消化性溃疡患者幽门螺杆菌感染与治疗效果关系的临床观察

本研究为了探讨治疗幽门螺杆菌感染对消化性溃疡的影响,从而为临床治疗提供更加有针对性的方案。方法 整理2020年3月至2023年3月期间60名消化性溃疡患者的临床数据。根据肠胃镜检查结果,将消化性溃疡患者以随机的方法分为对照组(常规治疗)和观察组(根治治疗),各30例,对患者的治疗效果进行观察。结果 与对照组(6.7%、14.9%、23.5%)比,观察组在治疗后的3、6、18个月复发率更低(0%、4.3%和7.2%),P<0.05;治疗后,相比于对照组(59.9%),观察组幽门螺杆菌的清除率更高(97%),P<0.05,根治幽门螺杆菌感染对消化性溃疡的治疗更为有效;在不良反应方面,观察组的不良反应发生率为13.7%,而对照组为7.5%,P>0.05,差异不显著。结论 针对幽门螺杆菌的根治治疗对于消化性溃疡患者具有显著的治疗效果,值得临床广泛应用。

Causal role of Helicobacter pylori infection in gastric cancer

Gastric cancer is the second most frequent cancer in the world, accounting for a large proportion of all cancer cases in Asia, Latin America, and some countries in Europe. Helicobacter pylori（H pylori） is regarded as playing a specific role in the development of atrophic gastritis, which represents the most recognized pathway in multistep intestinal-type gastric carcinogenesis. Recent studies suggest that a combination of host genetic factors, bacterial virulence factors, and environmental and lifestyle factors determine the severity of gastric damage and the eventual clinical outcome of H pylori infection. The seminal discovery of Hpylori as the leading cause of gastric cancer should lead to effective eradication strategies. Prevention of gastric cancer requires better screening strategies to identify candidates for eradication.

Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection

AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori ) infection. METHODS:This open randomized trial recruited 234 H. pylori positive gastritis patients from seven local centers. The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid , clarithromycin 500 mg bid , and amoxicillin 1000 mg bid ; OCA group, n = 79); two weeks of pre-treatment with probiotics, containing 3 × 107 Lactobacillus acidophilus per day, prior to one week of triple therapy (POCA group, n = 78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group, n = 77). Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy. Patients were asked to report associated symptoms at baseline and during follow-up, and side effects related to therapy were recorded. Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods. RESULTS:PP analysis involved 228 patients, 78 in the OCA, 76 in the POCA and 74 in the OCAP group. Successful eradication was observed in 171 patients; by PP analysis, the eradication rates were significantly higher (P = 0.007 each) in the POCA (62/76; 81.6%, 95% CI 72.8%-90.4%) and OCAP (61/74; 82.4%, 95% CI 73.6%-91.2%) groups than in the OCA group (48/78; 61.5%, 95% CI 50.6%-72.4%). ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5%, 95% CI 70.4%-88.6%) and OCAP (61/77; 79.2%, 95% CI 70%-88.4%) groups than in the OCA group (48/79; 60.8%, 95% CI 49.9%-71.7%), (P = 0.014 and P = 0.015). The symptom relieving rates in the POCA, OCAP and OCA groups were 85.5%, 89.2% and 87.2%, respectively. Only one of the 228 patients experienced an adverse reaction. CONCLUSION:Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates.

Interleukin-1 and TNF-α polymorphisms and Helicobacter pylori in a Brazilian Amazon population

AIM： To study the association between Interleukin-1 （IL-1） and tumor necrosis factor （TNF）-α polymorphisms, infection by Helicobacter pylori （H pylori） and the development of gastrointestinal diseases.METHODS： Genomic DNA was extracted from the peripheral blood of 177 patients with various gastrointestinal diseases and from 100 healthy volunteers. The polymorphisms in IL-1β and TNF-α genes were analyzed using the polymerase chain reactionrestriction fragment length polymorphism method （PCRRFLP） and those from IL-1RN with PCR. The presence of infection due to H pylori and the presence of the CagA toxin were detected by serology. The histopathological parameters in the gastric biopsies of the patients were according to the Sydney classification.RESULTS： A comparison of the frequencies of the different polymorphisms studied among the patients and the control group demonstrated that the allele IL- 1RN＊2 was more frequent among patients with gastric ulcers and adenocarcinoma. Carriers of the allele IL- RN＊2 and those with reactive serology for anti-CagA IgG had a greater risk of developing peptic ulcer and gastric adenocarcinoma, as well as a higher degree of inflammation and neutrophilic activity in the gastricCONCLUSION： Our results indicate a positive association between IL-1RN gene polymorphism and infection by positive H pylori CagA strains and the development of gastric ulcers and adenocarcinoma.

