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PubMed2002

[Helicobacter pylori--overview of therapy].

The clinical significance of Helicobacter pylori infection in the etiopathogenesis of many gastroduodenal disorders, especially peptic ulcer disease and current awareness of the benefits of its eradication has entirely changed the current treatment of these diseases. Eradication was already defined as the disappearance of Helicobacter pylori from the gastric mucosa (finding negativization) confirmed at least 4 weeks (or later) after completed antibiotic eradication therapy. The regimen has to be simple, cheap and tolerable so that the patient could carry it out completely and as easy as possible (good compliance is required). The success of Helicobacter pylori eradication, evaluated by the strict "intention-to-treat" criteria, has to be higher than 80%. Current modern therapy should be triple and not longer than 7 days. One of three proton pump inhibitors is recommended as the antisecretory component (omeprazole, pantoprazole or lansoprazole). Two of three following antibiotis is added to this therapy: metronidazole/tinidazole, clarithromycin or amoxicillin. Treatment failure and growing number of antimicrobial resistant Helicobacter pylori strains require new ways of therapy and more effective drugs. Our results of 7-, 10- and 14-day therapy consisting of omeprazole, amoxicillin and metronidazole are poorer than those of drug combination including clarithromycin instead of amoxicillin. The results of Clinical Hospital "Merkur" showed that combination of amoxicillin, metronidazole and pantoprazole was more effective than the same combination with omeprazole, and the opposite was true for metronidazole and azithromycin combined with omeprazole and pantoprazole, respectively. The results of other medical centers prescribing the same eradication protocols were completely different. The differences are probably caused by poor patient compliance.

Anti-Bacterial Agents↗
PubMed2002

[Association between chronic gastritis in childhood, Helicobacter pylori and ABO blood groups].

Gastritis can be defined in the simplest way such as inflammation of gastric mucous membrane. There are numerous causes of gastritis and the most often is Helicobacter pylori infection. Studying of the blood groups also includes the question of their connection with certain diseases. Up to date it has been explained the role that blood groups have in haemolytic disease of newborn infant but for other diseases we know little, it is insufficient or we know nothing. The aim of this work was to analyze connection of chronic gastritis in childhood, Helicobacter pylori and ABO blood groups. It has been treated 68 patients out of which 57 (83%) were Helicobacter pylori positive (Hp+) and 11 (17%) were Helicobacter pylori negative (Hp-). Thirty patients had chronic gastritis out of which 22 (73%) were Hp+ and 8 (27%) Hp-. It prevailed blood group A and O, comparing with other blood group phenotypes connected with gastritis.

ABO Blood-Group System↗
PubMed2003

[Prevalence of Helicobacter pylori infection in normal or asymptomatic patients].

The propose of this prospective study was to assess the prevalence of Helicobacter pylori infection in asymptomatic subjects in year 2000. Ninety eight patients not suffering from upper gastrointestinal symptoms were enrolled in this study. The mean age was 39 years. Helicobacter pylori was present in 81 patients (82.7%). Helicobacter pylori infection increase with age. It was maximal between 30 and 50 years. Helicobacter pylori prevalence is still high in Tunisia as well as in most developing countries. Improvement of hygiene conditions will decrease this prevalence.

Adolescent↗
PubMed2003

[A study on the relationship of Helicobacter pylori, gastrin and gastroesophageal reflux disease].

