Helicobacter pylori and other factors in recurrent aphthous stomatitis: A cross-sectional study.

OBJECTIVES: To evaluate the role of Helicobacter pylori and other risk factors in recurrent aphthous stomatitis (RAS). METHODS: Patients with functional dyspepsia responded to questionnaires regarding demographic and clinical data, anxiety and depression, and a specific RAS questionnaire. They underwent upper digestive endoscopy and H. pylori evaluation. RESULTS: 476 patients were included and of the 372 evaluated for H. pylori, 65.6% were H. pylori-positive. RAS was reported by 32.6% (155/476). In the bivariate analysis of the 372 patients evaluated for gastric H. pylori status, positive subjects had a lower RAS prevalence (29.9%; 73/244) than H. pylori-negative (41.4%; 53/128) (p = .026). Smoking (p = .005) and older age (p = .034) were also associated with a lower prevalence, while female gender (p = .032) and lower income (p = .046) presented higher RAS prevalence. In the multivariate analysis, H. pylori infection (p = .017), smoking (p = .001), and older age (p = .013) were protective factors, while lower income (p = .030) and anxiety (p = .042) were risk factors. In the multivariate analysis of all patients, female gender, lower income, and more schooling years were risk factors. CONCLUSIONS: An unexpected lower prevalence of RAS was found in H. pylori-positive patients. Smoking, sex, age, income, education, and anxiety were associated with RAS.

ASSOCIATION OF DUODENAL EOSINOPHILIC INFILTRATE WITH HELICOBACTER PYLORI INFECTION, BUT NOT WITH FUNCTIONAL DYSPEPSIA.

BACKGROUND: The role of Helicobacter pylori infection on eosinophilic infiltration in duodenal mucosa is poorly studied. An increase in the number of eosinophils in duodenum has been associated with functional dyspepsia. OBJECTIVE: To evaluate the influence of H. pylori infection on duodenal eosinophil count and the role of eosinophilic infiltrate of duodenum in functional dyspepsia. METHODS: Positive and negative H. pylori individuals were included. Both functional dyspeptic patients according to Rome III criteria (cases) and individuals without gastrointestinal symptoms (controls) were enrolled. They were submitted to upper endoscopy and H. pylori infection was verified by gastric histopathology and urease test. Eosinophils in the duodenal mucosa were counted in five high-power fields, randomly selected on slides of endoscopic biopsies. RESULTS: Thirty-nine H. pylori positive (mean age 40.5 and 69.2% women) and 24 negative patients (mean age 37.3 and 75% women) were included. The influence of the infection was observed in the duodenal eosinophil count, which was higher in infected individuals: median 13.2 vs 8.1 in non-infected individuals (P=0.005). When we analyzed patients according to symptoms, cases - mean age 39.6; 71.4% women - and controls - mean age 38.7; 71.4% women - had similar duodenal eosinophil count: median 11.9 and 12.6 respectively (P=0.19). CONCLUSIONS: We did not demonstrate association of duodenal eosinophil count with functional dyspepsia but found association with H. pylori infection.

Associação de infiltrado eosinofílico duodenal com infecção por Helicobacter pylori, mas não com dispepsia funcional / Association of duodenal eosinophilic infiltrate with helicobacter pylori infection, but not with functional dyspepsia

ABSTRACT BACKGROUND: The role of Helicobacter pylori infection on eosinophilic infiltration in duodenal mucosa is poorly studied. An increase in the number of eosinophils in duodenum has been associated with functional dyspepsia. OBJECTIVE: To evaluate the influence of H. pylori infection on duodenal eosinophil count and the role of eosinophilic infiltrate of duodenum in functional dyspepsia. METHODS: Positive and negative H. pylori individuals were included. Both functional dyspeptic patients according to Rome III criteria (cases) and individuals without gastrointestinal symptoms (controls) were enrolled. They were submitted to upper endoscopy and H. pylori infection was verified by gastric histopathology and urease test. Eosinophils in the duodenal mucosa were counted in five high-power fields, randomly selected on slides of endoscopic biopsies. RESULTS: Thirty-nine H. pylori positive (mean age 40.5 and 69.2% women) and 24 negative patients (mean age 37.3 and 75% women) were included. The influence of the infection was observed in the duodenal eosinophil count, which was higher in infected individuals: median 13.2 vs 8.1 in non-infected individuals (P=0.005). When we analyzed patients according to symptoms, cases - mean age 39.6; 71.4% women - and controls - mean age 38.7; 71.4% women - had similar duodenal eosinophil count: median 11.9 and 12.6 respectively (P=0.19). CONCLUSIONS: We did not demonstrate association of duodenal eosinophil count with functional dyspepsia but found association with H. pylori infection.

