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Alfau M, Delgado A, Reyes C, Durán D, Arbaje D, García A. Accuracy of Stool Antigen Test in the Diagnosis of Helicobacter pylori Infection in the Dominican Republic. Cureus 2023; 15:e44290. [PMID: 37779804 PMCID: PMC10533417 DOI: 10.7759/cureus.44290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Helicobacter pylori is a well-studied infectious agent due to its pathogenic potential for peptic ulcers and gastric cancer. It has a high prevalence worldwide and has several diagnostic methods, both invasive and non-invasive. It is important to address the diagnostic efficacy of these tests, as the data vary by location and the specific population in which they are used. Therefore, an effective testing method should be obtained, evaluating the possibility of substantially reducing invasive procedures and, therefore, associated costs. OBJECTIVE This study proposes to define the diagnostic accuracy of the stool antigen test for H. pylori infection in the Dominican Republic. METHODS An observational, retrospective, and cross-sectional study was conducted. The results of the stool antigen test for H. pylori infection were compared with the results of the gastric biopsy, as a gold standard test. Patients over 18 years of age with an indication for endoscopy due to suspicion of H. pylori infection, who attended the gastroenterology clinic in 2021, were included in the study. RESULTS It was shown that the stool antigen test for H. pylori infection has a 61.54% sensitivity and 59.65% specificity. According to the study population, the positive predictive value (PPV) was 67.60% and the negative predictive value (NPV) was 53.13%. CONCLUSION Low numbers of both sensitivity and specificity were determined, which is why it is pertinent to study alternative non-invasive methods. However, it is important to assess the antibiotic exposure of the study population, since the diagnostic accuracy of the stool test can be influenced by this factor.
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Affiliation(s)
- Miguel Alfau
- Gastroenterology and Hepatology, Instituto Materno Infantil y Especialidades, Santiago, DOM
| | - Annerys Delgado
- Pathology, Instituto Materno Infantil y Especialidades, Santiago, DOM
| | - Cinthia Reyes
- School of Medicine, Pontificia Universidad Católica Madre y Maestra, Santiago, DOM
| | - Diana Durán
- School of Medicine, Pontificia Universidad Católica Madre y Maestra, Santiago, DOM
| | - Diego Arbaje
- School of Medicine, Pontificia Universidad Católica Madre y Maestra, Santiago, DOM
| | - Annette García
- School of Medicine, Pontificia Universidad Católica Madre y Maestra, Santiago, DOM
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Shah S, Cappell K, Sedgley R, Pelletier C, Jacob R, Bonafede M, Yadlapati R. Healthcare costs among patients with newly diagnosed helicobacter pylori infection in the United States: a linked claims-EHR study. J Med Econ 2023; 26:1227-1236. [PMID: 37748019 DOI: 10.1080/13696998.2023.2263252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
AIMS The study objectives were to 1) characterize the cost drivers of patients with Helicobacter pylori (HP) and 2) estimate HP-related cost savings following lab-confirmed HP eradication with US guideline-recommended treatment compared to failed eradication. METHODS We identified adults newly diagnosed with HP between 1/1/2016-12/31/2019 in the Veradigm Electronic Health Record Database linked to claims data (earliest HP diagnosis = index date). For the overall costs analysis, we required patients to have data available for ≥12 months before and after the index date. Then, we used multivariable modeling to assess the marginal effects of comorbidities on all cause-healthcare costs in the 12 months following HP diagnosis. For the eradication savings analysis, we identified patients with ≥1 HP eradication regimen, a subsequent HP lab test result, and ≥1 year of data after the test result. Then we used multivariable modeling to estimate HP-related cost while adjusting for eradication status, demographics, post-testing HP-related clinical variables, and the interactions between eradication status and each HP-related clinical variable. RESULTS The overall cost analysis included 60,593 patients with HP (mean age 54.2 years, 65.5% female). Mean (SD) 12-month unadjusted all-cause costs were $23,693 ($78,089). Rare comorbidities demonstrated the highest marginal effect. The marginal effects of gastric cancer and PUD were $15,705 and $7,323, respectively. In the eradication savings analysis, 1,835 (80.0%) of the 2295 patients had lab test-confirmed HP eradication. Compared to failed eradication, there were significant one-year cost savings among patients with successful HP eradication and select conditions: $1,770 for PUD, $518 for atrophic gastritis, $494 for functional dyspepsia, and $352 for gastritis. CONCLUSIONS The healthcare costs of patients with HP are partially confounded by their burden of high-cost comorbidities. In the subset of patients with available results, confirmed vs. failed eradication of HP was associated with short-term cost offsets among those with specific to HP-related sequelae.
