Infection by Helicobacter pylori and acute myocardial infarction. Do cytotoxic strains make a difference?

The classical risk factors for acute myocardial infarction (AMI) fail to explain all the epidemiological variations of the disease. Among the risk factors recently reported, several infectious agents appear to increase the risk of AMI. Helicobacter pylori (H. pylori) infection, a bacterium involved in duodenal and gastric ulcer, gastric cancer and MALT-lymphoma, seems to be strongly associated with AMI. More virulent (anti-CagA positive) strains of the bacterium are almost exclusively the causative agents of such diseases. To determine the prevalence of H. pylori infection and of virulent strains, a case-control study was conducted in a group of male patients with AMI. A group of patients consecutively admitted to the Emergency Care Unit served as controls. We studied 223 consecutive male patients, mean age 60.2 (range 40-79) years, admitted for AMI to the Coronary Care Units at Hospitals in two towns of Northern Italy, 223 age matched male patients (mean age 61.8, range 40-79 years) admitted to the Emergency Care Unit, served as control. H. pylori seroprevalence was assessed by presence of antibodies (IgG) against H. pylori and anti-CagA in circulation. Among the patients we investigated the presence of hypertension, levels of cholesterol and glucose in serum, fibrinogen in plasma and smoking habits. H. pylori infection was present in 189/223 (84.7%) of the patients and in 138/223 (61.8%) of the control population (p < 0.0001 OR 3.42 [IC 95% 2.12-5.54]). The anti-CagA antibodies were detected in 33.8% of infected patients with AMI (64/189) versus 26.8% in the control subjects (37/138) (p:0.17, OR 1.40 [IC 95% 0.84-2.33]). Classical risk factors for AMI did not differ among patients with and without H. pylori infection. Patients admitted to the Coronary Care Unit for acute myocardial infarction had a notably higher prevalence of anti-H. pylori not restricted to virulent strains, when compared to a population of patients referred to the Emergency Care Unit. The classical risk factors for coronary disease were present in the patients with AMI irrespective of H. pylori status.     

Helicobacter pylori in gastric biopsies of Taiwanese patients with gastroduodenal diseases

This study was designed to study the in vivo prevalence and the heterogeneity of H. pylori in patients with gastroduodenal diseases in central Taiwan. H. pylori infection was detected in 74.1% (575/776) of the symptomatic population studied. The prevalence of H. pylori infection increased from 11.1% in those between the ages of one to 20, to 82.9% in those between the ages of 41 and 50, and to 84% in those between the ages of 51 and 60. There was no significant difference in the prevalence of H. pylori infection between men and women. Among different blood types, the prevalence and relative risk of H. pylori infection was significantly higher in blood group O patients (90.3%) than in blood group A (41%), blood group B (27.4%), or blood group AB (62%) patients. Metronidazole resistance was found in 6.7% of the primary isolates. The prevalence of metronidazole-resistant H. pylori strains was higher in women (7.69%) than in men (6.25%), but this difference was not significant. A total of 88% of H. pylori strains were cagA-positive. CagA gene-positive strains were present in 90.1% of duodenal ulcers, 90% of duodenal ulcers combined with gastric ulcer, 85.8% of gastric ulcers, and 69.2% of gastritis patients, and was significantly higher in peptic ulcer disease groups than in the gastritis group. In conclusion, there was a low incidence (6.7%) of metronidazole-resistant H. pylori strains and a high prevalence (88%) of H. pylori cagA-positive strains in central Taiwan. This study also demonstrated a significant in vivo correlation between active H. pylori infection and blood group O-positive patients, and showed a significant association between cagA gene-positive H. pylori strains and the development of peptic ulcers.     

