Bacteraemia, antimicrobial susceptibility and treatment among Campylobacter-associated hospitalisations in the Australian Capital Territory: a review

Background Campylobacter spp. cause mostly self-limiting enterocolitis, although a significant proportion of cases require hospitalisation highlighting potential for severe disease. Among people admitted, blood culture specimens are frequently collected and antibiotic treatment is initiated. We sought to understand clinical and host factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations. Methods Using linked hospital microbiology and administrative data we identified and reviewed Campylobacter-associated hospitalisations between 2004 and 2013. We calculated population-level incidence for Campylobacter bacteraemia and used logistic regression to examine factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations. Results Among 685 Campylobacter-associated hospitalisations, we identified 25 admissions for bacteraemia, an estimated incidence of 0.71 cases per 100,000 population per year. Around half of hospitalisations (333/685) had blood culturing performed. Factors associated with bacteraemia included underlying liver disease (aOR 48.89, 95% CI 7.03–340.22, p < 0.001), Haematology unit admission (aOR 14.67, 95% CI 2.99–72.07, p = 0.001) and age 70–79 years (aOR 4.93, 95% CI 1.57–15.49). Approximately one-third (219/685) of admissions received antibiotics with treatment rates increasing significantly over time (p < 0.05). Factors associated with antibiotic treatment included Gastroenterology unit admission (aOR 3.75, 95% CI 1.95–7.20, p < 0.001), having blood cultures taken (aOR 2.76, 95% CI 1.79–4.26, p < 0.001) and age 40–49 years (aOR 2.34, 95% CI 1.14–4.79, p = 0.02). Non-susceptibility of isolates to standard antimicrobials increased significantly over time (p = 0.01) and was associated with overseas travel (aOR 11.80 95% CI 3.18–43.83, p < 0.001) and negatively associated with tachycardia (aOR 0.48, 95%CI 0.26–0.88, p = 0.02), suggesting a healthy traveller effect. Conclusions Campylobacter infections result in considerable hospital burden. Among those admitted to hospital, an interplay of factors involving clinical presentation, presence of underlying comorbidities, complications and increasing age influence how a case is investigated and managed.

Spectrum of esophageal lesions- A study of endoscopic biopsies

Endoscopic biopsies is a very common outpatient procedure in gastroenterology unit. The present article is a study of endoscopic biopsies taken from the esophagus. The gastrointestinal tract cannot be visualized directly and endoscopy is a very important and easy tool for visualization of GI tract lesions directly and helping in the diagnosis in the early stage, there by helping in the overall well being of the patient. To emphasize the utility of endoscopic biopsies in the diagnosis of esophageal lesions. To correlate the endoscopic findings with pathological diagnosis. To study the various pathologies. Endoscopic biopsies taken from the esophagus were studied and analysed in the present study. The biopsies are taken by the gastroenterologist. The biopsies are fixed in 10%formalin.After fixation the biopsy specimen is processed and embedded in paraffin.4 to 5 microns thick sections were cut, stained with Haematoxylin & Eosin and studied. Out of the 118 cases of esophageal biopsies received at the Department of Pathology, Mediciti Institute of Medical Sciences from December 2016 to November, 2018. ,50 were non neoplastic lesions, 68 cases were neoplastic lesions, 50 were non neoplastic lesions, 68 cases were neoplastic lesions. Chronic non specific esophagitis was the commonest non neoplastic esophageal lesion. Squamous cell carcinoma was the commonest neoplastic lesion. The lower one third is the commonest site of pathology for esophagus. Males are mostly effected and predominant age of presentation is around 40-60 years for non neoplastic lesion and 50-70 years for neoplastic region.

Effcacy of quadruple therapy for the treatment of H. pylori infection at Gia Dinh people’s hospital

Helicobacter pylori (H. pylori) infection is one of the most common chronic bacterial infections in the world. For the purpose of eradicating H. pylori, quadruple therapies are widely prescribed in patients infected with H. pylori. According to the Maastricht V Consensus Conference, in regions where the rate of resistance of H. pylori to CLR and MTZ is high such as Viet Nam, bismuth quadruple therapy is the first choice. However, bismuth also causes many side efects. The aim of this study was to assess the effectiveness of quadruple therapies on H. pylori infection at Gia Dinh people’s hospital. Seventy-one patients aged 18 years old and older diagnosed with H. pylori infection at the Gastroenterology Unit of Gia Dinh People’s hospital were enrolled in this descriptive cross–sectional study. The efficacy and frequency of side effects of bismuth and non-bismuth quadruple therapies for H. pylori eradication were evaluated and the total rate of H. pylori eradication with both therapies was reported to be 70.4%. The success rate of bismuth quadruple therapy was 80.0%, significantly higher than that of non bismuth quadruple therapy (47.6%). Additionally, the frequency of side effects encountered by bismuth quadruple therapy was insignificantly higher than non-bismuth quadruple therapy (p > 0.05). In conclusion, the effectiveness of treatment with bismuth quadruple therapy was higher than that with non-bismuth quadruple therapy.

