Parental Knowledge and Attitudes Towards Helicobacter Pylori Screening in Adolescents: A School-Based Questionnaire Study Among Guardians of Junior High School Students in Yokosuka City, Japan.

PURPOSE: Helicobacter pylori (HP) infection, a risk factor for gastric cancer, is prevalent in Japan. Consequently, some municipalities across Japan are implementing HP screening and treatment programs for adolescents. However, little is known about parents' attitudes and awareness regarding HP screening for their children. This study aimed to elucidate parental perspectives on HP screening for their children and identify the factors influencing these attitudes. METHODS: This study focused on the parents of first-year junior high school students in Yokosuka City, Kanagawa Prefecture, where an HP screening and treatment program had been implemented for adolescents. The survey questionnaire was distributed among parents in all 23 public junior high schools in Yokosuka City. RESULTS: Among the 618 respondents, 86.4% supported HP screening for their children. Regression analysis identified sufficient knowledge about HP (adjusted odds ratio (aOR) = 5.80; 95% confidence interval (CI), 2.10-16.03) and being in their 40s (aOR = 2.25; 95% CI, 1.35-3.77) as significant factors influencing supportive attitudes. For parents favoring the screening, common reasons included perceiving it as a promising opportunity (53.2%) and considering the test necessary (44.0%). In contrast, those who opposed screening frequently cited it as unnecessary (66.7%) or believed that their children did not have HP. CONCLUSIONS: A significant proportion of parents in Yokosuka City, Japan, demonstrated a good understanding of HP and expressed a high level of interest in HP screening for their children. Further investigation of parents' attitudes is essential for the effective implementation of adolescent HP screening programs.

Herpes Labialis, Chlamydophila pneumoniae, Helicobacter pylori, and Cytomegalovirus Infections and Risk of Dementia: The Framingham Heart Study.

BACKGROUND: An association between chronic infectious diseases and development of dementia has been suspected for decades, based on the finding of pathogens in postmortem brain tissue and on serological evidence. However, questions remain regarding confounders, reverse causality, and how accurate, reproducible and generalizable those findings are. OBJECTIVE: Investigate whether exposure to Herpes simplex (manifested as herpes labialis), Chlamydophila pneumoniae (C. pneumoniae), Helicobacter pylori (H. pylori), and cytomegalovirus (CMV) modifies the risk of dementia in a populational cohort. METHODS: Questionnaires regarding incidence of herpes infections were administered to Original Framingham Study participants (n = 2,632). Serologies for C. pneumoniae, H. pylori, and CMV were obtained in Original (n = 2,351) and Offspring cohort (n = 3,687) participants. Participants are under continuous dementia surveillance. Brain MRI and neuropsychological batteries were administered to Offspring participants from 1999-2005. The association between each infection and incident dementia was tested with Cox models. Linear models were used to investigate associations between MRI or neuropsychological parameters and serologies. RESULTS: There was no association between infection serologies and dementia incidence, total brain volume, and white matter hyperintensities. Herpes labialis was associated with reduced 10-year dementia risk (HR 0.66, CI 0.46-0.97), but not for the duration of follow-up. H. pylori antibodies were associated with worse global cognition (ß -0.14, CI -0.22, -0.05). CONCLUSION: We found no association between measures of chronic infection and incident dementia, except for a reduction in 10-year dementia risk for patients with herpes labialis. This unexpected result requires confirmation and further characterization, concerning antiviral treatment effects and capture of episodes.

Functional Dyspepsia, Peptic Ulcer, and Helicobacter pylori Infection in a Rural Community of South Asia: An Endoscopy-Assisted Household Survey.