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Affiliation(s)
- Shailja Shah
- Division of Gastroenterology, University of California, San Diego, CA, USA
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, CA, USA
| | | | | | | | - Rinu Jacob
- Medical Affairs, Phathom Pharmaceuticals, NJ, USA
| | | | - Rena Yadlapati
- Division of Gastroenterology, University of California, San Diego, CA, USA
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3
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Kismat S, Tanni NN, Akhtar R, Roy CK, Rahman MM, Molla MMA, Anwar S, Ahmed S. Diagnosis and Comparison of Three Invasive Detection Methods for Helicobacter pylori Infection. Microbiol Insights 2022; 15:11786361221133947. [PMID: 36325107 PMCID: PMC9619850 DOI: 10.1177/11786361221133947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare different invasive methods for Helicobacter pylori (H. pylori) detection, namely PCR for H. pylori specific ureC gene, Rapid urease test (RUT), and histopathological examination by modified Giemsa staining. METHODOLOGY Endoscopic gastroduodenal biopsy materials were collected from dyspeptic patients who underwent endoscopic examination upon fulfilling the inclusion criteria. Three to four samples were collected from each patient after taking informed consent and proper clinical history. A rapid urease test (RUT) was done on spot with in-house RUT media from 1 specimen. One to two specimens were preserved in 10% formaldehyde for histopathology and PCR for ureC gene was done from 1 specimen. Collected biopsy specimens from gastric and duodenal mucosa of 142 patients were categorized as H. pylori-positive cases and H. pylori-negative cases based on the case definition used in the study upon positivity of 3 diagnostic tests. RESULTS Among 142 biopsy specimens, 34.5% were categorized as H. pylori-positive cases, 35.2% as H. pylori-negative cases, and finally 30.2% as doubtful or indeterminate cases. Rapid urease test was the most sensitive method, closely followed by ureC gene PCR and histopathology, with a sensitivity of 94.2%, 83.0%, and 76.5%, respectively. Whereas histology was the most specific, having 98.0% specificity followed by 83.0% in PCR. RUT was the least specific, with 55.5% specificity. CONCLUSION While histopathology could detect H. pylori infection with the highest specificity, for definitive diagnosis combination of any 2 methods should be used, if available.
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Affiliation(s)
- Saifa Kismat
- Department of Microbiology and
Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh,Saifa Kismat, Department of Microbiology
and Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
| | - Nusrat Nur Tanni
- Department of Microbiology and
Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Rokshana Akhtar
- Department of Microbiology and
Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Chandan Kumar Roy
- Department of Microbiology and
Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Md. Maruf Ahmed Molla
- Department of Virology, National
Institute of Laboratory Medicine and Referral Center, Dhaka, Bangladesh
| | - Shaheda Anwar
- Department of Microbiology and
Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sharmeen Ahmed
- Department of Microbiology and
Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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4
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Zhou Y, Deng Y, You Y, Li X, Zhang D, Qi H, Shi R, Yao L, Tang Y, Li X, Ma L, Li Y, Liu J, Feng Y, Chen X, Hao Q, Li X, Li Y, Niu M, Gao H, Bai F, Hu S. Prevalence and risk factors of Helicobacter pylori infection in Ningxia, China: comparison of two cross-sectional studies from 2017 and 2022. Am J Transl Res 2022; 14:6647-6658. [PMID: 36247252 PMCID: PMC9556490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Helicobacter pylori (H. pylori) infection causes a variety of intragastric and extragastric diseases. Despite its decreasing global prevalence, it remains a major public health problem in many developing countries. This study aimed to understand the prevalence of H. pylori infection and its risk factors in five cities of the Ningxia Hui Autonomous Region, an area with high incidence of gastric cancer. METHODS Cross-sectional studies were conducted in Ningxia from 2017 and 2022, to detect the prevalence of H. pylori using the 14C urea breath test. All participants completed a questionnaire that included demographics, personal habits, household economic characteristics, and previous health status. Multiple logistic regression analyses were used to identify independent factors for H. pylori infection. RESULTS Our findings demonstrated that the prevalence of H. pylori infection in Ningxia decreased significantly from 60.3% in 2017 to 43.6% in 2022, with an increase in public awareness rate from 35.9% in 2017 to 68.5% in 2022. The lowest infection rate was found in Zhongwei and highest in Guyuan. The prevalence of H. pylori infection was higher among Hui ethnicity, farmers, individuals living in rural areas, individuals with lower income, low education, and those who consumed less fruit. Gallbladder, respiratory, cardiovascular and autoimmune diseases were not associated with H. pylori infection. CONCLUSIONS The prevalence of H. pylori in Ningxia decreased in the past five years. Ethnicity, location, occupation, income, education, and consumption of fruits were independent risk factors for H. pylori infection in Ningxia. It was not associated with extra-gastric disease.
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Affiliation(s)
- Yan Zhou
- Ningxia Medical UniversityYinchuan, China
| | - Yanhong Deng
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Yanjie You
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Xue Li
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Di Zhang
- Department of Gastroenterology, People’s Hospital of JingyuanGuyuan, China
| | - Hailong Qi
- Department of Gastroenterology, Second People’s Hospital of ShizuishanShizuishan, China
| | - Ruichun Shi
- Department of Gastroenterology, People’s Hospital of WuzhongWuzhong, China
| | - Li Yao
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Yuanyuan Tang
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Xiaofei Li
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Linke Ma
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Yanlin Li
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Jun Liu
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Yaning Feng
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Xianmei Chen
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Qian Hao
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Xuemei Li
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Yuzhen Li
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Min Niu
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
| | - Hengjun Gao
- Tongji Hospital, School of Medicine, Tongji UniversityShanghai, China
- Institute of Digestive Disease, School of Medicine, Tongji UniversityShanghai, China
- China Center for Helicobacter Pylori Molecular MedicineShanghai, China
| | - Feihu Bai
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical CollegeHaikou, China
- The Gastroenterology Clinical Medical Center of Hainan ProvinceHaikou, China
| | - Shengjuan Hu
- People’s Hospital of Ningxia Hui Autonomous Region (Ningxia Medical University Affiliated People’s Hospital of Autonomous Region)Yinchuan, China
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Tanni NN, Ahmed S, Anwar S, Kismat S, Halder K, Nesa M, Habib FB. Endoscopic and histopathological findings in adult dyspeptic patients, and their association with Helicobacter pylori infection in Dhaka, Bangladesh. IJID REGIONS 2022; 2:30-34. [PMID: 35757067 PMCID: PMC9216390 DOI: 10.1016/j.ijregi.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of H. pylori in our study was 32.9%. Most of the dyspeptic patients were found to have gastritis endoscopically. The presence of H. pylori infection was found in 55.5% of duodenal ulcer cases.
