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Background: The continuous increase in drug-resistant strains, the lack of novel antibiotics, and the fewer options available to combat antibiotic-resistant infections in pediatrics pose significant challenges to the eradication of Helicobacter pylori (H. pylori) in children. This study evaluated the efficacy of first-line therapy with bismuth quadruple therapy in H. pylori-positive pediatric patients with peptic ulcers., Materials and Methods: 136 patients (aged between 8 and 17 years) diagnosed with active peptic ulcers with H. pylori infection were enrolled in this study. Patients with H. pylori strain sensitive to tetracycline and metronidazole were assigned to bismuth quadruple therapy, including a proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole. Antibiotic resistance of H. pylori was analyzed by the Epsilometer test. Treatment efficacy was evaluated at 12 weeks based on H. pylori eradication and peptic ulcer healing rates. H. pylori infection status was evaluated by a 13 C-urea breath test., Results: Most isolates showed extremely high rates of resistance to commonly prescribed antibiotics used for children, including clarithromycin (97.0%) and amoxicillin (84.6%), while the low rate of resistance to levofloxacin (16.2%). The overall success rate of eradication therapy in the intention-to-treat and the per-protocol group were 86.0% and 89.3%, respectively. Peptic ulcer healing rates for total patients at 6 weeks and 12 weeks were 75.0% and 97.7%, respectively. There were no entail unpleasant adverse events, and peptic ulcer symptoms decreased steadily over time in all cases., Conclusions: The bismuth quadruple therapy with a 2-week PPI pretreatment and followed by prolonged PPI was highly successful in eradicating H. pylori infection and healing ulcers in pediatric patients with active peptic ulcer. This might be preferable as a first-line empiric treatment regimen for H. pylori-positive pediatric patients with peptic ulcers, especially in populations with high rates of resistance to amoxicillin and clarithromycin., (© 2024 John Wiley & Sons Ltd.)

Background: Helicobacter pylori is an infection of concern for its chronic colonization leading to peptic ulcers and gastric cancer. In recent times, microRNAs have been extensively studied to understand their role in the pathogenesis of this bacteria in diverse contexts of gastric diseases. The current analysis reports the microRNA-mRNA interactions that are associated with effective survival and virulence of this pathogen., Materials and Methods: We convened differentially regulated human microRNAs responsive to H. pylori infection (HP-hDEmiRs) at different multiplicity of infection and time points in human gastric cell lines through retrospective data mining of experimental studies. In view of the molecular disparity of clinical samples and animal models, data from tissue, serum/plasma, urine, and ascites were excluded. Further, we utilized diverse bioinformatics approaches to retrieve experimentally validated, high-confidence targets of the HP-hDEmiRs to analyze the microRNA-mRNA interactions that are relevant to H. pylori pathogenesis., Results: A total of 39 HP-hDEmiRs that showed unidirectional expression of either overexpression or downregulation were identified to modulate 23 targets explicitly studied under this infection. We also identified 476 experimentally validated targets regulated by at least 4 of the HP-hDEmiRs. In addition to the pathways prior-associated with H. pylori infection, the microRNA-mRNA interactome analysis identified several cellular processes and pathways highly associated with cell cycle, cell division, migration, and carcinogenesis., Conclusion: This study generated a platform to study the mechanisms utilized by this pathogen using microRNAs as surrogate., (© 2022 John Wiley & Sons Ltd.)

