Role of TRPV4 in the Diagnosis and Treatment of Helicobacter pylori Infection in Children with Duodenal Ulcers

Duodenal ulcer seriously affects the quality of life and life safety of children, but the pathogenesis of children with duodenal ulcer is still unclear. As an important second messenger in the body, Ca2+ participates in the physiological and pathological processes of various diseases. Therefore, transient receptor potential vanilloid type 4 (TRPV4) as one of the channels that mediate Ca2+ has attracted widespread attention in recent years. Here, we found that TRPV4 is highly expressed in children with duodenal ulcer and has good diagnostic value through specimens of children with duodenal ulcer, and animal experiments have proved that TRPV4 is also highly expressed in duodenal ulcer mice. In addition, TRPV4 can enhance intestinal permeability, thereby promoting further infiltration of inflammatory factors. In summary, these results indicate that TRPV4 is involved in the occurrence and development of duodenal ulcer. Therefore, this study provides the diagnostic and therapeutic value of TRPV4 in children with duodenal ulcer.

Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers

Background We aimed to identify risk factors of mortality in patients hospitalized with duodenal ulcers (DUs). Methods A National Inpatient Sample–based retrospective cohort study from 2005 to 2014 was conducted on patients undergoing emergency admission for chronic DUs. Demographics, clinical data, and outcomes were collected. Multivariable logistic regression model was applied to find the risk factors of mortality. Results 70 641 patients were included in this study, of which 30 525 (43%) were non-elderly (< 65 years) and 40 116 (57%) were elderly (65+ years) patients. 72% of non-elderly and 57% of elderly patients were males. Mortality rate of men vs women was similar in non-elderly group (1.9% vs 2%, respectively), whereas it significantly differed in elderly patients (4.5% vs 5.3%, respectively, P<.0001). Time to operation was 1.15 (1.83) days in survived vs 1.55 (3.86) days in deceased non-elderly patients ( P < .001). Time to operation was .85 (1.73) days in survived vs 1.79 (7.28) days in deceased elderly patients ( P < .001). In patients with operation, age, delayed operation, frailty, and presence of perforation were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was shown as a protective factor in elderly patients. In the final model for patients with no operation, age, hospital length of stay, and frailty were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was revealed as a protective factor in all patients as well. Conclusion Early operation in patients with DU requiring surgical intervention is essential to improve the outcomes.

Risk assessment of gastric cancer in the presence of Helicobacter pylori cagA and hopQII genes

Helicobacter pylori bacterium is one of the most common bacterial infections globally and is the leading cause of indigestion, gastric and duodenal ulcers, and gastric cancer. This bacterium can escape the antibacterial effects of stomach acid by adapting to the inner layers of the stomach. It combines with the natural sugars in the gastric mucosa. The compound is so effective that it makes bacterium resistant. For genes related to the pathogenesis of H. pylori, using the existence of genes such as cagA, hopQI, and hopQII, PCR is performed on some of these genes to amplify fragments of different lengths. One of the less-studied cases is that two or more pathogenic genes are simultaneously associated with H. pylori. This study examined the frequency of diseases and healthy individuals infected with H. pylori and cagA and hopQII genotypes. To diagnose H. pylori infection in healthy and stomach cancer patients, the PCR products are electrophoresed on the agarose gel after glmM gene amplification by PCR. To this aim, stomach tissue biopsies were used for patients, and saliva was used for healthy individuals. For this purpose, 150 gastric biopsy samples from stomach cancer patients and 150 saliva samples from healthy people were collected. Data showed a significant relationship between the coexistence of two genes, cagA and hopQII, and stomach cancer. 34.2% of patients and 10.1% of healthy individuals showed two genotypes, while other healthy people (89.9%) infected with H. pylori did not have this genotype. Therefore, the simultaneous presence of these two bacterial genes in human societies can be an essential biomarker for the diagnosis and prognosis of gastric cancer.

