Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5625
Revised: December 13, 2013
Accepted: January 8, 2014
Published online: May 21, 2014
Processing time: 231 Days and 11.5 Hours
To evaluate vital signs and body indices in Helicobacter pylori (H. pylori) positive and negative persons. A total of 22 centres entered the study. They were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1818 subjects (aged 5-98 years) took part in the study, randomly selected out of 38147 subjects. H. pylori infection was investigated by means of a 13C-urea breath test. Data on height, weight, systolic and diastolic blood pressure and heart rate were collected at the clinics of general practitioners. The overall prevalence of H. pylori infection was 30.4% (402/1321) in adults (≥ 18 year-old) and 5.2% (26/497) in children and adolescents (≤ 17 year-old). Once adjusted for age and gender, only a difference in body mass index remained statistically significant with H. pylori positive adults showing an increase of 0.6 kg/m2 in body mass index. Once adjusted for age and gender, we found a difference in height between H. pylori positive and H. pylori negative children and adolescents. On further adjustment for place of residence, this difference became statistically significant, with H. pylori positive children and adolescents being on average 3.5 cm shorter. H. pylori positive adults were significantly older compared to H. pylori negative subjects. Once adjusted for age and gender, H. pylori infection had no impact on body weight, body mass index and vital signs either in adults or children and adolescents. Chronic H. pylori infection appeared to be associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.
Core tip: Our group studied body indices and basic vital signs in Helicobacter pylori (H. pylori) positive and negative persons in 2001. The prevalence of H. pylori infection decreased significantly in the Czech Republic from 41.7% (2001) to 23.5% (2011). The aim of this multi-centre prospective study was to evaluate body indices and vital signs using comparable methods in the general population from identical geographical areas 10 years later. According to our current results, chronic H. pylori infection was associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.
-
Citation: Kopacova M, Koupil I, Seifert B, Fendrichova MS, Spirkova J, Vorisek V, Rejchrt S, Douda T, Tacheci I, Bures J. Blood pressure and stature in
Helicobacter pylori positive and negative persons. World J Gastroenterol 2014; 20(19): 5625-5631 - URL: https://www.wjgnet.com/1007-9327/full/v20/i19/5625.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i19.5625
Helicobacter pylori (H. pylori) is the most common chronic bacterial infection in humans. H. pylori has been demonstrated worldwide and in individuals of all ages. Infection is acquired at an earlier age and is more frequent in developing countries compared with industrialised ones. H. pylori is a cause of chronic gastritis. About one third of all gastric cancers in developed and developing countries, respectively, are solely attributable to H. pylori. H. pylori infection is a major aetiological agent in peptic ulcer disease[1].
It has been hypothesised that chronic H. pylori infection may be associated with and/or contribute towards several extra-gastric diseases, including ischemic heart disease[2-12], arterial hypertension[2,13-20], cerebral non-cardioembolic ischemic stroke[21,22], peripheral arterial disease[23,24], obesity[13,25-27], metabolic syndrome[28,29] and short stature[30-36]. Our group studied body indices and basic vital signs in H. pylori positive and negative persons in a large prospective multi-centre study in 2001[37,38]. In the meantime, prevalence of H. pylori infection decreased significantly in the Czech Republic from 41.7% to 23.5% within a 10-year period[39,40]. The aim of our current multi-centre prospective study was to evaluate blood pressure and stature in H. pylori positive and negative persons in the Czech Republic using comparable methods in a representative sample of general unselected population from identical geographical areas 10 years after the initial study.
The study was approved by the University Ethics Committee. All participants received detailed written information about the Project in advance and signed written consent (parents on behalf of their children). For all data obtained, all personal identification information was deleted in compliance with the laws for the protection of confidentiality of the Czech Republic.
A total of 22 centres entered the study. They included 15 centres of general practitioners for adults and 7 for children and adolescents. These centres covered cities and towns with more than 20000 inhabitants (10 centres), smaller towns (≤ 20000 inhabitants) with surrounding villages (9) and rural areas (3 centres), and were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1818 subjects (aged 5-98 years) took part in the study, randomly selected out of 38147 registered males and females in this age range.
Urea breath tests were performed in the morning after overnight fasting by means of 13C-urea breath test[41]. Citric acid solution (3 g dissolved in 150 mL of still water) was given initially as a test drink. Five minutes later two baseline exhaled breath samples were collected into 20-mL vacutainers using a straw. After this, all of the subjects ingested 75 mg 13C-urea (Helicobacter Test INFAI, INFAI GmbH, Köln, Germany) dissolved in 50 mL of still water with 1 g citric acid (at time 0). Breath samples were collected in duplicates using a straw in 20-mL vacutainers after 30 min. Tubes with breath samples were sent to a single analytical centre by post and measured within a one-week period. Breath samples in duplicates were analysed using isotope ratio mass spectrometry (AP 2003, Analytical Precision Products, Cambridge, United Kingdom). The cut-off point was 3.5.
