Mucormicosis gástrica en un niño inmunocompetente / Gastric mucormycosis in an immunocompetent child

La mucormicosis es una infección oportunista rara usualmente fatal, que afecta mayoritariamente a personas con déficit inmunológico o patologías asociadas. Hay pocos reportes de esta enfermedad en pacientes sin los factores de riesgo tradicionales, desconociéndose aún cuáles podrían ser las causas predisponentes reales implicadas. Las formas de presentación son rinocerebral, cutánea, pulmonar, gastrointestinal y diseminada. Es por esto que, debido al difícil diagnóstico, alta mortalidad y presentación poco común reportamos el caso de un niño de 4 años sin inmunodeficiencia ni patologías de fondo que desarrolló una mucormicosis esófago-gástrica.

Mucormycosis is a rare, usually fatal, opportunistic infection that mostly affects people with immune deficiency or associated pathologies. There are few reports of this disease in patients without the traditional risk factors, still unknown what could be the real predisposing causes involved. The forms of presentation are rhinocerebral, cutaneous, pulmonary, gastrointestinal and disseminated. This is why, due to the difficult diagnosis, high mortality and uncommon presentation, we report the case of a 4-year-old child without immunodeficiency or background pathologies who developed an esophagogastric mucormycosis.

Prevalencia de cepas cagA-positivo en la región de Coquimbo, determinada mediante nested-qPCR en muestras fecales / Frequency of CagA-positive Helicobacter pylori strains in 160 patients subjected to endoscopy

Background: Helicobacter pylori is the most significant pathogen associated with gastric diseases, including gastric cancer. Infected patients with strains that are CagA-positive generally have worse outcomes than those infected with CagA-negative strains. Patients infected with CagA-positive strains have a higher risk for developing gastric cancer. Aim: To determine the prevalence of CagA-positive H. pylori strains in fecal samples of patients from the Coquimbo Region of Chile, using a non-invasive, nested-qPCR method. Material and Methods: We evaluated 160 patients with gastrointestinal symptoms subjected to an upper gastrointestinal endoscopy. DNA was extracted from fecal samples and tested for the presence of H. pylori using nested-qPCR for the ureC gene, and subsequently compared with the results of histology-Giemsa stain from the patients' endoscopic biopsies. When H. pylori was found, the presence of CagA-positive strains was determined via nested-qPCR. Results: The histology-Giemsa stain was positive for H. pylori infection in 123 patients (76.9%), while the analysis of fecal samples detected H. pylori in 129 patients (80.6%). The sensitivity and specificity of nested-qPCR to detect the bacterium was 96.7 and 73.0% respectively. Among patients with the infection, 25% had CagA-positive strains. Conclusions: In this sample of patients, there is a low prevalence of CagA-positive H. pylori strains.

Guía de práctica clínica para el diagnóstico y tratamiento de la infección por Helicobacter pylori en adultos / Clinical Practice Guideline for the Diagnosis and Management of Adult Patients with Helicobacter pylori Infection

Objetivo: brindar una guía de práctica clínica basada en la evidencia más reciente para el diagnóstico y tratamiento de la infección por Helicobacter pylori teniendo en cuenta la efectividad y seguridad de las intervenciones dirigidas a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atención en Colombia. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; una de ellas cumplió los criterios de adaptación, por lo que se decidió adaptar 4 preguntas clínicas y construir 10 de novo. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base en la metodología GRADE. Las recomendaciones de la guía fueron socializadas en una reunión de expertos con entes gubernamentales y pacientes. Resultados: se desarrolló una guía de práctica clínica basada en la evidencia para el diagnóstico y tratamiento de la infección de Helicobacter pylori en Colombia. Conclusiones: la erradicación de H. pylori, curará las ulceras pépticas asociadas al mismo, la gastritis crónica sin atrofia o metaplasia intestinal y contribuirá a disminuir el riesgo de cáncer gástrico, que es la primera causa de muerte por cáncer en Colombia.

Objective: To provide a clinical practice guideline with the latest evidence for diagnosis and treatment of Helicobacter pylori infection for patients, caregivers, administrative and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated quality and applicability. One guideline met the criteria for adaptation, so the group decided to adapt 4 clinical questions and to develop 10 de novo clinical questions. Systematic literature searches were conducted by the Cochrane Group. The tables of evidence and recommendations were made based on the GRADE methodology. The recommendations of the guide were socialized in a meeting of experts with government agencies and patients. Results: An evidence-based Clinical Practice Guidelines for the diagnosis and treatment of Helicobacter pylori infection was developed for the Colombian context. Conclusions: The opportune detection and appropriate management of Helicobacter pylori would contribute to the burden of the disease in Colombia and its associated diseases.

