Is Helicobacter pylori infection protective against esophageal cancer?

Helicobacter pylori(H.pylori)infection affects a substantial proportion of the global population and causes various gastric disorders,including gastric cancer.Recent studies have found an inverse relationship between H.pylori infection and eso-phageal cancer(EC),suggesting a protective role against EC.This editorial focuses on the possible mechanisms underlying the role of H.pylori infection in EC and explores the role of gut microbiota in esophageal carcinogenesis and the prac-ticality of H.pylori eradication.EC has two major subtypes:Esophageal squamous cell carcinoma(ESCC)and esophageal adenocarcinoma(EAC),which have different etiologies and risk factors.Gut microbiota can contribute to EC via inflammation-induced carcinogenesis,immunomodulation,lactagenesis,and genotoxin production.H.pylori infection is said to be inversely related to EAC,protecting against EAC by inducing atrophic gastritis,altering serum ghrelin levels,and triggering cancer cell apoptosis.Though H.pylori infection has no significant association with ESCC,COX-2-1195 polymorphisms and endogenous nitrosamine production can impact the risk of ESCC in H.pylori-infected in-dividuals.There are concerns regarding a plausible increase in EC after H.pylori eradication treatments.However,H.pylori eradication is not associated with an increased risk of EC,making it safe from an EC perspective.

Treatment of Helicobacter pylori with potassium competitive acid blockers:A systematic review and meta-analysis

BACKGROUND Helicobacter pylori(H.pylori)infects over half the global population,causing gastrointestinal diseases like dyspepsia,gastritis,duodenitis,peptic ulcers,GMALT lymphoma,and gastric adenocarcinoma.Eradicating H.pylori is crucial for treating and preventing these conditions.While conventional proton pump inhibitor(PPI)-based triple therapy is effective,there’s growing interest in longer acid suppression therapies.Potassium competitive acid blocker(P-CAB)triple and dual therapy are new regimens for H.pylori eradication.Initially used in Asian populations,vonoprazan(VPZ)has been recently Food and Drug Administration-approved for H.pylori eradication.AIM To assess the efficacy of regimens containing P-CABs in eradicating H.pylori infection.METHODS This study,following PRISMA 2020 guidelines,conducted a systematic review and meta-analysis by searching MEDLINE and Scopus libraries for randomized clinical trials(RCTs)or observational studies with the following command:[("Helicobacter pylori"OR"H pylori")AND("Treatment"OR"Therapy"OR"Eradication")AND("Vonaprazan"OR"Potassium-Competitive Acid Blocker"OR"P-CAB"OR"PCAB"OR"Revaprazan"OR"Linaprazan"OR"Soraprazan"OR"Tegoprazan")].Studies comparing the efficacy of P-CABs-based treatment to classical PPIs in eradicating H.pylori were included.Exclusion criteria included case reports,case series,unpublished trials,or conference abstracts.Data variables encompassed age,diagnosis method,sample sizes,study duration,intervention and control,and H.pylori eradication method were gathered by two independent reviewers.Meta-analysis was performed in R software,and forest plots were generated.RESULTS A total of 256 references were initially retrieved through the search command.Ultimately,fifteen studies(7 RCTs,7 retrospective observational studies,and 1 comparative unique study)were included,comparing P-CAB triple therapy to PPI triple therapy.The intention-to-treat analysis involved 8049 patients,with 4471 in the P-CAB intervention group and 3578 in the PPI control group across these studies.The analysis revealed a significant difference in H.pylori eradication between VPZ triple therapy and PPI triple therapy in both RCTs and observational studies[risk ratio(RR)=1.17,95%confidence interval(CI):1.11-1.22,P<0.0001]and(RR=1.13,95%CI:1.09-1.17,P<0.0001],respectively.However,no significant difference was found between tegoprazan(TPZ)triple therapy and PPI triple therapy in both RCTs and observational studies(RR=1.04,95%CI:0.93-1.16,P=0.5)and(RR=1.03,95%CI:0.97-1.10,P=0.3),respectively.CONCLUSION VPZ-based triple therapy outperformed conventional PPI-based triple therapy in eradicating H.pylori,positioning it as a highly effective first-line regimen.Additionally,TPZ-based triple therapy was non-inferior to classical PPI triple therapy.

