Ilva Daugule

Prevalence of Helicobacter pylori infection and atrophic gastritis in Latvia.

Objectives Helicobacter pylori infection and atrophic gastritis are related to an increased risk for gastric cancer. There is a decrease in global H. pylori prevalence. We analyzed the prevalence of H. pylori infection in Latvia by the plasma IgG test and the presence of atrophy by means of pepsinogen testing. Methods This subanalysis was carried out on a randomly selected cross-sectional sample of a general population of adults to access cardiovascular risk factors. Plasma samples were screened for H. pylori IgG (cutoff value 24 U/ml), and pepsinogens (Pg) I and II. Pg cutoff values of PgI/PgII⩽3 and PgI⩽70 ng/ml were used to assess the prevalence of atrophy of any grade and PgI/PgII⩽2 and PgI⩽30 ng/ml for advanced atrophy. Results Altogether, 3564 serum samples were available for the study (2346 women, 1218 men; median age 54 years). Of the tested individuals, 79.21% were H. pylori positive, with no difference between sexes. The prevalence increased with age (P<0.001). Atrophy of any grade was identified in 1444 individuals (40.52%) and advanced atrophy in 475 individuals (13.33%). Linear association with age was present in both response types (P<0.001). The prevalence of atrophy of any grade was higher in women (41.73%) than in men (38.18%; P=0.04); this difference was lost for advanced atrophy (women 13.98%, men 12.07%; P=0.1). Conclusion The prevalence of H. pylori infection or atrophy remains high in Latvia. Determining the right cutoff value is critically important for pepsinogen-based atrophy detection in Europe in order to objectively stratify gastric cancer risk.

Helicobacter pylori Infection in Children

The review summarizes the articles published on Helicobacter pylori in children between April 2007 and March 2008. Evidence is emerging in different populations including developing countries that the prevalence of H. pylori is declining in all age groups. The reasons for this are unclear but it is unlikely that treatment of infection or improvement in socioeconomic conditions fully explains the decline. For the first time, differences in the inflammatory response between adults and children have been well characterized in a group of adults and children from Chile with similar levels of H. pylori infection. This study suggests that the reduced inflammatory response to H. pylori at a cellular level in children could be the consequence of an enhanced Treg cell response, which in turn down‐regulates H. pylori‐induced inflammation. The publication of the Paediatric European Register for Treatment of Helicobacter pylori study (PERTH) is important as it demonstrates the advantages of different centers working in collaboration for the benefit of children. It also highlights the fact that while bismuth‐based treatment is more effective than proton pump inhibitor‐based treatment in children, bismuth preparations are not widely available for use in children.

Helicobacter pylori infection among children with gastrointestinal symptoms: a high prevalence of infection among patients with reflux oesophagitis

Aim: To investigate the link between H.pylori infection and dyspepsia in children, and association with reflux oesophagitis.

Gastric plasma biomarkers and Operative Link for Gastritis Assessment gastritis stage.

Introduction The Operative Link for Gastritis Assessment (OLGA) staging system has been proposed as a histopathological reporting system of gastric atrophy. Noninvasive methods for indirect evaluation of gastric mucosal atrophy by biomarkers are also being introduced. Objectives To analyze gastric mucosal atrophy by biomarkers, pepsinogen I (PgI), pepsinogen II (PgII), PgI/PgII ratio, fasting gastrin-17 (G-17), stimulated gastrin-17 (sG-17), in relation to OLGA gastritis stage. Patients and methods Gastric biopsies were taken from 269 prospective patients referred for upper endoscopy because of dyspeptic problems and evaluated by two expert pathologists (D.J. and P.S.). Atrophy was assessed according to the OLGA staging system. Pg I, PgII, Pg I/II, G-17, sG-17 were determined in a plasma sample. Results The mean levels of PgI and PgI/PgII decreased significantly from 90.8 &mgr;g/l and 7.6 in stage 0 gastritis to 64.3 &mgr;g/l and 4.3 in high-stage gastritis. The mean values of G-17 and sG-17 were significantly higher among patients with stage II gastritis compared with stage 0 and high-stage gastritis. The proportion of patients with normal mucosa and nonatrophic gastritis according to biomarkers decreased from 78% in stage 0 to 22% in high-stage (III–IV) gastritis. Among the latter no case with normal mucosa, according to biomarkers, was observed. Conclusions A significant inverse correlation between the mean levels of PgI, PgI/II ratio and the OLGA stage was observed. Percentage of dyspeptic patients with normal mucosa, by blood biomarkers, decreased with increasing OLGA gastritis stages. OLGA staging system provides a good frame for scientific analysis of gastric mucosal atrophy.

Association of obesity with proteasomal gene polymorphisms in children.

The aim of this study was to ascertain possible associations between childhood obesity, its anthropometric and clinical parameters, and three loci of proteasomal genes rs2277460 (PSMA6 c.-110C>A), rs1048990 (PSMA6 c.-8C>G), and rs2348071 (PSMA3 c. 543+138G>A) implicated in obesity-related diseases. Obese subjects included 94 otherwise healthy children in Latvia. Loci were genotyped and then analyzed using polymerase chain reactions, with results compared to those of 191 nonobese controls. PSMA3 SNP frequency differences between obese children and controls, while not reaching significance, suggested a trend. These differences, however, proved highly significant (P < 0.002) in the subset of children reporting a family history of obesity. Among obese children denying such history, PSMA6 c.-8C>G SNP differences, while being nonsignificant, likewise suggested a trend in comparison to the nonobese controls. No PSMA6 c.-110C>A SNP differences were detected in the obese group or its subsets. Finally, PSMA3 SNP differences were significantly associated (P < 0.05) with circulating low-density lipoprotein cholesterol (LDL) levels. Our results clearly implicate the PSMA3 gene locus as an obesity risk factor in those Latvian children with a family history of obesity. While being speculative, the clinical results are suggestive of altered circulatory LDL levels playing a possible role in the etiology of obesity in the young.