Endoscopic and iistopathologic gastric changes in chronic users of proton-pump inhibitors / Alterações endoscópicas e histopatológicas gástricas em pacientes usuários crônicos de inibidores de bomba de prótons

Background Proton-pump inhibitors have been used for at least two decades. They are among the most commonly sold drugs in the world. However, some controversy remains about the indications for their use and the consequences of their prolonged use. Objectives To evaluate and compare the endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors to changes in non-users. Methods A prospective study performed at a tertiary Public Hospital involving 105 patients undergoing upper-gastrointestinal endoscopy. Subjects included 81 proton-pump inhibitor users and 24 non-users (control group). Biopsies of the antral-type mucosa, the antral-fundic transition, and the fundus were evaluated by the Sydney System. The presence of erosion or ulceration, lymphatic follicles, reactive gastropathy, and polypoid or epithelial hyperplasia was also determined. Serum levels of gastrin were measured. Results We found two polyps, one in each group, both of which were negative for Helicobacter pylori. There were two cases of parietal cell hyperplasia in users of proton-pump inhibitors. Gastrin was elevated in 28 users of proton-pump inhibitors and in four members of the control group. We did not find statistically significant differences in the endoscopic or histopathologic findings between the two groups. Conclusions Chronic use of proton-pump inhibitors for the duration examined was not associated with significant gastric changes. An interesting finding was that the 4 chronic users of proton-pump inhibitors who had serum gastrin levels above 500 pg/mL also had positive serology for Chagas disease. .

Contexto Os inibidores da bomba de prótons são usados há pelo menos duas décadas e estão entre as drogas mais vendidas no mundo. Ainda existem controvérsias sobre as indicações e as consequências de seu uso a longo prazo. Objetivos Avaliar as alterações endoscópicas e histopatológicas gástricas em usuários crônicos de inibidores da bomba de prótons e comparar com controles. Métodos Estudo prospectivo reali­zado em Hospital Público terciário com 105 pacientes, 81 usuários de bomba de prótons e 24 controles, submetidos a endoscopia digestiva alta. As biópsias das mucosas do tipo antral, da transição antro fúndica e fúndica foram avaliadas segundo a Classificação de Sidney e verificando também erosão ou úlcera, folículo linfático, gastropatia reativa, hiperplasia epitelial e pólipo. Realizada também a dosagem sérica da gastrina. Resultados Encontramos dois pólipos, um em cada grupo, ambos negativos para Helicobacter pylori e dois casos de hiperplasia de células parietais nos usuários de inibidores da bomba de prótons. A gastrina estava aumentada em 28 usuários de inibidor da bomba de protóns e em 4 do grupo controle. Não encontramos diferenças estatisticamente significantes nos achados endoscópicos e histopatológicos dos dois grupos. Conclusões O uso crônico de inibidores da bomba de prótons no período examinado não se associou com alterações gástricas significantes. O achado mais importante foi a positividade das sorologias para doença de Chagas nos quatro pacientes do grupo de usuários crônicos de inibidores que apresentavam níveis de gastrina sérica superiores a 500 pg/ mL .

Prevalence of iffection with caga-positive heliobacter pylori strains among chhildren and adolescents in southern Brazil / Prevalência da infecção por cepas de Helicobacter pylori cagA-positivo em crianças e adolescentes do Sul do Brasil

Context Helicobacter pylori (H. pylori) has a worldwide distribution, but the prevalence of infection, virulence factors, and clinical presentation vary widely according to the studied population. In Brazil, a continental country composed of several ethnicities and cultural habits, the behavior of infection also appears to vary, as many other studies have shown. Objectives Describe the prevalence of infection with cagA-positive H. pylori strains in a group of children and adolescents who underwent esophagogastroduodenoscopy in Porto Alegre, Rio Grande do Sul. Methods Fifty-four gastric biopsy specimens of children and adolescents with H. pylori infection demonstrated by histology, urease test and molecular analysis were tested for the presence of cagA positive H. pylori strains by the polymerase chain reaction method. Results he prevalence of cagA-positive H. pylori was 29.6% (95% confidence interval, 18 to 43.6%). There were no statistically significant differences in clinical or demographic characteristics or in the endoscopic and histological features of patients infected with cagA-positive strains as compared with those infected by cagA-negative strains. Conclusions he study showed a low prevalence of infection with cagA-positive H. pylori strains among children and adolescents who underwent EGD in southern Brazil, in comparison to studies conducted with children from other regions of Brazil. There was no association between the presence of cagA-positive strains and more severe clinical presentations in the studied sample. .