CpG island methylator phenotype and Helicobacter pylori infection associated with gastric cancer

AIM： To investigate the association between the CpG island methylator phenotype （CIMP） and serum Helico- bacter pylori （H. pylori） levels for clinical prediction of gastric cancer （GC） progression. METHODS： We analyzed the serum ClMP status of 75 patients with GC using a methylation marker panel and a methylation-specific polymerase chain reaction. Serum samples from 40 healthy persons were examined at the same time. The genes examined were APC, WIF-1, RUNX-3, DLC-1, SFRP-1, DKK and E-cad. H. pylori infec- tion in serum was assayed with an anti-H, pylori immu- noglobulin G antibody test and a rapid urease test. RESULTS： The frequencies of high-level methylation in GC tissues for the seven genes were： 48% for APC, 57.33% for WIF-1, 56% for RUNX-3, 50.67% for DLC-1, 52% for SFRP-1, 54.67% for DKK, and 48% for E-cad.The frequencies in GC serum were 30.67% for APC, 34.67% for WIF-1, 37.33% for RUNX-3, 29.33% for DLC-1, 33.33% for SFRP-1, 32% for DKK, and 26.67% for E-cad. CIMP＋ （defined as ≥ 3 methylated genes） was associated with 47 （62.67%） GC tissue samples and 44 （58.67%） GC serum samples. CIMP＋ was not associated with non-neoplastic mucosal tissues or the serum of healthy persons. Of the 75 GC cases, 51 （68%） were H. pylori＋, and 24 （32%） were H. pylori-. Of the 51 H. pylori＋ cases, 36 were CIMP＋ and 15 were CIMP-. In contrast, for the 24 H. pylori- cases, 11 were CIMP＋, and 13 were CIMP-. The difference was signifi- cant between the H. pylori＋ and H. pylori- groups χ2 = 4.27, P 〈 0.05）. Of the 51 H. pylori＋ GC patients, 34 were CIMP＋ and 17 were CIMP-, while among the 24 H. pylori- GC cases, 10 were CIMP＋ and 14 were CIMP-. The difference was significant between the H. pylori＋ and H. pylori- groups （χ2 = 4.21, P 〈 0.05）. A 2-year follow-up showed significant difference in the rates of metastasis and recurrence between H. pylori＋/CIMP＋ cases and the H. pylori＋/CIMP- cases or CIMP- cases associated with H. pylori assayed in serum （P 〈 0.05）. However, there were no significant differences in sur- vival rates between the two groups. CONCLUSION： H. pylori＋/CIMP＋ cases are associ- ated with higher rates of metastasis and recurrence thanH, pylori＋/CIMP- cases. Serum may be useful for examining CIMP status.

Quality of ulcer healing in gastrointestinal tract:Its pathophysiology and clinical relevance

In this paper, we review the concept of quality of ulcer healing （QOUH） in the gastrointestinal tract and its role in the ulcer recurrence. In the past, peptic ulcer disease （PUD） has been a chronic disease with a cycle of repeated healing/remission and recurrence. The main etiological factor of PUD is Helicobacter pylori （H. pylorl~, which is also the cause of ulcer recur- rence. However, H. pylori-negative ulcers are pres- ent in 12%-20% of patients; they also recur and are on occasion intractable. QOUH focuses on the fact that mucosal and submucosal structures within ulcer scars are incompletely regenerated. Within the scars of healed ulcers, regenerated tissue is immature and with distorted architecture, suggesting poor QOUH. The abnormalities in mucosal regeneration can be the basis for ulcer recurrence. Our studies have shown that persistence of macrophages in the regenerated area plays a key role in ulcer recurrence. Our studies in a rat model of ulcer recurrence have indicated that proinflammatory cytokines trigger activation of macro- phages, which in turn produce increased amounts of cytokines and chemokines, which attract neutrophils to the regenerated area. Neutrophils release proteolytic enzymes that destroy the tissue, resulting in ulcer re- currence. Another important factor in poor QOUH can be deficiency of endogenous prostaglandins and a defi- ciency and/or an imbalance of endogenous growth fac- tors. Topically active mucosal protective and antiulcer drugs promote high QOUH and reduce inflammatory cell infiltration in the ulcer scar. In addition to PUD, the concept of QOUH is likely applicable to inflammatory bowel diseases including Crohn＇s disease and ulcer- ative colitis.