RESUMO CONTEXTO: O papel de infecção por Helicobacter pylori no infiltrado eosinofílico duodenal ainda é pouco compreendido. Um aumento no número de eosinófilos duodenais tem sido associado a dispepsia funcional. OBJETIVO: Avaliar a influência do H. pylori na contagem de eosinófilos duodenais e o papel do infiltrado eosinofílico duodenal na dispepsia funcional. MÉTODOS: Indivíduos H. pylori positivo e negativo foram incluídos. Ambos os grupos, compreendendo dispépticos funcionais pelos critérios de Roma III (casos) e indivíduos sem sintomas gastrointestinais (controles), foram submetidos à endoscopia digestiva alta para pesquisa de H. pylori, efetuada por histopatologia e teste de urease. Eosinófilos na mucosa duodenal foram contabilizados em cinco campos de maior aumento, selecionados randomicamente nas lâminas de biópsia endoscópicas. RESULTADOS: Trinta e nove indivíduos H. pylori positivo (média de idade 40,5 e 69,2% mulheres) e 24 H. pylori negativos (média de idade 37,3 e 75% mulheres) foram incluídos. A influência da infecção por H. pylori foi observada na contagem de eosinófilos, que foi maior nos positivos: mediana 13,2 vs 8,1 (P=0,005). Quando analisados pacientes de acordo com sintomas, os casos (média de idade 39,6 e 71,4% mulheres) e controles (média de idade 38,7 e 71,4% mulheres), apresentaram semelhante contagem de eosinófilos duodenais: mediana 11,9 e 12,6, respectivamente (P=0,19). CONCLUSÃO: Não demonstramos associação da contagem de eosinófilos duodenais com dispepsia duodenal, mas encontramos associação com infecção por H. pylori.

Analysis of the Influence of Interleukin-1ß Gene Polymorphism on Gastric Inflammatory Response and Precancerous Lesions Development in Patients with Functional Dyspepsia.

The present study aimed to evaluate the influence of the IL1B -31C/T polymorphism on gastric inflammatory response and precancerous lesions development - atrophic gastritis (AG) and intestinal metaplasia (IM) - in patients positive for Helicobacter pylori infection with functional dyspepsia (FD). The diagnosis of FD followed the Rome III criteria, and the H. pylori infection was evaluated by urease test and histological examination of gastric biopsies (corpus, antrum, and incisura). The severity of chronic inflammation and inflammatory activity, as well as the presence of precancerous lesions were evaluated accordingly to the updated Sydney System. Genotyping of the IL1B -31C/T polymorphism (rs1143627) was performed by polymerase chain reaction-restriction fragment length polymorphism. A total of 303 patients positive for H. pylori infection with FD were analyzed (81.8% women; mean age of 46.3 ± 12.3 years). No differences were observed in overall genotype frequencies among outcomes evaluated. However, in the dominant -31C allele model (CC+CT vs. TT), the frequency of the TT genotype was significantly higher among patients with moderate/severe chronic inflammation of the antrum than the frequency of the CC+CT genotypes (80.8% vs. 65.2%; OR = 2.25; 95% CI = 1.23-4.24; P = .005). The presence of AG and IM in the gastric mucosa of patients was of 19.5% and 19.1%, respectively. No significant association was observed concerning the frequencies of the genotypes of IL1B -31C/T polymorphism with development of precancerous lesions. In conclusion, our data suggest that genetic variants of the IL1B -31C/T polymorphism play a role in chronic inflammation of the gastric mucosa in H. pylori-infected FD patients.