Data on height and weight were collected at the clinics of general practitioners (measured in underwear by nurses). Body mass index was calculated as weight/height2 (in kg/m2). Systolic and diastolic blood pressure measurements were performed by a trained nurse in a standard manner[42] at the study clinics. Manual resting pulse measurement at the wrist (radial artery) was performed in sitting position by a trained nurse for 60 s. The blood pressure and heart rate were measured in the morning (from 8 to 12 a.m.).
Data were collected by self-completed questionnaires distributed to adults and parents of children aged 5-15. The questionnaire included information on the place of residence in childhood, mother’s and father’s education, access to running warm water in childhood, crowding in childhood and number of siblings. Information on the study subjects’ current place of residence, education, marital status, self-reported socio-economic group and smoking habits was also collected in the questionnaire and was used in the analysis of determinants of H. pylori positivity in subjects aged 15+ years of age. We combined the mother’s and father’s education and generated a variable indicating highest education achieved by any of the two parents (or the mother if single). This variable was used in analyses of blood pressure and stature in children and adolescents.
The data was analysed using STATA statistical software (StataCorp. 2011. Stata Statistical Software: Release 12, College Station, TX, United States)[43]. Descriptive statistics, non-paired t test and Mann-Whitney test were used. Associations of H. pylori positivity with body indices and vital signs were analysed by univariable and multivariable linear regression. Crude and adjusted differences between groups of H. pylori positive and H. pylori negative study subjects are presented as beta coefficients with 95%CI.
The overall prevalence of H. pylori infection was 30.4% (402/1321) in adults (≥ 18 year-old) and 5.2% (26/497) in children and adolescents (≤ 17 year-old). There was no statistically significant difference in prevalence between males and females (Tables 1 and 2). H. pylori infection was strongly associated with higher age.
Parameter | Helicobacter pylori negative | Helicobacter pylori positive | Statistical significance |
n = 471 | n = 26 | ||
(mean ± SD) | (mean ± SD) | ||
Gender (% males) | 47.1 | 46.1 | NS |
Age (yr) | 11 ± 3 | 12 ± 3 | NS |
Weight (kg) | 42.3 ± 17.5 | 40.3 ± 16.9 | NS |
Height (cm) | 145.4 ± 19.6 | 143.6 ± 19.7 | NS |
BMI (kg/m2) | 19.1 ± 3.9 | 18.6 ± 3.7 | NS |
Systolic blood pressure (mmHg) | 107.6 ± 12.6 | 110.3 ± 10.2 | NS |
Diastolic blood pressure (mmHg) | 65.5 ± 8.6 | 65.2 ± 8.2 | NS |
Heart rate | 77.7 ± 7.7 | 80.9 ± 8.4 | 0.040 |
(beats per minute) | |||
Residence1 | NS | ||
Larger town | 32.0% | 32.0% | |
Smaller town | 24.7% | 32.0% | |
Village | 43.3% | 36.0% | |
Parental education | 0.006 | ||
Secondary or higher | 66.0% | 57.7% | |
Vocational | 29.3% | 23.1% | |
Elementary | 4.7% | 19.2% |
Parameter | Helicobacter pylori negative | Helicobacter pylori positive | Statistical significance |
n = 919 | n = 402 | ||
(mean ± SD) | (mean ± SD) | ||
Gender (% males) | 46.3 | 48.5 | NS |
Age (yr) | 48 ± 20 | 57 ± 17 | P < 0.001 |
Weight (kg) | 76.3 ± 16.2 | 79.1 ± 16.4 | P = 0.004 |
Height (cm) | 171.6 ± 9.9 | 170.2 ± 9.9 | P = 0.020 |
BMI (kg/m2) | 25.9 ± 4.7 | 27.2 ± 4.8 | P < 0.001 |
Systolic blood pressure (mm Hg) | 126.7 ± 16.6 | 129.9 ± 17.9 | P = 0.001 |
Diastolic blood pressure (mm Hg) | 77.0 ± 9.2 | 78.5 ± 9.8 | P = 0.009 |
Heart rate | 71.1 ± 7.8 | 71.0 ± 8.0 | NS |
(beats per minute) | |||
Residence1: | P = 0.023 | ||
Larger town | 59.0% | 52.2% | |
Smaller town | 16.3% | 22.1% | |
Village | 24.6% | 25.6% | |
Education2: | P < 0.001 | ||
University | 28.9% | 22.2% | |
Secondary | 39.5% | 34.5% | |
Vocational | 20.1% | 30.5% | |
Elementary | 4.2% | 10.8% | |
Studying | 7.2% | 2.0% |
There were no significant differences in weight, height, body mass index or blood pressure among H. pylori positive and H. pylori negative children and adolescents, while heart rate was statistically significantly higher among those who were H. pylori positive (Table 1). There was a statistically significant difference in blood pressure, weight, height, and body mass index among H. pylori positive and H. pylori negative adults. H. pylori positive subjects were significantly older (Table 2).
