Real-time EndoFaster improves Helicobacter pylori detection in chronic active gastritis

Helicobacter pylori is the most frequent cause of chronic active gastritis (CAG), namely the first step for gastric cancer development. When infection is not detected at histology, another test is advised. EndoFaster is novel device that reveal the presence of H. pylori by determining ammonium concentration in the gastric juice during endoscopy. We evaluated whether this test may improve etiological diagnosis in CAG patients. In 595 consecutive patients who underwent upper endoscopy gastric juice was analysed with EndoFaster and standard biopsies were taken. CAG with typical bacteria was detected in 102 (17.1%) patients, and CAG without H. pylori was found in 36 (6.3%) cases. EndoFaster detected the infection in 22 (61.1%) of these patients. Neither ongoing proton pump inhibitor therapy nor previous eradication therapy affect the test accuracy. By using EndoFaster, another test to search for the infection in H. pylori-negative CAG patients may be avoided in more than 60% of cases, impacting on both patients discomfort and health resources use.

Role of Immunohistochemistry Versus he Stain in Helicobacter pylori Detection in Gastric Lesions

Helicobacter pylori are a spiral campylobacter like bacteria which infects the stomach causing chronic active gastritis. This can result in peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. In 1989, studies involving 16S ribosomal RNA gene sequencing and others revealed that the bacterium does not come under the genus Campylobacter. Hence the bacterium was classified under a unique genus named Helicobacter. This term is taken from the Greek language with helix meaning - "spiral" or "coil" and pylori meaning- gatekeeper (pylorus of stomach). This bacterium is said to penetrate the pylori or mucoid lining of the stomach. When infected during the early stages of life, people develop intense inflammation that may be followed by atrophic gastritis which serves as a risk factor for gastric ulcer, gastric cancer or both. Being infected during later stages of life changes the gastric system leading to duodenal ulcer. The present study analyzes the role of Immunohistochemistry versus Hematoxylin and Eosin and special stains in detecting Helicobacter pylori in gastric lesions.

Combatting Helicobacter pylori with oral nanomedicine

Helicobacter pylori (H. pylori) infection is considered as the main cause of most digestive diseases such as chronic active gastritis, gastroduodenal ulcer, or even gastric cancer. Oral medication is a...

Association of Helicobacter pyloriin Gastric Lesions with Emphasis on Immunohistochemistry

Introduction:Helicobacter pylori (H.pylori) is associated with many gastro-duodenal diseases like peptic ulcers and gastric adenocarcinoma. Hence, it is important to identify H.Pylori in the endoscopic gastric biopsies. Though Immunohistochemistry (IHC) is time-consuming and expensive, it has shown excellent results and is considered as gold standard method for detecting H.Pylori. Aim: To study the morphological patterns of gastric lesions, different histo-pathological gastric lesions with clinical presentation and the association of H.Pylori using Haematoxylin and Eosin (H&E), Giemsa and IHC staining techniques and their efficacy. Materials and Methods: The present study was an observational study conducted at a tertiary care hospital Kalaburagi for a period of 5 years (1 July 2014 to 30 June 2019). All patients were referred to endoscopic section for the biopsy. History was documented and clinical examination was performed. For the retrospective cases, clinical details were obtained from medical records section, blocks were retrieved, stained with H&E, Giemsa and IHC, studied, tabulated and results were analysed. Results: A total of 95 samples (mean age 49.74 years) were studied. Male: female ratio was 2.8:1. Most common histological benign lesions were Chronic Active Gastritis (CAG) 23 (24.21%) and Chronic Superficial Gastritis (CSG) 14 (14.73%). Malignant tumours were seen in 23 cases, among which moderately (39.13%) and poorly differentiated (39.13%) adenocarcinoma was the commonest. H pylori was identified by IHC in benign and malignant lesions in 20 (23.53%) and 01 (4.35%), respectively. Sensitivity and specificity of H&E and Giemsa was 57.14%, 66.67% and 100%, 100%, respectively. Positive Predictive Value (PPV) was 100% for both stains and Negative Predictive Value (NPV) was 89.16% and 91.36% for H&E and Giemsa. Conclusion: The present study highlights the utility of IHC in detecting H.Pylori in gastric lesions as inflammation and other factors are known to affect the detection rate by H&E and Giemsa staining methods. Hence, IHC can be considered as the best method in detecting H.pylori.

Progression of Primary Gastric Diffuse Large B-Cell Lymphoma after Helicobacter pylori Eradication

In <i>Helicobacter pylori</i>-positive, localized primary gastric diffuse large B-cell lymphoma (DLBCL), an increasing number of reports have recently been published on the effectiveness of <i>H. pylori</i> eradication (HPE). However, HPE treatment strategies for gastric DLBCL, including its indications, have yet to be examined. No detailed report has been published on a case of gastric DLBCL unsuccessfully treated by HPE. A 64-year-old female and a 70-year-old male were pathologically diagnosed with chronic active gastritis and mucosa-associated lymphoid tissue lymphoma, respectively. Both patients were positive for <i>H. pylori</i>, so HPE was employed. The disease progressed within 1 year, and both patients were pathologically diagnosed with DLBCL by endoscopic biopsy. On reviewing the first pathology slide, both patients were diagnosed with DLBCL. That is, the 2 patients had primary gastric DLBCL; however, they exhibited progressive disease after HPE. This failure of HPE treatment may be due to the initial lymphomas being multiplex ulcerative lesions. In both cases, complete remission was achieved by chemotherapy (plus radiation therapy) without recurrence for more than 3 years.

