Ibuprofen, a Potential Cause of Acute Hemorrhagic Gastritis in Children - A Case Report

Helicobacter pylori in Human Stomach: The Inconsistencies in Clinical Outcomes and the Probable Causes

Pathogenic potentials of the gastric pathogen, Helicobacter pylori, have been proposed, evaluated, and confirmed by many laboratories for nearly 4 decades since its serendipitous discovery in 1983 by Barry James Marshall and John Robin Warren. Helicobacter pylori is the first bacterium to be categorized as a definite carcinogen by the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO). Half of the world’s population carries H. pylori, which may be responsible for severe gastric diseases like peptic ulcer and gastric cancer. These two gastric diseases take more than a million lives every year. However, the role of H. pylori as sole pathogen in gastric diseases is heavily debated and remained controversial. It is still not convincingly understood, why most (80–90%) H. pylori infected individuals remain asymptomatic, while some (10–20%) develop such severe gastric diseases. Moreover, several reports indicated that colonization of H. pylori has positive and negative associations with several other gastrointestinal (GI) and non-GI diseases. In this review, we have discussed the state of the art knowledge on “H. pylori factors” and several “other factors,” which have been claimed to have links with severe gastric and duodenal diseases. We conclude that H. pylori infection alone does not satisfy the “necessary and sufficient” condition for developing aggressive clinical outcomes. Rather, the cumulative effect of a number of factors like the virulence proteins of H. pylori, local geography and climate, genetic background and immunity of the host, gastric and intestinal microbiota, and dietary habit and history of medicine usage together determine whether the H. pylori infected person will remain asymptomatic or will develop one of the severe gastric diseases.

Prevalence and associated risk factors of gastritis among patients visiting Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background

The health of individuals is not only the absence of disease checked medically, but also encompasses social and psychological aspects. Any departure from the state of physiological, psychological, or social well-being was affected by different factors. However, all contributory factors were not equally responsible for affecting disease. This study was undertaken as a search for the relative effects of sociocultural and individual behavioral factors contributing to acute and chronic gastritis patients visiting Saint Paul Hospital Millennium Medical College (SPHMMC).

Methods

A cross-sectional study was carried out on 364 patients visited SPHMMC in the study. Primary data were collected through an interview schedule tool with an exit approach by validating questions pertaining to sociocultural and individual behavioral factors. The status of gastritis was measured as whether patients had Helicobacter Pylori infection, signs and symptoms indicated gastritis that occurred, and persisted for less than a month, greater than a month, or none of the signs and symptoms. Descriptive statistics, bivariate analysis, and multivariable ordinal logistic regression model were used to identify the predictors of gastritis severity. P-value ≤ 0.05 was declared as an indicator of statistically significant.

Results

The prevalence of gastritis in the study area was 78.8%. Specifically, 48.9% and 29.9% had acute and chronic gastritis, respectively. The study found that low income and taking medicinal drugs was slightly significantly contributed to higher gastritis status; however, being younger age was slightly significantly contributed to lower gastritis status. Furthermore, the results indicated that eating spiced foods (Adjusted Odds Ratio (AOR) = 1.508; 95% CI: 1.046, 2.174), lack of physical exercise regularly (AOR = 1.780; 95% CI: 1.001, 3.168), stress (AOR = 2.168; 95% CI: 1.379, 3.4066), and substance use (AOR = 1.478; 95% CI: 1.093, 1.999) were significantly contributed to higher gastritis status.

Conclusions

The findings suggested that women should take enough rest and sleep well, men refrain from involvement in any risky behaviors, young people and those who earn low income per month should equip with knowledge and understanding on how to practice good health behaviors, eating foods on time, avoiding eating spiced food frequently, doing physical exercise regularly, and taking medicinal drugs according to physician advice are recommended.

An uncommon case of herpetic esophagitis in a small child with allergic rhinitis: A case report and literature review (CARE compliant)

RATIONALE

Herpetic esophagitis (HE) is a common condition in immunosuppressed patients, but a rare entity in immunocompetent patients affecting especially male teenagers and young adults.

PATIENT CONCERNS

We report the case of a 5-year-old male patient, with a history of allergic rhinitis admitted in our clinic for acute onset fever refractory to antipyretics, chest pain, anorexia, refusal of solid food, accepting only small amounts of fluids, odynophagia, and epigastric pain. The clinical exam revealed severe malaise, pallor, decreased skin turgor, abdominal epigastric tenderness, heartburn at palpation within the epigastric area. The laboratory tests showed leukocytosis, monocytosis, hypoglycaemia, and elevated inflammatory biomarkers.

DIAGNOSES

The serology tests for human immunodeficiency virus (HIV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV) were negative, except for immunoglobulin G (IgG) anti-EBV which was positive. The chest radiography was normal, and the abdominal ultrasound showed abdominal bloating. The upper digestive endoscopy revealed friable esophageal mucosa, with multiple ulceration on the entire esophagus, and whitish exudates especially on the middle and lower part of the esophagus suggesting a possible eosinophilic esophagitis or caused by Candida. Despite the empirical initiated treatment, the patient's evolution was only slowly favorable. The histological exam established the diagnosis of HE.

INTERVENTIONS

We initiated acyclovir therapy with an outstandingly favorable evolution.

OUTCOMES

After 1 month, we detected the seroconversion of IgG anti-HSV. The patient's follow-up revealed no additional complaints.

LESSONS

Despite its rarity in immunocompetent individuals, HE must be taken into account even in otherwise healthy small children. Allergic conditions might represent a predisposing factor for HE.