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Archampong TN, Asmah RH, Richards CJ, Martin VJ, Bayliss CD, Botão E, David L, Beleza S, Carrilho C. Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana. World J Gastroenterol 2019; 25:3344-3358. [PMID: 31341360 PMCID: PMC6639557 DOI: 10.3748/wjg.v25.i26.3344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/14/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
Gastroduodenal disease (GDD) was initially thought to be uncommon in Africa. Amongst others, lack of access to optimal health infrastructure and suspicion of conventional medicine resulted in the reported prevalence of GDD being significantly lower than that in other areas of the world. Following the increasing availability of flexible upper gastro-intestinal endoscopy, it has now become apparent that GDD, especially peptic ulcer disease (PUD), is prevalent across the continent of Africa. Recognised risk factors for gastric cancer (GCA) include Helicobater pylori (H. pylori), diet, Epstein-Barr virus infection and industrial chemical exposure, while those for PUD are H. pylori, non-steroidal anti-inflammatory drug (NSAID)-use, smoking and alcohol consumption. Of these, H. pylori is generally accepted to be causally related to the development of atrophic gastritis (AG), intestinal metaplasia (IM), PUD and distal GCA. Here, we perform a systematic review of the patterns of GDD across Africa obtained with endoscopy, and complement the analysis with new data obtained on pre-malignant gastric his-topathological lesions in Accra, Ghana which was compared with previous data from Maputo, Mozambique. As there is a general lack of structured cohort studies in Africa, we also considered endoscopy-based hospital or tertiary centre studies of symptomatic individuals. In Africa, there is considerable heterogeneity in the prevalence of PUD with no clear geographical patterns. Furthermore, there are differences in PUD within-country despite universally endemic H. pylori infection. PUD is not uncommon in Africa. Most of the African tertiary-centre studies had higher prevalence of PUD when compared with similar studies in western countries. An additional intriguing observation is a recent, ongoing decline in PUD in some African countries where H. pylori infection is still high. One possible reason for the high, sustained prevalence of PUD may be the significant use of NSAIDs in local or over-the-counter preparations. The prevalence of AG and IM, were similar or modestly higher over rates in western countries but lower than those seen in Asia. . In our new data, sampling of 136 patients in Accra detected evidence of pre-malignant lesions (AG and/or IM) in 20 individuals (14.7%). Likewise, the prevalence of pre-malignant lesions, in a sample of 109 patients from Maputo, were 8.3% AG and 8.3% IM. While H. pylori is endemic in Africa, the observed prevalence for GCA is rather low. However, cancer data is drawn from country cancer registries that are not comprehensive due to considerable variation in the availability of efficient local cancer reporting systems, diagnostic health facilities and expertise. Validation of cases and their source as well as specificity of outcome definitions are not explicit in most studies further contributing to uncertainty about the precise incidence rates of GCA on the continent. We conclude that evidence is still lacking to support (or not) the African enigma theory due to inconsistencies in the data that indicate a particularly low incidence of GDD in African countries.
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Affiliation(s)
- Timothy N Archampong
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra Box 4236, Ghana
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Richard H Asmah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra Box 4236, Ghana
| | - Cathy J Richards
- Department of Histopathology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Vicki J Martin
- Department of Histopathology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Christopher D Bayliss
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Edília Botão
- Department of Pathology, Maputo Central Hospital, Maputo POBox 1164, Mozambique
| | - Leonor David
- Department of Pathology, Medical Faculty of the University of Porto, Porto 4200-465, Portugal
- Institute of Molecular Pathology and Immunology at the University of Porto (Ipatimup), Porto 4200-465, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto 4200-465, Portugal
| | - Sandra Beleza
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo POBox 257, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo POBox 1164, Mozambique
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Smith S, Fowora M, Pellicano R. Infections with Helicobacter pylori and challenges encountered in Africa. World J Gastroenterol 2019; 25:3183-3195. [PMID: 31333310 PMCID: PMC6626727 DOI: 10.3748/wjg.v25.i25.3183] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/02/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is the causative agent of gastritis, peptic ulcer disease, mucosa associated lymphoid tissue lymphoma and gastric cancer (GC). While this bacterium infects 50% of the world's population, in Africa its prevalence reach as high as 80% as the infection is acquired during childhood. Risk factors for H. pylori acquisition have been reported to be mainly due to overcrowding, to have infected siblings or parent and to unsafe water sources. Despite this high H. pylori prevalence there still does not exist an African guideline, equivalent to the Maastricht V/Florence Consensus Report of the European Helicobacter and Microbiota Study Group for the management of this infection. In this continent, although there is a paucity of epidemiologic data, a contrast between the high prevalence of H. pylori infection and the low incidence of GC has been reported. This phenomenon is the so-called "African Enigma" and it has been hypothesized that it could be explained by environmental, dietary and genetic factors. A heterogeneity of data both on diagnosis and on therapy have been published. In this context, it is evident that in several African countries the increasing rate of bacterial resistance, mainly to metronidazole and clarithromycin, requires continental guidelines to recommend the appropriate management of H. pylori. The aim of this manuscript is to review current literature on H. pylori infection in Africa, in terms of prevalence, risk factors, impact on human health, treatment and challenges encountered so as to proffer possible solutions to reduce H. pylori transmission in this continent.