CHARACTERISTICS AND SUBSTANTIATION OF THE USE OF PELLETS AS A MODERN DOSAGE FORM ON THE MARKET OF UKRAINE

currently, omeprazole pellets are one of the most common pellet formulations on the pharmaceutical market of Ukraine (Gorobets, Matyash, Pekhenko & Barna, 2019). This medication is available in capsule form. Pellets are multi particular dosage forms that have several advantages over monoparticular dosage forms; therefore, pellets are promising oral delivery systems for active pharmaceutical ingredients (APIs). Pellets are used when the stability of the active substance changes with fluctuations in the pH of the environment, when irritation of the gastric mucosa is possible, to facilitate swallowing (especially important for patients with dysphagia, elderly patients, and children). When using polymers in the shell, it is possible to regulate the release in a certain part of the gastrointestinal tract, this allows you to get a point pharmacological effect. In addition, pellets can be of different sizes (from 0.1 to 2 mm), because of their shape, pellets exhibit abrasion resistance and are more fluid. Omeprazole is a synthetic substance. The active ingredient suppresses gastric acid secretion. In refers to the pharmaceutical group of proton pump inhibitors, it prescribes drugs in this group to treat active duodenal ulcers, gastric ulcers, gastro-oesophageal reflux disease (GERD), severe erosive esophagitis, pathological hypersecretory conditions, for example, Zollinger Ellison syndrome. Among the most commonly used methods for the production of pellets are: stage-by-stage spraying of solutions or suspensions (the second name is stage-by-stage layering); direct pelletization (the second name is extrusion-spheronization); spray drying and spray cooling of melts; agglomeration-spheronization. Unfortunately, at the moment, none of the Ukrainian manufacturers is manufactured enteric pellets on their own (they buy ready-made pellets), while there are medicines of both foreign and Ukrainian origin on the domestic market. The article contains an overview of pharmaceutical preparations as pellets, systematization of information on production methods, a review of omeprazole drugs as pellets, presented on the pharmaceutical market of Ukraine. The purpose of this study was to summarize the cases when the use of such a form as pellets is the most reasonable; make an overview of medicines in Ukraine containing pellets; summarize modern methods of pellet production.

Helicobacter pylori-associated comorbidity

Helicobacter pylori (H. pylori) infection is known to lead to various diseases such as gastric and duodenal ulcers, chronic gastritis and malignant diseases, including MALT lymphoma and stomach cancer. To date, various factors of pathogenicity and virulence of the H. pylori bacterium have been studied. The interaction of infection with host cells leads to the induction of inflammatory responses through the release of cytokines, activation of apoptosis or proliferation, which leads to inflammation and dysfunction of the epithelial barrier. This process can facilitate the movement of H. pylori virulence factors and inflammatory mediators into the bloodstream and promote or enhance the development of a systemic inflammatory response and the possible clinical effects of H. pylori infections outside the stomach. The purpose of this review is to clarify the available data on H. pylori-associated comorbidity with diseases of the cardiovascular, nervous, endocrine systems, autoimmune diseases and some other pathologies outside the digestive system.

Gastrointestinal Dopamine in Inflammatory Bowel Diseases: A Systematic Review

Background: an increased prevalence of gastro-duodenal ulceration was described almost sixty years ago as prodromal to idiopathic Parkinson’s disease, while duodenal ulcers have been rarely diagnosed in patients with schizophrenia. The cytoprotective role of dopamine in animal models of gastrointestinal ulcerations has also been described. Interestingly, Parkinson’s disease (PD) might share common pathophysiological links with inflammatory bowel disease (IBD) as epidemiological and genetic links already suggest. Thus, the aim of our study was to review the existing literature on the role of the gastrointestinal dopaminergic system in IBD pathogenesis and progression. Methods: a systematic search was conducted according to the PRISMA methodology. Results: twenty-four studies satisfied the predetermined criteria and were included in our qualitative analysis. Due to different observations (cross-sectional studies) as well as experimental setups and applied methodologies (in vivo and in vitro studies) a meta-analysis could not be performed. No ongoing clinical trials with dopaminergic compounds in IBD patients were found. Conclusions: the impairment of the dopaminergic system seems to be a significant, yet underestimated, feature of IBD, and more in-depth observational studies are needed to further support the existing preclinical data.

