scholarly journals Helicobacter pylori genotypes in patients with stable angina combined with chronic gastritis

2021 ◽  
pp. 119-124
Author(s):  
M. N. Prikhodko ◽  
Zh. G. Simonova
Keyword(s):  
Helicobacter Pylori ◽  
Chronic Gastritis ◽  
Stable Angina ◽  
Antibiotic Sensitivity ◽  
Dilution Method ◽  
Prospective Clinical Study ◽  
Serological Method ◽  
Pcr Diagnosis ◽  
Serial Dilution Method ◽  
H Pylori

Research objective. То study the genotypes of Helicobacter pylori and their antibiotic sensitivity in patients with stable angina in combination with chronic gastritis. Material and methods. 46 patients with stable angina with a combination of chronic H. pylori-associated gastritis were included in the open prospective clinical study. To diagnose H. pylori, serological method of detection of antibodies in blood serum was used, PCR - diagnosis of H. pylori genes. Antibiotic sensitivity of H. pylori strains was studied by serial dilution method. Results. In the patients (n = 46) stable angina in combination with chronic gastritis in the endoscopic study by the EGDS method, gastrobioptates were obtained and further investigated. Chronic neatrophic gastritis was diagnosed in 54.3% of patients, atrophic gastritis - in 45.7%. It was found that the genotypes of H. pylori VacA had 8.7% of patients, CagA - 34.7%, HopQ - 13.1%, Oip - 30.4% of patients. Only 13.1% of patients had non-toxic genotypes. The absence of antibiotic resistance of the first line of erication therapy - clarithromycin and amoxicillin - was revealed. 45.7% of patients showed resistance, 39.1% showed weak sensitivity of H. pylori isolates to metronidazole. Conclusions. In patients with stable angina with a combination of chronic gastritis, H. pylori strains with toxigenic genotypes: CagA, Oip, Vac A, HopQ predominate. Resistance of H. pylori isolates to metronidazole was determined in 45.7% of patients.

scholarly journals Guality eradication anti-helicobacter therapy increases the effectiveness of treatment of patients with stable angina pectoris

2021 ◽  
pp. 41-46
Author(s):  
M. N. Prikhodko ◽  
Zh. G. Simonova ◽  
E. P. Kolevatykh
Keyword(s):  
Chronic Gastritis ◽  
Clinical Status ◽  
Eradication Therapy ◽  
Antibiotic Sensitivity ◽  
Prospective Clinical Study ◽  
Group I ◽  
Group Ii ◽  
H Pylori ◽  
Gastroduodenal Zone ◽  
Endoscopic Picture

Aim. On the basis of the complex analysis, to evaluate the efficiency of eradication therapy at patients with stable stenocardia with a combination of chronic gastritis. Material and methods. 46 patients with stable stenocardia with a combination of chronic H. pylori-associated gastritis were included in the open prospective clinical study. Two groups of patients were formed during the study. Patients of group I (n = 25) received eradication therapy in accordance with antibiotic sensitivity of H. pylori strains, patients of group II (n = 21) - without antibiotic sensitivity. In all patients before and after treatment were performed: evaluation of clinical status, laboratory indicators, EGDS with biopsy sampling, diagnosis of H. pylori. Results. The effectiveness of eradication therapy was 86.9%, at the same time, 96% -in group I and 76.2% - in group II. It is established: stabilization of clinical status of patients, improvement of morphological and endoscopic picture of gastroduodenal zone, improvement of laboratory indices. Conclusions. The inclusion of antibiotic-sensitive erication therapy in the algorithm of treatment of patients with stable stenocardia in combination with chronic gastritis allows to achieve high effectiveness of killing the infection Helicobacter pylori. At the same time stabilizes clinical status of patients, laboratory indices, has a positive effect on morphological and endoscopic picture of gastroduodenal zone, preventing progression of metaplastic changes.

CHRONIC GASTRITIS AND OLD AGE: A PROBLEM OR NOT?

