Lucia Libanez Bessa Campelo Braga

Peripheral neuropathy and neurological disorders in an unselected Brazilian population-based cohort of IBD patients.

Background: Several neurological disorders have been described in inflammatory bowel disease (IBD) patients, but their exact frequency is unknown. Methods: We prospectively studied the prevalence of neurological disorders (especially peripheral neuropathy) in a group of 82 patients with Crohns disease (CD, n = 31) or ulcerative colitis (UC, n = 51) from 2 Brazilian tertiary care university clinics and followed them through a period of at least 1 year. All patients were interviewed and had complete neurological evaluations. Results: Large‐fiber sensory or sensorimotor polyneuropathy (PN) was observed in 16.1% of the CD and 19.6% of the UC patients. PN was usually mild, predominantly symmetric, and distal with axonal involvement. One patient had demyelinating PN at the diagnosis of CD. Mild carpal tunnel syndrome was common in female UC patients. Sensory symptoms without electromyography abnormalities, suggestive of small‐fiber neuropathy or subclinical myelopathy, affected 29% and 11.8%, respectively. After excluding other known etiological or contributory factors for PN, 13.4% of the IBD patients had otherwise unexplained large‐fiber or small‐fiber PN (7.3% with large‐fiber SM PN). Nondebilitating headache was the most common neurological complaint. Three patients had ischemic strokes, 5 were epileptic, and 1 transient chorea. Conclusions: Neurological disorders, especially PN, are common in our Brazilian cohort of IBD patients. They are diverse, multifactorial, and more common in women. Despite the mild phenotype in most cases, attention should be given by the general practitioner and gastroenterologist since they are frequently undiagnosed. Further studies are necessary to confirm these findings in populations with different genetic and nutritional backgrounds.

Helicobacter pylori infection in adults from a poor urban community in northeastern Brazil: demographic, lifestyle and environmental factors

We investigated the prevalence and the risk factors for infection with Helicobacter pylori in a randomly-selected population of adults from a low-income community in Northeastern Brazil. Helicobacter pylori infection was determined by ELISA. Risk factors were assessed using a structured interview. Two hundred and four individuals were included in the study, including 49 males and 155 females, ranging from 18 to 80 years old. Overall, 165 of 204 participants (80%) were H. pylori positive, without significant gender differences (p= 0.49). The infection rate was of 84.7% in subjects 18 to 30 years of age, increasing to 92% in subjects 46-60 years old. Above 60 years old, the prevalence decreased slightly. As a whole, the prevalence of infection did not increase significantly (p=0.147) with age. There were no significant differences in the prevalence of H. pylori infection, when patients were classified by age, smoking habit, educational level, alcohol consumption, the number of persons per room, the number of children per household, the number of adults per household, cup-sharing, household pets, toilet location, number of persons per bed and medical history of antibiotic and raw vegetable ingestion. In conclusion, no risk factors associated with infection was found in these adults, suggesting that the infection, even in a poor population, may be acquired predominantly during childhood; the relatively high prevalence that we observed may be more due to a cohort effect than to acquisition of infection during adulthood.

Prevalence of Helicobacter pylori infection in Fortaleza, Northeastern Brazil

The prevalence of Helicobacter pylori infection was assessed in a randomly selected sample of individuals from low-income community in Fortaleza, Northeastern Brazil. Overall, 384 out of 610 participants (62.9%) were H. pylori positive. A 47.5% infection rate was found in subjects aged six months to 10 years old, increased to 73.3% in subjects aged 11-20 years and then continued to increase with age reaching up to 87% in those over 60 years old. After this age group, the prevalence decreased slightly. The prevalence of infection increased significantly with age (p<0.0001).

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.

Gastric Precancerous Lesions and Helicobacter pylori Infection in Relatives of Gastric Cancer Patients from Northeastern Brazil

Background: Helicobacter pylori infection predisposes to gastric cancer. First-degree relatives of patients with gastric cancer have an increased risk of developing the disease. Aim: To evaluate the prevalence of gastric precancerous gastric lesions and H. pylori infection in first-degree relatives of non-cardia gastric cancer patients. Methods: Gastric cancer relatives (n = 104) from a region with high prevalence of H. pylori infection and gastric cancer were invited for screening endoscopy; 80% of them had dyspeptic symptoms. The control group was composed of patients (n = 118) who concurrently underwent upper gastrointestinal endoscopy for investigation of dyspepsia with no family history of gastric cancer. The groups were matched for gender, age and social class. H. pylori status was evaluated by urease test, and histology and histological parameters were assessed according to the Houston Updated Sydney System. Results: The prevalence of H. pylori infection was high in both the relative (84.7%) and the control (75.9%) groups. Corpus-predominant gastritis was more frequently observed in the relative group, whereas antral gastritis predominated in the controls. The density of lymphoid follicles was higher among the relatives. Also, intestinal metaplasia in the corpus and dysplasia were more prevalent in the cancer relative group than in the control group. Early gastric cancer was detected in 1 relative of gastric cancer patient with high-grade dysplasia. Conclusion: Individuals with a family history of non-cardia gastric cancer need to be routinely screened for H. pylori infection and precancerous gastric lesions.