Once adjusted for age and gender, we found a difference in height between H. pylori positive and H. pylori negative children and adolescents that was of borderline statistical significance. On further adjustment for place of residence, this difference became statistically significant, with H. pylori positive children and adolescents being on average 3.5 (95%CI: 0.2-6.7) cm shorter. This association was affected relatively little by further adjustment for parental education and remained of borderline statistical significance.
A higher average heart rate among H. pylori positive children and adolescents was consistently seen in all univariable and adjusted analyses with a difference of 3.4 (95%CI: 0.7-6.2) beats per minute in fully adjusted analysis (Table 3).
Parameter | β-coefficient (95%CI) | |||
Crude | Adjusted for age and gender | + place of residence | + parental education | |
Weight (kg) | -1.1 (-8.2-5.9) | -3.4 (-7.4-0.6) | -3.4 (-7.4-0.5) | -3.4 (-7.4-0.7) |
Height (cm) | -0.4 (-8.3-7.4) | -3.2 (-6.5-0.0) | -3.5 [-6.7-(-0.2)]1 | -3.2 (-6.4-0.0) |
Body mass index (kg/m2) | -0.4 (-2.0-1.1) | -0.8 (-2.1-0.5) | -0.7 (-2.0-0.6) | -0.7 (-2.0-0.6) |
Systolic blood pressure (mmHg) | 3.5 (-1.5-8.5) | 2.4 (-1.8-6.7) | 2.3 (-1.9-6.6) | 2.3 (-2.0-6.5) |
Diastolic blood pressure (mmHg) | 0.3 (-3.1-3.8) | -0.4 (-3.3-2.5) | -0.4 (-3.3-2.5) | -0.7 (-3.6-2.3) |
Heart rate (beats per minute) | 3.4 (0.2-6.5)1 | 3.5 (0.3-6.6)1 | 3.7 (0.9-6.5)1 | 3.4 (0.7-6.2)1 |
Although our crude analyses indicated differences in several body indices and vital signs between groups of H. pylori positive vs H. pylori negative study subjects aged 18+, these findings were mainly driven by substantial differences in age distribution among the H. pylori positive compared to H. pylori negative groups. Once adjusted for age and gender, only a difference in body mass index remained statistically significant with H. pylori positive adults showing an increase of 0.6 kg/m2 in body mass index. This association weakened and became statistically non-significant on adjustment for place of residence and education (Table 4).
Parameter | β-coefficient (95%CI) | |||
Crude | Adjusted for age and gender | + place of residence | + own education | |
Weight (kg) | 2.8 (0.9-4.7)1 | 1.3 (-0.5-3.0) | 1.1 (-0.6-2.8) | 1.1 (-0.6-2.8) |
Height (cm) | - 1.4 [-2.6-(0.2)]1 | -0.5 (-1.4-0.3) | -0.5 (-1.3-0.4) | -0.2 (-1.1-0.6) |
Body mass index (kg/m2) | 1.4 (0.8-2.0)1 | 0.6 (0.0-1.1)1 | 0.5 (0.0-1.1) | 0.4 (-0.1-1.0) |
Systolic blood pressure (mmHg) | 3.3 (1.3-5.3)1 | -0.7 (-2.5-1.1) | -1.0 (-2.8-0.8) | -1.1 (-2.9-0.6) |
Diastolic blood pressure (mmHg) | 1.5 (0.4-2.6)1 | 0.0 (-1.0-1.1) | -0.1 (-1.2-0.9) | -0.2 (-1.3-0.8) |
Heart rate (beats per minute) | -0.1 (-1.0-0.8) | -0.2 (-1.1-0.8) | -0.2 (-1.1-0.7) | -0.2 (-1.1-0.8) |
The prevalence of H. pylori in the Czech Republic in 2011 was significantly lower compared to the prevalence reported from identical geographical areas in 2001[40]. In our previous project (run in 2001), we evaluated body indices and basic vital signs in H. pylori positive and negative persons in a large prospective study[37]. The aim of current research was to assess same parameters in 2011 in a prospective setting, using the same methods in identical geographical areas of the Czech Republic.
In 2001, there was a negative effect of H. pylori infection on systolic and diastolic blood pressure in subjects below the age of 25 and a relatively strong positive effect on blood pressure in subjects over 65[37]. We were not able to prove such an association in our current project.