Objectives Conventional upper-intestinal endoscopy is usually performed to diagnose Helicobacter pylori (H. pylori) associated diseases, using gastric mucosa from the biopsy. The objective of our study was to identify the prevalence of H. pylori and its relation with endoscopic findings and histopathological features in dyspeptic adult patients. Methods Gastroduodenal biopsy specimens were collected from 143 adult dyspeptic outpatients who attended the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH), for endoscopy. H. pylori was identified by rapid urease test (RUT), ureC gene PCR, and histological staining (Giemsa). Results The study population was divided into H. pylori-positive cases (47; 32.9%) and H. pylori-negative cases (96; 67.1%), based on the case definitions used in the study. The highest rate of H. pylori infection was found in the 41–50 years age group (25.5%). Endoscopically, 101 (97.1%) dyspeptic patients had gastritis, with the majority of H. pylori infections found among histopathologically diagnosed duodenal ulcer patients. Endoscopic findings were significantly correlated with histological findings (p < 0.001). Conclusion Significant correlations between endoscopic and histopathological findings were observed. Early detection and prompt treatment of H. pylori infection are essential for the prevention of serious complications.
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Harris RB, Brown HE, Begay RL, Sanderson PR, Chief C, Monroy FP, Oren E. Helicobacter pylori Prevalence and Risk Factors in Three Rural Indigenous Communities of Northern Arizona. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020797. [PMID: 35055622 PMCID: PMC8775467 DOI: 10.3390/ijerph19020797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori (H. pylori) is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about H. pylori prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active H. pylori. Accounting for intrahousehold correlation, H. pylori prevalence was 56.4% (95% CI, 45.4–66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50–53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05–10.07) higher odds than female. The prevalence of H. pylori in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment.
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Affiliation(s)
- Robin B. Harris
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA; (H.E.B.); (R.L.B.)
- Correspondence:
| | - Heidi E. Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA; (H.E.B.); (R.L.B.)
| | - Rachelle L. Begay
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA; (H.E.B.); (R.L.B.)
| | - Priscilla R. Sanderson
- Department of Health Sciences, College of Health and Human Services, Northern Arizona University, SAS (Bldg 60), 1100 S. Beaver St., POB 15095, Flagstaff, AZ 86011, USA;
| | - Carmenlita Chief
- Center for Health Equity Research, College of Health and Human Services, Northern Arizona University, 1395 South Knoles Drive, POB 4065, Flagstaff, AZ 86011, USA;
| | - Fernando P. Monroy
- Department of Biological Sciences, College of the Environment, Forestry and Natural Sciences, Northern Arizona University, 617 S. Beaver St., Flagstaff, AZ 86011, USA;
| | - Eyal Oren
- Division of Epidemiology & Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA;
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Duan F, Song C, Shi J, Wang P, Ye H, Dai L, Zhang J, Wang K. Identification and epidemiological evaluation of gastric cancer risk factors: based on a field synopsis and meta-analysis in Chinese population. Aging (Albany NY) 2021; 13:21451-21469. [PMID: 34491229 PMCID: PMC8457565 DOI: 10.18632/aging.203484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022]
Abstract
To summarize and assess the credibility and strength of non-genetic factors and genetic variation on gastric cancer risk, we performed a field synopsis and meta-analysis to identify the risk of gastric cancer in Chinese population. Cumulative evidence was graded according to the Venice criteria, and attributable risk percentage (ARP) and population attributable risk percentage (PARP) were used to evaluate the epidemiological effect. A total of 956 studies included non-genetic (404 studies) and genetic factors (552 studies) were quantified, and data on 1161 single nucleotide polymorphisms (SNPs) were available. We identified 14 non-genetic factors were significantly associated with gastric cancer risk. For the analysis of time trends, H. pylori infection rate in gastric cancer and population showed a downward trend. Meanwhile 22 variants were identified significantly associated with gastric cancer: 3 (PLCE1 rs2274223, PSCA rs2976392, MUC1 rs4072037) were high and 19 SNPs were intermediate level of summary evidence, respectively. For non-genetic factors, the top three for ARP were 54.75% (pickled food), 65.87% (stomach disease), and 49.75% (smoked and frying). For PARP were 34.22% (pickled food), 34.24% (edible hot food) and 23.66%(H. pylori infection). On the basis of ARP and PARP associated with SNPs of gastric cancer, the top three for ARP were 53.91% (NAT2, rs1799929),53.05% (NAT2 phenotype), and 42.85% (IL-10, rs1800896). For PARP (Chinese Han in Beijing) were 36.96% (VDR, rs731236), 25.58% (TGFBR2, rs3773651) and 20.56% (MUC1, rs4072037). Our study identified non-genetic risk factors and high-quality biomarkers of gastric cancer susceptibility and their contribution to gastric cancer.
