Introduction

Various virulence factors of H. pylori have been identified that play an important role in pathogenesis. The aim of this study was to investigate the prevalence of H. pylori infection by rapid urea test and histopathology examination and determining the prevalence of the cytotoxin associated gene A (cagA), vaculating cytotoxin A (vacA) and restriction endonuclease-replacing gene (hrgA) in H. pylori strains isolated from patients with upper gastrointestinal diseases from Khuzestan.

Aims & Methods

Gastric biopsy specimens were obtained from 426 patients with gastrointestinal disorders undergoing endoscopy in Imam Khomeini Hospital, Ahvaz, the capital of Khuzestan province. H. pylori infection was investigated in patients by rapid urea test and histopathology examination and positive specimens were reconfirmed by PCR of the ureB gene. The presence of cagA, vacA s/m and hrgA genotypes were determined by PCR from culture or gastric biopsies.

Results

H. pylori was detected in 33.8% (144/426) of patients by rapid urea test and in 44.13% (188/426) by histopathology. 60.2% of infected patients were female and 39.8% were male and the mean age of patients was 47.1 years (range 14 to 89 years old). Epigastric pain was the most commonly reported symptom (62.7%), followed by anorexia (24.9%), nausea (21.4%), epigastric burning (20.4%), gastrointestinal bleeding (14.9%), fullness (12.4%), vomiting (12.4%), weight loss (12.9%) and bloating (11.9%). The main endoscopic findings were non-ulcer dyspepsia 56.7%, erosive gastritis 20.9%, gastric ulcer 13.4%, duodenal ulcer 7.5% and gastric cancer 1%. The cagA, vacAs1, vacAs2, vacAm1, vacAm2 and hrgA genotypes were detected in 93.3%, 71.6%, 23.1%, 25.4%, 70.1% and 67.2% of isolates, respectively. The allelic variant vacAs1m2 was more prevalent (45.5%) than vacAs1m1 (23.9%) and vacAs2m2 (23.1%).
There was a statistically significant association between the presence of vacAs1m2 genotype and gastric ulcer (P = 0.004), while the vacAs2m2 significantly was observed in strains isolated from patients with non-ulcer dyspepsia (P = 0.017). Also the presence of hrgA gene was associated with duodenal ulcer (P = 0.043).

Conclusion

the histopathology examination is more specific than the rapid urea test especially in gastric ulcer bleeding cases and the use of both tests can help to more accurate diagnosis of H. pylori infection. Based on the results vacAs1, vacAs2 and hrgA genotypes may be the predictors of gastric ulcer, non-ulcer dyspepsia and duodenal ulcer, respectively.

Introduction

Russia is among the countries with a high prevalence of Helicobacter pylori (H. pylori) infection. The North-Western Federal District, comprising one-tenth of Russia's population, is predominantly urban. As of 2023, its population is over 13 million people. Current information on H. pylori infection prevalence is necessary for the development of clinical guidelines for the prevention of H. pylori-associated disorders.

Aims & Methods

To evaluate the dynamics of H. pylori infection prevalence among patients with dyspepsia between 2015 and 2023 based on ¹³C-urea breath test (¹³C-UBT).
The study was conducted in the North-Western Federal District. Patients with dyspepsia (n=50,884) who underwent ¹³C-UBT between 2015 and 2023 were included in this descriptive study. If Delta Over Baseline (DOB, δ¹³СО2) was less than 2.5‰, the result of the test was considered negative, while δ¹³СО2 value ≥2.5‰ indicated the presence of H. pylori infection. The criteria for the infection grade (IG) were defined as follows: IG I (2.5–3.4‰), IG II (3.5–6.4‰), IG III (6.5–9.4‰), and IG IV (>9.5‰). The database for subsequent statistical analysis included such parameters as the patients’ age, gender, history of prior eradication therapy, and the result of the ¹³C-UBT test.

Results

Among all included individuals (mean age 43.3 years (31.0; 55.0); 57.5% of whom were female), there were 83.6% (n=42,543) of primary “naive” patients (who had had no history of prior eradication therapy) (95% confidence interval (CI) 83.3-83.9). The proportion of treated patients was 16.4% (n=8,341; 95% CI 16.1-16.7). The prevalence of H. pylori infection among the primary patients was 51.4% in 2015 (874/1701 subjects; 95% CI 49.0–53.8) and gradually decreased to 32.2% (1904/5916 subjects; 95% CI 31.0–33.4) in 2022. In 2023 H. pylori-positive was 32.7% (1450/4433 subjects; 95% CI 31.3–34.1). Eradication failure was 39.1% in 2015 (148/379 subjects; 95% CI 34.5-44.3). Eradication rate in 2016 was 80.2% (684/853 subjects; 95% CI 77.4-82.7) and increased to 86.8% (702/809 subjects; 95% CI 84.3-88.9) in 2023.
Naive and unsuccessful treated patients demonstrated a very high IG - 73.0 and 66.5%, respectively. H. pylori was detected more often in young adults (18–44 years old (y.o.)). The infection was less commonly detected among children (1.6% of primary and 1.3% of treatment-failure patients).