Potential roles of Helicobacter pylori treatment, body mass index and waist circumference in the causation of erosive esophagitis: a randomized clinical trial (HEROES-GERD).

BACKGROUND: In recent decades, the prevalence of gastroesophageal reflux disease (GERD) and obesity has been increasing while Helicobacter pylori infection has been decreasing. OBJECTIVE: To evaluate if H. pylori treatment, excess body weight and other anthropometric measurements are associated with incident erosive esophagitis, as a secondary objective of a trial which tested the efficacy of treatment of H. pylori on the symptoms of functional dyspepsia. SUBJECTS/METHODS: Upper gastrointestinal endoscopy and anthropometric assessments were performed, at baseline and after 12 months, in H. pylori positive patients with functional dyspepsia who had no baseline reflux symptoms or esophagitis. Patients were randomly assigned to receive omeprazole, amoxicillin, and clarithromycin (antibiotic group; n = 201) or omeprazole plus placebo (control group; n = 203). The primary outcome was the incidence of esophagitis 12 months after randomization, according to treatment groups, and the association of BMI and other anthropometric measurements. RESULTS: Four hundred and four patients were included (mean age, 46.1 years; 78.7% women). The 12-month follow-up endoscopic esophagitis rates for the antibiotic and control groups were 10.9% (22/201) and 9.4% (19/203), respectively (p = 0.60). The number needed to harm was 67. Baseline anthropometric measurements were performed in 94% (380/404) of patients. The 12-month follow-up esophagitis rates for overweight and normal body weight patients were 13.6% (29/213) and 6.0% (10/167), respectively (p = 0.015); rates for patients with and without increased baseline waist circumference were 15.4% (24/156) and 6.7% (15/224), respectively (p = 0.006). Following logistic regression, only the combination of increased baseline body mass index and waist, but not H. pylori treatment, was independently associated with new-onset esophagitis (OR 2.88; 95% CI: 1.28-6.45). CONCLUSIONS: Excess body weight and concomitant increased waist circumference, but not H. pylori treatment, predicts new-onset esophagitis.

Helicobacter pylori eradication: influence of interleukin-1beta -31 C/T polymorphism

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.

Helicobacter pylori eradication: influence of interleukin-1beta -31 C/T polymorphism.

AIM: To analyze the influence of the -31 C/T polymorphism of the interleukin-1ß 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.

The association between adult-type hypolactasia and symptoms of functional dyspepsia

Abstract Functional dyspepsia and lactose intolerance (adult-type hypolactasia, ATH) are common conditions that may coexist or even be confounded. Their clinical presentation can be similar, however, lactose intolerance does not form part of the diagnostic investigation of functional dyspepsia. Studies on the association between functional dyspepsia and ATH are scarce. This study aimed to evaluate whether ATH is associated with symptoms of functional dyspepsia. Patients fulfilling the Rome III diagnostic criteria for functional dyspepsia underwent genetic testing for ATH. Dyspeptic symptoms were evaluated and scored according to a validated questionnaire. The diagnostic criteria for ATH was a CC genotype for the -13910C/T polymorphism, located upstream of the lactase gene. The mean scores for dyspeptic symptoms were compared between patients with ATH and those with lactase persistence. A total of 197 functional dyspeptic patients were included in the study. Mean age was 47.7 years and 82.7% patients were women. Eighty-eight patients (44.7%) had a diagnosis of ATH. Abdominal bloating scores were higher in ATH patients compared to the lactase persistent patients (P=0.014). The remaining dyspeptic symptom scores were not significantly different between the two groups. The study results demonstrate an association between ATH and bloating in patients with functional dyspepsia.

The association between adult-type hypolactasia and symptoms of functional dyspepsia.

