Risk Factors and Prevalence of Helicobacter pylori Infection in Persistent High Incidence Area of Gastric Carcinoma in Yangzhong City. Gastroenterol Res Pract. 2014;2014:481365. [PMID: 24550981 DOI: 10.1155/2014/481365]

Factors associated with irritable bowel syndrome and Helicobacter pylori infection: public knowledge and awareness of signs and symptoms

OBJECTIVE

To investigate factors related to the risk of developing irritable bowel syndrome (IBS) or Helicobacter pylori infection.

METHODS

This cross-sectional, questionnaire-based study analysed the responses from participants that completed an online questionnaire, which asked about their knowledge of the causes and risk factors associated with IBS and H. pylori infection.

RESULTS

The study analysed responses from 230 participants: 181 females (of 227 participants; 79.7%) and 190 aged 18-40 years (of 228; 83.3%). Of the 230 participants, 40 (17.4%) had been diagnosed by a physician with IBS and 57 (24.8%) had been diagnosed with H. pylori infection. Of 226 participants, 93 (41.2%) had self-medicated with antibiotics in the past 6 months for various reasons. The overall mean ± SD knowledge score about IBS and H. pylori infection for the study cohort (n = 230) was 35.8 ± 19.2%. Wald χ2-test analysis demonstrated that chronic diseases, antibiotic use and having an endoscopy were significantly associated with developing IBS. Male sex and chronic diseases were significantly associated with H. pylori infection. Logistic regression analysis showed no relationship between IBS and H. Pylori infection.

CONCLUSION

Chronic diseases was the only risk factor common for IBS and H. pylori infection.

Gastric troubles in Iran: The role of social and economic factors in Helicobacter pylori infection

Background

Helicobacter pylori infection is a major risk factor for gastric cancer in Iran, but the impact of socioeconomic factors on its prevalence is poorly understood. This study aimed to assess the socioeconomic inequalities and risk factors associated with H. pylori infection in Iran.

Methods

This cross-sectional study was conducted based on the PERSIAN cohort study. A total of 20460 individuals aged 35 to 70 years in Ardabil, Iran were included in the study. H. pylori infection was determined based on stool tests and clinical records. Multilevel logistic regression models with random intercepts at household and community levels were used to identify risk factors associated with H. pylori prevalence. The concentration index (CIn) and concentration curve (CC) were employed to assess socioeconomic-related inequality.

Results

In this study, 70.4% (CI 69.6-71.0) of the participants were infected with H. pylori, with a higher prevalence in women (71.2%) than men (69.6%). Age (OR: 1.37, CI: 1.17-1.61), sex (OR: 1.20, CI: 1.12-1.28), level of education (OR: 1.33, CI: 1.17-1.49), cardiac disease (OR: 1.32, CI:1.18-1.46), and BMI groups (OR: 2.49, CI: 1.11-5.58) were significantly associated with H. pylori infection based on the multivariable logistic regression. The results of the CIn and CC indicated that H. pylori were more prevalent among economically disadvantaged groups (CIn: -0.1065; [-0.1374 to -0.0755]).

Conclusion

The prevalence of H. pylori in Iran is higher than in other developing countries, and significant socioeconomic inequality exists between the poor and the rich. To reduce the rate of gastric cancer, socio-economic and demographic factors, especially the poor and people with low levels of education, should be considered.

Association of Alcohol Drinking and Helicobacter pylori Infection : A Meta-analysis

BACKGROUND

The association between drinking and Helicobacter pylori infection was not clear in the literature. Owing to mixed and inconclusive results, a meta-analysis was conducted to summarize and clarify this association systematically.

METHODS

Based on a comprehensive search of PubMed, Embase, and Web of Science databases, studies investigating the association between drinking and H. pylori infection were retrieved. We evaluated the strength of this relationship using odds ratios (ORs) with 95% confidence intervals. Sensitivity analysis was also conducted.

RESULTS

A total of 24 individual studies were included in this meta-analysis. The risk of H. pylori infection was significantly lower in alcohol drinkers than nondrinkers (OR=0.83). People who drink wine (OR=0.90) or mixed types of alcoholic beverages (OR=0.78) had a lower risk of infection compared with those who drink beer. Among people aged 40 years or older, alcohol drinkers had a lower risk of H. pylori infection than nondrinkers (OR=0.68). Among people less than 40 years of age, alcohol drinking was not associated with H. pylori infection risk. Data showed that women were at a lower risk of H. pylori infection than men (OR=0.86).

CONCLUSIONS

This meta-analysis suggests that the risk of H. pylori infection among alcohol drinkers is lower than that of nondrinkers. Drinking wine and mixed types of alcohol are better at reducing H. pylori infection than drinking beer. Nonetheless, we discourage reducing H. pylori infection through drinking, which increases the risk of other diseases.

Community prevalence of Helicobacter pylori and dyspepsia and efficacy of triple therapy in a rural district of eastern Uganda

Background

Helicobacter pylori (H. pylori) infection and chronic dyspepsia represent significant medical burdens in the developing world. An accurate assessment of the prevalence of chronic dyspepsia, as well as of the effectiveness of population-based screening and eradication of H. pylori are warranted.

Objectives

We determined the prevalence of H. pylori and chronic dyspepsia within the general adult population in a region of eastern Uganda. Independent predictors of H. pylori infection were assessed. Finally, we evaluated the efficacy of standard triple therapy on H. pylori eradication.

Methods

Of 400 randomly selected adult residents in eastern Uganda, 376 were administered a validated, chronic dyspepsia questionnaire and provided a stool sample for H. pylori testing. H. pylori-positive participants were given standard triple therapy and monitored for medication adherence. The efficacy of triple therapy on H. pylori eradication was determined by fecal antigen testing after treatment. Log-linear and logistic regression analyses identified predictors of H. pylori positivity and eradication failure.

Results

H. pylori prevalence within the study population was 48%. The prevalence of chronic dyspepsia was 87%. The presence or severity of dyspepsia did not predict H. pylori infection. However, a higher level of education was an independent predictor of H. pylori infection. Standard triple therapy resulted in ∼90% eradication. Missing at least four doses of any of the triple therapy medications over the 14-day course predicted eradication failure.

Conclusions

In our study population, chronic dyspepsia did not predict H. pylori infection, though clinical suspicion for this prevalent pathogen should nonetheless remain high. Population-based screening and adherence to triple therapy are effective at eradicating H. pylori within this region.

Prevalence and risk factors of Helicobacter pylori infection in Ningxia, China: comparison of two cross-sectional studies from 2017 and 2022

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.

Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori infection prevalence of approximately 50%. The most important risk factors in America include being male, poor adherence or difficult access to treatment, and the lack of in-home water service. Despite the descending trend in prevalence worldwide, the overall prevalence in Africa remains very high (70%). Nevertheless, the prevalence of H. pylori in children without gastrointestinal who underwent screening was reported to be only 14.2%. The main risk factors in Africa are having a traditional pit or no toilet, poverty, birth order, source of drinking water, or being a farmer. Asia seems to have the widest variations in terms of H. pylori prevalence. Several risk factors were reported in Asia to be associated with this infection, such as lower income and educational level, house crowding, rural residence, ethnicity, the use of tanks as water supplies, alcohol drinking, active smoking, eating spicy food or raw uncooked vegetables, poor living conditions and sanitation. The overall prevalence of H. pylori infection in European children is almost 25%. Portugal has the highest prevalence of all European countries at 66.2% in children 13 years of age. The risk factors in European individuals consist of living in rural areas, eating unwashed fruits and vegetables, not washing hands after school, low parental education and unemployment, and short education duration. Further studies are required to identify the precise mechanisms involved in the discrepancies of H. pylori prevalence worldwide.

Current and Future Perspectives in the Diagnosis and Management of Helicobacter pylori Infection

Helicobacter pylori (Hp) is a prevalent organism infecting almost half the global population. It is a significant concern, given its associated risk of gastric cancer, which is the third leading cause of cancer death globally. Infection can be asymptomatic or present with dyspeptic symptoms. It may also present with alarm symptoms in the case of progression to cancer. Diagnosis can be achieved non-invasively (breath tests, stool studies, or serology) or invasively (rapid urease test, biopsy, or culture). Treatment involves acid suppression and regimens containing several antibiotics and is guided by resistance rates. Eradication is essential, as it lowers the risk of complications and progression to cancer. Follow-up after eradication is similarly important, as the risk of cancer progression remains. There have been many recent advances in both diagnosis and treatment of Hp. In particular, biosensors may be effective diagnostic tools, and nanotechnology, vaccines, and potassium-competitive acid blockers may prove effective in enhancing eradication rates.

Influences of Helicobacter pylori infection on diversity, heterogeneity, and composition of human gastric microbiomes across stages of gastric cancer development

BACKGROUND

About a half of the world's population is infected with Helicobacter pylori (H. pylori), but only 1%-3% of them develop gastric cancer. As a primary risk factor for gastric cancer, the relationship between H. pylori infection and gastric microbiome has been a focus in recent years.

MATERIALS AND METHODS

We reanalyze 11 human gastric microbiome datasets with or without H. pylori, covering the healthy control (HC) and four disease stages (chronic gastritis (CG), atrophic gastritis (AG), intestinal metaplasia (IM), and gastric cancer (GC)) of gastric cancer development to quantitatively compare the influences of the H. pylori infection and disease stages on the diversity, heterogeneity, and composition of gastric microbiome. Four medical ecology approaches including (i) diversity analysis with Hill numbers, (ii) heterogeneity analysis with Taylor's power law extensions (TPLE), (iii) diversity scaling analysis with diversity-area relationship (DAR) model, and (iv) shared species analysis were applied to fulfill the data reanalysis.

RESULTS

(i) The influences of H. pylori infection on the species diversity, spatial heterogeneity, and potential diversity of gastric microbiome seem to be more prevalent than the influences of disease stages during gastric cancer development. (ii) The influences of H. pyloriinfection on diversity, heterogeneity, and composition of gastric microbiomes in HC, CG, IM, and GC stages appear more prevalent than those in AG stage.

CONCLUSION

Our study confirmed the impact of H. pylori infection on human gastric microbiomes: The influences of H. pylori infection on the diversity, heterogeneity, and composition of gastric microbiomes appear to be disease-stage dependent.

Seroprevalence of Helicobacter pylori among dyspeptic patients in northern Lebanon: a 6-year retrospective study in two tertiary hospitals

Helicobacter pylori causes chronic gastritis and plays a significant role in duodenal/gastric ulcer disease and gastric cancer. Its prevalence varies among different populations and geographical areas. Here, in a hospital-based retrospective study, we investigated the seroprevalence of H. pylori infection in northern Lebanon. We examined the records of 4000 consecutive dyspeptic patients attending 2 tertiary care centres in the North (Tripoli) and Akkar (Halba) governorates. Seropositivity for H. pylori was determined using enzyme immunoassays investigating specific anti- H. pylori IgG antibodies. The association of infection with the available patients' demographic characteristics was also evaluated. The mean age of our study population was 36.9±16.6 years. With 2486 female and 1514 male subjects, the overall female/male ratio was 1.64. In total, H. pylori seropositivity was detected in 1367/4000 (34.2 %) tested individuals. The multivariate logistic regression analysis showed that H. pylori infection is less prevalent in female than in male examined patients [adjusted odds ratio (OR): 0.84; 95 % confidence interval (CI): 0.73-0.96; P<0.013]. Seroprevalence gradually increased with age - from 14.6 % in patients below 18 years to 42.9 % in those above 49 years - and was significantly higher among Akkar patients compared to those from the North governorate: 49.6 versus 28.7 %, respectively (P<0.001). Overall, a third of symptomatic patients in northern Lebanon are infected with H. pylori . However, the prevalence of infection was markedly different in close geographical zones in this region. Additional screening studies using different screening methods are needed in the future to determine the accurate prevalence of this bacterium and its clinical implications to establish efficient national intervention strategies.

Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study

BACKGROUND

 Helicobacter pylori (H. pylori) plays an important role in causing peptic ulcer disease (PUD) in the general population. However, the role of H. pylori in cirrhotic patients for causing PUD is obscure. There are various studies evaluating H. pylori association with PUD in cirrhotic patients, but the results have been controversial. We sought to analyze the association of H. pylori with the development of PUD in cirrhotic patients from the largest United States population-based database.

METHODS

 We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2017. Adult hospitalizations due to cirrhosis were identified by previously validated ICD-10-CM codes. PUD and H. pylori were identified with the presence of ICD-10-CM codes in primary and secondary diagnosis fields, respectively. We performed weighted analyses using Chi-Square and paired Student's t-test to compare the groups. Multivariable survey logistic regression was performed to find an association of H. pylori with PUD in cirrhotic patients.

RESULTS

 Our study showed that the prevalence of H. pylori infection was 2.2% in cirrhotic patients with PUD. In regression analysis, H. pylori was found to be associated with PUD in cirrhotic patients (OR 15.1; 95% CI: 13.9-16.4; p <0.001) and non-cirrhotic patients (OR 48.8; 95% CI: 47.5-50.1; p <0.001). In the studied population, H. pylori was more commonly seen in the age between 50 and 64 years (49.4% vs 44.1%; p <0.0001), male (63.4% vs 59.9%; p <0.0413), African American (16.3% vs 10.6%; p <0.0001), and Hispanic (26.2% vs 14.9%; p <0.0001). H. pylori is more likely to be associated with complicated PUD hospitalizations (51.2% vs 44.2%; p <0.0067). Alcoholism and smoking were more common in H. pylori group compared to those without (43.6% vs 35.8%; p <0.0001 and 33.7% vs 24.8% p <0.0001, respectively). Factors associated with increased odds of H. pylori infection include African American (OR 2.3, 95% CI: 1.5-3.6), Hispanic (OR 2.6, 95% CI: 1.7-4.0), and smoking (OR 1.5, 95% CI: 1.1-2.2).

