Helicobacter pylori eradication in renal transplant candidates

Introduction: Treatment for Helicobacter pylori (H. pylori) infection is recommended in transplant candidates due to the association between this infection and gastrointestinal disorders, which could significantly increase morbidity after renal transplantation with the use of immunosuppression. The objective of this study was to analyze the rate of eradication of H. pylori after antimicrobial treatment in chronic kidney disease patients who are candidates for kidney transplantation. Methods: A multicenter prospective cohort study was conducted. All adult chronic kidney disease patients seen at our institution were included. In the pre-transplantation evaluation, 83 patients underwent an upper gastrointestinal endoscopy with 2 diagnostic methods to detect H. pylori: histology and the rapid urease test. In total, 33 patients with H. pylori infection received treatment with 20 mg omeprazole, 500 mg amoxicillin, and 500 mg clarithromycin once daily for 14 days. Another upper gastrointestinal endoscopy was performed 8 to 12 weeks after the end of treatment to check for healing. Results: The study showed a prevalence of H. pylori in 51 (61.4%) patients. Histology was positive in 50 (98%) patients and the rapid urease test was positive in 31 (60.8%). The infection eradication rate was 48.5% (16 patients). Conclusions: There was a high prevalence rate of H. pylori and a low eradication rate after the long-term antimicrobial triple scheme used. The association of the rapid urease test with gastric mucosa histology did not increase the detection rate of H. pylori.

Genotyping and Association of the Presence of Helicobacter Pylori in Dental Plaque and Gastric Biopsy Specimens in Dyspeptic Patients by PCR-RFLP Technique in Southwest of Iran

The oral cavity can act as an extra gastric reservoir for H pylori, and also the presence of the bacteria in the oral cavity is associated with a higher risk of dental caries development. The aim of this study was to determine the genotype and evaluate the association of the presence of H. pylori in dental plaque and gastric biopsy specimens in dyspeptic patients in Ahvaz, Southwest of Iran. In this study, 106 patients with recruited dyspeptic complaints were selected and from each patient, two gastric antral biopsy specimens and two dental plagues were examined. The presence of H. pylori was identified by the Rapid Urease Test (RUT) and the amplification of ureAB and 16S rRNA genes. Also, to verify a hypothetical mouth-to-stomach infection route, the enzymatic digestions of three genes of cagA, vacA, and ureAB in H. pylori strains isolated from dental plaques and stomach samples were compared for each same case. H. pylori was found in the stomach of 52.8% (56 /106) and the dental plaques of 17.9% (19/106) of the studied cases. On the other hand, H. pylori was recognized in the stomach of all 19 cases with oral colonization. Following a combination of restriction fragment length polymorphism (RFLP) patterns of these three known genes on stomach and dental plague samples, 14 and 11 unique patterns were seen, respectively. However, for all H. pylori-positive cases (19), the comparison of RLFP patterns of these genes in the dental plaque and gastric biopsy specimens was different for the same case. This study showed, no significant association was observed between the presence of H. pylori in dental plaque and the stomach of the same case.

Impact of Mobile Endoscopy Unit for Rendering Gastrointestinal Endoscopy Services at Two Community Health Centers in Western India

Background Patients with gastrointestinal (GI) symptoms in remote areas do not have access to standard medical care with the issues related to cost of medical care, transportation, health literacy, lack of healthcare insurance—all preventing healthcare access in a timely manner. To overcome this, we designed a mobile endoscopy van with the intent to provide free essential medical services to the rural population. Methods This is a retrospective study of patients with predominantly upper GI symptoms at two community health centers (each 2 days camp). This is an audit of endoscopy findings in a community set up using a Mobile Endoscopy Unit (MEU). Patients' details were collected in a pre-designed questionnaire. Only those patients with alarm symptoms and suspicion of any pathological state underwent esophagogastroduodenoscopy (EGD) in MEU. Data analysis was done using descriptive statistics. Results A total of 724 patients (424 [58.5%] males; mean [SD] age 48.5 [5.2] years) were included. The commonest presenting symptom was heartburn in 377 (52.1%) patients. The median duration of symptoms was 6.5 (range: 2–36) months. Gastroesophageal reflux disease was seen in 16 (6.8%) patients, ulceroproliferative growth was noted in the stomach in 3 (1.3%) patients. Eighteen (7.6%) patients had a positive rapid urease test and received Helicobacter pylori eradication therapy. The most commonly prescribed drugs were proton-pump inhibitors in 692 (95.6%) patients. Nine (1.2%) patients had chronic liver disease secondary to alcoholism and were counseled for abstinence. All procedures were safely performed without any immediate adverse events. Conclusions Community outreach strategies such as the use of mobile endoscopy unit were found to be very useful in the diagnosis of GI symptoms. More research is needed in low-income countries to treat complex pathological states in rural patients.