Functional dyspepsia and lactose intolerance (adult-type hypolactasia, ATH) are common conditions that may coexist or even be confounded. Their clinical presentation can be similar, however, lactose intolerance does not form part of the diagnostic investigation of functional dyspepsia. Studies on the association between functional dyspepsia and ATH are scarce. This study aimed to evaluate whether ATH is associated with symptoms of functional dyspepsia. Patients fulfilling the Rome III diagnostic criteria for functional dyspepsia underwent genetic testing for ATH. Dyspeptic symptoms were evaluated and scored according to a validated questionnaire. The diagnostic criteria for ATH was a CC genotype for the -13910C/T polymorphism, located upstream of the lactase gene. The mean scores for dyspeptic symptoms were compared between patients with ATH and those with lactase persistence. A total of 197 functional dyspeptic patients were included in the study. Mean age was 47.7 years and 82.7% patients were women. Eighty-eight patients (44.7%) had a diagnosis of ATH. Abdominal bloating scores were higher in ATH patients compared to the lactase persistent patients (P=0.014). The remaining dyspeptic symptom scores were not significantly different between the two groups. The study results demonstrate an association between ATH and bloating in patients with functional dyspepsia.

LACK OF ASSOCIATION BETWEEN HELICOBACTER PYLORI'S VIRULENCE AND INCREASED SERUM C-REACTIVE PROTEIN LEVELS IN FUNCTIONAL DYSPEPTIC PATIENTS.

BACKGROUND: Recently, a great variety of studies aimed to investigate and even suggest Helicobacter pylori as an important key factor in gastrointestinal and non-gastrointestinal events development. The well-established relationship between bacterial virulence and increased risk for peptic ulcer or gastric carcinoma is not so clear when comparing inflammation markers alterations, such C-reactive protein, with the pathogen. OBJECTIVE: The objective of this study was to evaluate the presence of H. pylori, bacterial virulence and C-reactive protein serum levels in individuals diagnosed with functional dyspepsia. METHODS: Were prospectively included in this study 489 dyspeptic individuals. They fulfill Rome III clinical criteria for the diagnosis of functional dyspepsia with no organic disease at endoscopy. The bacterial infection was established by histology and urease rapid test. The levels of serum C-reactive protein were obtained by immunonefelometry and CagA status of H. pylori positive individuals was determined through an imunoenzimatic assay. RESULTS: Prevalence rate of H. pylori was 66.3% and virulence factor CagA was detected in nearly 43% of positive samples. In addition, it has been noticed an association between Ilex paraguariensis (yerba maté) consumption and pathogen's prevalence. An important effect of bacterial infection on inflammation was only observed in gastric epithelium. CONCLUSION: No systemic response to the pathogen, measured through C-reactive protein levels, was observed, regardless of CagA status. Otherwise, the intake of yerba maté should be considered as a cultural factor possibly related to H. pylori's transmission.

Lack of association between helicobacter pylori's virulence and increased serum c-reactive protein levels in functional dyspeptic patients

ABSTRACT Background Recently, a great variety of studies aimed to investigate and even suggestHelicobacter pylori as an important key factor in gastrointestinal and non-gastrointestinal events development. The well-established relationship between bacterial virulence and increased risk for peptic ulcer or gastric carcinoma is not so clear when comparing inflammation markers alterations, such C-reactive protein, with the pathogen. Objective The objective of this study was to evaluate the presence of H. pylori, bacterial virulence and C-reactive protein serum levels in individuals diagnosed with functional dyspepsia. Methods Were prospectively included in this study 489 dyspeptic individuals. They fulfill Rome III clinical criteria for the diagnosis of functional dyspepsia with no organic disease at endoscopy. The bacterial infection was established by histology and urease rapid test. The levels of serum C-reactive protein were obtained by immunonefelometry and CagA status ofH. pylori positive individuals was determined through an imunoenzimatic assay. Results Prevalence rate of H. pylori was 66.3% and virulence factor CagA was detected in nearly 43% of positive samples. In addition, it has been noticed an association between Ilex paraguariensis(yerba maté) consumption and pathogen's prevalence. An important effect of bacterial infection on inflammation was only observed in gastric epithelium. Conclusion No systemic response to the pathogen, measured through C-reactive protein levels, was observed, regardless of CagA status. Otherwise, the intake of yerba maté should be considered as a cultural factor possibly related toH. pylori's transmission.