Contexto Helicobacter pylori (H. pylori) tem distribuição geográfica universal, embora a prevalência da infecção, os fatores de virulência, bem como a apresentação clínica, variem de acordo com a população estudada. No Brasil, um país continental composto por várias etnias e hábitos culturais diversos, o comportamento da infecção também parece variar, como muitos estudos têm demonstrado. Objetivos Descrever a prevalência da infecção por cepas de H. pylori cagA-positivo em um grupo de crianças e adolescentes submetidos a esofagogastroduodenoscopia em Porto Alegre, Rio Grande do Sul. Métodos Cinquenta e quatro (54) fragmentos de biópsia gástrica com presença de H. pylori demonstrada pela análise histológica, teste da urease e análise molecular foram testados para a presença de cepas de H. pylori cagA-positivo pelo método da reação em cadeia da polimerase. Resultados prevalência de cepas de H. pylori cagA-positivo foi de 29,6% (intervalo de confiança de 95%, 18% a 43,6%). Não houve diferenças estatisticamente significativas nas características clínicas e demográficas e nos achados endoscópicos e histológicos entre os pacientes infectados por cepas de H. pylori cagA-positivo em comparação com os cagA-negativo. Conclusões O estudo demonstrou uma baixa prevalência de infecção por cepas de H. pylori cagA-positivo nas crianças e adolescentes submetidas a esofagogastroduodenoscopia no Sul do Brasil em comparação com os estudos realizados com crianças de outras regiões do Brasil. Não houve associação entre a presença de cepas cagA-positivo e desfechos clínicos desfavoráveis na amostra estudada. .

Low dose capsul based 13c-urea breath test comared with the conventional 13c--urea breath test and invasive tests / Teste respiratório com 13C-uréia em cápsula de baixa dose em comparação com o teste respiratório com 13C-uréia convencional e testes invasivos

Context One of the limitations of 13C-urea breath test for Helicobacter pylori infection diagnosis in Brazil is the substrate acquisition in capsule presentation. Objectives The purpose of this study was to evaluate a capsule-based 13C-urea, manipulated by the Pharmacy Division, for the clinical practice. Methods Fifty patients underwent the conventional and the capsule breath test. Samples were collected at the baseline and after 10, 20 and 30 minutes of 13C-urea ingestion. Urease and histology were used as gold standard in 83 patients. Results In a total of 50 patients, 17 were positive with the conventional 13C-urea (75 mg) breath test at 10, 20 and 30 minutes. When these patients repeated breath test with capsule (50 mg), 17 were positive at 20 minutes and 15 at 10 and 30 minutes. The relative sensitivity of 13C-urea with capsule was 100% at 20 minutes and 88.24% at 10 and at 30 minutes. The relative specificity was 100% at all time intervals. Among 83 patients that underwent capsule breath test and endoscopy the capsule breath test presented 100% of sensitivity and specificity. Conclusions Capsule based breath test with 50 mg 13C-urea at twenty minutes was found highly sensitive and specific for the clinical setting. HEADINGS- Helicobacter pylori. Breath Test. Urea, analysis. .