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Affiliation(s)
- Fujiao Duan
- College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, Henan Province, China.,Medical Research Office, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Chunhua Song
- College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, Henan Province, China
| | - Jiachen Shi
- Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University,Zhengzhou, Henan Province, China
| | - Peng Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, Henan Province, China
| | - Hua Ye
- College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, Henan Province, China
| | - Liping Dai
- College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, Henan Province, China
| | - Jianying Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, Henan Province, China
| | - Kaijuan Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China.,Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, Henan Province, China
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8
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Evaluation of management of patients who apply to emergency service with dyspeptic complaints. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.913357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dugan K, Ablah E, Okut H, Srinivasan S, Salyers W. Guideline Adherence in Dyspepsia Investigation and Treatment. Kans J Med 2020; 13:306-310. [PMID: 33343824 PMCID: PMC7735428 DOI: 10.17161/kjm.vol13.13838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction The impact of dyspepsia guidelines on clinical practice may be poor. Provider adherence with dyspepsia guidelines was examined to determine their impact on clinical practice. Methods Provider adherence with the 2005 American College of Gastroenterology Guidelines for the Management of Dyspepsia and the 2017 American College of Gastroenterology and Canadian Association of Gastroenterology joint Dyspepsia Management Guidelines was assessed on a national level using data from the National Ambulatory Medical Care Survey (NAMCS). Patient visit data, including reason for visit of dyspepsia, diagnosis of dyspepsia, or diagnosis of H. pylori infection from NAMCS years 2012 through 2015, were used. Provider adherence with dyspepsia management guidelines was determined based upon provision of at least one recommended test or treatment for dyspepsia. Results Providers appeared to adhere to the 2005 ACG guidelines for 49.7% of patient visits. Providers appeared to adhere to the 2017 ACG/CAG guidelines for 51.0% of patient visits. Conclusion Provider adherence with the 2005 ACG and the 2017 ACG/CAG Dyspepsia Management Guidelines was determined to be low in this study, highlighting the need to increase evidence-based medical treatment and efficient resource use for dyspepsia.
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Affiliation(s)
- Katelyn Dugan
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS.,Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Sachin Srinivasan
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - William Salyers
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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Azadbakht S, Azadbakht S, Esmaili A, Rahmani P. Comparison of clinical symptoms after Helicobacter pylori eradication in functional dyspepsia patients based on endoscopic view of antral gastropathy. New Microbes New Infect 2020; 38:100806. [PMID: 33365132 PMCID: PMC7749399 DOI: 10.1016/j.nmni.2020.100806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Functional dyspepsia is a common gastric disease that can be associated with Helicobacter pylori infection. The aim of this study is to evaluate antral endoscopy of individuals who presented with functional dyspepsia, H. pylori infection status and the effects of eradication therapy on the symptoms. Following the diagnosis of dyspepsia as per Rome III criteria, 260 individuals who were eligible for the study underwent upper gastrointestinal endoscopy and were divided into four groups of 65 according to the endoscopic view, grades I, II, III and IV (negative). Stool antigen test was also performed for all patients to identify H. pylori infection. The early signs of dyspepsia were assessed by a standard questionnaire. In all groups, omeprazole, amoxicillin, clarithromycin and metronidazole were used for eradication treatment, and 1 month after the treatment, a faecal antigen test was repeated to evaluate the eradication of H. pylori. There was no statistically significant difference between the groups in terms of clinical symptoms before treatment. The highest response to eradication treatment was seen in individuals with antral gastropathy grade III (66.2%) and the lowest response was in patients without antral gastropathy Grade IV (32.3%). This difference was statistically significant. There was no statistically significant relationship between the participants in terms of family history, age, gender and response to treatment. Eradicating H. pylori reduces the symptoms of dyspepsia. The response of eradication therapy was greatest among the patients with grade III antral gastropathy.