Conclusion

Overall, our study highlighted a significant decrease of H. pylori-infection from 2015 to 2023. However, the eradication rates in the North-Western district of Russia remain low and do not reach the threshold value of 95%.

References

1. Li Y., Choi H., Leung K. et al. Global prevalence of Helicobacter pylori infection between 1980 and 2022: a systematic review and meta-analysis // Lancet Gastroenterol. Hepatol. 2023. Vol. 8, No. 6. P. 553–564. DOI: 10.1016/S2468-1253(23)00070-5
2. Malfertheiner P., Megraud F., Rokkas T. et al; European Helicobacter and Microbiota Study group. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report // Gut. 2022:gutjnl-2022-327745. DOI: 10.1136/gutjnl-2022-327745

Introduction

Portugal is an intermediate-high risk country for gastric cancer and Helicobacter pylori (Hp) infection is an important risk factor for such condition. All of infected patients should be treated; however, the increasing frequency of antibiotic resistance reduces its eradication rate.

Aims & Methods

Aims: To analyze the prevalence of Hp infection in Portugal and its antimicrobial resistance profile. To evaluate the prevalence of premalignant gastric conditions.
Methods: A multicentric cross-sectional study involving 9 endoscopy units from Portugal, distributed across the country (north, central and south regions). We included patients aged ≥40 who underwent upper endoscopy in these units between February and March 2024. Hp detection was performed using immunohistochemistry (IHC). In positive IHC samples, clarithromycin, fluoroquinolones and metronidazole resistances were assessed in biopsy samples using real-time polymerase chain reaction.

Results

Four hundred twenty-one patients were included (58% women, mean age 60), 172 of which were Hp-positive (41%). Excluding patients with prior eradication therapy, the prevalence of Hp infection was 47.4%. Infection was more prevalent in the north region of the country (north 46.8%; central 36%; south 36.5%). The antimicrobial resistance rates were: clarithromycin 26%; fluoroquinolones 16%; metronidazole 2%; clarithromycin/fluoroquinolones 4%. Intestinal metaplasia (IM) was identified in 138 patients (32.8%), 24 of which (6%) had extensive IM (both antrum and corpus) and 31 (7%) had an endoscopic grading of gastric IM (EGGIM) ≥5.

Conclusion

Hp infection in Portugal is frequent, showing a north-south gradient, albeit smaller than expected. More than half of the strains showed no antibiotic resistance and only 4% exhibited dual resistance to clarithromycin/fluoroquinolones. We demonstrate the feasibility of studying resistance profile in endoscopic biopsies, suggesting that such tests may lead to reduce antibiotic consumption and associated side effects, as well as lower therapeutic costs. The presence of IM in approximately one-third of patients, in a predominantly young population, reinforces the relevance of endoscopic screening in Portugal.

References

1. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71:1724-62.
2. Hooi JKY, Lai WY, Ng WK, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153:420-9.
3. Howden CW, Graham DY. Recent Developments Pertaining to H. pylori Infection. Am J Gastroenterol. 2021;116:1-3.
4. Savoldi A, Carrara E, Graham DY, et al. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions. Gastroenterology. 2018;155:1372-82.
5. Lopo I, Libânio D, Pita I, et al. Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta-analysis. Helicobacter. 2018;23:e12493.
6. Kovacheva-Slavova M, Valkov H, Angelov T, et al. Screening for Helicobacter pylori infection and Clarithromycin resistance using Real-Time Polymerase Chain Reaction. Eur Rev Med Pharmacol Sci. 2021;25:5042-46.
7. Egli K, Wagner K, Keller PM, et al. Comparison of the Diagnostic Performance of qPCR, Sanger Sequencing, and Whole-Genome Sequencing in Determining Clarithromycin and Levofloxacin Resistance in Helicobacter pylori. Front Cell Infect Microbiol. 2020;10:596371.
8. Nyssen OP, Espada M, Gisbert JP. Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis. Front Microbiol. 2022;13:913436.