Contexto Uma das limitações para o teste respiratório com 13C-uréia ser incorporado na prática clínica no Brasil para diagnóstico de infecção pelo Helicobacter pylori (H. pylori) é a aquisição do substrato em apresentação de cápsula. Objetivos O objetivo deste estudo foi avaliar a utilidade de 13C-uréia em cápsula, manipulada pela Divisão de Farmácia de um Hospital terciário para a prática clínica. Métodos Cinquenta pacientes foram submetidos ao teste respiratório convencional com 75mg de 13C-uréia e ao teste com cápsula de 50 mg de 13C-uréia. Amostras de ar expirado foram coletadas no basal e após 10, 20 e 30 minutos da ingestão de 13C-uréia para definição do melhor tempo de coleta. A urease e a histologia foram usadas como padrão ouro em 83 pacientes que se submeteram ao teste respiratório com único ponto de coleta. Resultados Num total de 50 pacientes, 17 foram positivos com teste respiratório convencional com 75 mg de 13C-uréia aos 10, 20 e 30 minutos. Quando esses pacientes repetiram o teste respiratório com 13C-uréia em cápsulas de 50 mg, 17 foram positivos aos 20 minutos (Índice Kappa 1,0; P<0,05) e 15 aos 10 e 30 minutos (Índice Kappa 0,90; P<0,05). A sensibilidade relativa da 13C-uréia em cápsulas de 50 mg foi 100% aos 20 minutos e 88,24% aos 10 e 30 minutos. A especificidade relativa foi de 100% em todos os intervalos de tempo. Entre 83 pacientes que se submeteram ao teste respiratório com cápsula e endoscopia, aqueles que eram H. pylori positivos tiveram teste respiratório positivo e aqueles H. pylori negativo tiveram teste respiratório negativo, mostrando sensibilidade e especificidade de 100%. Conclusões O teste respiratório com cápsula de 50 mg de 13C-uréia ...

Role of helicobccter pylori infection and lifesyle habits in the development oof gastroduodenal diseases in a population from the Brazilian amazon / Papel da infeccao por Helicobacter pylori e habitos de vida no desenvolvimento das doencas gastroduodenais em uma populacao da amazonia brasileira

Context Although more than half of the world's population is colonized with Helicobacter pylori, it remains unknown why this organism is able to produce severe disease in some hosts and be innocuous in others. The clinical outcome of infection is determined by several factors, including differences in the host response to bacterial stimulation, specific virulence factors of the organism and environmental influences, or a combination of these factors. Objectives This study compared the prevalence of H. pylori infection and risk factors (infection with CagA+ strains, excessive alcohol consumption, smoking, and inadequate eating habits) between patients with different gastrointestinal disorders and associated these risk factors with the histopathological findings. Methods In a prospective study, samples were collected from 442 patients and a standardized questionnaire regarding lifestyle habits (excessive alcohol consumption, smoking, and eating habits) was applied. The presence of H. pylori and of the cagA gene was investigated by polymerase chain reaction (PCR). Gastric biopsies were obtained for histological assessment. Results The frequency of alcohol consumption, smoking, inadequate diet and infection with CagA+ H. pylori was higher among patients with peptic ulcer and adenocarcinoma when compared to those with gastritis. Gastric inflammation was more pronounced in patients infected with CagA+ strains. Conclusion We conclude that infection with CagA+ H. pylori strains, excessive alcohol consumption, smoking and inadequate eating habits increase the risk of developing peptic ulcer and gastric carcinoma. .

Contexto Apesar de o H. pylori colonizar o estômago de aproximadamente metade da população mundial, ainda se desconhece por quê esse organismo é capaz de causar doença severa em certos hospedeiros e ser inofensivo em outros. As manifestações clínicas da infecção são determinadas por vários fatores, tais como: diferentes respostas do hospedeiro ao estímulo bacteriano, fatores de virulência específicos do organismo e influências ambientais ou a combinação desses fatores. Objetivos Esse estudo tem como objetivo comparar a prevalência e a associação dos fatores de risco, tais como: infecção por cepas H. pylori CagA+, consumo excessivo de bebidas alcoólicas, uso de tabaco e hábitos inadequados de alimentação entre pacientes com diferentes doenças gastrointestinais e a associação deles com achados histopatológicos. Métodos Em estudo prospectivo, foram cole-tadas amostras de 442 pacientes submetidos a um questionário padronizado com perguntas sobre hábitos de vida (uso excessivo de álcool, tabaco e, hábitos alimentares). A presença do H. pylori e do gene cagA foi detectada utilizando a Reação em Cadeia da Polimerase (PCR). As biópsias gástricas foram avaliadas histologicamente. Resultados O consumo de bebida alcoólica, uso de tabaco, dieta inadequada e infecção por cepas H. pylori CagA+ foram maiores entre pacientes com úlcera péptica e adenocarcinoma do que em pacientes com gastrite. Os pacientes infectados por cepas H. pylori CagA+ apresentaram inflamação gástrica de maior intensidade. Conclusão A presença de infecção por cepas H. pylori CagA+, o consumo excessivo de álcool, de tabaco ...