CONCLUSION

 H. pylori are associated with PUD and concurrent cirrhosis, although it is less prevalent than general population. African American, Hispanic, and smoking were independently associated with increased odds of H. pylori infection. Further studies are required to better understand the epidemiology and confirm our findings.

Helicobacter pylori infection in Iran: demographic, endoscopic and pathological factors

Background

Helicobacter pylori (H. pylori) infection is the most important risk factor for gastritis and peptic ulcer. However, factors other than H. pylori are involved in its pathogenesis. In the current study, we aimed to compare the clinical manifestations and endoscopic and histopathological findings of patients with and without H. pylori infection.

Methods

In this cross-sectional study, 233 patients with dyspepsia, referred for endoscopy, were examined regarding the presence of H. pylori infection. During an endoscopic exam, 5 biopsy specimens were taken from the stomach. The criteria for the presence of H. pylori infection was the presence and identification of bacteria in pathology. Two groups of H. pylori-positive and H. pylori-negative patients were compared regarding their demographic, endoscopic, and pathological findings.

Results

Of 233 patients, 154 (66.1%) were non-smokers, 201 (86.3%) were not alcohol users, and 153 (65.7%) used tap water. The most common symptom, reported in 157 (67.4%) patients, was epigastric pain. There was a significant difference between patients with and without H. pylori infection in terms of the educational status, occupational status, family history of gastrointestinal cancer, and some gastrointestinal symptoms. Also, there was a significant relationship between the endoscopic and pathological findings of patients with H. pylori.

Conclusions

The results of the present study revealed that H. pylori infection was not associated with sex, alcohol consumption, or non-steroidal anti-inflammatory drug use. The role of H. pylori in the pathophysiology of peptic ulcer was clarified. Also, there was a significant difference in the endoscopic and pathological findings of patients with H. pylori.

Prevalence and risk factors of Helicobacter pylori infection in Wuwei, a high-risk area for gastric cancer in northwest China: An all-ages population-based cross-sectional study

OBJECTIVE

This study aimed to determine the prevalence and risk factors of Helicobacter pylori infection across all age groups in Wuwei City, a high-risk area for gastric cancer in Northwest China.

METHODS

We conducted this study from 2016 to 2017 in an urban and a rural community in Wuwei City. Stool antigen tests targeted individuals aged 0 to 3 years old, and ¹³ C-urea breath tests targeted individuals aged above 3 years. We selected participants based on hierarchical cluster sampling. We assessed the association between variables and H. pylori infection based on logistic regression models.

RESULTS

Ultimately, the results of 2,163 participants (age: 0 to 77 years old) were included (1,238 minors and 925 adults) in the analysis. The overall prevalence of H. pylori infection was 35.6%. It increased with age, reaching the peak in the 30 to 39 age group, and then began to decline. In multivariate analysis, age was positively associated with prevalence of H. pylori infection, and factors negatively associated with the prevalence were drinking running water, the frequency of yoghurt consumption, and an annual household income of Renminbi (¥) 30,000-100,000 or 100,000 above. In the subgroup analyses, however, the same variables associated differently in different age groups. Additionally, we interestingly noticed that boarding, eating at school cafeterias over six times per week, and frequently drinking untreated water were independent predictors of H. pylori infection in junior and senior high school students.

CONCLUSION

The prevalence of H. pylori infection is moderate and closely associated with the socioeconomic conditions of Wuwei City, as well as the sanitary situations and dietary habits of the participants in the city. Boarding, eating at school, and drinking untreated water are the main factors explaining the rising infection rate in junior-senior high school students.

Sex differences in the relationship among alcohol, smoking, and Helicobacter pylori infection in asymptomatic individuals

Objective

We aimed to investigate the relationship of Helicobacter pylori infection with alcohol and smoking.

Methods

We conducted a cross-sectional study among participants who underwent health check-ups for H. pylori infection between January 2013 and March 2017. We subsequently investigated the relationship of H. pylori infection with alcohol and smoking.

Results

A total of 7169 participants were enrolled in this study. The overall prevalence of H. pylori infection was 55.2%. Participants with H. pylori infection were more likely to be older than those without H. pylori infection. For male participants with H. pylori infection, multivariable logistic regression analysis indicated that both smoking (odds ratio (OR): 1.61; 95% confidence interval (CI): 1.41–1.83) and alcohol consumption (OR: 1.30; 95% CI: 1.10–1.52) were independently positively associated with H. pylori infection. For female participants, multivariable logistic regression analysis indicated that both smoking (OR: 0.03; 95% CI: 0.02–0.07) and alcohol consumption (OR: 0.20; 95% CI: 0.12–0.33) were inversely significantly associated with H. pylori infection after adjustment for age.

Conclusions

Smoking and alcohol consumption were risk factors for male participants but these were protective factors for female individuals with H. pylori infection.

Molecular testing for H. pylori clarithromycin and quinolone resistance: a prospective Chinese study

In China, there is a high prevalence of antibiotic-resistant Helicobacter pylori infections in the population. The aim of the study was to assess a new ARMS-PCR test for detection of H. pylori clarithromycin resistance (CR) and quinolone resistance (QR) mutations and evaluate the spectrum of antibiotic resistance in patients from three Chinese provinces. Sanger sequencing and multiplex ARMS-PCR were used to detect H. pylori CR and QR bacteria in gastric biopsy samples. Among the 1,182 patients enrolled with gastritis, 643 (54.4%) were positive for H. pylori. Of these, 371 (57.7%) had antibiotic-resistant strains, comprising 236 (63.6%) with a single drug antibiotic-resistant strain and 135 (36.4%) with multiple drug-resistant strains. Following Sanger sequencing analysis of 23S rRNA and gyrA gene for mutations (antibiotic resistance markers), rates of CR, QR, and multidrug resistance (CR and QR) were 19.9, 12.0, and 25.8%, respectively. The 23S rRNA CR mutation A2143G (286, 96.9%) and the gyrA QR mutations C261A (85, 31.5%) and G271A (71, 26.3%) were common. Benchmarking against Sanger sequencing results, multiplex ARMS-PCR test had a high diagnostic sensitivity and specificity for detection of CR (96 and 93%), QR (95 and 92%) and multidrug resistance (95 and 95%). Based on our findings, the high incidence of single and multiple antibiotic resistance requires the routine checking of antibiotic resistance in all patients with suspected H. pylori infections. Multiplex ARMS-PCR is a simple and rapid test that can be now used for more efficient treatment of H. pylori infections and reduces the misuse of antibiotics.