OBJECTIVE: To study the relationship of Helicobacter pylori, lower esophageal sphincter pressure and gastrin in gastroesophageal reflux disease, to evaluate the effect of Helicobacter pylori on gastroesophageal reflux disease. METHODS: 20 patients were underwent 24-hour ambulatory esophageal pH monitoring to confirm the diagnosis of gastroesophageal reflux disease, and their lower esophageal sphincter pressure was measured by esophageal manometry. The patients were diagnosed endoscope negative GERD and endoscope positive GERD by endoscopy, and 3 biopsy specimens obtained from the gastric antrum at the same time were used for Helicobacter pylori culture, rapid urease test and Warthin-Starry stain. Hp infection was affirmed when at least two of the three tests were positive, then the patients were divided into Hp-negative group and Hp-positive group. Fasting serum gastrin concentration was determined by radioimmunoassay in 13 patients. RESULTS: Hp-positive patients were 8 (male 4, endoscope negative GERD 2, mean age 55 +/- 9), Hp-negative patients were 12 (male 10, endoscope negative GERD 3, mean age 55 +/- 10). 13 of these patients were performed fasting serum gastrin measurement. The mean lower esophageal sphincter pressure, gastrin concentration and 24-hour pH monitoring DeMeester score in Hp-positive patients group were 11.25 mm Hg, 87.437 pg/ml and 72.30 respectively, and those in Hp-negative patients group were 13.75 mm Hg, 88.725 pg/ml and 55.64. Between the two groups, there was no significant difference in LESP, gastrin and DeMeester score (P = 0.193, P = 0.932 and P = 0.479); There was no correlation between LESP and gastrin, while serum gastrin level is associated strongly with DeMeester score (r = 0.902, P < 0.01). CONCLUSION: The study showed that Helicobacter pylori had no effect on LESP by gastrin, however serum fasting gastrin concentration and DeMeester score were associated with each other.

Adult↗
PubMedDate not supplied

Is there an association between Helicobacter pylori cytotoxin Cag A seropositivity and risk for gastric cancer?

BACKGROUND: Since discovered in 1990, Cag A, a protein expressed by specific strains of Helicobacter pylori, was thought able to explain why only a few Helicobacter infected patients develop peptic diseases and gastric cancer. However, clinical trials provide discordant results. MATERIALS AND METHODS: In this study we evaluate Helicobacter pylori and Cag A seropositivity in 35 cancer affected patients, in 36 gastritis affected patients and in 40 healthy blood donors by means of two commercially available fluorescence enzyme-immunoessay (ELISA). RESULTS: Odds ratios determination strongly suggests that Cag A bearer Helicobacter strains play a pathogenetic role in gastric diseases (OR 4.23, 95% CI 3.22-5.24 for cancer versus healthy volunteers, OR 3.2, 95% CI 2.19-4.21 for gastritis versus asymptomatic patients), but is unable to demonstrate a direct carcinogenic activity (cancer-gastritis difference is not significant: OR 1.32, 95% CI 0.39-1.25). CONCLUSIONS: Cag A seropositivity can be considered a risk factor for peptic disease, and only indirectly for gastric carcinoma. The paper also discuss some sampling, laboratory and statistical bias that can explain a wide eterogenity of the results reported in the literature.

Adult↗
PubMed2003

[Four different treatment protocols for Helicobacter pylori infection--a clinical pilot study].

A pilot clinical trial specially designed to test four different treatment regimens of Helicobacter pylori infection was performed among hospitalized and outpatient based patients in Clinical Centre University of Sarajevo, Gastroenterohepatology Clinics. Another objective was to assess Helicobacter pylori total cradication rates, partial cradication rates and after treatment persistent Helicobacter pylori infection rates among patients with clinically proven peptic ulcer disease (PUS). All patients randomly assigned into four groups had endoscopically and Helicourcasa test (HUT Astra) proven peptic ulcers. Each group was treated with one of the following four triple regimens: ranitidine + amoxicillin + metronidazole (RAM); ranitidine + clarithromycin + metronidazole (RCM); omeprazole + amoxicillin + metronidazole (OAM) and omeprazole + clarithromycin + m etronidazole (OCM). All triple regimens were given twice-a-day for one week following either ranitidine or omeprazole for two weeks depending of basic regimens. The highest Helicobacter pylori eradication was produced with OCM regimens (91.7%). Using same regimens we found the lowest partial eradication rate of all regimens (8.3%) and no persistency of H. pylori after the treatment. The lowest total eradication rate was found using RCM regimens (67.7%), while there was no difference in the cure rate between OAM (76.9%) and RAM (77.3%) regimens. If it is applicable, recommended treatment regimen as a first choice for proven H. pylori infection is OCM.

Adult↗
PubMed2003

[The use of fermented milk drink with topinambur for the treatment of Helicobacter infection in the liquidators of Chernobyl nuclear power plant accident].

