Disparity in Helicobacter pylori Positivity among Israeli Adults with Uninvestigated Dyspepsia in an Urban Setting with Mixed Ethnicity.

BACKGROUND: Helicobacter pylori (H. pylori) prevalence varies according to both geographical region and ethnicity. The interplay between these two factors has been poorly studied. OBJECTIVES: To determine the positivity rate of H. pylori infection among Jewish and Arab patients who live in a mixed urban center in Israel. METHODS: Between November 2009 and September 2014, dyspeptic patients referred to a gastroenterology clinic in Lod, Israel, were enrolled in a prospective study. For each patient, clinical and epidemiological data were collected and a noninvasive or endoscopy-based test for H. pylori was performed. RESULTS: A total of 429 consecutive patients (322 Jewish and 107 Arabs), mean age 45 years (range 15-91 years) were included; 130 males. Overall positivity for H. pylori was 42.4% (182/429). The positivity rate of H. pylori was 38.8% for Jews (125/322) and 53.2% for Arabs (57/107) in Lod (P < 0.01). When immigrants were excluded, the difference in H. pylori positivity did not reach statistical significance (45.0% [77/171] vs. 53.2% [57/107], P = 0.217, in Jews and Arabs, respectively). CONCLUSIONS: H. pylori infection was more common in Arabs that Jews in the mixed city of Lod, Israel. This finding may suggest that non-environmental factors were responsible for the observed difference in H. pylori positivity.

The Incidence and Prevalence of Inflammatory Bowel Disease in the Jewish and Arab Populations of Israel.

BACKGROUND: Temporal trends in the incidence of inflammatory bowel disease (IBD) in the Arab and Jewish populations in Israel have been poorly described. OBJECTIVES: To compare the annual incidence and prevalence rates of Crohn's disease (CD) and ulcerative colitis (UC) in the Arab and Jewish populations in Israel between the years 2003 and 2008. METHODS: We applied a common case identification algorithm to the Clalit Health Services database to both determine trends in age-adjusted incidence and prevalence rates for IBD in both populations during this period and estimate the burden of IBD in Israel. RESULTS: The incidence of CD in the Arab population increased from 3.1/100,000 in 2003 to 10.6/100,000 person-years in 2008, compared with a decrease in the Jewish population from 14.3/100,000 to 11.7/100,000 person-years for the same period. The incidence of UC in the Arab population increased from 4.1/100,000 in 2003 to 5.0/100,000 person-years in 2008, a low but stable rate, compared with a decrease from 16.4/100,000 to 9.5/100,000 person-years for the same time period in the Jewish population. The prevalence of both diseases increased due to the accumulation of incident cases but remained much lower among Arabs. CONCLUSIONS: Understanding the factors underlying the differences in incidence and prevalence of IBD in the Jewish and Arab populations may shed light on the genetic and environmental factors associated with these diseases.

Effect of Postprandial Administration of Esomeprazole on Reflux Symptoms in Gastroesophageal Reflux Disease: A Randomized, Controlled Trial.

BACKGROUND: Esomeprazole is commonly administered with food; however, clinical data to support this practice are lacking. We aimed to determine the effect of postprandial ingestion of esomeprazole on reflux symptoms among patients with gastroesophageal reflux disease (GERD). METHODS: Consecutive patients with GERD adequately controlled with esomeprazole 40 mg daily, entered a 2-week lead-in period during which esomeprazole was administered 30 min before breakfast. Patients were then randomized to continue preprandial ingestion or to ingest esomeprazole following a standardized meal. Outcomes included GERD frequency and severity indices, GERD-health-related quality of life (GERD-HRQL) questionnaire and Short Form 36 (SF-36). RESULTS: Thirty-two patients (17 [53.1%] men, aged 53.5 ± 17.2 years) were included, and 16 (50%) switched to postprandial ingestion of esomeprazole. GERD frequency and severity decreased in both groups (Δ9.0 ± 7.2 vs. Δ10.0 ± 8.1, p = 0.29; Δ6.6 ± 6.8 vs. Δ10.2 ± 7.4, p = 0.57 in postprandial group vs. controls, for frequency and severity, respectively). GERD-HRQL improved in both study groups to a similar degree (Δ10.7 ± 10.5 vs. Δ10.0 ± 13.8, p = 0.97). All SF-36 subscores increased in both groups to a similar degree. In a mixed linear model, there were no differences between the study groups in the changes observed in GERD frequency (p = 0.49), severity (p = 0.32), and GERD-HRQL (p = 0.98) during the study period. CONCLUSION: Switching to postprandial administration of esomeprazole is not associated with deterioration in reflux symptoms among patients with GERD. Esomeprazole seems to remain efficacious when administered after meals.

