Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship?

INTRODUCTION: Marginal ulcers are the most prevalent endoscopic abnormality after RYGB. The etiology is still poorly understood; however, an increase in acid secretion has been strongly implicated as a causal agent. Although gastrin is the greatest stimulant of acid secretion, to date, the presence of gastrin producing G cells retained in the gastric pouch, related to the occurrence of marginal ulcers, has not been evaluated. OBJECTIVE: Evaluate the density of G cells and parietal cells in the gastric pouch of RYGB patients with a diagnosis of marginal ulcer on the post-op EGD. METHOD: We retrospectively evaluated 1104 gastric bypasses performed between 2010 and 2020. Patients with marginal ulcer who met the inclusion criteria and controls were selected from this same population. Endoscopic gastric pouch biopsies were evaluated using immunohistochemical study and HE staining to assess G cell and parietal cell density. RESULTS: In total, 572 (51.8%) of the patients performed endoscopic follow-up after RYGB. The incidence of marginal ulcer was 23/572 (4%), and 3 patients required revision surgery due to a recalcitrant ulcer. The mean time for ulcer identification was 24.3 months (2-62). G cell count per high-power field (× 400) was statistically higher in the ulcer group (p < 0.05). There was no statistical difference in parietal cell density between groups (p 0.251). CONCLUSION: Patients with a marginal ulcer after gastric bypass present a higher density of gastrin-producing G cells retained in the gastric pouch.

Exploiting drug delivery systems for oral route in the peptic ulcer disease treatment.

Peptic ulcer disease (PUD) is a common condition that is induced by acid and pepsin causing lesions in the mucosa of the duodenum and stomach. The pathogenesis of PUD is a many-sided scenario, which involves an imbalance between protective factors, such as prostaglandins, blood flow, and cell renewal, and aggressive ones, like alcohol abuse, smoking, Helicobacter pylori colonisation, and the use of non-steroidal anti-inflammatory drugs. The standard oral treatment is well established; however, several problems can decrease the success of this therapy, such as drug degradation in the gastric environment, low oral bioavailability, and lack of vectorisation to the target site. In this way, the use of strategies to improve the effectiveness of these conventional drugs becomes interesting. Currently, the use of drug delivery systems is being explored as an option to improve the drug therapy limitations, such as antimicrobial resistance, low bioavailability, molecule degradation in an acid environment, and low concentration of the drug at the site of action. This article provides a review of oral drug delivery systems looking for improving the treatment of PUD.

A Review of the Role of Flavonoids in Peptic Ulcer (2010-2020).

Peptic ulcers are characterized by erosions on the mucosa of the gastrointestinal tract that may reach the muscle layer. Their etiology is multifactorial and occurs when the balance between offensive and protective factors of the mucosa is disturbed. Peptic ulcers represent a global health problem, affecting millions of people worldwide and showing high rates of recurrence. Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most important predisposing factors for the development of peptic ulcers. Therefore, new approaches to complementary treatments are needed to prevent the development of ulcers and their recurrence. Natural products such as medicinal plants and their isolated compounds have been widely used in experimental models of peptic ulcers. Flavonoids are among the molecules of greatest interest in biological assays due to their anti-inflammatory and antioxidant properties. The present study is a literature review of flavonoids that have been reported to show peptic ulcer activity in experimental models. Studies published from January 2010 to January 2020 were selected from reference databases. This review refers to a collection of flavonoids with antiulcer activity in vivo and in vitro models.

Systematic Analysis of Monoterpenes: Advances and Challenges in the Treatment of Peptic Ulcer Diseases.

Peptic ulcer disease (PUD) is a multifactorial and complex disease caused by an imbalance of protective and aggressive factors (endogenous and exogenous). Despite advances in recent years, it is still responsible for substantial mortality and triggering clinical problems. Over the last decades, the understanding of PUD has changed a lot with the discovery of Helicobacter pylori infection. However, this disease continues to be a challenge due to side-effects, incidence of relapse from use of various anti-ulcer medicines, and the rapid appearance of antimicrobial resistance with current H. pylori therapies. Consequently, there is the need to identify more effective and safe anti-ulcer agents. The search for new therapies with natural products is a viable alternative and has been encouraged. The literature reports the importance of monoterpenes based on the extensive pharmacological action of this class, including wound healing and anti-ulcerogenic agents. In the present study, 20 monoterpenes with anti-ulcerogenic properties were evaluated by assessing recent in vitro and in vivo studies. Here, we review the anti-ulcer effects of monoterpenes against ulcerogenic factors such as ethanol, nonsteroidal anti-inflammatory drugs (NSAIDs), and Helicobacter pylori, highlighting challenges in the field.