幽门螺杆菌感染对过敏性紫癜患儿的影响

目的 探讨幽门螺杆菌(H.pylori)感染对过敏性紫癜(henochschonlein purpura,HSP)患儿肠道菌群、疗效及疾病复发情况的影响。 方法 选取2017年1月至2018年6月我院收治的100例HSP患儿作为观察组,同时随机选取同时段于我院体检的100例健康儿童作为对照组。采用13C同位素呼吸试验法检测H.pylori感染情况,根据H.pylori感染情况进一步将观察组患儿分为感染组和非感染组。收集观察组患儿粪便样本,采用Illumina MiSeq平台对患儿肠道菌群的16S rRNA V4序列进行测序,分析肠道菌群组成,同时分析患儿疗效及疾病复发情况与H.pylori感染的关系。 结果 观察组患儿H.pylori感染率显著高于对照组(47.00% vs 30.00%,χ2=6.100,P=0.015)。治疗后非感染组患儿有效率明显高于感染组(92.45% vs 78.72%,χ2=3.900,P=0.048),复发率显著低于感染组(24.53% vs 44.68%,χ2=4.510,P=0.034)。感染组和非感染组患儿肠道菌群多样性差异无统计学意义,但在门、科水平上肠道菌群结构相对丰度差异有统计学意义。非感染组患儿肠道厚壁菌门、放线菌门相对丰度显著高于感染组,同时其拟杆菌科、瘤胃菌科、链球菌科、双歧杆菌科、巴斯德菌科相对丰度也显著高于感染组(均P结论 H.pylori感染与儿童HSP的发生存在一定相关性。H.pylori感染可影响HSP患儿肠道菌群组成,同时降低疾病治疗效果以及增加复发风险。     

Does Helicobacter pylori eradication affect symptoms in nonulcer dyspepsia: a 5-year follow-up study

The role of Helicobacter pylori infection in nonulcer dyspepsia remains controversial. To date studies exploring the effect of H. pylori eradication on symptoms have reported conflicting results. Randomised control trials employing validated outcome measures have also been difficult to interpret because of several important issues such as the large placebo response seen in patients with nonulcer dyspepsia and both the natural variability in symptoms and symptom severity with time. The association of symptom improvement with resolution of gastritis has meant that the length of follow up employed in most studies has been insufficient. We report the findings of a randomised placebo controlled trial (n = 100), using a validated symptom questionnaire and 5 year follow up to determine the effect of H. pylori eradication on symptoms in nonulcer dyspepsia. In all 64 that were reviewed at 5 years there was a significant difference between patients who were H. pylori negative and those who remained positive with regard to complete symptom resolution, consumption of relevant medications and peptic ulcer disease development, in favour of active treatment. There was a trend for gradual symptom improvement over time irrespective of H. pylori status, which may reflect the natural history of this condition. For those who remained symptomatic at 5 years, there was no difference in symptom severity based on H. pylori status. The findings of this study support the use of H. pylori eradication in symptomatic patients with nonulcer dyspepsia both to induce symptom resolution and to prevent disease progression.     

Helicobacter pylori infection and coronary artery disease

The aim of this investigation was to determine the seroprevalence of H. pylori in patients with coronary artery disease (CAD). Patients with coronary artery disease (n = 90) and control group (n = 90) were enrolled into this randomized, multi-centre study. CAD risk factors analyzed included age, male gender, diabetes mellitus, systemic hypertension, cigarette smoking, hypercholesterolemia and socioeconomic status. The results of this study showed a higher seroprevalence of Helicobacter pylori infection in patients with CAD compared to controls (78.8% versus 58.3%, p < 0.05). However, Helicobacter pylori seropositivity was not associated with coronary artery risk factors (smoking, body mass index, diabetes mellitus, hypertension, total cholesterol and socioeconomic status) either in the whole study population or in the patients and control subjects analyzed separately (P > 0.05). Further study are needed to clarify the precise role of Helicobacter pylori infection on the development of coronary artery disease.     

Epidemiological study on Helicobacter pylori infection and extragastroduodenal disorders in Polish population.

