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Yalaki S, Caglar R, Pulat H. Effect of gastric helicobacter pylori colonization in the development of erosive esophagitis in patients with hiatal hernia. Niger J Clin Pract 2023; 26:43-48. [PMID: 36751822 DOI: 10.4103/njcp.njcp_1928_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background/Aims There may be various factors that determine gastroesophageal reflux disease (GERD) as a result of hiatal hernia (HH) (such as the size of the hernia, age, other host and environmental factors) and the presence of protective factors to explain the absence of reflux disease should not be ignored. Helicobacter pylori (Hp) infection can prevent the development of GERD or cause it. This study aimed to determine whether Hp colonized in the stomach and hernia affects the development of erosive esophagitis (EE) in patients with HH. Materials and Methods In this case-controlled study, 111 patients with HH were eligible for the study. Study group with EE (n = 61, 55%) and control group without EE (n = 50, 45%) were formed. Groups were compared for gastric Hp and Hp in the hernia. Results While the frequency of Hp in the antrum was 55.7% in the group with EE, it was 30% in the control group (p = 0.01, OR: 2.94 in 95% CI 1.34-6.46). The rates in terms of HP frequency in the corpus were 43.6% and 32.1%, respectively, (p = 0.45). Hp colonization in HH was detected in 18 cases (29.50%) and 14 cases (28%), respectively, (p = 0.86). In regression analysis, antral Hp was found to be effective in the development of EE (p = 0.01). Conclusion As a result of this study, we think that antral Hp may have a causative role in the development of reflux esophagitis, but the presence of Hp in HH does not have an effective role in reflux esophagitis formation.
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Affiliation(s)
- S Yalaki
- Department of Gastroenterology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - R Caglar
- Department of General Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
| | - H Pulat
- Department of General Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
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Factors Affecting the Intraluminal Therapy for Helicobacter pylori Infection. Microorganisms 2022; 10:microorganisms10020415. [PMID: 35208870 PMCID: PMC8876938 DOI: 10.3390/microorganisms10020415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023] Open
Abstract
Helicobacter pylori (H. pylori) can be eradicated immediately while conducting an endoscopic examination. The eradication rate of intraluminal therapy for H. pylori infection (ILTHPI) is 53.7% (51/95) via local application of single-dose medicament containing amoxicillin, metronidazole, and clarithromycin. We aimed to evaluate factors affecting ILTHPI and to assess the efficacy among single antibiotics, and compared our results with combined antibiotics. We enrolled H. pylori-infected treatment-naïve symptomatic patients; 95 completed triple-antibiotic ILTHPI were evaluated for risk factors, along with 60 completed mono-antibiotic ILTHPI containing amoxicillin, clarithromycin, or metronidazole in each of the 20 patients. Univariate analysis revealed the significant influence of BMI (OR: 1.15; 95% CI: 1.03–1.27, p = 0.011) and gastric juice pH (OR: 1.35; 95% CI: 1.16–1.58, p = 0.0001). Logistic regression analysis also showed significant influence of gastric juice pH (OR: 1.30; 95% CI: 1.10–1.54, p = 0.002). The eradication rate of mono-antibiotic ILTHPI is significantly lower than triple-antibiotic ILTHPI (11.7% vs. 53.7%; p < 0.0001; α = 0.05, power = 1.0). The efficacy was 20% (4/20) for metronidazole, 10% (2/20) for amoxicillin, and 5% (1/20) for clarithromycin. In conclusion, the level of gastric juice pH is a crucial factor affecting the ILTHPI. The detection of gastric juice pH and selection of optimal intraluminal medicaments are important. Further studies with combined antibiotics for ILTHPI, perhaps metronidazole-containing medicaments, are recommended.