Clinical, Endoscopic, and Histologic Findings at the Distal Esophagus and Stomach Before and Late (10.5 Years) After Laparoscopic Sleeve Gastrectomy: Results of a Prospective Study with 93% Follow-Up.

OBJECTIVE: Perform a prospective study based on sequential clinical, endoscopic, and histologic evaluations of the foregut late after laparoscopic sleeve gastrectomy (LSG) in obese patients. After LSG, several studies have suggested an increase in the incidence of clinical gastroesophageal reflux (GERD) while others have reported an improvement but based mainly on clinical questionnaires. METHODS: Prospective study of 104 consecutive patients submitted to LSG. Several postoperative endoscopic and histologic evaluations of the esophagogastric junction (EGJ) and the gastric tube (GT) were performed and correlated with symptomatic findings. RESULTS: According to clinical preoperative findings, patients were divided into non-refluxers (Group I) and refluxers (Group II). Seven patients were unreachable, leaving 97 (93%) for late evaluation. Among Group I, 58.5% developed de novo GERD, while in Group II just 13.6% showed the disappearance of them. Endoscopic evaluations showed progressive deterioration of the EGJ in Group I, with the development of erosive esophagitis (EE), hiatal hernia (HH), and dilated cardia in a large proportion of them. In the GT, the presence of bile was seen in 40%, and an open immobile pylorus was detected in 82%. Short-segment Barrett's esophagus (BE) appeared in 4%. CONCLUSIONS: Patients submitted to LSG showed a significant and progressive increase in the presence of "de novo" GERD. Also, an increased duodenogastric reflux was seen through an open and immobile pylorus. Therefore, based on these results, it seems like LSG is a "pro-reflux" surgical procedure, which should be continuously evaluated late after surgery.

Tratamiento endoscópico del sangrado digestivo alto por úlcera péptica / Endoscopic treatment of the high digestive bleeding by peptic ulcer

RESUMEN Introducción: la hemorragia digestiva alta ocurre por una lesión sangrante localizada entre el esfínter esofágico superior y el ángulo de Treitz. Objetivo: determinar el comportamiento del tratamiento endoscópico del sangrado digestivo alto por úlcera péptica, en el departamento de Gastroenterología del Hospital Universitario Comandante "Faustino Pérez". Materiales y métodos: se realizó un estudio descriptivo, prospectivo para evaluar el resultado del tratamiento endoscópico en el sangrado digestivo alto por úlcera péptica en el Hospital Universitario Comandante "Faustino Pérez" de Matanzas, de enero del 2016 a febrero del 2018. El tratamiento endoscópico fue la inyectoterapia con epinefrina al 1:10000. Se analizaron las variables: grupo de edades, sexo, resultado del tratamiento endoscópico, estigmas endoscópicos de sangrado, recidiva hemorrágica, mortalidad directa, necesidad de cirugía, estadía hospitalaria y cantidad de unidades transfusionales. Resultados: se constató un predominio de pacientes masculinos (87.5 %), menores de 60 años (70%). Prevalecieron los pacientes con estigmas endoscópicos de sangrado activo venoso (45%). La terapia endoscópica tuvo un resultado satisfactorio (92.5%) en su mayoría. La ocurrencia de resangrado (45%), mortalidad directa por hemorragia digestiva, promedio de estadía hospitalaria, cantidad de unidades transfusionales y necesidad de intervención quirúrgica de urgencia (17.5%), resultó similar a los estudios reportados, demostrando que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas. Conclusiones: la mayoría de los casos tratados con inyectoterapia endoscópica tuvieron un sangrado activo venoso o Forrest IB que fue satisfactoria. La inyectoterapia no satisfactoria fue en pacientes con sangrado activo. La mortalidad directa relacionada con el sangrado fue infrecuente y en relación con el sangrado arterial. Se demostró que la inyectoterapia endoscópica aún constituye una opción eficaz si no se cuenta con otras terapias endoscópicas (AU).