INTRODUCTION: Functional dyspepsia (FD), although commoner than organic dyspepsia (OD) in-hospital studies, community data, particularly from rural areas, are lacking. We performed a rural community study in Bangladesh with the primary aims to evaluate (i) the prevalence of uninvestigated dyspepsia (UD), FD, and OD and (ii) the risk factors for UD. METHODS: This house-to-house survey was performed using a translated-validated enhanced Asian Rome III questionnaire and endoscopy with Helicobacter pylori tests, including genotyping. RESULTS: Of 3,351/3,559 responders ([94.15%], age 40.41 ± 16.05 years, female 1924 [57.4%]), 547 (16.3%) had UD (female 346 [18%] vs male 201 [14%]; P = 0.002); 201 (6%), 88 (2.6%), and 258 (7.7%) had postprandial distress (PDS), epigastric pain syndromes (EPS) and PDS-EPS overlap, respectively. On multivariate analysis, age >50 years (adjusted odds ratio [AOR] 1.34 [1.07-1.68]), female sex (AOR 1.42 [1.17-1.74]), being married (AOR 1.57 [1.21-2.07]), lower family income (AOR 1.79 [1.43-2.26]), nonsteroidal anti-inflammatory drug use (AOR 7.05 [2.11-23.55]), previous acute gastroenteritis (AOR 5.42 [1.83-16]), and psychological distress (AOR 5.02 [2.87-8.76]) were risk factors for UD. Of 346/547 (63.25%) undergoing endoscopy, 232 (67.05%) and 114 (32.95%) had FD and OD (peptic ulcers [PU] 99 [28.61%] and erosive esophagitis 13 [3.76%]). About 53% of FD subjects had EPS-PDS overlap, 32% had PDS, and only 15% had EPS. H. pylori was detected in 266/342 (78%) dyspeptics (FD 173/230 [75.2%], vs OD 92/114 [82.1%], P = 0.169). DISCUSSION: Sixteen percent, 11% and 5% of rural Bangladeshi Asian adults had UD, FD, and PU, respectively. One-third of UD subjects had OD, mostly PU.JOURNAL/cltg/04.03/01720094-202104000-00016/inline-graphic1/v/2021-04-15T161418Z/r/image-tiff.

Impaired decision-making under risk in patients with functional dyspepsia.

INTRODUCTION: The cognitive processing in patients with functional dyspepsia (FD) has not been well established. Decision-making is an important component of cognitive function. Most brain regions involved in decision-making are abnormal in FD patients. This study aimed to investigate the decision-making under ambiguity and risk in FD patients. METHODS: We recruited 40 FD patients meeting Rome III criteria and 40 healthy controls (HCs) matched for age, sex, marital status, and education level. The Hamilton Anxiety Scale (HAMA) and the 17-item Hamilton Depression Scale (HAMD-17) were used to evaluate their anxiety and depression emotions. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to evaluate decision-making under ambiguity and risk, respectively. Helicobacter pylori status, disease duration, dyspeptic symptom score, and the Nepean Dyspepsia Life Quality Index (NDLQI) were obtained from all patients. RESULTS: In IGT, FD patients had a lower total net score, chose more adverse choices, and showed a slower response to change their behavior than HCs. However, there was no significant difference in the net score of the first 2 blocks between the two groups. In GDT, FD patients had a lower total net score, higher risk score, and lower use of negative feedback than HCs. In addition, FD patients showed better GDT performance than those without early satiation. CONCLUSIONS: FD patients showed impaired decision-making under risk. The deficiency might be related to dyspeptic symptoms of FD patients.

Evidence of gut enteropathy and factors associated with undernutrition among slum-dwelling adults in Bangladesh.