Vomiting and dysphagia predict delayed gastric emptying in diabetic and nondiabetic subjects.

BACKGROUND: Gastroparesis is a heterogeneous disorder most often idiopathic, diabetic, or postsurgical in nature. The demographic and clinical predictors of gastroparesis in Israeli patients are poorly defined. METHODS: During the study period we identified all adult patients who were referred to gastric emptying scintigraphy (GES) for the evaluation of dyspeptic symptoms. Of those, 193 patients who were referred to GES from our institution were retrospectively identified (76 (39%) males, mean age 60.2 ± 15.6 years). Subjects were grouped according to gastric half-emptying times (gastric T 1/2). Demographic and clinical data were extracted from electronic medical records or by a phone interview. KEY RESULTS: Gastric emptying half-times were normal (gastric T 1/2 0-99 min) in 101 patients, abnormal (gastric T 1/2 100-299 min) in 67 patients, and grossly abnormal (gastric T 1/2 ≥ 300 min) in 25 patients. Vomiting and dysphagia, but neither early satiety nor bloating, correlated with delayed gastric emptying. Diabetes was associated with grossly abnormal gastric T 1/2. Idiopathic gastroparesis was associated with a younger age at GES. No correlation was observed between gastric T 1/2 values and gender, smoking, H. pylori infection, HBA1C, or microvascular complication of diabetes. CONCLUSIONS INFERENCES: Vomiting and dysphagia are predictive of delayed gastric emptying in both diabetic and nondiabetic subjects. Diabetes is associated with more severe gastroparesis.

The prevalence of inflammatory bowel disease in an Israeli Arab population.

AIMS: To determine the prevalence of inflammatory bowel disease among the 1.5 million Arab residents in Israel who represent 20% of the total population. METHODS: Family physicians in all Arab towns and villages were contacted to obtain information on patients with inflammatory bowel disease. Relevant clinical data were retrieved and updated to December 31, 2009. RESULTS: Information was obtained from 23/71 municipalities approached (representing 200,000 out of 1.5 million Arabs). There were 64 confirmed cases of Crohn's disease indicating a prevalence rate of 32/100,000. The rate of smoking within this cohort was lower than in the general population (1.5% vs. 40%; P<0.001). There were 44 confirmed cases of ulcerative colitis with a prevalence rate of 22/100,000. The percentage of active smokers in this cohort was 18%. Clinical remission or mild activity was observed in 75% of patients in both cohorts at the time of the survey. Fourteen patients (21%) had undergone surgery for Crohn's disease, whereas none had undergone surgery for ulcerative colitis. Twenty-eight (42%) patients with Crohn's disease and 20 (45%) with ulcerative colitis were on maintenance therapy with 5-aminosalicylic acid. Only 18% with Crohn's disease and 6.8% with ulcerative colitis had received anti-tumor necrosis factor. The most prevalent extra-intestinal manifestations were perianal disease (18%) in Crohn's disease, and arthralgia or arthritis (6.8%) in ulcerative colitis. CONCLUSIONS: We found a low prevalence rate of inflammatory bowel disease in the Israeli Arab population.

Predictors of specialized intestinal metaplasia in patients with an incidental irregular Z line.