Association between central serous chorioretinopathy and Helicobacter pylori infection: a systematic review and Meta-analysis

AIM:To investigate the association between central serous chorioretinopathy(CSC)and Helicobacter pylori(Hp)by summarizing all available evidence.METHODS:The Scopus,Embase,EBSCO,PubMed,Web of Science,and Cochrane Library databases for all relevant studies published from inception to October 2022 were searched,and manually searched for relevant reference lists as a supplement.Studies investigating the association between CSC and Hp infection were included.Finally,8 case-control studies were included in the Meta-analysis after study selection.RESULTS:The results showed no significant correlation between Hp infection and CSC[odds ratio(OR)1.89,95%confidential interval(CI)0.58–6.15,I2=96%,P=0.29].After subgroup analysis based on the degree of development of the study(developing/developed countries),it was found that the results of the two subgroups were the same as the whole,and no significant difference between the two subgroups existed.Meta-regression showed that the effect of sample size on heterogeneity among studies was more prominent(P<0.01,adjusted R^(2)=89.72%),which can explain 89.72%of the sources of heterogeneity.CONCLUSION:This Meta-analysis reveals no significant correlation between Hp infection and CSC,which still warrants further well-designed extensive sample studies to reach a more reliable conclusion and promote a better understanding of the treatment of CSC.

Estimate the Prevalence of Helicobacter pylori Infection among Diabetes & Non-Diabetes Mellitus Patients and Its Correlation with Malignant Gastritis Patients Attending in Lower Shabelle Region (Somalia)

Background: Several conducted studies have reported a higher and more frequent Helicobacter pylori infection rate in type 2 diabetes mellitus (T2DM). The aim of this study was to estimation the prevalence of H. pylori and its association between H. pylori infection and T2DM. Materials and Methods: A sectional-cross study was conducted based on 200 patients studded with socioeconomic characteristics through a questionnaire & H. pylori was diagnosed by serum anti-H. pylori immunoglobulin G (IgG) and IgA. Furthermore, patients were investigated for fasting blood glucose (FBG) levels, glycosylated hemoglobin (HbA1c), serum cholesterol, and other biochemistry parameters. Results: The findings showed The prevalence of Hp positive infection was significantly higher in the total sample was 134 with (67%). While 66 out of 200 patients with (33%) was H. pylori negative infection. of H. pylori. Further, the mean values were statistically significant for diabetes with H. pylori infection for IgG > 300 titer and IgA > 250 titer, regarding, HbA1C (7.52 ± 0.41) (P Conclusions: The current study revealed that H. pylori prevalence infections were significantly higher in diabetic patients studied compared to non-diabetic patients. Furthermore, T2DM patients infected with H. pylori positive reported a higher prevalence rate of symptoms than H. pylori negative.

Research Progress of Radical Treatment of Helicobacter Pylori Based on Drug Sensitivity Test as First-Line Treatment

Helicobacter pylori (HP) infection is a global problem that affects about half of the world’s population and requires sufficient attention in clinical and scientific work. Due to differences in economic and medical conditions among countries around the world, there is currently no unified treatment plan for anti-HP. In China, empirical quadruple therapy is mainly used. With the abuse of antibiotics, many patients face the problem of secondary eradication after failure, and the resistance rate of HP is gradually increasing. After eradication failure, drug sensitivity cultivation is carried out to choose sensitive antibiotics for treatment. A new strategy is currently needed to address how to improve the eradication rate of HP during the first eradication. This article aims to discuss the first-line treatment plans and research progress for eradicating HP based on drug sensitivity testing before eradication. Compared with traditional empirical therapies, treatment based on drug sensitivity results can effectively improve the eradication rate of HP, and reduce drug resistance rates, and adverse reactions, among other benefits. .

Furazolidone-induced pulmonary toxicity in Helicobacter pylori infection:Two case reports

BACKGROUND Helicobacter pylori(H.pylori)infection is a global problem,causing significant morbidity and mortality.Furazolidone is recommended to eradicate H.pylori infections in China owing to the highly associated antibiotic resistance.CASE SUMMARY This article presents two cases of lung injury caused by furazolidone treatment of H.pylori infection and the relevant literature review.Two patients developed symptoms,including fever,cough,and fatigue after receiving a course of furazolidone for H.pylori infection.Chest computed tomography showed bilateral interstitial infiltrates.Laboratory studies revealed elevated blood eosinophil count.After discontinuing furazolidone with or without the use of corticosteroids,the symptoms improved rapidly.A PubMed database literature search revealed three reported cases of lung injury suggestive of furazolidone-induced pulmonary toxicity.CONCLUSION Clinicians should be aware of the side effects associated with the administration of furazolidone to eradicate H.pylori infection.