Dependence of the state of the large intestine parietal microflora on the activity of Helicobacter pylori associated chronic gastritis

Introduction. The aim of the study was to detect the dependence of the composition of the parietal microflora of the colon on the activity of Helicobacter pylori-associated chronic gastritis and the degree of Helicobacter pylori contamination of the gastric mucosa. Materials and methods. The study was carried out on 50 patients aged 24 to 72 years, who were diagnosed with HP-associated chronic gastritis in the phase of exacerbation based on the results of FEGDS and histological examination of biopsies of the mucous membrane of the antrum of the stomach in combination with a rapid urease test. A series of dilutions 10¹-10⁹ was prepared from a homogenized biopsy specimen of the mucous membrane of the sigmoid colon in 0.1 ml of isotonic sodium chloride solution, and 0.1 ml of a solution of the corresponding dilution was inoculated onto the surface of the nutrient medium. The study of mucosal microflora was carried out by means of bacteriological examination of biopsies of the mucous membrane of the sigmoid and cecum. The degree of H. pylori contamination of the gastric mucosa was assessed in the course of histological examination by a semi-quantitative method: low degree of contamination — up to 20 microbial bodies, average — 20-50 microbial bodies, strong — over 50 microbial bodies in the field of view. Results. The study demonstrated that the indicators of the average concentrations of bifidobacteria, lactobacilli and typical strains of E. coli progressively decreased with the transition to a higher degree of HP infection. This tendency was maximum in relation to bifidobacteria — 6.1-1.57-1.09 x 10⁸ CFU/g, with a difference between the maximum (I degree) and minimum (III degree) 5.59 times. A similar relationship, but much less pronounced, was observed for Lactobacterium spp. and E. coli. As the severity of HP infiltration of the gastric mucosa increases, there is a decrease in the concentration of the above microorganisms in the parietal mucin - the correlation coefficient is r = -0.74. Discussion. Since the mucous microflora is more stable and functionally significant than the cavity microflora, the data obtained allow us to consider Helicobacter pylori as an etiological factor of colonic dysbiosis. Conclusion. The probability of excessive growth of conditionally pathogenic fraction of intestinal parietal microflora has a direct dependence on the severity of Helicobacter pylori infestation, being maximum at degree III contamination. Content of bifidobacteria, lactobacilli and typical E. coli strains in the intestinal biotope of the large intestine is inversely related to the degree of histological activity of HP-associated gastritis.

A Comparative Study between Helicobacter Pylori Antigen in Stool with Histopathology and Rapid Urease Test of Endoscopic Biopsy in PUD Patient

Purpose: To assess stool antigen test as an early effective diagnostic tool like other methods for the diagnosis of H. pylori infection in PUD patient. Patients and Methods: This cross-sectional study was carried in a clinical pathology department of a tertiary level hospital. We included all patients with peptic ulcer disease those who were diagnosed by upper GIT endoscopy. Demographic variables and value of laboratory test including Stool antigen test, rapid urease test was studied in this study. Result: A total of eighty-six patients were undergone for endoscopy after tested for Helicobactor pylori antigen in stool. Among 86 study subjects, Male was 56 (65%) and female was 30 (35%). The Mean (±SD) age was found 38.53(±10.40) years with range from 21 to above 60 years. Stool antigen test positive in 66 (66/86, 76.74%), negative in 20 (20/86, 23.3%). Rapid Urease Test positive in 76 (76/86, 88.4%), negative in 20 (20/86, 11.6%). Histopathology positive in 65 (65/86, 75.58%), negative in 21 (21/86, 24.42%). The result was statistically highly significant (P<0.001). Conclusion: Stool antigen test (SAT) is an early effective diagnostic tool like other methods for the diagnosis of H. pylori infection in our country. CBMJ 2020 July: Vol. 09 No. 02 P: 19-25

Association of gastric infection and periodontal disease through Helicobacter pylori as a common denominator: A systematic review and meta-analysi

Review question / Objective: Is gastric helicobacter pylori infection related to periodontal diseases? Condition being studied: Therefore, the aim of this systematic review and meta-analysis was to identify and analyze clinical studies to determine the direct correlation between Helicobacter Pylori gastric infection andPeriodontal Disease. Study designs to be included: Clinical studies that provided data on Helicobacter Pylori infection in both the stomach and oral cavity, confirmed by polymerase chain reaction (PCR), rapid urease test (RUT) or enzyme-linked immunosorbent assay (ELISA). Clinical studies that associated PD with Helicobacter Pylori. The diagnosis of PD was confirmed ac-cording to the diagnostic criteria in periodontology.