SUMMARY Introduction: high digestive bleeding happens due to a bleeding lesion located between the upper anatomical sphincter of the esophagus and the angle of Treitz. Objective: to determine the endoscopic treatment behavior of high digestive bleeding caused by peptic ulcer, in the department of Gastroenterology of the University Hospital "Comandante Faustino Perez". Materials and methods: a prospective descriptive study was carried out to evaluate the result of the endoscopic treatment in high digestive bleeding caused by peptic ulcer in the University Hospital "Comandante Faustino Perez", of Matanzas, from January 2016 to February 2018. The endoscopic treatment was injecto-therapy with epinephrine at 1:10000. The analyzed variables were: age group, sex, result of the endoscopic treatment, bleeding endoscopic stigma, hemorrhagic relapse, direct mortality, surgery necessity, hospital staying, and quantity of transfusion units. Results: male patients (87.5 %), aged less than 60 years predominated. Patients with endoscopic stigma of venous active bleeding (45 %) prevailed. In most of cases, endoscopic therapy achieved satisfactory results (92.5 %). The authors found that bleeding relapse (45 %), direct mortality by digestive hemorrhage, average hospital staying, quantity of transfusion units and necessity of urgent surgeries (17.5 %) were similar to those reported in other studies. Conclusions: most cases treated with endoscopic injectotherapy had active venous or Forrest IB bleeding and treatment was satisfactory. Therapy was unsatisfactory in patients with active bleeding. The direct mortality related to bleeding was infrequent, and related to arterial bleeding. It was showed that endoscopic injectotherapy is still an efficacious option if other endoscopic therapies are not available (AU).

Úlcera gastroduodenal isquémica como complicación de la quimioembolización transarterial hepática de hepatocarcinoma / Ischemic gastroduodenal ulcer as a complication of hepatic hepatocarcinoma transarterial chemoembolization

La quimioembolización transarterial hepática es uno de los tratamientos del carcinoma hepatocelular irresecable en el que se han descrito de forma infrecuente lesiones isquémicas asociadas. Ante la aparición de sintomatología gastrointestinal alta inusual o que exceda el denominado síndrome postquimiembolización tras el procedimiento debe valorarse la realización de una gastroscopia para descartar la aparición de dichas complicaciones. Las variantes anatómicas con origen común de arterias gástricas y hepáticas pueden favorecer la migración de las microesferas hacia territorio gástrico obligando a valorar la eventual modificación de la técnica para prevenirlo.

Transarterial hepatic chemoembolization is one of the treatments of unresectable hepatocellular carcinoma in which associated ischemic lesions have been described infrequently. When unusual upper gastrointestinal symptoms or exceeding the so-called post-chemoembolization syndrome after the procedure, the performance of a gastroscopy should be assessed to rule out the occurrence of these complications. The anatomical variants with common origin of gastric and hepatic arteries can favor the migration of the microspheres into gastric territory, forcing the possible modification of the technique to prevent it.

[Ischemic gastroduodenal ulcer as a complication of hepatic hepatocarcinoma transarterial chemoembolization]. / úlcera gastroduodenal isquémica como complicación de la quimioembolización transarterial hepática de hepatocarcinoma.

Transarterial hepatic chemoembolization is one of the treatments of unresectable hepatocellular carcinoma in which associated ischemic lesions have been described infrequently. When unusual upper gastrointestinal symptoms or exceeding the so-called post-chemoembolization syndrome after the procedure, the performance of a gastroscopy should be assessed to rule out the occurrence of these complications. The anatomical variants with common origin of gastric and hepatic arteries can favor the migration of the microspheres into gastric territory, forcing the possible modification of the technique to prevent it.