Introduction

Inflammatory Bowel Diseases (IBD) are chronic conditions whose etiology remains elusive. Several hypotheses, including a potential association with Helicobacter pylori (HP), have been proposed, as evidenced by declining prevalence due to eradication protocols. However, literature data exhibit considerable variability. Our study aims to determine the prevalence of HP infection in a population of IBD patients based on gastric biopsy results, alongside predictive factors for HP infection in this population, integrating epidemiological, endoscopic, and histological analyses.

Aims & Methods

This retrospective descriptive study spanned four and a half years from January 2019 to July 2023, encompassing all IBD patients who underwent gastroscopy with biopsy. Patients with fewer than four gastric biopsies were excluded. Data were collected from medical records, and statistical analysis was performed using SPSS software version 21.0.

Results

150 patients were included, with a median age of 39.9 years [range: 18-71 years; ±13.49], including 80 females (53.3%) and a sex - ratio of 0.8. All patients reported tea consumption (100%), while 25 patients (16.66%) were smokers, and 18 (12%) reported alcohol use. NSAID use was noted in 17 patients (11.3%), and proton pump inhibitor (PPI) use in 5 patients (3.3%). Additionally, 15 patients reported herbal therapy. All patients underwent gastroscopy with at least 3 antral and 2 fundic biopsies. 93.3% of patients underwent systematic gastroscopy. Among participants, 66 tested positive for HP (HP+) , including 61 asymptomatic individuals. Symptomatically, 4 patients experienced epigastric pain, and one case of gastroesophageal reflux disease (GERD) was observed. HP prevalence in our sample was 44%, with a higher prevalence among females (56% vs. 44% males). HP infection was more common among individuals aged 21-45 and over 60, peaking between 30 and 40. Endoscopic findings in HP+ patients included esophagitis in 6 patients (9%), erythematous and erosive gastritis in 4 patients (6%), hiatal hernia in 3 patients (4.5%), and micronodular antritis in 1 patient (1.5%). Duodenal and bulbar aphthoid ulcers were observed in 5 patients (7.5%). Notably, gastroscopy was normal in 112 patients. Epidemiological data analysis revealed that chronic NSAID use (P=0.01), herbal therapy (P=0.05), tea consumption (P=0.03), history of digestive cancer (P=0.01), young age (<37 years; P=0.05), and patients with ulcerative colitis (P=0.001) were significant risk factors for HP infection.

Conclusion

In our study, the prevalence of Helicobacter pylori infection was 44%. Ulcerative colitis was a significant risk factor for HP infection in our sample, with a highly significant P value of 0.0001. Therefore, should all IBD patients be systematically screened for HP infection?

Disclosure

No there is no Conflict of Interest into the text field below.

Introduction

Autoimmune atrophic gastritis (AAG) is an immune-mediated disorder characterized by corpus-restricted atrophy and pseudopyloric or intestinal metaplasia, associated with reduced hydrochloric acid and intrinsic factor production and heterogeneous clinical consequences. The aetiology of AAG is autoimmune, but the role of Helicobacter pylori (Hp) has been proposed, although not definitively proven. A possible antigenic crossreactivity with H+,K+-ATPase, the main autoantigen in AAG, has been reported and Hp seropositivity has been described in histologically Hp negative AAG. One study employed molecular biology techniques to characterize a cohort of AAG patients as definitively Hp naïve.

Aims & Methods

The aim was to assess the presence of Hp-related genes in corpus mucosa biopsies of pts with AAG and Hp-positive and negative ctr by using real-time PCR.
Single-centre, experimental molecular biology study on 55 pts with histologically diagnosed AAG, of whom at histology 52 were Hp negative (age 61.5, range 28-88 yrs, 75% F, 96.2% parietal cell (PCA) and 44.2% intrinsic factor antibodies (IFA) positive), while 3 were Hp positive (age 74,69,33 yrs; 1 F; all 3 PCA and 1 IFA positive). Ctr were 4 pts who underwent gastroscopy for non-ulcer dyspepsia, 2 with Hp-positive superficial antral gastritis (positive ctr), and 2 with a healthy stomach (negative ctr). Hp serology (ELISA or multiplex) was available from all pts. DNA was extracted from formalin-fixed, paraffin-embedded (FFPE) tissue sections of corpus mucosa biopsies and real-time PCR was performed using specific probes for UreA, UreC, and CagA Hp related genes; 16sRNA and Beta2 microglobulin (B2M) specific probes were used as amplification ctr of bacterial and human DNA (real-time PCR cycle threshold (CT) >28<38).