BACKGROUND: Adult undernutrition (BMI <18.5 kg/m2) is responsible for immune deficits, increased risk of disease burden, and higher rates of mortality. The prevalence of adult undernutrition in Bangladesh is substantial, but there have been few studies on the etiology of this condition for the inhabitants of urban slums. OBJECTIVE: The aim of this study was to identify the factors associated with undernutrition among slum-dwelling adults in Bangladesh. METHODS: A case-control study was conducted in the Bauniabadh area of Dhaka, Bangladesh. 270 adult participants (135 cases with a BMI <18.5 and 135 controls with a BMI between 18.5 and 24.9) aged 18-45 y were enrolled between October 2018 and January 2019. Sociodemographic variables, dietary diversity, micronutrient deficiencies, psychological symptoms, infection, and biomarkers of gut health were assessed to identify the factors associated with undernutrition using multivariable logistic regression analysis. RESULTS: A higher number of siblings [adjusted odds ratio (aOR): 1.39; 95% CI: 1.11, 1.77], increased self-reporting questionnaire-20 score (an instrument to screen mental health disorders and detect psychological symptoms) (aOR: 1.12; 95% CI: 1.04, 1.23), elevated fecal concentration of α-1 antitrypsin (aOR: 4.82; 95% CI: 1.01, 25.29), and anemia (aOR: 3.63; 95% CI: 1.62, 8.58) were positively associated with undernutrition in adults. Age (aOR: 0.90; 95% CI: 0.84, 0.96), dietary diversity score (aOR: 0.75; 95% CI: 0.56, 0.99), C-reactive protein (aOR: 0.82; 95% CI: 0.73, 0.92), Helicobacter pylori infection (aOR: 0.11; 95% CI: 0.05, 0.23), and always washing hands before eating or preparing foods (aOR: 0.33; 95% CI: 0.12, 0.87) were associated with reduced odds of undernutrition among the study population. CONCLUSIONS: Our results indicate that undernutrition in slum-dwelling adults in Bangladesh is associated with numerous physiological and sociodemographic factors, including evidence of gastrointestinal inflammation and altered intestinal permeability.

Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country.

BACKGROUND & AIMS: Developing countries are making efforts to improve health management. Practice deviating from the guideline means inefficient control. The study aims to investigate the management of Helicobacter pylori (H pylori) infection from a developing country perspective. METHODS: An authoritative survey was conducted in 14th (2014) and 17th (2017) Congress of Gastroenterology China, respectively. The Maastricht V/Florence consensus report was invoked as the evaluation criterion. RESULTS: A total of 4182 valid samples were included in this study. Most of the respondents (94%) updated knowledge by lectures. Respondents had a different awareness rate of H pylori-related diseases, ranging from 45% to 95%. Up to 40% of the respondents did not follow the recommendations for the diagnosis. Choice accuracy of eradication regimens and antibiotic combinations was <70%. About 20% of the respondents did not pay attention to the confirmation after the eradication. The situation had been improved in 2017 when compared with that in 2014 (all P < .05). Multivariate logistic regression analysis revealed that influencing factors including nongastroenterologists, bachelor degree and below, the primary professional title, hospital location, and a small proportion of H pylori infection in daily practice related to the deviation of consensus (all P < .05). CONCLUSIONS: Although the management of H pylori infection has been improved in a developing country, there is still a gap between the real-world practices and the consensus. Influencing factors should be taken into account in decision-making, and the corresponding population should be strengthened with precision training during the promotion of the guideline.

Relationship between primary eradication of Helicobacter pylori and drinking habits in women: collaborative research between a pharmacy and a clinic.

Helicobacter pylori is a cause of stomach cancer and peptic ulcer. For prevention, improving the eradication rate of H. pylori is crucial. However, the association between eradication and lifestyle of infected patients, including alcohol consumption, remains unclear. We explored associations between failed primary eradication therapy and drinking status by sex. This study involved 356 patients who visited a pharmacy with prescriptions for primary H. pylori eradication therapy. We assessed drinking habits using a questionnaire. Data on patients with failed primary eradication were provided by the nearby local clinic. We performed logistic regression analysis to examine the effect of drinking habit and frequency of drinking on failed primary eradication by sex. The odds ratio of primary eradication failure in female patients with a drinking habit was 3.75 (P = 0.001), but that in male patients was not significant. The odds ratio tended to increase in relation to drinking frequency in women. Frequent consumption of alcohol is not only likely to affect eradication, but also has a large impact on the bodies of women, who are more susceptible than men to the effects of alcohol. Thus, women should take greater care in alcohol consumption.

Fermented milk containing Lactobacillus paracasei and Glycyrrhiza glabra has a beneficial effect in patients with Helicobacter pylori infection: A randomized, double-blind, placebo-controlled study.