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Affiliation(s)
- Stella Smith
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos PMB 2013, Nigeria
| | - Muinah Fowora
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos PMB 2013, Nigeria
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Baxendell K, Walelign S, Tesfaye M, Wordofa M, Abera D, Mesfin A, Wolde M, Desta K, Tsegaye A, Taye B. Association between infection with Helicobacter pylori and platelet indices among school-aged children in central Ethiopia: a cross-sectional study. BMJ Open 2019; 9:e027748. [PMID: 30962240 PMCID: PMC6500313 DOI: 10.1136/bmjopen-2018-027748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Previous clinical studies in adults from developed countries have implicated Helicobacter pylori infections in the development of thrombocytopenia. However, studies in children, particularly those from low-income countries, are unusually scarce. We examined the association between H. pylori infection and platelet indices in young Ethiopian school children. DESIGN Cross-sectional study SETTING: This study was conducted in five elementary schools located in central Ethiopia. PARTICIPANTS Blood and stool samples were collected from 971 children across five elementary schools in Ethiopia. H. pylori infection was diagnosed using stool antigen and serum antibody tests, and haematological parameters were measured using an automated haematological analyser. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. The independent effects of H. pylori infection on platelet indices were determined using multivariate linear and logistic regressions. STUDY OUTCOMES H. pylori-infected children had a lower average platelet count and mean platelet volume than uninfected after adjusting the potential confounders (adjusted mean difference: -20.80×109/L; 95% CI -33.51 to -8.09×109, p=0.001 and adjusted mean difference: -0.236 fL; 95% CI -0.408 to -0.065, p=0.007, respectively). Additionally, H. pylori-infected children had lower red blood cell counts (adjusted mean difference: -0.118×1012/L; 95% CI -0.200 to -0.036, p=0.005) compared with non-infected. CONCLUSION Our study from a developing country provides further support for an association between H. pylori infections and reduced platelet indices in young Ethiopian school children, after controlling for potential confounders. Further research is needed, particularly longitudinal studies, to establish causality.
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Affiliation(s)
- Kellyann Baxendell
- Department of Biology, Colgate University Division of Natural Sciences and Mathematics, Hamilton, New York, USA
| | - Sosina Walelign
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mehret Tesfaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Moges Wordofa
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessie Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abiyot Mesfin
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mistire Wolde
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bineyam Taye
- Department of Biology, Colgate University Division of Natural Sciences and Mathematics, Hamilton, New York, USA
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Correlation between Helicobacter pylori Infection and Gastric Atrophy Examined in the Sera of Mongolian People. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1020019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Serum specimens obtained from 680 individuals were examined to measure the amounts of pepsinogens 1 and 2, anti-CagA antibodies, and anti-Helicobacter pylori antibodies. We examined sera obtained from 610 Mongolian individuals living in the capital city, Ulaanbaatar. Seventy serum specimens were collected from Japanese people who were health-screened: These were stored at the gastroenterology laboratory of Jichi Medical University. The sera of the Japanese people were used as a control specimen. Two enzyme-linked immunosorbent assay (ELISA) kits, an E-plate ELISA kit from Eiken Chemical Co., Ltd. (Tokyo, Japan), and a Biohit ELISA kit from Biohit Oyj (Helsinki, Finland), were used for the detection of anti-H. pylori IgG antibodies in the sera of the 610 Mongolian people. An ELISA kit EIA-4138 from DRG Instruments GmbH (Germany) was used for the detection of anti-CagA IgG antibodies in the serum specimens. Serum pepsinogens were detected by an ELISA kit from Biohit Oyj. Of the 610 serum specimens, 385 specimens tested positive for the detection of anti-H. pylori antibodies using the two ELISA kits, and 47 tested negative. For the detection of anti-H. pylori antibodies by the Biohit ELISA kit, 560 and 50 specimens were positive and negative, respectively. The ratio of serum pepsinogen 1/2 was statistically lower (p < 0.0001) in the H. pylori-positive (560 specimens) than in the H. pylori-negative (50 specimens) specimens. However, the levels of serum pepsinogen 1 had no statistical significance (p = 0.465) between the specimens of the H. pylori-positive and -negative specimens. The ratio of serum pepsinogen 1/2 was 6.74 ± 0.12 in the H. pylori-positive specimens, whereas the ratio of serum pepsinogen 1/2 was 12.69 ± 1.02 in the H. pylori-negative specimens. This study demonstrated the high prevalence of H. pylori infection in Mongolian people, including young generations, and the people infected with H. pylori possessed low pepsinogen 1/2 ratios, indicating atrophic gastritis. The serological examinations by the two ELISA kits did not consistently reflect the prevalence of H. pylori infection in Mongolian people.
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Pucułek M, Machlowska J, Wierzbicki R, Baj J, Maciejewski R, Sitarz R. Helicobacter pylori associated factors in the development of gastric cancer with special reference to the early-onset subtype. Oncotarget 2018; 9:31146-31162. [PMID: 30123433 PMCID: PMC6089554 DOI: 10.18632/oncotarget.25757] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023] Open
Abstract
Nowadays, gastric cancer is one of the most common neoplasms and the fourth cause of cancer-related death on the world. Regarding the age at the diagnosis it is divided into early-onset gastric carcinoma (45 years or younger) and conventional gastric cancer (older than 45). Gastric carcinomas are rarely observed in young population and rely mostly on genetic factors, therefore provide the unique model to study genetic and environmental alternations. The latest research on early-onset gastric cancer are trying to explain molecular and genetic basis, because young patients are less exposed to environmental factors predisposing to cancer. In the general population, Helicobacter pylori, has been particularly associated with intestinal subtype of gastric cancers. The significant association of Helicobacter pylori infection in young patients with gastric cancers suggests that the bacterium has an etiologic role in both diffuse and intestinal subtypes of early-onset gastric cancers. In this paper we would like to ascertain the possible role of Helicobacter pylori infection in the development of gastric carcinoma in young patients. The review summarizes recent literature on early-onset gastric cancers with special reference to Helicobacter pylori infection.
