Dyspepsia is associated with CagA-positive Helicobacter pylori

The association between functional dyspepsia and depression: a meta-analysis of observational studies

Concomitant functional dyspepsia (FD) and psychosocial stressors have been reported; however, the association between FD and depression remains controversial and no quantitative meta-analysis exists. Published articles were identified through a comprehensive review of PubMed, Embase, and Web of Science from inception to the 8 July 2018. The pooled odds ratios (ORs) with 95% confidence intervals and subgroup analyses were calculated using a random-effects model. Findings for a total of 59 029 individuals were pooled across 23 studies and examined. Our analyses showed a positive association between FD and depression, with an OR of 2.28 (95% confidence interval: 2.02-3.81; I=100%). In the subgroup analysis, FD patients in Europe (OR=6.19) were more likely to have depression compared with Asians (OR=2.47); the overall significance results decreased the most in subgroup which the overall significance of the subgroup analyses results decreased the most in studies that adjusted for BMI (OR=1.42). Our meta-analysis showed a positive association between FD and depression. Further large-scale prospective cohort studies are needed to investigate the causality between FD and depression.

Clinical and epidemiological differences in functional dyspepsia between the East and the West

BACKGROUND

Functional dyspepsia (FD) is a common condition, affecting adults in both Western (North America and Europe) and Eastern (Asian) parts of the globe. The prevalence has been reported to range from 5% to 40%, largely due to variation from definition criteria and geographical location. Recent published reports in Western and Eastern populations separately indicate that differences in the epidemiology and clinical patterns of FD may exist. Such differences will have implications for the clinical management of and healthcare strategizing for FD at the local level.

PURPOSE

This review aims to examine the prevalence and clinical patterns of FD in specific groups, namely Western and Eastern populations, based on the Rome criteria. Further differences in the epidemiological associations of FD will be explored between population-based studies in both the East and the West. Finally, the socio-economic consequences of FD, an important measure of the impact of the disease, will be compared between the East and the West.

Evaluation of Helicobacter pylory colonization by serologic test (IgG) and dyspepsia in volunteers from the countryside of Monte Negro, in the Brazilian western Amazon region

The present study intended to analyze the seroprevalence of Helicobacter pylori, IgG, and its relation to dyspepsia in a population from the western Amazon region. During the "Projeto Bandeira Científica", a University of São Paulo Medical School program, in Monte Negro's rural areas, state of Rondônia, 266 blood samples were collected from volunteers. The material was tested for IgG antibodies anti-Helicobacter pylori by ELISA method and the participants were also interviewed on dyspepsia, hygiene and social aspects. Participants aged between five and 81 years old (34 years on average), 149 (56%) were female and 117 (44%) male. We found 210 (78.9%) positive, 50 (18.8%) negative and six (2.3%) undetermined samples. Dyspeptic complaints were found in 226 cases (85.2%). There was no statistical association between dyspepsia and positive serology for H. pylori. We concluded that the seroprevalence in all age categories is similar to results found in other studies conducted in developing countries, including those from Brazil. On the other hand, the seroprevalence found in Monte Negro was higher than that reported in developed countries. As expected, there was a progressive increase in the positivity for H. pylori in older age groups.

Could gastric histology be a useful marker for making decision on Helicobacter pylori eradication therapy in patients with dyspepsia?

CONTEXT: It still remains an open debate whether Helicobacter pylori eradication is beneficial or not for the improvement of symptoms in functional dyspepsia. Differences in geographic distribution, the worldwide H. pylori genetic variability and the fact that the outcome of infection is strongly related to the virulence of the infecting strain are factors that might be driving ongoing controversies. OBJECTIVE: To study the correlation between gastric histology and H. pylori serology status in patients with dyspepsia. METHODS: This is a cross-sectional study where 40 consecutive dyspeptic patients (28 women and 12 men, mean age 48.5 years) with endoscopically normal stomachs were selected from the endoscopy unit at a university hospital in Recife, PE, Northeast of Brazil, between March 1998 and July 1999. Patients underwent gastric mucosal biopsy and serological tests (anti-Hp and anti-CagA antibodies). Gastric biopsies were examined using H-E and Giemsa stains and gastritis was classified and graded (mild, moderate or severe) according to "the updated Sydney System - Houston, 1994". RESULTS: Among 40 patients with dyspepsia the gastric histology revealed that about ¼ had moderate (25%) or severe (2.5%) gastritis. This subgroup of patients also had a greater positive frequency of anti-Hp (100% vs 41%; P = 0.0005) and anti-CagA (91% vs 58%; P = 0.09) antibodies when compared with those with normal histology (27.5%) or mild gastritis (45%). CONCLUSION: Since upper gastrointestinal endoscopy is part of the functional dyspepsia investigation and serology for anti-CagA antibody is not available in daily clinical practice, by biopsying gastric mucosa we would only be able to selectively apply H. pylori eradication therapy for those with histology that best correlate with virulent infecting strains (moderate or severe gastritis) - around ¼ of our study patients with dyspepsia.