An association between Helicobacter pylori (H. pylori) infection and extragastroduodenal disorders (EGDD) is still not clear. The aim of the study was to investigate the relationship between H. pylori infection and the symptoms of coronary artery disease (CAD), facial dermatological changes (FDC), gastroesophageal reflux diseases (GERD), and periodontal diseases (PD) in Polish population. The study was performed between 1996-1999 year on 7,060 adult inhabitants of municipal area of Krakow (aged 18-76, mean 46.3 year; 55.8% female, 44.2% male): 2,204 subjects with EGDD and 4,856 without symptoms of EGDD. Each patient responded to a detailed questionnaire under supervision of medical staff. The H. pylori status was assessed non-invasively using urea breath test (UBT) with capsulated low-dose 13C-UBT (38 mg). Exclusion criteria were: recent H. pylori eradication, treatment with PPI, bismuth and/or antibiotics in the last 4 weeks. Four groups of cases with EGDD symptoms were selected. Within each group exclusively only one of studied symptoms was recorded. The study included 328, 138, 688, and 1,050 patients with CAD, FDC, GERD and PD, respectively. For each studied group an age and sex-matched asymptomatic controls were selected (897, 387, 1,083, and 2,489 control patients). Results: Overall H. pylori infection rate was 69,9% (in 71.4% of 2,204 cases and in 69.31% of 4,856 controls). In CAD group: 68% of 328 cases were H. pylori (+ve) vs. 70% H. pylori (+ve) of 897 controls. An association was not significant: OR = 0.93 (95% CI, 0.72-1.20). In 138 of FDC cases, 59% were H. pylori (+ve) vs. 71% H. pylori (+ve) in 387 controls showing the lack of positive association; OR = 0.60 (95% CI, 0.42-0.87). In GERD, 69% of 688 cases were H. pylori (+ve) vs. 73% of 1,083 H. pylori (+ve) controls and negative association was observed; OR=0.80 (95% CI, 0.65-1.00). In 1,050 of PD cases 75% were H. pylori (+ve) vs. 68% H. pylori (+ve) of 2,489 controls; positive association was significant; OR = 1.4 (95% CI, 1.16-1.68). We conclude that in the studied Polish population, no positive association exists between H. pylori positivity and CAD, FDC or GERD possibly due very high overall H. pylori infection rate. The only positive link observed between H. pylori infection and periodontal disease may reflect direct "in situ" H. pylori pathological action of H. pylori in oral cavity. It is not excluded that periodontal diseases may facilitate the H. pylori oro-gastric transmission and colonisation of the bacteria in the digestive tract.     

牙周干预联合常规四联药物治疗对口腔及胃幽门螺杆菌根除效果的临床研究

探讨牙周干预联合常规四联药物对口腔及胃部幽门螺杆菌根除的效果, 为该类患者的治疗提供参考。

选择胃部H.pylori阳性转诊口腔科进行牙周健康状况及口腔H.pylori检查的患者140例, 随机分为观察组和对照组各70例。对照组患者采用常规四联药物治疗, 观察组在对照组的用药基础上给予牙周干预治疗。对比两组患者治疗前及停药1个月、6个月及12个月后的牙周临床指数和胃肠道症状; 记录并比较两组患者停药1个月、6个月及12个月后口腔H.pylori根除率和胃H.pylori根除率, 评估两组患者治疗不良反应。

停药1个月、6个月及12个月后, 两组患者牙周临床指数中GI、SBI、PD及CAL值和胃肠道症状评分(腹痛腹胀、恶心呕吐、反酸嗳气)较治疗前显著降低, 同时观察组患者均显著低于对照组(均P < 0.05)。观察组患者停药6个月及12个月后口腔H.pylori根除率和胃H.pylori根除率均显著高于对照组(81.43%vs 60.00%, 71.43%vs 48.57%, 75.71%vs 51.43%, 68.57%vs 41.43%;χ²=7.761、7.619、8.914、10.418, 均P < 0.05)。观察组和对照组患者的不良反应总发生率对比差异无统计学意义(4.29%vs 2.86%, P > 0.05)。

牙周干预联合常规四联药物能显著改善胃部H.pylori感染患者的牙周组织健康状况, 减轻其胃肠道症状, 并能有效降低其口腔H.pylori根除率和胃H.pylori根除率, 安全性良好。

     