Comparison of sequential and 7-,10-,14-d triple therapy for Helicobacter pylori infection

AIM:To compare the effectiveness of sequential therapy for Helicobacter pylori(H.pylori) infection with that of triple therapy of varying durations.METHODS:The 460 patients enrolled in this study had H.pylori-associated gastritis or a gastric or duodenal ulcer.After screening,H.pylori-infected patients were randomly assigned to receive either conventional triple therapy for 7,10 or 14 d,or a new 10-d sequential therapy.Each of the 4 treatment groups included 115 patients.The outcomes of eradication therapy were assessed 4 wk after treatment by the urea breath test and histology.RESULTS:The overall eradication rate was 81.0%,and eradication rates were 75.7% for 7-d conventional triple therapy,81.9% for 10-d conventional triple therapy,84.4% for 14-d conventional triple therapy,and 82.0% for 10-d sequential therapy.Neither intention-to-treat analysis nor per protocol analysis showed significant differences in eradication rates using sequential therapy or the standard triple therapy(P = 0.416 and P = 0.405,respectively).CONCLUSION:There are no significant differences between 10-d sequential eradication therapy for H.pylori and any duration of standard triple treatment in Korean patients.

E-cadherin in gastric cancer

Cadherin is an adhesion molecule and a superfamily of calcium-mediated membrane glycoproteins. E-cadherin is the prototype of the class E-cadherin that links to catenins to form the cytoskeleton. Recent evidence has shown that E-cadherin not only acts as an adhesive, but also plays important roles in growth development and carcinogenesis. It has been recently viewed as an invasion as well as a growth suppressor gene. This review summarizes the recent discoveries on E-cadherin and its role in gastric cancer. In particular, our work on E-cadherin in gastric cancer, including its relation with Helicobacter pylori and clinical applications, are described in detail.

Autoimmune thyroid diseases and Helicobacter pylori: The correlation is present only in Graves's disease

AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto' s thyroiditis HT), at their first diagnosis of ATDs. We tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher' s exact test and the respective odds ratio (OR) was calculated. RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3)in Graves' disease, but not in Hashimoto's thyroiditis, where we found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present. CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.

Association of CagA and VacA presence with ulcer and non-ulcer dyspepsia in a Turkish population

AIM:The mostly known genotypic virulence features,of H.pylori are cytotoxin associated gene A (cagA) and Vacuolating cytotoxin gene A (VacA).We investigated the association of these major virulence factors with ulcer and non-ulcer dyspepsia in our region. METHODS:One hundred and forty two dyspeptic patients were studied (average age 44.8±15.9 years,range 15-87 years,64 males and 78 females).Antral and corpus biopsies were taken for detecting and genotyping of H.pylori.107 patients who were H.pylori positive by histological assessment were divided into three groups according to endoscopic findings:Duodenal ulcer (DU),gastric ulcer (GU) and non-ulcer dyspepsia (NUD).The polymerase chain reaction (PCR) was used to detect CagA and VacA genes of H.pylori using specific primers. RESULTS:H.pyloriwas isolated from 75.4% (107/142) of the patients.Of the 107 patients,66 (61.7%) were cagA- positive and 82 (76.6%) were VacA-positive.CagA gene was positively associated with DU and GU (P<0.01,P<0.02), but not with NUD (P>0.05).Although VacA positivity in ulcer patients was higher than that in NUD group,the difference was not statistically significant (P>0.05). CONCLUSION:There is a significantly positive association between CagA genes and DU and GU.The presence of VacA is not a predictive marker for DU,GU,and NUD in our patients.

Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus

AIM： To investigate the clinicopathologic features which predict surgical overall survival in patients with proxima gastric carcinoma involving the esophagus （PGCE）. METHODS： Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009. Each retrieved pa- thology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were se- lected as PGCE. Each tumor was re-staged, following the guidelines on esophageal adenocarcinoma, accord- ing to the 7th edition of the American Joint Commission on Cancer Staging Manual. All histology slides were studied along with the pathology report for a retrospec- tive analysis of 13 clinicopathologic features, i.e., age, gender, Helicobacter pylori （H. pylon} infection, surgical modality, Siewert type, tumor Bormann＇s type, size, dif- ferentiation, histology type, surgical margin, lympho- vascular and perineural invasion, and pathologic stage in relation to survival after surgical resection. Prognos- tic factors for overall survival were assessed with uni- and multi-variate analyses. RESULTS： Patients＇ mean age was 65 years （range： 47-90 years）. The male： female ratio was 3.3. The 1-, 3- and 5-year overall survival rates were 87%, 61% and 32%, respectively. By univariate analysis, age, male gender, H. pylori, tumor Bormann＇s type, size, histology type, surgical modality, positive surgical margin, lym- phovascular invasion, and pT stage were not predictive for overall survival; in contrast, perineural invasion （P = 0.003）, poor differentiation （P = 0.0003）, 〉 15 to- tal lymph nodes retrieved （P = 0.008）, positive lymph nodes （P = 0.001）, and distant metastasis （P = 0.005） predicted poor post-operative overall survival. Celiac axis nodal metastasis was associated with significantly worse overall survival （P = 0.007）. By multivariate analysis, ≥ 16 positive nodes （P = 0.018）, lymph node ratio 〉 0.2 （P = 0.003）, and overall pathologic stage （P= 0.002） were independent predictors for poor overa survival after resection. CONCLUSION： Patients with PGCE showed worse over- all survival in elderly, high nodal burden and advanced pathologic stage. This cancer may be more accurately staged as gastric, than esophageal, cancer.

CD74 in antigen presentation,inflammation,and cancers of the gastrointestinal tract

CD74 is a protein whose initial role in antigen presentation was recognized two decades ago. Recent studies have revealed that it has additional functions as a receptor for macrophage migration inhibitory factor and as a receptor for an important human pathogen, Helicobacter pylori （H pylon）. The role of CD74 as a receptor is important because after binding of migration inhibitory factor or H pylori, NF-κB and Erkl/2 activation occurs, along with the induction of proinflammatory cytokine secretion. This review provides an up-to-date account of the functions of CD74 and how it might be involved in inflammation and cancer within the gastrointestinal tract.

Gastric dysplasia may be an independent risk factor of an advanced colorectal neoplasm

AIM: To evaluate the relationship between gastric dysplasia and Helicobacter pylori (H pylori) and the occurrence of colorectal adenoma, and to defi ne the necessity for colonoscopy in patients with gastric dysplasia or H pylori infection.METHODS: From May 2005 to February 2008, 133 patients with established gastric dysplasia by gastroduo-denoscopy (EGD) were additionally investigated by colonoscopy. The authors compared results with those of 213 subjects who underwent both EGD and colonoscopy during the same period at the author’s Health Promotion Center as a control group. H pylori infection was evaluated in both the gastric dysplasia and control groups.RESULTS: The mean age of all 346 study subjects was 54.1 ± 10.5 years, and there were 258 (73%) men and 87 (27%) women. No signif icant difference was found between the H pylori positive and negative subjects in terms of the prevalence of colorectal adenoma and advanced colorectal adenoma (P = 0.261). Patients with gastric dysplasia showed no elevated risk of colorectal adenoma (OR = 0.910, 95% CI: 0.587-1.411, P = 0.738), but had a signif icantly higher risk of having advanced colorectal adenoma (OR = 3.382, 95% CI: 1.700-6.342, P = 0.000).CONCLUSION: The study emphasizes the need for colon surveillance in patients with gastric dysplasia, regardless of H pylori infection.

Levofloxacin/amoxicillin-based schemes vs quadruple therapy for Helicobacter pylori eradication in second-line

Worldwide prevalence of Helicobacter pylori(H.pylori) infection is approximately 50%,with the highest being in developing countries.We compared cure rates and tolerability(SE) of second-line anti-H.pylori levofloxacin/amoxicillin(LA)-based triple regimens vs standard quadruple therapy(QT).An English language literature search was performed up to October 2010.A meta-analysis was performed including randomized clinical trials comparing 7-or 10-d LA with 7-d QT.In total,10 articles and four abstracts were identified.Overall eradication rate in LA was 76.5%(95% CI:64.4%-97.6%).When only 7-d regimens were included,cure rate was 70.6%(95% CI:40.2%-99.1%),whereas for 10-d combinations,cure rate was significantly higher(88.7%;95% CI:56.1%-109.9%;P < 0.05).Main eradication rate for QT was 67.4%(95% CI:49.7%-67.9%).The 7-d LA and QT showed comparable efficacy [odds ratio(OR):1.09;95% CI:0.63-1.87],whereas the 10-d LA regimen was significantly more effective than QT(OR:5.05;95% CI:2.74-9.31;P < 0.001;I 2 = 75%).No differences were reported in QT eradication rates among Asian and European studies,whereas LA regimens were more effective in European populations(78.3% vs 67.7%;P = 0.05).Incidence of SE was lower in LA therapy than QT(OR:0.39;95% CI:0.18-0.85;P = 0.02).A higher rate of side effects was reported in Asian patients who received QT.Our findings support the use of 10-d LA as a simple second-line treatment for H.pylori eradication with an excellent eradication rate and tolerability.The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.