RESUMO Contexto Recentemente, uma grande variedade de estudos tem investigado e até mesmo sugerido a presença de Helicobacter pylori como um importante fator no desenvolvimento de eventos restritos ou não ao trato gastrointestinal. A relação já bem estabelecida entre virulência bacteriana e risco aumentado para úlcera péptica ou adenocarcinoma gástrico não parece estar tão elucidada quando se comparam alterações de marcadores inflamatórios, como a proteína C-reativa, com a presença do patógeno. Objetivo O objetivo deste estudo foi avaliar a presença da infecção por H. pylori, a virulência bacteriana e os níveis séricos de proteína C-reativa em indivíduos diagnosticados com dispepsia funcional. Métodos Foram incluídos neste estudo, prospectivamente, 489 indivíduos dispépticos. Os pacientes deveriam preencher os critérios clínicos de Roma III para o diagnóstico de dispepsia funcional sem apresentar doença orgânica evidenciada a partir da endoscopia. A infecção bacteriana foi estabelecida por histologia e pelo teste rápido da urease. Os níveis de proteína C-reativa foram quantificados através de imunonefelometria e o status para a presença da CagA dos indivíduos infectados por H. pylorifoi determinado por ensaio imunoenzimático. Resultados A taxa de prevalência de H. pylori foi de 66.3% e o fator de virulência CagA foi detectado em aproximandamente 43% das amostras positivas. Adicionalmente, denotou-se uma associação entre o consumo deIlex paraguariensis (chimarrão) e a prevalência do patógeno. Um importante efeito da infecção bacteriana na inflamação apenas foi observado localmente, no epitélio gástrico. Conclusão Não foi evidenciada resposta sistêmica ao patógeno aferido através dos níveis de proteína C-reativa, independentemente do status para CagA. Por outro lado, o consumo de chimarrão pode ser sugerido como um fator cultural possivelmente relacionado à transmissão de H. pylori.

Resistance to amoxicillin, clarithromycin and ciprofloxacin of Helicobacter pylori isolated from Southern Brazil patients.

INTRODUCTION: Helicobacter pylori is a bacteria which infects half the world population and is an important cause of gastric cancer. The eradication therapy is not always effective because resistance to antimicrobials may occur. The aim of this study was to determine the susceptibility profile of H. pylori to amoxicillin, clarithromycin and ciprofloxacin in the population of Southern Brazil. MATERIAL AND METHODS: Fifty four samples of H. pylori were evaluated. The antibiotics susceptibility was determined according to the guidelines of the British Society for Antimicrobial Chemotherapy and the Comité de l'Antibiogramme de la Société Française de Microbiologie. RESULTS: Six (11.1%) H. pylori isolates were resistant to clarithromycin, one (1.9%) to amoxicillin and three (5.5%) to ciprofloxacin. These indices of resistance are considered satisfactory and show that all of these antibiotics can be used in the empirical therapy. CONCLUSION: The antibiotics amoxicillin and clarithromycin are still a good option for first line anti-H. pylori treatment in the population of Southern Brazil.

RESISTANCE TO AMOXICILLIN, CLARITHROMYCIN AND CIPROFLOXACIN OF Helicobacter pylori ISOLATED FROM SOUTHERN BRAZIL PATIENTS / Resistência à amoxicilina, claritromicina e ciprofloxacina de Helicobacter pylori isolados de pacientes do Sul do Brasil