Stool Antigen Test is Effective and Sensitive for Detecting Helicobacter Pylori Infection in Bangladeshi Peptic Ulcer Patients

Aims: Helicobacter pylori (H. pylori) is the primary causative agent of peptic ulcer in multiple developing countries, including Bangladesh. This study was designed to investigate the diagnostic value of a rapid immunochromatography-based H. Pylori stool antigen (HpSAg) test to screen H. pylori infection in Bangladeshi population. Methodology and results: A total of 140 suspected peptic ulcer patients who underwent upper gastrointestinal endoscopy at Chittagong Medical College and Hospital, Chattogram, Bangladesh, were included in the study. Histopathology, Rapid Urease Test (RUT), and Microscopic examination of the stained smears were conducted to define H. pylori positive cases. Later, stool antigen detection test was done in H. pylori positive status group, H. pylori negative status group, indeterminate status group, and healthy controls. Out of 140 peptic ulcer suspected patients, 75 (53.6%) patients were confirmed to have peptic ulcer or erosions. Although the proportion of antral erosion was 57.4% in patients who were below 40 years, the proportion decreased to 23.4% in patients over 40 years. Patients over 40 years were mostly suffering from Prepyloric erosion (42.9%). All peptic ulcer patients were also positive on histopathological analysis. However, micorscopic grading of curved bacilli and RUT found 93.3% (70/75) and 89.3% (67/75) patients positive, respectively. High sensitivity (95%), specificity (80%), and diagnostic accuracy (91%) scores for HpSAg assay was obtained in our study. Conclusions, significance and impact of studies: The HpSAg test, for a comparatively less sophisticated assay, can be efficient in detecting the presence of H. pylori pre-and post-therapy and provide more valid test results than other invasive test methods.

Antiulcer activity of ethanolic leaf extract of Capparis zeylanica against chemically induced ulcers

Background Peptic ulcer is the term which refers to acid peptic injury of the digestive tract, and it results in mucosal break reaching the submucosa. Leaves of Capparis zeylanica are used as counterirritant, rubefacient, as a cataplasm in piles, boils and swellings. The objective of the present study was to evaluate the antiulcer activity of C. zeylanica ethanolic extract against chemically induced ulcers. The leaves were extracted with ethanol (50%) as solvent using hot perforation method. The extract was evaluated against acute and chronic ulcer models. Further, extract was evaluated for gastric autopsy of animals infected with Helicobacter pylori bacteria. The genes of rats were evaluated by gel electrophoresis method. Morphology of stomach was also studied after treatment with plant extract. Results Results exhibited that the area of ulcer was significantly reduced in both acute [naproxen-induced ulcer model (3.62 mm2), histamine-induced ulcer model (3.2 mm2) and ethanol-induced ulcer model (106.4 mm2)] and chronic [chronic naproxen-induced ulcer model (2.14 mm2), chronic histamine-induced ulcer model (0.16 mm2)]. The animals of naproxen-induced ulcer infected with H. pylori showed 91.48% reduction of ulcer area on 9th week after treatment with C. zeylanica extract (360 mg/kg). The rapid urease test and DNA observation revealed that no infection was present from 4th week after treatment with C. zeylanica extract (480 mg/kg). Morphological studies showed less conspicuous petechial marks and hemorrhages in stomach tissues after treatment with test drugs. Histopathological study revealed that C. zeylanica extract reduced stomach damages and eradicated H. pylori infections. Conclusion It can be concluded from the study that C. zeylanica possess antiulcer and anti-helicobacter activities.

Prevalence of Idiopathic Peptic Ulcer in Southeastern Iran

Background: The idiopathic peptic ulcers (IPU) or non-Helicobacter pylori, non-steroidal anti-inflammatory drug non-NSAIDs associated peptic ulcers are a serious therapeutic challenge. The prevalence of IPU is increasing in some parts of the world. Objectives: This study aimed to determine the prevalence of IPU in southeastern Iran. Methods: In this cross-sectional study, a total of 367 patients with active peptic ulcer were diagnosed by endoscopy between Jan 2018 and Feb 2019. The patients were assessed for history of medication use (including NSAIDs) in the past month, smoking, alcohol, as well as a complete history of health problems related to underlying disease such as cardiopulmonary, hepatic, renal problems, and chronic pancreatitis. Biopsy samples from antrum were performed for rapid urease test (RUT), and if RUT was negative, then biopsies were sent for histopathology. If both RUT and pathologic findings were negative for H. pylori, in patients who had treatment for H. pylori eradication, anti-H. pylori IgG antibody of blood samples was assessed. Patients were considered infected with H. pylori if any of the diagnostic tests had a positive result. Results: According to the results, 336 (91.3%) cases had at least one of the two main etiologic factors (H. pylori and NSAIDs) for peptic ulcer. While 323 (87.7%) patients were H. pylori-positive, 45 (12.3%) patients were H. pylori-negative. However, out of 45 H. pylori-negative cases, 13 patients had a positive history of using NSAIDs, and 32 (8.69%) patients were IPU. Conclusions: Our study showed that both H. pylori infection and NSAIDs use remain the main cause of peptic ulcers, and the prevalence of IPU is relatively high in Zahedan.