research were to identify the eradication rate of H. pylori after first line standard triple therapy and the possible characteristics associated with its eradication. It was studied 119 patients with a diagnosis of H. pylori infection, selected consecutively from the outpatient department of Gastroenterology of the San Juan de Dios General Hospital. Diagnostic endoscopy and gastric biopsy was performed. Standard triple therapy was given with lansoprazole, amoxicillin and clarithromycin for 10 days, followed by 30 days with lansoprazole. Six weeks after the treatment was completed, the H. pylori antigen in feces was evaluated to determine if there was eradication. The average age of the participants was 49.0 years, 81.5% women, 85.7% of urban area, the most common symptom was dyspepsia in 86.6%. In the post-treatment examination 89.9%, 95% CI [83.0, 94.7] presented negative antigen in feces. No association was found between the characteristics of the patients with the response to treatment. In conclusion, the response to first line triple therapy is within the acceptable range to continue with this scheme, but a constant evaluation must be maintained due to the presence of possible resistance.

Humans , Male , Female , Middle Aged , Helicobacter pylori/drug effects , Gastrointestinal Neoplasms , Biopsy , Helicobacter Infections/therapy , Clarithromycin/therapeutic use , Dyspepsia/drug therapy , Lansoprazole/therapeutic use , Heartburn/diagnosis , Amoxicillin/therapeutic use
Rev. gastroenterol. Mex ; 82(4): 309-327, oct.-dec. 2017.
Article in Spanish | LILACS, BIGG | ID: biblio-966188


Desde la publicación de las guías de dispepsia 2007 de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed (01/2007 a 06/2016) con el fin de revisar y actualizar las guías 2007 y proporcionar nuevas recomendaciones basadas en evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron enunciados que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Treinta y un enunciados fueron redactados, votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología y fisiopatología. La endoscopia debe realizarse en dispepsia no investigada cuando hay datos de alarma o falla al tratamiento. Las biopsias gástricas y duodenales permiten confirmar infección por Helicobacter pylori y excluir enfermedad celiaca, respectivamente. Establecer una fuerte relación médico-paciente, cambios en la dieta y en el estilo de vida son útiles como medidas iniciales. Los bloqueadores H2, inhibidores de la bomba de protones, procinéticos y fármacos antidepresivos son efectivos. La erradicación de H. pylori puede ser eficaz en algunos pacientes. Con excepción de Iberogast y rikkunshito, las terapias complementarias y alternativas carecen de beneficio. No existe evidencia con respecto a la utilidad de prebióticos, probióticos o terapias psicológicas. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presenta la discusión, el grado y la fuerza de la recomendación de cada uno de ellos.

Abstract Since the publication of the 2007 dyspepsia guidelines of the Asociación Mexicana de Gastroenterología, there have been significant advances in the knowledge of this disease. A systematic search of the literature in PubMed (01/2007 to 06/2016) was carried out to review and update the 2007 guidelines and to provide new evidence-based recommendations. All high-quality articles in Spanish and English were included. Statements were formulated and voted upon using the Delphi method. The level of evidence and strength of recommendation of each statement were established according to the GRADE system. Thirty-one statements were formulated, voted upon, and graded. New definition, classification, epidemiology, and pathophysiology data were provided and include the following information: Endoscopy should be carried out in cases of uninvestigated dyspepsia when there are alarm symptoms or no response to treatment. Gastric and duodenal biopsies can confirm Helicobacter pylori infection and rule out celiac disease, respectively. Establishing a strong doctor-patient relationship, as well as dietary and lifestyle changes, are useful initial measures. H2-blockers, proton-pump inhibitors, prokinetics, and antidepressants are effective pharmacologic therapies. H. pylori eradication may be effective in a subgroup of patients. There is no evidence that complementary and alternative therapies are beneficial, with the exception of Iberogast and rikkunshito, nor is there evidence on the usefulness of prebiotics, probiotics, or psychologic therapies. The new consensus statements on dyspepsia provide guidelines based on up-to-date evidence. A discussion, level of evidence, and strength of recommendation are presented for each statement. © 2017 Asociacion Mexicana de Gastroenterologiia.