Background: Helicobacter pylori causes dangerous and deadly diseases such as gastric cancer and duodenal ulcers. Eradication and treatment of this bacterium are very important due to the deadly diseases caused by H. pylori and the high cost of treatment for countries., Methods: Thus, we present a complete list of the most important causes of failure in the treatment and eradication of H. pylori, and address new therapeutic methods that may be effective in controlling this bacterium in the future., Results: Many efforts have been made to control and eradicate this bacterium over the years, but no success has been achieved since its eradication is a complex process affected by the bacterial properties and host factors. Previous studies have shown that various factors are involved in the failure to eradicate H. pylori, such as new genotypes of the bacterium with higher pathogenicity, inappropriate patient cooperation, mutations, biofilm formation and dormant forms that cause antibiotic resistance, acidic stomach pH, high bacterial load, smoking, immunosuppressive features and intracellular occurrence of H. pylori. On the other hand, recent studies reported that the use of probiotics, nanoparticles, antimicrobial peptides, natural product and vaccines can be helpful in the treatment and eradication of H. pylori infections., Conclusion: Eradication of H. pylori is crucial for the treatment of important diseases such as gastric cancer. Therefore, it seems that identifying the failure causes of treating this bacterium can be helpful in controlling the infections. Besides, further studies on new therapeutic strategies may help eradicate H. pylori in the future., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Aim: The aim of the present study is to investigate the frequency of celiac disease in children with peptic ulcers and to compare it with that of non-celiac peptic ulcers in terms of clinical and laboratory values., Methods: Upper gastrointestinal endoscopy was performed in 1769 patients at the Department of Pediatric Gastroenterology, The Faculty of Medicine, Cukurova University, Turkey, between January 2012 and January 2017. These cases consisted of subjects presenting with various GIS symptoms and indicated for endoscopy (with chronic diarrhea, delayed growth and development, abdominal pains, GIS bleeding, etc.). The levels of immunoglobulin A (IgA) serum anti-tissue transglutaminase antibodies, IgA anti-endomysial antibodies (EMA), and IgA serum were estimated in the patients with peptic ulcers., Results: Celiac disease was diagnosed with serology, endoscopy, and histopathology in 250 (14%) of all cases undergoing endoscopy. Peptic ulcers were diagnosed in 74 patients (4.2%) of all cases undergoing endoscopy. tTGA and EMA (+) levels were determined in 22 (29%) of the 74 patients with peptic ulcers, and then the presence of peptic ulcers was investigated in the upper gastrointestinal system using gastrointestinal endoscopy, followed by histopathological confirmation of celiac disease. HP infection was present in 14 (63%) of the patients with celiac disease and in 23 (44%) of non-celiac peptic ulcers; the difference was not statistically significant (p = 0.12). In the total ulcer group, 10.8% (8/74) of patients with celiac peptic ulcers were negative for HP infection, whereas 21% (8/37) of HP-negative patients with ulcers had celiac disease., Conclusion: There exists a high risk of celiac disease in children with peptic ulcers. We thus recommend celiac disease to be investigated, particularly in HP-negative patients with peptic ulcers but with no history of NSAID use.

Although proton pump inhibitors (PPIs) have been used widely, acid-related diseases are still associated with a huge burden on the health care system. Recently, the efficacy and safety of a new acid suppressant named vonoprazan in the treatment of acid-related diseases have been evaluated by a series of studies. As a novel potassium-competitive acid blocker, vonoprazan may provide reversible acid suppression by preventing K + from binding to gastric H + /K + -ATPase. It has been clinically used for the short-term treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease and Helicobacter pylori (H. pylori) infection in Japan. The healing rate of GERD and gastric ulcers by vonoprazan is more than 95 and 90%, respectively; also, it is effective in curing PPI-resistant GERD. It increases H. pylori eradication rate to more than 88% as part of both first-line and second-line therapy. It is also effective in the eradication of clarithromycin-resistant H. pylori strains. All of these short-term studies show vonoprazan is safe and well-tolerated. As a safe and effective acid inhibitor, vonoprazan might be a novel alternative in the treatment of acid-related diseases.

Helicobacter pylori (H. pylori) usually colonizes the gastric mucosa of more than 50% of the human population, causing an infection that may appear in early childhood and can persist for life. H. pylori is suggested as the main cause of peptic ulcer and chronic gastritis. It is also associated with gastric cancer. Its severity and symptoms depend on environmental factors, host susceptibility and bacterial components, which allow H. pylori to switch between commensalism and pathogenicity. H. pylori is genetically highly variable, and the variability which affects H. pylori virulence factors might be useful in identifying the strains with different degrees of pathogenicity. The geographic distribution of distinct H. pylori genotypes is largely unknown and should be established. The prevalence of more pathogenic genotypes in certain areas may have important epidemiological consequences. It also might be associated with the severity of H. pylori related diseases in such regions. Given that Iran is located in the Middle East and Asian populations have revealed high levels of gastric cancer, it is of clinical interest to clarify the potential of H. pylori virulence markers in predicting the associated clinical outcomes. In this review, clinical relevance of adhesion molecules and significant virulence factors of H. pylori in Iranian patients with gastrointestinal diseases are discussed in comparison to other countries., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Helicobacter pylori (H. pylori) infection is regarded as the major cause of various gastric diseases (gastritis, peptic ulcers and gastric cancer) and induces the production of several cytokines. Interleukin-17 (IL-17) is recently recognized as an important player in the pathophysiology of infectious and immune-mediated gastrointestinal diseases. H. pylori infection increases IL-17 in the gastric mucosa of humans. IL-17 usually causes secretion of IL-8 through activation of ERK 1/2 MAP kinase pathway. The released IL-8 attracts neutrophils promoting inflammation. T regulatory cells (Tregs) suppress the inflammatory reaction driven by IL-17, there by favoring bacterial persistence in H. pylori-infection. The pathogenesis of H. pylori-induced inflammation is not well understood. Inflammation is promoted by both host factors and H. pylori factors, such as the proteins cytotoxin associated gene A (cagA) and vacuolating cytotoxin A (vacA). IL-1β, IL-6, tumor necrosis factor (TNF)-α, TGF-β1, IL-17, IL-18, IL-21 and IL-22 have been reported to be involved in H. pylori-induced gastric mucosal inflammation, but the details and relation to different patterns of inflammation remain unclear. Numerous studies have demonstrated important functions of IL-17 in acute and chronic inflammatory processes. This paper reviews the role of IL-17 in gastritis, peptic ulcers and gastric cancer related to H. pylori., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The optimal therapy for Helicobacter pylori (H. pylori) infection should combine a high cure rate and a short treatment duration with a favorable side-effect profile and should maintain a low cost. Several strategies have been proposed to increase the H. pylori eradication rate, including the extension of the treatment duration to 14 d, the use of a four-drug regimen (quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as levofloxacin. However, triple therapy remains the most widely accepted first-line treatment regimen in Brazil and the United States and throughout Europe. Because this therapy is limited by resistance to clarithromycin, other therapeutic regimens have been investigated worldwide. This review describes the current literature involving studies directly comparing these different therapies and their efficacies.