Introduction: Helicobacter pylori is a bacteria which infects half the world population and is an important cause of gastric cancer. The eradication therapy is not always effective because resistance to antimicrobials may occur. The aim of this study was to determine the susceptibility profile of H. pylori to amoxicillin, clarithromycin and ciprofloxacin in the population of Southern Brazil. Material and methods: Fifty four samples of H. pylori were evaluated. The antibiotics susceptibility was determined according to the guidelines of the British Society for Antimicrobial Chemotherapy and the Comité de l'Antibiogramme de la Société Française de Microbiologie. Results: Six (11.1%) H. pylori isolates were resistant to clarithromycin, one (1.9%) to amoxicillin and three (5.5%) to ciprofloxacin. These indices of resistance are considered satisfactory and show that all of these antibiotics can be used in the empirical therapy. Conclusion: The antibiotics amoxicillin and clarithromycin are still a good option for first line anti-H. pylori treatment in the population of Southern Brazil.

Introdução: Helicobacter pylori é uma bactéria que infecta metade da população mundial e é considerada importante causa de câncer gástrico. A terapia de erradicação nem sempre é eficaz, pois pode ocorrer a resistência aos antimicrobianos. Este estudo determinou a sensibilidade de H. pylori frente à amoxicilina, claritromicina e ciprofloxacina na população do Sul do Brasil. Material e métodos: Foram avaliadas 54 amostras de H. pylori. A sensibilidade aos antibióticos foi determinada segundo as orientações da British Society for Antimicrobial Chemotherapy e do Comité de l'Antibiogramme de la Société Française de Microbiologie. Resultados e discussão: Sete (13%) isolados de H. pylori foram resistentes à claritromicina, um (1,9%) à amoxicilina e três (5,5%) à ciprofloxacina. Estes índices são satisfatórios e demonstram que esses antibióticos podem ser utilizados na terapia empírica. Conclusão: Os antibióticos amoxicilina e claritromicina ainda são uma boa opção no tratamento de primeira linha anti-H. pylori na população do Sul do Brasil.

Dispepsia funcional: diagnóstico e tratamento / Functional dispepsy: diagnosis and treatment

Dispepsia Funcional é a causa mais frequente das dispepsias. Sua fisiopatologia permanece obscura e ainda não dispomos de um método diagnóstico específico. Além disso, há uma ampla lista de diagnósticos diferenciais de doenças as quais também cursam com dispepsia. O tratamento muitas vezes tem benefícios discretos, e deve ser individualizado sempre que possível, juntamente com uma boa abordagem psicossocial, a qual pode auxiliar na terapêutica e no manejo destes pacientes.

Funcional Dyspepsia is the most frequent cause of dyspepsia. Its pathophysiology remains unclear and there is not still a specific diagnostic method. Moreover, there is an extensive list of differential diagnosis of diseases which also presents with dyspepsia. The treatment often has discrete benefits and must be individually whenever possible, with good psychosocial, which can aid in the treatment and the management of these patients.

Helicobacter pylori eradication in functional dyspepsia: HEROES trial.

BACKGROUND: Eradication of Helicobacter pylori in patients with functional dyspepsia continues to be a matter of debate. We studied eradication effects on symptoms and quality of life of primary care patients. METHODS: Helicobacter pylori -positive adult patients with functional dyspepsia meeting the Rome III International Consensus criteria were randomly assigned to receive omeprazole, amoxicillin trihydrate, and clarithromycin, or omeprazole plus placebo for 10 days. Endoscopy and H pylori tests were performed at screening and at 12 months. Outcome measures were at least 50% symptomatic improvement at 12 months using a validated disease-specific questionnaire (primary end point), patient global assessment of symptoms, and quality of life. RESULTS: We randomly assigned 404 patients (78.7% were women; mean age, 46.1 years); 201 were assigned to be treated with antibiotics (antibiotics group) and 203 to a control group. A total of 389 patients (96.3%) completed the study. The proportion of patients who achieved the primary outcome was 49.0% (94 of 192) in the antibiotics group and 36.5% (72 of 197) in the control group (P = .01; number needed to treat, 8). In the patient global assessment of symptoms, 78.1% in the antibiotics group (157 of 201) answered that they were better symptomatically, and 67.5% in the control group (137 of 203) said that they were better (P = .02). The antibiotics group had a significantly larger increase in their mean (SD) Medical Outcomes Study 36-Item Short Form Health Survey physical component summary scores than the control group did (4.15 [8.5] vs 2.2 [8.1]; P = .02). CONCLUSION: Helicobacter pylori eradication provided significant benefits to primary care patients with functional dyspepsia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00404534.

