Is There an Association between Variceal Bleed and Helicobacter pylori Infection in Cirrhotic Patients with Portal Hypertension?

Objectives: The objective of this study was to find the association of H. pylori in patients with variceal bleeding as well as rebleeding in cases of cirrhosis with portal hypertension. Methods: This was a prospective cohort of patients with bleeding esophageal varices. The primary outcome was correlation between prevalence of H. pylori and the incidence of bleeding/ rebleeding from varices and with encephalopathy. The secondary outcome were correlation between the site of bleeding with H. pylori infection and the association of pepsinogen I & II and the ratio of pepsinogen I/II with bleeding. Results: A total of 190 patients were assessed for eligibility, out of which 159 patients were included in this study. 124 out of 159 patients (77.9%) had alcohol-related liver disease. 8 out of 159 patients had HBV-related liver disease. 7 patients with varices had neither bled at presentation nor did bleed in the follow-up period. A total of 78 out of 159 (49.05%) patients were H.pylori-infected. Patients with esophageal varices [Adjusted Risk (AR)=0.7] and H.pylori infection (AR=0.7) had a lower risk of variceal rebleeding. Among the patients negative for H.pylori, pepsinogen I was higher in patients with rebleeding (30.7 vs 14.4; p<0.001). Among H.pylori positive patients, the ratio of pepsinogen I/II was higher in patients with rebleeding (2.9 vs 1.3; p=0.023). Conclusion: H.pylori infection was associated with a lower risk of rebleeding in cases of cirrhosis with portal hypertension. Irrespective of the status of H.pylori infection, rebleeding was associated with more gastric acid output demonstrated by the level of pepsinogen. Keywords: Pepsinogen; hepatic encephalopathy; gastric acid output, Helicobacter pylori

EXPERIENCE OF USING THE TEST SYSTEM «GASTROPANEL» IN THE PREVENTIVE MEDICAL EXAMINATION OF WORKFORCE IN JSC RZD

Non-invasive diagnosis of the gastric mucosa was carried out in 181 people in the preventive medical examination of workforce in JSC RZD. A set of diagnostics from Vector-Best (Novosibirsk, Russia) was used for enzyme immunoassay of pepsinogen I, pepsinogen II, and immunoglobulins for Helicobacter pylori. The prevalence of H. pylori infection in more than half of the employees, the presence of deviations of biomarkers from the norm in more than one in three employees were revealed. Laboratory signs of atrophy were detected eight times less frequently than signs of inflammation of the gastric mucosa, but when infected with H. pylori and increased with age.

520Helicobacter pylori infection in parents and their children

Background Helicobacter pylori (H.pylori) may be commonly transmitted among family members, especially from parents to their children. Therefore, we investigated the prevalence of H.pylori infection in parents and their children. Method The subjects (n = 607) were selected from participants of the Japan Multi-Institutional Collaborative Cohort Study in Okazaki, Japan, which was conducted from November 2018 to March 2019, and their families. Of the 607 subjects, 126 subjects (32 men=fathers, 94 women=mothers) participated in this study with at least one of their children (126 children in total). We defined ‘H.pylori infection+’ as 1) H.pylori antibody titer≥3U/mL or 2) pepsinogen I ≤ 70ng/mL with the ratio of pepsinogen I/II≤3.0 or 3) past eradication of H.pylori or 4) past history of gastric cancer. The prevalence of ‘H.pylori infection+’ was compared with between mothers and fathers who has infected children. Finally, the 94 mothers were divided into two groups according to their birth-year (1936-1963 and 1964-1973), and we compared the prevalence of ‘H.pylori infection+’ in mothers and their children by group. Result The prevalence of ‘H.pylori infection+’ in mothers and fathers was 44 (46.8%) and 9 (28.1%), respectively. 13 (29.5%) of the 44 infected mothers had at least one infected child, but the infected fathers did not have infected children. The prevalence of ‘H.pylori infection+’ in 50 mothers born in 1936-1963 was 28 (56.0%), and 9 (32.1%) of the 28 infected mothers had at least one infected child. The prevalence of ‘H.pylori infection+’ in 44 mothers born in 1964-1973 was 16 (36.4%), and 4 (25.0%) of the 16 infected mothers had at least one infected child. Conclusion In family members, H.pylori may be transmitted mainly from mothers, rather than from fathers, to their children. Key messages Among Japanese, the prevalence of H.pylori infection will decrease with decline of the infection in women.

Helicobacter pylori infection: place of serological and cultural diagnostics in clinical guidelines

The purpose of this work was to familiarize doctors with the methods and significance of serological and cultural diagnostics of H. pylori infection on the example of the test for diagnosing the state of the gastric mucosa «Gastropanel». Blood serum tests were performed for 1057 patients and 122 healthy people aged 18-64 years: pepsinogen I (PG I), pepsinogen II (PG II), gastrin-17 (G-17), basal/stimulated), antibodies (IgGHp) to H. pylori (Biohit Oyj, Finland). The medians of the studied group indicators did not exceed the reference intervals. 398 (34%) patients have negative H. pylori status (IgGHp-). 275 (26%) patients with serum PG I≤70 mcg/ml were identified. The ratio of PG I/II≤3 in 84 (8%), 36 of them (43% of the group PG I/II≤3) - IgGHp-.