Utilidad del diagnóstico serológico de Helicobácter Pylori en pacientes con úlcera gastroduodenal / Usefulness of the serological diagnosis of Helicobacter Pylori in patients with gastroduodenal ulcer

Fundamento: la infección por Helicobacter Pylori es la causa fundamental de la enfermedad ulcerosa gastroduodenal.Objetivo: determinar la utilidad del diagnóstico serológico de Helicobacter Pylori en pacientes con úlcera gastroduodenal.Métodos: se realizó una investigación de tipo analítico, longitudinal, prospectivo, con el objetivo de describir el diagnóstico serológico de Helicobacter Pylori en pacientes con úlcera gastroduodenal en el Hospital Universitario Manuel Ascunce Domenech desde el primero de julio de 2015 hasta el 31 de julio de 2016. El universo de estudio estuvo constituido por 104 pacientes con diagnóstico de úlcera gastroduodenal y que cumplieron los criterios de inclusión. A todos los pacientes se les aplicó una encuesta la cual fue validada por criterios de expertos. Para la ejecución del estudio se estableció la comunicación con los pacientes con el objetivo de lograr la participación de los mismos en dicha investigación, lo que quedó validado a través del consentimiento informado.Resultados: en la investigación existió una elevada incidencia de la infección por Helicobacter Pylori en el grupo etáreo de 40-49 años. La mayoría de los pacientes infectados fueron del sexo femenino. En los casos estudiados las manifestaciones clínicas que predominaron fueron: dolor en epigastrio y la dispepsia.Conclusiones: la utilidad del diagnóstico serológico esta dado porque esta técnica no invasiva para la detección del anticuerpo contra la infección por la bacteria Helicobacter Pylori es de una alta sensibilidad al mostrar valores de 0,93 y una baja especificidad con valores de 0,05(AU)

Background: Helicobacter Pylori infection is the main cause of gastroduodenal ulcer disease.Objective: to determine the usefulness of Helicobacter Pyloriserological diagnosis in patients with gastroduodenal ulcer.Methods: a longitudinal, prospective, analytical study was carried out with the purpose of describing the serological diagnosis of Helicobacter Pyloriin patients with gastroduodenal ulcer at the Manuel Ascunce Domenech hospital from July 1st, 2015 to July 31st, 2016. The universe of study that consisted of 104 patients diagnosed with gastroduodenal ulcer who met the inclusion criteria. A survey of all patients was conducted which was validated by expert criteria. For the implementation of the study, communication with the patients was established aimed at ensuring their participation in this research, which was validated through informed consent.Results: in the research there was a high incidence of Helicobacter Pylori infection in the age group from 40-49 years. The majority of infected patients were female. In the cases studied, the clinical manifestations that predominated were: epigastrium pain and dyspepsia.Conclusions: the usefulness of serological diagnosis is due to the fact that this noninvasive technique for detecting the antibody against Helicobacter Pyloriinfection is highly sensitive, showing values of 0,93 and a low specificity with values of 0,05(AU)

[Gastrointestinal and hepatic diseases]. / Enfermedades gastrointestinales y hepáticas.

Diet is considered an important triggering factor for gastrointestinal symptoms whose physiopathology includes not only measurable, inflammatory reactions, but also functional disorders, where no organic effects may be measured or demonstrated. Moreover, the prevalence of the perceived intolerance to certain foods ranges from 20-25% (within the general population) to 50-70% in diseases like irritable bowel syndrome. This intolerance has been observed particularly after the consumption of milk and dairy products, which are frequently considered as causative of gastrointestinal symptoms, thus limiting their ingestion. However, this behavior reduces the dietary sources of calcium and consequently may lead to malnutrition and bone decalcification, amongst other complications. The true dairy intolerance (intestinal lactase deficiency) explains most of the symptoms ensuing their consumption, but the frequency of such alteration on the different gastrointestinal diseases has not been determined. This review focuses on the most frequent gastrointestinal diseases and the existing evidence regarding the alterations and symptoms related to the consumption of milk or dairy products.

Challenges to the Treatment and New Perspectives for the Eradication of Helicobacter pylori.

Helicobacter pylori (H. pylori) is one of the leading causes of gastric diseases such as chronic gastritis, peptic ulcer, and gastric adenocarcinoma. The current treatment of H. pylori infection with antibiotics and proton pump inhibitors has several limitations, including poor adherence and intrinsic patient-related factors, drug resistance, and the absence of adequate treatments. This review summarizes the current therapeutic approaches to eradicating H. pylori, the difficulties associated with its treatment, and several new perspectives aimed at improving existing treatment strategies.

[Meckel's diverticulum duplication. Case report and literature review]. / Doble divertículo de Meckel. Presentación de caso y revisión de la bibliografía.