Background: Distinguishing the rates of Helicobacter pylori infection in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients with peptic ulcer disease (PUD) from that in PUD patients without CKD is critical., Methods: We first stratified the original 1 million study population according to CKD or ESRD. We retrospectively investigated the incidence of H. pylori infection in PUD patients with or without CKD or ESRD between 2000 and 2008 in a nationwide, population-based cohort using data from the Taiwan National Health Insurance Research Database. The comparison cohort consisted of PUD patients without CKD. A logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals, to determine whether the occurrence of H. pylori infection in CKD or ESRD patients with PUD differed from that of PUD patients without CKD., Results: Among the CKD patients, 261 patients had H. pylori-positive and 185 H. pylori-negative peptic ulcers. Among the ESRD patients, 81 had H. pylori-positive and 63 H. pylori-negative peptic ulcers. Among the non-CKD control patients, 1658 patients had H. pylori-positive and 702 H. pylori-negative peptic ulcers. Our results revealed a lower H. pylori infection rate in CKD (OR = 0.64, p < 0.001) and ESRD (OR = 0.54, p = 0.001) patients with PUD than in PUD patients without CKD., Conclusion: The H. pylori infection rate is lower in PUD patients with CKD and ESRD than in those without CKD., (Copyright © 2014. Published by Elsevier B.V.)

The widely believed Helicobacter pylori infection has never explained the birth-cohort phenomenon of peptic ulcers. Although numerous studies have observed that environmental factors are associated with peptic ulcers, their role in the disease has yet to be identified. A new etiological theory proposed that environmental factors cause peptic ulcers via inducing psychological stress. Starting from this etiology, an integration of the mortality rates caused by social and natural environmental factors reproduced a representative fluctuation curve in the birth-cohort phenomenon, where a causal role of environmental factors in peptic ulcers was hidden. The reproduced fluctuation curve revealed that multiple environmental factors caused the birth-cohort phenomenon by Superposition Mechanism, and the causal role of each individual environmental factor surfaced if the fluctuation curves in the birth-cohort phenomenon were properly differentiated. A full understanding of the birth-cohort phenomenon highlights the importance of environmental management in improving clinical outcomes, and suggests that the Superposition Mechanism is an indispensable methodological concept for life science and medicine. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori (H. pylori) is a causative agent of peptic ulcer which presently affects more than half of the world's population. This study determined H. pylori prevalence and risk variables among peptic ulcer patients in Akure, Ondo State, Nigeria. Methods: Two-hundred (200) study participants consented at local hospitals. A pre-tested, structured questionnaire collected socio-demographic and risk factor information from participants. Participants' blood samples were tested with a fast chromatographic immunoassay kit for H. pylori antibodies. Results: 73.5 %of the 200 tested subjects had H. pylori. Prevalence was greater among women (74.8%) than men (71.6%). The most heavily impacted age group for H. pylori infection is 21–30 years with 78.4% prevalence, while the least affected is 51–60 years with 66.7% prevalence. Married respondents (77.2%) had a greater prevalence of H. pylori than singles (71.1%). The difference in prevalence rate based on individuals' education and occupation was not statistically significant (p=0.407 and 0.999, respectively). Helicobacter pylori infection was significantly associated with NSAID use (X2= 8.917, p=