Clinical usefulness of linked color imaging in identifying Helicobacter pylori infection:A systematic review and meta-analysis

BACKGROUND Accurate diagnosis of Helicobacter pylori(H.pylori)infection status is a crucial premise for eradication therapy,as well as evaluation of risk for gastric cancer.Recent progress on imaging enhancement endoscopy(IEE)made it possible to not only detect precancerous lesions and early gastrointestinal cancers but also to predict H.pylori infection in real time.As a novel IEE modality,linked color imaging(LCI)has exhibited its value on diagnosis of lesions of gastric mucosa through emphasizing minor differences of color tone.AIM To compare the efficacy of LCI for H.pylori active infection vs conventional white light imaging(WLI).METHODS PubMed,Embase,Embase and Cochrane Library were searched up to the end of April 11,2022.The random-effects model was adopted to calculate the diagnostic efficacy of LCI and WLI.The calculation of sensitivity,specificity,and likelihood ratios were performed;symmetric receiver operator characteristic(SROC)curves and the areas under the SROC curves were computed.Quality of the included studies was chosen to assess using the quality assessment of diagnostic accuracy studies-2 tool.RESULTS Seven original studies were included in this study.The pooled sensitivity,specificity,positive likelihood rate,and negative likelihood rate of LCI for the diagnosis of H.pylori infection of gastric mucosa were 0.85[95%confidence interval(CI):0.76-0.92],0.82(95%CI:0.78-0.85),4.71(95%CI:3.7-5.9),and 0.18(95%CI:0.10-0.31)respectively,with diagnostic odds ratio=26(95%CI:13-52),SROC=0.87(95%CI:0.84-0.90),which showed superiority of diagnostic efficacy compared to WLI.CONCLUSION Our results showed LCI can improve efficacy of diagnosis on H.pylori infection,which represents a useful endoscopic evaluation modality for clinical practice.

Topic highlight on texture and color enhancement imaging in gastrointestinal diseases

Olympus Corporation developed texture and color enhancement imaging(TXI)as a novel image-enhancing endoscopic technique.This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting.A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate(ADR)and the mean number of adenomas per procedure(MAP)of TXI compared with those of white-light imaging(WLI)observation(58.7%vs 42.7%,adjusted relative risk 1.35,95%CI:1.17-1.56;1.36 vs 0.89,adjusted incident risk ratio 1.48,95%CI:1.22-1.80,respectively).A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI(1.5 vs 1.0,adjusted odds ratio 1.4,95%CI:1.2-1.6;58.2%vs 46.8%,1.5,1.0-2.3,respectively).A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure(0.29 vs 0.30,difference for non-inferiority-0.01,95%CI:-0.10 to 0.08).A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis.A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI(0.71%vs 0.29%).A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI(69.2%vs 52.5%and 85.3%vs 78.7%,res-pectively).In conclusion,TXI can improve gastrointestinal lesion detection and qualitative diagnosis.Therefore,further studies on the efficacy of TXI in clinical practice are required.

An epidemiologic study of Helicobacter pylori infection in three areas with high,medium or low incidence of gastric carcinoma

AIMS To study the relation of Helicobacter pylori (Hp) infection rate to the incidence of and mortality from gastric cancer. METHOD Hp infection rate of natural population in three areas was detected by measuring the specific IgG-antibody to Hp using indirect ELISA method. RESULTS Hp positive rate was 59.4%,55.9% and 34.5% in the areas with high,medium and low inci- dence of gastric carcinoma respectively. The differ- ences in incidence among the areas were significant (x^2 =25.029,P<0.05). In persons under 40 years of age,the Hp infection rate was the highest in high inci- dence area of gastric cancer. Hp infection rate was 50% in children under 5 years of age in the high inci- dence area. In the people under 40 years of age,the Hp infection rates showed no difference among the three areas. The average levels of anti-Hp IgG in high, medium and low incidence areas were 2.3±0.49, 2.04±0.47 and 1.84±0.46 respectively. Multivariate regression analysis showed that Hp infection is related to bad hygienic habit,low income,frequent use of an- tibiotics and mental depression. Single factor analysis showed that Hp infection may also be related to raising animals in home. CONCLUSION Gastric cancer is closely related to the incidence of Hp infection.