BACKGROUND: Meckel's diverticulum is the most frequent congenital abnormality of the gastrointestinal tract. Preoperative diagnosis is difficult due to its variable clinical presentation that can simulate several causes of gastrointestinal bleeding or abdominal pain. CLINICAL CASE: We present the case of a 61-year-old female patient with multiple abdominal surgeries who developed intestinal occlusion during several admissions beginning 8 months earlier. She was treated with conservative measures. During her last admission, she developed dehydration, persistent abdominal pain and bowel dilation with failure to respond to conservative treatment. Surgical intervention was decided upon, ruling out adhesions and revealing the presence of two diverticular defects at 40 and 70 cm from the ileocecal valve with torsion. Histological report described gastric heterotrophic mucosa and inflammatory hemorrhagic process. CONCLUSION: Presence of duplicated Meckel's diverticulum is a rare finding with only nine reports in the international literature to date. Diagnosis is frequently made during surgery. Treatment for symptomatic diverticulum is surgical, whereas management for asymptomatic diverticulum is controversial and relies on the surgeon's decision and clinical characteristics of the patient.

Antecedentes: el divertículo de Meckel es la anomalía congénita más común del tubo digestivo. El diagnóstico preoperatorio es difícil de establecer, por su variable presentación clínica. Caso clínico: paciente femenina de 61 años de edad, con antecedente de cuadros de oclusión intestinal repetitivos ocho meses antes de nuestra valoración. En el último internamiento tuvo: desequilibrio hidroelectrolítico, dolor persistente y falta de respuesta al tratamiento médico; por esto se le realizó una laparotomía exploradora que descartó el síndrome adherencial, y como hallazgo dos defectos diverticulares a 40 y 70 cm de la válvula ileocecal, con torsión sobre su eje. El reporte histopatológico confirmó la existencia de dos divertículos de Meckel con cambios de tipo inflamatorio hemorrágico y mucosa gástrica heterotópica de tipo antral. Conclusión: la duplicación del divertículo de Meckel es un hallazgo raro, con solo nueve casos publicados en la bibliografía internacional. El diagnóstico se realiza, frecuentemente, como hallazgo transoperatorio. El tratamiento del divertículo sintomático es quirúrgico; sin embargo, en el asintomático existe controversia y depende del criterio del cirujano y de las características propias de cada paciente.

Etiopathogenesis of peptic ulcer: back to the past?

OBJECTIVES: To review some aspects of the etiopathogenesis of peptic ulcerous disease especially on the basis of studies on its correlation with Helicobacter pylori (H. pylori). METHODS: A search was made in the data bases MEDLINE, LILACS and PubMed, and in Brazilian and foreign books, referring to the incidence and prevalence of infection by H. pylori and of peptic ulcerous disease in various populations of different countries. RESULTS: It was observed that the prevalence of H. pylori infection is similar in individuals with peptic ulcerous disease and the general population. There are differences between countries with respect to the prevalence of infection and of gastric or duodenal peptic ulcers. In many countries the prevalence of infection by H. pylori shows stability while the prevalence of peptic ulcerous disease is declining. The prevalence of peptic ulcerous disease without H. pylori infection varies between 20% and 56% in occidental countries. DISCUSSION: The observations might be suggestive of H. pylori being only one more factor to be summed together with other aggressive components in the genesis of peptic ulcerous disease. We would therewith be returning to the classic concept that peptic gastric and duodenal ulcers have multifactorial etiology and would result from imbalance between aggressive and defensive factors. The focus of studies should be enriched with the identification of the defensive factors and of other aggressive factors besides the well known H. pylori and non-steroidal anti-inflammatory drugs, since these two aggressors do not exhaust the full causal spectrum.

ETIOPATHOGENESIS OF PEPTIC ULCER: back to the past? / Etiopatogenia da úlcera péptica: de volta ao passado?