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Affiliation(s)
- S. Azadbakht
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - S. Azadbakht
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - A. Esmaili
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - P. Rahmani
- Paediatric Gastroenterology and Hepatology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Bielefeldt K. Time Trends in Healthcare Utilization Due to Self-Reported Functional Diseases of the Stomach. Dig Dis Sci 2020; 65:2824-2833. [PMID: 32088796 DOI: 10.1007/s10620-020-06154-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cohort studies from referral centers suggest an increasing burden of functional gastric disorders, with frequent emergency room (ER) visits, hospitalizations, or absenteeism. We hypothesized that recruitment from tertiary care sites skews results and thus investigated the burden of these illnesses, using the population-based data of the Medical Expenditure Panel Survey (MEPS). METHODS Using MEPS data for the years 2000-2015, demographic, economic, healthcare-related, and quality-of-life indicators were extracted for adults reporting the diagnosis of functional gastric diseases to assess trends and to compare results with data from all adults surveyed. RESULTS Between 2000 and 2015, 2.7 ± 0.2% of the adults surveyed reported a functional gastric illness. Within the period studied, 28.8 ± 2.8% and 17.9 ± 1.6% of this cohort reported ER visits or hospitalizations, respectively. Only a fraction of these persons attributed the ER visits (22.6 ± 0.9%) or admissions (10.9 ± 0.8%) to the functional gastric disorder. Rates remained stable rates during the period studied. Female sex, measures of physical function, comorbidities, and an income below the poverty line were predictors of healthcare utilization. While utilization was stable over time, annual costs increased by 113.9 ± 16.6% during the study period, outpacing the inflation rate of 37.6%. CONCLUSIONS Persons with functional gastric disorders have significant healthcare needs and face increasing costs of care, largely due to coexisting illnesses. While it is important to recognize this impact, the need for emergency care or hospitalizations remained stable and lower than reported for patients seen in tertiary referral centers, providing reassuring information for patients and providers.
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Affiliation(s)
- Klaus Bielefeldt
- Section of Gastroenterology, George E. Wahlen VA Medical Center, 500 Foothill Dr, Salt Lake City, UT, 84148, USA. .,University of Utah, Salt Lake City, USA.
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Parkman HP, Yamada G, Van Natta ML, Yates K, Hasler WL, Sarosiek I, Grover M, Schey R, Abell TL, Koch KL, Kuo B, Clarke J, Farrugia G, Nguyen L, Snape WJ, Miriel L, Tonascia J, Hamilton F, Pasricha PJ, McCallum RW. Ethnic, Racial, and Sex Differences in Etiology, Symptoms, Treatment, and Symptom Outcomes of Patients With Gastroparesis. Clin Gastroenterol Hepatol 2019; 17:1489-1499.e8. [PMID: 30404035 PMCID: PMC6500483 DOI: 10.1016/j.cgh.2018.10.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Gastroparesis is a chronic disorder of the stomach characterized by nausea, vomiting, early satiety, postprandial fullness, and abdominal pain. There is limited information on gastroparesis in minority populations. We assessed ethnic, racial, and sex variations in the etiology, symptoms, quality of life, gastric emptying, treatments, and symptom outcomes of patients with gastroparesis. METHODS We collected information from the National Institutes of Health Gastroparesis Consortium on 718 adult patients, from September 2007 through December 2017. Patients were followed every 4 or 6 months, when data were collected on medical histories, symptoms (based on answers to the PAGI-SYM questionnaires), and quality of life (based on SF-36). Follow-up information collected at 1 year (48 week) was used in this analysis. Comparisons were made between patients of self-reported non-Hispanic white, non-Hispanic black, and Hispanic ethnicities, as well as and between male and female patients. RESULTS Our final analysis included 552 non-Hispanic whites (77%), 83 persons of Hispanic ethnicity (12%), 62 non-Hispanic blacks (9%), 603 women (84%), and 115 men (16%). A significantly higher proportion of non-Hispanic blacks (60%) had gastroparesis of diabetic etiology than of non-Hispanic whites (28%); non-Hispanic blacks also had more severe retching (2.5 vs 1.7 score) and vomiting (2.9 vs 1.8 score) and a higher percentage were hospitalized in the past year (66% vs 38%). A significantly higher proportion of Hispanics had gastroparesis of diabetic etiology (59%) than non-Hispanic whites (28%), but Hispanics had less-severe nausea (2.7 vs 3.3 score), less early satiety (3.0 vs 3.5 score), and a lower proportion used domperidone (8% vs 21%) or had a peripherally inserted central catheter (1% vs 7%). A higher proportion of women had gastroparesis of idiopathic etiology (69%) than men (46%); women had more severe symptoms of stomach fullness (3.6 vs 3.1 score), early satiety (3.5 vs 2.9 score), postprandial fullness (3.7 vs 3.1 score), bloating (3.3 vs 2.6 score), stomach visibly larger (3.0 vs 2.1 score), and upper abdominal pain (2.9 vs 2.4 score). A lower proportion of women were hospitalized in past year (39% vs 53% of men). CONCLUSIONS In patients with gastroparesis, etiologies, symptom severity, and treatments vary among races and ethnicities and between sexes. ClinicalTrials.gov Identifier: NCT01696747.
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Affiliation(s)
- Henry P Parkman
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania.