For estimation of anti-helicobacter activity of new fermented milk drink with Helianthus tuberosus called 23 liquidators of crash after-effects of Chernobyl Nuclear Power Plant were observed. Helicobacter pylori were determined in faeces by PCR-method, immune system readings--by first-level methods. The drink was applied in 200 grams portions during 18 days. After therapy appearance of Helicobacter pylori in faeces was reduced for 3 times. Reading of HCT-test, increased up to 16% in the first test before therapy, was normalized after therapy. Listed figures prove anti-helicobacter activity of fermented milk drink with Helianthus tuberosus.

Adult↗
PubMedDate not supplied

[Risk factors for Helicobacter pylori infection in children].

OBJECTIVE: To establish the seroprevalence of Helicobacter pylori infection in children and to identify risk factors for seropositivity.\par METHODS: A cross-sectional study established the seroprevalence of infection by Helicobacter pylori and afterwards a comparative study was performed amongst seropositive and seronegative children. A group of 228 children were cared for at the outpatient clinic of Instituto Materno Infantil de Pernambuco, from May to July 1999. Age, sex, indicators of environmental, social and economic conditions, health and nutritional status as well as children living in contact with dwellers with history of gastrointestinal pain or peptic disease were evaluated. All data was obtained through an interview with children's parents or caretakers. Nutritional status was evaluated by anthropometric index. \par RESULTS: Seroprevalence of infection caused by Helicobacter pylori was found in 32% (95% CI 26% - 38%); 25.8% (95% CI 17.8% - 33.8%) in preschool children and 39.4% (95% CI 30.4% - 48.4%) in school age children. Analysis of environmental variables demonstrated higher frequency of seropositivity in children living in houses without toilets or sanitary flush toilet facilities (p = 0.008), overcrowded (p = 0.05), lower family income (p = 0.03) and poor maternal education (p = 0.002). There were no statistically significant differences between the groups regarding health indicators, anthropometric indexes and children living with dwellers with history of gastritis or peptic ulcer.\par CONCLUSION: Seroprevalence of Helicobacter pylori infection was high in the studied population, being even higher among the school age group. A positive association between seropositivity and less favorable environmental variables was detected.

Brazil↗
PubMed2003

A retrospective study on efficacy of proton-pump inhibitor-based triple therapy for eradication of Helicobacter pylori in patients with chronic renal failure.

OBJECTIVE: The efficacy of short-course triple eradication therapy has been documented in patients with Helicobacter pylori infection and normal renal function. We have evaluated a one-week proton-pump inhibitor-based triple therapy for Helicobacter pylori eradication in a retrospective review of patients with chronic renal failure. METHODS: We studied 25 patients (mean age 65.1 +/- 2.4 years) with creatinine clearance <30 ml/min/1.73 m2 or serum creatinine level >200 micromol/L (13 on dialysis), who had Helicobacter pylori infection, documented by histological examination or rapid urease test, together with either peptic ulcer disease or severe gastritis. The combination of Omeprazole 20 mg BID or Lansoprazole 30 mg BID, amoxicillin 1 gm BID and clarithromycin 500 mg BID was given for one week, in addition to therapy for peptic ulcers. All patients were re-endoscoped four weeks later. RESULTS: All but one patient (96%) had successful eradication. On repeat endoscopy, all 13 patients with peptic ulcers had healed ulcers. For the 12 gastritis patients, three became normal and nine had persistent gastritis. For patients not on dialysis, the serum creatinine level and creatinine clearance remained stable at two weeks after treatment (303 +/- 37 vs. 330 +/- 36 micromol/l, p=ns; 23.6 +/- 3.4 vs. 26.0 +/- 3.9 ml/min/1.73 m2, p=ns, respectively). CONCLUSION: The short course triple therapy was highly efficacious for Helicobacter pylori eradication in patients with chronic renal failure, with no adverse effect on renal function.

Aged↗
PubMed2003

[A case of gastric ulcer induced by Helicobacter heilmannii-like organism].