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Affiliation(s)
| | | | - Ryszard Wierzbicki
- Department of Surgery with Trauma, Orthopaedic and Urological Subunit, Independent Public Health Care Center of the Ministry of Interior and Administration in Lublin, Poland
- Department of Surgical Oncology, Medical University of Lublin, Poland
| | - Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, Poland
| | | | - Robert Sitarz
- Department of Human Anatomy, Medical University of Lublin, Poland
- Department of Surgery with Trauma, Orthopaedic and Urological Subunit, Independent Public Health Care Center of the Ministry of Interior and Administration in Lublin, Poland
- Department of Surgery, St. John's Cancer Center, Lublin, Poland
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El Khadir M, Alaoui Boukhris S, Benajah DA, El Rhazi K, Ibrahimi SA, El Abkari M, Harmouch T, Nejjari C, Mahmoud M, Benlemlih M, Bennani B. VacA and CagA Status as Biomarker of Two Opposite End Outcomes of Helicobacter pylori Infection (Gastric Cancer and Duodenal Ulcer) in a Moroccan Population. PLoS One 2017; 12:e0170616. [PMID: 28125638 PMCID: PMC5268467 DOI: 10.1371/journal.pone.0170616] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/06/2017] [Indexed: 12/13/2022] Open
Abstract
Helicobacter pylori (H. pylori) infection induces inflammation of the gastric mucosa, which may progress to precancerous lesions leading to gastric cancer. Pathological determinism is associated to some virulence genes of the bacterium, notably the vacA and cagA genes. The present study aimed to determine the H. pylori genotypes distribution and their association with sex, age and gastric diseases in a Moroccan population. Gastric biopsy was taken from 1079 consenting patients. The specimens were processed by PCR to identify H. pylori and to determine the genotypic profile by PCR characterizing vacA s, vacA m and vacA i regions directly from biopsies H. pylori positives. VacA genotyping revealed the predominance of vacA m2 (53.2%), vacA s2 (52.9%) and vacA i2 (52%). The most virulent vacA alleles (s1, i1 and m1) are more predominant in men (47.3%, 41.9% and 46.1% respectively) than in women (38.3%, 33.3% and 37% respectively). However, the association between vacA genotypes and age did not reach a statistical significant value. Logistic regression analysis results show that vacA i1m1 and vacA i1m2 genotypes were strongly associated with the risk of GC, the Odds Ratio (95% confidence interval) was 29.73 [5.08-173.73] and 9.17 [2.06-40.82] respectively, while vacAs1/cagA+ seems to be a risk factor for DU since it is inversely associated with GC (OR was 0.13 [0.02-0.75]. The results of this study suggest that vacA i1 genotype independently to vacAm status may be of a clinical usefulness and will help to identify patients at a high risk of GC development.
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Affiliation(s)
- Mounia El Khadir
- Laboratoire de Microbiologie et de Biologie Moléculaire, Equipe Micro-organismes, Génomique et Facteurs Oncogènes, Faculté de Médecine et de Pharmacie de Fès (FMPF), Université Sidi Mohammed Ben Abdellah (USMBA), Fez, Morocco
- Laboratoire de Biotechnologie, Faculté des Sciences Dhar El Mehraz, USMBA, Fez, Morocco
| | - Samia Alaoui Boukhris
- Laboratoire de Microbiologie et de Biologie Moléculaire, Equipe Micro-organismes, Génomique et Facteurs Oncogènes, Faculté de Médecine et de Pharmacie de Fès (FMPF), Université Sidi Mohammed Ben Abdellah (USMBA), Fez, Morocco
| | - Dafr-Allah Benajah
- Service d’Hépato Gastro-entérologie, CHU Hassan II de Fès, Equipe Maladies de l’Appareil Digestif, FMPF, Fez, Morocco
- Laboratoire de Pathologie Humaine, Biomédecine et Environnement, FMPF, USMBA, Fez, Morocco
| | - Karima El Rhazi
- Laboratoire d’Epidémiologie et de Recherche Clinique, FMPF, USMBA, Fez, Morocco
| | - Sidi Adil Ibrahimi
- Service d’Hépato Gastro-entérologie, CHU Hassan II de Fès, Equipe Maladies de l’Appareil Digestif, FMPF, Fez, Morocco
- Laboratoire de Pathologie Humaine, Biomédecine et Environnement, FMPF, USMBA, Fez, Morocco
| | - Mohamed El Abkari
- Service d’Hépato Gastro-entérologie, CHU Hassan II de Fès, Equipe Maladies de l’Appareil Digestif, FMPF, Fez, Morocco
- Laboratoire de Pathologie Humaine, Biomédecine et Environnement, FMPF, USMBA, Fez, Morocco
| | | | - Chakib Nejjari
- Laboratoire d’Epidémiologie et de Recherche Clinique, FMPF, USMBA, Fez, Morocco
| | | | - Mohamed Benlemlih
- Laboratoire de Biotechnologie, Faculté des Sciences Dhar El Mehraz, USMBA, Fez, Morocco
| | - Bahia Bennani
- Laboratoire de Microbiologie et de Biologie Moléculaire, Equipe Micro-organismes, Génomique et Facteurs Oncogènes, Faculté de Médecine et de Pharmacie de Fès (FMPF), Université Sidi Mohammed Ben Abdellah (USMBA), Fez, Morocco
- Laboratoire de Pathologie Humaine, Biomédecine et Environnement, FMPF, USMBA, Fez, Morocco