| | - Goro Yamada
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Mark L Van Natta
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Katherine Yates
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - William L Hasler
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Irene Sarosiek
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Madhusudan Grover
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Ron Schey
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Thomas L Abell
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Kenneth L Koch
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Braden Kuo
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - John Clarke
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Gianrico Farrugia
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Linda Nguyen
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - William J Snape
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Laura Miriel
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - James Tonascia
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Frank Hamilton
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Pankaj J Pasricha
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Richard W McCallum
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
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Van Oudenhove L, Jasper F, Walentynowicz M, Witthöft M, Van den Bergh O, Tack J. The latent structure of the functional dyspepsia symptom complex: a taxometric analysis. Neurogastroenterol Motil 2016; 28:985-93. [PMID: 27339217 DOI: 10.1111/nmo.12798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/21/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Rome III introduced a subdivision of functional dyspepsia (FD) into postprandial distress syndrome and epigastric pain syndrome, characterized by early satiation/postprandial fullness, and epigastric pain/burning, respectively. However, evidence on their degree of overlap is mixed. We aimed to investigate the latent structure of FD to test whether distinguishable symptom-based subgroups exist. METHODS Consecutive tertiary care Rome II FD patients completed the dyspepsia symptom severity scale. Confirmatory factor analysis (CFA) was used to compare the fit of a single factor model, a correlated three-factor model based on Rome III subgroups and a bifactor model consisting of a general FD factor and orthogonal subgroup factors. Taxometric analyses were subsequently used to investigate the latent structure of FD. KEY RESULTS Nine hundred and fifty-seven FD patients (71.1% women, age 41 ± 14.8) participated. In CFA, the bifactor model yielded a significantly better fit than the two other models (χ² difference tests both p < 0.001). All symptoms had significant loadings on both the general and the subgroup-specific factors (all p < 0.05). Somatization was associated with the general (r = 0.72, p < 0.01), but not the subgroup-specific factors (all r < 0.13, p > 0.05). Taxometric analyses supported a dimensional structure of FD (all CCFI<0.38). CONCLUSIONS AND INFERENCES We found a dimensional rather than categorical latent structure of the FD symptom complex in tertiary care. A combination of a general dyspepsia symptom reporting factor, which was associated with somatization, and symptom-specific factors reflecting the Rome III subdivision fitted the data best. This has implications for classification, pathophysiology, and treatment of FD.
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Affiliation(s)
- L Van Oudenhove
- Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - F Jasper
- Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg University, Mainz, Germany
| | | | - M Witthöft
- Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg University, Mainz, Germany
| | | | - J Tack
- Department of Clinical and Experimental Medicine, Translational Research Centre for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
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Honarmand-Jahromy S, Siavoshi F, Malekzadeh R, Sattari TN, Latifi-Navid S. Multiple repeats of Helicobacter pylori CagA EPIYA-C phosphorylation sites predict risk of gastric ulcer in Iran. Microb Pathog 2015; 89:87-92. [DOI: 10.1016/j.micpath.2015.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022]
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Honarmand-Jahromy S, Siavoshi F, Malekzadeh R, Nejad Sattari T, Latifi-Navid S. Reciprocal impact of host factors and Helicobacter pylori genotypes on gastric diseases. World J Gastroenterol 2015; 21:9317-9327. [PMID: 26309357 PMCID: PMC4541383 DOI: 10.3748/wjg.v21.i31.9317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/22/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the impact of Helicobacter pylori (H. pylori) genotypes and patient age and sex on the development of gastric diseases.
METHODS: H. pylori-infected patients (n = 233) referred to the endoscopy unit at Tehran University of Medical Sciences (Tehran, Iran) were diagnosed with chronic gastritis (CG), gastric ulcer (GU), or duodenal ulcer (DU). Brucella blood agar was used for biopsy cultures and H. pylori isolation under microaerobic conditions. H. pylori isolates were confirmed with biochemical tests and through amplification of the 16S rRNA gene. DNA was extracted from fresh cultures of the H. pylori isolates and used for amplification of vacA alleles and the cagA gene. Statistical analysis was performed to determine the association between H. pylori genotypes, age (< 40 years vs > 40 years) and sex of the patient, and gastric diseases.
RESULTS: CG was the most prevalent gastric disease (113/233; 48.5%), compared to GU (64/233; 27.5%) and DU (56/233; 24%). More patients were male, and gastric diseases were more frequent in patients > 40 years (P < 0.05). The percentage of CG and GU patients that were male and female did not show a significant difference; however DU was more common in males (P < 0.05). Interestingly, a diagnosis of CG in patients > 40 years was more common in females (18.5%) than males (11.6%) (P = 0.05), whereas a diagnosis of GU or DU in patients > 40 years was more frequent in males (14.6% vs 10.7% and 12.4% vs 4.3%, respectively). Overall, genotyping of the H. pylori isolates revealed that the vacA s1 (82%), vacA m2 (70%), and cagA+ (72.5%) alleles were more frequent than vacA s2 (18%), vacA m1 (29.2%), and cagA- (all P < 0.05). The vacA s1m2cagA+ genotype was the most prevalent within the three disease groups. vacA s1m2 frequency was 56.2% with a similar occurrence in all diagnoses, while vacA s1m1 appeared more often in DU patients (33.9%). A genotype of vacA s2m2 occurred in 15% of isolates and was more common in CG patients (21.2%); vacA s2m1 was the least common genotype (3%). The vacA s1 allele was found to be a risk factor for DU, vacA s2 for CG, and vacA s1 and vacA s2 for GU (all P < 0.05). The vacA s2m2 genotype was associated with the development of CG and GU compared to DU (P < 0.05). No correlation was found between vacA m or cagA and gastric diseases.
CONCLUSION: The outcome of H. pylori infection is the result of interaction between bacterial genotypes and the age and sex of infected individuals.
