Geographic distribution of the cagA, vacA, iceA, oipA and dupA genes of Helicobacter pylori strains isolated in China

Background There are geographic variations in the genotypes of Helicobacter pylori (H. pylori) cagA, vacA, iceA, oipA and dupA. The aim of the study was to investigate the distribution of these genotypes among H. pylori strains from five regions of China and their association with clinical outcomes. Materials and methods Gastric biopsy specimens were obtained from 348 patients with different gastrointestinal diseases in the five regions of China. The regional distribution was 89 patients from Shandong, 91 from Guangxi, 57 from Hunan, 58 from Qinghai and 53 from Heilongjiang. The presence of cagA, vacA, iceA, oipA and dupA genotypes was determined by polymerase chain reaction (PCR) from H. pylori DNA. Results A total of 269 H. pylori isolates were obtained, of which 74 isolates were from Shandong, 78 from Guangxi, 46 from Hunan, 33 from Qinghai and 38 from Heilongjiang. The cagA-positive status was predominant in the five regions. The predominant vacA genotypes were s1c (73.4%), m2 (70.6%) and i1 (92.9%). In strains from Shandong, s1a and m1 were dominant. By contrast, s1c was dominant in Guangxi and i1 was dominant in Hunan and Heilongjiang. The prevalence of m2 subtype in Qinghai (78.8%) was significantly higher than that in other regions (P < 0.05). The predominant iceA genotype was iceA1 and the frequency of iceA1 was significantly more prevalent in Hunan than in other regions (P < 0.05). The oipA status “on” gene was more frequent in Shandong (91.9%) and Guangxi (91%) than in Heilongjiang (71.7%) (P < 0.05). Conversely, the dupA-positive status was less than half in Shandong (31.1%) and Guangxi (15.4%), whereas it was 73.9% in Hunan and 81.8% in Qinghai (P < 0.001). There were no significant associations between the cagA, vacA, iceA, oipA genotypes and clinical outcomes. The dupA-positive strains were more common in peptic ulcer disease (PUD) patients than in non-ulcer dyspepsia (NUD) patients in Shandong and Guangxi (P < 0.05), but the association was not observed in other geographic regions. Conclusions There was significant geographic diversity of H. pylori genotypes in different regions of China and the presence of dupA gene can be considered as a marker for the development of gastroduodenal diseases. However, the cagA, iceA, vacA and oipA genes cannot be regarded for prediction of the clinical presentation of H. pylori infection in China.

HVEM/BTLA Immune Checkpoint Expression in Development of Gastric Cancer

Purpose: Regarding the role of B- and T-lymphocyte attenuator/Herpesvirus entry mediator (BTLA/HVEM) in tumorigenesis, this research was conducted to determine the HVEM/BTLA expression in development of gastric cancer.Methods: The statistical population of this study consisted of 114 patients, who were divided into 3 groups of non-ulcer dyspepsia (NUD; n=32), intestinal metaplasia (IM; n=19), and gastric cancer (GC; n=63). BTLA and HVEM in gastric biopsies were evaluated using SYBR Green-based on real-time PCR and immunohistochemistry. In this research, soluble HVEM (sHVEM) concentration and anti-Helicobacter pylori IgG antibody were assessed in sera of all study subjects. Results: Our result showed that in contrast to mRNA, HVEM protein expression was significantly higher in the GC group, compared to that in the NUD and IM groups (P<0.0001 and P=0.0002, respectively). It was found that BTLA mRNA expression was significantly higher in the GC group than in the IM and NUD groups (P=0.004 and P=0.0003, respectively). It was also significantly elevated in the advanced stages of GC (P=0.039). IHC results showed significant expression of BTLA in GC and IM groups, compared to the NUD group (P=0.0002, and P=0.008, respectively), and advanced stages than early stages of gastric cancer (p = 0.005). The sHVEM concentration was also higher in the GC group than in the NUD groups (P=0.001). Conclusions: High expression of BTLA/HVEM and sHVEM suggested that this inhibitory pathway is involved in immune regulation and progression of IM and GC. Therefore, these molecules can be used for the diagnosis and prognosis of GC.

