C. Martín-de-Argila

Recurrence of Helicobacter pylori Infection after Eradication: Incidence and Variables Influencing It

Background: Our aim was to study the incidence of Helicobacter pylori recurrence in our country and to assess the different variables that might influence it. Methods: We studied prospectively 331 duodenal ulcer patients (mean age, 48_14 years, 71% male) in whom H. pylori had been eradicated. Several therapies were used, classified as low-efficacy (omeprazoleamoxycillin, 32% eradication rate; omeprazole_amoxycillin_metronidazole, 56%) and high-efficacy therapies (omeprazole_clarithromycin_ amoxycillin or metronidazole, 88%; bismuth triple therapy, 77%). One month after completion of therapy an endoscopy with biopsies and/or 13C-urea breath test was performed. A breath test was carried out again at 6 months, 1 year, and 2 years, to study H. pylori recurrences. Endoscopy (with biopsies) was performed only to confirm recurrences. Multiple logistic regression analysis was used. Differences between Kaplan-Meier curves were evaluated with the log-rank test. Results: Sixty-seven patients were followed up for 6 m...

Helicobacter pylori infection in a healthy population in Spain

Objective: To determine the seroprevalence of Helicobacter pylori infection in healthy individuals in Spain and its relationship with different epidemiological features. Patients and methods: The study was conducted on a large group of healthy individuals without ulcer disease antecedents or other gastrointestinal disease; moreover, information was obtained on symptoms attributable to the gastrointestinal tract, smoking, alcohol consumption, non-steroidal anti-inflammatory drug (NSAID) use as well as the presence of peptic ulcer disease antecedents among first-degree relatives. The H. pylori infection status was ascertained by immunoglobulin G (IgG) antibody determination, using a quantitative enzyme-linked immunosorbent assay. Results: Three hundred and eighty-one individuals (138 males and 243 females) were included in the study (mean age: 34.3±12.9 years; range: 5–77). Two hundred and two individuals (53%) were positive for H. pylori IgG antibodies. A consistent increase in H. pylori infection seroprevalence with increasing age was observed. No association was observed between H. pylori infection and consumption of alcohol, NSAID use or smoking. On the other hand, the presence of digestive symptoms and peptic ulcer disease antecedents among first-degree relatives were associated with a higher prevalence of infection in a given individual (P<0.05). Conclusion: H. pylori infection seroprevalence in healthy individuals in Spain is similar to that in countries with high socio-economic standards and other Western countries. Digestive symptoms and previous antecedents of peptic ulcer disease in first-degree relatives were associated with a higher prevalence of Helicobacter pylori infection. European Journal of Gastroenterology & Hepatology 1996, 8:1165–1168

Relation between Histologic Subtypes and Location of Gastric Cancer and Helicobacter pylori

BACKGROUND Epidemiologic studies have consistently shown an association between Helicobacter pylori infection and gastric cancer, and it is now widely accepted that this organism plays a role in the pathogenesis of this tumor. Nevertheless, there are discrepant results on its relationship with the histologic type and location of gastric cancer within the stomach. The aim of this study was to determine the seroprevalence of H. pylori in a group of gastric cancer patients and the association between H. pylori and specific histologic types of gastric cancer and tumor location within the stomach. METHODS Systemic IgG antibodies against H. pylori were assayed using an enzyme-linked immunosorbent assay technique in 48 patients (male to female ratio, 31:17; age range, 39-88 years; mean, 69 years) with histologically confirmed gastric cancer and 50 controls (male to female ratio, 33:17; age range, 40-77 years, mean, 64 years). RESULTS Thirty-one cases of gastric cancer were of the intestinal type, and 12 of the diffuse type; the remaining 5 were unclassified. Thirteen gastric cancers were located in the distal stomach (antrum/pylorus), 12 in the body, and 5 in the proximal stomach (cardia/fundus); the remaining 17 were unclassified because the tumor extended towards more than one location. The overall seroprevalence of H. pylori in patients with gastric cancer and controls was 85.4% and 66%, respectively (P < 0.05). The seroprevalence increased with increasing age in cancer patients, but the difference was not significant. H. pylori seroprevalence among patients with the intestinal type of gastric cancer was higher than in those with the diffuse type (P < 0.05). The prevalence of H. pylori infection was higher among patients with the cancer located distally than in those with the cancer located proximally (P < 0.05). CONCLUSIONS H. pylori seroprevalence was higher in gastric cancer patients than in controls. The prevalence of H. pylori infection in intestinal-type gastric cancer was clearly higher than in the diffuse type and in the control group. An association was found between H. pylori infection and tumors located distally (antrum/pylorus).

