Recent epidemiological studies have reported a threefold increase in the incidence of adenocarcinoma of the lower oesophagus and gastro-oesophageal junction (cardia). There are conflicting reports available implicating both gastro-oesophageal reflux disease and Helicobacter pylori infection in the aetiology of carditis and cardia intestinal metaplasia, despite strong evidence to show that these two conditions are, if anything, inversely related. We aimed to determine the prevalence of carditis and cardia intestinal metaplasia in dyspeptic subjects and also their association with H. pylori infection and gastro-oesophageal reflux disease.Histological samples from the gastric cardia were obtained from dyspeptic subjects. H. pylori status was assessed based on histological, microbiological and rapid urease testing. Gastro-oesophageal disease was diagnosed on the basis of histological evidence and/or erosive oesophagitis. Patient demographics were recorded. Cardia intestinal metaplasia (CIM), when present, was subgrouped as complete or incomplete.Overall, 276 subjects were enrolled; 163 (59%) had carditis and 36 (13%) CIM. H. pylori infection and gastro-oesophageal reflux disease occurred in 64 (23%) and 150 (54%), respectively. H. pylori infection was strongly associated with carditis and CIM (P<0.001 and P<0.01). Older age and male gender were also associated with inflammation and intestinal metaplasia of the cardia. Gastro-oesophageal reflux was not associated with either entity.Carditis and CIM occur frequently. Both conditions are strongly associated with H. pylori infection, older age and male gender. There was no association with gastro-oesophageal reflux disease.
Although oesophageal perforation is a well-recognized complication during endoscopic ultrasonography [1], perforation of the duodenum during the procedure has not previously been reported.
Dyspepsia is a poorly understood term that is used to describe symptoms that originate in the upper gastrointestinal tract. There is increasing evidence that Helicobacter pylori infection plays an aetiological role in some forms of dyspepsia. H. pylori infection is more common in dyspeptic patients than asymptomatic controls. Clinical trials of the benefit of H. pylori eradication therapy in non-ulcer dyspepsia have given conflicting results. This may be due to methodological flaws in the studies to date. Trials in non-ulcer dyspepsia may have several end-points. Future studies should be long-term, placebo-controlled, double-blind, and use a validated symptom questionnaire. Acid secretion studies demonstrate acid hypersecretion in non-ulcer dyspepsia that is intermediate between that seen in duodenal ulcers and asymptomatic carriers. This suggests that H. pylori gastritis represents a spectrum of disease that includes duodenal ulceration, whose natural history is one of relapses and remissions, and non-ulcer dyspepsia.
Background : Ranitidine bismuth citrate is a novel salt of ranitidine and a bismuth citrate complex. It has intrinsic antisecretory and anti‐ Helicobacter pylori activity, but monotherapy rarely eradicates H. pylori infection in man. Aim : A pilot study to investigate rates of H. pylori eradication achieved by co‐prescription of ranitidine bismuth citrate with antibiotics, and to identify several regimens which would merit further investigation. Method : One hundred dyspeptic patients infected with H. pylori were randomly allocated to treatment with ranitidine bismuth citrate 800 mg b.d. plus either amoxycillin, metronidazole, clarithromycin, cefuroxime axetil, tetracycline, tetracycline plus metronidazole or clarithromycin plus tetracycline for 14 days. Eradication of infection was assessed using the 13 C‐urea breath test 4 weeks after the end of treatment. Results : In a per protocol analysis eradication of H. pylori ranged between 22 and 100%; the intention‐to‐treat eradication rates ranged between 15 and 92%. No adverse events were specifically attributed to ranitidine bismuth citrate. Conclusion : Co‐prescription therapy, using ranitidine bismuth citrate and one or more antibiotics, is suitable for further investigation in large‐scale clinical trials in patients infected with H. pylori.
The genomic contents of Helicobacter pylori strain C1 from a patient with gastric cancer and strain 98587 from a patient with duodenal ulcer disease were compared using a rapid subtractive hybridisation approach. A total of 11 tester-specific sequences representing gene specificity, DNA rearrangement and sequence variation were identified. This included two novel sequences, clone P32 and clone F5, which have no significant homologue in the database. H. pylori strains positive for clone P32 were less prevalent in patients with gastric intestinal metaplasia (12.5%) than in duodenal ulcer (39.1%) (p=0.036), or chronic gastritis (38.1%) (p=0.036). The results suggest that H. pylori clone P32 is potentially a useful marker for distinguishing intestinal metaplasia associated strains from others.
Abstract Stress and sleep are linked with overall well-being. Bifidobacterium longum 1714 has been shown to influence stress responses and modulate neural responses during social stress, and influence sleep quality during examination stress in healthy adults. Here, we explored the ability of this strain to alter sleep quality in adults using subjective and objective measures. Eighty-nine adults (18–45y) with impaired sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI) and with a global score ≥ 5 were randomized to receive B. longum 1714 or placebo daily for eight weeks. Assessing the effect of the strain on PSQI global score was the primary objective. Secondary objectives assessed sleep quality and well-being subjectively and sleep parameters using actigraphy objectively. While PSQI global score improved in both groups, B. longum 1714 significantly improved the PSQI component of sleep quality ( p < 0.05) and daytime dysfunction due to sleepiness ( p < 0.05) after 4 weeks and social functioning ( p < 0.05) and energy/vitality ( p < 0.05) after 8 weeks, compared to placebo. No significant effect on actigraphy measures were observed. The 1714 strain had a mild effect on sleep, demonstrated by a faster improvement in sleep quality at week 4 compared to placebo, although overall improvements after 8 weeks were similar in both groups. B. longum 1714 improved social functioning and increased energy/vitality in line with previous work that showed the strain modulated neural activity which correlated with enhanced vitality/reduced mental fatigue (ClinicalTrials.gov: NCT04167475).
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