[Helicobacter pylori infection: prospective study for asymptomatic Tunisian children]

[Isolated primary gastric localization of a mantle cell lymphoma]

Primary mantle cell lymphoma of the digestive tract is uncommon; it rarely involves the stomach and generally manifests as a lymphomatous polyposis. Isolated gastric localization is exceedingly rare. We present a case of a 57-year-old man who presented with a six-month history of atypical epigastric pain. Endoscopy revealed a large ulceration of the gastric mucosa. Histological examination of the biopsied specimens concluded to a marginal zone B-cell lymphoma (MALT-type) of low-grade. Patient underwent two courses of anti-Helicobacter pylori therapy followed by chemotherapy, without endoscopic amelioration. Histological control showed the persistence of a nodular lymphomatous proliferation that respects glands. It was made of monotonous small cells reactive with CD5 and cyclin D1. The diagnosis of gastric mantle cell lymphoma was made. No other digestive or nodal localization was found. Patient underwent intensive chemotherapy anti-CD20; he was free of disease three years after diagnosis. Primary mantle cell lymphoma of the stomach is an uncommon neoplasm. Diagnosis is often difficult and requires the use of CD5 to exclude a MALT-cell lymphoma, which is much more frequent in this location.

The effect of non-steroidal anti-inflammatory drugs and Helicobacter pylori infection on the gastric mucosa in children with upper gastrointestinal bleeding

OBJECTIVE

To study the effect of non-steroidal anti-inflammatory drugs (NSAID) and of Helicobacter pylori infection on the gastric mucosa in children with upper GI bleeding (UGIB).

METHODS

Eighty-four children, 41 males (mean age 92.6 months, 4-168 months) underwent an upper GI endoscopy with gastric biopsies for UGIB. Biopsies were analysed for histological assessment according to the updated Sydney classification and bacterial culture. The presence of H. pylori infection was retained when histology and/or culture were positive. A negative result was retained when both tests were concomitantly negative. Children were divided into two groups according to the severity of mucosal endoscopic injury. The risk factors, i.e. NSAIDs intake, laboratory haemostatic disorders, were reported.

RESULTS

Helicobacter pylori infection was detected in 41 children (48.8%) out of the 84 presented with UGIB. Severe endoscopic damage (SED) group (n = 38, 45.2%), exhibited frank gastric lumen haemorrhage (n = 12), petechia (n = 12), erosions (n = 8), ulcerations (n = 4) in the gastric antrum and corpus. Mild endoscopic damage (MED) group (n = 46, 54.8%), exhibited; congestive mucosa (n = 16), nodular mucosa (n = 15) and pale mucosa (n = 4); 25 children out of 84 (29.8%) received NSAID. According to the severity of endoscopic injuries, none of the following risk factors exhibited significant results; gender, GI endoscopy <24 h, H. pylori infection. H. pylori-positive patients exhibited the same NSAIDs intake level between both groups, SED group; 9 NSAIDs intake (41%) versus 13 without NSAIDs intake (59%), n.s. and MED group; 5 NSAID intake (26%) versus 14 without NSAID intake (74%), n.s.

CONCLUSION

In children presenting with UGIB, gut mucosal damage severity is significantly correlated to NSAIDs level intake especially in children younger than 24 months. The presence of H. pylori infection in children receiving NSAID seems not to increase gut mucosal injury severity.

An African perspective on Helicobacter pylori: prevalence of human infection, drug resistance, and alternative approaches to treatment

Helicobacter pylori is a Gram-negative, micro-aerophilic, motile, curved rod that inhabits the gastric mucosa of the human stomach. It chronically infects thousands of millions of people world-wide, and is one of the most genetically diverse of bacterial species. Infection with the bacterium leads to chronic gastritis, peptic ulceration, gastric cancers and gastric mucosa-associated lymphoid-tissue (MALT) lymphoma. The prevalence of infection appears to be partly determined by geographical and socio-demographic factors, being higher in Africa than elsewhere. Current treatment, based on potent combinations that each consist of a proton-pump inhibitor and two antibiotics, is successful in 80%-90% of patients. Some undesirable side-effects, poor patient compliance and drug resistance are, however, associated with significant levels of treatment failure and with contra-indications for some patients. Antibiotic resistance in H. pylori is a growing global concern that merits the urgent attention of public-health authorities. Numerous pieces of clinical evidence have revealed that eradication of the organism from a patient results in improvement of gastritis and drastically decreases the frequency of relapse of gastric and duodenal ulcers. Natural products, including medicinal plants and honey, may offer useful alternatives in the treatment of H. pylori-related infections.

Seroprevalence of Helicobacter pylori among Tunisian blood donors (outpatients), symptomatic patients and control subjects

OBJECTIVES

Helicobacter pylori is a worldwide infection, although little data are available in the Tunisian population. The aims of our study were to detect the prevalence of H. pylori in a blood-donor population (n=250) and in another population of hospital-consulting patients comprising 87 symptomatic patients and 59 controls, and to determine the factors that influence the prevalence.

MATERIALS AND METHODS

Study subjects answered a standardized questionnaire, and IgG anti-H. pylori and anti-cag were detected by ELISA. In the second population, culture and cagA polymerase chain reaction were performed.