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Sáenz JB. Follow the Metaplasia: Characteristics and Oncogenic Implications of Metaplasia's Pattern of Spread Throughout the Stomach. Front Cell Dev Biol 2021; 9:741574. [PMID: 34869328 PMCID: PMC8633114 DOI: 10.3389/fcell.2021.741574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
The human stomach functions as both a digestive and innate immune organ. Its main product, acid, rapidly breaks down ingested products and equally serves as a highly effective microbial filter. The gastric epithelium has evolved mechanisms to appropriately handle the myriad of injurious substances, both exogenous and endogenous, to maintain the epithelial barrier and restore homeostasis. The most significant chronic insult that the stomach must face is Helicobacter pylori (Hp), a stomach-adapted bacterium that can colonize the stomach and induce chronic inflammatory and pre-neoplastic changes. The progression from chronic inflammation to dysplasia relies on the decades-long interplay between this oncobacterium and its gastric host. This review summarizes the functional and molecular regionalization of the stomach at homeostasis and details how chronic inflammation can lead to characteristic alterations in these developmental demarcations, both at the topographic and glandular levels. More importantly, this review illustrates our current understanding of the epithelial mechanisms that underlie the pre-malignant gastric landscape, how Hp adapts to and exploits these changes, and the clinical implications of identifying these changes in order to stratify patients at risk of developing gastric cancer, a leading cause of cancer-related deaths worldwide.
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Affiliation(s)
- José B Sáenz
- Division of Gastroenterology, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Wang YC, Chen YP, Ho CY, Liu TW, Chu CH, Wang HY, Liou TC. The Impact of Gastric Juice pH on the Intraluminal Therapy for Helicobacter pylori Infection. J Clin Med 2020; 9:jcm9061852. [PMID: 32545856 PMCID: PMC7356802 DOI: 10.3390/jcm9061852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Helicobacter pylori (H. pylori) can be topically eradicated in stomach lumen on endoscopic examination. The procedures of intraluminal therapy for H. pylori infection (ILTHPI) include the control of intragastric pH, mucolytic irrigation of the gastric mucosal surface, and a single-dose medicament containing antimicrobial agents. Aims: To detect gastric juice pH and evaluate its impact on the success rate of ILTHPI. Methods: We enrolled 324 patients with upper abdominal discomfort for endoscopic examinations. Among them, 13C-urea breath test was positive in 218 patients, where 100 underwent ILTHPI, and negative in 106. All patients had their gastric juice pH detected and set into three ranges, including normal acidity (pH < 4.0), low-level hypoacidity (pH 4.0–5.5), and high-level hypoacidity (pH ≥ 6.0). The impact of gastric juice pH on the success rate of ILTHPI was evaluated. Results: Distribution of pH level showed no significant difference between two groups of H. pylori-infected patients (p = 0.942). The eradication rate of ILTHPI is significantly lower in patients with gastric juice pH below 4 (p < 0.001). Conclusions: Detection of gastric juice pH in ILTHPI is extremely important. Rapid control of stomach pH at or above 4 for patients prior to ILTHPI is strongly recommended. (NCT03124420).
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Affiliation(s)
- Yu-Chio Wang
- Department of General Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-C.W.); (T.-W.L.); (C.-H.C.)
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (Y.-P.C.); (C.-Y.H.); (H.-Y.W.)
| | - Yen-Po Chen
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (Y.-P.C.); (C.-Y.H.); (H.-Y.W.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City 25173, Taiwan
| | - Cheng-Yu Ho
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (Y.-P.C.); (C.-Y.H.); (H.-Y.W.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City 25173, Taiwan
| | - Ting-Wen Liu
- Department of General Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-C.W.); (T.-W.L.); (C.-H.C.)
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (Y.-P.C.); (C.-Y.H.); (H.-Y.W.)
| | - Cheng-Hsin Chu
- Department of General Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-C.W.); (T.-W.L.); (C.-H.C.)
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (Y.-P.C.); (C.-Y.H.); (H.-Y.W.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Horng-Yuan Wang
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (Y.-P.C.); (C.-Y.H.); (H.-Y.W.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Tai-Cherng Liou
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan; (Y.-P.C.); (C.-Y.H.); (H.-Y.W.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City 25173, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
- Correspondence: ; Tel.: +88-62-2543-3535 (ext. 3993)
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