An Overview of Helicobacter pylori Infection

Helicobacter pylori (H. pylori) represents one of the most widespread bacterial infections globally. Infection causes chronic gastritis and increases the risk of peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. The pioneering discovery of H. pylori by Marshall and Warren in the early 1980s has initiated fervent research into H. pylori as a pathogen ever since. This chapter aims to provide an overview of our understanding of H. pylori infection and its management, with a focus on current options for diagnosis, the challenges associated with H. pylori eradication, and the need for alternative therapeutic strategies based on furthering our understanding of host: H. pylori interactions.

Prevalence and associated risk factors of Helicobacter pylori infection in the Wuwei cohort of north-western China

OBJECTIVES

To evaluate the prevalence of Helicobacter pylori infection and risk factors and to serotype the strains in Wuwei, located in north-western China, which has a high incidence of gastric cancer.

METHODS

Helicobacter pylori infection was analysed in 21 291 adults by ¹⁴ C-urea breath test, and H. pylori antibody were detected in 9183 serum samples by latex immunoturbidimetric method. The correlation of H. pylori infection with demographic-economic, lifestyle factors and medical history among the participants was determined by questionnaire. The antibodies against H. pylori urease, VacA and CagA in serum were determined by dot immunobinding assay.

RESULTS

The infection rate of H. pylori was 53.0%, and 90.1% of strains were type I strains. The H. pylori infection rate was higher among farmers (OR = 1.34, 95% CI: 1.19-1.50) and individuals who had a junior high school or higher education level (OR = 1.10, 95% CI: 1.06-1.15), and was lower in older individuals (OR = 0.86, 95% CI: 0.83-0.90), individuals with high income (OR = 0.93, 95% CI: 0.90-0.95), individuals with a habit of eating quickly (OR = 0.93, 95% CI: 0.87-0.99) and individuals who consumed more fruit and vegetables (OR = 0.90, 95% CI: 0.85-0.95). Individuals with history of cholecystitis/cholecystolithiasis, hypertension and asthma were negatively correlated with H. pylori infection (P < 0.05).

CONCLUSION

The prevalence of H. pylori infection is high in Wuwei. The major prevalent strain is type I strain. Age, education, occupation, household income, consumption of fruit and vegetables, and habit of eating quickly are independent risk factors for H. pylori infection, which is also associated with individuals with a history of extragastric diseases.

Association of tobacco smoke-infused water (tuibur) use by Mizo people and risk of Helicobacter pylori infection

The study aims to understand the influence of environmental and lifestyle factors and more specifically the role of tobacco smoke-infused water (tuibur) on Helicobacter pylori infection. It was a cross-sectional study to measure the epidemiological risk factors associated with H. pylori infection among the tribal population in Northeast India. Endoscopic samples were collected from the antrum region of the stomach from 863 participants with gastritis. H. pylori infection was confirmed in 475 samples by the rapid urease test and PCR-based methods. Information on demographic and lifestyle factors was collected using a validated and standardized questionnaire. Logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (CI) for the association between the various factors and H. pylori. The use of tuibur was associated with an increased OR of H. pylori infection (OR = 3.32, 95% Cl = 1.95-5.83). Tobacco chewers (OR = 1.49, 95% Cl = 1.06-2.09), smokers (OR = 1.81, 95% Cl = 1.26-2.61), and alcohol consumers (OR = 1.81, 95% Cl = 1.19-2.76) were also infected with H. pylori. The results were not attenuated after adjusting for major well-known risk factors of H. pylori infection. The habit of tuibur consumption may be a contributing factor to the high prevalence of H. pylori infection and in turn, may contribute to the high prevalence of gastritis among the Mizo population.

Assessment of prevalence and risk factors of helicobacter pylori infection in an oilfield Community in Hebei, China

Background

Only a paucity of large-scale perspective and cross-sectional studies on H. pylori infection in China have been published. The purpose of this study was to investigate the prevalence and risk factors for H. pylori infection among residents of Jidong community located in Hebei Province of China.

Methods

A perspective, cross-sectional study was conducted in Jidong community. Questionnaires and ¹³C-urea breath test were performed, and 10-ml blood samples were obtained for laboratory tests.

Results

Four thousand seven hundred ninety-six subjects were enrolled in this study, and 2506 (52.25%) were H. pylori positive. There was no difference in prevalence between both sexes (P = 0.5974). Age (P = 0.004) and education level (P = 0.0128) were significantly associated with H. pylori infection, and there were statistical trends in the prevalence across five age subgroups (χ² test for trend = 23.5; P < 0.001) and education levels (χ² test for trend = 19.50; P < 0.001). H. pylori infection was also associated with marital status (P = 0.0243), source of drinking water (P = 0.0433), frequency of eating raw garlic (P = 0.0310), alcohol drinking (P = 0.0207), knowledge about H. pylori transmission route (P = 0.0125) and related diseases (P = 0.0257). Age, alcohol drinking and knowledge about transmission route were found to be independent predictors of H. pylori infection.

Conclusions

More than half of the population was infected with H. pylori in Jidong community. The socio-demographic profiles, socio-economic factors and lifestyle are worthy taking into consideration to prevent diseases associated with H. pylori infection. Understanding the prevalence and risk patterns for H. pylori infection in China will help in prioritizing public health efforts to better manage the H. pylori infection.

Epidemiology, Diagnosis and Risk Factors of Helicobacter pylori Infection

Helicobacter pylori is a human-specific pathogen, which leads to gastric pathologies including gastric cancer. It is a highly unique bacterium considered as a carcinogenic agent. H. pylori remains a major human health problem, responsible for ~90% of the gastric cancer cases. Approximately four billion individuals have been detected for H. pylori infection worldwide in 2015. At the turn of the twenty-first century, the prevalence of H. pylori has been declining in highly industrialized countries of the Western world, whereas prevalence has plateaued at a high level in developing and newly industrialized countries. However, the infection status remains high in immigrants coming from countries with high prevalence of H. pylori infection. H. pylori can be diagnosed both by invasive and non-invasive methods. Urea breath test and stool antigens detection are among the most commonly used non-invasive ones. Although the way H. pylori is transmitted remains still not fully clear, the level of contamination is strongly dependent on the familial and environmental context, with a drastic impact of living conditions with poor hygiene and sanitation. However, familial socioeconomic status is the main risk factor for H. pylori infection among children. In addition, food and water source have a high impact on the prevalence of H. pylori infection worldwide. This chapter highlights the latest knowledge in the epidemiology of H. pylori infection, its diagnosis and critical risk factors responsible for its high prevalence in some populations and geographic areas.