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Elhanafi S, Saadi M, Lou W, Mallawaarachchi I, Dwivedi A, Zuckerman M, Othman MO. Gastric polyps: Association with Helicobacter pylori status and the pathology of the surrounding mucosa, a cross sectional study. World J Gastrointest Endosc 2015; 7:995-1002. [PMID: 26265993 PMCID: PMC4530333 DOI: 10.4253/wjge.v7.i10.995] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/22/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the endoscopic characteristics of gastric polyps and their association with Helicobacter pylori (H. pylori) status in a predominantly Hispanic population.
METHODS: We conducted a retrospective study of all esophagogastroduodenoscopies performed at our institution. Demographic, endoscopic and histopathological data were reviewed. Categorization of patients into Hispanic and Non-Hispanic was based on self-identification. Patients without resection/biopsy were not included in the analysis. Identification of polyps type was based on histological examination. One way analysis of variance was used to compare continuous variables among different polyp types and Fisher’s exact test was used compare categorical variables among polyp types. Unadjusted and adjusted comparisons of demographic and clinical characteristics were performed according to the H. pylori status and polyp type using logistic regressions.
RESULTS: Of 7090 patients who had upper endoscopy, 335 patients had gastric polyps (4.7%). Resection or biopsy of gastric polyps was performed in 296 patients (88.4%) with a total of 442 polyps removed or biopsied. Of 296 patients, 87 (29%) had hyperplastic polyps, 82 (28%) had fundic gland polyps and 5 (1.7%) had adenomatous polyps. Hyperplastic polyps were significantly associated with positive H. pylori status compared with fundic gland polyps (OR = 4.621; 95%CI: 1.92-11.13, P = 0.001). Hyperplastic polyps were also found to be significantly associated with portal hypertensive gastropathy compared with fundic gland polyps (OR = 6.903; 95%CI: 1.41-33.93, P = 0.0174). Out of 296 patients, 30 (10.1%) had a follow-up endoscopy with a mean duration of 26 ± 16.3 mo. Interval development of cancer was not noted in any of the patients during follow up period.
CONCLUSION: Gastric hyperplastic polyps were significantly associated with positive H. pylori status and portal hypertensive gastropathy as compared with fundic gland polyps.
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Niknam R, Seddigh M, Fattahi MR, Dehghanian A, Mahmoudi L. Prevalence of Helicobacter pylori in Patients With Dyspepsia. Jundishapur J Microbiol 2014; 7:e12676. [PMID: 25632327 PMCID: PMC4295317 DOI: 10.5812/jjm.12676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 02/19/2014] [Accepted: 03/09/2014] [Indexed: 01/26/2023] Open
Abstract
Background: The prevalence rate of gastric infections caused by Helicobacter pylori is different in between as well as within various countries, including Iran. Objectives: This study was aimed to evaluate the prevalence of H. pylori in Iranian adult patients with dyspepsia. Patients and Methods: A total of 548 patients with dyspepsia referred to Namazi Hospital, a referral center for gastrointestinal diseases in Shiraz, south of Iran, were evaluated in a cross-sectional study. The diagnosis of dyspepsia was based on clinical findings. Upper gastrointestinal endoscopy was performed for all the patients and two antral biopsies were taken from all the included ones. The patients were categorized based on the endoscopic findings, to four groups: Two positive test results (Gram staining, rapid urease test, and culture) was considered as a positive-definite H. pylori infection for each patient. Results: From the 548 included patients (238 males and 310 females), H. pylori was detected in 170 (31.2%). The mean age was 40.38 ± 15.39 years old. H. pylori infection was detected in 26.1% of male and 34.8% of female patients and its prevalence increased with age. Eighty three (48.8%) patients were positive for H. pylori infection, of which, 12.4% had normal and 36.4% had abnormal nonulcerative endoscopic findings; 17.1% of patients were ulcerative and 34.1% had ulcer with or without concurrent abnormality. Conclusions: Findings from this study showed a lower prevalence of H. pylori infection than other studies and its prevalence increased with age. There was no association between sex and infection. The most common endoscopic abnormality in H. pylori-positive patients was ulcerative lesion.
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Affiliation(s)
- Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mehrdad Seddigh
- Pharmaceutical Science Research Center (PSRC), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Amirreza Dehghanian
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Laleh Mahmoudi
- Pharmaceutical Science Research Center (PSRC), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Laleh Mahmoudi, Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7112424128, Fax: +98-7112424126, E-mail:
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Siao D, Somsouk M. Helicobacter pylori: evidence-based review with a focus on immigrant populations. J Gen Intern Med 2014; 29:520-8. [PMID: 24065381 PMCID: PMC3930769 DOI: 10.1007/s11606-013-2630-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/26/2013] [Accepted: 09/09/2013] [Indexed: 12/24/2022]
Abstract
Helicobacter pylori has been causally linked to a number of diseases, including peptic ulcer disease, gastric adenocarcinoma, mucosa-associated lymphoid tissue lymphoma, and dyspepsia. It is the most prevalent bacterial pathogen in humans, and while the overall prevalence in the United States is about 30 %, the distribution is heterogeneous amongst different ethnic groups. Recent immigrants from high prevalence areas such as Korea, Japan, and China bear an increased burden of its disease and complications. There is clear evidence that treatment of H. pylori resolves peptic ulcer disease, and increasing evidence for protection against development of gastric adenocarcinoma. However, H. pylori treatment failure is common and alternative regimens may be necessary. The following case-based review will highlight these issues, including the epidemiology of H. pylori in the immigrant population, an approach to dyspepsia, and the role of H. pylori in gastric adenocarcinoma.