2020 ◽  
pp. 30-39
Author(s):  
Zh.G. Simonova ◽  
M.N. Prikhod'ko ◽  
E.M. Shul'gina
Keyword(s):  
Helicobacter Pylori ◽  
Gastric Mucosa ◽  
Elderly Patients ◽  
Old Age ◽  
Chronic Gastritis ◽  
Morphological Changes ◽  
Eradication Therapy ◽  
Prospective Clinical Study ◽  
H Pylori ◽  
Endoscopic Picture

The objective of the paper is to study the clinical and functional characteristics of chronic H. pylori-associated gastritis in the elderly patients. Materials and Methods. A group of elderly patients (n=116) (aged 69.5±3.2) with chronic H. pylori-associated gastritis was formed during a prospective clinical study. All patients underwent esophagogastroduodenoscopy with biopsy. OLGA staging system was used for histological assessment. The dyspeptic index (DI) was used to measure dyspepsia. The patients were followed up for 48 weeks. Results. Dyspepsia was found only in 41.3 % of patients, while 58.7 % of patients had asymptomatic disease progression. Atrophic changes in the gastric mucosa were found in 30.1 % of the trial subjects. The efficacy of the eradication therapy was 88.7 %. During the study, the endoscopic picture of the gastroduodenal zone improved. There was no progression of atrophic and metaplastic changes in the gastric mucosa. Conclusion. Thus, in elderly patients, chronic H. pylori-associated gastritis is often asymptomatic. Eradication of H. pylori infection promotes disease remission and prevents morphological changes in the gastric mucosa. Keywords: chronic gastritis, Helicobacter pylori, atrophic gastritis, dyspepsia, old age, eradication therapy. Цель – изучить клинико-функциональные особенности течения хронического H. pylori-ассоциированного гастрита у лиц пожилого возраста. Материалы и методы. В процессе проспективного клинического исследования была сформирована группа больных (n=116) пожилого возраста (69,5±3,2 года) с хроническим H. pylori-ассоциированным гастритом. Всем больным была выполнена эзофагогастродуоденоскопия с биопсией. Для гистологической оценки применяли классификацию OLGA. Для оценки диспепсического синдрома использовали диспепсический индекс (ДИ). Длительность наблюдения больных составила 48 нед. Результаты. Наличие диспепсического синдрома было установлено у 41,3 % больных, 58,7 % пациентов имели бессимптомное течение заболевания. У 30,1 % обследуемых выявлены атрофические изменения слизистой оболочки желудка. Эффективность проведенной эрадикационной терапии составила 88,7 %. В процессе исследования установлено улучшение эндоскопической картины гастродуоденальной зоны. Отмечено отсутствие прогрессирования атрофических и метапластических изменений слизистой оболочки желудка. Выводы. У больных пожилого возраста течение хронического H. pylori-ассоциированного гастрита чаще имеет бессимптомный характер. Эрадикация инфекции H. pylori способствует ремиссии заболевания и предотвращает морфологические преобразования слизистой оболочки желудка. Ключевые слова: хронический гастрит, Helicobacter pylori, атрофический гастрит, синдром диспепсии, пожилой возраст, эрадикационная терапия.

Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles

Blood ◽  
2007 ◽  
Vol 110 (12) ◽  
pp. 3833-3841 ◽  
Author(s):  
Giovanni Emilia ◽  
Mario Luppi ◽  
Patrizia Zucchini ◽  
Monica Morselli ◽  
Leonardo Potenza ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Chronic Gastritis ◽  
Immune Thrombocytopenic Purpura ◽  
Long Term Results ◽  
Platelet Response ◽  
Related Factors ◽  
Thrombocytopenic Purpura ◽  
Platelet Recovery ◽  
Chronic Immune Thrombocytopenic Purpura ◽  
H Pylori