An experimental in-vitro study to evaluate the anti-helicobacter activity of Glycyrrhetinic acid

Aim: The aim of this study was to investigate the in-vitro efficacy of Glycyrrhetinic acid against Helicobacter pylori (H. pylori) strains, as compared with conventional antibacterial agents.

Methods: A total of 41 H. pylori isolates were used, 6 of which were of standard strains (NCTC 1637), 8 of which were drug-sensitive, and 27 were resistant to drugs isolates. Clarithromycin and metronidazole resistance in all strains of H. pylori were determined by the Epsilometer test (E-test) method. MIC study was performed by using microdilution broth method.

Results: Glycyrrhetinic acid was found to be effective against H. pylori NCTC 1637 in doses of 12.0±4.38 µg/mL, while the MIC value of clinical H. pylori isolates susceptible to antimicrobials was 20.8±10.11 µg/ml. It was found that the MIC values for antimicrobial-sensitive clinical H. pylori isolates was higher when compared with H. pylori NCTC 1637 strains. The MIC values of the standard antimicrobial agents against drug-resistant H. pylori strains were higher than H. pylori NCTC 1637 strains and drug-sensitive H. pylori strains. The MIC value was found to be 14.22±7.77 µg/ml for metronidazole, 3.89±1.90 µg/ml for clarithromycin, 2.33±1.0 µg/ml for amoxicillin, 2.44±0.88 µg/ml for levofloxacin and 4.89±2.47 µg/ml for tetracycline, whereas the MIC value of Glycyrrhetinic acid was 26.67±8.0 µg/ml in metronidazole-resistant H. pylori isolates. Besides, MIC values of the antimicrobials and 18ß-Glycyrrhetinic acid among the strains resistant to clarithromycin were as follows: 3.25±2.12 µg/ml for metronidazole, 9.71±4.54 µg/ml for clarithromycin, 2.06±1.32 µg/ml for amoxicillin, 3.88±4.22 µg/ml for levofloaxacin and 3.25±1.04 µg/mL for tetracycline and 22.0±11.11 µg/ml for Glycyrrhetinic acid.

Conclusion: Glycyrrhetinic acid had significant antimicrobial activity against H. pylori strains. Although further in-vivo studies are needed on antimicrobial activity of Glycyrrhetinic acid, increased resistance to drugs currently used in treatment suggests that Glycyrrhetinic acid may be a potential agent for the treatment of H. pylori.

Time Trends of Gastrointestinal Cancers Incidence and Mortality in Yangzhong From 1991 to 2015: An Updated Age-Period-Cohort Analysis

Background: Gastrointestinal (GI) cancers are the common cause of morbidity and mortality in China which seriously threaten people's health and lives. The aim of this study was to describe the temporal trend in the epidemiology of GI cancers from 1991 to 2015, with an emphasis on the effects of age, period and cohort in Yangzhong City, Jiangsu province, a high-risk area of GI cancers in China. Methods: Our study extracted cases of gastric cancer, esophageal cancer and colorectal cancer diagnosed from 1991 to 2015 from Yangzhong Cancer Registry. Age-standardized rates (ASRs) were calculated and joinpoint regression was used to compute the estimated annual percent changes. Age-period-cohort (APC) model was performed to investigate the independent effects of age, calendar period, and birth cohort. Results: Between 1991 and 2015, 18,006 new cases and 10,262 deaths were registered with GI cancers in Yangzhong. The age-standardized incidence rates (ASIRs) of gastric cancer decreased in both sexes during the study period. And the incidence rates of esophageal cancer stabilized at first then continued to decline, the turning point was in 2005 for men and 2001 for women. Changes in the mortality rates of gastric cancer and esophageal cancer showed significant declined trends around 2000-2010 in both genders. The incidence rates of colorectal cancer increased steadily during the entire study period, and the increase was more pronounced in the mortality rates of men. The results of APC analysis suggest that general decreases in incidence and mortality of esophageal cancer and gastric cancer might be caused by the downward trend of the period and cohort effects, while the increases in colorectal cancer might be caused by the uptrend of the period effects. Conclusions: The incidence and mortality rates of esophageal and gastric cancers showed a downward trend and colorectal cancer was on the rise as a whole in Yangzhong City. The different burden of gastrointestinal cancer indicating heterogeneous risk factors exist and may have contributed to these temporal variations.

Magnitude of Helicobacter pylori among Dyspeptic Patients Attending at University of Gondar Hospital, Gondar, Northwest Ethiopia

Background

Helicobacter pylori (H.pylori) infection is predominantly acquired in childhood from family members. The infection can cause dypepepsia, chronic and acute gastritis and gastric cancer. Dyspepsia is the most common illness in the Ethiopian population visiting outpatient department of health facilities, and it has also been associated with H.pylori infection. The aim of this study was to assess the magnitude of H.pylori and its associated factors among dyspeptic patients who visited University of Gondar Hospital Outpatient Department.

Materials and Methods

An institutional-based cross-sectional study was conducted on 354 dyspeptic patients. A systematic random sampling technique was employed to select study participants. Data were collected by using structured questionnaire via face-to-face interview. H.pylori infection was diagnosed using stool antigen test method. The data were entered into Epi info version 3.5.3 and transferred to Statistical Package for Social Sciences version 20. Both Bivariable and multivariable binary logistic regression analyses were performed to see the effect of independent variables on the dependent variable.

Result

Of the total study participants, 201(56.8%), 195(55.1%) and 182(51.4%) were married, urban residents and females, respectively. The overall magnitude of H.pylori infection was 37.6%. In bivariable logistic regression analysis, sex and marital status were significantly associated with H.pylori infection, but in multivariable logistic regression analysis only marital status was significantly associated with H.pylori infection.

Conclusion

The magnitude of H.pylori infection is high indicating that it is a public health problem in the study to area. According to this study, none of the variables were significantly associated with H.pylori infection. Hence, effective preventive, control and screening strategies need to be designed to reduce the burden of the disease.

Helicobacter pylori in patients with gastritis in West Cameroon: prevalence and risk factors for infection

Objectives

Helicobacter pylori is a pathogenic bacterium that parasitizes the gastric mucous layer and the epithelial lining of the stomach causing duodenal ulcers, gastric ulcers and cardiovascular disease amongst others. This study aimed at establishing the epidemiologic profile of H. pylori infection in gastritis patients presenting at the Melong District Hospital.

