A standardized system and App for continuous patient symptom logging in gastroduodenal disorders: design, implementation, and validation

Background Functional gastroduodenal disorders include functional dyspepsia, chronic nausea and vomiting syndromes, and gastroparesis. These disorders are common, but their overlapping symptomatology poses challenges to diagnosis, research, and therapy. This study aimed to introduce and validate a standardized patient symptom-logging system and App to aid in the accurate reporting of gastroduodenal symptoms for clinical and research applications. Methods The system was implemented in an iOS App including pictographic symptom illustrations, and two validation studies were conducted. To assess convergent and concurrent validity, a diverse cohort with chronic gastroduodenal symptoms undertook App-based symptom logging for 4-hours after a test meal. Individual and total post-prandial symptom scores were averaged and correlated against two previously validated instruments: PAGI-SYM (for convergent validity) and PAGI-QOL (for concurrent validity). To assess face and content validity, semi-structured qualitative interviews were conducted with patients. Key Results App-based symptom reporting demonstrated robust convergent validity with PAGI-SYM measures of nausea (rS=0.68), early satiation (rS=0.55), bloating (rS=0.48), heartburn (rS=0.47), upper gut pain (rS=0.40) and excessive fullness (rS=0.40); all p<0.001 (n=79). The total App-reported Gastric Symptom Burden Score correlated positively with PAGI-SYM (rS=0.56; convergent validity; p<0.001), and negatively with PAGI-QOL (rS=-0.34; concurrent validity; p=0.002). Interviews demonstrated that the pictograms had adequate face and content validity. Conclusions and Inferences The continuous patient symptom-logging App demonstrated robust convergent, concurrent, face, and content validity when used within a 4-hour post-prandial test protocol. The App will enable standardized symptom reporting and is anticipated to provide utility in both research and clinical practice.

Determine the Prevalence of cagA and Baba of Helicobacter Pylori Isolated from Gastric Atrophic Patients

Objective: The aim of this study is to determine the prevalence of cagA and babA of helicobacter pylori isolated from gastric atrophic patients. Study Design: Descriptive/Analytical Place and Duration: The study was conducted at Medicine/Gastroenterology department of Khyber Teaching Hospital and Peshawar Institute of Medical Sciences, Peshawar for six months duration from March 2020 to August 2020. Methods: Total one hundred and twenty patients of both genders were presented in this study. Patients were aged between 20-80 years of age. Patients detailed demographics age, sex and body mass index were recorded after taking informed written consent. All patients of gastroduodenal disorders were undergone for isolation of bacteria by using standard techniques. Complete data was analyzed by SPSS 22.0 version. Results: Total 50 (41.7%) patients were males and 70 (58.3%) patients were females. Mean age of the patients were 41.96 ± 16 years with mean BMI 25.24 ± 4.8 kg/m2. Frequency of H pylori was isolated in 30 (25%) patients in which 13 patients had atrophic gastritis, 9 patients had gastric ulcer and 8 patients had acute gastritis. Prevalence of cagA gene was 16 (53.33%) and babA was 10 (33.33%) in H. pylori isolated patients. Significantly difference with p value <0.05 was observed between cagA positive strains and patients of gastric atrophic. The involvement of gastric atrophic patients was not correlated to the babA gene. Conclusion: We concluded in this study that different cagA positive H. pylori can be retrieved from gastric atrophy patients. Keywords: Gastric atrophy, Gastric cancer, cagA, babA, Helicobacter pylori

Epstein–Barr Virus and Helicobacter Pylori Co-Infection in Non-Malignant Gastroduodenal Disorders

Epstein–Barr virus (EBV) and Helicobacter pylori (H. pylori) are two pathogens associated with the development of various human cancers. The coexistence of both microorganisms in gastric cancer specimens has been increasingly reported, suggesting that crosstalk of both pathogens may be implicated in the carcinogenesis process. Considering that chronic inflammation is an initial step in the development of several cancers, including gastric cancer, we conducted a systematic review to comprehensively evaluate publications in which EBV and H. pylori co-infection has been documented in patients with non-malignant gastroduodenal disorders (NMGDs), including gastritis, peptic ulcer disease (PUD), and dyspepsia. We searched the PubMed database up to August 2019, as well as publication references and, among the nine studies that met the inclusion criteria, we identified six studies assessing EBV infection directly in gastric tissues (total 949 patients) and three studies in which EBV infection status was determined by serological methods (total 662 patients). Due to the substantial methodological and clinical heterogeneity among studies identified, we could not conduct a meta-analysis. The overall prevalence of EBV + H. pylori co-infection in NMGDs was 34% (range 1.8% to 60%). A higher co-infection rate (EBV + H. pylori) was reported in studies in which EBV was documented by serological methods in comparison with studies in which EBV infection was directly assessed in gastric specimens. The majority of these studies were conducted in Latin-America and India, with most of them comparing NMGDs with gastric cancer, but there were no studies comparing the co-infection rate in NMGDs with that in asymptomatic individuals. In comparison with gastritis caused by only one of these pathogens, EBV + H. pylori co-infection was associated with increased severity of gastric inflammation. In conclusion, only relatively small studies testing EBV and H. pylori co-infection in NMGDs have been published to date and the variable report results are likely influenced by geographic factors and detection methods.