Furazolidone therapy for Helicobacter pylori:Is it effective and safe?

Some aspects related with the use of furazolidone as a rescue therapy for Helicobacter pylori （H pylorl） infection should be remarked, especially regarding its potential oncologic risk. The inclusion of furazolidone in a treatment regimen for H pylori infection is, at least, controversial, and it does not appear to be safe.

Relatedness of Helicobacter pylori populations to gastric carcinogenesis

Helicobacter pylori （H. pylorl） is a Gram-negative bac- terium that infects half of the human population. The infection is associated with chronic inflammation of the gastric mucosa and peptic ulcers. It is also a major risk factor for gastric cancer. Phylogenetic analysis of global strains reveals there are seven populations of H. pylori, including hpAfrical, hpAfrica2, hpEastAsia, hpEurope, hpNEAfrica, hpAsia2 and hpSahul. These populations are consistent with their geographical origins, and pos- sibly result from geographical separation of the bac- terium leading to reduced bacterial recombination in some populations. For each population, H. pylori has evolved to possess genomic contents distinguishable from others. The hpEurope population is distinct in that it has the largest genome of 1.65 mbp on average, and the highest number of coding sequences. This confers its competitive advantage over other populations but at the cost of a lower infection rate. The large genomic size could be a cause of the frequent occurrence of the deletion of the cag pathogenicity island in H. pylori strains from hpEurope. The incidence of gastric cancer varies among different geographical regions. This can be attributed in part to different rates of infection of H. pylori. Recent studies found that different popula- tions of H, pylori vary in their carcinogenic potential and contribute to the variation in incidence of gastric cancer among geographical regions. This could be related to the ancestral origin of H, pylori. Further studies are indi- cated to investigate the bacterial factors contributing to differential virulence and their influence on the clinical features in infected individuals.

Association between Helicobacter pylori seropositivity and digestive tract cancers

AIM： To explore the role of Helicobacter pylori （Hpylori） infection on the risk of digestive tract cancers. METHODS： In total, 199 oral squamous-cell carcinoma （SCC）, 317 esophagea! SCC, 196 gastric cardia and non-cardia adenocarcinoma and 240 colon adenocarcinoma patients were recruited for serum tests of Hpylori infection. Two hospital- and one community-based control groups were used for the comparisons. Hpylori seropositivity was determined by an enzyme linked immunosorbent assay method against Hpylori IgG. RESULTS： Presence of H pylori infection was significantly inversely associated with esophageal SCC [adjusted odds ratio （AOR）： 0.315-0.472, all P-value 〈 0.05] but positively associated with gastric adenocarcinoma （both cardia and non-cardia） （AOR： 1.636-3.060, all P-value 〈 0.05） in comparison to the three control groups. Similar results were not found in cancers of the oral cavity and colon. CONCLUSION： Our findings support the finding that H pylori seropositivity is inversely associated with esophageal SCC risk, but increases the risk of gastric cardia adenocarcinoma.

Bacterial flora concurrent with Helicobacter pylori in the stomach of patients with upper gastrointestinal diseases

AIM： To investigate the non-He/icobacterpy/ori （H. pylori） bacterial flora concurrent with H. pylori infection.METHODS： A total of 103 gastric biopsy specimens from H. pylori positive patients were selected for bacterial culture. All the non-H, pylori bacterial isolates were identified by matrix assisted laser desorption ionization time-of-flight mass spectrometry （MALDI-TOF MS）.RESULTS： A total of 201 non-H, pyiori bacterial isolates were cultivated from 67 （65.0%） of the 103 gastric samples, including 153 isolates identified successfully at species level and 48 at genus level by MALDI-TOF MS. The dominant species were Streptococcus, Neisseria, Rothla and Staphylococcus, which differed fromthe predominantly acid resistant species reported previously in healthy volunteers. The prevalence of non-H. pylori bacteria was higher in non-ulcer dyspepsia group than in gastric ulcer group （100% vs 42.9%, P 〈 0.001）. Six bacterial species with urease activity （Staphylococcus epidermidis, Staphylococcus warneri, Staphylococcus capitis, Staphylococcus aureus, Brevibacteriurn spp. and Klebsiella pneumoniae） were also isolated.CONCLUSION： There is a high prevalence of the non-H, pylori bacteria concurrent with H. pylori infection, and the non-H, pylori bacteria may also play important as-yet-undiscovered roles in the pathogenesis of stomach disorders.