Development of early gastric cancer 4 and 5 years after complete remission of Helicobacter pyloriassociated gastric low-grade marginal zone B-cell lymphoma of MALT type

AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of H. pylori infection. PATIENTS AND RESULTS: Three patients (two men, 74 and 70 years; one women, 77 years) with H. pylori-associated low-grade MALT lymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years after complete lymphoma remission in two patients, and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type IIa and type IIc, respectively, was detected, which were completely removed by endoscopic mucosa resection. In one patient, the gastric cancer was diagnosed at the same location as the previous MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time. CONCLUSION: These findings strengthen the importance of regular Long-term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H. pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.

Type 2 diabetes mellitus affects eradication rate of Helicobacter pylori

AIM: To study the eradication rate of Helicobacter pylori (Hp) in a group of type 2 diabetes and compared it with an age and sex matched non-diabetic group.METHODS: 40 diabetic patients (21 females, 19 males;56±7 years) and 40 non-diabetic dyspeptic patients (20females, 20 males; 54±9 years) were evaluated. Diabetic patients with dyspeptic complaints were referred for upper gastrointestinal endoscopies; 2 corpus and 2 antral gastric biopsy specimens were performed on each patient. Patients with positive Hp results on histopathological examination comprised the study group. Non-diabetic dyspeptic patients seen at the Gastroenterology Outpatient Clinic and with the same biopsy and treatment protocol formed the control group.A triple therapy with amoxycillin (1 g b.i.d), clarithromycin (500 mg b.i.d) and omeprazole (20 mg b.i.d.) was given to both groups for 10 days. Cure was defined as the absence of Hp infection assessed by corpus and antrum biopsies in control upper gastrointestinal endoscopies performed 6weeks after completing the antimicrobial therapy.RESULTS: The eradication rate was 50 % in the diabetic group versus 85 % in the non-diabetic control group (P＜0.001).CONCLUSION: Type 2 diabetic patients showed a significantly lower eradication rate than controls which may be due to changes in microvasculature of the stomach and to frequent antibiotic usage because of recurrent bacterial infections with the development of resistant strains.

Helicobacter species sequences in liver samples from patients with and without hepatocellular carcinoma

AIM:Only a minority of patients carrying a defined viral aetiologic agent develop cirrhosis and ultimately hepatocellular carcinoma(HCC),the mechanism underlying the worsening is still undefined.Experimental infection by Helicobacter hepaticus in mice causes chronic hepatitis and HCC and recently,more Helicobacterspecies(Helicobacter spp.)have been detected in the liver of patients suffering from cholestatic diseases and HCC arising from non-cirrhotic liver.We investigated whether Helicobacterspp.sequences could be detected in the liver of patients with cirrhosis and HCC compared to subjects with metastasis to liver from colon cancer. METHODS:Twenty-three liver samples from patients operated upon for HCC superimposed on hepatitis C virus (HCV)-related cirrhosis and 6 from patients with resected metastases from colorectal cancer,were tested by polymerase chain reaction for presence of genomic 16S rRNA of Helicobacter genus using specific primers.DNA sequencing and cag A gene analysis were also performed. RESULTS:Genornic sequences of Helicobacter spp.were found in 17 of 20(85%)liver samples from patients with HCC and in 2 of 6 samples from patients with liver metastasis. In three samples of the first group the result was uncertain. Hpyloriwas revealed in 16 out of 17 positive samples and Helicobacter pullorum in the other. CONCLUSION:Helicobacter spp.,carcinogenic in mice, were found at a higher frequency in the liver of patients with HCV-related cirrhosis and HCC than those in patients without primary liver disease.

Helicobacter pylori infection and respiratory diseases:a review

In the past few years,a variety of extradigestive disorders, including cardiovascular,skin,rheumatic and liver diseases, have been associated with Helicobacter pylori(H.pylori) infection.The activation of inflammatory mediators by H.pylori seems to be the pathogenetic mechanism underlying the observed associations.The present review summarizes the current literature,including our own studies,concerning the association between H.pyloriinfection and respiratory diseases. A small number of epidemiological and serologic,case- control studies suggest that H.pylori infection may be associated with the development of chronic bronchitis.A frequent coexistence of pulmonary tuberculosis and H.pylori infection has also been found.Moreover,recent studies have shown an increased H.pyloriseroprevalence in patients with bronchiectasis and in those with lung cancer.On the other hand,bronchial asthma seems not to be related with H.pylori infection. All associations between H.pylori infection and respiratory diseases are primarily based on case-control studies, concerning relatively small numbers of patients.Moreover, there is a lack of studies focused on the pathogenetic link between respiratory diseases and H.pylori infection. Therefore,we believe that larger studies should be undertaken to confirm the observed results and to clarify the underlying pathogenetic mechanisms.