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Abdi E, Latifi-Navid S, Latifi-Navid H, Safarnejad B. Helicobacter pylori vacuolating cytotoxin genotypes and preneoplastic lesions or gastric cancer risk: a meta-analysis. J Gastroenterol Hepatol 2016; 31:734-44. [PMID: 26648346 DOI: 10.1111/jgh.13256] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 11/21/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Disease progression to gastric cancer (GC) occurs in only a small proportion of Helicobacter pylori (H. pylori) infected patients. The bacterium vacuolating cytotoxin A (vacA) gene polymorphisms may determine the clinical consequences. We examined the strength of this association in adult-infected populations and modeled the impact of mean age-standardized incidence rates (ASRs) of GC as a hypothesized moderator variable. METHODS Pooled relative risk (RR) estimates were calculated. Subgroup, sensitivity, and meta-regression analyses were conducted. RESULTS Totally, 33 studies (1446 cases/2697 controls) were analyzed. The vacA-s1 genotype was significantly associated with an increased risk of atrophic gastritis(AG), intestinal metaplasia(IM), and GC (RR = 1.116, 95% CI, 1.019-1.222; RR = 1.418, 95% CI, 1.035-1.942; and RR = 1.333, 95% CI, 1.115-1.593, respectively); however, the vacA m1 genotype strongly increased the risk of IM and GC, but not AG (RR = 1.571, 95% CI, 1.247-1.980 and RR = 1.431, 95% CI, 1.180-1.735, respectively). The vacA s1m1 allelic combination was linked to an increased risk of GC. The m1-type of vacA was more potent than s1 for predicting the risk of GC within the subgroups with the mean ASRs of 11/100,000-19/100,000 and less than 10/100,000. The meta-regression analysis indicated that the ASR of GC modified the association between H. pylori genotypes and GC risk, where the estimated risk was significantly decreased with increasing the mean ASRs of GC (P-values = 0.025, 0.00009, and 0.0005 for s1, m1, and s1m1, respectively). CONCLUSIONS The H. pylori vacA-s1 and vacA-m1 allelic variants strongly increased susceptibility to IM and GC; however, only s1 showed an association with AG. These associations were largely influenced by geographic variations in the GC incidence rate.
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Affiliation(s)
- Esmat Abdi
- Department of Biology, Faculty of Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Saeid Latifi-Navid
- Department of Biology, Faculty of Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Hamid Latifi-Navid
- Department of Biology, Faculty of Sciences, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Bahareh Safarnejad
- Department of Neurology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Amberbir A, Medhin G, Abegaz WE, Hanlon C, Robinson K, Fogarty A, Britton J, Venn A, Davey G. Exposure to Helicobacter pylori infection in early childhood and the risk of allergic disease and atopic sensitization: a longitudinal birth cohort study. Clin Exp Allergy 2014; 44:563-71. [PMID: 24528371 PMCID: PMC4164268 DOI: 10.1111/cea.12289] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 12/21/2013] [Accepted: 01/12/2014] [Indexed: 12/21/2022]
Abstract
Background An inverse relation between Helicobacter pylori infection and allergic disease has been reported by a range of independent epidemiological studies, but evidence from longitudinal studies is scarce. Objective We have investigated the effects of H. pylori infection on the incidence and prevalence of allergic diseases and sensitization in a low-income birth cohort. Methods In 2005/2006, a population-based birth cohort was established in Butajira, Ethiopia, and the 1006 singleton babies born were followed up at ages 1, 3, and 5. Symptoms of allergic disease were collected using the ISAAC questionnaire, allergen skin tests performed, and stool samples analysed for H. pylori antigen and geohelminths. Multiple logistic regression was used to determine the independent effects of H. pylori measured at age 3 on the incidence of each outcome between ages 3 and 5 years (in those without the outcome at age 3), controlling for potential confounders, and to additionally assess cross-sectional associations. Results A total of 863 children were followed up to age 5. H. pylori infection was found in 25% of the children at both ages 3 and 5, in 21% at age 5 but not 3, and in 17% at age 3 but not at age 5. H. pylori infection at age 3 was significantly associated with a decreased risk of incident eczema between ages 3 and 5 (adjusted OR, 95% CI, 0.31; 0.10–0.94, P = 0.02). Cross-sectionally at age 5, H. pylori infection was inversely associated with skin sensitization (adjusted OR, 95% CI, 0.26; 0.07–0.92, P = 0.02). Conclusion and clinical relevance These findings provide further evidence to suggest that early-life exposure to H. pylori may play a protective role in the development of allergy.