Background: Helicobacter pylori (H. pylori) is a causative agent of peptic ulcer which presently affects more than half of the world's population. This study determined H. pylori prevalence and risk variables among peptic ulcer patients in Akure, Ondo State, Nigeria. Methods: Two-hundred (200) study participants consented at local hospitals. A pre-tested, structured questionnaire collected socio-demographic and risk factor information from participants. Participants' blood samples were tested with a fast chromatographic immunoassay kit for H. pylori antibodies. Results: 73.5 %of the 200 tested subjects had H. pylori. Prevalence was greater among women (74.8%) than men (71.6%). The most heavily impacted age group for H. pylori infection is 21–30 years with 78.4% prevalence, while the least affected is 51–60 years with 66.7% prevalence. Married respondents (77.2%) had a greater prevalence of H. pylori than singles (71.1%). The difference in prevalence rate based on individuals' education and occupation was not statistically significant (p=0.407 and 0.999, respectively). Helicobacter pylori infection was significantly associated with NSAID use (X²= 8.917, p=<0.001), smoking (X²=4.988, p=0.02), residing in a crowded room (X²=4.439, p=0.03), and a family history of peptic ulcer (X²=19.70, p=<0.0001). Conclusion: This study found substantial H. pylori prevalence among peptic ulcer patients. Helicobacter pylori testing should be considered relevant in clinical practice, especially in patients with peptic ulcer symptoms, and not only antacid prescriptions. For efficient patient treatment and to prevent chronic gastritis and stomach cancer, H. pylori must be thoroughly investigated and treated. [ABSTRACT FROM AUTHOR]

The development of sequencing technology has expanded our knowledge of the human gastric microbiome, which is now known to play a critical role in the maintenance of homeostasis, while alterations in microbial community composition can promote the development of gastric diseases. Recently, carcinogenic effects of gastric microbiome have received increased attention. Gastric cancer (GC) is one of the most common malignancies worldwide with a high mortality rate. Helicobacter pylori is a well-recognized risk factor for GC. More than half of the global population is infected with H. pylori, which can modulate the acidity of the stomach to alter the gastric microbiome profile, leading to H. pylori-associated diseases. Moreover, there is increasing evidence that bacteria other than H. pylori and their metabolites also contribute to gastric carcinogenesis. Therefore, clarifying the contribution of the gastric microbiome to the development and progression of GC can lead to improvements in prevention, diagnosis, and treatment. In this review, we discuss the current state of knowledge regarding changes in the microbial composition of the stomach caused by H. pylori infection, the carcinogenic effects of H. pylori and non-H. pylori bacteria in GC, as well as the potential therapeutic role of gastric microbiome in H. pylori infection and GC.

The development of sequencing technology has expanded our knowledge of the human gastric microbiome, which is now known to play a critical role in the maintenance of homeostasis, while alterations in microbial community composition can promote the development of gastric diseases. Recently, carcinogenic effects of gastric microbiome have received increased attention. Gastric cancer (GC) is one of the most common malignancies worldwide with a high mortality rate. Helicobacter pylori is a well-recognized risk factor for GC. More than half of the global population is infected with H. pylori , which can modulate the acidity of the stomach to alter the gastric microbiome profile, leading to H. pylori -associated diseases. Moreover, there is increasing evidence that bacteria other than H. pylori and their metabolites also contribute to gastric carcinogenesis. Therefore, clarifying the contribution of the gastric microbiome to the development and progression of GC can lead to improvements in prevention, diagnosis, and treatment. In this review, we discuss the current state of knowledge regarding changes in the microbial composition of the stomach caused by H. pylori infection, the carcinogenic effects of H. pylori and non- H. pylori bacteria in GC, as well as the potential therapeutic role of gastric microbiome in H. pylori infection and GC. [ABSTRACT FROM AUTHOR]

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Background: The incidence of peptic ulcers unrelated to H. pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs), termed idiopathic peptic ulcers (IPUs), has increased worldwide. We recently reported that IPUs were refractory to proton pump inhibitor (PPI) treatment. Vonoprazan, which was recently developed in Japan, has shown a more potent acid-inhibitory effect than ordinary PPIs. In the present study, we compared the healing rates among peptic ulcers of different etiologies following treatment with vonoprazan.Method: A multicenter observational study was performed at six participating hospitals in Akita Prefecture, Japan. Consecutive patients who had endoscopically confirmed gastro-duodenal ulcers were enrolled between August 2016 and March 2018. For each patient, the Helicobacter pylori infection status and NSAID use, including aspirin, were checked, and 20 mg vonoprazan was administered for 6 weeks for duodenal ulcers and 8 weeks for gastric ulcers. The healing status was checked by endoscopy at the end of vonoprazan treatment. Patients were divided into four subgroups according to the H. pylori status and NSAID usage.Results: The proportion of IPUs was 18.2%. A total of 162 patients completed the study protocol. The healing rate of IPUs was marginally lower than that of simple H. pylori-associated ulcers (81.2% vs. 93.5%, P = 0.05). Similarly, the healing rate of NSAID-related ulcers, irrespective of concomitant H. pylori infection, was significantly lower than that of simple H. pylori-associated ulcers.Conclusions: Six- or 8-week vonoprazan treatment still seems to be insufficient for healing IPUs. Longer-term vonoprazan or another treatment option may be required to heal potentially refractory peptic ulcers. [ABSTRACT FROM AUTHOR]