益生菌四联疗法对比铋剂四联疗法根除幽门螺杆菌感染的Meta分析

目的 系统评价益生菌四联疗法对比铋剂四联疗法根除幽门螺杆菌（H. pylori）感染的疗效和不良反应。方法 计算机检索中英文数据库,收集上述2种方案根除H. pylori感染的随机对照试验（RCT）,检索时间均从建库至2016年10月。由2名评价员独立筛选文献、提取资料、评价纳入研究的偏倚风险,采取RevMan 5.3软件进行Meta分析。结果 最终纳入12个RCT（共1 687例患者）。Meta分析结果显示：益生菌四联组患者对比铋剂四联组的H. pylori根除率按ITT分析为：80.6% vs 81.2%;按PP分析为：81.2% vs 83.7%,差异无统计学意义（ITT分析：RR=0.99,95%CI：0.95~1.04,P=0.76;PP分析：RR=0.97,95%CI：0.93~1.01,P=0.17）;益生菌四联组的总不良反应的发生率明显低于对照组（16.0% vs 34.9%）,且差异有统计学意义（RR=0.46,95%CI：0.37~0.57,P＜0.01）。结论 现有证据显示,益生菌四联疗法与铋剂四联疗法的H. pylori根除率相当,但益生菌四联疗法的不良反应低于铋剂四联疗法。由于纳入研究数量有限,质量不高,上述结论有待高质量的研究予以验证。     

Negative association between Helicobacter pylori infection and reflux esophagitis in older patients: case-control study in Japan

Background. Recent studies have clarified a close association between H. pylori infection and gastritis, peptic ulcer disease, and gastric cancer, but there is little information concerning the relationship between H. pylori infection and reflux esophagitis (RE). We investigated the relationship between H. pylori , RE, and corpus gastritis.
Subjects and Methods. Ninety-five patients with RE and 190 sex- and age-matched asymptomatic healthy controls demonstrating no localized lesions in the upper GI tract were studied and evaluated for H. pylori infection, histologic gastritis, serum gastrin, and pepsinogens (PGs).
Results. H. pylori infection was significantly lower in RE patients than in asymptomatic controls (41% vs. 76%, p < .01). Histologic gastritis of both the antrum and corpus was significantly less frequent (antrum; p < .01, corpus; p < .01), and serum levels of PGI and the PG I/II ratio were significantly higher in RE patients than in controls (PGI; p < .05, PG I/II ratio; p < .01). When the subjects were divided into two age groups (59 years of age and younger and 60 years of age and older), a significant difference was found only among patients over 60 years of age (29% vs. 85%, p < .01). Among subjects in this age group, gastritis in both the antrum and corpus were significantly milder in RE patients than in controls. Although the prevalence of H. pylori infection was similar between the two groups of patients under 59 years of age, corpus gastritis was significantly milder in patients than in controls ( p < .05).
Conclusions. A significantly low prevalence of H. pylori infection was found in RE patients over 60 years of age but not in those under 59 in comparison with sex- and age-matched controls. The relative lack of corpus gastritis might play a role in the pathogenesis of RE in our population through preservation of the acid secretion area.     

酪酸梭菌活菌胶囊联合标准四联疗法 清除幽门螺杆菌感染的临床研究

目的评估酪酸梭菌活菌胶囊(阿泰宁)联合标准四联疗法清除幽门螺杆菌的临床疗效。方法收集2017年1月至2018年1月就诊于甘肃省人民医院消化科门诊,经胃镜及尿素-14 C呼气试验检查诊断为幽门螺杆菌感染的慢性胃炎患者220例为研究对象并随机分为两组。其中对照组患者给予标准四联疗法,疗程2周。观察组患者在标准四联疗法基础上加用酪酸梭菌活菌胶囊,疗程2周。停药1个月后复查尿素-14 C呼气试验,分析患者临床疗效和不良反应发生率。结果 (1)观察组患者幽门螺旋杆菌清除率(88.18%)明显高于对照组(76.36%),差异有统计学意义(P0.05)。(2)观察组的不良反应发生率(8.18%)低于对照组(26.37%),差异有统计学意义(P0.05)。结论酪酸梭菌活菌胶囊联合标准四联疗法清除幽门螺杆菌的疗效显著,值得临床推广。     