Humans , Adult , Dyspepsia/diagnosis , Dyspepsia/therapy , Endoscopy, Gastrointestinal , Helicobacter pylori/drug effects , Helicobacter Infections , Helicobacter Infections/diagnosis , Helicobacter Infections/therapy , Dyspepsia , Dyspepsia/drug therapy , Dyspepsia/epidemiology
Electron. j. biotechnol ; 25: 75-83, ene. 2017. tab, graf, ilus
Article in English | LILACS | ID: biblio-1008594


Background: Helicobacter pylori is considered as the main risk factor in the development of gastric cancer. In the present study, we performed a detailed characterization of the probiotic properties and the anti-H. pylori activity of a previously isolated lactobacillus strain ­ Lactobacillus fermentum UCO-979C ­ obtained from human gut. Results: The strain tolerated pH 3.0; grew in the presence of 2% bile salts; produced lactic acid and hydrogen peroxide; aggregated in saline solution; showed high hydrophobicity; showed high adherence to glass; Caco-2 and gastric adenocarcinoma human cells (AGS) cells; showed an efficient colonization in Mongolian Gerbils; and potently inhibited the growth and urease activity of H. pylori strains. L. fermentum UCO-979C significantly inhibited H. pylori-induced IL-8 production in AGS cells and reduced the viability of H. pylori. With regard to innocuousness, the strain UCO-979C was susceptible to several antibiotics and did not produce histamine or beta-haemolysis in blood agar containing red blood cells from various origins. Conclusion: The results demonstrated that L. fermentum UCO-979C is a very good candidate as a probiotic for the protection of humans against H. pylori infections.

Humans , Animals , Helicobacter pylori/drug effects , Helicobacter Infections/prevention & control , Probiotics/pharmacology , Lactobacillus fermentum/physiology , Anti-Bacterial Agents/pharmacology , Stomach Neoplasms/prevention & control , Urease/antagonists & inhibitors , Interleukin-8/antagonists & inhibitors , Gerbillinae , Disease Models, Animal , Hydrophobic and Hydrophilic Interactions
Arq. gastroenterol ; 53(4): 215-223, Oct.-Dec. 2016. tab, graf
Article in English | LILACS | ID: lil-794599


ABSTRACT Background Helicobacter pylori has a worldwide distribution and is associated with the pathogenesis of various diseases of the digestive system. Treatment to eradicate this microorganism involves the use of a combination of antimicrobials, such as amoxicillin, metronidazole, clarithromycin, and levofloxacin, combined with proton pump inhibitors. Although the current therapy is effective, a high rate of treatment failure has been observed, mainly because of the acquisition of point mutations, one of the major resistance mechanisms developed by H. pylori. This phenomenon is related to frequent and/or inappropriate use of antibiotics. Conclusion This review reported an overview of the resistance to the main drugs used in the treatment of H. pylori, confirming the hypothesis that antibacterial resistance is a highly local phenomenon and genetic characteristics of a given population can influence which therapy is the most appropriate.

RESUMO Contexto Helicobacter pylori tem uma distribuição a nível mundial, e está associado a patogênese de várias doenças do sistema digestivo. O tratamento para a erradicação deste microrganismo envolve a utilização de uma combinação de agentes antimicrobianos, tais como amoxicilina, metronidazol, claritromicina e levofloxacino, combinados com inibidores da bomba de prótons. Embora a terapia atual seja eficaz, uma elevada taxa de fracasso de tratamento tem sido observada, principalmente devido à aquisição de mutações pontuais, um dos principais mecanismos de resistência desenvolvida por H. pylori, relacionado com o uso frequente e/ou inadequado dos antibióticos. Conclusão Esta revisão abordou uma visão geral da resistência às principais drogas utilizadas no tratamento de H. pylori, confirmando a hipótese de que a resistência bacteriana é um fenômeno altamente local e as características genéticas de uma dada população podem influenciar qual terapia é a mais apropriada.

Humans , Male , Female , Helicobacter pylori/drug effects , Helicobacter Infections/microbiology , Helicobacter Infections/drug therapy , Drug Resistance, Multiple, Bacterial , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacology , Helicobacter pylori/genetics , Point Mutation , Drug Therapy, Combination
Braz. j. infect. dis ; 20(6): 534-538, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-828170


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.

