The ulcer bug: Gut reaction

Dietary amelioration of Helicobacter infection

We review herein the basis for using dietary components to treat and/or prevent Helicobacter pylori infection, with emphasis on (a) work reported in the last decade, (b) dietary components for which there is mechanism-based plausibility, and (c) components for which clinical results on H pylori amelioration are available. There is evidence that a diet-based treatment may reduce the levels and/or the virulence of H pylori colonization without completely eradicating the organism in treated individuals. This concept was endorsed a decade ago by the participants in a small international consensus conference held in Honolulu, Hawaii, USA, and interest in such a diet-based approach has increased dramatically since then. This approach is attractive in terms of cost, treatment, tolerability, and cultural acceptability. This review, therefore, highlights specific foods, food components, and food products, grouped as follows: bee products (eg, honey and propolis); probiotics; dairy products; vegetables; fruits; oils; essential oils; and herbs, spices, and other plants. A discussion of the small number of clinical studies that are available is supplemented by supportive in vitro and animal studies. This very large body of in vitro and preclinical evidence must now be followed up with rationally designed, unambiguous human trials.

Isolation and characterization of bacteriophages of Helicobacter pylori isolated from Egypt

Aim: The aim of this work was to isolate and characterize bacteriophages from wastewater for the pathogenic bacteria Helicobacter pylori. Materials & methods: In this study, we isolated and characterized two phages against H. pylori isolated from gastric biopsies. The specific phages were isolated by the single plaque isolation technique, propagated by the liquid enrichment method and purified by the polyethylene glycol–dextran sulfate two-phase system. Results: The phages were designated as φHPE1 and φHPE2; φHPE1 had a head with a diameter of approximately 62 nm and short noncontractile tail with a length and width of approximately 12 × 6 nm and φHPE2 had an isometric head with a diameter of approximately 92.5 nm and a tail with a length of approximately 180 nm and width of approximately 15 nm. The host ranges were investigated with four strains of Helicobacter and all strains were susceptible to either φHPE1 or φHPE2. Conclusion: These results suggest that it may be possible to use this phage to control the disease caused by H. pylori.

A study of Helicobacter pylori outer-membrane proteins (hom) A and B in Iraq and Turkey

Helicobacter pylori outer-membrane proteins (hom), especially the homB gene, have been suggested as a novel virulence factor. However, no study has been conducted in Middle Eastern countries regarding the association between these genes and clinical outcome. Gastric biopsies were obtained from 70 and 64 unselected H. pylori+ patients from Iraq and Turkey, respectively. PCR was performed to study the presence of the homA, homB, and cagA. No association was found between homA or homB and clinical outcomes. When Iraqi and Turkish strains were combined as Middle Eastern samples, cagA positivity was significantly higher in patients with peptic ulcer disease (PUD) than those with non-peptic ulcer disease (NPUD) (p=0.003, OR=3.6, CI=1.5-8.8). Two Iraqi strains showed intermediate, non-homA non-homB, length PCR products. The function of such gene is yet to be determined. In conclusion, hom genes might not be a good indicator for disease prediction in the Middle East. More studies are needed to confirm these results and determine the function of intermediate length hom.

Differences in virulence markers between Helicobacter pylori strains from Iraq and those from Iran: potential importance of regional differences in H. pylori-associated disease

Helicobacter pylori causes peptic ulceration and gastric adenocarcinoma; the latter is common in Iran but not in Iraq. We hypothesized that more virulent H. pylori strains may be found in Iran than in Iraq and so compared established and newly described virulence factors in strains from these countries. We studied 59 unselected dyspeptic patients from Iran and 49 from Iraq. cagA was found in similar proportions of strains from both countries (76% in Iran versus 71% in Iraq) and was significantly associated with peptic ulcer disease in Iraq (P <or= 0.01) but not in Iran. cagA alleles encoding four or more tyrosine phosphorylation motifs were found in 12% of the Iranian strains but none of the Iraqi strains (P = 0.02). There were no significant differences in the vacA signal-, middle-, or intermediate-region types between Iranian and Iraqi strains. Among the strains from Iran, vacA genotypes showed no specific peptic ulcer associations, but among the strains from Iraq, vacA i1 strains were associated with gastric ulcer (P <or= 0.02), mimicking their previously demonstrated association with gastric cancer in Iran. dupA was found in similar proportions of Iranian and Iraqi strains (38% and 32%, respectively) and was associated with peptic ulceration in Iraqi patients (P <or= 0.01) but not Iranian patients. H. pylori strains from Iraq and Iran possess virulence factors similar to those in Western countries. The presence of cagA with more phosphorylation motifs in Iranian strains may contribute to the higher incidence of gastric cancer. However, the association between strain virulence markers and disease in Iraq but not Iran suggests that other host and environmental factors may be more important in the disease-prone Iranian population.

Implications of molecular genotyping of Helicobacter pylori isolates from different human populations by genomic fingerprinting of enterobacterial repetitive intergenic consensus regions for strain identification and geographic evolution

Biogeographic partitioning of the genome is typical of the gastric pathogen Helicobacter pylori. Such population-specific evolution could serve as a model for understanding host-pathogen interaction and the impact of genetic drift and recombination on insular populations. With a total of 320 isolates from six geographic regions (Japan, India, England, Spain, Ireland, Africa, and Peru) analyzed by enterobacterial repetitive intergenic consensus (ERIC)-based genotyping, we examined genetic affinities among various H. pylori populations in the world. Several strain-specific and region-specific differences were observed by ERIC-based typing. Polymorphic ERIC patterns indicated that the ERIC sequences are in fact dispersed in the H. pylori chromosome at different locations separated by various distances. Phylogenetic analysis of 61 representative isolates revealed three distinct genetic clusters populated by isolates with shared ERIC types independent of the cag right-junction motif type and vacA allele status. Among the notable genetic relationships were the genotypic similarities between Irish and Japanese and between Peruvian and Japanese isolates. Insular genotypic characteristics of Irish isolates amid genetic similarity to East Asian, as well as North European, strains have been once again proved in this study. Peruvian genotypes were more similar to those of Japanese isolates than to those of Iberian or European isolates. Given the current debate on the origin and age of present-day H. pylori, this is a significant finding that supports the possibility of ancient colonization of Amerindians with East Asian strains. Genotypic data presented here will be additionally helpful in realizing the importance of H. pylori geographical genomics in the development of gastroduodenal pathology.