RESULTS

The seroprevalence of H. pylori in blood donors was 64%, and 11% had anti-cag. All patients positive for anti-cag were also positive for anti-H. pylori antibodies. The seroprevalence of H. pylori was 99.3% in the hospital-consulting patients, of whom 55.5% were positive for anti-cag. The difference between the anti-cag and symptomatic patients (66.7%) and controls (39%) was significant. Symptomatic patients had a higher rate of anti-cag (66.7%) compared with the controls (39%) and blood donors (11%).

CONCLUSION

H. pylori seroprevalence in blood donors is low (64%) compared with symptomatic patients (99.3%), and anti-cag was statistically associated with symptomatic patients and pathology. Also, some environmental factors were correlated with H. pylori seroprevalence.

Long-term follow up of Helicobacter pylori IgG serology after eradication and reinfection rate of H. pylori in South Korea

BACKGROUND

Serology is widely used for epidemiologic research of Helicobacter pylori. However, there is limited information on the long-term follow up of H. pylori titers after eradication. In addition, it is presumed that the reinfection rate decreases as the H. pylori infection rate decreases. The aim of this study was to investigate the long-term follow up of H. pylori IgG, and to evaluate the reinfection rate of H. pylori in Korea.

METHODS

Among 247 patients, who were enrolled during 2003-07, 185 patients with invasive H. pylori test positive received proton pump inhibitor-based triple therapy, and follow-up H. pylori testing, including histology, CLOtest, culture, and serology, were evaluated 2, 10, and 18 months after H. pylori eradication.

RESULTS

The initial H. pylori IgG optical density (OD(450 nm)), 2.06, gradually decreased to 0.63 (67% reduction) at 18 months after H. pylori eradication. The seroreversion rate was 5, 10, and 45% at 2, 10, and 18 months after H. pylori eradication, respectively. The recrudescence of H. pylori was 3.49%, and the annual reinfection rate was 2.94% per year. H. pylori IgG titers abruptly increased in cases with recrudescence and reinfection, and correlated with the results of the invasive H. pylori tests.

CONCLUSION

The results of this study showed that H. pylori IgG serology could be used for the determination of reinfection of H. pylori, but not for the diagnosis of H. pylori eradication. The reinfection rate of H. pylori, in Korea, was found to be very low, 2.94% per year.

Prevalence and risk factors of Helicobacter pylori infection in healthy schoolchildren

OBJECTIVE

Data regarding the prevalence of Helicobacter pylori infection and its potential risk factors among schoolchildren from the Middle East is scarce.

METHODS

An enzyme-linked immunosorbent assay was used to investigate H. pylori status in four groups of children: The first and second groups, 50 children each (25 boys, 25 girls) included children from high socioeconomic class (group 1 = 6 years old; group 2 = 9 years old). The third and fourth groups were sex- and age-matched, but from low socioeconomic class. To evaluate the association between the seroprevalence of H. pylori and selected risk factors, odds ratios (crude and adjusted) were calculated using multiple regression analysis.

RESULTS

Overall seroprevalence rate was 55.5%. Seropositivity was 42%, 52%, 60%, and 68% for groups 1, 2, 3, and 4, respectively. Age and sex were not significantly associated with H. pylori seropositivity. In the final logistic regression model, which was adjusted for age and sex, the following risk factors were found to be significantly associated with seropositivity: living in rural areas (P = 0.015), poor sanitation (P < 0.001), overcrowding (P = 0.014), low maternal educational level (P = 0.010) and low socioeconomic status (P = 0.011).

CONCLUSIONS

The prevalence of H. pylori infection in Jordanian schoolchildren is high, suggesting that most acquisition occurs before the age of 6 years. The seroprevalence for H. pylori increases with social deprivation.

Helicobacter pylori colonization in infants in a peri-urban community in Karachi, Pakistan

BACKGROUND

The prevalence and incidence of Helicobacter pylori in children in Pakistan is not known.

OBJECTIVES

To measure the prevalence and age of acquisition of Helicobacter pylori infection/colonization in infants in a peri-urban community in Karachi, Pakistan.

SETTING

Field based epidemiologic study in a peri-urban community in Karachi, Pakistan.

METHODS

Infants aged 1 to 3 months were recruited from a birth cohort from the community. C-urea breath test (C-UBT) was performed on recruitment, and the test was repeated at 2, 3, 6, and 9 months of age.

RESULTS

One hundred forty-eight infants were recruited and had C-UBT on 319 occasions over a period of 2 years. Two hundred thirty-one=(72%) tests were positive: 80% (49/61) infants at 1 month of age, 79% (33/42) at 2 month of age, 76% (92/121) at 3 month of age, 58% (37/64) at 6 months of age, and 67% (20/30) at 9 months of age.

CONCLUSIONS

The study reveals an early colonization/infection of infants and a high prevalence of Helicobacter pylori in a peri-urban community in Karachi, Pakistan.

Epidemiology of Helicobacter pylori infection

This review summarizes key results of epidemiologic studies published in peer-reviewed journals between April 2003 and March 2004. The prevalence of H. pylori infection continues to vary strongly between developing countries and developed countries, and according to ethnicity, place of birth and socioeconomic factors among people living in the same country. Intrafamilial spread appears to play a central role in transmission of the infection in both developing and developed countries. The role of H. pylori infection in development of noncardia gastric cancer appears to be even much stronger than previously assumed, whereas the lack of an association with cardia cancer and an inverse association with adenocarcinoma of the esophagus could be confirmed. Suggestions for an inverse association of the infection with atopic diseases have recently received further support, whereas evidence concerning the role of the infection (or its eradication) in GERD and a large variety of other extragastric diseases, including cardiovascular disease, remains inconclusive.