Recently, there was growing interest in a gastric spiral-shaped bacterium morphologically deviating from Helicobacter pylori (H. pylori), which was classified as Helicobacter heilmannii (H. heilmannii). It rarely inhabits human species whereas the observation of structurally comparable bacteria in other mammals, including cats and dogs, is a commonplace. Therefore, it is now generally recognized that H. heilmannii is an animal Helicobacter, which is occasionally transmitted to man. H. heilmannii is usually associated with chronic gastritis. Here, we described a case of gastric ulcer caused by spiral bacteria morphologically identical to H. heilmannii. The patient complained of epigastric pain over a two day period. He took the gallbladder of a wild raccoon dog 7 days before. Upper gastrointestinal endoscopy revealed multiple geographic gastric ulcers in the distal body and antrum. After eradication of another Helicobacter spp, H. heilmannii, the symptom resolved completely in 4 days. Eight weeks later, a follow-up endoscopy showed complete healing of the ulcer.

Animals↗
PubMed2003

Retrospective histologic comparison of Helicobacter pylori infection in gastric carcinoma, ulcerous disease and non-ulcerous dyspepsia.

Although a number of epidemiological, biological and clinical studies have been published, the effective role of Helicobacter pylori infection in gastric carcinogenesis remains unclear. In the present work we retrospectively compared Helicobacter infection rate, by means of histologic examination of gastric bioptic samples, in 70 patients affected by gastric carcinoma, 70 with ulcerous disease and 70 with non-ulcerous dyspepsia. The analysis was carried out by a single pathologist. The differences between the 3 groups were not statistically significant. From our present and previously reported data, the Helicobacter infection cannot be considered per se a significant risk factor for malignant gastric disease and further studies are needed to evaluate the role of Helicobacter infection in the development of some preneoplastic conditions such as chronic atrophic gastritis and intestinal metaplasia.

Adult↗
PubMed2003

Expression of class I and II MHC receptors in Helicobacter pylori-positive patients with active gastritis and duodenal ulcer.

BACKGROUND/AIMS: Helicobacter pylori colonizes on the epithelial surface below the mucous membrane in the gastric antrum, causing chronic active gastritis and duodenal ulcer. However, we know little about the response of the immune system, which is responsible for protecting the organism, to this bacteria and the duodenal tissue damage. The aims of our study were to examine the expression of class I and II MHC receptors in the immune cells in the peripheral venous blood of patients with chronic active gastritis and duodenal ulcer. METHODS: The study included a total of 124 cases (Helicobacter pylori-positive patients without prior treatment, 47 of whom had small-sized and 56 medium-sized duodenal ulcer, and 21 healthy individuals). Immune cells carrying receptors CD3, CD4, CD3/4, CD8, CD3/8, CD14, CD45, CD14/45, HLA-DR, CD3/HLA-DR, CD16/56, and CD3/16/56 by applying DAKO Dual Color Reagent, and non-specific indicators of reactivity, were investigated in the peripheral venous blood samples. RESULTS: In both study groups, nonspecific indicators of reactivity in peripheral venous blood were not different from those in the healthy group irrespective of the ulcer size. It was detected that NK cells which express only CD3/16/56 receptor are more aggressive than class I MHC carriers, which were increased in both patient groups more markedly than in the control group (p<0.05). The number of CD14 cells in patient groups with small- and medium-sized duodenal ulcers was found to be lower than in the control group. This difference was more marked in the small-sized ulcer group than in the medium-sized ulcer group. While there was a similarity in the number of CD45 cells in all three groups, the number of CD14/45 cells was reduced in the study group. This reduction was found statistically insignificant in the medium-sized ulcer group, but significant in the small-sized ulcer group (p<0.05). As compared to the control group, the number of HLA-DR cells was found to be increased in both study groups, and CD3/HLA-DR was found to be increased in the medium-sized ulcer group (p<0.05). CONCLUSIONS: The reduced number of CD14 cells may have been among the factors predisposing to the development of Helicobacter pylori infection. Such a deficit in cellular defense may be compensated through the upregulation of cells with HLA-DR and CD3/HLA-DR markers by the organism. The increase in the number of cells expressing CD3/16/56 in chronic antral gastritis and duodenal ulcer patients positive for Helicobacter pylori suggests a role for autoimmune events in these diseases.