Helicobacter pylori as a potential target for the treatment of central serous chorioretinopathy

OBJECTIVES: The objective of this study was to evaluate the relationship between the treatment of Helicobacter pylori gastric infection and changes in best-corrected visual acuity and macular detachment in patients with chronic central serous chorioretinopathy. METHODS: Seventeen patients diagnosed with central serous chorioretinopathy were examined for gastric infection with Helicobacter pylori using the urease test and gastric biopsy. Helicobacter pylory-positive patients were treated with the appropriate medication. The response to therapy was monitored by evaluating the best-corrected visual acuity and optical coherence tomography. The data were analyzed using Student's t-test before and after treatment. RESULTS: Fourteen patients (15 eyes) aged 30-56 years (mean 43.4 ± 8.3 years) were positive for Helicobacter pylori. Most of the positive patients had gastric symptoms (78.5%); one had bilateral central serous chorioretinopathy. The mean baseline best-corrected visual acuity was 20/98 (logMAR = 0.53 ± 0.28). Three months after starting treatment with antibiotics, the serous detachment had resolved in 14 of 15 eyes, but two cases required laser treatment. The follow-up period ranged from 6 to 27 months. The mean final best-corrected visual acuity differed significantly from baseline. CONCLUSION: Our findings suggest that Helicobacter pylori infection may be present in many chronic central serous chorioretinopathy patients and that treatment for the infection may have a favorable effect on the outcome of chronic central serous chorioretinopathy. Due to the possibility of the spontaneous regression of chronic central serous chorioretinopathy and the high prevalence of the infection in the general population, prospective and masked clinical trials are necessary to confirm that treatment for Helicobacter pylori infection may benefit patients with chronic central serous chorioretinopathy.

Characterization of 23S rRNA domain V mutations in gastric biopsy patients from the eastern Amazon

Resistance of Helicobacter pylori to clarithromycin is characterised by simple point mutations in the 23S ribosomal RNA (rRNA) gene and is responsible for the majority of cases of failure to eradicate this bacterium. In this paper, we characterised the variability of the 23S rRNA gene in biopsies of patients with gastric pathologies in the eastern Amazon (Northern Region of Brazil) using PCR and sequencing. A total of 49 sequences of H. pylori strains were analysed and of those, 75.6 percent presented nucleotide substitutions: A2142G (3.3 percent), T2182C (12.9 percent), G2224A (6.45 percent), T2215C (61.3 percent), A2192G (3.3 percent), G2204C (6.4 percent) and T2221C (6.4 percent). Of the mutations identified, four are known mutations related to cases of resistance and 16.1 percent are not yet described, revealing a high prevalence of mutations in the H. pylori 23S rRNA gene among the strains circulating in the in the eastern Amazon. The high prevalence in individuals with gastric pathologies in the Northern Region of Brazil demonstrates the need for characterising the profile of these strains to provide correct therapy for patients, considering that mutations in this gene are normally associated with resistance to the primary medication used in controlling H. pylori infection.

A Case of Gastric Candidiasis Presented as Subepithelial Mass in an Immunocompromised Host / 대한소화기학회지

Hepatosplenic candidiasis is also called chronic disseminated candidiasis and usually seen in patients with hematologic malignancies who have just recovered from an episode of neutropenia. Gastric candidiasis most commonly present as a mucosal lesion such as an ulcer or erosions, but other gastric lesion is very rare. We experienced a case of gastric candidiasis which presented as gastric subepithelial mass in a 60-year old woman who had undergone the 2nd consolidation chemotherapy due to acute myeloid leukemia. The pathologic diagnosis was confirmed by fine needle aspiration of the gastric subepithelial mass under the guidance of endoscopic ultrasonography.

Primary gastric fundus tuberculosis in immunocompetent patient: a case report and literature review

We report on a 29-year-old Pakistani man who presented to the clinic with epigastric pain, of one-month duration. He did not report fever, cough, vomiting blood, passing black stools, loss of appetite or diarrhea. However, he had lost 7 kg since his symptoms had begun. Clinical examination was unremarkable. Laboratory results were within normal limits. An abdominal CT scan showed a mass with enhancement in the stomach. Gastric endoscopy revealed an ulcerative mass in the fundus. An endoscopic-biopsy specimen revealed caseating granulomas with acid-fast bacilli. The patient was diagnosed to have primary gastric tuberculosis, and antituberculous medications were initiated. Cultures of the gastric mass subsequently grew Mycobacterium tuberculosis sensitive to isoniazid and rifampcin. Follow-up after six months showed a good response to treatment; an upper gastrointestinal tract endoscopy after six months was normal.