A relatively low prevalence of Helicobacter pylori infection in a healthy paediatric population in Riga, Latvia: a cross-sectional study

The aim of this study was to investigate the prevalence, age of acquisition and risk factors for Helicobacter pylori (H. pylori) among asymptomatic children. 13C‐urea breath tests and questionnaires were obtained from 142 children and 40 parents. The prevalence of H. pylori was 19%. H. pylori positivity was higher in children with a positive parent (p= 0.003) and independently inversely related to antibiotic treatment during the previous year in preschool children (p= 0.045).

Infection with cagA-Positive and cagA-Negative Types of Helicobacter pylori Among Children and Adolescents with Gastrointestinal Symptoms in Latvia

In order to determine the prevalence of concomitant cagA-positive and cagA-negative Helicobacter pylori genotypes in individual subjects, a group of 56 symptomatic patients (aged 8–18 years) was studied. Among 31 patients culture-positive for Helicobacter pylori, only cagA-positive colonies were isolated from 18 patients, both cagA-positive and cagA-negative genotypes were isolated from 4 patients, and in 9 patients all of the individual colonies isolated were cagA-negative, but in seven of them a pool of colonies was positive for cagA. Thus, the presence of both cagA-positive and cagA-negative genotypes in the same individual was identified in 11 of the 31 culture-positive patients tested, and most of the patients predominantly colonized by cagA-negative strains also harbored a small amount of cagA-positive strains. Previous or current infection with cagA-positive strains of Helicobacter pylori was observed in 50 of the 56 patients studied.

Previous antibacterial treatment due to concomitant infections in preschool children is associated with a lower Helicobacter pylori positivity

Use of antimicrobial agents has been proposed as 1 of the factors that contribute to the loss of Helicobacter pylori (H. pylori) infection. The aim of the study was to investigate the influence of a previous treatment with antibiotics on the prevalence of H. pylori infection in preschool children. Parents of 146 asymptomatic children (aged 0.5–5 y; no antibiotic treatment during the previous 4 weeks) completed a questionnaire about previous treatment with antibiotics and socioeconomic status. Infection with H. pylori was assessed by the monoclonal stool antigen test. H. pylori positivity was 18% (27/146). It was significantly lower in children who had been treated with antibiotics previously compared to those who had been never treated (12.5% (12/96) vs 30% (15/50), p=0.01). It is concluded that previous antibiotic treatment for concomitant infections is associated with a lower prevalence of H. pylori infection in preschool children.

Prevalence of Helicobacter pylori infection among preschool children in Latvia: no significant decrease in prevalence during a ten year period

Aims: Published data show a trend of decreasing prevalence of Helicobacter pylori in Eastern European countries due to socioeconomic changes. The aim of this study was to determine the prevalence of H. pylori infection among children in Latvia and to compare these results with previous studies in the same population. The risk factors associated with infection were also analysed. Methods: Preschool children in kindergartens and primary health care centres were investigated using a stool antigen test. Their parents were asked to fill out a questionnaire about possible risk factors. Statistical analysis included Pearson’s χ2 test and linear regression analysis. Results: The prevalence of H. pylori infection determined by the monoclonal stool antigen test in children aged 1–6 years (median 5 years) was 15.5% (15/101) (95% confidence interval 8.67–23.48%). In the regression analysis, H. pylori positivity was significantly negatively associated with the consumption of imported fruit at least once per week (p=0.02). Conclusions: The prevalence of H. pylori in the studied population has not decreased significantly during the last decade and is still associated with socioeconomic factors. The role of some dietary factors (e.g. the consumption of fruit) in the spread of infection should be studied further.

Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping.

Background Prevalence estimates for celiac disease (CD) depend on the method used. The role of deamidated gliadin peptide (DGP) and genetic testing in epidemiological studies and diagnostic settings of celiac disease (CD) has still to be established. Objectives The objective of this article is to assess the prevalence of CD in Latvia by combining serological tests with DQ2.5/DQ8 testing. Methods A total of 1444 adults from a randomly selected cross-sectional general population sample were tested by ELISA for tTG IgA, DGP IgA and IgG antibodies (QUANTA Lite®, Inova Diagnostics Inc). Samples with tTG IgA ≥20U were tested for EMA IgA by indirect immunofluorescence assay, and all specimens with tTG IgA ≥15U were tested by QUANTA-Flash® chemiluminescent assays (CIA) (Inova Diagnostics Inc) for tTG IgA, DGP IgA and IgG. DQ2.5/8 was detected in individuals with any positive ELISA test and a subgroup of controls. Results Forty-three individuals (2.98%; 95% CI: 2.10–3.86%) tested positive by at least one ELISA test; 41.86% of the serology-positive individuals (any test above the cutoff) were DQ positive. Six individuals (0.42%; 95% CI: 0.09–0.75%) were triple ELISA positive, and DQ2.5 or DQ8 was positive in all; 0.35% (95% CI: 0.05–0.65%) were tTG IgA and EMA positive. Two tTG IgA-negative cases were both DGP IgG and IgA positive, both being DQ positive; including them in the “serology-positive” group would increase the prevalence to 0.49% (95% CI: 0.13–0.85%). CIA tests revealed 2 tTG IgA-positive and EMA-negative cases with a positive genotype. DQ2.5 or DQ8 genotype was positive in 28.6% of the serology-negative population. Conclusions Estimates of the prevalence of CD in Latvia based on the serogenetic testing approach range from 0.35% to 0.49% depending on the criteria used. There is a rationale for combining serological tests and DQ2.5/8 genotyping.