AbstractEradication of Helicobacter pylori may lead to improvement of chronic immune thrombocytopenic purpura (ITP), although its efficacy over time is uncertain. We report the results of H pylori screening and eradication in 75 consecutive adult patients with ITP. We also used molecular methods to investigate lymphocyte clonality and H pylori genotypes in the gastric biopsies from 10 H pylori–positive patients with ITP and 19 H pylori–positive patients without ITP with chronic gastritis. Active H pylori infection was documented in 38 (51%) patients and successfully eradicated in 34 (89%) patients. After a median follow-up of 60 months, a persistent platelet response in 23 (68%) of patients with eradicated infection was observed; 1 relapse occurred. No differences in mucosal B- or T-cell clonalities were observed between patients with ITP and control participants. Of note, the frequency of the H pylori cagA gene (P = .02) and the frequency of concomitant H pylori cagA, vacAs1, and iceA genes (triple-positive strains; P = .015) resulted statistically higher in patients with ITP than in control participants. All asymptomatic H pylori–positive patients with ITP were suffering from chronic gastritis. Our data suggest a sustained platelet recovery in a proportion of patients with ITP by H pylori eradication alone. Overrepresentation of specific H pylori genotypes in ITP suggests a possible role for bacterium-related factors in the disease pathogenesis.

scholarly journals Helicobacter pyloriAnti-CagA Antibodies: Prevalence in Symptomatic and Asymptomatic Subjects in Turkey

2002 ◽  
Vol 16 (8) ◽  
pp. 527-532 ◽  
Author(s):  
M Fatih Abasiyanik ◽  
Ersan Sander ◽  
Barik A Salih
Keyword(s):  
Gastric Cancer ◽  
Duodenal Ulcer ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Chronic Gastritis ◽  
Molecular Weights ◽  
Cancer Antigens ◽  
Gastroduodenal Disease ◽  
H Pylori ◽  
Asymptomatic Subjects

BACKGROUND: Several reports have shown the prevalence of anti-CagA antibodies to be associated with the development of peptic ulcer diseases, while others have indicated that there is no such association.AIM: To examine the prevalence of antibodies to CagA and otherHelicobacter pyloriantigens in symptomatic and asymptomatic subjects in Turkey.SUBJECTS AND METHODS: Sixty-six symptomatic subjects, 16 to 74 years of age, were examined forH pyloriby biopsy-based tests and ELISA. One hundred nineteen asymptomatic subjects, 20 to 65 years of age, were also tested serologically for the presence ofH pylori. Samples from both groups that were found to be positive forH pyloriby ELISA were then tested by immunoblotting.RESULTS: Fifty-four (82%) symptomatic subjects and 76 (64%) asymptomatic subjects were found to beH pylori-positive by ELISA. Samples from 30 symptomatic subjects who were found to beH pylori-positive by ELISA were analyzed by immunoblotting. Antibodies to CagA (116 kDa) antigen were detected in immunoblots of 11 of 14 (79%) with chronic gastritis, 12 of 13 (92%) with duodenal ulcer and three of three (100%) with gastric cancer. Antigens of the following molecular weights were also detected in these 30 subjects: 89 kDa (VacA) in 21 (70%), 37 kDa in 21 (70%), 35 kDa in 19 (63%), 30 kDa in 27 (90%) and 19.5 kDa in 19 (63%). Immunoblots of 40 ELISA-positive asymptomatic subjects showed that 33 (83%) had antibodies to CagA antigen, 26 (65%) to VacA antigen, 30 (75%) to a 37 kDa antigen, 30 (75%) to a 35 kDa antigen, 39 (98%) to a 30 kDa antigen and 36 (90%) to a 19.5 kDa antigen.CONCLUSIONS: Antibodies to CagA antigen were prevalent in both groups, regardless of the presence of gastroduodenal disease.

scholarly journals Histopathological Changes in Helicobacter pylori Associated Gastritis and Scope of Special Stain and Immunohistochemistry as Diagnostic Aids

2020 ◽  
Vol 7 (50) ◽  
pp. 3027-3032
Author(s):  
Ruby Elizabeth Elias ◽  
Bindiya Gisuthan ◽  
Sreeganesh A.S
Keyword(s):  
Helicobacter Pylori ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Chronic Gastritis ◽  
Predictive Value ◽  
Diagnostic Methods ◽  
P Value ◽  
Special Stain ◽  
Frequent Finding ◽  
H Pylori