Prevalence of Helicobacter pylori infection in medical professionals in Spain.

OBJECTIVE The epidemiology of Helicobacter pylori infection is still under investigation, and the exact source of infection and its mode of transmission are still unknown. The purpose of this prospective study was to determine whether medical professionals in Spain, especially gastroenterologists and gastrointestinal endoscopists, have a higher prevalence of H. pylori infection. METHODS Two hundred and twenty four medical professionals attending the annual gastroenterology meeting in Spain (176 men, 48 women; mean age, 41.8 +/- 11.4 years; range, 25-73 years) and a control group of 189 persons of similar age were investigated for the prevalence of H. pylori infection by using the 13C-urea breath test. All medical professionals completed a questionnaire regarding medical specialty and regular performing of gastrointestinal endoscopy procedures. RESULTS The overall prevalence of H. pylori infection in total medical professionals was 52.7%, compared with 51.9% in the control group (P > 0.05). When specialty was considered, the prevalence of H. pylori infection among gastroenterologists was 53.3%, also not significantly higher than 50.0% among non-gastroenterologists (P > 0.05). There were no statistical differences of H. pylori prevalence among endoscopists and non-endoscopists. CONCLUSIONS Medical practice and, more specifically, gastroenterology and the regular performance of gastrointestinal endoscopy pose no additional risk for H. pylori infection in Spain.

Concordance Between noninvasive tests in detecting Helicobacter pylori and potential use of serology for monitoring eradication in gastric ulcer

Our aim was to determine concordance between 13C-urea breath test and serology in detecting Helicobacter pylori and to study their potential use for monitoring eradication in patients with gastric ulcer. We prospectively studied 73 gastric ulcer patients. On endoscopy, biopsies were taken for hematoxylin-eosin staining and rapid urease testing. Blood samples were drawn for immunoglobulin G antibody determination by enzyme-linked immunosorbent assay (ELISA). A 13C-urea breath test was performed as well. Histology, serology, and urea breath tests were all repeated 1, 6, and 12 months after therapy completion in 56 infected patients. A proportion of positive agreement between serology and breath test results as high as 0.95 was found. McNemar statistic was 3 (p = 0.08), whereas kappa statistic was 0.83 (p < 0.0001). At month 6, significant differences in patients successfully treated relative to baseline serologic values were observed (&khgr;2 = 11.7;p < 0.001). The area under the receiver operating characteristic (ROC) curve for diagnostic efficiency was 0.76, sensitivity was 74%, and specificity was 90% (for H. pylori eradication) when the fall of at least one category in serologic levels was considered as cut-off point. No further decreases in serologic levels were noted over the next 6 months, and 48.8% of patients remained seropositive 1 year after completion of successful treatment. A high concordance between serology and 13C-urea breath test results is observed when the two procedures are used for H. pylori infection diagnosis in patients with gastric ulcer. Also, serology can be successfully used for monitoring H. pylori eradication 6 months after therapy completion.

Long-term clinical follow-up of non-A, non-B post-transfusional chronic hepatitis

Objectives To study the natural history of non-A, non-B post-transfusional chronic hepatitis. Design and setting A prospective study in a university hospital. Patients The study included 63 patients with non-A, non-B post-transfusional chronic hepatitis who were followed up over 106.8 pM 24.5 months after the acute stage of the disease. Measurements We examined the relationship between the clinical and analytical parameters at baseline, during follow-up and their subsequent evolution. Results Of the patients studied, 56 were seropositive for anti-hepatitis C virus (HCV). During follow-up, liver biochemistry became permanently normal in 13 patients (group 1). In 37 patients, high alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were maintained with no clinical, biochemical or ultrasound evidence of progression (group II), while 13 patients did show evidence of progression (group III). In the patients from group III, the mean levels of ALT, AST, γ-glutamyl transpeptidase and γ-globulin were significantly higher than those in group II (P<0.05) and group I (P<0.05) after the fourth year of follow-up. The γ-globulin levels after the fourth year were also significantly higher in group II than in group I (P<0.05). When assessed according to the Knodell index, piecemeal necrosis and fibrosis in the initial biopsy specimens were significantly greater in group III than in groups I and II (P<0.05). Conclusions In 13 patients from our series, the disease resolved from a biochemical point of view, while in another 13 patients, signs of evolution of the disease continued during follow-up. There was no difference in the baseline clinical and biochemical parameters of the patients from the different groups, although this was not so after the fourth year of follow-up. Moreover, a greater degree of necrosis and fibrosis was seen in the initial histological damage in those patients whose disease was seen to progress than in the rest.