Adult↗
PubMed2003

[Helicobacter pylori in children in Hospital Nacional de Niños, San José de Costa Rica].

Infection with Helicobacter pylori is more prevalent in developing than in developed countries. Several publications from Costa Rica associate this agent with almost 70% of the adults suffering gastritis; however, there are not data about its prevalence in children. In order to address that gap in the epidemiology of Helicobacter pylori in Costa Rica, we study 264 children (3 months to 17 years old) remitted to upper endoscopy due to dyspeptic disorders. From each case at least two biopsies were taken; one for Helicobacter isolation and the others for histopathological study. 96 of the children showed any grade of gastritis and in 73 of them was identified H. pylori; also, this agent was associated with 11 of the children without alteration in their gastric mucosa. In total, H. pylori was identified in the 31.8% of the studied cases. The two younger patients infected were a 1 and 2 years-old boys; the former had normal mucosa and the other had gastritis. These data confirm the importance of investigate Helicobacter in young children with gastric discomfort, mainly in developing countries.

Adolescent↗
PubMed2003

Evaluation of a liquid urease test (LUT) for detection of Helicobacter pylori.

UNLABELLED: The aim of our study was to develop a rapid diagnostic urease test to demonstrate the presence of Helicobacter pylori in the Endoscopy room. MATERIALS AND METHODS: 200 consecutive patients referred to gastroscopy for different indications, were included in this study. One antral biopsy sample was obtained to be immersed in our test. The same sample was used for histological evaluation, considered to be the gold standard method for diagnose of Helicobacter pylori infection. RESULTS: 135 patients (67.5%) were found positives and 65 patients (32.5%) were negatives in our test. 128 patients (64%) showed Helicobacter pylori on histological examination. Our test showed a sensitivity of 91%, specificity of 88.1%, and positive and negative predictive values of 95% and 80% respectively. A remarkable correlation between density of Helicobacter pylori and reading time was also observed, where a high density of the bacteria reduced the reaction time in this liquid test. Furthermore, an overall accuracy of 90% was shown, which is comparable with other available commercial tests. CONCLUSION: LUT is easy to handle, cost effective and fast, with a high positive predictive value.

Clinical Enzyme Tests↗
PubMed2004

Use of the P167 recombinant antigen for serodiagnosis of Helicobacter bilis.

Helicobacter bilis is widespread among research mouse colonies. Serodiagnosis of Helicobacter infections involves use of bacterial lysates or membrane antigen preparations that lack specificity, necessitating the need to identify a specific and sensitive antigen. A previously reported recombinant protein (P167) was evaluated for use as an H. bilis-specific antigen for serologic testing. Seventy-six mice naturally infected with Helicobacter spp. were identified from commercially bred or sentinel mice. Infection was confirmed and speciated by use of cecal specimen culture and fecal polymerase chain reaction (PCR) analysis, followed by restriction enzyme digest of the amplicon. Forty-one mice were determined to be monoinfected with H. bilis, 27 mice were determined to be monoinfected with H. hepaticus, and eight mice were infected with another species of Helicobacter. Serum was diluted 1:100 to evaluate the immunoreactivity to enzyme-linked immunosorbent assay preparations of H. bilis membrane extract and the immunodominant C and D fragments of the p167 gene. The sensitivity was greatest for the membrane extract preparation (76%), whereas sensitivity to the P167C and D recombinants was lower (62 and 51%, respectively). However, the specificity of the membrane extract preparation was low (87%), compared with the much improved specificity of the recombinant P167C and D fragments (96 and 96%, respectively). These findings suggest that the recombinant P167C and D fragments of the p167 gene product from H. bilis can be used as specific reagents in the serodiagnosis of H. bilis infection in mice.

Animals↗
PubMed2004

Natural and experimental Helicobacter infections.