BACKGROUND: Lactobacillus paracasei and Glycyrrhiza glabra have been reported as having beneficial effects on Helicobacter pylori infection. We aimed to assess the efficacy and safety of fermented milk containing L paracasei HP7 and G glabra in patients with H pylori infection. METHODS: This multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial was conducted in 2 hospitals from April to December 2017. Patients with H pylori infection were randomized into either the treatment group (fermented milk with L paracasei HP7 and G glabra) or placebo group (fermented milk only) once daily for 8 weeks. The primary endpoint was the gastric load of H pylori measured by C-urea breath test (UBT). Secondary endpoints were histologic and clinical improvement. RESULTS: A total of 142 patients were randomly allocated to the treatment (n = 71) or placebo groups (n = 71). Compared to baseline data, the quantitative value of C-UBT at 8 weeks was significantly reduced in the treatment group (from 20.8 ±â€Š13.2% to 16.9 ±â€Š10.8%, P = .035), but not in the placebo group (P = .130). Chronic inflammation improved significantly only in the treatment group (P = .013), whereas the neutrophil activity deteriorated significantly only in the placebo group (P = .003). Moreover, the treatment group had significant improvement in gastrointestinal symptoms (P = .049) and quality of life (P = .029). No serious adverse events were observed. CONCLUSION: The combination of fermented milk containing L paracasei and G glabra reduced H pylori density and improved histologic inflammation. However, their mechanisms of action should be elucidated in further studies.

Predictors of triple therapy treatment failure among H. pylori infected patients attending at a tertiary hospital in Northwest Tanzania: a prospective study.

BACKGROUND: Helicobacter pylori (H.pylori) infection is a common medical problem in resource limited areas. The treatment outcome after triple therapy has not been well studied in developing countries and preliminary data suggests a high rate of treatment failure. This study investigated the triple therapy treatment failure rate and associated factors among dyspeptic patients receiving H. pylori first line therapy at a tertiary hospital, Tanzania. METHODS: A prospective study in the Gastroenterology unit of the Bugando Medical Centre (BMC) was conducted between October 2015 and May 2017. All dyspeptic patients with stool antigen tests positive for H.pylori were given first line therapy, and stool antigen testing was repeated within 7 days and 5 weeks after completion of the treatment. Biopsies were taken before initiation of therapy and analysed for clarithromycin and quinolone resistance mutations using polymerise chain reaction (PCR) and sequencing. Adherence and other social-demographic characteristics were documented. RESULTS: A total of 210 patients were enrolled; the median age was 35 years (interquartile range, 27-48). First line treatment failure as defined by positive stool antigen 5 weeks post treatment was observed in 65/210 (31%) of patients. Independent predictors of first line treatment failure were presence of clarithromycin resistance mutations (OR: 23.12, 95% CI (9.38-56.98), P < 0.001) and poor adherence (OR: 7.39, 95% CI (3.25-16.77), P < 0.001). The sensitivity and specificity of stool antigen testing within 7 days after completion therapy in detecting treatment failure was 100 and 93.2%, respectively. CONCLUSION: Nearly one-third of patients with clarithromycin resistance mutations and poor adherence develop first line treatment failure. Routine stool antigen testing within seven days after completion of therapy can be considered in order to initiate second line treatment early to prevent associated morbidities.

Spanish primary care survey on the management of Helicobacter pylori infection and dyspepsia: Information, attitudes, and decisions.

