Helicobacter pylori and gastroesophageal reflux disease

The role of digestive system diseases in cerebrovascular disease: a comprehensive Mendelian randomization study

Background

Cerebrovascular disease, among the most prevalent neurological disorders, poses a substantial threat to human health with its elevated mortality and disability rates, placing considerable strain on healthcare systems. Although several studies in recent years have suggested a potential association between digestive system diseases and cerebrovascular diseases, the findings remain inconsistent.

Methods

Genome-wide association study (GWAS) summary data for 12 digestive diseases and cerebrovascular diseases were used to conduct Mendelian randomization (MR) analysis. In this investigation, we endeavored to elucidate the causal relationship between digestive system diseases and cerebrovascular diseases. Employing a comprehensive approach, including two-sample MR (TSMR), multivariate MR (MVMR), and two-step MR analysis, we leveraged summary statistics data obtained from published GWAS. The primary analysis method employed was inverse variance weighted (IVW), with MR-Egger and weighted median (WM) as secondary methods. Sensitivity analysis included heterogeneity testing, horizontal multivariate testing, MR-PRESSO, and a "leave-one-out" method. Additionally, the F-statistic was utilized to assess the strength of instrumental variables, ensuring robust results.

Results

In the TSMR analysis, this study found a significant causal relationship between genetically predicted gastroesophageal reflux disease (GERD) and any stroke (AS), any ischemic stroke (AIS), large-artery atherosclerotic stroke (LAS), intracranial aneurysm (IA), and subarachnoid hemorrhage (SAH). In MVMR analysis, this study found that even after adjusting for systolic blood pressure (SBP), body mass index (BMI) and type 2 diabetes (T2D), the causal relationship remains exist. In the two-step MR mediation analysis, it was found that BMI, SBP and T2D play mediating role in the causal relationship between GERD and cerebrovascular diseases.

Conclusion

This study indicates a clear positive causal relationship between GERD and cerebrovascular diseases, and this causal association remains significant even after adjusting for BMI, SBP and T2D. The mediation MR analysis suggests that BMI, SBP and T2D may mediate the causal relationship between GERD and the risk of cerebrovascular diseases.

Analysis of antibiotic susceptibility patterns of Helicobacter pylori isolates from Malaysia

BACKGROUND

The prevalence of antibiotic resistance varies in geographic areas. The information on the antibiotic susceptibility patterns of Helicobacter pylori (H. pylori) in our local setting is therefore relevant as a guide for the treatment options.

OBJECTIVE

This study was conducted to determine the primary resistance rates among H. pylori isolated from Malaysian patients.

MATERIALS AND METHODS

Biopsy samples were obtained from the stomach antrum and corpus of 777 patients from September 2004 until 2007. H. pylori isolated from these patients were then subjected to minimum inhibitory concentration (MICs) determination using E-test method, against metronidazole, clarithromycin, levofloxacin, ciprofloxacin, amoxicillin, and tetracycline.

RESULTS

From 777 patients, 119 were positive for H. pylori where a total of 187 strains were isolated. The resistance rates were noted to be 37.4% (metronidazole), 2.1% (clarithromycin), 1% (levofloxacin and ciprofloxacin), and 0% (amoxicillin and tetracycline). Different resistance profiles were observed among isolates from the antrum and corpus of 13 patients. Resistance to one type of antibiotic was observed in 36.4% of the strains where mono-resistance to metronidazole was the most common. Resistance to ≥2 antibiotics was noted in 3.3% of isolates. High metronidazole MICs of ≥256 μg/mL were observed among the resistant strains.

CONCLUSIONS

The resistance rates of the antibiotics used in primary treatment of H. pylori infections in Malaysia are low, and multi-antibiotic-resistant strains are uncommon. Infections with mixed populations of metronidazole-sensitive and -resistant strains were also observed. However, the high metronidazole MIC values seen among the metronidazole-resistant strains are a cause for concern.

Gastroesophageal reflux disease: From pathophysiology to treatment

This review focuses on the pathophysiology of gastroesophageal reflux disease (GERD) and its implications for treatment. The role of the natural anti-reflux mechanism (lower esophageal sphincter, esophageal peristalsis, diaphragm, and trans-diaphragmatic pressure gradient), mucosal damage, type of refluxate, presence and size of hiatal hernia, Helicobacter pylori infection, and Barrett’s esophagus are reviewed. The conclusions drawn from this review are: (1) the pathophysiology of GERD is multifactorial; (2) because of the pathophysiology of the disease, surgical therapy for GERD is the most appropriate treatment; and (3) the genesis of esophageal adenocarcinoma is associated with GERD.

Helicobacter pyloriinfection and its correlation to extraesophageal and esophageal reflux in contact granuloma patients

To evaluate the presence of Helicobacter pylori (H. pylori) infection and its correlation to extraesophageal and esophageal reflux, 18 consecutive contact granuloma patients were examined by laryngoscopy, 24-hour double probe pH monitoring and [13C]-urea breath test. Sixteen of the 18 patients (89%) were H. pylori-negative, while 2 patients (11%) showed positive test results. Extraesophageal reflux was detected in 14 patients; one of them was H. pylori-positive. In the ten patients with abnormal distal esophageal reflux, one was H. pylori-positive. The present results do not confirm increased prevalence for H. pylori infection in contact granuloma patients and the occurrence of H. pylori infection was not correlated to the amount of pharyngeal or esophageal acid exposure.