This year's Nobel Prize to gastroenterology:Robin Warren and Barry Marshall awarded for their discovery of Helicobacter pylori as pathogen in the gastrointestinal tract

TO THE EDITORPeptic ulcer disease is a major health care concern in the society today, in view of personal suffering as well as economical health care costs.

Predictive model using four ferroptosis-related genes accurately predicts gastric cancer prognosis

BACKGROUND Gastric cancer(GC)is a common malignancy of the digestive system.According to global 2018 cancer data,GC has the fifth-highest incidence and the thirdhighest fatality rate among malignant tumors.More than 60%of GC are linked to infection with Helicobacter pylori(H.pylori),a gram-negative,active,microaerophilic,and helical bacterium.This parasite induces GC by producing toxic factors,such as cytotoxin-related gene A,vacuolar cytotoxin A,and outer membrane proteins.Ferroptosis,or iron-dependent programmed cell death,has been linked to GC,although there has been little research on the link between H.pylori infection-related GC and ferroptosis.AIM To identify coregulated differentially expressed genes among ferroptosis-related genes(FRGs)in GC patients and develop a ferroptosis-related prognostic model with discrimination ability.METHODS Gene expression profiles of GC patients and those with H.pylori-associated GC were obtained from The Cancer Genome Atlas and Gene Expression Omnibus(GEO)databases.The FRGs were acquired from the FerrDb database.A ferroptosis-related gene prognostic index(FRGPI)was created using least absolute shrinkage and selection operator–Cox regression.The predictive ability of the FRGPI was validated in the GEO cohort.Finally,we verified the expression of the hub genes and the activity of the ferroptosis inducer FIN56 in GC cell lines and tissues.RESULTS Four hub genes were identified(NOX4,MTCH1,GABARAPL2,and SLC2A3)and shown to accurately predict GC and H.pylori-associated GC.The FRGPI based on the hub genes could independently predict GC patient survival;GC patients in the high-risk group had considerably worse overall survival than did those in the low-risk group.The FRGPI was a significant predictor of GC prognosis and was strongly correlated with disease progression.Moreover,the gene expression levels of common immune checkpoint proteins dramatically increased in the highrisk subgroup of the FRGPI cohort.The hub genes were also confirmed to be highly overexpressed in GC cell lines and tissues and were found to be primarily localized at the cell membrane.The ferroptosis inducer FIN56 inhibited GC cell proliferation in a dose-dependent manner.CONCLUSION In this study,we developed a predictive model based on four FRGs that can accurately predict the prognosis of GC patients and the efficacy of immunotherapy in this population.

Effects of Helicobacterpyloriinfection on gastric emptying rate in patients with non-ulcer dyspepsia

AIM:The pathogenesis of delayed gastric emptying in patients with non-ulcer dyspepsia(NUD)remains unclear. We aimed to examine whether gastric emptying rate in NUD patients was associated with Helicobacter pylori(Hpylori) infection and whether it was affected by eradication of the infection. METHODS:Gastric emptying rate of a mixed solid-liquid meal was assessed by the paracetamol absorption method in NUD patients and asymptomatic controls(n=17).Hpylori status was assessed by serology and biopsy urease test. H pylori-positive NUD patients(n=23)received 10-day triple eradication therapy.Hpyloristatus was re-assessed by biopsy urease test four weeks later,and if eradication was confirmed,gastric emptying rate was re-evaluated. RESULTS:Thirty-three NUD patients and 17 controls were evaluated.NUD patients had significantly delayed gastric emptying compared with controls.The mean maximum plasma paracetamol concentration divided by body mass (Cmax/BM)was 0.173 and 0.224 mg/L.kg respectively (P=0.02),the mean area under plasma paracetamol concentration-time curve divided by body mass(AUC/BM) was 18.42 and 24.39 mg.min/L.kg respectively(P=0.01). Gastric emptying rate did not differ significantly between H pylori-positive and H pylori-negative NUD patients.The mean Cmax/BM was 0.172 and 0.177 mg/L·kg respectively (P=0.58),the mean AUC/BM was 18.43 and 18.38 mg·min/ L·kg respectively(P=0.91).Among 14 NUD patients who were initially H pylori-positive,confirmed eradication of the infection did not significantly alter gastric emptying rate. The mean Cmax/BM was 0.171 and 0.160 mg/L.kg before and after Hp eradication,respectively(P=0.64),the mean AUC/BM was 17.41 and 18.02 mg.min/L.kg before and after eradication,respectively(P=0.93). CONCLUSION:Although gastric emptying is delayed in NUD patients compared with controls,gastric emptying rate is not associated with H pylori status nor it is affected by eradication of the infection.