Influence of Helicobacter pylori infection on ghrelin levels in children

AIM:To compare ghrelin levels in plasma and gastric mucosa before and after Helicobacter pylori(H.pylori) treatment in children with H.pylori-associated functional dyspepsia.METHODS:Children with H.pylori-associated functional dyspepsia were enrolled in this study.H.pylori infection was confirmed by positive bacterial culture results.All of the children received triple H.pylori eradication therapy(a 2 wk course of omeprazole,amoxicillin,and clarithromycin).The children were divided into two groups based on the success of the H.pylori treatment:group 1(eradicated)-patients who had a negative 13C-urea breath test 2 mo after the end of therapy;and group 2(non-eradicated)-patients who had a positive 13C-urea breath test.Plasma ghrelin,gastric ghrelin mRNA,and the body mass index were evaluated in both groups before and after the H.pylori treatment.The plasma ghrelin levels were measured by a radioimmunoassay.The expression of gastric ghrelin mRNA was determined by real-time reverse transcription polymerase chain reaction.RESULTS:A total of 50 children with H.pylori-associated functional dyspepsia were treated with triple H.pylori eradication therapy.The mean age of the children was 5.52 ± 0.83 years,and there were 28 males and 22 females.Among the 50 H.pylori-positive children,30 successfully achieved eradication,and 20 did not.The mean plasma ghrelin levels of group 1 were 22.17 ± 1.73 ng/L and 26.59 ± 2.05 ng/L before and after the treatment,respectively,which was a significant increase(P = 0.001).However,the mean plasma ghrelin level of group 2 before and after the H.pylori treatment was 21.34 ± 2.40 ng/L and 22.24 ± 2.10 ng/L(P = 0.785).The plasma ghrelin levels increased substantially after treatment in group 1 but showed only minor changes in group 2.Similarly,the gastric ghrelin mRNA expression in group 1 before treatment was 2.84 ± 0.08.After treatment,the level was 3.11 ± 0.65,which was significantly different(P = 0.023).The gastric ghrelin mRNA expression in group 2 did not change significantly during the treatment(2.82 ± 0.44 vs 2.79 ± 0.31,P = 0.875).The plasma ghrelin and gastric ghrelin mRNA levels in group 1 increased substantially after the treatment but did not do so in group 2.In addition,the body mass index the two groups did not differ significantly 2 mo before and after the H.pylori treatment.CONCLUSION:H.pylori eradication increases the plasma and tissue ghrelin levels in children with H.pylori-associated functional dyspepsia.

Azithromycin-containing versus standard triple therapy for Helicobacter pylori eradication:A meta-analysis

AIM： To evaluate whether adding azithromycin to firstline Helicobacter pylori （H pylorl） eradication improved eradication and reduced side effects. METHODS： Eligible articles were identified by searches of electronic databases. We included all randomized trials that compared azithromycin-containing with standard triple-therapy regimens for first-line treatment of H pylori infection. Statistical analysis was performed with Review Manager 5.0.10. Sub-analyses were also performed. RESULTS： We identified 14 randomized trials （1431 patients）. Pooled Hpylori eradication rates were 72.01% （95% CI： 58.09%-85.93%） and 69.78% （95% CI： 66.47%-73.09%） for patients with or without azithromycin by intention-to-treat analysis, and the odds ratio （OR） was 1.17 （95% CI： 0.64-2.14）. The occurrence of side effects differed significantly and was 15.81% （95% CI： 12.50%-19.12%） and 25.20% （95% CI： 21.44%-28.96%） for treatment with or without azithromycin, respectively, and the summary OR was 0.58 （95% CI： 0.41-0.82）. Furthermore, the azithromycin-containing group had a lower occurrence of diarrhea, nausea and taste disturbance. CONCLUSION： Our review suggests that azithromycincontaining triple-therapy regimens could be equally effective in eradication of Hpylori compared with standard first-line triple-therapy regimens.