Influence of organic and functional dyspepsia on work productivity: the HEROES-DIP study.

OBJECTIVES: Dyspepsia is defined as persistent or recurrent abdominal pain or discomfort centered in the upper abdomen. Dyspepsia represents up to 8.3% of all primary care physician visits and causes huge economic costs to patients and to the economy as a whole. The aim of this study was to measure the influence of dyspepsia on work productivity of people within the Brazilian workforce. METHODS: Adult patients were enrolled if they met the Roma III criteria for uninvestigated dyspepsia. All patients answered a demographic questionnaire. Productivity impairment was measured by the Work Productivity and Activity Impairment questionnaire. Subjects underwent upper gastrointestinal endoscopy and were classified as having functional or organic dyspepsia. The study protocol was approved by the Ethics Committee of Hospital de Clínicas de Porto Alegre, Brazil. RESULTS: Eight hundred fifty patients with dyspepsia were evaluated: 628 were women (73.9%); mean age was 46.4 ± 12.9 years; 387 (45.5%) were active workers. Among active workers, 32.2% mentioned that dyspepsia had caused absenteeism from work during the preceding week and 78% reported a reduction of the work productivity (presenteeism). The lost work productivity score was 35.7% among all employed patients. The affect on work productivity was similar between patients with functional or organic dyspepsia. CONCLUSIONS: Our study showed an important influence of dyspepsia on work productivity. We did not find any statistically significant difference on the influence on work between patients with organic dyspepsia and functional dyspepsia. The social impact of these findings is underscored by taking into account the prevalence (up to 40%) of this condition in Brazil.

Portuguese validation of the Rome III diagnostic questionnaire for functional dyspepsia / Validação do questionário diagnóstico de Roma III para dispepsia funcional na língua portuguesa

CONTEXT: Validated questionnaires are essential tools to be utilized in epidemiological research. At the moment there are no Rome III diagnostic questionnaires translated to Portuguese. OBJECTIVE: To validate the Portuguese version of the Rome III Diagnostic Questionnaire for Functional Dyspepsia. METHODS: The questionnaire has been translated following the Rome III recommendations. Hundred and nine consecutive patients with functional dyspepsia answered the questionnaire. The control group comprised 100 healthy consecutive blood donors, without digestive problems. Internal consistency, reproducibility, responsiveness, discriminate validity and content analysis were evaluated. RESULTS: Cronbach's α coefficient was 0.92. The questionnaire showed reliability: the patients answered it in a similar way on two distinct occasions and their responses were substantially very similar (P = 1.00). The questionnaire was able to demonstrate changes when they occur (P<0.01). Two "blinded" gastroenterologists agreed that the questionnaire adequately evaluated Functional Dyspepsia. When we compared the answers between patients and controls, the questionnaire showed that 5.3 percent of controls had Functional Dyspepsia symptoms compared with 91.2 percent of the patients (P<0.01). CONCLUSION: The Rome III Diagnostic Questionnaire for Functional Dyspepsia is ready to be used in clinical researches in lusophone countries, as it has been successfully validated in Portuguese.