BACKGROUND Helicobacter pylori associated chronic gastritis plays a vital role in the development of majority of gastric adenocarcinomas and most gastric MALT (Mucosa Associated Lymphoid Tissue) lymphomas. Many diagnostic methods are available for the identification of this organism. However, in gastroenterology practice, histopathological examination of biopsy samples provides visual identification of the pathogen and the associated mucosal changes with special stains like Giemsa. The aim of this study was to evaluate the efficacy of three stains H & E- (Haematoxylin and Eosin), Giemsa and IHC (Immunohistochemistry) in the identification of H. pylori. Associated histologic changes were noted and the relationship between the degree of colonisation and the activity and chronicity of gastritis were analysed. METHODS 585 gastric biopsies taken from dyspeptic patients were evaluated for gastritis, based on updated Sydney System. In 250 randomly selected cases, three staining methods were used. RESULTS Out of 585 cases, 413 (70.60 %) had features of chronic gastritis. Mild chronic gastritis was the commonest finding and is seen in most cases of mild H. pylori colonisation. When activity was monitored, mild activity was the most frequent finding [225 (38.46 %)]. Majority of the severe activity cases showed severe H. pylori colonisation. 13.16 %, 4.79 % and 7.35 % showed intestinal metaplasia, atrophy and dysplastic changes respectively. Out of 250 cases, H & E and Giemsa stains showed 45.6 % and 57.2 % positivity while IHC demonstrated maximum number of positivity (156 cases - 62.4 %). Sensitivity and specificity of H & E was found to be 77.90 % and 98.95 %, positive predictive value was 99.13 % and negative predictive value was 69.18 %. For Giemsa stain, sensitivity was 91.67 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 87.85 %. DISCUSSION H. pylori gastritis was a frequent finding in dyspeptic patients in southern part of India. When chi-square test was done, a significant statistical relationship between the severity of H. pylori colonisation, activity and chronicity of gastritis was noted. P value was < 0.001. With the use of special stain, Giemsa and ancillary techniques like IHC, the detection rate of H. pylori was enhanced considerably. CONCLUSIONS With increasing number of H. pylori in the mucosa, there was increase in the chronicity and activity of gastritis. Although immunohistochemistry revealed more cases of H. pylori, Giemsa can be a cost-effective substitute, because of its high specificity and positive predictive value. KEYWORDS H. pylori Gastritis, Giemsa, Haematoxylin and Eosin Stain, Immunohistochemistry

scholarly journals Induction and prevention of gastric cancer with combined Helicobacter pylori and capsaicin administration and DFMO treatment, respectively

2020 ◽  
Author(s):  
Faisal Aziz ◽  
Mingxia Xin ◽  
Yunfeng Gao ◽  
Josh Monts ◽  
Kjersten Monson ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Mouse Models ◽  
Chronic Gastritis ◽  
Molecular Mechanisms ◽  
Gastric Carcinogenesis ◽  
Lifestyle Changes ◽  
Host Susceptibility ◽  
Anti Inflammatory ◽  
H Pylori

Abstract Background: Gastric cancer risk evolves over time due to environmental, dietary, and lifestyle changes including Helicobacter pylori (H. pylori) infection and consumption of hot peppers (i.e. capsaicin). H. pylori infection promotes gastric mucosal injury in the early phase of capsaicin exposure. In addition, capsaicin consumption is reported to suppress immune function and increase host susceptibility to microbial infection. This relationship suggests a need to investigate the mechanism of how both H. pylori infection and capsaicin contribute to gastric inflammation and lead to gastric cancer. No previous experimental animal models have been developed to study this dual association. Here we developed a series of mouse models that progress from chronic gastritis to gastric cancer. C57-Balb/c mice were infected with the H. pylori (SS1) strain and then fed capsaicin (0.05% or 0.2g/kg/day) or not. Consequently, we investigated the association between H. pylori infection and capsaicin consumption during the initiation of gastric inflammation and the later development of gastric cancer. Tumor size and phenotype were analyzed to determine the molecular mechanism driving the shift from gastritis to stomach cancer. Gastric carcinogenesis was also prevented in these models using the ornithine decarboxylase inhibitor DFMO (2-difluoromethylornithine). Results: This study provides evidence showing that a combination of H. pylori infection and capsaicin consumption leads to gastric carcinogenesis. The transition from chronic gastritis to gastric cancer is mediated through interleukin-6 (IL-6) stimulation with an incidence rate of 50%. However, this progression can be prevented by treating with anti-inflammatory agents. In particular, we used DFMO to prevent gastric tumorigenesis by reducing inflammation and promoting recovery of disease-free stasis. The anti-inflammatory role of DFMO highlights the injurious effect of inflammation in gastric cancer development and the need to reduce gastric inflammation for cancer prevention. Conclusions: Overall, these mouse models provide reliable systems for analyzing the molecular mechanisms and synergistic effects of H. pylori and capsaicin on human cancer etiology. Accordingly, preventive measures like reduced capsaicin consumption, H. pylori clearance, and DFMO treatment can lessen gastric cancer incidence. Lastly, anti-inflammatory agents like DFMO can play important roles in prevention of inflammation-associated gastric cancer.