Blood pressure, weight and body mass index were significantly higher in H. pylori positive adults compared to H. pylori negative ones in our current study. However, H. pylori positive adults were significantly older compared to H. pylori negative subjects. Once adjusted for age and gender, H. pylori infection did not influence body weight, body mass index and basic vital signs either in adults or children and adolescents.
Controversial data have been published in literature on the association of H. pylori infection and hypertension with both positive[2,13,17,18] and negative results[14,15]. In a large community-based cross sectional study (1634 H. pylori positive and 3267 H. pylori negative persons out of 10537 subjects enrolled), H. pylori infection had little effect on blood pressure in the general population, mean systolic blood pressure was higher in H. pylori infected individuals than in those who were not infected and, although this was significant statistically, the authors concluded that it was unlikely to be clinically important and might be explained by unknown residual confounding factors[15]. Migneco et al[17] demonstrated a significant decrease in blood pressure values (in particular in the diastolic one) after successful H. pylori eradication. There are several methodological difficulties in carrying out studies to determine a possible relationship between H. pylori infection and raised blood pressure, there are several other factors that must be considered (weight gain, salt intake, aging, co-morbidity, antihypertensive therapy, and compliance of patients etc.)[44,45].
Several epidemiological studies showed association between H. pylori infection and short growth in children[46-49]. However, contradictory data are available on this topic, as other authors did not find any relationship[31,32,50,51]. Results and conclusions of all published papers (including our findings) must be assessed with caution. It is necessary to distinguish intrinsic shortness and delayed or attenuated growth. Several factors can influence growth and stature, including chronic inflammation, nutrition and several gastrointestinal diseases[52].
Family social conditions are possibly a common determinant of H. pylori infection and growth. However, quite a large difference in children’s height remains after adjustment for parental education, indicating that there may be other mechanisms in place. Possibly, this also might be a causal effect of H. pylori infection on children’s growth. The adults’ socioeconomic conditions and life style may be a common cause of higher body mass index and H. pylori infection. Although our earlier paper[39] indicated that most subjects become infected in childhood and childhood social conditions may thus be relevant for many different aspects of adult health, including H. pylori infection and higher body mass index (or overweight/obesity).
It is necessary to mention another interesting phenomenon: the decreased prevalence of H. pylori represents a prominent decline of CagA positive H. pylori strains[53,54]. CagA positive H. pylori strains are more susceptible to eradication treatment than CagA negative strains. This might partly explain their more pronounced decline[55]. It is necessary to admit that the reasons for decline of H. pylori infection have not been fully clarified yet. It is necessary to also consider that the fundamental environmental changes could cause gradual disappearance of H. pylori from the human microbiome[56-58].
In conclusion, chronic H. pylori infection appeared to be associated with short stature in children. H. pylori infection did not influence blood pressure, body weight and body mass index either in adults or children and adolescents.
Our sincerest thanks go to all general practitioners and their staff. They performed some really great work in their respective centres. Project participants: Sarka Bilkova, MD (Slany), Pavel Brejnik, MD (Kladno), Otto Herber, MD (Veltrusy), Petr Herle, MD (Praha 4), Otakar Ach-Hübner, MD, (Brno), Eva Charvatova, MD (Praha 4), Karel Janik, MD (Horni Becva), Olga Kobesova MD (Praha 10), Tomas Koudelka, MD (Pocatky), Greta Koudelkova, MD (Zatec), Milada Kratochvilova, MD (Brno), Milos Ponizil, MD (Hrusovany nad Jevisovkou), Assoc. Professor Bohumil Seifert, MD, Ph.D. (Praha 8), Helena Vesela, MD (Chyne), Norbert Kral, MD (Praha 2), Jana Vojtiskova, MD (Praha 2), Ruth Adamova, MD (Caslav), Romana Balatkova, MD (Most), Irena Bumbova, MD (Kamenne Zehrovice), Jana Ponizilova, MD (Hrusovany nad Jevisovkou), Miroslava Sircova, MD (Slany), Jarmila Seifertova, MD (Kladno) and Vera Sevcikova, MD (Praha 2).