CONTEXTO: Questionários validados são ferramentas essenciais para serem utilizados em estudos epidemiológicos. No momento não existem questionários diagnósticos de Roma III traduzidos para português. OBJETIVO: Validar a versão em português do Questionário Diagnóstico de Roma III para Dispepsia Funcional. MÉTODOS: O questionário foi traduzido seguindo as recomendações de Roma III. Cento e nove pacientes consecutivos com dispepsia funcional responderam ao questionário. O grupo controle foi composto por 100 doadores de sangue consecutivos, sem problemas digestivos. Consistência interna, reprodutibilidade, sensibilidade, validade discriminante e análise de conteúdo foram avaliadas. RESULTADOS: O coeficiente αde Cronbach foi de 0,92. O questionário mostrou reprodutibilidade: os pacientes responderam-no de forma semelhante em duas ocasiões distintas e suas respostas foram substancialmente semelhantes (P = 1,00). O questionário foi capaz de demonstrar alterações quando elas ocorreram (P<0,01). Dois gastroenterologistas "cegos" concordaram que o questionário avalia a dispepsia funcional adequadamente. Quando comparadas as respostas entre pacientes e controles, o questionário mostrou que 5,3 por cento dos controles e 91,2 por cento dos pacientes tinham sintomas de dispepsia funcional (P<0,01). CONCLUSÃO: O Questionário Diagnóstico de Roma III para Dispepsia Funcional está pronto para ser utilizado em pesquisas clínicas em países lusófonos, como foi validado com sucesso para o português.

Tratamento e retratamento do Helicobacter pylori / Treatment and retreatment of Helicobacter pylori

O Helicobacter pylori (H. pylori) é o responsável pela mais prevalente infecção dos seres humanos. Aproximadamente metade da população mundial é portadora dessa bactéria e, no Brasil, a prevalência da infecção é de aproximadamente 60%. Apesar disso, os meios de transmissão do H. pylori ainda não estão totalmente estabelecidos. A infecção está claramente associada com diversas doenças, como úlcera péptica, adenocarcinoma gástrico e linfoma gástrico tipo MALT (mucosal associated lymphoid tissue). Parte da literatura aceita que o H. pylori seja uma das causas da dispepsia funcional, pelo menos em subgrupo dos pacientes com essa doença. Existem evidências de que o H. pylori esteja associado a manifestações extradigestivas. A identificação da infecção pode ser feita com procedimentos não invasivos e invasivos (usando a endoscopia). Embora nenhum consenso preconize o tratamento indiscriminado de todos os portadores do H. pylori, visto que a maioria é assintomática e não irá apresentar problemas em decorrência da infecção, a erradicação está inquestionavelmente indicada em algumas situações clínicas, como no tratamento das úlceras pépticas associadas ao H. pylori. A erradicação da infecção não é simples e os esquemas terapêuticos necessitam associação de múltiplos agentes farmacológicos. Mesmo com a utilização de complexas associações de antibióticos com bloqueadores da secreção gástrica, significativa parcela dos pacientes não consegue eliminar a bactéria e necessita retratamento com diferentes esquemas terapêuticos. Esta revisão aborda aspectos da infecção pelo H. pylori, do seu diagnóstico, das indicações para o tratamento e quais os esquemas terapêuticos mais indicados para a erradicação da bactéria.

Portuguese validation of the Rome III diagnostic questionnaire for functional dyspepsia.

CONTEXT: Validated questionnaires are essential tools to be utilized in epidemiological research. At the moment there are no Rome III diagnostic questionnaires translated to Portuguese. OBJECTIVE: To validate the Portuguese version of the Rome III Diagnostic Questionnaire for Functional Dyspepsia. METHODS: The questionnaire has been translated following the Rome III recommendations. Hundred and nine consecutive patients with functional dyspepsia answered the questionnaire. The control group comprised 100 healthy consecutive blood donors, without digestive problems. Internal consistency, reproducibility, responsiveness, discriminate validity and content analysis were evaluated. RESULTS: Cronbach's α coefficient was 0.92. The questionnaire showed reliability: the patients answered it in a similar way on two distinct occasions and their responses were substantially very similar (P = 1.00). The questionnaire was able to demonstrate changes when they occur (P<0.01). Two "blinded" gastroenterologists agreed that the questionnaire adequately evaluated Functional Dyspepsia. When we compared the answers between patients and controls, the questionnaire showed that 5.3% of controls had Functional Dyspepsia symptoms compared with 91.2% of the patients (P<0.01). CONCLUSION: The Rome III Diagnostic Questionnaire for Functional Dyspepsia is ready to be used in clinical researches in lusophone countries, as it has been successfully validated in Portuguese.