After a long time of searching for microbial agents responsible for gastric disorders, in 2005 the noble prize was given to Robin Warren and Barry Marshall for the isolation of Helicobacter pylori (H. pylori) from human stomach and discovering the association between H. pylori infection and gastritis, peptic ulcers, and gastric cancer. Currently, an important part of research on digestive diseases is concerned with microbiology of H. pylori and its control, with the aim of preventing peptic ulcers and gastric cancer. Reports indicate that peptic diseases are developed as the consequence of interaction between H. pylori infection, genetic background of the human host, and the lifestyle of individuals. As most of H. pylori-infected individuals are asymptomatic, the role of host genetics and lifestyle might be more important than what previously suggested. Up to now investigators have not been successful to show that H. pylori isolates from gastritis, ulcer, and cancer are different. H. pylori acquisition occurs during childhood and food ingestion and close contact of infant with mother are the most probable routes of bacterial transmission. High frequency of H. pylori infection in many human populations indicates that the bacterium might have been established in yeast as an environmental host. Inside yeast H. pylori is protected from environmental stresses and can have access to plenty of food. Furthermore, yeast can serve as a reservoir for H. pylori, which facilitates bacterial spread in the environment as well as within human hosts. It has been suggested that H. pylori could have jumped from an intermediate host to humans and migrated along with human host from Africa to different geographic regions of the world. Peptic ulcer and gastric cancer are the important consequences of H. pylori infection that can be treated or prevented, in most of the cases, by antimicrobial therapy. Reports indicate a considerable decrease in peptic ulcers; however gastric cancers is one of the important issues in medical practice. Reports show high incidence of gastric cancer in northern provinces of Iran including Mazandaran, Guilan, Golestan, and Ardabil. High-incidence regions of gastric cancer are located in Asia and comprise a cancer belt that passes through Japan, Korea, certain regions in China, and Northern Iran. In Iran gastric cancer is the most prevalent cancer in men and the third cancer in women. Ardabil is the highest in the incidence of gastric and esophageal cancers. Eradication of H. pylori has been recommended in cases of gastric ulcer and those patients at the risk of gastric cancer. Occurrence of a considerable number of H. pylori-infected individuals in different human populations without symptoms indicates that H. pylori might be a beneficial human commensal microorganism rather than a pathogen. [ABSTRACT FROM AUTHOR]

Introduction: To meet key millennium development goals, the rural population needs to be reached for health assessment and service delivery. Gastroduodenal ulcer disease is a common ailment affecting the health of people in Uganda. A cross-sectional study was conducted at Bwera Hospital in Kasese district of western Uganda, to establish the prevalence and predisposing factors of Helicobacter pylori among gastroduodenal ulcer disease patients. Methods: A sample of 174 patients with symptoms of gastroduodenal ulcer disease was purposively obtained. Using two laboratory test methods, the prevalence of H. pylori among these patients was determined. A structured questionnaire was administered to participants to establish their demographic background and selected aspects of their lifestyle. Finally, the results obtained by enzyme-linked immunosorbent assay (ELISA) and immunochromatographic rapid test (IRT) were compared. Results: We established the prevalence of H. pylori as 29.9% (52/174) by ELISA and 37.4% (65/174) by IRT. Cigarette smoking, poor sanitation, and lack of formal education were the significant predisposing factors with p-values