P- Reviewers: Kluger Y, Jung YD S- Editor: Wen LL L- Editor: A E- Editor: Ma S
1. | Crowe SE. Bacteriology and epidemiology of Helicobacter pylori infection. UpToDate online, vol. 21. 2: Wellesley 2013; . [Cited in This Article: ] |
2. | Lip GH, Wise R, Beevers G. Association of Helicobacter pylori infection with coronary heart disease. Study shows association between H pylori infection and hypertension. BMJ. 1996;312:250-251. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 31] [Cited by in F6Publishing: 37] [Article Influence: 1.3] [Reference Citation Analysis (0)] |
3. | Haider AW, Wilson PW, Larson MG, Evans JC, Michelson EL, Wolf PA, O’Donnell CJ, Levy D. The association of seropositivity to Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus with risk of cardiovascular disease: a prospective study. J Am Coll Cardiol. 2002;40:1408-1413. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 71] [Cited by in F6Publishing: 79] [Article Influence: 3.6] [Reference Citation Analysis (0)] |
4. | Sotiropoulos A, Gikas A, Skourtis S, Merkouris P, Pentzeridis P, Polydorou A, Pappas S. Seropositivity to Chlamydia pneumoniae or Helicobacter pylori and coronary artery disease. Int J Cardiol. 2006;109:420-421. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 15] [Cited by in F6Publishing: 19] [Article Influence: 1.0] [Reference Citation Analysis (0)] |
5. | Vcev A, Nakić D, Mrden A, Mirat J, Balen S, Ruzić A, Persić V, Soldo I, Matijević M, Barbić J. Helicobacter pylori infection and coronary artery disease. Coll Antropol. 2007;31:757-760. [PubMed] [Cited in This Article: ] |
6. | Azarkar Z, Jafarnejad M, Sharifzadeh G. The relationship between helicobacter pylori infection and myocardial infarction. Caspian J Intern Med. 2011;2:222-225. [PubMed] [Cited in This Article: ] |
7. | Celik T, Iyisoy A, Yuksel UC. Possible pathogenetic role of Helicobacter pylori infection in cardiac syndrome X. Int J Cardiol. 2010;142:193-194. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 4] [Cited by in F6Publishing: 7] [Article Influence: 0.4] [Reference Citation Analysis (0)] |
8. | Christodoulou DK, Milionis HJ, Pappa P, Katsanos KH, Sigounas D, Florentin M, Elisaf M, Tsianos EV. Association of Helicobacter pylori infection with cardiovascular disease--is it just a myth? Eur J Intern Med. 2011;22:191-194. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 21] [Cited by in F6Publishing: 28] [Article Influence: 2.2] [Reference Citation Analysis (0)] |
9. | Eskandarian R, Ghorbani R, Shiyasi M, Momeni B, Hajifathalian K, Madani M. Prognostic role of Helicobacter pylori infection in acute coronary syndrome: a prospective cohort study. Cardiovasc J Afr. 2012;23:131-135. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 12] [Cited by in F6Publishing: 19] [Article Influence: 1.7] [Reference Citation Analysis (0)] |
10. | Longo-Mbenza B, Nsenga JN, Mokondjimobe E, Gombet T, Assori IN, Ibara JR, Ellenga-Mbolla B, Vangu DN, Fuele SM. Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans. Vasc Health Risk Manag. 2012;6:455-461. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 40] [Cited by in F6Publishing: 44] [Article Influence: 3.7] [Reference Citation Analysis (0)] |
11. | Rogha M, Nikvarz M, Pourmoghaddas Z, Shirneshan K, Dadkhah D, Pourmoghaddas M. Is helicobacter pylori infection a risk factor for coronary heart disease? ARYA Atheroscler. 2012;8:5-8. [PubMed] [Cited in This Article: ] |
12. | Rogha M, Dadkhah D, Pourmoghaddas Z, Shirneshan K, Nikvarz M, Pourmoghaddas M. Association of helicobacter pylori infection with severity of coronary heart disease. ARYA Atheroscler. 2012;7:138-141. [PubMed] [Cited in This Article: ] |
13. | Ekesbo R, Nilsson PM, Lindholm LH, Persson K, Wadström T. Combined seropositivity for H. pylori and C. pneumoniae is associated with age, obesity and social factors. J Cardiovasc Risk. 2000;7:191-195. [PubMed] [Cited in This Article: ] |
14. | Woodward M, Morrison C, McColl K. An investigation into factors associated with Helicobacter pylori infection. J Clin Epidemiol. 2000;53:175-181. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 87] [Cited by in F6Publishing: 100] [Article Influence: 4.2] [Reference Citation Analysis (0)] |
15. | Harvey R, Lane A, Murray L, Harvey I, Nair P, Donovan J. Effect of Helicobacter pylori infection on blood pressure: a community based cross sectional study. BMJ. 2001;323:264-265. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 14] [Cited by in F6Publishing: 14] [Article Influence: 0.6] [Reference Citation Analysis (0)] |