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Affiliation(s)
- A Amberbir
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Alikhani MY, Arebestani MR, Sayedin Khorasani M, Majlesi A, Jaefari M. Evaluation of Helicobacter pylori vacA and cagA Genotypes and Correlation With Clinical Outcome in Patients With Dyspepsia in Hamadan Province, Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e19173. [PMID: 25763216 PMCID: PMC4329959 DOI: 10.5812/ircmj.19173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 06/14/2014] [Accepted: 07/09/2014] [Indexed: 01/04/2023]
Abstract
Background: Helicobacter pylori is known to be a causative agent of chronic active gastritis, peptic ulcer and gastric cancer in human. Diverse genotypes of H. pylori strains have different virulence potency and geographic distribution. Objectives: The purpose of this study was to investigate the association between the cytotoxin-associated gene (cagA), and the various vacuolating cytotoxin (vacA) genotypes of H. pylori strains and clinical outcomes in patients referred to Shahid-Beheshti Hospital in Hamadan, Iran. Patients and Methods: In this cross-sectional study, biopsy samples were collected consecutively from 153 patients with gastric cancer (GC), peptic ulcer dyspepsia (PUD) and non-ulcer dyspepsia (NUD) in the gastroenterology department of Shahid-Beheshti Hospital in Hamadan province, the west of Iran. H. pylori infection was confirmed in 83 patients (3 with GC, 27 with PUD, and 53 with NUD) by histology, rapid urease test (RUT) and culture. Genomic DNA was extracted from the bacterial isolate and was further confirmed with 16S rRNA gene sequencing as H. pylori, and characterized based on cagA and vacA genotyping using the polymerase chain reaction (PCR) method. Results: In this study, vacA genotypes s1/m2, s1/m1, s2/m2 and s2/m1 were determined in 43.4%, 19.3%, 13.2% and 6% of the isolated H. pylori, respectively. The vacAs1 genotype was detected in 52 (62.6%) isolates, of which the vacAs1a genotype was detected in 45.2, 40.7, and 66.6% of the isolates from patients with NUD, PUD, and GC, respectively. The cagA-positive genotype was determined in 73 (87.9%) isolates and 10 (12.1%) were negative. The frequency rates of cagA gene were 84.9, 92.6 and 100% in isolates of patients with NUD, PUD, and GC, respectively. The cagA-positive genotype is strongly associated with s1a/m2 and s1a/m1 vacA genotypes. Conclusions: The most predominant VacA genotypes in our areas were s1/m2 and s1/m1, which regard as the genotypes with more virulence intensity. The H. pylorivacAs1a, cagA genotypes have a significant relationship with the presence of PUD and GC in Iranian patients with dyspepsia.
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Affiliation(s)
- Mohammad Yousef Alikhani
- Brucellosis Research Center, Hamadan University of Medical Sceinces, Hamadan, IR Iran
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Mohammad Reza Arebestani
- Brucellosis Research Center, Hamadan University of Medical Sceinces, Hamadan, IR Iran
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
- Corresponding Author: Mohammad Reza Arebestani, Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran. Tel: +98-9188662009, Fax: +98-8118380762, E-mail:
| | - Masood Sayedin Khorasani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Amir Majlesi
- Department of Gastrointestinal Diseases, Beheshti Hospital, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Mohammad Jaefari
- Department of Pathology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
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Yadegar A, Mobarez AM, Alebouyeh M, Mirzaei T, Kwok T, Zali MR. Clinical relevance of cagL gene and virulence genotypes with disease outcomes in a Helicobacter pylori infected population from Iran. World J Microbiol Biotechnol 2014; 30:2481-90. [PMID: 24854336 DOI: 10.1007/s11274-014-1673-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/16/2014] [Indexed: 12/11/2022]
Abstract
Helicobacter pylori infection is common in Iran as in other developing countries. Certain genotypes of H. pylori have been associated with increased occurrence of chronic gastritis, peptic ulcers, and gastric adenocarcinoma. The aim of this study was to investigate the clinical relevance of cagL gene and other virulence genotypes of H. pylori isolates with clinical outcomes in Iranian patients. Totally, 126 symptomatic patients who underwent gastroduodenal endoscopy were enrolled in the study. Sixty-one H. pylori strains were isolated from the patients studied. The presence of the cagL, cagA, vacA, iceA, babA2 and sabA genes in the corresponding H. pylori isolates were determined by polymerase chain reaction and the results were compared with clinical outcomes and histopathology. The cagL, cagA, vacA s1, vacA s2, vacA m1, vacA m2, iceA1, iceA2, babA 2 , and sabA genotypes were detected in 96.7, 85.2, 75.4, 24.6, 29.5, 70.5, 42.6, 23, 96.7, and 83.6% of the isolates, respectively. The three genotypic combinations, cagL/cagA/vacAs1m1/iceA1/babA2/sabA, cagL/cagA/vacAs1m2/iceA1/babA2/sabA, and cagL/cagA/vacAs1m2/iceA2/babA2/sabA were determined as the most prevalent combined genotypes. There was a significant correlation between the presence of cagL gene and cagA positivity (P = 0.02). No significant correlation was found between the various genotypes and clinical outcomes (P > 0.05). The present study showed a very high prevalence of cagL genotype among the H. pylori isolates from Iranian patients. Our results demonstrated that neither single genotype nor combination genotypes of virulence-associated genes was significantly helpful markers for predicting the severity of gastroduodenal disease associated with H. pylori infection in Iranian patients.