Objectives: Rheumatoid arthritis (RA) patients often take non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids as supportive drugs. In this study, we investigated the prevalence of endoscopic gastric damage and their prescribed medications under an actual clinical condition. Methods: We collected the data of 1704 RA patients who underwent upper gastrointestinal fiberscopy. Gastric mucosal erosion and ulcer were classified using modified LANZA score. We analyzed these data with a multiple regression analysis. Results: The prevalence of endoscopic gastric mucosal damage in these RA patients was 16.7% (285 cases). A multiple regression analysis indicated that prednisolone (PSL), NSAIDs and proton pump inhibitors (PPIs) were independent risk factors associated with the modified LANZA score. PSL and NSAIDs were positively correlated with the score, while the administration of PPIs was inversely correlated with the score. The modified LANZA score in RA patients treated with both PSL and NSAIDs was significantly higher than that in those treated with PSL alone (no NSAIDs use). Conclusions: Our findings suggest that PSL and NSAIDs were exacerbating factors for gastric mucosal damage, while PPIs usage was a protective factor. And, the combined usage of corticosteroids and NSAIDs may induce the development of gastric ulcers. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy and tolerability of tetracycline vs. high-dose amoxicillin in bismuth-based quadruple therapy for Helicobacter pylori(H. pylori) eradication. Methods: This randomized, open-label clinical trial included 228 patients with H.pylori infection and duodenal ulcer without a history of H.pylori treatment. Patients were randomly divided into two groups. The amoxicillin group received metronidazole 500mg, bismuth subcitrate 240mg, and amoxicillin 1000mg, all three times a day, plus omeprazole 20 mg twice a day, for 14 days. The tetracycline group received metronidazole 500mg three times a day; bismuth subcitrate240mg and tetracycline HCl 500mg, both four times a day; and omeprazole 20 mg twice a day, for 14 days. Evaluation for compliance and drug-relatedadverse effects were evaluated at the end of two weeks. Eight weeks after the end of treatment, the rate of H.pylori eradication was assessed by the C13urease breath test. Results: There were no significant demographic differences between the two groups. Eradication rate was higher with the amoxicillin-containing regimen than the tetracycline-containing regimen: 105/110 (95.51%; 95% confidence interval, 91.5%–99.3%) vs. 88/105 (83.8%; 95%CI, 76.7%–90.8%) by per-protocol analysis (p = 0.005) and 92.9% (95%CI, 88.1%–97.6%) vs. 76.5% (95%CI, 68.7%–84.2%) by intention-to-treat analysis (ITT, p = 0.001). Adverse effects were significant higher in the tetracycline groupthan in the amoxicillin group (65.2% vs. 43.4%; p = 0.001). Conclusion: Bismuth-based quadruple therapy including high-dose amoxicillin and metronidazole achieved an acceptable rate of H.pylori infection eradication with good tolerance in patients with duodenal ulcer. This regimen can overcome treatment resistance in areas with high prevalence of metronidazole and clarithromycin resistance. Trial registration: The Thai Clinical Trial Registry (TCTR) [ABSTRACT FROM AUTHOR]

Background and aims: The prevalence of Helicobacter pylori (H. pylori) tends to be lower in Western countries such as central Europe compared with Asia. The virulence of H. pylori is influenced by its subtype composition, most importantly by the presence or absence of different types of cytotoxin-associated gene A(CagA). This study aimed to assess the prevalence of H. pylori and its respective CagA phenotype in a large retrospective cohort of patients with gastric cancer or duodenal ulcer at a Western tertiary referral institution. Methods: H. pylori positive gastric biopsy samples from patients diagnosed with the afore mentioned diseases within the past 25 years were re-evaluated by histology for H. pylori and status of gastritis. Confirmed H. pylori positive cases were processed for immunohistochemistry (IHC) for H. pylori,CagA, and EastAsiantype CagA. Results: The prevalence of H. pylori positive gastric biopsy samples decreased from 20.7% to 2.3% within the study period. Among the gastric cancer patients, the H. pylori positive rate was 16.6%, and didn’t show significant changes over time (p = 0.38). Contrary, the H. pylori positive rate of duodenal ulcer decreased significantlyfrom 40% to 5% (p = 0.01). Within H. pylori positive groups ofboth diseases, CagA was highly detected at IHC (86% and 78%, respectively). Except for a few patients originating from East Asian countries, all CagA detected in this study were of Western type. Conclusion: In this first Western investigation on the chronological prevalence of H. pylori and its most relevant subtypes, Western type of CagA was highly detected in two important index diseases of the pathogen. This raises further questions about the virulence of this subtype. [ABSTRACT FROM AUTHOR]

The evidences on the association of Helicobacter pylori (H. pylori) to coronary heart diseases (CHD) are conflicting. In order to answer this important but yet unanswered clinical health issue, a large cohort study such as big data from the Taiwan National Health Insurance Research Database should be more convincing. Therefore, we aimed to make use of these big data source to analyze and clarify the relevance of H. pylori eradication and CHD risks. We looked through a total of 208196 patients with peptic ulcer diseases (PUD) from the years of 2000 to 2011. First, 3713 patients who received H. pylori eradication within 365 days of the index date were defined as the group A. We randomly selected the same number of patients as cohort A from 55249 non-eradication patients to be the comparison group B using propensity scores (including age, gender and comorbidity) so that we could control the confounding variables of CHD and mortality. Importantly, we perform sensitivity analysis for the time-dependent association between H. pylori eradication and risk of CHD, interactions between patient demographic characteristics and therapy by age (≥ or < 65 years old). The results showed that a trend of decreased association of CHD in patients with early eradication was observed compared to those without eradication (2.58% vs. 3.35%, p = 0.0905). The mortality rate was lower in early eradication subgroup compared to cohort B (2.86% vs. 4.43%, p = 0.0033). Interestingly, there was also significant difference observed in composite end-points for CHD and death in the early eradication subgroup (0.16% vs.0.57%, p = 0.0133). Further, the cumulative CHD rate was significantly lower in younger patients (< 65 years old) with H. pylori eradication therapy started < 1 year compared to those patients without eradication at all (p = 0.0384); the treatment did not appear to have an effect in older patients (≥ 65 years old) (p = 0.1963). Multivariate analysis showed that hypertension and renal diseases were risk factors for CHD in patients without eradication whilst younger age (< 65 years old) initiated with H. pylori therapy was a protective factor. In conclusion, the trend of decrease in CHD occurrence after early H. pylori eradication in addition to the significant decrease in composite end points for CHD and death, the significantly lower cumulative CHD rate in younger patients < 65 years old with H. pylori treated within 365 days suggested that there was positive association between H. pylori eradication and CHD. [ABSTRACT FROM AUTHOR]