16. | Lin RC, Morris BJ. Association analysis of polymorphisms at the interleukin-1 locus in essential hypertension. Am J Med Genet. 2002;107:311-316. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 18] [Cited by in F6Publishing: 20] [Article Influence: 0.9] [Reference Citation Analysis (0)] |
17. | Migneco A, Ojetti V, Specchia L, Franceschi F, Candelli M, Mettimano M, Montebelli R, Savi L, Gasbarrini G. Eradication of Helicobacter pylori infection improves blood pressure values in patients affected by hypertension. Helicobacter. 2003;8:585-589. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 42] [Cited by in F6Publishing: 48] [Article Influence: 2.3] [Reference Citation Analysis (0)] |
18. | Beevers DG, Lip GY, Blann AD. Salt intake and Helicobacter pylori infection. J Hypertens. 2004;22:1475-1477. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 33] [Cited by in F6Publishing: 27] [Article Influence: 1.4] [Reference Citation Analysis (0)] |
19. | Liu L, Liu Y, Tong W, Ye H, Zhang X, Cao W, Zhang Y. Pathogen burden in essential hypertension. Circ J. 2007;71:1761-1764. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 21] [Cited by in F6Publishing: 22] [Article Influence: 1.4] [Reference Citation Analysis (0)] |
20. | Vahdat K, Pourbehi MR, Ostovar A, Hadavand F, Bolkheir A, Assadi M, Farrokhnia M, Nabipour I. Association of pathogen burden and hypertension: the Persian Gulf Healthy Heart Study. Am J Hypertens. 2013;26:1140-1147. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 30] [Cited by in F6Publishing: 35] [Article Influence: 3.2] [Reference Citation Analysis (0)] |
21. | Rizzo M, Corrado E, Coppola G, Muratori I, Novo S. Prediction of cerebrovascular and cardiovascular events in patients with subclinical carotid atherosclerosis: the role of C-reactive protein. J Investig Med. 2008;56:32-40. [PubMed] [DOI] [Cited in This Article: ] [Cited by in F6Publishing: 1] [Reference Citation Analysis (0)] |
22. | Mousavi SA, Ataei B, Karimi I, Ashrafi K. Helicobacter pylori serum antibody titers in patients with cerebral non-cardioembolic ischemic stroke. J Res Med Sci. 2011;16 Suppl 1:S407-S411. [PubMed] [Cited in This Article: ] |
23. | Ohnishi M, Fukui M, Ishikawa T, Ohnishi N, Ishigami N, Yoshioka K, Hasegawa G, Yoshikawa T, Nakamura N. Helicobacter pylori infection and arterial stiffness in patients with type 2 diabetes mellitus. Metabolism. 2008;57:1760-1764. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 23] [Cited by in F6Publishing: 21] [Article Influence: 1.3] [Reference Citation Analysis (0)] |
24. | Sawayama Y, Hamada M, Otaguro S, Maeda S, Ohnishi H, Fujimoto Y, Taira Y, Hayashi J. Chronic Helicobacter pylori infection is associated with peripheral arterial disease. J Infect Chemother. 2008;14:250-254. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 16] [Cited by in F6Publishing: 17] [Article Influence: 1.1] [Reference Citation Analysis (0)] |
25. | Rosenstock SJ, Jørgensen T, Andersen LP, Bonnevie O. Association of Helicobacter pylori infection with lifestyle, chronic disease, body-indices, and age at menarche in Danish adults. Scand J Public Health. 2000;28:32-40. [PubMed] [Cited in This Article: ] |
26. | Maksud FA, Alves JS, Diniz MT, Barbosa AJ. Density of ghrelin-producing cells is higher in the gastric mucosa of morbidly obese patients. Eur J Endocrinol. 2011;165:57-62. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 26] [Cited by in F6Publishing: 29] [Article Influence: 2.2] [Reference Citation Analysis (0)] |
27. | Gerig R, Ernst B, Wilms B, Thurnheer M, Schultes B. Gastric Helicobacter pylori infection is associated with adverse metabolic traits in severely obese subjects. Obesity (Silver Spring). 2013;21:535-537. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 17] [Cited by in F6Publishing: 18] [Article Influence: 1.6] [Reference Citation Analysis (0)] |
28. | Longo-Mbenza B, Nkondi Nsenga J, Vangu Ngoma D. Prevention of the metabolic syndrome insulin resistance and the atherosclerotic diseases in Africans infected by Helicobacter pylori infection and treated by antibiotics. Int J Cardiol. 2007;121:229-238. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 61] [Cited by in F6Publishing: 72] [Article Influence: 4.2] [Reference Citation Analysis (0)] |
29. | Shin DW, Kwon HT, Kang JM, Park JH, Choi HC, Park MS, Park SM, Son KY, Cho B. Association between metabolic syndrome and Helicobacter pylori infection diagnosed by histologic status and serological status. J Clin Gastroenterol. 2012;46:840-845. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 40] [Cited by in F6Publishing: 42] [Article Influence: 3.5] [Reference Citation Analysis (0)] |