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Affiliation(s)
- Abbas Yadegar
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Vaziri F, Peerayeh SN, Alebouyeh M, Mirzaei T, Yamaoka Y, Molaei M, Maghsoudi N, Zali MR. Diversity of Helicobacter pylori genotypes in Iranian patients with different gastroduodenal disorders. World J Gastroenterol 2013; 19:5685-5692. [PMID: 24039362 PMCID: PMC3769906 DOI: 10.3748/wjg.v19.i34.5685] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 09/11/2012] [Accepted: 11/14/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the diversity of Helicobacter pylori (H. pylori) genotypes and correlations with disease outcomes in an Iranian population with different gastroduodenal disorders. METHODS Isolates of H. pylori from patients with different gastroduodenal disorders were analyzed after culture and identification by phenotypic and genotypic methods. Genomic DNA was extracted with the QIAamp DNA mini kit (Qiagen, Germany). After DNA extraction, genotyping was done for cagA, vacA (s and m regions), iceA (iceA1 , iceA2 ) and babA with specific primers for each allele using polymerase chain reaction (PCR). All patients' pathologic and clinical data and their relation with known genotypes were analyzed by using SPSS version 19.0 software. χ² test and Fisher's exact test were used to assess relationships between categorical variables. The level of statistical significance was set at P < 0.05. RESULTS A total of 71 isolates from 177 patients with different gastroduodenal disorders were obtained. Based on analysis of the cagA gene (positive or negative), vacA s-region (s1 or s2), vacA m-region (m1 or m2), iceA allelic type (iceA1 and iceA2 ) and babA gene (positive or negative), twenty different genotypic combinations were recognized. The prevalence of cagA, vacA s1 , vacA s2 , vacA m1 , vacA m2 , iceA1 , iceA2 , iceA1+iceA2 and babA were 62%, 78.9%, 19.7%, 21.1%, 78.9%, 15.5%, 22.5%, 40.8% and 95.8%, respectively. Interestingly, evaluation of PCR results for cagA in 6 patients showed simultaneous existence of cagA variants according to their size diversities that proposed mixed infection in these patients. The most prevalent genotype in cagA-positive isolates was cagA⁺/vacAs1m2 /iceA1 +A2 /babA+ and in cagA-negative isolates was cagA⁻/vacAs1m2 /iceA-/babA+. There were no relationships between the studied genes and histopathological findings (H. pylori density, neutrophil activity, lymphoid aggregation in lamina propria and glandular atrophy). The strains which carry cagA, vacAs1/m1 , iceA2 and babA genes showed significant associations with severe active chronic gastritis (P = 0.011, 0.025, 0.020 and 0.031, respectively). The vacAs1 genotype had significant correlation with the presence of the cagA gene (P = 0.013). Also, babA genotype showed associations with cagA (P = 0.024). In the combined genotypes, only cagA⁺/vacAs1m1 /iceA2 /babA+ genotype showed correlation with severe active chronic gastritis (P = 0.025). CONCLUSION This genotyping panel can be a useful tool for detection of virulent H. pylori isolates and can provide valuable guidance for prediction of the clinical outcomes.
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Tanih NF, McMillan M, Naidoo N, Ndip LM, Weaver LT, Ndip RN. Prevalence of Helicobacter pylori vacA, cagA and iceA genotypes in South African patients with upper gastrointestinal diseases. Acta Trop 2010; 116:68-73. [PMID: 20529658 DOI: 10.1016/j.actatropica.2010.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 05/11/2010] [Accepted: 05/31/2010] [Indexed: 02/07/2023]
Abstract
Clinical response to Helicobacter pylori infection may be determined by specific virulence-associated genotypes which varies geographically. The aim of this study was to investigate the diversity of putative virulence markers of H. pylori; cagA, vacA and iceA in the Eastern Cape Province of South Africa. One hundred H. pylori strains obtained from dyspeptic patients were used. Gastric biopsies were obtained from 254 dyspeptic patients. H. pylori was cultured and strains were studied. Bacterial genotypes cagA, vacA (s and m subtypes) and iceA were analysed by PCR using specific primers. CagA was identified in 90% of the strains investigated. Fifty-eight of the 100 strains had the vacA signal sequence genotype s1 and 26 had subtype s2. Combined vacA s1/s2 was detected in 16 of the strains. VacA middle region analysis showed that 8 (8%) strains were m1 while 50 were m2. Combined vacA m1/m2 was detected in 36 of the strains. s1m2 (20%) and s2m2 (20%) genotypes were the most common allelic combinations of the vacA gene among the strains. Multiple vacA genotypes were detected in this study. Twenty-six percent of the strains identified had both iceA1 and iceA2. All our strains tested positive for the ureC (glmM) gene. This study reveals a high prevalence of vacA, cagA and iceA2.
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Affiliation(s)
- Nicoline F Tanih
- Microbial Pathogenicity and Molecular Epidemiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag X 1314, Alice 5700, South Africa
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Frequency of Helicobacter pylori vacA genotypes in Iranian patients with gastric and duodenal ulcer. J Infect Public Health 2009; 2:204-8. [PMID: 20701884 DOI: 10.1016/j.jiph.2009.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 08/07/2009] [Accepted: 08/27/2009] [Indexed: 11/21/2022] Open
Abstract
Helicobacter pylori infection is a risk factor for developing chronic peptic ulcers and gastric cancer. The purpose of this study was to investigate the frequency of Helicobacter pylori vacA genotypes in patients with gastric and duodenal ulcer. A total of 100 biopsy specimens of patients with gastric (n=50) and duodenal (n=50) ulcer were collected. The specimens were cultured on selective media and incubated in a microaerophilic atmosphere at 37 degrees C for 5-10 days. The isolates were characterized to species level by conventional biochemical tests. The extracted DNA from isolates was used to perform a polymerase chain reaction based, simultaneous analysis of the cagA status, allelic variation of the signal regions (s1, s2) and the middle regions (m1, m2) of the vacA gene. H. pylori isolated from 50 specimens of patients and the vacA gene was detected in all isolates. Among vacA genotypes the s1/m1 was the most common in H. pylori isolates from patients with gastric ulcer (56%) and duodenal ulcer (68%). This study demonstrated that vacA slml is common genotype of H. pylori in patients with peptic ulcer and the vacA allele s1 of this bacterium is associated with ulcer.