Background: Evidence is conflicting regarding the association between Helicobacter pylori infection and diabetes mellitus. The study objective was to examine associations of H. pylori infection, gastric ulcers and duodenal ulcers, with diabetes mellitus. Methods: This cross-sectional study was undertaken using coded data from the computerized database of Maccabi Health Services in Israel, on 147,936 individuals aged 25–95 years who underwent the urea breath test during 2002–2012. Multiple logistic regression models were conducted, while adjusting for known risk factors for diabetes mellitus. Results: A H. pylori positive test was recorded for 76,992 (52.0%) individuals and diabetes for 12,207 (8.3%). The prevalence of diabetes was similar in individuals with and without H. pylori infection, but this association was modified (P for heterogeneity 0.049) by body mass index (BMI): adjusted odds ratio (aOR) 1.16 (95% confidence intervals (CI) 1.04–1.29) in persons with BMI<25 kg/m2 versus aOR 1.03 (95% CI 0.98–1.08) in persons with BMI≥25 kg/m2. Diabetes mellitus prevalence was higher in persons with gastric (aOR 1.20 (95% CI 1.06–1.34)) and duodenal ulcers (aOR 1.20 (95% CI 1.12–1.28)) compared to persons without these diagnoses. Conclusions: In this large population-based study, we demonstrated significant positive associations, albeit of small magnitude, of H. pylori infection and peptic disease with diabetes. The long-term gastric inflammation and associated-damage to the gastric mucosa might play a role in such associations. [ABSTRACT FROM AUTHOR]

The primary study objectives were to estimate the frequencies and rates of gastrointestinal bleeding and peptic ulcerative disorder in HIV-positive patients compared with age- and sex-matched HIV-negative subjects. Data from a US insurance claims database was used for this analysis. Among 89,207 patients with HIV, 9.0% had a GI bleed, 1.0% had an upper gastrointestinal bleed, 5.6% had a lower gastrointestinal bleed, 1.9% had a peptic ulcerative disorder diagnosis, and 0.6% had both gastrointestinal/peptic ulcerative disorder. Among 267,615 HIV-negative subjects, the respective frequencies were 6.9%, 0.6%, 4.3%, 1.4%, and 0.4% (p<0.0001 for each diagnosis subcategory). After combining effect measure modifiers into comedication and comorbidity strata, gastrointestinal bleeding hazard ratios (HRs) were higher for HIV-positive patients without comedication/comorbidity, and those with comedication alone (HR, 2.73; 95% confidence interval [CI], 2.62–2.84; HR, 1.59; 95% CI, 1.47–1.71). The rate of peptic ulcerative disorder among those without a history of ulcers and no comorbidity/comedication was also elevated (HR, 2.72; 95% CI, 2.48–2.99). Hazard ratios of gastrointestinal bleeding, and peptic ulcerative disorder without a history of ulcers were lower among patients infected with HIV with comedication/comorbidity (HR, 0.64; 95% CI, 0.56–0.73; HR, 0.46; 95% CI, 0.33–0.65). Rates of gastrointestinal bleeding plus peptic ulcerative disorder followed a similar pattern. In summary, the rates of gastrointestinal/peptic ulcerative disorder events comparing HIV-infected subjects to non–HIV-infected subjects were differential based on comorbidity and comedication status. [ABSTRACT FROM AUTHOR]