30. | Raymond J, Bergeret M, Benhamou PH, Mensah K, Dupont C. A 2-year study of Helicobacter pylori in children. J Clin Microbiol. 1994;32:461-463. [PubMed] [Cited in This Article: ] |
31. | Oderda G, Palli D, Saieva C, Chiorboli E, Bona G. Short stature and Helicobacter pylori infection in italian children: prospective multicentre hospital based case-control study. The Italian Study Group on Short Stature and H pylori. BMJ. 1998;317:514-515. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 27] [Cited by in F6Publishing: 35] [Article Influence: 1.3] [Reference Citation Analysis (0)] |
32. | Cacciari E, Menegatti M, Salardi S, Ali A, Stella FA, Figura N, Landi F, Holton J, Farinelli S, Cuccaro V. Helicobacter pylori infection and cytotoxic antigen associated gene “A” status in short children. J Pediatr Endocrinol Metab. 1999;12:197-201. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 10] [Cited by in F6Publishing: 12] [Article Influence: 0.5] [Reference Citation Analysis (0)] |
33. | Choe YH, Kim SK, Hong YC. Helicobacter pylori infection with iron deficiency anaemia and subnormal growth at puberty. Arch Dis Child. 2000;82:136-140. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 79] [Cited by in F6Publishing: 91] [Article Influence: 3.8] [Reference Citation Analysis (0)] |
34. | Takahashi M, Kimura H, Watanabe K. Helicobacter pylori infection in patients with idiopathic short stature. Pediatr Int. 2002;44:277-280. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 22] [Cited by in F6Publishing: 23] [Article Influence: 1.0] [Reference Citation Analysis (0)] |
35. | Moayyedi P, Forman D, Duffett S, Mason S, Brown J, Crocombe W, Feltbower R, Axon A. Association between Helicobacter pylori infection and adult height. Eur J Epidemiol. 2005;20:455-465. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 8] [Cited by in F6Publishing: 11] [Article Influence: 0.6] [Reference Citation Analysis (0)] |
36. | Fialho AM, Braga AB, Queiroz DM, Rodrigues MN, Herbster ID, Braga LL. The association between Helicobacter pylori infection and height in children from an urban community in north-east Brazil. Ann Trop Paediatr. 2007;27:55-61. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 19] [Cited by in F6Publishing: 25] [Article Influence: 1.5] [Reference Citation Analysis (0)] |
37. | Kopácová M, Bures J, Koupil I, Rejchrt S, Vorísek V, Seifert B, Pozler O, Zivný P, Douda T, Palicka V. Body indices and basic vital signs in Helicobacter pylori positive and negative persons. Eur J Epidemiol. 2007;22:67-75. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 20] [Cited by in F6Publishing: 21] [Article Influence: 1.2] [Reference Citation Analysis (0)] |
38. | Rejchrt S, Koupil I, Kopácová M, Vorísek V, Seifert B, Pozler O, Zivný P, Douda T, Palicka V, Holcík J. Prevalence and sociodemographic determinants of uninvestigated dyspepsia in the Czech Republic. Eur J Gastroenterol Hepatol. 2008;20:898-905. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 10] [Cited by in F6Publishing: 11] [Article Influence: 0.7] [Reference Citation Analysis (0)] |
39. | Bures J, Kopácová M, Koupil I, Vorísek V, Rejchrt S, Beránek M, Seifert B, Pozler O, Zivný P, Douda T. Epidemiology of Helicobacter pylori infection in the Czech Republic. Helicobacter. 2006;11:56-65. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 45] [Cited by in F6Publishing: 40] [Article Influence: 2.2] [Reference Citation Analysis (0)] |
40. | Bureš J, Kopáčová M, Koupil I, Seifert B, Skodová Fendrichová M, Spirková J, Voříšek V, Rejchrt S, Douda T, Král N. Significant decrease in prevalence of Helicobacter pylori in the Czech Republic. World J Gastroenterol. 2012;18:4412-4418. [PubMed] [DOI] [Cited in This Article: ] [Cited by in CrossRef: 32] [Cited by in F6Publishing: 33] [Article Influence: 2.8] [Reference Citation Analysis (0)] |
41. | Kopácová M, Bures J, Vorísek V, Konstacký M, Rejchrt S, Zivný P, Douda T, Palicka V. Comparison of different protocols for 13C-urea breath test for the diagnosis of Helicobacter pylori infection in healthy volunteers. Scand J Clin Lab Invest. 2005;65:491-498. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 10] [Cited by in F6Publishing: 12] [Article Influence: 0.6] [Reference Citation Analysis (0)] |
42. | European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21:1011-1053. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 2620] [Cited by in F6Publishing: 2408] [Article Influence: 114.7] [Reference Citation Analysis (0)] |