Helicobacter pylori and gastroesophageal reflux disease: a case-control study

BACKGROUND

Gastric colonization with Helicobacter pylori is a proposed protective factor against gastroesophageal reflux disease (GERD), but little population-based data exist and other data conflict.

METHODS

We conducted a case-control study within the membership of a large integrated health-care system that compared GERD-free subjects with two groups: subjects with a physician-assigned GERD diagnosis and randomly selected members with self-described weekly GERD symptoms. Subjects completed interviews, GERD questionnaires, and antibody testing for H. pylori and its cagA protein.

RESULTS

Serologic data were available for 301 physician-assigned GERD patients, 81 general membership subjects with GERD symptoms, and 175 general membership subjects without GERD symptoms. Physician-assigned GERD patients were less likely to have H. pylori antibodies than GERD-free member controls (odds ratio (OR) = 0.27, 95% confidence interval (CI) 0.15-0.47); there was also an inverse association between H. pylori and GERD symptom severity (OR = 0.18, 95% CI 0.08-0.41; severe or very severe symptoms) and GERD frequency (OR = 0.18, 95% CI 0.09-0.38; for symptoms at least weekly). The association was stronger among persons with erosive GERD and was similar between H. pylori-positive subjects with and without cagA. There was no association among persons who were cagA positive, but H. pylori negative. Similar findings were found in analyses of the general membership with self-described GERD symptoms.

CONCLUSIONS

H. pylori antibody status was inversely associated with a GERD diagnosis and GERD symptoms compared with a general membership population.

Role of Helicobacter pylori virulence factor and genotypes in non-ulcer dyspepsia

BACKGROUND AND AIM

The role of Helicobacter pylori (HP) in non-ulcer dyspepsia is debatable. Eradicating HP will help a small group of non-ulcer dyspeptic patients. However, it is unclear which subgroup of patients will benefit from eradication therapy. The aim of the present study was to compare the cagA and cagE status, as well as vacA genotypes, of HP in non-ulcer dyspeptic patients who responded successfully to eradication therapy compared with those patients who did not.

METHODS

Consecutive patients with moderate to severe (Likert 2 or 3) non-ulcer dyspepsia with HP were recruited prospectively. Gastric biopsies were taken, DNA extracted and polymerase chain reaction performed to determine the cagA and cagE status and vacA alleles. Eradication therapy was offered until HP was eradicated successfully. The HP status was checked 1 month after eradication therapy using the [(13)C]-urea breath test. All patients were assessed by one interviewer using Gastrointestinal Symptom Rating Scale (GSRS), a four-point Likert scale, and SF-36 for quality of life over 12 months. Treatment success was defined as minimal or no symptoms (Likert 1 or 0). The cagA, cagE and vacA status was blinded to the investigators until completion of the study.

RESULTS

Seventy-three patients (36 males, 37 females) were recruited to the study. The mean+/-SD patient age was 53.38+/-12.09 years. When the 36 patients who improved (group A) were compared with the 37 (group B) who did not, no significant difference was found in the cagE positive rate (55.6 vs 43.2%, respectively; P=0.638), cagA positive rate (83.1 vs 73.0%, respectively; P=0.247), vacA m1 versus m2 subtype (84.0 vs 55.6%, respectively; P=0.472) or vacA s1a versus s1c (39.4 vs 57.1%, respectively; P=0.166). There was also no significant difference noted in the SF-36 scores between the two groups after the conclusion of eradication therapy.

CONCLUSIONS

Stratification of HP genotypes and virulence factor has no significant impact on the treatment success of non-ulcer dyspepsia.

Cytotoxin associated gene A-positive Helicobacter pylori strains in dyspeptic pregnant women

OBJECTIVE

The aim of the present study was to compare the Helicobacter pylori (HP) seropositivity and cytotoxin associated gene A (cagA) status in pregnant women with dyspeptic complaints and pregnant women with no gastrointestinal symptoms.