Objectives To review some aspects of the etiopathogenesis of peptic ulcerous disease especially on the basis of studies on its correlation with Helicobacter pylori (H. pylori). Methods A search was made in the data bases MEDLINE, LILACS and PubMed, and in Brazilian and foreign books, referring to the incidence and prevalence of infection by H. pylori and of peptic ulcerous disease in various populations of different countries. Results It was observed that the prevalence of H. pylori infection is similar in individuals with peptic ulcerous disease and the general population. There are differences between countries with respect to the prevalence of infection and of gastric or duodenal peptic ulcers. In many countries the prevalence of infection by H. pylori shows stability while the prevalence of peptic ulcerous disease is declining. The prevalence of peptic ulcerous disease without H. pylori infection varies between 20% and 56% in occidental countries. Discussion The observations might be suggestive of H. pylori being only one more factor to be summed together with other aggressive components in the genesis of peptic ulcerous disease. We would therewith be returning to the classic concept that peptic gastric and duodenal ulcers have multifactorial etiology and would result from imbalance between aggressive and defensive factors. The focus of studies should be enriched with the identification of the defensive factors and of other aggressive factors besides the well known H. pylori and non-steroidal anti-inflammatory drugs, since these two aggressors do not exhaust the full causal spectrum. .

Objetivos Revisar a etiopatogenia da doença ulcerosa péptica com base em revisão de estudos sobre a correlação entre Helicobacter pylori (H. pylori) e doença ulcerosa péptica. Métodos Foi realizada busca nas bases de dados MEDLINE, LILACS e PubMed, e em livros brasileiros e estrangeiros referentes à incidência e prevalência de infecção pelo H. pylori e de doença ulcerosa péptica em várias populações de diferentes países. Resultados Observamos que a prevalência da infecção pelo H. pylori é semelhante em indivíduos com doença ulcerosa péptica e a população geral; que existem diferenças entre países no que tange as prevalências de infecção e a de úlceras péptica gástrica e duodenal e que, em muitos países, a prevalência de infecção pelo H. pylori se mantém estável, enquanto a prevalência de doença ulcerosa péptica está em queda. A prevalência de doença ulcerosa péptica na ausência de infecção pelo H. pylori varia de 20% a 56% nos países ocidentais. Discussão As observações sugerem que o H. pylori constituiria somente mais um fator a ser somado ao rol dos agressores na gênese da doença ulcerosa péptica. Assim, estaríamos retornando ao conceito de que as úlceras pépticas, gástrica e duodenal, têm etiologia multifatorial e decorreriam, como era admitido no passado, do desequilíbrio entre fatores agressivos e defensivos da mucosa. O foco dos estudos deveria ser redirecionado à identificação dos fatores defensivos e de outros fatores agressivos além dos bem conhecidos H. pylori e medicamentos anti-inflamatórios não-esteróides, desde que esses dois agentes não cobrem todo o espectro ...

Comportamiento higiénico-sanitario de pacientes con diagnóstico de úlcera gastroduodenal por Helicobacter pylori / Hygienic-sanitary behavior of patients diagnosed with gastroduodenal ulcer caused Helicobacter pylori

Introducción: actualmente la infección por Helicobacter pylori constituye la infección crónica más extensamente difundida en la especie humana, la cual puede cursar como síndrome dispéptico funcional u orgánico, gastritis, úlcera gastroduodenal y con síntomas subjetivos de cáncer gástrico. Diferentes estudios epidemiológicos cifran prácticamente en el 95 por ciento de los casos la asociación entre úlcera duodenal e infección por Helicobacter pylori. Objetivo: describir el comportamiento de algunas variables higiénicas-sanitarias en pacientes con úlceras gastroduodenales por Helicobacter pylori. Métodos: se realizó un estudio descriptivo y prospectivo de corte transversal a 908 pacientes con diagnóstico de úlcera péptica y positiva al test rápido de ureasa, en el período comprendido desde enero de 2007 hasta diciembre de 2008, en el Centro de Diagnóstico Integral del municipio Rafael Urdaneta, estado Miranda, República Bolivariana de Venezuela. Resultados: predominaron los pacientes que mantenían una higiene alimentaria inadecuada; los que no hervían el agua para tomar; y los que compartían los cubiertos sin previo lavado, elementos que pueden favorecer la infección por Helicobacter pylori. Conclusiones: hay estrecha relación entre la infección por Helicobacter pylori y el hábito higiénico, siendo más frecuente en los pacientes con hábito higiénico inadecuado(AU)