43. | Kopácová M; StataCorp. Stata Reference Manual. Release 7.0. College Station. Texas: Stata Press 2001; . [Cited in This Article: ] |
44. | Kaplan NM, Rose BD. Obesity and weight reduction in hypertension. UpToDate online, vol. 21.2. : Wellesley 2013; . [Cited in This Article: ] |
45. | Patel P, Mendall MA, Khulusi S, Northfield TC, Strachan DP. Helicobacter pylori infection in childhood: risk factors and effect on growth. BMJ. 1994;309:1119-1123. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 150] [Cited by in F6Publishing: 178] [Article Influence: 5.9] [Reference Citation Analysis (0)] |
46. | Perri F, Pastore M, Leandro G, Clemente R, Ghoos Y, Peeters M, Annese V, Quitadamo M, Latiano A, Rutgeerts P. Helicobacter pylori infection and growth delay in older children. Arch Dis Child. 1997;77:46-49. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 72] [Cited by in F6Publishing: 89] [Article Influence: 3.3] [Reference Citation Analysis (0)] |
47. | Thomas JE, Dale A, Bunn JE, Harding M, Coward WA, Cole TJ, Weaver LT. Early Helicobacter pylori colonisation: the association with growth faltering in The Gambia. Arch Dis Child. 2004;89:1149-1154. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 63] [Cited by in F6Publishing: 72] [Article Influence: 3.6] [Reference Citation Analysis (0)] |
48. | Elitsur Y, Yahav J. Helicobacter pylori infection in pediatrics. Helicobacter. 2005;10 Suppl 1:47-53. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 20] [Cited by in F6Publishing: 21] [Article Influence: 1.1] [Reference Citation Analysis (0)] |
49. | Vaira D, Menegatti M, Salardi S, Alì A, Altomare Stella F, Figura N, Landi F, Holton J, Farinelli S, Cuccaro V. Helicobacter pylori and diminished growth in children: is it simply a marker of deprivation? Ital J Gastroenterol Hepatol. 1998;30:129-133. [PubMed] [Cited in This Article: ] |
50. | Naficy AB, Frenck RW, Abu-Elyazeed R, Kim Y, Rao MR, Savarino SJ, Wierzba TF, Hall E, Clemens JD. Seroepidemiology of Helicobacter pylori infection in a population of Egyptian children. Int J Epidemiol. 2000;29:928-932. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 26] [Cited by in F6Publishing: 34] [Article Influence: 1.4] [Reference Citation Analysis (0)] |
51. | Soylu OB, Ozturk Y. Helicobacter pylori infection: effect on malnutrition and growth failure in dyspeptic children. Eur J Pediatr. 2008;167:557-562. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 26] [Cited by in F6Publishing: 30] [Article Influence: 1.9] [Reference Citation Analysis (0)] |
52. | Rogol AD. Causes of short stature. UpToDate online, vol. 21.2. : Wellesley 2013; . [Cited in This Article: ] |
53. | Perez-Perez GI, Salomaa A, Kosunen TU, Daverman B, Rautelin H, Aromaa A, Knekt P, Blaser MJ. Evidence that cagA(+) Helicobacter pylori strains are disappearing more rapidly than cagA(-) strains. Gut. 2002;50:295-298. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 61] [Cited by in F6Publishing: 69] [Article Influence: 3.1] [Reference Citation Analysis (0)] |
54. | den Hoed CM, Vila AJ, Holster IL, Perez-Perez GI, Blaser MJ, de Jongste JC, Kuipers EJ. Helicobacter pylori and the birth cohort effect: evidence for stabilized colonization rates in childhood. Helicobacter. 2011;16:405-409. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 42] [Cited by in F6Publishing: 51] [Article Influence: 3.9] [Reference Citation Analysis (0)] |
55. | Blaser MJ. Disappearing microbiota: Helicobacter pylori protection against esophageal adenocarcinoma. Cancer Prev Res (Phila). 2008;1:308-311. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 77] [Cited by in F6Publishing: 74] [Article Influence: 4.9] [Reference Citation Analysis (0)] |
56. | Atherton JC, Blaser MJ. Coadaptation of Helicobacter pylori and humans: ancient history, modern implications. J Clin Invest. 2009;119:2475-2487. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 367] [Cited by in F6Publishing: 378] [Article Influence: 25.2] [Reference Citation Analysis (0)] |
57. | Cover TL, Blaser MJ. Helicobacter pylori in health and disease. Gastroenterology. 2009;136:1863-1873. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 474] [Cited by in F6Publishing: 465] [Article Influence: 31.0] [Reference Citation Analysis (0)] |
58. | Blaser MJ. Heterogeneity of Helicobacter pylori. Eur J Gastroenterol Hepatol. 2012;9 Suppl 1:S3-6; discussion S6-7. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 32] [Cited by in F6Publishing: 35] [Article Influence: 2.9] [Reference Citation Analysis (0)] |