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Sugimoto M, Yamaoka Y. The association of vacA genotype and Helicobacter pylori-related disease in Latin American and African populations. Clin Microbiol Infect 2009; 15:835-42. [PMID: 19392900 PMCID: PMC3118417 DOI: 10.1111/j.1469-0691.2009.02769.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the populations of Western countries, particular genotypes of the vacuolating cytotoxin gene, vacA (vacA s, signal region variants; vacA m, middle region variants) of Helicobacter pylori are believed to be risk factors for the development of peptic ulcers and gastric cancer. However, it was unclear whether these vacA gene variants are associated with the development of gastrointestinal diseases in developing nations. The relationship between vacA genotypes and H. pylori-related disease development in Latin American and African populations was investigated using meta-analysis of 2612 patients from Latin America (2285 strains) and 520 patients from Africa (434 strains). The frequencies of vacA s and m genotypes differed between strains from Latin America (77.2% for s1 and 68.1% for m1) and Africa (83.9% for s1 and 56.7% for m1). Latin American strains with s1 and m1 genotypes increased the risk of gastric cancer (OR 4.17, 95% CI 2.49-6.98 for s1, and 3.59, 2.27-5.68 for m1) and peptic ulcers (e.g. 1.73, 1.37-2.20 for s1). African strains with the s1 or m1 genotypes also increased the risk of peptic ulcers (8.69, 1.16-64.75 for s1) and gastric cancer (10.18, 2.36-43.84 for m1). The cagA-positive genotype frequently coincided with s1 and m1 genotypes in both populations. Overall, the vacA s and m genotypes were related to gastric cancer and peptic ulcer development and might be useful markers of risk factors for gastrointestinal disease, especially in Latin America. Further studies will be required to evaluate the effects of vacA genotypes in African populations because of the small sample number currently available.
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Affiliation(s)
- M Sugimoto
- Department of Medicine-Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Li J, Ou Z, Wang F, Guo Y, Zhang R, Zhang J, Li P, Xu W, He Y. Distinctiveness of the cagA genotype in children and adults with peptic symptoms in South China. Helicobacter 2009; 14:248-55. [PMID: 19674128 DOI: 10.1111/j.1523-5378.2009.00690.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Helicobacter pylori infection is different between children and adults, not only in infection rate but also in virulence genotypes. However, the 3' region of CagA, important in stomach carcinogenesis, still remains unclear in children. The present study aims to compare the frequency of cagA and the distribution of its subtypes between children and adults in South China. MATERIALS AND METHODS One hundred and twenty-eight children and 99 adults with peptic symptoms were enrolled in our research. Histology, rapid urease test, and real-time polymerase chain reaction (PCR) assay were used to diagnose H. pylori infection. vacA s1 was detected by real-time PCR, and EPIYA motifs in the 3' region of CagA by conventional PCR and DNA sequencing. RESULTS H. pylori infection was diagnosed in 53 children and 62 adults. vacA s1 was identified in 90.6% and 91.9% of infected children and adults, respectively. Furthermore, cagA was identified in 73.6% and 82.3% of infected children and adults, respectively. No patient with multiple cagA subtypes was observed. A higher prevalence of more virulent cagA genotype was found in children compared to adults (p < .05). Thirty-eight of 39 (97.4%) cagA-positive children were found to have EPIYA-ABD and only one (2.6%) with EPIYA-ABC. In adults, four types of EPIYA motifs--ABC (29.4%), ABD (64.7%), ABAB (2%), and AAD (3.9%)--were identified, and the ABD type was found more commonly in severe diseases, such as atrophic gastritis (53.3%) and gastric cancer (71.4%). CONCLUSION cagA genotypes in children and in adults are different, and EPIYA-ABD may have potential clinical implication in the development of gastric cancer in South China.
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Affiliation(s)
- Juan Li
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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Said Essa A, Alaa Eldeen Nouh M, Mohammed Ghaniam N, Graham DY, Said Sabry H. Prevalence of cagA in relation to clinical presentation of Helicobacter pylori infection in Egypt. ACTA ACUST UNITED AC 2009; 40:730-3. [PMID: 19086246 DOI: 10.1080/00365540802023725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Helicobacter pylori infection, peptic ulcer and gastric cancer are common problems in Egypt. We investigated the prevalence of cagA-positive Helicobacter pylori infections among Egyptian adults in relation to presentation (e.g. dyspepsia vs asymptomatic controls) in Minofyia, Egypt. Patients included men or women seeking care for at least 3 months of upper gastrointestinal symptoms. Helicobacter pylori status was determined by rapid urease test and gastric histopathology in patients and by anti-Helicobacter pylori IgG antibodies in controls. CagA status was determined using an anti-cag A ELISA. 99 Helicobacter pylori infected patients were entered including 90 dyspeptic patients (30 each with gastric cancer, peptic ulcer, and non-ulcer dyspepsia) and 9 non-dyspeptic healthy controls. Age ranged from 27 to 78 y (mean 49.5 y); 50% were men. Anti-cagA antibodies were present in 62.2% of dyspeptic patients compared with 11% of asymptomatic controls (p = 0.004). Anti-cagA antibodies were more prevalent among dyspeptic patients with gastric cancer or peptic ulcer (73.3%) compared to those with non-ulcer dyspepsia (40%) (p = 0.004). The prevalence of cagA in Egypt was related to the clinical presentation of Helicobacter pylori infection being lowest in asymptomatic controls (11.1%) and increasingly prevalent in non-ulcer dyspepsia (40%), peptic ulcer (66.7%), and gastric cancer (89%).
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Affiliation(s)
- Abdallah Said Essa
- Department of Tropical Medicine and Biochemistry Department, Minofyia University, Minofyia, Egypt
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Dube C, Tanih NF, Ndip RN. Helicobacter pylori in water sources: a global environmental health concern. REVIEWS ON ENVIRONMENTAL HEALTH 2009; 24:1-14. [PMID: 19476289 DOI: 10.1515/reveh.2009.24.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Helicobacter pylori are Gram-negative micro-aerophilic motile curve rods that inhabit the gastric mucosa of the human stomach. The bacterium chronically infects billions of people worldwide and is one of the most genetically diverse of bacterial species. More than half of the world population in both developed and developing countries are infected with this organism. Infection usually occurs without overt clinical symptoms, particularly in poor communities. If untreated, the infection can last for decades without causing symptoms. In some communities, however, infection with the organism causes peptic and duodenal ulcers, gastritis, duodenitis, and gastric cancers. How H. pylori initially enters the stomach is not known, but contaminated food particles and water are suspected, with the former physically shielding it from stomach acid. Similarly, the route of transmission of this pathogen is unknown. Several reports have suggested the possibility of waterborne transmission as the organism can survive for a few days in fresh cold water, salt water, distilled water, and tap water. Knowledge of the epidemiology and mode of transmission of H. pylori is important to prevent its spread and may be useful in identifying high risk populations.