Prevalence of gastroesophageal reflux disease and its association with Helicobacter pylori infection in chronic renal failure patients and in renal transplant recipients

BACKGROUND/AIMS

The prevalence of gastroesophageal reflux disease (GERD) in chronic renal failure patients and in renal transplant recipients (RTR) has been a subject of discussion in the last few years. Our aims are to clarify this association and its relation to Helicobacter pylori infection, and also to identify possible pathogenic factors in the development of this disease in both groups.

METHODS

The study involved 40 end-stage renal disease (ESRD) patients with upper gastrointestinal (GI) symptoms (group I), 36 patients who had undergone kidney transplantation and had similar symptoms (group II), and 44 age- and sex-matched controls with the same upper GI symptoms (group III). All patients were subjected to esophagogastroduodenoscopy, and biopsies were obtained from the antrum for histological evaluation and identification of H. pylori.

RESULTS

The prevalence of GERD in the first two groups was similar (77.5 vs. 75.0%, P = 0.412), while it was significantly lower in the control group (38.6%, P < 0.01). H. pylori infection was present in 40.0, 36.1 (P > 0.05) and 75% (P < 0.01 and < 0.001) of the patients in groups I, II, and III, respectively. Multivariate logistic regression analysis in groups I and II showed that high serum creatinine (Odds ratio [OR] = 6.78, 95% Confidence Interval (CI) = 1.12-45.82), immunosuppressive therapy (OR = 5.78, 95% CI = 1.01-32.5), and absence of H. pylori infection (OR = 3.58, 94% CI = 1.11-18.6) were significantly associated with GERD. The duration of ESRD correlated significantly with the prevalence of GERD in group I.

CONCLUSIONS

This study showed a similar prevalence of H. pylori infection and GERD in ESRD and RTR patients. GERD prevalence was higher in these two groups than in the controls. Renal transplantation, chronic renal disease, immunosuppressive therapy, and the absence of H. pylori infection seem to be risk factors for the development of GERD.

Helicobacter pylori infection: a clinical overview

BACKGROUND

Helicobcater pylori colonizes the stomach of more than half of the world's population, and the infection continues to play a key role in the pathogenesis of a number of gastroduodenal diseases. Colonization of the gastric mucosa with Helicobcater pylori results in the development of chronic gastritis in all infected individuals and in a subset of patients chronic gastritis progresses to complications (i.e. ulcer disease, gastric neoplasias, some distinct extragastric disorders). The clinical outcome of the disease is dependent on many variables, including Helicobcater pylori genotype, innate host physiology, genetic predisposition and environmental factors. Helicobcater pylori eradication decreases the incidence of gastroduodenal ulcer and prevents its recurrence. Helicobcater pylori eradication for gastric cancer prevention has been suggested by preclinical research and clinical trials, showing even reversibility of precancerous lesions (atrophic gastritis and intestinal metaplasia) after Helicobcater pylori eradication.

AIMS

To review the current literature about H. pylori and its related pathologies.

CONCLUSION

At present, several clinical manifestations are recognized to be causally linked to Helicobcater pylori infection, and most of them can be cured by Helicobcater pylori eradication. Besides the relationship of Helicobcater pylori and gastroduodenal diseases, it has been well established that Helicobcater pylori infection is also involved in some extragastrointestinal diseases.

Gastroesophageal reflux disease in chronic renal failure patients with upper GI symptoms: multivariate analysis of pathogenetic factors

OBJECTIVE

The association between gastroesophageal reflux disease and end-stage renal disease remains unclear. We aimed to assess the prevalence of gastroesophageal reflux disease and also to identify possible pathogenetic factors in the development of reflux in symptomatic end-stage renal disease patients.

METHODS

The study involved 42 end-stage renal disease patients with upper GI symptoms (group I) and 46 age- and sex-matched controls who did not have renal disease but had the same symptoms (group II). Endoscopy, endoscopic biopsies, and 24-h esophageal pH studies were used to diagnose gastroesophageal reflux disease. Subjects were also investigated for Helicobacter pylori gastritis and GI amyloidosis.

RESULTS

The prevalences of gastroesophageal reflux disease in the two groups were similar (81% vs 84.8%, p = 0.423). The prevalence of H. pylori infection was significantly lower in group I than in group II (38.1% vs 67.4%, p = 0.01). There were II cases of GI amyloidosis in group I. Multivariate logistic regression analysis in group I showed that GI amyloidosis (OR = 7.28, 95% CI = 1.13-46.93), chronic ambulatory peritoneal dialysis treatment (OR = 5.54, 95% CI = 1.01-30.43), and absence of H. pylori infection (OR = 3.75, 95% CI = 1.01-13.9) were significantly associated with reflux esophagitis.

CONCLUSIONS

Upper GI symptoms are important in predicting gastroesophageal reflux disease in end-stage renal disease patients. Chronic ambulatory peritoneal dialysis, GI amyloidosis, and absence of H. pylori infection seem to be risk factors for the development of gastroesophageal reflux disease in end-stage renal disease patients.