[Discrimination of dominant H. pylori strains isolated from patients with different gastroduodenal pathologies by protein profiling]

It is not clear what factors determine divergent outcomes of infections caused by H. pylori. The aim of this study was to differentiate H. pylori strains isolated from the patients with different gastroduodenal pathologies by protein profiling. The protein profiles of different strains of H. pylori isolated from 3 groups of patients with ulcerative disease, nonulcerative gastritis and cancer disease were analyzed using 1D-SDS-PAGE. Based on the highly divergent protein patterns, the similarity of the strains inside each group was 75%, 76.47% and 78.57% for cancerous, ulcerative and no ulcerative groups respectively, while about 30.76% of the protein bands were common in all strains isolated from three groups of the patients. Some of the observed bands were significantly specific for each group. We speculated that some H. pylori strains might be more associated with a specific disease than others, leading to the clustering of some, but not all, strains within each disease group. This study showed that protein profile can be a criterion used for discriminating of dominant states in different gastric clinical states. Specific and dominant proteins of different strains isolated from three groups of patients under the study could be welcome candidates for further exploration to be used both for laboratory tests, which analyze disease-specific H. pylori strains, and for diagnosis of different diseases and outcomes associated with this widespread bacterium

Neonatal gastrointestinal mucormycosis--a case report.

Mucormycosis is a rare opportunistic fungal infection. It occurs mainly in immunocompromised patients and is usually fatal in children. This fungus can affect central nervous system, nasopharynx, lungs, skin and gastrointestinal tract. It invades the blood vessels and causes thrombosis, leading to infarction of the surrounding tissues. The diagnosis depends mainly on histopathological examination and demonstration of the fungus in the tissue sections, therefore a high index of suspicion and early exploration is required. We report a case of malnourished child who presented with perforation peritonitis. Investigations revealed very low total serum proteins and raised serum creatinine and blood urea levels. On exploratory laparotomy three perforations were located in the gastrointestinal tract. Histopathlogical examination of the perforation edge sections showed characteristic fungal hyphae confirming the diagnosis of gastrointestinal mucormycosis.

Correlation between Helicobacter pylori infection, gastric diseases and life habits among patients treated at a university hospital in Southeast Brazil

Helicobacter pylori is considered a significant agent in the development of various gastric diseases. However, the diseases caused by this bacterium are known as being multi-factorial, with the genotype, immune system and life habits of the host playing important roles in the establishment of the clinical outcome. Also, H. pylori exhibit a high degree of genetic variability, contributing to the complexity of the host-pathogen relationship. These observations, considered together with the widely-varying origins and social habits of the Brazilian population, lead us to speculate about the influence of these life habits on H. pylori infection and the clinical outcome. Therefore, in this study we evaluated the relationship between H. pylori infection and certain diseases in 172 patients treated at the Hospital das Clínicas of Ribeirão Preto (HCRP), Brazil, taking into account their different life habits, such as non-steroidal anti-inflammatory drugs and alcohol ingestion, and smoking habit. Our analysis indicated that H. pylori infection is not affected by any of the life habits evaluated but is associated with the development of peptic ulcers (gastric and duodenal ulcer) and inverse correlate with gastroesophageal reflux disease (GERD). No correlation was found between the infection with this bacterium and gastritis or intestinal metaplasia. However, gastritis and erosive gastritis were directly correlated with non-steroidal anti-inflammatory drugs (NSAID) ingestion. Moreover, ingestion of alcohol beverages exhibited a protective effect on gastritis development in men. Our data also indicated that to achieve reliable detection of this bacterium in biopsies, two or three detection methods should be used.

Helicobacter pylori stool antigen test [HPSA] for the diagnosis of gastric infection

To determine the accuracy of Helicobacter pylori Stool Antigen test [HpSA], compared with endoscopic histopathology for the diagnosis of gastric HeUcobecter pylori infection. Cross-sectional study. Medical Unit II, Abbasi Shaheed Hospital, Karachi, from March 2003 to March 2004. A total of 50 patients underwent endoscopy for gastric antral mucosal tissue biopsy for histopathology of H.pyiori and advised for HpSA. Patient's information including age, gender, past history, presenting signs and symptoms, results of HpSA and histopathology were recorded. Sensitivity analysis was performed to calculate sensitivity, specificity, and predictive values of HpSA. Among 50 patients, 48% males and 52% females [M: F 1: 1.08], a total of 27 [54%] were true positive while 20 [40%] were true negative. Two patients were false negative and only one was false positive. Sensitivity of HpSA was, therefore, 93.1%, specificity 95% and positive and negative predictive values were 96.42% and 90.9% respectively. Helicobacter pylori stool antigen was an accurate and reliable test for the diagnosis of gastric H. pylori infection

Ureases display biological effects independent of enzymatic activity: Is there a connection to diseases caused by urease-producing bacteria?