Results

Blood, stool and epidemiological data collected from 500 patients were analyzed for the presence of H. pylori antibody in serum, antigen in stool and elucidation of risk factors captured in questionnaires. Of 500 blood samples, 217 (43.4%) were seropositive with male and female seroprevalences of 45.5% (61/134) and 42.6% (156/366) respectively. Similarly, 47.4% (237/500) samples tested positive for stool antigen with prevalences of 47.0% (63/134) for males and 47.5% (174/366) for females. The antigen prevalence was higher (53.2%; 118/222) in older patients (> 50 years) than in younger patients (42.8%; 119/278; P = 0.021). The antigen test had a higher (47.4%) prevalence than the antibody test (43.4%). Educational level, source of income, source of drinking water, age of patients, and alcohol consumption had positive associations with H. pylori infection. These results have clinical and epidemiological significance and call for intervention to mitigate the situation.

Flagellin glycosylation with pseudaminic acid in Campylobacter and Helicobacter: prospects for development of novel therapeutics

Many pathogenic bacteria require flagella-mediated motility to colonise and persist in their hosts. Helicobacter pylori and Campylobacter jejuni are flagellated epsilonproteobacteria associated with several human pathologies, including gastritis, acute diarrhea, gastric carcinoma and neurological disorders. In both species, glycosylation of flagellin with an unusual sugar pseudaminic acid (Pse) plays a crucial role in the biosynthesis of functional flagella, and thereby in bacterial motility and pathogenesis. Pse is found only in pathogenic bacteria. Its biosynthesis via six consecutive enzymatic steps has been extensively studied in H. pylori and C. jejuni. This review highlights the importance of flagella glycosylation and details structural insights into the enzymes in the Pse pathway obtained via a combination of biochemical, crystallographic, and mutagenesis studies of the enzyme-substrate and -inhibitor complexes. It is anticipated that understanding the underlying structural and molecular basis of the catalytic mechanisms of the Pse-synthesising enzymes will pave the way for the development of novel antimicrobials.

Effects of alcohol consumption, ALDH2 rs671 polymorphism, and Helicobacter pylori infection on the gastric cancer risk in a Korean population

The effect of alcohol consumption on the risk of gastric cancer (GC) has not yet been fully elucidated, and an aldehyde dehydrogenase 2 (ALDH2) polymorphism, rs671, is a genetic variant that influences alcohol consumption in East Asians. Additionally, the discrepancy between the Helicobacter pylori (H. pylori) infection prevalence and GC incidence across Asian countries has not been explained. This study evaluated the effects of alcohol consumption and genetic susceptibility to defective acetaldehyde metabolism on the GC risk and their interactions with H. pylori infection. This study included 450 Korean GC cases and 1,050 controls recruited at the National Cancer Center. Data for 795 patients and 4,893 controls were used for further confirmation of the effect of rs671. Increased GC risks were evident for rs671 A allele carriers (odds ratio (OR), 1.23; 95% confidence interval (CI), 1.08-1.41) and H. pylori-infected individuals (OR, 7.07; 95% CI, 4.60-10.86), but no dose-response association with alcohol consumption was observed. Furthermore, the interactions between these factors were not significant. This study has demonstrated that alcohol consumption and rs671 should be considered simultaneously when assessing the GC risk. Additionally, alcohol-related factors were not found to interact with H. pylori infection, and further studies evaluating other environmental factors are required to explain the Asian enigma.

Living Conditions and Helicobacter pylori in Adults

INTRODUCTION

Infection by the bacterium Helicobacter pylori (H. pylori) is transmissible and is considered a public health issue which affects people of all ages. The objective of this study was to identify factors (lifestyles, dietary factors, and hygiene conditions) related to the prevalence of H. pylori infection.

METHODS

We carried out an observational cross-sectional study with a community sample of adults from the municipalities of Viseu and Sátão, Portugal. The final sample resulted in 166 adults. The data were collected through a self-administered questionnaire with questions regarding sociodemographic aspects and lifestyles. H. pylori infection was identified using the 13C-urea breath test.

RESULTS

No association was found between the prevalence of H. pylori infection and the use of tobacco, alcohol, or coffee or dietary factors. The prevalence of H. pylori infection was higher in adults who reported higher consumption of fried food and lower consumption of vegetables and fruit. H. pylori infection was significant for the variables of lower frequency of handwashing before going to the bathroom (p = 0.02) and well water consumption (p = 0.05).

CONCLUSION

A significant association was found for H. pylori infection with the lower frequency of handwashing before going to the bathroom and the consumption of well water.

Influence of Dietary Factors on Helicobacter pylori and CagA Seroprevalence in Bulgaria

The aim of this study was to assess the association between some dietary factors and prevalence of H. pylori infection or strain virulence in 294 adult asymptomatic blood donors. Methods. Seroprevalence was evaluated using ELISA. Logistic regression was used. Results. Anti-H. pylori IgG prevalence was 72.4%, and CagA IgG seroprevalence was 49.3%. In the multivariate analyses, the frequent (>5 days per week) honey consumption was associated with both reduced H. pylori seroprevalence OR, 0.68 with 95% confidence interval (CI), 0.473-0.967 and reduced CagA IgG seroprevalence OR, 0.65 with 95% CI, 0.486-0859. Frequent (>5 days per week) yoghurt consumption also was associated with lower H. pylori virulence of the strains (CagA IgG OR, 0.56 with 95% CI, 0.341-0.921). Smoking and consumption of the other dietary factors resulted in no significant differences in the prevalence of H. pylori IgG and CagA IgG within the subject groups. Conclusion. To the best of our knowledge, this is the first report revealing reverse associations between honey or yoghurt consumption and CagA IgG prevalence as well as between frequent honey consumption and lower prevalence of the H. pylori infection. Regular honey and yoghurt consumption can be of value as a supplement in the control of H. pylori therapy.

Downregulated Expression of E-cadherin and TP53 in Patients with Gastric Diseases: the Involvement of H. pylori Infection and Its Virulence Markers

PURPOSE

Gastritis caused by infection with Helicobacter pylori is characterized by chronic inflammation and damage in gastric tissue, which is a main risk factor for gastric cancer. Associated with H. pylori, the TP53 gene tumor suppressor and the cell adhesion glycoprotein epithelial cadherin develop a relevant role in the integrity and carcinogenesis of the epithelium. We aimed to detection of H. pylori and its main virulence markers and measured the messenger RNA (mRNA) expression levels of E-cadherin and TP53 genes.

METHODS

The detection of H. pylori and its virulence markers, as well as the mRNA expression levels of E-cadherin and TP53 genes, were obtained for 161 samples of gastric biopsies including 37 with normal gastric tissue, 70 with gastritis, 24 from neoplastic tissue, and 27 from adjacent non-neoplastic by means of a quantitative real-time polymerase chain reaction.

RESULTS

The mRNA expression levels of E-cadherin and TP53 were found to be decreased in patients with gastritis, independently of H. pylori infection. In samples from gastric patients, the neoplastic tissue showed an accentuated decrease of expression; on the other hand, the expression of E-cadherin was normal in adjacent non-neoplastic.