Analysis of surgical treatment of duodenal ulcers with multiple combined complications

The aim of the research. Analysis of results and development of surgical tactics for the treatment of DU with multiple combined complications. Materials and methods. The results of the analysis of surgical treatment of duodenal ulcers with multiple combined complications (3 and 4 combined complications) for 3 periods are presented: 1st (1983–1995) (group A) – 77 patients, 2nd (2000–2007) years (group B) – 30 patients and 3rd (2008–2020) (group C) – 46 patients. Results. 153 patients (100 %) underwent surgery for complicated duodenal ulcer (DU), of which 130 patients (84.9 %) had a combination of three complications and 23 (15.1 %) had four complications. Bleeding complications were noted in 139 of 153 patients, accounting for 90.8 %, and ulcer perforation in 69 patients, accounting for 45.1 % of all other complications. Based on the obtained data of the analysis, there is a steady tendency to increase the proportion of organ-preserving operations (OPO) by 1.5 times (from 50.7 % to 76.2 %), reducing the number of gastrectomy (GR) by 3 times (from 14.5 % to 4.8 %) and palliative operations (PAL) 3.3 times (from 15.8 % to 4.8 %) with a relatively stable number of performed organ-saving operations (OSO): in group A – 17 (24.6 %) interventions, in group B – 4 (21.1 %), group C – 6 (14.3 %). Conclusions. The use of modern measures of endoscopic hemostasis allowed to operate on patients in the delayed period, and their share from the second period to the third increased 2.8 times. The number of patients who underwent emergency surgery with perforation of the ulcer as one of the complications decreased in the third period compared to the second by 2.6 times, due to the widespread use of PPIs in the conservative treatment of DU. According to the results of the analysis it became known that the chosen active-individualized tactics and developed algorithms for choosing the type of surgery allowed to achieve a stable level of postoperative mortality at 8.3 %.

Efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers

Objective. To estimate the efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers. Materials and methods. Into the investigation 80 patients were included, operated for the profuse hemorrhage complication of duodenal ulcers, penetrating into pancreatic head. The patients were distributed into two groups: the control - 40 patients, in whom the standard methods of the hemorrhage arrest were applied, and the main - 40 patients, in whom the method elaborated was used. Results. In the main group in postoperative period the complications have had occur in 1 (2.5±0.2%) patients (p<0.001) only - the duodenal fistula development. There was verified, that the best results of hemostasis in hemorrhage from penetrating duodenal ulcers were obtained in the patients of the main group, in whom іntraoperative endovascular arrest of the hemorrhage together with the ulcer suturing was applied, because in 100% of patients of this group the definite hemostasis was achieved. Conclusion. The proposed method of intraoperative endovascular arrest of hemorrhage from penetrating duodenal ulcer guarantees a qualitative hemostasis, lowers the rate of the hemorrhage early recurrence and the need for relaparotomy performance, and raises the surgical treatment quality.

An Overview of Surgical Treatment of Perforated Peptic Ulcer

A number of advancements in the therapy of perforated duodenal ulcers have been made in the recent two decades, suggesting that the disease's morbidity and mortality may be reduced. Recently, there has been a return to a more conservative first approach, with reports of either delayed resection or two-stage surgery, in which a non-radical resection is performed first, followed by lymphadenectomy at a later date. Furthermore, because gastric lymphoma can be cured without resection, many upper GI surgeons recommend performing a biopsy and repair at the index operation and then considering how best to continue if adenocarcinoma is discovered later.

Complete Genome Sequence of Helicobacter pylori Strain 3401, a Suitable Host for Bacteriophages KHP30 and KHP40

Helicobacter pylori 3401, isolated from a patient with duodenal ulcers in Japan, is susceptible to the bacteriophages KHP30 and KHP40. In this study, we report the complete genome sequence of H. pylori 3401. This study may lead to the establishment of phage therapy against H. pylori infection.