Humans , Male , Female , Adult , Plant Extracts/therapeutic use , Helicobacter pylori/drug effects , Helicobacter Infections/drug therapy , Clarithromycin/therapeutic use , Glycyrrhiza/chemistry , Anti-Bacterial Agents/therapeutic use , Peptic Ulcer/microbiology , Peptic Ulcer/drug therapy , Treatment Outcome , Dyspepsia/microbiology , Dyspepsia/drug therapy
Arq. gastroenterol ; 53(2): 113-117, April.-June 2016. tab
Article in English | LILACS | ID: lil-783810


ABSTRACT Background - Antimicrobial resistance is the major factor leading to eradication failure in H. pylori treatment. Molecular tests are useful to detect genetic mutations predictive of clarithromycin and fluoroquinolones resistance. Knowledge of the local prevalence rate of resistance is important to define the best recommended treatment. Objective - To assess the prevalence of primary resistance of H. pylori to clarithromycin and fluoroquinolones, using a molecular test, in a Southeastern urban Brazilian population. Methods - A total of 72 H. pylori seropositive patients [65% female, mean age 39 (19-73) years] never treated before for this infection were studied. All patients underwent gastroscopy in addition to antrum and corpus biopsies and molecular test GenoType HelicoDR (Hain Life Science, Germany) to detect H. pylori and point mutations in genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from biopsy samples, a multiplex amplification with biotinylated primers and a reverse hybridization. The most frequent point mutations involved in resistance to the two antibiotics were evaluated. Results - Resistance to clarithromycin was detected in nine (12.5%) patients and to fluoroquinolones in eight (11.1%) patients. The point mutation A2147G was the most common (77.8%) among resistant strains to clarithromycin. In 50% of the resistant strains to fluoroquinolones, the mutant codon couldn't be identified. Conclusion - The resistance rates to clarithromycin and fluorquinolones in a large urban population in the Southeast of Brazil were acceptable, suggesting that these drugs remain appropriate options to first and second-line of H. pylori treatment. The molecular test represents an adequate diagnostic tool for monitoring H. pylori resistance.

RESUMO Contexto - A resistência aos antimicrobianos é o principal fator associado à falha terapêutica no tratamento do H. pylori. Testes moleculares são úteis na detecção das mutações genéticas associadas ao desenvolvimento de resistência à claritromicina e fluorquinolonas. O conhecimento da taxa de prevalência local de resistência é importante na definição do melhor esquema terapêutico. Objetivo - Estimar a prevalência de resistência primária do H. pylori à claritromicina e fluorquinolonas, empregando-se um teste molecular, em uma capital do Sudeste do Brasil. Métodos - Setenta e dois pacientes com sorologia positiva para H. pylori [65% mulheres, idade média 39 (19-73) anos], nunca tratados previamente para essa infecção, foram selecionados. Todos os pacientes submeteram-se à endoscopia digestiva com biópsias de antro e corpo e realização do teste molecular GenoType HelicoDR (Hain Life Science, Alemanha) para a detecção do H. pylori e das mutações pontuais dos genes responsáveis pela resistência à claritromicina e fluorquinolonas. O procedimento molecular constituía-se de três etapas: extração do DNA a partir das amostras endoscópicas, amplificação multiplex com primers biotinilados e hibridização reversa. As mutações pontuais mais frequentemente envolvidas com resistência aos dois antibióticos foram avaliadas. Resultados - Resistência à claritromicina foi detectada em nove (12,5%) pacientes e às fluorquinolonas em oito (11,1%) pacientes. A mutação pontual A2147G foi a mais comum (77,8%) entre as cepas resistentes à claritromicina. Em 50% das cepas resistentes à fluorquinolonas, o códon mutante não pôde ser identificado. Conclusão - As taxas de resistência à claritromicina (12,5%) e às fluorquinolonas (11,1%), em uma importante capital do Sudeste do Brasil, mostraram índices aceitáveis, sugerindo que essas drogas permanecem opções apropriadas para o tratamento de primeira e segunda linha do H. pylori. O teste molecular constitui uma ferramenta diagnóstica adequada para monitorar a resistência do H. pylori.

Humans , Male , Female , Adult , Aged , Young Adult , Helicobacter pylori/drug effects , Helicobacter Infections/microbiology , Clarithromycin/pharmacology , Fluoroquinolones/pharmacology , Drug Resistance, Bacterial , Anti-Bacterial Agents/pharmacology , Urban Population , Biopsy , Risk Factors , Helicobacter pylori/isolation & purification , Helicobacter pylori/genetics , Helicobacter Infections/drug therapy , Clarithromycin/therapeutic use , Fluoroquinolones/therapeutic use , Middle Aged , Anti-Bacterial Agents/therapeutic use , Mutation/genetics