INTRODUCTION: Barrett's esophagus is a well-known complication of gastroesophageal reflux disease (GERD) and is associated with dysplasia and esophageal adenocarcinoma. Data on the prevalence of specialized intestinal metaplasia (SIM) in biopsy taken from an incidental irregular Z line are scarce. AIM: To determine the prevalence of SIM in biopsies taken from an incidental irregular Z line in consecutive patients undergoing upper endoscopy. METHODS: During the study period, we identified all adult patients who underwent an upper endoscopy with biopsies from an incidental finding of an irregular Z line. Demographic characteristics, prevalence of endoscopic findings, and major complaints were compared between those with SIM and those without. RESULTS: A total of 166 out of 2000 (8.3%) consecutive patients were identified. Specialized intestinal metaplasia was found in 43.5% of all cases. Male sex and the presence of hiatus hernia were predictors of SIM (P=0.043 and 0.001, respectively), with relative risks of 2.02 (95% confidence interval: 1.01-4.0) and 3.31 (95% confidence interval: 1.66-6.58), respectively. CONCLUSION: In this endoscopic and histological study, SIM was found to be a common finding in patients with irregular Z line. Male sex and the presence of diaphragmatic hernia were significantly associated with the presence of SIM.

The prevalence of ulcerative colitis in Israel: a twenty-year survey.

OBJECTIVES: This is the third survey we perform in the kibbutz population of Israel. The previous 2 surveys were 10 years apart, in 1987 and 1997, demonstrating an increase in ulcerative colitis (UC) prevalence. The aim of the present study was to confirm the trend for increasing UC prevalence in Israel. METHODS: There are 269 kibbutz settlements in Israel, with a total of 117,700 people, accounting for 2.4% of the Jewish Israeli population. The local physician for each kibbutz was contacted by mail, e-mail, telephone, and fax to obtain information on UC patients. Data were retrieved and updated to December 31, 2007, the point prevalence date. Details of sex, age, origin, clinical spectrum of the disease, therapy, and complications were recorded. RESULTS: There are 255 confirmed cases of UC, 138 women and 117 men (female: male ratio, 1.2:1). The prevalence rate rose from 121.08/100,000 in 1987 to 167.20/100,000 in 1997 and then to 216.65/100,000 in 2007 (P<0.0001). The rise in the second period was less than in the first period: 29% and 38%, respectively. The prevalence rate was higher in women than men, and in European/American-born>Asian/African-born>Israeli-born individuals. CONCLUSIONS: We observed an increase in the prevalence and mean annual incidence of UC in Israel, in men and women, with a decreasing gap between different ethnic groups. We believe that strong environmental influence is responsible for our observation.

The prevalence of Crohn's disease in Israel: a 20-year survey.

OBJECTIVES: This is the third survey that we have performed in the kibbutz population in Israel. The previous two surveys were 10 years apart, in 1987 and 1997, demonstrating an increase in Crohn's disease prevalence. The aim of the present study was to confirm the trend for increasing Crohn's disease prevalence in Israel. METHODS: There are 269 kibbutz settlements in Israel, with a total of 117,700 people, accounting for 2.4% of the Jewish Israeli population. The local physician for each kibbutz was contacted by mail, e-mail, telephone, and fax in order to obtain information on Crohn's disease patients. Data was retrieved and updated to 31st December 2007, the point prevalence date. Details of gender, age, origin, clinical spectrum of the disease, therapy, and complications were recorded. RESULTS: There were 133 confirmed cases of Crohn's disease. The prevalence rate rose from 25.53/100,000 in 1987 to 65.11/100,000 in 1997, and then to 112.99 in 2007 (P < 0.0001). The prevalence rate was higher in women than men, and Israeli- or European/American-born than Asian/African-born individuals. The rise in prevalence was steady from 1987 to 1997 and then to 2007 in all subgroups, except for Asian/African-born kibbutz members. In the last group, a decrease in prevalence was demonstrated between 1987 and 1997, and then a sharp increase between 1997 and 2007. CONCLUSIONS: We conclude that the incidence and prevalence of Crohn's disease increased in the three ethnic groups of Israeli Jews. Differences still exist but become smaller, maybe due to the strong environmental influence that overcame genetic preponderance.