scholarly journals Potential of FTIR-Spectroscopy for Drugs Screening against Helicobacter pylori

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 897
Author(s):  
Pedro Sousa Sampaio ◽  
Cecília R. C. Calado
Keyword(s):  
Helicobacter Pylori ◽  
Ftir Spectroscopy ◽  
Partial Least Square ◽  
Least Square ◽  
New Drugs ◽  
Partial Least Square Regression ◽  
Dilution Method ◽  
Agar Dilution Method ◽  
Molecular Fingerprint ◽  
H Pylori

Helicobacter pylori colonizes the human stomach of half of the world’s population. The infection if not treated, persists through life, leading to chronic gastric inflammation, that may progress to severe diseases as peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. The first line of treatment, based on 7 to 21 days of two antibiotics associated with a proton pump inhibitor, is, however, already failing most due to patient non-compliance that leads to antibiotic resistance. It is, therefore, urgent to screen for new and more efficient antimicrobials against this bacterium. In this work, Fourier Transform Infrared (FTIR) spectroscopy was evaluated to screen new drugs against H. pylori, in rapid (between 1 to 6 h), and high-throughput mode and based on a microliter volume processes in relation to the agar dilution method. The reference H. pylori strains 26,695 and J99, were evaluated against a peptide-based antimicrobial and the clinical antibiotic clarithromycin, respectively. After optimization of the assay conditions, as the composition of the incubation mixture, the time of incubation, and spectral pre-processing, it was possible to reproducibly observe the effect of the drug on the bacterial molecular fingerprint as pointed by the spectra principal component analysis. The spectra, obtained from both reference strains, after its incubation with drugs concentrations lower than the MIC, presented peak ratios statistically different (p < 0.05) in relation to the bacteria incubated with drugs concentrations equal or higher to the MIC. It was possible to develop a partial least square regression model, enabling to predict from spectra of both bacteria strains, the drug concentration on the assay, with a high correlation coefficient between predicted and experimental data (0.91) and root square error of 40% of the minimum inhibitory concentration. All this points to the high potential of the technique for drug screening against this fastidious growth bacterium.

Helicobacter pylori colonisation of duodenal foveolar metaplasia requires concurrent gastric infection

2020 ◽  
pp. jclinpath-2020-206844
Author(s):  
Adam L Booth ◽  
Raul S Gonzalez
Keyword(s):  
Helicobacter Pylori ◽  
Chronic Gastritis ◽  
Immunohistochemical Staining ◽  
Acute Inflammation ◽  
Common Symptom ◽  
Routine Examination ◽  
Histological Changes ◽  
Normal Limits ◽  
H Pylori ◽  
Duodenal Biopsies

AimsEvaluate the rate and significance of Helicobacter pylori (H. pylori) involving duodenal foveolar metaplasia of chronic peptic duodenitis (CPD).MethodsWe identified 100 biopsy cases of CPD with synchronous stomach biopsies. All 200 were reviewed for histological changes (eg, chronic gastritis, acute inflammation) and underwent immunohistochemical staining for H. pylori. Results were correlated with patient age, sex, endoscopy indication and findings on stomach biopsy.ResultsCases included 49 men and 51 women, with a median age of 56 years. Reflux or dysphagia was the most common symptom. Chronic gastritis was present in 46 stomach biopsies, with 54 within normal limits. Twelve stomach biopsies showed H. pylori, all of which showed gastritis. Two duodenal biopsies (2%) demonstrated H. pylori organisms on immunohistochemistry, both from patients with H. pylori gastritis.ConclusionsRoutine examination of CPD samples for H. pylori appears unnecessary if a stomach biopsy is available for review.

