Andre Fialho

Natural History of Helicobacter pylori Infection in Childhood: Eight‐Year Follow‐Up Cohort Study in an Urban Community in Northeast of Brazil

Background:  Helicobacter pylori infection is acquired predominantly in childhood. There is also evidence that children loss the infection. Therefore, factors that account for children remain infected need to be investigated because once established the infection persists throughout the life unless treated.

The association between Helicobacter pylori infection and height in children from an urban community in north-east Brazil

Abstract Background: An association between Helicobacter pylori infection and short stature in children has been described recently. Aim: To describe differences in stature between H. pylori-infected and non-infected children in a low-income community in north-east Brazil. Methods: H. pylori status was evaluated by 13C-urea-breath test; centile values for weight and height were calculated for each child. Results: The prevalence of H. pylori was 55.8% (197/353) and increased with age. Of 197 H. pylori-positive children, 62% were below the 25th centile for height compared with 48% of H. pylori-negative children (75/156) [AOR (adjusted odds ratio) 1.61, 95% CI 1.04–2.49, p=0.03] after adjustment for variables with p≤0.25 in univariate analysis (gender, number of residents, of children per household and of persons per bed). These results were significant only when older children were included. Thus, in children aged 8–14 years, 80% (89/111) of H. pylori-positive were <25th centile for height compared with 63% (35/56) of H. pylori-negative children (p=0.01). Compared with children with a height >25th centile, the AOR for H. pylori infection increased from 2.42 in the crude analysis to 6.62 after adjustment (p=0.006). Conclusions: H. pylori is associated with short stature in older children living in a poor urban community in Brazil.

Younger siblings play a major role in Helicobacter pylori transmission among children from a low-income community in the Northeast of Brazil.

Background and Aims:  To further evaluate intrafamilial transmission of H. pylori infection during childhood, we investigated the prevalence of H. pylori in family members from a poor H. pylori high‐prevalence urban community in the Northeast of Brazil.

Low prevalence of H. pylori Infection in HIV-Positive Patients in the Northeast of Brazil

BackgroundThis study conducted in Northeastern Brazil, evaluated the prevalence of H. pylori infection and the presence of gastritis in HIV-infected patients.MethodsThere were included 113 HIV-positive and 141 age-matched HIV-negative patients, who underwent upper gastrointestinal endoscopy for dyspeptic symptoms. H. pylori status was evaluated by urease test and histology.ResultsThe prevalence of H. pylori infection was significantly lower (p < 0.001) in HIV-infected (37.2%) than in uninfected (75.2%) patients. There were no significant differences between H. pylori status and gender, age, HIV viral load, antiretroviral therapy and the use of antibiotics. A lower prevalence of H. pylori was observed among patients with T CD4 cell count below 200/mm3; however, it was not significant. Chronic active antral gastritis was observed in 87.6% of the HIV-infected patients and in 780.4% of the control group (p = 0.11). H. pylori infection was significantly associated with chronic active gastritis in the antrum in both groups, but it was not associated with corpus chronic active gastritis in the HIV-infected patients.ConclusionWe demonstrated that the prevalence of H. pylori was significantly lower in HIV-positive patients compared with HIV-negative ones. However, corpus gastritis was frequently observed in the HIV-positive patients, pointing to different mechanisms than H. pylori infection in the genesis of the lesion.

Helicobacter pylori Virulence Genes Detected by String PCR in Children from an Urban Community in Northeastern Brazil

ABSTRACT The accuracy of a nested PCR in gastric DNA obtained by a string test for the diagnosis of Helicobacter pylori infection in asymptomatic children was 94.0%. The cagA-positive toxigenic vacAs1m1 strains were the most prevalent strains, indicating that this population is colonized early by the strains associated with gastric cancer.

Original ArticleAssociation between vitamin D deficiency and anemia in inflammatory bowel disease patients with ileostomyAssociação entre deficiência de vitamina D e anemia em pacientes com doença inflamatória intestinal submetidos a ileostomia

Background Vitamin D deficiency is commonly seen in patients with inflammatory bowel disease (IBD). Vitamin D deficiency in IBD patients with ileostomy has not been systemically studied. The aim of the study was to assess the frequency and risk factors associated with low 25(OH) D3 levels in those patients.

Case Series of 10 Patients with Cirrhosis Undergoing Emergent Repair of Ruptured Umbilical Hernias: Natural History and Predictors of Outcomes

OBJECTIVES Ascites represents an important event in the natural history of cirrhosis, portending increased 1-year mortality. Umbilical herniation with rupture is an uncommon complication of large-volume ascites that is associated with significant morbidity and mortality. The aim of this study was to describe predictors of outcomes in patients undergoing emergent repair for spontaneous umbilical hernia rupture. MATERIALS AND METHODS We report a case series of 10 patients with decompensated cirrhosis (mean age 66 ± 9 years, mean Model for End-Stage Liver Disease score of 21 ± 7) who presented with a ruptured umbilical hernia and had emergent repair. RESULTS Thirty percent (3/10) of patients died or required liver transplant. Factors associated with death or transplant included the development of bacterial peritonitis (P = .03) and the presurgical 30-day Mayo Clinic Postoperative Mortality Risk in Patient with Cirrhosis Score (P = .03). CONCLUSIONS Emergent repair after umbilical hernia rupture in patients with decompensated cirrhosis carries a poor prognosis with 30% of patients developing poor postsurgical outcomes.