STUDY DESIGN

Seventy-one consecutive pregnant women with gastrointestinal complaints and 72 age-matched pregnant women without any gastrointestinal symptoms or a history of gastrointestinal disease were included in the study. Demographic characteristics and H. pylori and cytotoxin associated gene A status of the groups were analysed.

RESULTS

The prevalence of H. pylori seropositivity was slightly but not significantly higher in patients with dyspeptic complaints compared to the controls (74.6% versus 63.8%, respectively, P > 0.05). The incidence of dyspeptic complaints were 53.5% in HP-seropositive and 40.9% in HP-seronegative women (P > 0.05). The prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls (75.5% versus 45.7%, respectively, P = 0.002). Among HP-seropositive women, the incidence of dyspeptic complaints was significantly higher in cagA-positive patients compared to the cagA-negative ones (65.6% versus 34.2%, respectively, P = 0.002). When analysed according to the trimesters, the prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls in the first trimester (68.0% versus 34.8%, respectively, P = 0.021).

CONCLUSION

Cytotoxin associated gene A-positive, virulent H. pylori strains were found to be more frequently associated with dyspeptic complaints in pregnant women.

Functional dyspepsia: relationship between clinical subgroups and Helicobacter pylori status in Western Turkey

The etiology of functional dyspepsia is not known. The objective of the present study was to determine the characteristics of functional dyspepsia in Western Turkey. We divided 900 patients with functional dyspepsia into three subgroups according to symptoms: ulcer-like (UL), 321 (35.6%), motility disorder-like (ML), 281 (31.2%), and the combination (C) of these symptoms, 298 (33.1%). All patients were submitted to endoscopic evaluation, with two biopsies taken from the cardia and corpus, and four from the antrum of the stomach. All biopsy samples were studied for Helicobacter pylori (Hp) density, chronic inflammation, activity, intestinal metaplasia, atrophy, and the presence of lymphoid aggregates by histological examination. One antral biopsy was used for the rapid urease test. Tissue cagA status was determined by PCR from an antral biopsy specimen by a random sampling method. We also determined the serum levels of tumor necrosis factor-alpha (TNF-alpha) and gastrin by the same method. Data were analyzed statistically by the Kolmogorov-Smirnov test and by analysis of variance. Hp and cagA positivity was significantly higher in the UL subgroup than in the others. The patients in the ML subgroup had the lowest Hp and cagA positivity and Hp density. The ML subgroup also showed the lowest level of Hp-induced inflammation among all subgroups. The serum levels of TNF-alpha and gastrin did not reveal any difference between groups. Our findings show a poor association of Hp with the ML subgroup of functional dyspepsia, but a stronger association with the UL and C subgroups.

Immune-mediated neural dysfunction in a murine model of chronic Helicobacter pylori infection

BACKGROUND & AIMS

Neuromuscular changes producing dysmotility and hyperalgesia may underlie symptom generation in functional gastrointestinal disorders. We investigated whether chronic Helicobacter pylori-induced gastritis causes neuromuscular dysfunction.

METHODS

In vitro muscle contractility and acetylcholine release were evaluated in mice before and after H. pylori eradication. H. pylori colonization and gastritis were graded histologically. Substance P (SP)-, vasoactive intestinal polypeptide (VIP)-, and calcitonin gene-related peptide (CGRP) immunoreactivity (IR) and macrophages were studied by immunohistochemistry.

RESULTS

In Balb/c mice, chronic H. pylori infection did not affect muscle function but augmented antral relaxation after nerve electric field stimulation. Infected mice had lower acetylcholine release by electric field stimulation and had higher density of SP-, CGRP-, and VIP-IR nerves in the stomach and of SP- and CGRP-IR in the spinal cord. Cholinergic nerve dysfunction worsened progressively and was associated with increasing macrophage and mononuclear but not polymorphonuclear infiltrate or bacterial colonization. SCID mice had unchanged acetylcholine release despite high H. pylori colonization and macrophage infiltration. Eradication of H. pylori normalized functional and morphologic abnormalities except for increased density of gastric SP- and CGRP-IR nerves.

CONCLUSIONS

H. pylori infection induces functional and morphologic changes in the gastric neural circuitry that are progressive and lymphocyte dependent, and some persist after H. pylori eradication. The data have direct implications regarding the role of H. pylori infection in functional dyspepsia.