Hans Selye in a note to Nature in 1936 initiated the field of stress research by showing that rats exposed to nocuous stimuli responded by way of a 'general adaptation syndrome' (GAS). One of the main features of the GAS was the 'formation of acute erosions in the digestive tract, particularly in the stomach, small intestine and appendix'. This provided experimental evidence for the view based on clinical data that gastroduodenal (peptic) ulcers could be caused by stress. This hypothesis was challenged by Marshall and Warren's Nobel Prize (2005)-winning discovery of a causal association between Helicobacter pylori and peptic ulcers. However, clinical and experimental studies suggest that stress can cause peptic ulceration in the absence of H. pylori. Predictably, the etiological pendulum of gastric and duodenal ulceration has swung from 'all stress' to 'all bacteria' followed by a sober realization that both factors play a role, separately as well as together. This raises the question as to whether stress and H. pylori interact, and if so, how? Stress has also been implicated in inflammatory bowel disease (IBD) and related disorders; however, there is no proof yet that stress is the primary etiological trigger for IBD. Central dopamine mechanisms seem to be involved in the stress induction of peptic ulceration, whereas activation of the sympathetic nervous system and central and peripheral corticotrophin-releasing factor appears to mediate stress-induced IBD. [ABSTRACT FROM AUTHOR]

Background: The effect of H. pylori eradication in gastric cancer prevention can be attributed to the improvement of atrophic gastritis, which is a known risk of gastric cancer. However, gastric cancer has also been diagnosed after long-term H. pylori eradication. This study aimed to clarify the association between gastric atrophy and gastric cancer after H. pylori eradication, including its clinicopathological features. Methods: A total of 55 consecutive patients with 64 early gastric cancers (EGCs) diagnosed after H. pylori eradication were enrolled. The degree of endoscopic atrophy and the histological degrees of mononuclear cell infiltration, atrophy, and metaplasia in the corpus and adjacent mucosa of the EGCs were determined and scored. Results: The majority of EGCs (63/64) were located within the endoscopically assessed atrophic mucosa or along the atrophic border. The adjacent mucosa of the EGCs presented significantly higher degrees of all histological parameters than in the corpus (mononuclear cell infiltration, 0.86+/-0.09 vs. 0.51+/-0.11, P = 0.016; atrophy, 1.77+/-0.13 vs. 0.65+/-0.14, P<0.0001; metaplasia, 1.68+/-0.13 vs. 0.48+/-0.1, P<0.0001). The degree of endoscopic atrophy improved in the patients with longer post-H. pylori eradication periods; however, this trend was not observed for the histological parameters, and high degrees of atrophy and metaplasia were observed in the adjacent mucosa of the EGCs compared with the corpus during all periods (all P<0.05). The histological degrees of atrophy and metaplasia in the adjacent mucosa were particularly higher in the patients who underwent eradication due to gastric ulcers. Conclusions: Severe gastric atrophy remained in the adjacent mucosa of the EGCs after H. pylori eradication, which may be linked to gastric carcinogenesis. [ABSTRACT FROM AUTHOR]

Background: Low-dose aspirin has proven effectiveness in secondary and primary prevention of cardiovascular events, but is also associated with an increased risk of major bleeding events. For primary prevention, this absolute risk must be carefully weighed against the benefits of aspirin; such assessments are currently limited by a lack of data from general populations. Methods: Systematic searches of Medline and Embase were conducted to identify observational studies published between 1946 and 4 March 2015 that reported the risks of gastrointestinal (GI) bleeding or intracranial hemorrhage (ICH) with long-term, low-dose aspirin (75–325 mg/day). Pooled estimates of the relative risk (RR) for bleeding events with aspirin versus non-use were calculated using random-effects models, based on reported estimates of RR (including odds ratios, hazard ratios, incidence rate ratios and standardized incidence ratios) in 39 articles. Findings: The incidence of GI bleeding with low-dose aspirin was 0.48–3.64 cases per 1000 person-years, and the overall pooled estimate of the RR with low-dose aspirin was 1.4 (95% confidence interval [CI]: 1.2–1.7). For upper and lower GI bleeding, the RRs with low-dose aspirin were 2.3 (2.0–2.6) and 1.8 (1.1–3.0), respectively. Neither aspirin dose nor duration of use had consistent effects on RRs for upper GI bleeding. The estimated RR for ICH with low-dose aspirin was 1.4 (1.2–1.7) overall. Aspirin was associated with increased bleeding risks when combined with non-steroidal anti-inflammatory drugs, clopidogrel and selective serotonin reuptake inhibitors compared with monotherapy. By contrast, concomitant use of proton pump inhibitors decreased upper GI bleeding risks relative to aspirin monotherapy. Conclusions: The risks of major bleeding with low-dose aspirin in real-world settings are of a similar magnitude to those reported in randomized trials. These data will help inform clinical judgements regarding the use of low-dose aspirin in prevention of cardiovascular events. [ABSTRACT FROM AUTHOR]

Abstracts of the oral and poster presentations and video festivals presented at the 26th World Congress of the International Association of Surgeons, Gastroenterologists and oncologists (IASGO) that will be held on September 8-10, 2016 in Seoul, South Korea are presented.