Endoscopic Evaluation of Dyspeptic Patients

Background: Dyspepsia is a common gastrointestinal problems affecting all age groups & social classes. Objectives: The purpose of the study was to determine the endoscopic findings of dyspeptic patients & to observe the demographic characteristics (age, sex, residence, education, socioeconomic condition) of the patients presented with dyspepsia. Methodology: This was a cross-sectional study conducted at Department of Medicine, Rangpur Medical College Hospital, Rangpur over a period of 1 year from 1st June 2010 to 31st May 2011. 150 dyspeptic patients of 18 or > 18 years old irrespective of sexes and suffering from one or more of the five symptoms (flatulence, food intolerance, epigastric pain, heartburn and aerophagia) for at least 6 months duration were recruited for the study from outpatient and inpatient department who were met the inclusion & exclusion criteria. Data were collected by using a structured questionnaire after taking written consent & upper GI Endocopy were done following meticulous history & through physical examination. Result: Over one-third (36%) of the patients were below 30 years, 17% between 30 – 40 years old, predominantly were rural residents, having primary to secondary level of education with monthly income below Taka 10000. Males to females ratio were 2:1. More than half (50.6%) of the patients was smoker, 32.7% had habit of taking tea, 10% were tobacco chewing and rest 6.7% used to take spicy meal.. Epigastric discomfort, flatulence and heartburn were the common complaints in both male and females but vomiting were proportionately higher in male dyspeptics compared to the female dyspeptics. Common associated symptoms like constipation and weight loss were equally in both sexes. Upper GI endoscopy revealed 17.3% of male and 11.5% of female with abnormal findings.Others abnormal findings included gastric ulcer, gastritis and duodenal ulcers (17.6 vs. 33.3%; 23.6 vs. 50% and 17.6 vs. 16.7% in male and female respectively). Majority (nearly 90% in either sex) of patients does not show any lesions on endoscopic examination and hence can be considered as non-ulcer dyspepsia. Conclusion: The study concludes that majority of patients with complaints of dyspepsia have no lesion on the gastric or duodenal mucosa and can be considered non-ulcer dyspepsia. The study findings also suggest that dyspepsia is a disease of young and early middle aged people with males being more likely to develop the disease than the females. However, large-scale community survey is recommended for further evaluation of dyspepsia. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 9-14

Efficacy and safety of Si-Jun-Zi-Tang-based therapies for functional (non-ulcer) dyspepsia: a meta-analysis of randomized controlled trials

Background The traditional Chinese medicine formula Si-Jun-Zi-Tang (SJZT) has a long history of application in the treatment of functional dyspepsia (non-ulcer dyspepsia, FD)-like symptoms. SJZT-based therapies have been claimed to be beneficial in managing FD. This study aimed to assess the efficacy and safety of SJZT-based therapies in treating FD by meta-analysis. Methods Systematic searches for RCTs were conducted in seven databases (up to February 2019) without language restrictions. Data were analyzed using Cochrane RevMan software version 5.3.0 and Stata software version 13.1, and reported as relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs). The primary outcome was response rate and the secondary outcomes were gastric emptying, quality of life, adverse effects and relapse rate. The quality of evidence was evaluated according to criteria from the Cochrane risk of bias. Results A total of 341 potentially relevant publications were identified, and 12 RCTs were eligible for inclusion. For the response rate, there was a statically significant benefit in favor of SJZT-based therapies (RR = 1.23; 95% CI 1.17 to 1.30). However, the benefit was limited to modified SJZT (MSJZT). The relapse rate of FD patients received SJZT-based therapies was lower than that of patients who received conventional medicines (OR = 0.23; 95% CI 0.10 to 0.51). No SJZT-based therapies-related adverse effect was reported. Conclusion SJZT-based prescriptions may be effective in treating FD and no serious side-effects were identified, but the effect on response rate appeared to be limited to MSJZT. The results should be interpreted with caution as all the included studies were considered at a high risk of bias. Standardized, large-scale and strictly designed RCTs are needed to further validate the benefits of SJZT-based therapies for FD management. Trial registration Systematic review registration: [PROSPERO registration: CRD42019139136].

COMPARATIVE EVALUATION OF THE EFFICACY AND TOLERABILITY OF ITOPRIDE HYDROCHLORIDE AND DOMPERIDONE IN PATIENTS WITH NONULCER DYSPEPSIAAT JLNMC, BHAGALPUR, BIHAR