INTRODUCTION: Dyspepsia and Helicobacter pylori are two of the most relevant digestive conditions in primary care. Several consensuses on the subject have been published, but the assimilation/implementation of these guidelines is uncertain. AIMS AND METHODS: To evaluate the attitudes, perceptions, limitations, and adherence to recommendations of Spanish primary care physicians using an open online survey. Responses were anonymously codified. Estimated margin of error was 3.4%. Responses were weighted by province, gender, age, and type of practice. Survey was performed using the AEG-REDCap platform. RESULTS: A total of 1445 responses, received between December 2017 and April 2018, were analyzed. Women represented 54%, and the average age was 48 years; 59% were from urban context, 20% from semi-urban, and 21% from rural; 93% provided public practice. Over 40% had read at least one Maastricht consensus (24% Maastricht V), and 34% had attended a course related to H. pylori. 16% reported no direct access to any validated diagnostic method, only 44% to urea breath test, and 33% did not systematically refer to eradication confirmation test. The first-line treatment of choice was standard triple therapy in 56%, followed by concomitant therapy (28%). Only 20% of physicians had optimal adherence to recommendations. CONCLUSION: Even though some improvements from guidelines have been partially incorporated, the level of penetration of recommendations is still poor and delayed. To provide optimal primary care, the barriers for implementation, access to diagnostic tests and to continuous medical education, should be removed. Rigorous dissemination, implementation, and evaluation programs are desired in future consensuses.

Association between Poor Sleep Quality and Subsequent Peptic Ulcer Recurrence in Older Patients with Mild Cognitive Impairment: Examining the Role of Social Engagement.

This study aims to examine whether perceived poor sleep quality predicts subsequent recurrence of peptic ulcer disease (PUD) in older patients with mild cognitive impairment following Helicobacter pylori eradication and to investigate whether social engagement status alters this association. Of 1,689 older patients with H. pylori-infected PUD recruited from eight Grade-A hospitals in the People's Republic of China between 2011 and 2014, H. pylori was eradicated and PUD cleared in 1,538 patients by the end of 2014; 1,420 of these were followed for up to 36 months. The Kaplan-Meier method was used to compare the proportion of PUD recurrence, as confirmed with esophagogastroduodenoscopy, among older patients with different levels of sleep quality and social engagement statuses. Multivariate Cox-proportional hazards models were performed to examine the association between sleep quality and PUD recurrence, and the role of social engagement in altering this relationship. The results showed that PUD recurrence was more prevalent in poor (10.8%) compared with good sleepers (5.5%). However, increased and continued social engagement reduced the proportion to 7.2% and 8.2% among poor sleepers, respectively. Poor sleep quality was associated with subsequent PUD recurrence (hazard ratio [HR] 1.965 (1.002, 3.518)). However, no significant difference was observed between good and poor sleepers who reported increased (HR 1.428 (0.736, 2.380)) and continued (HR 1.273 (0.915, 2.492)) social engagement, suggesting that increased and continued social engagement prevented the effect of poor sleep quality on PUD recurrence. To conclude, poor sleep quality is associated with subsequent PUD recurrence. However, increased and continued social engagement may moderate this association.

Time trends in dyspepsia and association with H. pylori and work-related stress-An observational study in white collar employees in 1996 and 2015.

PURPOSE: We aimed to describe time trends in functional dyspepsia and the association of dyspepsia-related factors, Helicobacter pylori (H. pylori) and work-related stress with functional dyspepsia in white collar employees in 1996 and 2015. MATERIALS AND METHODS: Repeat cross-sectional study conducted in 1996 (n = 190, response rate = 76.1) and 2015 (n = 195, response rate = 40.2) within a health insurance company in South-West Germany. Dyspeptic symptoms measured according to the Rome III criteria, effort-reward imbalance and further work- or dyspepsia-related factors were assessed by self-administered questionnaire. H. pylori infection as possible factor for dyspeptic symptoms was measured by a 13C-urea breath test or an antigen stool test. Kruskal-Wallis tests and multivariable logistic regression models were calculated comparing the upper tertile of dyspeptic symptom scale to the middle and lower tertile. RESULTS: Mean dyspepsia symptom scores and work-related stress did not differ comparing 1996 and 2015. In bivariate analyses, dyspeptic symptom scores were consistently correlated with sex, age, and using antacids. Further dyspepsia-related factors were smoking and non-leading occupational position in 1996 and non-steroidal anti-inflammatory drugs as well as high effort-reward imbalance in 2015. High intrinsic effort was positively associated with high dyspepsia symptom scores in both studies. Following multivariable adjustment, we observed a consistent association between high intrinsic effort at work and dyspeptic symptoms, although the association was only marginally statistically significant in 1996. Furthermore, a strong association of somatization, only measured in 2015, with dyspeptic symptoms was shown. CONCLUSIONS: Dyspepsia-related factors may have changed throughout the last decades. Nevertheless, although occupational situations might differ, the intrinsic effort is still strongly associated with dyspeptic symptoms.