Introduction: the present infection caused by Helicobacter pylori is the most spread chronic infection in the human species, which could also appear as functional or organic dyspeptic syndrome, gastritis, gastroduodenal ulcer and subjective symptoms of gastric cancer. Several epidemiological studies reveal that practically 95 percent of cases are associated to duodenal ulcer and H.pylori infection. Objective: to describe the behavior of some hygienic-sanitary variables in patients suffering H.pylori gastroduodenal ulcers. Methods: a prospective cross-sectional and descriptive study was conducted in 908 patients diagnosed with peptic ulcer after positive rapid urease test in the period of January 2007 through December 2008 at the Integral Diagnosis Center of Rafael Urdaneta municipality in Miranda state, Bolivarian Republic of Venezuela. Results: the patients who exhibited poor food hygiene, who did not boil drinking water and who shared unwashed cutlery prevailed. Those elements may favor H.pylori infection. Conclusions: close association between H. pylori infection and hygienic habits was found, being more frequent in patients with bad hygienic habits(AU)

Comportamiento higiénico-sanitario de pacientes con diagnóstico de úlcera gastroduodenal por Helicobacter pylori / Hygienic-sanitary behavior of patients diagnosed with gastroduodenal ulcer caused Helicobacter pylori

Introducción: actualmente la infección por Helicobacter pylori constituye la infección crónica más extensamente difundida en la especie humana, la cual puede cursar como síndrome dispéptico funcional u orgánico, gastritis, úlcera gastroduodenal y con síntomas subjetivos de cáncer gástrico. Diferentes estudios epidemiológicos cifran prácticamente en el 95 por ciento de los casos la asociación entre úlcera duodenal e infección por Helicobacter pylori. Objetivo: describir el comportamiento de algunas variables higiénicas-sanitarias en pacientes con úlceras gastroduodenales por Helicobacter pylori. Métodos: se realizó un estudio descriptivo y prospectivo de corte transversal a 908 pacientes con diagnóstico de úlcera péptica y positiva al test rápido de ureasa, en el período comprendido desde enero de 2007 hasta diciembre de 2008, en el Centro de Diagnóstico Integral del municipio Rafael Urdaneta, estado Miranda, República Bolivariana de Venezuela. Resultados: predominaron los pacientes que mantenían una higiene alimentaria inadecuada; los que no hervían el agua para tomar; y los que compartían los cubiertos sin previo lavado, elementos que pueden favorecer la infección por Helicobacter pylori. Conclusiones: hay estrecha relación entre la infección por Helicobacter pylori y el hábito higiénico, siendo más frecuente en los pacientes con hábito higiénico inadecuado...

Introduction: the present infection caused by Helicobacter pylori is the most spread chronic infection in the human species, which could also appear as functional or organic dyspeptic syndrome, gastritis, gastroduodenal ulcer and subjective symptoms of gastric cancer. Several epidemiological studies reveal that practically 95 percent of cases are associated to duodenal ulcer and H.pylori infection. Objective: to describe the behavior of some hygienic-sanitary variables in patients suffering H.pylori gastroduodenal ulcers. Methods: a prospective cross-sectional and descriptive study was conducted in 908 patients diagnosed with peptic ulcer after positive rapid urease test in the period of January 2007 through December 2008 at the Integral Diagnosis Center of Rafael Urdaneta municipality in Miranda state, Bolivarian Republic of Venezuela. Results: the patients who exhibited poor food hygiene, who did not boil drinking water and who shared unwashed cutlery prevailed. Those elements may favor H.pylori infection. Conclusions: close association between H. pylori infection and hygienic habits was found, being more frequent in patients with bad hygienic habits...

Helicobacter pylori: rol del agua y los alimentos en su transmisión / Role of water and foods in helicobacter pylori transmission