Background :Prokinetic drugs are widely used for treatment of non-ulcer dyspepsia (NUD). Aims and Objectives : To assess the efficacy and tolerability of a new prokinetic agent, itopride hydrochloride in patients of NUD and compare it with domperidone. Methods : Fifty-six patients who fulfilled the inclusion and exclusion criteria were enrolled in the study. Patients underwent upper gastrointestinal endoscopy to rule out organic pathology as a cause for their symptoms. The patient’s symptoms were graded on a 4-point scale (0 to 3) at the beginning of treatment and at the end of Week-one and Week-two Patients were randomly allocated to receive either one tablet of itopride hydrochloride 50mg three times daily or one tablet of domperidone 10mg three times daily for two weeks. Pre-treatment and post-treatment hemogram, liver function and renal function tests, prolactin level and ECG were done in all patients. The response to therapy was evaluated by assessing the relief of symptoms at the end of two weeks on a 5 -point scale. Statistical analysis was done using two-tailed paired t-test; Wilcoxon matched pairs ranks sum test, Mann-Whitney-U test and chi-square test as applicable. Results : Of the fifty-five patients enrolled in the study (age range of 18-60 yrs, median age of 35yrs), 26 were males and twenty nine were females. They had a median duration of symptoms for 4 weeks. Twenty-seven patients received itopride and 28 received domperidone. One patient did not follow up in the domperidone group, thus 54 patients were evaluable for analysis. Moderate to complete symptomatic relief was observed in 22 (81%) patients in the itopride group and 19 patients (70%) in the domperidone group (p > 0.05, NS). Both the drugs were well tolerated and neither caused prolongation of QT interval nor any abnormality in any serum biochemistry values. Conclusion : Therapy with itopride resulted in good symptomatic relief, was safe, well tolerated and comparable in efficacy to domperidone in relieving the symptoms of NUD. By virtue of its efficacy and tolerability, it could be an ideal choice for providing symptomatic relief to patients suffering from non-ulcer dyspepsia.

A CLINICAL STUDY TO EVALUATE THE EFFICACY OF AN AYURVEDIC FORMULATION IN THE MANAGEMENT OF AMLAPITTA WITH SPECIAL REFERENCE TO NON–ULCER DYSPEPSIA

The dietary habits of present day, changing lifestyle, stress and strain related to job or domestic worries adversely impact the normal functioning of agni (digestive fire). Such individuals are prone to suffer from Amlapitta (Non-ulcer dyspepsia). The present study was conducted to explore the therapeutic potential of an Ayurvedic formulation containing shankha bhasma, madhuyashti and khadira in the management of Amlapitta with special reference to non-ulcer dyspepsia. The study was conducted on 30 patients selected from O.P.D. and I.P.D. of R.G.G.P.G.A.C., Paprola. Investigations were done to rule out any pathology. The subjective criteria included the symptom complex comprising hrita kantha daha (retro-sternal burning), amlodgara (sour eructations), utklesha (nausea), avipaka (indigestion) chhardi (vomiting), aruchi (loss of appetite), kukshi daha (epigastric burning), udaradhamana (flatulence) and klama (mental fatigue). Most of the patients showed moderate to marked improvement (~86%) in their symptoms as analyzed on visual analogue scale and grade score. The results obtained in the study revealed that the trial drug was quite effective and safe in treating Amlapitta.

A COMPARATIVE CLINICAL STUDY ON THE EFFECTIVENESS OF VASADI DASHANGA KWATHA AND PATOLADI KWATHA IN AMLAPITTA (NON ULCER DYSPEPSIA)

The ignorance about food and present life styles has made people at large to indulge in unwholesome food habits and regimens. Due to this lifestyle and improper diet pattern, there will be metabolic impairment leading to Amlata and Vidhagdhata of the consumed food. This is recognized as Amlapitta in Ayurveda. The Lakshanas of Amlapitta can be correlated with signs and symptoms of Non-ulcer Dyspepsia. The line of treatment as per allied science is life style changes, use of H2 receptor blocking agents and Proton Pump Inhibitors (PPI). Long term use of these antacids has shown various side effects. The patients with non ulcer Dyspepsia will have regurgitation despite of adequate acid suppression by treatment. It causes significant economic impact due to the long-term management of the disease and costs of possible complications. There is a need for a better medicine which can counter such changes and can reduce Amlata and Vidagdhata of consumed food. Medicines explained in Ayurveda have the ability to do the same. For this purpose, Vasadidashanga kwatha which is explained in Bhaishajya Ratnavali in comparison with Patoladikwatha as per mentioned in Chakradatta in the management of Amlapitta is been undertaken. Methods: In Clinical study, 60 patients fulfilling the diagnostic inclusion criteria were selected from OPD and IPD of Hospitals of South Canara and special camps conducted for the same. Patients were divided into 2 groups Group A and Group B and compared with Vasadidashangakwatha and Patoladikwatha with the standard dosage of Kwatha for a period of 30 days. Results: Assessment of the total effect of therapy was made by analyzing the data with suitable statistical tests of significance. Overall the test has shown significant result in Group A compared to Group B. Conclusion: Both Vasadidashanga kwatha and Patoladi kwatha showed good results in reduction of signs and symptoms of Amlapitta. Vasadidashanga kwatha gave better results in comparison with Patoladikwatha clinically. The statistical analysis also supported this by concluding that the improvement after treatment is highly significant in Group A (Vasadidashanga kwatha) when compared to Group B (Patoladikwatha).