Helicobacter pylori moderates the association between 5-MTHF concentration and cognitive function in older adults.

OBJECTIVE: To explore potential interactions between folate-cycle factors and Helicobacter pylori seropositivity in the prediction of cognitive function. METHODS: We used data obtained from the 1999-2000 continuous National Health and Nutrition Examination Survey produced by the United States' Centers for Disease Control and Prevention. Using Ordinary Least Squares regression, we tested for associations between multiple folate-cycle factors, Helicobacter pylori seropositivity, and cognitive function assessed by the digit symbol coding subtest of the Wechsler Adult Intelligence Scale-III. We then tested for interactions between each of the folate-cycle factors and Helicobacter pylori in the prediction of cognitive function. RESULTS: Although Helicobacter pylori seropositivity, 5-methyltetrahydrofolate, vitamin B-12, and homocysteine were not associated with performance on the digit symbol coding task, Helicobacter pylori seropositivity interacted with 5-methyltetrahydrofolate concentration to predict performance on the digit symbol coding task. The Helicobacter pylori seropositive group performed worse on the digit symbol coding task as 5-methyltetrahydrofolate concentration decreased. CONCLUSION: The interaction between Helicobacter pylori seropositivity and reduced folate-cycle factor 5-methyltetrahydrofolate might impair aspects of cognitive function.

Association between Helicobacter pylori infection and cognitive impairment in the elderly.

BACKGROUND/PURPOSE: Helicobacter pylori (H. pylori) infection has been positively associated with cognitive impairment. However, previous studies have shown inconsistent findings. METHODS: This cross-sectional study included 587 elderly participants (age ≧ 65) from the annual elderly health checkup program at the National Taiwan University Hospital from 2011 to 2013. Both global and domain-specific cognition were assessed using various neuropsychiatric tests. Multivariable linear regression and logistic regression models were utilized to assess the association between the serum H. pylori IgG level and cognitive impairment. RESULTS: Compared with the lowest quartile of H. pylori IgG (Q1), the highest quartile (Q4) was associated with lower scores on verbal fluency-vegetables (ß = -0.24), domain-specific attention [digit span-forward: ß = -0.19; odds ratio (OR) = 1.83, 95% confidence interval (CI) = 1.03-3.24], and attention factors (ß = -0.20; OR= 2.67, 95% CI = 1.51-4.73). No significant association was observed for global cognition. Stratified analyses revealed that, among men, the highest quartile of serum H. pylori IgG (Q4) was associated with impaired scores on verbal fluency-vegetables (ß = -0.38; OR = 3.01, 95% CI = 1.42-6.38). CONCLUSION: Our findings disclosed a positive association between serum H. pylori level and cognitive impairment, which provides important information for the primary prevention of cognitive impairment through the eradication of H. pylori.

Psychological effects of Helicobacter pylori-associated atrophic gastritis in patients under 50 years: A cross-sectional study.