CONCLUSIONS

No evidence was found of the involvement of the cagA and vacA genes in the decreased expression of E-cadherin and TP53. The process of carcinogenesis is complex, and the decrease of the E-cadherin gene expression and TP53 gene expression appears to contribute significantly.

The All-Age Prevalence of Helicobacter pylori Infection and Potential Transmission Routes. A Population-Based Study

BACKGROUND AND AIMS

Previous research on H. pylori epidemiology has mostly focused on adult populations. We have aimed to study H. pylori prevalence in all age groups including children and adolescents and to identify potential routes of transmission.

METHODS

Subjects from all age groups (children 0-11 years, adolescents 12-17 years and adults ≥18 years of age), recruited from both an urban and a rural community in Northern Norway, were invited to provide stool samples for the diagnosis of H. pylori antigen and to fill in a questionnaire (adult and adolescents only) on gastrointestinal symptoms, lifestyle factors and biometric data.

RESULTS

A total of 1 624 (35.3%) of the invited subjects, including 173 (39.3%) of the children, 46 (19.2%) of the adolescents, and 1 416 (36.1%) of the adults, responded to the invitation. H. pylori infection was nearly undetectable (0.6%) among the children, whereas the prevalence increased from 20% in adolescents toward a peak of 45% in the highest age group. Univariate analyses of possible risk factors of H. pylori infection showed significant associations to private well water, the use of outhouse toilet, and having farm animals in childhood, but the associations waned in multivariate analyses.

CONCLUSIONS

In our populations, with apparent high hygienic standards, the transmission of H. pylori infection may start not only in childhood, but also in adolescence, where potential transmission routes may be outdoor toilet use, private well water, and farm animals.

Prevalence and Risk Factors for Helicobacter Pylori Infection among Healthy Inhabitants in Northern Jakarta, Indonesia

Background: The prevalence of Helicobacter pylori (H. pylori) infection in Indonesia has been reported to be exceedingly low. The purpose of our study was to confirm whether this is the case in Northern Jakarta using a sensitive 13C-urea breath test (UBT), and to examine any associations with lifestyle/environment factors and potential routes of transmission. Methods: We recruited a total of 196 subjects from a low-income community in Northern Jakarta, Indonesia, data from 193 who completed a questionnaire about their lifestyle/environment and had UBT being included as the final. Odds ratios (ORs) adjusted for sex and age with 95% confidence intervals (CIs) were calculated using a logistic regression model. Results: The overall H. pylori infection rate was 15.0% (95%CI, 10.3-20.9), with variation among Javanese (9.1%, total=77), Buginese (40.0%, 35), Betawi (9.1%, 33), Sundanese (3.7%, 27), and Batak (40.0%, 5). On multivariate analysis, the ORs for intake of soybean milk, cucumber more than once a week, infrequent hand washing practice before meals, and alcohol consumption were 0.10 (95%CI: 0.01-0.97), 6.61 (95%CI: 1.87-23.3), 4.10 (95%CI: 1.15-14.6), and 61.9 (95%CI: 1.67-2300.8), respectively. Rates for Buginese (OR=7.84; 95%CI: 1.82-33.8) and Batak (OR=20.1; 95%CI: 1.90-213.2) were significantly higher than for Javanese. Conclusions: The H. pylori infection rate in this study was relatively low, in line with previous studies. Regarding ethnicity factors, Buginese and Batak reported eating food using fingers more frequently than Javanese, Betawi, and Sundanese. Our study indicated that person-person transmission is possible in this low prevalence area. The low infection rates for H. pylori among Javanese, Betawi, and Sundanese ethnics could be partly due to their sanitary practices.

Management of Helicobacter pylori infections

BACKGROUND

Infection with Helicobacter pylori is associated with severe digestive diseases including chronic gastritis, peptic ulcer disease, and gastric cancer. Successful eradication of this common gastric pathogen in individual patients is known to prevent the occurrence of peptic ulcer disease and gastric cancer.

DISCUSSION

With half of the world's population being infected with H, pylori and only few antibiotics result in an effective eradication, a successful antibiotic driven worldwide eradication program seems unlikely. In addition, H. pylori eradication is not always beneficial as it has been described that eradication can be associated with an increased frequency of other disorders such as pediatric asthma, inflammatory bowel diseases and Barrett's Esophagus. We have to accept that eradication of this infection is a two-edged sword that is both useful and harmful and we should therefore focus our H. pylori eradication policy toward selectively identify and destroy only the virulent strains.

CONCLUSION

In order to still be able to effectively treat H. pylori infections in the future we need an alternative diagnostic/treatment algorithm. This would involve a shift towards more precise and enhanced disease predicting diagnosis that tries to identify patients with chance of developing severe diseases such as gastric cancer, rather than the current regime that is geared towards find and destroy all H. pylori.

Iodine-131 in Helicobacter pylori-positive patients: preliminary accidental finding and in differentiated thyroid cancer

OBJECTIVE

To investigate the eradicate effect of Helicobacter pylori in differentiated thyroid cancer patients who underwent I therapy.

MATERIALS AND METHODS

A total of 130 patients with differentiated thyroid cancer underwent I treatment. None of the patients had a history of stomach-related diseases. The C-urea breath test (UBT) was carried out for H. pylori examination before I treatment. The cut-off value for C-UBT was 4%. For H. pylori test-positive patients, a second C-UBT was performed 4-6 weeks after I treatment. T-tests were used to compare the difference before and 4-6 weeks after I treatment.

RESULTS

A total of 42 of 130 (32.31%) patients were H. pylori positive. The average value of H. pylori was 28.36% before I, whereas the value was 18.18% after I therapy. A significant decrease in C-UBT was found after I treatment compared with before therapy (P<0.01).

CONCLUSION

Our preliminary data showed that I exerts certain eradication effects on H. pylori, which could provide a new approach to multidrug resistance pathogens. As the exact molecular mechanism of this phenomenon is still unclear, future clinical applications of this anecdotal finding require further assessments.

Meta-analysis of the Prevalence of Helicobacter Pylori Infection among Children and Adults of Iran

Helicobacter pylori infection is a common health problem related to many gastrointestinal disorders. This study aims to estimate the total and age specific prevalence of Helicobacter Pylori infection in Iran. We systematically reviewed all national and international databases and finally identified 21 studies were eligible for meta-analysis. Each of them were assigned a quality score using STROBE checklist. Due to significant heterogeneity of the results, random effects model was used to estimate the pooled prevalence and 95% confidence interval of Helicobacter Pylori infection. All statistical analyses were performed using STATA. V11 software. The pooled prevalence (95% confidence interval) of Helicobacter Pylori infection among all population, children and adults were estimated as 54% (53%- 55%), 42% (41%- 44%) and 62% (61%- 64%) respectively. Helicobacter Pylori, has infected more than half of Iranian people during the last decade. Preventive strategies as well as taking into account this infection during clinical visits should be emphasized to reduce its transmission and prevalence within the community.