幽门螺杆菌根除治疗对消化性溃疡患者血清胃泌素水平的影响

目的 观察幽门螺杆菌(H.pylori)根除治疗对消化性溃疡患者血清胃泌素水平的影响,为该病治疗提供参考。 方法 选择我院2017年8月至2019年8月收治的120例H.pylori感染的消化性溃疡患者作为观察组,根据H.pylori分型结果进一步分为HPⅠ型组和HPⅡ型组,观察组患者接受根除幽门螺杆菌治疗。选择同期入院的40例非幽门螺杆菌感染消化性溃疡患者作为对照组,对照组患者接受常规治疗。比较两组患者治疗效果、胃镜检查结果、H.pylori清除情况及血清胃泌素、IL10、IL17水平。 结果 HPⅠ型组、HPⅡ型组和对照组患者临床总有效率差异无统计学意义(92.75%、96.08%、97.50%,χ2=1.384,P=0.051)。HPⅠ型组、HPⅡ型组、对照组患者胃镜检查总有效率差异无统计学意义(91.30%,96.08%,97.50%,χ2=1.384,P=0.051)。HPⅡ型组患者幽门螺杆菌根除率高于HPⅠ型组(98.04% vs 85.51%,χ2=4.129,P=0.042)。HPⅠ型组患者治疗后血清胃泌素、IL10、IL17水平均高于对照组(均P结论 不同类型H.pylori感染消化性溃疡患者行幽门螺杆菌根除治疗后临床效果无显著差异。幽门螺杆菌根除治疗可降低消化性溃疡患者血清胃泌素、IL10、IL17水平。     

胃息肉患者胃液菌群结构分析

目的 分析幽门螺杆菌（H. pylori）在胃息肉患者中的感染情况,利用高通量测序技术分析胃息肉患者的胃液菌群组成,探究整体菌群变化与息肉发生的关系。方法 收集7例胃息肉患者的胃液（GP组）,7例胃体黏膜未见异常体检者胃液为对照组（C组）,统计H. pylori感染情况。提取细菌总DNA,采用高通量测序技术对16S rRNA基因的V3‒V4高变区测序,分析比较菌群结构。结果 （1）7例胃息肉患者中5例H. pylori阳性,H. pylori感染率为71.4% ;对照组与胃息肉组H. pylori感染率无差异。（2）两组之间菌群α多样性差异无统计学意义,β多样性有显著区别。门水平上,两组之间菌群差异无统计学意义;属水平上,胃息肉组胃液奈瑟菌属（P＜0.05）、嗜血杆菌属（P＜0.05）、Parvimonas属（P＜0.05）比例显著增加。结论 胃息肉患者胃液菌群发生紊乱,以奈瑟菌属、嗜血杆菌属、Parvimonas属显著增加为特征。     

Expression of cyclooxygenase-2 and nitrotyrosine in human gastric mucosa before and after Helicobacter pylori eradication

To determine whether cure of Helicobacter pylori infection influences the expression of COX-2 and nitrotyrosine in the distal stomach of humans, biopsy specimens were examined immunohistochemically. H. pylori infection was determined using a rapid urease test, culture and histology. Positive staining of COX-2/nitrotyrosine in the epithelium was expressed as the percentage of stained cells to the total epithelial cells.There was a significant increase in COX-2/nitrotyrosine staining in H. pylori -positive subjects compared with H. pylori -negative subjects. Cure of the infection resulted in a significant decrease in both COX-2/nitrotyrosine staining in all patients (52.1+/-12.1% vs 15. 4+/-7.2%, P<0.001; and 57.3+/-13.6% vs 36.1+/-18.0%, P<0.01, respectively). However, immunoreactivity of COX-2/nitrotyrosine was observed in all cases with intestinal metaplasia even after the cure of H. pylori infection.Thus, cure of H. pylori infection may decrease the risk of gastric carcinogenesis due to COX-2 and NO-related compounds in gastric mucosa but not in those patients with intestinal metaplasia.     