Results

In 4(7.7%) of the 52 histologically Hp negative AAG pts, Hp-related genes were detected, in 4(7.7%) UreC, in 3(5.8%) UreA, and in 1(1.9%) CagA. All of them (3 F, aged 88,85,58,56 yrs) had positive Hp serology and PCA, only one was IFA-positive. The detectability of B2M and bacterial 16sRNA genes did not differ in UreC-positive or UreC-negative pts (B2M CT mean 29.6±1.2 for Ure-C positives vs 29.7±1.4 for Ure-C negatives, p=0.99; 16SrRNA gene CT mean 29.9±1.2 vs 29.4±1.2, p=0.27) indicating that the not-detectability of Hp-related genes was unrelated to reduced amounts of gastric bacterial or human DNA. Hp serology was positive in all 4 histologically Hp-negative AAG pts positive for UreC compared to 5/48(10.4%) UreC negative pts (p<0.0001) indicating previous exposure. PCA were present in all 4 UreC positive AAG pts compared to 46/48(95.8%) of UreC negatives (p=0.68). IFA positivity in UreC negatives was nearly 2x higher than that of UreC positives (45.8% vs 25%, p=0.42) without reaching significance. In 2/3 pts with histologically Hp-positive AAG, Hp-related genes could be detected; in the remaining patient, nor UreA, UreC neither CagA gene could be found (M, 69 yrs, no anemia, PCA-IFA-Hp serology positive).

Conclusion

In >90% of histologically Hp-negative and PCA or IFA positive AAG pts, Hp-related genes cannot be retrieved in the gastric mucosa. In 10% of these Hp-genes negative AAG pts, previous exposure to Hp can be testified by positive serology.
Hp-related genes can be detected in gastric biopsies in <10% of histologically Hp-negative AAG patients and positive Hp serology further confirms the role of Hp in this group.
These findings show that primary, Hp naive AAG is the more common type, but in a subset of pts, AAG seems to be secondary to Hp infection.

References

Lenti MV, Nature Rev Dis Primer 2020,
Lahner E, Dig Liv Dis 2019,
Annibale B, Helicobacter ,
Mini R, Clin Chem 2007,
Dottori L, UEGW 2023
Rugge M, Gut 2022

Introduction

Helicobacter pylori (Hp) is an etiological agent of chronic gastritis, gastric and duodenal ulcers and gastric cancers. The use of an appropriate animal model for experimental studies on the pathogenesis of H. pylori infections is necessary due to the chronic character of such infections and difficulties in identifying their early stage in humans.

Aims & Methods

The aim of this study was to develop a guinea pig model of H. pylori infection and identify its microbiological, histological, molecular and serological determinants.​ Guinea pigs (Cavia porcellus) were inoculated per os with H. pylori strain: CCUG 17874 positive for vacuolating cytotoxin A (VacA) and cytotoxin associated gene A (CagA) protein, suspended in Brucella broth with fetal calf serum (FCS) and Skirrow supplement (on permission of Local Ethics Committee for Anima Experiments, Medical University of Lodz Poland, Decision 58/ŁB45/2016). To determine H. pylori colonization, 7 and 28 days after inoculation, a gastric tissue was used for culturing Hp histopathological examination of gastric tissue sections, stained by Mayer,s haematoxylin and eosin, Giemsa staining or Warthin-Starry silver staining to assess inflammatory response, or to visualize Helicobacter-like organisms (HLO). Furthermore an immunostaining with anti-Ki-67 antibodies was developed to assess epithelial cell proliferation. H. pylori infection was also confirmed by polymerase chain reaction (PCR) for detection in gastric tissue of ureC and cagA genes and by serological assessment of Hp antigens in feces and serum anti-Hp antibodies.

Results

This study showed the successful colonization of guinea pigs with Hp on the basis of microbiological, histological, molecular and immunological determinants In the light of obtained results Cavia porcellus can be a good model for studying Hp pathogenesis and the related immune response against this pathogen.

Conclusion

The ability to induce and confirm the Hp infection in guinea pig makes this animal model suitable for studying the pathogenesis of infection and the course of related immune response, which in vivo is modulated by the components of these bacteria.
Financing: The research was financially supported by the National Science Center by the grant SONATA 18 “Assessment of the ability of Mycobacterium bovis BCG-onco bacilli to control the development of Helicobacter pylori infection”, UMO-2022/47/D/NZ7/01097.