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Affiliation(s)
- C Dube
- Microbial Pathogenicity and Molecular Epidemiology Research Group, Department of Biochemistry and Microbiology, Faculty of Science and Agriculture, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
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Erzin Y, Koksal V, Altun S, Dobrucali A, Aslan M, Erdamar S, Dirican A, Kocazeybek B. Prevalence of Helicobacter pylori vacA, cagA, cagE, iceA, babA2 genotypes and correlation with clinical outcome in Turkish patients with dyspepsia. Helicobacter 2006; 11:574-80. [PMID: 17083380 DOI: 10.1111/j.1523-5378.2006.00461.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Distinct virulence factors of Helicobacter pylori have been associated with clinical outcome of the infection; however, considerable variations have been reported from different geographic regions and data on genotypes of Turkish H. pylori isolates are sparse. AIM To determine the prevalence of specific genotypes of H. pylori in Turkish patients with dyspepsia. MATERIALS AND METHODS Ninety-three H. pylori-positive patients [30 with non-ulcer dyspepsia (NUD), 30 with duodenal ulcer (DU), and 33 with gastric cancer (GC)] who were admitted to our endoscopy unit due to dyspepsia were enrolled in the study. H. pylori infection was confirmed in all patients by histology and rapid urease test (RUT). The presence of vacA alleles, cagA, cagE, iceA, and babA2 genotypes were determined by polymerase chain reaction (PCR). Chi-squared test and Fisher's exact test were used for statistical comparisons and multivariate regression analysis was performed to find out independent predictors of different clinical outcomes. RESULTS Turkish strains examined predominantly possessed the vacA s1,m2 (48.4%) and s1,m1 (40.7%) genotypes. The vacA s1a genotype was detected in 66.7, 96.4, and 87.9% of isolates from patients with NUD, DU, and GC, respectively, and its presence was significantly associated with that of DU (p = .004), GC (p = .043), and cagA gene (p = .021). None of the cases was found to harbor the s1c genotype. The frequencies of the cagA and cagE genes among studied isolates were 73.6 and 59.3%, respectively. The cagA gene was significantly associated with the presence of DU (p = .004) and GC (p = .003), and the cagE gene, too, was significantly associated with the presence of DU (p = .002) and GC (p = .000). All H. pylori isolates possessed the iceA gene. In all, 68 isolates (74.7%) were positive for iceA1 and 23 (25.3%) for iceA2. The frequency of icea1 gene was significantly higher in cases with GC (85%) than in cases with NUD (60%) (p = .026). The frequency of babA2 gene was 23.3, 46.4, and 87.9% in isolates of patients with NUD, DU, and GC, respectively. When compared to cases with NUD (p = .000) and DU (p = .000), the presence of babA2 gene was significantly higher in cases with GC. Multivariate regression analysis disclosed cagE (p = .006) and vacA s1a (p = .027) genotypes to be independent predictors of DU and babA2 (p = .000) and cagE (p = .013) genotypes to be independent predictors of GC. CONCLUSIONS H. pylori vacA s1a, cagA, cagE genotypes have significant relations with the presence of DU and GC, and iceA1, babA2 with GC in Turkish patients with dyspepsia, whereas cagE and vacA s1a genotypes are independent predictors of DU, and babA2 and cagE genotypes are independent predictors of GC.
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Affiliation(s)
- Y Erzin
- Department of Gastroenterology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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de Baptista GA. Nutrients and dyspepsia: paradigms and reality. Curr Opin Clin Nutr Metab Care 2005; 8:562-7. [PMID: 16079630 DOI: 10.1097/01.mco.0000179165.33323.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Dyspepsia is a common disorder that presents as persistent or recurrent abdominal pain or discomfort in the upper abdomen and originates from organic or functional causes. Heterogeneous disorders, physiopathological, psychosomatic, sociocultural, demographic and genetic components have a great impact on its presentation. Physiopathological elements and the influence of nutrients on symptomatology are discussed to help establish clearer guidelines for treatment. RECENT FINDINGS Gastric emptying is affected by physiological, pharmacological and dietary factors and is translated into symptoms and signs such as anorexia, nausea, vomiting, weight loss and abdominal pain. Liquid or solid meals may cause early or delayed emptying, which is associated with symptoms of postprandial fullness. Abnormal glucose and electrolyte serum values may also cause transitory emptying delay. Fatty and acid nutrients have also been reported to aggravate symptoms of functional dyspepsia, especially after large meals. Studies have also pointed at food sensibility and the effect of Helicobacter pylori infection on gastric emptying in symptomatic patients. Patients may suffer antral hypomotility and total/partial postingestion pattern conversion. Spinal brain axis dysfunction caused by peripheral inflammation is associated with gastric dysmotility. An association between symptoms and functional polymorphisms is pending further clarification. It has been questioned whether the genotype is associated with a specific physiopathological mechanism, postinfectious functional disorders or psychological/social alterations. SUMMARY The treatment of dyspepsia is empiric and is directed at improving symptoms associated with alterations in emptying, postprandial accommodation, hypersensibility and hyperalgesia. Further studies are required to correlate symptoms with food kinetics at the initial postfood ingestion stages.
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