scholarly journals CURCUMIN IN COMBINATION WITH TRIPLE THERAPY REGIMES AMELIORATES OXIDATIVE STRESS AND HISTOPATHOLOGIC CHANGES IN CHRONIC GASTRITIS-ASSOCIATED HELICOBACTER PYLORI INFECTION

2017 ◽  
Vol 54 (3) ◽  
pp. 177-182 ◽  
Author(s):  
Arezu JUDAKI ◽  
Asghar RAHMANI ◽  
Jalil FEIZI ◽  
Khairollah ASADOLLAHI ◽  
Mohammad Reza HAFEZI AHMADI
Keyword(s):  
Oxidative Stress ◽  
Helicobacter Pylori ◽  
Triple Therapy ◽  
Chronic Gastritis ◽  
Therapy Group ◽  
Standard Triple Therapy ◽  
Before And After ◽  
Total Antioxidant ◽  
H Pylori ◽  
Triple Regimen

ABSTRACT BACKGROUND Helicobacter pylori (H. pylori) gastric infection is a main cause of inflammatory changes and gastric cancers. OBJECTIVE The aim of this study was finding the effects of curcumin on oxidative stress and histological changes in chronic gastritis associated with H. pylori. METHODS In a randomized clinical trial, patients were divided into two groups: a standard triple therapy group and triple therapy with curcumin group. Endoscopic and histological examinations were measured for all patients before and after 8 weeks. RESULTS Triple therapy with curcumin treatment group significantly decreased malondialdehyde markers, glutathione peroxides and increased total antioxidant capacity of the gastric mucosa at the end of study compared to baseline and triple regimen groups. In addition, the oxidative damage to DNA was significantly decreased in triple therapy with curcumin group at the end of study compared to baseline and compared to triple therapy (P<0.05 for both). Triple therapy group in combination with Curcumin significantly decreased all active, chronic and endoscopic inflammation scores of patients compared to the baseline and triple therapy group (P<0.05 for both). The eradication rate by triple therapy + curcumin was significantly increased compared to triple therapy alone (P<0.05). CONCLUSION Curcumin can be a useful supplement to improve chronic inflammation and prevention of carcinogenic changes in patients with chronic gastritis associated by H. pylori.

scholarly journals Chronic gastritis and Helicobacter pylori in digestive form of Chagas' disease

1993 ◽  
Vol 35 (2) ◽  
pp. 117-121 ◽  
Author(s):  
A. J. A. Barbosa ◽  
D. M. M. Queiroz ◽  
A. M. M. F. Nogueira ◽  
M. J. A. Roquette Reis ◽  
E. N. Mendes ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastric Mucosa ◽  
Atrophic Gastritis ◽  
Chagas Disease ◽  
Chronic Gastritis ◽  
Antral Mucosa ◽  
Common Cause ◽  
Superficial Gastritis ◽  
H Pylori ◽  
Inflammatory Changes

Patients with the digestive form of Chagas'disease frequently present chronic gastritis. As the microorganism Helicobacter pylori is now accepted as the most common cause of human chronic gastritis, the present work was undertaken to verify a possible relationship between the presence of this bacterium and inflammatory changes of antral mucosa in chagasic patients. Seventeen chagasics, with megaesophagus and or megacolon were studied. Fragments from two different regions of antral mucosa were obtained by endoscopy, fixed in 4% neutral formaldehyde and embedded in paraffin. The sections were stained by haematoxylin and eosin for histology analysis, and by carbolfuchsin for H. pylori identification. H. pylori was found in 16 (94.1%) chagasic patients, all of them presenting chronic gastritis. Superficial gastritis was seen in 9 (52.9%) while atrophic gastritis was present in 8 (47.1%) patients. H. pylori was present on gastric mucosa of 8 (100%) patients with atrophic gastritis and of 8 (88.8%) patients with superficial gastritis. We concluded that the microorganism H. pylori should be considered a possible factor connected with the etiopathogenesis of chronic superficial and atrophic gastritis frequently observed in patients with the digestive form of Chagas' disease.

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