Helicobacter pylori Infection in Congestive Gastropathy

Background. This study determines the prevalence and significance of Helicobacter pylori infection in portal hypertensive patients.
Materials and Methods. Patients numbered 118 and consisted of 90 patients with portal hypertension (66 men; 24 women; mean age, 49.1 ± 2.1 years) and 28 noncirrhotic patients with nonucler dyspepsia, (12 men; 16 women; mean age, 47.6 ± 2.8 years), who made up the control group. In all patients, diagnostic upper endoscopy was performed, and gastric biopsies were taken for histological examination and diagnosis of H. pylori.
Results. Of the portal hypertensive patients, 42 (47%) had congestive gastropathy, 11 (26%) of whom were positive for H. pylori. and 48 (53%) did not have gastropathy, 12 (25%) of whom were positive for H. pylori. In the control group, 15 of 28 (54%) were positive for H. pylori. H. Pylori was found less frequently in congestive gastropathy patients than in the control group. We found also that the presence and severity of congestive gastropathy is independent of H. pylori status.
Conclusions. We conclude that the role of H. pylori in the pathogenesis of congestive gastropathy is unlikely, and we suggest that there is no need for its routine eradication in cirrhotic patients.     

幽门螺杆菌感染对冠心病患者血清炎症因子及颈动脉硬化的影响

目的 探讨幽门螺杆菌感染对冠心病患者血清炎症因子及颈动脉硬化的影响。方法 选取2015年6月至2017年2月在安康市中心医院治疗的幽门螺杆菌感染冠心病患者（感染组）50例,以及同时期未被幽门螺杆菌感染的冠心病患者（非感染组）50例。对两组患者血清炎症因子及颈动脉硬化程度进行评估。结果 幽门螺杆菌感染组患者TC、TG及LDL水平均显著高于非感染组,HDL水平显著低于非感染组,差异均有统计学意义（P0.05）,感染组患者不稳定斑块的检出率为48.00%,显著高于非感染组的24.00%,差异有统计学意义（P<0.05）。结论 幽门螺杆菌感染能显著升高冠心病患者血脂水平,加重机体炎症反应,并增加患者颈动脉中膜厚度及斑块的不稳定性。     

cagA gene variants in Malaysian Helicobacter pylori strains isolated from patients of different ethnic groups

Helicobacter pylori infection of a distinct subtype of cagA may lead to different pathological manifestation. The aim of this study is to determine the presence of cagA gene and its variants in H. pylori infection among different ethnic groups and its effect on gastroduodenal diseases. Overall detection of cagA among the 205 clinical isolates of H. pylori was 94%. Variations in size of the 3' region of cagA gene were examined among 192 Malaysian H. pylori cagA-positive strains. Results showed that three cagA variants differing in fragment length of PCR products were detected and designated as type A (621-651bp), type B (732-735bp) and type C (525 bp). Although there was no association between any of the cagA subtypes with peptic ulcer disease (p>0.05), an association between cagA subtypes with a specific ethnic group was observed. Specific-cagA subtype A strains were predominantly isolated from Chinese compared to Malays and Indians (p<0.0005), and cagA subtype B strains were predominantly isolated from Malays and Indians compared to Chinese (p<0.05). The cagA type A strains of H. pylori is commonly found in the Chinese patients who have a higher risk of peptic ulcer disease, thus indicating that it could be used as an important clinical biomarker for a more severe infection.     

幽门螺杆菌感染与慢性口臭关系的初步研究

目的 调查主诉口臭患者的幽门螺杆菌（H．pylori）感染率和主诉消化不良的口臭发生率。方法 研究对象为125例主诉慢性口臭患者和212例主诉慢性消化不良患者。口臭以口气挥发性硫化物（VSC）检测与闻诊联合诊断,H．pylori感染以^14C-尿素呼气试验诊断。结果 125例主诉慢性口臭的患者有87例是真性口臭,其余38例为假性口臭,真性口臭患者的H．pylori感染率显著高于假性口臭（40．2％和13．2％,P〈0．01）。212例主诉慢性消化不良的患者发生口臭105例（49．5％）、感染H．pylori 94例（44．3％）,H．pylori阳性患者的口臭发生率显著高于H．pylori阴性患者（57．5％和43．2％,P〈0．05）。无论何种主诉,大部分口臭患者属于VSC阳性（88．5％）,但H．pylori阳性患者和H．pylor阴性患者口气VSC水平差异无显著性,VSC阳性口臭和VSC阴性口臭的H．pylori感染率差异也无显著性。结论 H．pylori感染可能与口臭的发生有一定关系,但口气VSC并非由H．pylori直接产生。     

Relationship of gastric metaplasia and age, sex, smoking and Helicobacter pylori infection in patients with duodenal ulcer and duodenitis