Helicobacter pylori: the primary cause of duodenal ulceration or a secondary infection?

INTRODUCTIONIt is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:

Interobserver variation in histopathological assessment of Helicobacter pylori gastritis

AIM:Because the presence or absence of H pylori infection has important implications for therapeutic decisions based on histological assessment,the reproducibility of Sydney system is important.The study was designed to test the reproducibility of features of Helicobacter pylori gastritis, using the updated Sydney classification. METHODS:Gastric biopsies of 40 randomly selected cases of H pylori gastritis were scored semiquantitatively by three pathologists.Variables analysed induded chronic inflammation, inflammatory activity,atrophy,intestinal metaplasia,H pylori, surface epithelial damage.κ values below 0.5 represented poor,those between 0.5 and 0.75 good and values over 0.75 excellent interobserver agreement. RESULTS:The best interobserver agreement(κ=0.62)was present for intestinal metaplasia.The agreement was the poorest for evaluating atrophy(κ=0.31). CONCLUSION:Although the results of this study were in accordance with some previous studies,an excellent agreement could not be reached for any features of H pylori gastritis.This low degree of concordance is assumed to be due to the personal evaluation differences in grading the features,the lack of standardized diagnostic criteria,and the ignorance to reach a consensus about the methods to be used in grading the features of H pylori gastritis before initiating the study.

Helicobacter pylori infection and micronutrient deficiencies

It is known that deficiencies of micronutrients due to infections increase morbidity and mortality.This phenomenon depicts itself conspicuously in developing countries. Deficiencies of iron,vitamins A,E,C,B12,etc are widely prevalent among populations living in the third world countries.Helicobacter pylori(H pylori)infection has a high prevalence throughout the world.Deficiencies of several micronutrients due to H pylori infection may be concomitantly present and vary from subtle sub-clinical states to severe clinical disorders.These essential trace elements/ micronutrients are involved in host defense mechanisms, maintaining epithelial cell integrity,glycoprotein synthesis, transport mechanisms,myocardial contractility,brain development,cholesterol and glucose metabolism.In this paper H pylori infection in associaed with various micronutrients deficiencies is briefly reviewed.

Modalities of testing Helicobacter pylori in patients with nonmalignant bile duct diseases

AIM:This paper describes the procedure of detection of Helicobacter pylori(H.pylori)in bile specimens in patients suffering from benign diseases of biliary ducts(lithiasis with/without nonspecific cholangitis). METHODS:The group of 72 patients entering the study consisted of 32 male and 40 female(45 % and 55 %, respectively).Bile was obtained during ERCP in 68 patients, and during cholecystectomy in 4 patients.A fast urease test (FUT)to determine the existence of H.pylori in gastric mucosa was carried out for all the patients during the endoscopic examination.The existence of genetic material of H.pylori was determined by detection of ure A gene by the method of nested PCR.The results of this reaction were shown by electrophoresis on 10 g·L^(-1)agarose gel in a band of 256 bp. RESULTS:The majority of the patients included in our study had biliary lithiasis without signs of cholangitis(48 patients, 67 %),whereas other patients were complicated by cholangitis(17 patients,24 %).Seven patients(9 %)had normal ERCP,forming thus the control group.In the group of patients with lithiasis 26 patients(24.2 %)had positive PCR of H.pylori in bile and among the patients with associated cholangitis positive PCR was detected in 9 patients(52.9 %).Among the seven patients with normal ERCP only one(14 %)had positive PCR of H.pylori.A high percentage of H.pylori infection of gastric mucosa was observed(57 patients,79 %).It was also observed that its slightly higher positivity was in the patients with distinct bile pathology:81% FLIT positive patients in the group with choledocholithiasis alone and 76 % in the group with choledocholithiasis associated with cholangitis.Seventy-one percent of the patients with regular findings had positive FUT.CONCLUSION: The prevalence of H. pylori infection both in bile and in gastric mucosa in patients with benign diseases of biliary ducts does not show a statistically significant difference in relation to the prevalence of the same with the patients with normal ERCP. The existence of H. pylori infection possibly does not play a role in pathogenesis of benign biliary diseases.