Anti-Helicobacter activity of medicinal plants and probiotics as alternatives for Helicobacter pylori treatment: Review article

Helicobacter pylori, a gram-negative bacterium, known factor for chronic active gastritis, stomach and peptic ulceration, which may progress to gastric cancer. It is also associated with other non-gastric diseases such as stroke, diabetes mellitus and alzheimer’s disease. Although conventional treatment achieved a great advancements in controlling H.pylori infection nowadays it is not effective thus it’s intended to find some other alternative sources that may be used alone or in combination with antibiotics to eradicate the infection. Recently published literature of natural sources such as plant -derived bioactive compounds and probiotics are studied for their reduced side effects and for being safe and inexpensive. However, the mechanism of action by which these herbs and probiotics exert their medicinal properties in H.pylori treatment is still not fully clear. In this review, we highlight the potential antibacterial mechanisms of some traditionally used bioactive compounds and their possible role on H.pylori colonization. On the other hand, we focused on the possible inhibitory role of probiotics in the eradication of H. pylori infection through the release of organic acids and their role in the stabilization of the gastric barrier function in order to decrease the mucosal inflammation, modulate H.pylori colonization and enhance compliance in infected patients.

Increased Resistance of Fluoroquinolones among H. pylori isolates from Patients with Gastroduodenal Diseases in Jordan

Recently, Helicobacter pylori has been connected to more than 80% of chronic active gastritis and other gastroduodenal diseases worldwide. Treatment of H. pylori is routinely dependent on the use of multiple antimicrobial agents however, recent data showed the emergence of resistance among clinical strains especially against metronidazole and clarithromycin. This study was conducted to investigate the rate of resistance to different antibiotics that are routinely used in the first line and second line therapies including ciprofloxacin and levofloxacin, tetracycline, amoxicillin, clarithromycin and metronidazole among H. pylori strains isolated from patients with gastroduodenal diseases in Jordan. Both antral and corpus mucosal biopsies from the stomach of patients with positive results of H. pylori stool antigen and urease breath tests were used for the isolation of H. pylori on selective culture media. The standard agar diffusion method was performed to determine the sensitivity of H. pylori clinical isolates against ciprofloxacin and levofloxacin according to CLSI. Among 62 H. pylori clinical strains isolated from gastric biopsies, 21% and 11% were resistant to levofloxacin and ciprofloxacin respectively. Resistance to metronidazole and clarithromycin was found in 90% and 11% respectively. No resistance was observed against amoxicillin, tetracycline and gemifloxacin. The following MIC90 (mg/L) of resistant strains results were obtained at neutral pH 7.3, 64 for metronidazole, 2 for clarithromycin, 2 for ciprofloxacin and 1 for levofloxacin. The present study reported the emergence of increased resistance of fluoroquinolones among H. pylori clinical isolates in Jordan. Concern should be taken into consideration when triple and quadruple therapy regimens are applied for the management of H. pylori infections in our region

SERUM LEVELS OF IL-8 IN PATIENTS WITH CHRONIC ACTIVE GASTRITIS AND PEPTIC ULCER DISEASE

The majority of researchers discover associations between H. pylori (Hp) and serum IL-8 production with the stage of chronic inflammation. Data on IL-8 levels in chronic gastritis (CG) and a gastroduodenal ulcer (GDU) are insufficient, and often controversial. All patients with chronic active gastritis (CAG) and GDU were divided into 4 subgroups: patients with GDU and found Hp infection according to common methods (GDU+Hp), patients with GDU and no documented Hp infection (GDU), patients with CAG and found Hp infection according to common methods (CAG+Hp), and patients with CAG with no documented Hp infection (CAG). The highest serum IL-8 levels were seen in patients with GDU+Hp, whereas the lowest ones were observed in patients with CAG. Men have the lowest IL-8 levels in the CAG+Hp subgroup as compared with other subgroups. The IL-8 values were significantly different from higher values in women. The rate of fecal Oantigen of H. pylori LPS found using the coagglutination test is 86%. The highest levels of O-antigen of H. pylori LPS were detected in the CAG subgroup. In patients with GDU+Hp, the levels of O-antigen of H. pylori LPS were significantly higher as compared with the GDU subgroup. So patients with GDU, especially those with GDU+Hp, and with CAG, have active IL-8 production. Coagglutination to detect O-antigen of H. pylori LPS in feces used along with common methods increases the probability to confirm that the patients (especially those with chronic gastritis) are infected with this microbe.