BACKGROUND: While gastrointestinal function is known to be closely related to psychological status, the influence of Helicobacter pylori-associated atrophic gastritis is currently unknown. We aimed to determine whether atrophic gastritis status or H. pylori infection is associated with psychological distress or depressed mood. MATERIALS AND METHODS: We performed a cross-sectional, observational study involving 975 Japanese individuals (503 females; mean age, 44 ± 8 years) who underwent a health checkup. Psychological distress was defined as a Kessler-6 Scale score ≥13 and depressive mood as a Center for Epidemiological Studies Depression Scale score ≥ 16. The odds ratios with 95% confidence intervals assessing the risk of psychological distress or depressive mood associated with H. pylori infection (H. pylori-specific immunoglobulin G levels >10 U/mL) and atrophic gastritis status (pepsinogen I levels < 70 µg/L and pepsinogen I/II ratio < 3) were calculated using multiple logistic analysis adjusting for several covariates. RESULTS: Individuals with atrophic gastritis had a significantly higher risk of experiencing psychological distress, with younger females (<50 years) displaying the highest risk for psychological distress and depressive mood regardless of H. pylori infection status. Among females aged <50 years, H. pylori-seropositive participants with atrophic gastritis (HP+AG+) showed the highest risk of psychological distress (OR, 16.4; 95% CI, 3.45-94.9) and depression (OR, 2.86; 95% CI, 1.31-6.05), using HP-AG- status as the reference. CONCLUSIONS: Our findings support the results of previous animal studies regarding the psychological response to gastritis in humans. Further studies are needed to elucidate whether H. pylori eradication provides psychological benefits.

[Analysis of the clinical efficiency of eradication therapy in patients with coronary heart disease associated with gastroduodenal pathology]. / Analiz klinicheskoi éffektivnosti éradikatsionnoi terapii u bol'nykh ishemicheskoi bolezn'iu serdtsa, assotsiirovannoi s patologiei gastroduodenal'noi zony.

AIM: To comparatively analyze the clinical efficiency of eradiation therapy (ET) in patients with coronary heart disease (CHD) concurrent with gastroduodenal pathology (GDP). SUBJECTS AND METHODS: The study was conducted in three steps. In Step 1, 1588 patients with chronic CHD were examined. In Step 2, the characteristics of the course of CHD concurrent with Helicobacter pylori-associated GDP in 147 patients with these conditions compared to the same number of CHD patients without GDP. In Step 3, the impact of a GDP treatment option on the efficiency of treatment was investigated in the patients with CHD. Group 1 received ET + basic therapy (BT); Group 2 used antisecretory therapy + BT; Group 3 consisted of CHD patients without concomitant GDP who received BT only. The time course of changes in clinical and quality-of-life (QOL) indicators was assessed. RESULTS: The patients with CHD concurrent with GDP have a more severe course of the disease as manifested by deterioration in clinical status and QOL. After ET, anginal attack rates were decreased by 62.6% in Group 1, by 30.7% in Group 2 (during antisecretory therapy), and by 29.5% in Group 3. The level of physical QOL increased by 23.7% in Group 1, which was not observed in Groups 2 and 3. CONCLUSION: Inclusion of ET in an algorithm for treating CHD patients with GDP promotes the angina stability and normalizes QOL in the patients.

The study of memory and executive dysfunction in patients infected with Helicobacter pylori.

Background Infectious agents are considered as potential causes of Alzheimer's disease. Recently, evidence of a high prevalence of Helicobacter pylori (H. pylori) infection in patients with Alzheimer's disease has been observed. The aim of this study was to investigate memory and executive function in H. pylori positive persons not suffering from Alzheimer's or other marked cognitive disorders. Methods This is a cross-sectional study. A total 140 participants were selected using purposive sampling from the patients within the age group of 18-60 years old at Fayyaz Bakhsh Hospital, Tehran in spring 2016. The participants were divided into two groups of H. pylori positive and negative according to results of the serologic tests to measure the levels of specific antibodies of IgA and IgG against H. pylori using ELISA method. They were subsequently assessed using two tests of Trail Making (TMT) part A and B and Wechsler Memory Scale - Third Edition. Data were analyzed using independent t-test and chi-square. The level of significance was considered P-value ≤ 0.05. Results Out of 140 participants, there were 41 male (29.3%) and 99 female (70.7%) among which 84 patients (60%) suffered from H. pylori infection (seropositive) and 56 patients (40%) were not infected. Comparison of the results using independent t-test showed a significant difference (P = 0.006) between the memory scores of patients (M: 106, SD: 8.12) and healthy ones (M: 112, SD: 1.12). In addition, the executive function showed there is a significant difference in the executive ability of seropositive individuals in the two age groups of 20-50 years old (Part A: M: 1.36, SD: 7.11, and Part B: M: 8.8, SD: 8.25 p = 0.01) and over 50 years old (Part A: M: 55, SD: 8.20, and Part B: M: 106, SD: 7.22, p = 0.009). Conclusion The results of this study showed that the infected patients have a lower cognitive performance in comparison to healthy individuals. In other words, H. pylori infection increases the prevalence of memory and executive dysfunction.