Su1041 Non-Alcoholic Fatty Liver Disease (NAFLD) and Metabolic Syndrome Are Associated With Small Intestine Bacterial Overgrowth

Background: Qualitative changes in gut bacteria have been shown to play a role in the development non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome. There is a lack of studies evaluating the association between small intestine bacterial overgrowth (SIBO) and NAFLD and metabolic syndrome. Aim: To evaluate the prevalence of NAFLD and metabolic syndrome in patients with SIBO and their relationship. Methods: In this case-control study, 372 eligible patients who had abdominal imaging and glucose hydrogen breath test in our institution from 2006 to 2014 were included. SIBO positive patients (the study group) were compared with those without SIBO (the control group). Clinical, demographic, laboratory variables and the presence of fatty liver on abdominal imaging were analyzed. Metabolic syndrome was defined as a minimum of 3/5 risk factors from The National Cholesterol Education Programs (NCEP) Adult Treatment Panel III report (ATP III). Results: Among the 372 patients, 141 (38%) had SIBO and 231 (62%) did not have SIBO. Patients with SIBO were more frequently being males (31.2% vs. 20.8%; p= 0.02), older in age (61.86±1.23 vs. 58.48 ±0.98 yrs; p=0.03), and having a higher frequency of low albumin (13.0% vs. 5.4%; p=0.009), hypertension (58.9% vs. 42.9%; p=0.002), diabetes mellitus (30.5% vs. 16.9%; p=0.002), NAFLD (33.3% vs. 20.8%; p=0.005), and metabolic syndrome (80.1% vs. 63.6%; p<0.000). Risk factors for NAFLD and/or metabolic syndrome were further evaluated. In the multivariable logistic regression analysis, SIBO remained as an independent risk factor for NAFLD along withmetabolic syndrome (p=0.038 and p<0.001, respectively). SIBO also remained as an independent risk factor for metabolic syndrome itself along with age above 60 years old and male gender (p=0.012, p<0.001 and p=0.036 respectively). Conclusion: SIBO is an independent risk factor for the development of both NAFLD and metabolic syndrome. These findings suggest that treatment of SIBO may benefit patients who concomitantly have NALFD and/or metabolic syndrome. The findings suggest a possible role of gut fermentation by bacterial overgrowth in the pathogenesis of NAFLD and metabolic syndrome. Furthermore, patients with SIBO should be routinely screened for NAFLD and metabolic syndrome and its consequences.

Higher Frequency of CagA EPIYA-C Phosphorylation Sites in H. pylori Strains From Relatives of Gastric Cancer Patients

Background and aims:Helicobacter pylori dupA (duodenal ulcer promoting) gene was reported as a virulence factor that induced duodenal ulcer and had a suppressive action on gastric cancer. However, the association of the dupA gene on clinical outcomes is different in different populations. Full-sequenced data of H. pylori showed that the length of the dupA gene is depends on the strain; Shi470 and G27 have approximately 600bp longer than that of other strains (e.g., strain J99) in the C-terminal region of the dupA gene. This suggests that the dupA gene has two genotypes: long and short type. In addition, previous studies indicated that some strains have a presence of the mutation (insertion or mutation) in the dupA gene, which created a premature stop codon . In this study, we aimed to examine the dupA genotypes (long type or short type), presence of the mutation, and examined the association with clinical outcomes in Japanese population. Methods: A total of 388 patients (97 with gastritis, 137 with duodenal ulcer [DU], 121 with gastric ulcer [GU], and 24 with gastric cancer [GC]) were included in this study. The status of the dupA genes was examined by polymerase chain reaction. The oligonucleotide primers for the dupA typing were designed according to the dupA gene sequence deposited in Genbank. First primers were designed to include the additional region of C-terminal of the dupA gene (long type dupA). Second primers were designed to include the conventional dupA gene (short type dupA). We also sequenced full-length dupA gene and evaluated the presence of mutation. Results: The prevalence of short type dupA gene alone was not significantly different among four groups (gastritis 14.4%, DU 8.0%, GU 6.5%, and GC 4.2%, respectively). Interestingly, the prevalence of the long type dupA gene in strains from DU was significantly higher than that from gastritis (19.7 v.s. 9.3%, p = 0.02). Those of GU, GC were also significantly higher than that of gastritis (25.8, 25.0 and 9.3%, p = 0.0001, p = 0.03, respectively). Full-length sequence of the dupA gene was completed in 33 strains. Among them, point mutation lead to stop codon was found in only one strain. Conclusions: The long type but not the short type dupA gene can be used as discriminating factor of peptic ulcer and gastric cancer from gastritis in Japan. These observations suggest that only strains that are intact dupA-positive might be involved in gastroduodenal diseases.