Gastric metaplasia is one of the factors in duodenal ulcer appearance. The aim of this study was to investigate the frequency of gastric metaplasia and its connection with age, sex, cigarette smoking and H. pylori infection. In the study 216 patients were included. There were 98 patients with duodenal ulcer, 60 with duodenitis, and 58 healthy control subjects. There was no statistically significant difference in gastric metaplasia frequency according to age and sex. Gastric metaplasia was statistically more significant in patients with duodenal ulcer (p < 0.01). In all the subjects cigarette smoking did not significantly influence gastric metaplasia. In smokers with duodenal ulcer, and those who besides duodenal ulcer and smoking had H. pylori infection gastric metaplasia was more frequent (p < 0.01). However, in patients with duodenal ulcer, there was no statistically significant difference of gastric metaplasia related to H. pylori presence. It may be suggested that H. pylori infection is not of indispensable significance for gastric metaplasia appearance.     

Helicobacter pylori, ethnicity, and the gastroesophageal reflux disease spectrum: a study from the East

BACKGROUND: Ethnic differences in gastroesophageal reflux disease (GERD) and its complications as well as racial variations in the prevalence of Helicobacter pylori infection are well documented. Nevertheless, the association between reflux disease, H. pylori, and race has not been adequately explored. AIMS: We estimated the strength of the association between H. pylori, ethnicity, and the gastroesophageal reflux disease (GERD) spectrum, including Barrett's esophagus, in Asian patients presenting for endoscopy in a tertiary referral center. METHODS: Prospectively, we studied 188 consecutive patients with GERD, short- and long-segment Barrett's esophagus, and controls. All patients underwent gastroscopy with gastric biopsies to assess H. pylori, gastritis, and atrophy. CagA status and H. pylori infection were determined by immunoblot assay. RESULTS: The overall prevalence of H. pylori infection was 52.1% (of which 77.6% were cagA(+)) and was lowest in the long-segment Barrett's esophagus group (36.7%) (p = .048). When Barrett's esophagus was present, the length of abnormality was 44.8% shorter in the presence of H. pylori (p = .015). Indians had the highest prevalence of H. pylori (75%) and Malays the lowest (19.6%) (p < .001). In Indians, increased prevalence of H. pylori and cagA-positive strains was associated with reduced severity of GERD (p < .004 and p < .001, respectively), a trend not apparent in the other races. Corpus atrophy, which was almost exclusively associated with H. pylori, was highest in Indians as compared to the other races (p = .013). CONCLUSIONS: Presence of H. pylori was associated with a reduced severity of GERD spectrum disease in Asians, especially Indians. H. pylori infection may protect against complicated reflux disease via induction of corpus atrophy.     

功能性消化不良患儿Hp 治疗前后的症状及胃排空变化的超声观察

目的:探讨功能性消化不良患儿(Functional Dyspepsia,FD)幽门螺杆菌(Helicobacterpylori,Hp)治疗前后的症状及胃排空变化的超声观察。方法:选择我院6~10岁FD小儿患者70例为FD组,将其中28例Hp阴性者作为Hp阴性组,其余42例Hp阳性者作为治疗组。选取健康小儿72例作为对照组。超声测量入选者服用试餐即刻、20、40、60、90 min的近端、远端胃区面积,计算胃半排空时间。结果:FD组患儿上腹疼痛、上腹烧灼感、腹胀、恶心、嗳气和早饱症状的发生率均高于对照组,差异具有统计学意义(P0.05);FD组近端、远端、全胃的半排空时间均较对照组慢,差异具有统计学意义(P0.05)。腹胀、嗳气和早饱是远端胃半排空延迟的危险因素(OR1,P0.05);腹胀和上腹疼痛是全胃半排空延迟的危险因素(OR1,P0.05)。Hp阴性组、Hp治疗组近端、远端、全胃半排空时间较常规治疗组短,差异有统计学意义(P0.05);Hp治疗组与Hp阴性组之间差异无统计学意义(P0.05)。结论:FD患儿的胃排空有所延迟,对Hp感染患儿进行Hp根治有助于消化不良症状的改善,在临床工作中可合理选择应用。