Helicobacter pylori colonization in Nepal; assessment of prevalence and potential risk factors in a hospital-based patient cohort

Background

Helicobacter pylori, a gram-negative bacterium, can cause gastritis, peptic and duodenal ulcers. It is considered an important public health problem for both developed and developing world. This bacterium is classified as the class 1 carcinogen because it can cause cancer.

Methods

A hospital based study was conducted at Chitwan Medical College Teaching Hospital (CMCTH) from May to October 2014. Stool samples were collected from the suspected patients and were subjected to detection of the H. pylori stool antigen (HpSAg) following the procedures recommended by the manufacturer. A standard questionnaire on the potential risk factors was also designed and completed.

Result

HpSAg was detected in 16 % of suspected patients. The children up to 10 years of age were found to be highly infected (36 %). The patients living in urban area were found more susceptible to develop H. pylori infection (P < 0.05). Tea drinking and repeated eating habit (more than twice a day) were listed as the important factors that can limit the H. pylori infections significantly (P < 0.05).

Conclusion

In this hospital based study, a significant rate of prevalence was evaluated. However, we recommend a community based extensive study to reveal the real scenario of H. pylori infection in Nepalese populations.

Correlation of nodular gastritis with Helicobacter pylori infection

Nodular gastritis (NG) is a form of chronic Helicobacter pylori (H. pylori) associated gastritis affecting the gastric antrum, which is characterized endoscopically by the presence of small nodular lesions resembling gooseflesh. It is generally accepted that NG is characterized histologically by hyperplasia of lymphoid follicles. At present, there is a wide range of H. pylori infections in the world, and NG is an endoscopic sign of H. pylori infection. After H. pylori eradication therapy, the clinical manifestations, pathology and endoscopic performance of NG patients can be improved significantly. Therefore, H. pylori eradication should be performed as early as possible in NG patients. The research data about NG is still very limited. The relationship between NG as potentially precancerous lesions and gastroduodenal diseases is still a debate and needs to be further explored. Here we review the research progress in understanding the correlation between NG and H. pylori.

Evaluation of Clinicopathological and Risk Factors for Nonmalignant H. Pylori Associated Gastroduodenal Disorders in Iraqi Patients

AIM:

To determine the risk factors associated with H. pylori infection and possible correlation with clinicopathological parameters.

MATERIAL AND METHODS:

Gastroduodenal biopsies were examined by rapid urease test and Gram staining. Cag A cytotoxin was detected by in situ hybridization.

RESULTS:

Risk of H. pylori acquisition reported as following: Males have 1.38 fold, rural residents have 0.63 fold, Nonsmokers have 0.39 fold, mild smokers have 18 fold, and moderate smokers have 1.4 fold while heavy smokers have 1 fold. A person who’s in contact with animals has 1.52 fold risks. Illiterates and patients with primary education have 5.36 & 3 fold risk respectively. Patients under proton pump inhibitor (PPI) therapy have 1.02 fold. Patients under NSAID therapy have 3.48 fold while nonalcoholic Patients have 0.75 fold. Patients using tap water have 0.45 fold risk. H. pylori infection positively correlated with age, weight loss, and heartburn. H. pylori inversely correlated with endoscopic diagnosis, Cag A positivity, and education level. Cag A positivity correlated with animal contact and NSAID usage.

CONCLUSIONS:

Several life style factors, education, animal contact, using of PPI, and NSAIDs increase the risk of H. pylori infection. Weight loss and heartburn cardinal signs for H. pylori infection. Endoscopic diagnosis and clinicopathological parameters not strictly associated with Cag A positivity.

Helicobacter pylori cytotoxin-associated gene A activates tumor necrosis factor-α and interleukin-6 in gastric epithelial cells through P300/CBP-associated factor-mediated nuclear factor-κB p65 acetylation

Helicobacter pylori‑initiated chronic gastritis is characterized by the cytotoxin‑associated gene (Cag) pathogenicity island‑dependent upregulation of pro‑inflammatory cytokines in gastric epithelial cells, which is largely mediated by the activation of nuclear factor (NF)‑κB as a transcription factor. However, the precise regulation of NF‑κB activation, particularly post‑translational modifications in the CagA‑induced inflammatory response, has remained elusive. The present study showed that Helicobacter pylori CagA, an important virulence factor, induced the expression of P300/CBP‑associated factor (PCAF) in gastric epithelial cells. Further study revealed that PCAF was able to physically associate with the NF‑κB p65 sub‑unit and enhance its acetylation. More importantly, PCAF‑induced p65 acetylation was shown to contribute to p65 phosphorylation and further upregulation of tumor necrosis factor (TNF)‑α and interleukin (IL)‑6 in gastric adenocarcinoma cells. In conclusion, the results of the present study indicated that Helicobacter pylori CagA enhanced TNF‑α and IL‑6 in gastric adenocarcinoma cells through PCAF‑mediated NF‑κB p65 sub‑unit acetylation.

Review: clinical management of Helicobacter pylori infection in China

Helicobacter pylori (H. pylori) infection has been associated with gastric disorders. The situation of H. pylori infection in China-where a high prevalence of H. pylori infection, a high incidence of gastric cancer, and widespread resistance to clarithromycin, metronidazole, and levofloxacin exist-is quite different from that in Western countries. In order for Chinese clinicians to better manage H. pylori infection, a Chinese Study Group on H. pylori published four consensus reports regarding the management of H. pylori infection in China between 1999 and 2012. The eradication rate with standard triple therapy was <80% in most areas of China. Bismuth is available in China, and bismuth-containing quadruple therapy has been shown to produce a high eradication rate; thus, bismuth quadruple therapy could be recommended both as an initial and as a rescue therapy in China. There is no advantage of sequential therapy over triple therapy in Chinese patients, but the efficacy of concomitant therapy must be studied further. This review introduces the epidemiology, diagnosis, indicators, and therapies for the eradication of H. pylori in China in recent years.

Epidemiology of Helicobacter pylori infection

Medline and PubMed databases were searched on epidemiology of Helicobacter pylori for the period of April 2013-March 2014. Several studies have shown that the prevalence of H. pylori is still high in most countries. In north European and North American populations, about one-third of adults are still infected, whereas in south and east Europe, South America, and Asia, the prevalence of H. pylori is often higher than 50%. H. pylori remains highly prevalent in immigrants coming from countries with high prevalence of H. pylori. However, the lower prevalence of infection in the younger generations suggests a further decline of H. pylori prevalence in the coming decades. Low socioeconomic conditions in childhood are confirmed to be the most important risk factors for H. pylori infection. Although the way the infection is transmitted is still unclear, interpersonal transmission appears to be the main route. Finally, H. pylori recurrence after successful eradication can still occur, but seems to be an infrequent event.