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Affiliation(s)
- Derrick Siao
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, 513 Parnassus Ave., Rm-357, San Francisco, CA, 94143, USA,
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Mapel DW. Functional disorders of the gastrointestinal tract: Cost effectiveness review. Best Pract Res Clin Gastroenterol 2013; 27:913-31. [PMID: 24182611 DOI: 10.1016/j.bpg.2013.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The project aim was to review current cost-effectiveness research for each functional gastrointestinal disorder, as defined by the Rome III classification system. METHODS Biomedical databases were searched for articles with the functional gastrointestinal disorders and their pseudonyms included in the title, abstract, or medical subject headings, plus the terms benefit, cost, effectiveness, outcomes, test, utility, or utilization in any search field. RESULTS Highly prevalent conditions such as dyspepsia and irritable bowel syndrome have advanced cost-effectiveness analyses including cost-utility studies that have helped support current management guidelines. The rarer functional gastrointestinal disorders have few or no published cost-effectiveness analyses, but the Rome III classification system provides a framework for identifying the specific cost data or outcomes measures available or needed for future research. CONCLUSIONS The Rome process has provided a useful system for defining the functional gastrointestinal disorders and identifying specific clinical questions to be examined using cost-effectiveness analysis techniques.
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Affiliation(s)
- Douglas W Mapel
- Health Services Research Division, Lovelace Clinic Foundation, 2309 Renard Place SE, Suite 103, Albuquerque, NM 87106-4264, United States.
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Neumann WL, Coss E, Rugge M, Genta RM. Autoimmune atrophic gastritis--pathogenesis, pathology and management. Nat Rev Gastroenterol Hepatol 2013; 10:529-41. [PMID: 23774773 DOI: 10.1038/nrgastro.2013.101] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Autoimmune gastritis is a chronic progressive inflammatory condition that results in the replacement of the parietal cell mass by atrophic and metaplastic mucosa. A complex interaction of autoantibodies against the parietal cell proton pump and sensitized T cells progressively destroy the parietal cells, inducing hypochlorhydria and then achlorhydria, while autoantibodies against the intrinsic factor impair the absorption of vitamin B₁₂. The resulting cobalamin deficiency manifests with megaloblastic anaemia and neurological and systemic signs and symptoms collectively known as pernicious anaemia. Previously believed to be predominantly a disease of elderly women of Northern European ancestry, autoimmune gastritis has now been recognized in all populations and ethnic groups, but because of the complexity of the diagnosis no reliable prevalence data are available. For similar reasons, as well as the frequent and often unknown overlap with Helicobacter pylori infection, the risk of gastric cancer has not been adequately assessed in these patients. This Review summarizes the epidemiology, pathogenesis and pathological aspects of autoimmune metaplastic atrophic gastritis. We also provide practical advice for the diagnosis and management of patients with this disease.
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Affiliation(s)
- William L Neumann
- Miraca Life Sciences Research Institute, 6655 North MacArthur Boulevard, Irving, TX 75039, USA
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Beydoun MA, Beydoun HA, Shroff MR, Kitner-Triolo MH, Zonderman AB. Helicobacter pylori seropositivity and cognitive performance among US adults: evidence from a large national survey. Psychosom Med 2013; 75:486-96. [PMID: 23697465 PMCID: PMC3679320 DOI: 10.1097/psy.0b013e31829108c3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Helicobacter pylori seropositivity is a potential risk for poor cognition among US adults. METHODS Cross-sectional data from the National Health and Nutrition Examination Survey III, Phase 1 (1988-1991), were used. Measures included age group-specific neuropsychological test batteries and two measures of H. pylori seropositivity (immunoglobulin G [IgG] and IgG CagA) (20-59 years old: n = 2090-2,248; 60-90 years old: n = 2123-2388). We explored sex- and race-specific associations. RESULTS Using multiple ordinary least square and zero-inflated Poisson regression models, we detected a poorer performance among those 60-90 years old with H. pylori IgG+ versus IgG- on a verbal memory test (story recall, correct items), overall (β = -0.04 [0.01], p = .010). Non-Hispanic (NH) blacks and women (20-59 years old) performed worse on the serial digits learning total errors (SDL-TE) when H. pylori IgG+ (versus IgG-), another verbal memory test (β = +0.94 [0.40; p = .029] and β = +1.19 [0.44; p = .012], respectively; p<.10 for interaction by sex and race). More trials to completion on this test (SDL-TTC) were also required among H. pylori IgG+ overall (20-59 years old; β = +0.30 [0.13], p = .033). Other race-specific associations without significant interaction by race were detected in the same direction of worse performance with seropositivity in all three major race groups and for both age categories, covering several domains of cognition. CONCLUSIONS H. pylori seropositivity markers were associated with poor cognition among US adults. Longitudinal research is needed to extrapolote those findings to cognitive decline, incident dementia, and Alzheimer's disease.
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Affiliation(s)
- May A Beydoun
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd, Suite 100, Baltimore, MD 21224, USA.
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