Helicobacter pylori infection and low dietary iron alter behavior, induce iron deficiency anemia, and modulate hippocampal gene expression in female C57BL/6 mice.

Helicobacter pylori (H.pylori), a bacterial pathogen, is a causative agent of gastritis and peptic ulcer disease and is a strong risk factor for development of gastric cancer. Environmental conditions, such as poor dietary iron resulting in iron deficiency anemia (IDA), enhance H.pylori virulence and increases risk for gastric cancer. IDA affects billions of people worldwide, and there is considerable overlap between regions of high IDA and high H.pylori prevalence. The primary aims of our study were to evaluate the effect of H.pylori infection on behavior, iron metabolism, red blood cell indices, and behavioral outcomes following comorbid H. pylori infection and dietary iron deficiency in a mouse model. C57BL/6 female mice (n = 40) were used; half were placed on a moderately iron deficient (ID) diet immediately post-weaning, and the other half were maintained on an iron replete (IR) diet. Half were dosed with H.pylori SS1 at 5 weeks of age, and the remaining mice were sham-dosed. There were 4 study groups: a control group (-Hp, IR diet) as well as 3 experimental groups (-Hp, ID diet; +Hp, IR diet; +Hp,ID diet). All mice were tested in an open field apparatus at 8 weeks postinfection. Independent of dietary iron status, H.pylori -infected mice performed fewer exploratory behaviors in the open field chamber than uninfected mice (p<0.001). Hippocampal gene expression of myelination markers and dopamine receptor 1 was significantly downregulated in mice on an ID diet (both p<0.05), independent of infection status. At 12 months postinfection, hematocrit (Hct) and hemoglobin (Hgb) concentration were significantly lower in +Hp, ID diet mice compared to all other study groups. H.pylori infection caused IDA in mice maintained on a marginal iron diet. The mouse model developed in this study is a useful model to study the neurologic, behavioral, and hematologic impact of the common human co-morbidity of H. pylori infection and IDA.

Brain-gut axis in the pathogenesis of Helicobacter pylori infection.

Helicobacter pylori (H. pylori) infection is the main pathogenic factor for upper digestive tract organic diseases. In addition to direct cytotoxic and proinflammatory effects, H. pylori infection may also induce abnormalities indirectly by affecting the brain-gut axis, similar to other microorganisms present in the alimentary tract. The brain-gut axis integrates the central, peripheral, enteric and autonomic nervous systems, as well as the endocrine and immunological systems, with gastrointestinal functions and environmental stimuli, including gastric and intestinal microbiota. The bidirectional relationship between H. pylori infection and the brain-gut axis influences both the contagion process and the host's neuroendocrine-immunological reaction to it, resulting in alterations in cognitive functions, food intake and appetite, immunological response, and modification of symptom sensitivity thresholds. Furthermore, disturbances in the upper and lower digestive tract permeability, motility and secretion can occur, mainly as a form of irritable bowel syndrome. Many of these abnormalities disappear following H. pylori eradication. H. pylori may have direct neurotoxic effects that lead to alteration of the brain-gut axis through the activation of neurogenic inflammatory processes, or by microelement deficiency secondary to functional and morphological changes in the digestive tract. In digestive tissue, H. pylori can alter signaling in the brain-gut axis by mast cells, the main brain-gut axis effector, as H. pylori infection is associated with decreased mast cell infiltration in the digestive tract. Nevertheless, unequivocal data concerning the direct and immediate effect of H. pylori infection on the brain-gut axis are still lacking. Therefore, further studies evaluating the clinical importance of these host-bacteria interactions will improve our understanding of H. pylori infection pathophysiology and suggest new therapeutic approaches.