Helicobacter pylori es una bacteria Gram negativa, microaerofílica, que coloniza eficientemente la mucosa gástrica humana. Fue aislada por primera vez en el año 1982 y actualmente se considera como un importante patógeno humano que causa diversas enfermedades gastrointestinales y además se reconoce como agente carcinógeno. Se habla de una alta prevalencia en el mundo, con un mayor porcentaje en los países en vías de desarrollo, esto probablemente relacionado con las condiciones de vida. De esta manera, el estatus socio-económico es el determinante más importante para el desarrollo de la infección por H. pylori, siendo las clases sociales más bajas las que exhiben mayor prevalencia. A la fecha, las rutas de transmisión de este microorganismo no se encuentran totalmente esclarecidas. Sobre la base de diversas evidencias epidemiológicas y microbiológicas se han propuesto varias vías. Dentro de estas se incluye al agua y a los alimentos como posibles vectores, a pesar de la compleja detección de esta bacteria en muestras distintas al tejido gástrico. H. pylori puede pasar a un estado viable no cultivable (VNC) bajo condiciones de estrés. No obstante, se han llevado a cabo diversos estudios para evaluar la prevalencia y supervivencia de esta bacteria en diversas fuentes de agua y muestras de alimentos, cuyos resultados indican la posibilidad de que los mismos actúen como un reservorio en su transmisión. Por esta razón, el presente artículo de revisión se enfoca en las evidencias que apoyan la transmisión de H. pylori a través del agua y los alimentos(AU)

Helicobacter pylori is a Gram-negative, microaerophilic, which efficiently colonizes the human gastric mucosa. It was first isolated in 1982 and is now considered an important human pathogen that causes various gastrointestinal diseases and is also recognized as a carcinogen. There is a high prevalence worldwide, with a higher percentage in developing countries, probably related to living conditions. Thus, the socio-economic status is the most important determinant for the development of the infection by H. pylori, being lower social classes exhibiting the highest prevalence. To date, the routes of transmission of this organism are not fully elucidated. Based on numerous epidemiological and microbiological evidences, several transmission paths have been suggested. Among them water and food are included as potential vectors, although the detection of these bacteria is complex in distinct samples to gastric tissue. H. pylori can happen to a viable but non-culturable state (VBNC) under conditions of stress. However, there have been several studies to assess the prevalence and survival of the bacteria in various water sources and food samples. Results indicate the possibility that they act as a reservoir for transmission. For this reason, this review article focuses on the evidence supporting the transmission of H. pylori through water and food(AU)

Different risk factors influence peptic ulcer disease development in a Brazilian population.

AIM: To investigate age, sex, histopathology and Helicobacter pylori (H. pylori) status, as risk factors for gastroduodenal disease outcome in Brazilian dyspeptic patients. METHODS: From all 1466 consecutive dyspeptic patients submitted to upper gastroscopy at Hospital das Clinicas of Marilia, antral biopsy specimens were obtained and subjected to histopathology and H. pylori diagnosis. All patients presenting chronic gastritis (CG) and peptic ulcer (PU) disease localized in the stomach, gastric ulcer (GU) and/or duodenal ulcer (DU) were included in the study. Gastric biopsies (n = 668) positive for H. pylori by rapid urease test were investigated for vacuolating cytotoxin A (vacA) medium (m) region mosaicism by polymerase chain reaction. Logistic regression analysis was performed to verify the association of age, sex, histopathologic alterations, H. pylori diagnosis and vacA m region mosaicism with the incidence of DU, GU and CG in patients. RESULTS: Of 1466 patients submitted to endoscopy, 1060 (72.3%) presented CG [male/female = 506/554; mean age (year) ± SD = 51.2 ± 17.81], 88 (6.0%) presented DU [male/female = 54/34; mean age (year) ± SD = 51.4 ± 17.14], and 75 (5.1%) presented GU [male/female = 54/21; mean age (year) ± SD = 51.3 ± 17.12] and were included in the comparative analysis. Sex and age showed no detectable effect on CG incidence (overall χ² = 2.1, P = 0.3423). Sex [Odds ratios (OR) = 1.8631, P = 0.0058] but not age (OR = 0.9929, P = 0.2699) was associated with DU and both parameters had a highly significant effect on GU (overall χ² = 30.5, P < 0.0001). The histopathological results showed a significant contribution of ageing for both atrophy (OR = 1.0297, P < 0.0001) and intestinal metaplasia (OR = 1.0520, P < 0.0001). Presence of H. pylori was significantly associated with decreasing age (OR = 0.9827, P < 0.0001) and with the incidence of DU (OR = 3.6077, P < 0.0001). The prevalence of m1 in DU was statistically significant (OR = 2.3563, P = 0.0018) but not in CG (OR = 2.678, P = 0.0863) and GU (OR = 1.520, P= 0.2863). CONCLUSION: In our population, male gender was a risk factor for PU; ageing for GU, atrophy and metaplasia; and H. pylori of vacA m1 genotype for DU.