Prevalence of Helicobacter pylori vacA, cagA, cagE1, cagE2, dupA and oipA Genotypes in Patients With Gastrointestinal Diseases

Helicobacter pylori (H. pylori) is a bacterium that resides in the human stomach, which is associated with gastroduodenal diseases. We investigate the prevalence of cagA, vacA, oipA, cagE1, cagE2 and dupA genotypes in H. pylori isolated from patients with Gastric ulcer, duodenal ulcer, and Gastric Cancer. Collected 74 samples from the Gastroenterology Unit of the Rasool Akram Hospital were included in this study. Gastric disorders were identified by endoscopy .gastric cancer was further confirmed by histopathology. H. pylori were detected by the urease test. Subsequently, DNA was extracted from gastric tissue of the subjects with the CLO-test yielded positive results. In general, 74 patients with a mean age of 53.45 years (Range 22 to 86-year-old), including 45 men and 29 women, were studied. Among 74 H. pylori-positive patients, 70 (94.5%) patients were positive for the cagA gene. About 95.8% (23/24) of the patients with gastric carcinoma were dupA positive and VacA gene (91.8%). The oipA genotype was detected in 71 (96%) of H.pylori positive samples. This gene was more common in patients with gastritis rather than cancer group. Also, 97.2% of 74 H. pylori isolates were cagE2-positive. In 25 patients with PUD, the occurrence percent of cagA+/VacA+, cagA+/Vac- , cagA- /VacA+ and cagA- /VaxA- genotypes were found 80%, 12%, 4.2% and 4.2 respectively. The results of the present study suggest that a high prevalence of virulent factors could contribute to the risk of developing gastroduodenal diseases.

Higher Prevalence of Obesity among Children with Functional Abdominal Pain Disorders

Background Functional abdominal pain (FAP) disorders are one of the most common gastrointestinal disorders in children. We aimed to define the association between obesity and functional abdominal pain (FAP) disorders and to assess differences between overweight/obese children and normal weight children with FAP disorders.Methods We conducted a retrospective study of children (2-18 years old) with a clinical diagnosis of FAP who were followed-up in our pediatric gastroenterology unit between 1/2016-10/2018. FAP disorders were defined according to the ROME IV criteria. Body mass index (BMI) percentiles were defined by CDC standards. Patients with BMIs ≥85% were designated as being overweight/obese. A healthy control group was obtained from the 2015-2016 Israel national health survey.Results Data from 173 children with FAP disorders (median age 11.5 years, 114 females) were included. Seventy-one children (41%) were classified as having abdominal pain-NOS, 67 (38.7%) as having irritable bowel syndrome (IBS), and 35 (20.2%) has having functional dyspepsia. Fifty-three children (30.6%) were classified as being overweight/obese. Adolescents with FAP disorders had a significantly higher prevalence of overweight/obesity compared to controls (39.5% vs. 30%, respectively, p = 0.04). Overweight FAP children were older [12.4 (range 9.8-15.3) vs. 10.8 (7.4-14.1) years, p = 0.04] and had more hospitalizations due to FAP (20.8% vs. 7.6%, p = 0.01) compared to normal weight FAP children.Conclusions Children with FAP had higher prevalence of overweight/obesity compared to healthy controls. Future studies are warranted to raise awareness of weight issues in FAP and determine the effect of weight loss on FAP.

CIRRHOSIS

Objectives: To investigate the histological changes in gastric mucosa of livercirrhosis patients. Study design: Cross sectional study. Place and Duration: Department ofAnatomy and Medicine, Gastroenterology unit, Isra University Hospital (June to December2012). Subjects and Methods: 85 diagnosed cases of liver cirrhosis were selected accordingto inclusion and exclusion criteria. Specimen of 2 mm thickness was taken by punch biopsyfrom gastric body and antrum by endoscope. Tissues were fixed in 10% formaldehyde, 3-5 μsections were stained with H & E for microscopy. Data was analyzed on SPSS version 21.0.Results: Age (mean ±SD) was noted as 47±11.5 years. Of 85, 56 (65.8%) were male and29 (34.1%) female. Frequency of mild, moderate, severe and no gastropathy were notedin 52.94%, 34.12%, 4.71%, and 8.24% respectively. 9.4% of cases show capillary dilationand edematous lamina propria. Conclusion: Microscopy shows gastropathy in majority ofspecimens. Thick gastric mucosa, increased gland size and mucosa capillary dilation wasnoted.