Current information about Helicobacter infections in humans and various domestic, wild, and research animal species that have been used or have the potential to be used as animal models of human disease is presented. The Helicobacter genus now includes at least 26 formally named species, with additional novel species in the process of being characterized. The natural history, host range with zoonosis potential, pathology, and diagnostic techniques are presented, along with examples of how Helicobacter infection has interfered with unrelated in vivo research. Current recommendations for deriving and managing helicobacter-free animal colonies for research are provided.

Animals↗
PubMed2004

The detection of Helicobacter pylori in paraffin sections using the PCR technique and various primers as compared to histological techniques.

Helicobacter pylori is thought to represent a significant etiopathogenic factor in diseases of the upper gastrointestinal tract. It seems, therefore, important to elaborate effective techniques for its detection. The aim of the present study was to evaluate the effectiveness of Helicobacter pylori detection using the PCR technique on paraffin sections with various pairs of primers and to compare the results with those of a histological appraisal. Material for the studies involved 50 paraffin blocks with gastric mucosa biopsies fixed in 4% buffered formalin. In this material 4 tests were performed with the aim of diagnosing Helicobacter pylori infection: 1) H+E staining, 2) staining by the Giemsa technique, 3) an immunocytochemical technique with antibodies against H. pylori and 4) the PCR technique with various primers. In the present study the most reliable results for H. pylori detection as well as the most pronounced correlation were obtained by using the PCR technique with primers for the ureC gene, immunohistochemistry and staining according to Giemsa. Less compatible results were obtained employing the two PCR techniques which utilise various primers. The experiments confirmed the usefulness of the PCR technique in the detection of Helicobacter pylori in paraffin sections by using a suitable pair of primers, and also indicated that Giemsa staining and immunohistochemistry should be taken into account.

Antigens, Viral↗
PubMed2004

Gastroduodenal lesions and Helicobacter pylori infection in hemodialysis patients.

OBJECTIVE: The purpose of this prospective study is to determine the prevalence of upper gastrointestinal (GI) abnormalities and Helicobacter pylori (H. pylori) infection among stable chronic hemodialysis (HD) patients. METHODS: The study was carried out at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia during the period January 1996 to June 1997. Fifty-four chronic HD patients underwent upper GI endoscopy. Endoscopic changes were described and multiple antral gastric biopsies were taken for histological examination and detection of H. pylori infection. Gastric biopsy findings were compared to findings in 60 consecutive patients with normal renal function undergoing endoscopy for assessment of dyspepsia. RESULTS: Fifty-four stable chronic HD patients (32 men, mean age 42.4 +/- 18 years) underwent upper GI endoscopy and multiple antral gastric biopsies for histological examination and H. pylori detection. The endoscopic findings were abnormal in 49 (90.7%) patients. Chronic gastritis was seen in 20 (37%) patients, acute gastritis was seen in 13 (20.1%) patients, duodenal ulcer was seen in 6 (11.1%) patients, duodenitis with or without erosions was seen in 5 (9.3%) patients, gastroduodenitis was seen in 3 (5.56%) patients, and gastroesophageal reflux disease was seen in 2 (3.7%) patients. Histological examination of multiple antral gastric biopsies documented chronic active gastritis in 28 (51.9%) patients. Helicobacter pylori were present in 34(63%) patients. Helicobacter pylori were detected in the majority (85.7%) of patients with the histological diagnosis of chronic active gastritis. Patients harboring H. pylori were significantly older than negative patients (52 +/- 16.1 versus 33.9 +/- 17.3 years, p<0.018). In a group of 60 patients with normal renal function undergoing endoscopy for assessment of dyspeptic symptoms during the same period, chronic active gastritis was found in 40 (66.7%) patients and H. pylori was detected in 38 (63.3%) patients. CONCLUSION: Upper GI abnormalities are common among HD patients even in the absence of symptoms. Biopsy proven chronic active gastritis is the most common histological diagnosis among these patients and is highly associated with H. pylori infection. Prevalence of H.pylori infection in HD patients is similar to those with normal renal function undergoing endoscopy for dyspepsia. Helicobacter pylori infected HD patients tend to be older than patients without H.pylori infection.

Adult↗