Ureases are enzymes from plants, fungi and bacteria that catalyze the hydrolysis of urea to form ammonia and carbon dioxide. While fungal and plant ureases are homo-oligomers of 90-kDa subunits, bacterial ureases are multimers of two or three subunit complexes. We showed that some isoforms of jack bean urease, canatoxin and the classical urease, bind to glycoconjugates and induce platelet aggregation. Canatoxin also promotes release of histamine from mast cells, insulin from pancreatic cells and neurotransmitters from brain synaptosomes. In vivo it induces rat paw edema and neutrophil chemotaxis. These effects are independent of ureolytic activity and require activation of eicosanoid metabolism and calcium channels. Helicobacter pylori, a Gram-negative bacterium that colonizes the human stomach mucosa, causes gastric ulcers and cancer by a mechanism that is not understood. H. pylori produces factors that damage gastric epithelial cells, such as the vacuolating cytotoxin VacA, the cytotoxin-associated protein CagA, and a urease (up to 10 percent of bacterial protein) that neutralizes the acidic medium permitting its survival in the stomach. H. pylori whole cells or extracts of its water-soluble proteins promote inflammation, activate neutrophils and induce the release of cytokines. In this paper we review data from the literature suggesting that H. pylori urease displays many of the biological activities observed for jack bean ureases and show that bacterial ureases have a secretagogue effect modulated by eicosanoid metabolites through lipoxygenase pathways. These findings could be relevant to the elucidation of the role of urease in the pathogenesis of the gastrointestinal disease caused by H. pylori.

Absence of vertical transmission of Helicobacter pylori in an experimental murine model

Helicobacter pylori (H. pylori) infection is acquired mainly in early childhood but the precise transmission routes are unclear. This study examined the maternal H. pylori infection status in order to determine the potential of perinatal transmission. These issues were investigated using an experimental murine model, the Mongolian gerbil, which has been reported to be the most suitable laboratory animal model for studying H. pylori. Pregnant Mongolian gerbils, infected experimentally with H. pylori, were divided into two groups. The stomachs of the mother and litters were isolated and assessed for the transmission of H. pylori at the prenatal period (2 weeks after pregnancy) and at the parturition day. The bacterial culture, polymerase chain reaction (PCR) and rapid urease test were used to examine the presence of the transmitted H. pylori. There was no H. pylori observed in any of the fetuses during pregnancy and in the litters at parturition. This suggests that vertical infection during the prenatal period or delivery procedure is unlikely to be route of mother-tochild transmission of a H. pylori infection.

Immunodominant antigens of helicobacter pylori strains isolated from patients with different gastroduodenal diseases

To detect the immunogenic proteins in Helicobacter pylori [H. pylori] strains isolated from patients with different gastric diseases. We performed this study in the Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, during July 2003 to September 2004. Total proteins of H. pylori strains isolated from the gastric biopsies of 3 groups of patients were separated by 1D-SDS-PAGE and then blotted with the sera of their respective hosts. In SDS-PAGE the members of each group showed high correlation according to similarity in their patterns, resulting in considering them in the same cluster. The patterns of immunoblots differed from that of Coomassie Brilliant Blue stained gels. The blotting method did not recognize some of the protein bands in the SDS-PAGE. Only the bands of 106 and 45 kDa from H. pylori strains isolated from patients with gastric cancer were significantly [p<0.05] recognized specifically with the sera of their respective patients, and the band of 13 kDa was recognized specifically [p<0.05] with the sera of nonulceric patients. With the exception of these bands, in the patterns of blotting of the sera from all patients no significant differences were observed. By using 1D blotting methods we could find 2 antigenic protein bands [106 and 45 kDa] for H. pylori strains isolated from cancerous patients, and one [13 kDa] for the strains isolated from nonulceric patients, which were specifically recognized with their respective host