Gastric Polyps and Atrophic Gastritis

Aim. A study of atrophic gastritis severity and rate in patients with gastric polyps (GP).Materials and methods. The study enrolled 61 patients with hyperplastic (HGP) and 41 — with adenomatous GP (AGP). All patients had 24-h gastric pH-metry, control of the pepsinogen I, II and gastrin-17 levels, in addition to a general clinical, endoscopic, histological examination and testing for Helicobacter pylori.Results. GP patients had benign manifestations prevailed with epigastric heaviness and overflow, and a scarce history of H. pylori testing at no control of rendered eradication therapy. A symptomatic proton pump inhibitor treatment in GP was either prescribed or voluntary. Focal atrophic gastritis in endoscopy was revealed in 12 (19.7 %) HGP and 16 (39.0 %) AGP patients, diffused atrophic gastritis — in 49 (80.3 %) HGP and 25 (60.9 %) AGP patients. Low-grade chronic gastritis in histology prevailed in HGP, moderate — in AGP, and severe — in 21.9 % cases. Moderate (27.9 %) to severe (65.6 %) atrophy of gastric mucosa was registered in HGP, with 53.7 and 39.0 % respective AGP cases. Polyp dysplasia was detected in 20 % HGP and 75.6 % AGP cases. Pepsinogen I <25 µg/L at a pepsinogen I/II ratio ><3 was observed in 38 (62.3 %) HGP and 18 (43.9 %) AGP patients. Hypo- and anacidic were 65.6 % HGP and 31.7 % AGP patients. >H. pylori-positive were 52.5 % HGP and 70.7 % AGP cases.Conclusion. A largely similar aetiopathogenesis of gastric polyps and chronic atrophic gastritis warrants the H. pylori diagnosis and a more detailed patient control for chronic gastritis grading and staging, functional insufficiency of gastric mucosa and the severity of hyperplastic and dysplastic change. The H. pylori eradication, in contrast to anti-secretory therapy, allows the containment of chronic gastritis and is a critical measure in gastric cancer prevention.

Gastric cancer detection using the serum pepsinogen test method

Background: Gastric cancer (GC) is the eighth most common cause of cancer deaths in Croatia and one of the most common causes of cancer deaths worldwide. A reliable diagnostic tool for the early detection of GC is essential. Objective: We previously suggested a pepsinogen test method to reduce the mortality from GC by allowing early detection. Here, we report an updated analysis from a prospective single-center clinical study to evaluate the sensitivity and specificity of the pepsinogen test method and to determine whether this test can be used as a part of routine laboratory assessment of high-risk patients. Methods: We present mature data of the pepsinogen test method in the Croatian population after a median follow-up of 36 months. Statistical analyses were performed using a Mann-Whitney U test, multiple logistic regression, and receiver operating characteristics (ROC) to evaluate the predictive power of the assayed biomarkers. Results: Of the 116 patients, 25 patients had GC and 91 demonstrated a nonmalignant pathology based on tissue biopsy. Cutoff values were pepsinogen I ⩽70 and pepsinogen I/II ratio ⩽3.0. Using ROC curve analysis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were determined to be 87.22%, 78.12%, 90.10%, 71.43%, and 92.86%, respectively, for the diagnosis of GC. The area under the curve was 0.700 (95% confidence interval 0.57–0.83). Conclusion: Pepsinogen tests are valuable for screening a population in need of further diagnosis and could help to avoid unnecessary invasive endoscopic procedures.

Association of Helicobacter Pylori Infection with Cardiovascular Diseases Subjects from Cameroon, Using GastroPanel® Serological Biomarker Panel (Pepsinogen I; Pepsinogen II; Gastrin-17; Helicobacter Pylori IgG)

Introduction: Helicobacter pylori infection is associated with gastrointestinal diseases including atrophic gastritis and gastric cancer. Epidemiologic studies have demonstrated associations between H. pylori infection andextra gastrointestinal organ involvements including coronary artery disease and peripherical artery disease, dyslipidemia, insulin resistance and hematologic disorders. We sought to evaluate the prevalence of H. pylori infection in patients suffering cardiovascular diseases attending the Yaounde Central Hospital. Materials and Methods: Patients suffering from various cardiovascular complications were recruited at the Yaounde Central Hospital, between January and May 2019. The clinical and socio-demographic information of the patients was recorded. Five ml of blood were collected aseptically for Pepsinogen I and II enzymes, gastrin17 hormone and IgG anti H. pylori anti-body. The test parameters were analyzed using a GastroSoft software application. The data was analyzed using Epi Info 7.0. All statistics were 95% CI. Ethical clearance was also obtained from the National Ethics Committee. The study was accepted by the authorities of the Yaounde CentralHospital. All patients signed an informed consent form. Results: A total of 62 subjects were recruited aged 30-75 years, (mean±SD 52.03 ± 12,78 years); 34(54,84%) females aged 30 to 75years (mean±SD 54,47 ± 13,47 years) and 28 (45,16%) males aged 30 to 65,(mean±SD 49,07± 11,44years). Female/male ratio was 1:2. H. pylori seropisitivity occurred in 58 (93,55%) of the subjects (IgG ≥30 EIU). H. pylori seropositivity was significantly associated with high blood pressure (RR=2.2 95%C.I 1.67 -2.96, p=0, 024). Significantly low Triglyceride concentrations were observed in H. pyloripositive(0,51±0,03g/l) compared to negative subjects (1,04 ± 0,50g/l), (p=0.03). A significant inverse correlation was observed between IgG levels and blood glucose levels (r= 0,4 p=0, 004). Conclussion: The study indicates that H. pylori infection is highly associated with various cardiovascular complications and disease risk factors.