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.

Entamoeba histolytica and Entamoeba dispar infections as detected by monoclonal antibody in an urban slum in Fortaleza, Northeastern Brazil

In this study the authors used the Elisa-based antigen detection tests that distinguish E. histolytica from E. dispar to examine the prevalence of E. histolytica infection in individuals from an urban slum in Fortaleza, Northeastern, Brazil. This test has a sensitivity and specificity that is comparable to PCR and isoenzyme analysis, which is the gold standard. Single stools samples were obtained from 735 individuals. The prevalence of E. histolytica infection was 14.9% (110/735) and 25.4%(187/735) for E. dispar-E. histolytica complex. The most affected age group for E. histolytica /E. histolytica-E. dispar infection was the 1-5 year olds but there was no remarkable decrease with age. There was no significant difference in colonization rates between males and females. The results from this survey demonstrate that E. histolytica is highly prevalent in the Community studied. Furthermore, it offers promise for the antigen detection test as a sensitive and technically simple tool for detecting E. histolytica infection in the field.

Helicobacter pylori eradication using tetracycline and furazolidone versus amoxicillin and azithromycin in lansoprazole based triple therapy: an open randomized clinical trial

BACKGROUND Optimal anti-Helicobacter pylori treatment has not yet been established. AIM To evaluate H. pylori eradication using tetracycline and furazolidone versus amoxicillin and azithromycin in lansoprazole based triple therapy in northeastern of Brazil. PATIENTS AND METHODS One hundred and four patients with H. pylori infection, as determined by rapid urease testing and histology, were randomly assigned to receive either: lansoprazole (30 mg q.d.), tetracycline (500 mg q.i.d.), and furazolidone (200 mg t.i.d.) for 7 days (LTF; n = 52); or lansoprazole (30 mg b.i.d.) and amoxicillin (1 g b.i.d.) for 1 week, plus azithromycin (500 mg q.d.) for the first 3 days (LAAz; n = 52). H. pylori eradication was assessed 3 months following completion of therapy by means of rapid urease testing, histology and a 14C-urea breath test. RESULTS H. pylori eradication was achieved in 46 of 52 (88.4%, 95% CI: 77.5%-95.1%) patients in LTF group and in 14 of 52 (26.9%, 95% CI: 16.2%-40,1%) patients in LAAz group. On a per-protocol analysis, eradication rates were 91.8% (95% CI: 81.4%-97.3%) and 28.5% (95% CI: 17.2%-42.3%), respectively in LTF and LAAz groups. CONCLUSION The LAAz regimen yielded unacceptably low eradication rates. On the other hand, the LTF scheme represents a suitable alternative for H. pylori eradication.

Helicobacter pylori Infection in Infants and Toddlers in South America: Concordance between [13C]Urea Breath Test and Monoclonal H. pylori Stool Antigen Test

ABSTRACT Accurate noninvasive tests for diagnosing Helicobacter pylori infection in very young children are strongly required. We investigated the agreement between the [13C]urea breath test ([13C]UBT) and a monoclonal ELISA (HpSA) for detection of H. pylori antigen in stool. From October 2007 to July 2011, we enrolled 414 infants (123 from Brazil and 291 from Peru) of ages 6 to 30 months. Breath and stool samples were obtained at intervals of at least 3 months from Brazilian (n = 415) and Peruvian (n = 908) infants. [13C]UBT and stool test results concurred with each other in 1,255 (94.86%) cases (kappa coefficient = 0.90; 95% confidence interval [CI] = 0.87 to 0.92). In the H. pylori-positive group, delta-over-baseline (DOB) and optical density (OD) values were positively correlated (r = 0.62; P < 0.001). The positivity of the tests was higher (P < 0.001; odds ratio [OR] = 6.01; 95% CI = 4.50 to 8.04) in Peru (546/878; 62.2%) than in Brazil (81/377; 21.5%) and increased with increasing age in Brazil (P = 0.02), whereas in Peru it decreased with increasing age (P < 0.001). The disagreement between the test results was associated with birth in Brazil and female gender but not with age and diarrhea. Our results suggest that both [13C]UBT and the stool monoclonal test are reliable for diagnosing H. pylori infection in very young children, which will facilitate robust epidemiological studies in infants and toddlers.