דו״ח מאומת

Dyspepsia is the medical term for difficult digestion. It consists of various symptoms in the upper abdomen, such as fullness, discomfort, early satiation, bloating, heartburn, belching, nausea, vomiting, or pain. The prevalence of dyspepsia in the western world is approximately 20% to 25%. Dyspepsia can be divided into 2 main categories: "organic" and "functional dyspepsia" (FD). Organic causes of dyspepsia are peptic ulcer, gastroesophageal reflux disease, gastric or esophageal cancer, pancreatic or biliary disorders, intolerance to food or drugs, and other infectious or systemic diseases. Pathophysiological mechanisms underlying FD are delayed gastric emptying, impaired gastric accommodation to a meal, hypersensitivity to gastric distension, altered duodenal sensitivity to lipids or acids, altered antroduodenojenunal motility and gastric electrical rhythm, unsuppressed postprandial phasic contractility in the proximal stomach, and autonomic nervous system-central nervous system dysregulation. Pathogenetic factors in FD are genetic predisposition, infection from Helicobacter pylori or other organisms, inflammation, and psychosocial factors. Diagnostic evaluation of dyspepsia includes upper gastrointestinal endoscopy, abdominal ultrasonography, gastric emptying testing (scintigraphy, breath test, ultrasonography, or magnetic resonance imaging), and gastric accommodation evaluation (magnetic resonance imaging, ultrasound, single-photon emission computed tomography, and barostat). Antroduodenal manometry can be used for the assessment of the myoelectrical activity of the stomach, whereas sensory function can be evaluated with the barostat, tensostat, and satiety test. Management of FD includes general measures, acid-suppressive drugs, eradication of H. pylori, prokinetic agents, fundus-relaxing drugs, antidepressants, and psychological interventions. This review presents an update on the diagnosis of patients presenting with dyspepsia, with an emphasis on the pathophysiological and pathogenetic mechanisms of FD and the differential diagnosis with organic causes of dyspepsia. The management of uninvestigated and FD, as well as the established and new pharmaceutical agents, is also discussed.…

PMID: 22327302

<h4>Background</h4>Since Japanese national insurance coverage was expanded to include <i>Helicobacter pylori</i> (<i>H. pylori</i>) gastritis in 2013, approximately 1.5 million patients have received eradication therapy annually. However, the prevalence and clinical features of uninvestigated dyspepsia in the post-eradication era remain unclear.<h4>Aim</h4>To evaluate the prevalence of dyspepsia and related endoscopic findings in the general population.<h4>Methods</h4>We analyzed data from a gastric cancer screening program using esophagogastroduodenoscopy in Sendai city between 2019 and 2021. Data regarding endoscopic findings, upper gastrointestinal symptoms, and history of <i>H. pylori</i> eradication were collected. Dyspepsia was defined as the presence of upper abdominal pain, bloating, or both. Multivariate logistic regression was used to identify independent factors associated with dyspepsia.<h4>Results</h4>Among 23250 participants, overall dyspepsia prevalence was 28.0%. It was 28.7% in the non-infected and post-eradication cohorts, and lower (25.8%, <i>P</i> < 0.05) in the currently infected or naturally eradicated cohort. In addition, 23.1% of participants reported heartburn. The following were independently associated with dyspepsia: Age < 60 years, female sex, gastric ulcers, duodenal ulcers, erosive esophagitis, a history of gastric surgery, and successful <i>H. pylori</i> eradication. Gastric or esophageal cancer showed no association.<h4>Conclusion</h4>Uninvestigated dyspepsia remains common even after successful <i>H. pylori</i> eradication. Dyspepsia was not considered a reliable indicator of gastric or esophageal cancer.…

PMID: 41025005

Helicobacter pylori can cause many gastrointestinal and also extra-gastrointestinal disorders and is a major risk factor for gastric carcinoma and MALT lymphoma. Currently, numerous antibiotic-based therapies are available; however, these therapies have numerous drawbacks, mainly due to increasing prevalence of antibiotic resistant strains. Thus, there is an urgent need to develop novel therapeutic agents against H. pylori infections. In this study, the anti-H. pylori activity of 2:1 mixture of Satureja hortensis and Origanum vulgare subsp. hirtum essential oils (2MIX) was investigated in vivo. After screening in vitro cytotoxicity of 2MIX on mammalian cell lines, the therapeutic efficiency was studied in a mouse model, where changes in H. pylori colonization were detected by PCR and histology of gastric samples. The immune reaction of mice was tested based on cytokine and chemokine production, and the in vivo toxicity of 2MIX was also investigated by measuring ALT and AST enzyme activities and Cyp3a11 and HO-1 mRNA levels in livers of mice. 2MIX had not shown in vitro cytotoxicity against cell lines, only the highest concentration caused significant decrease in their survival rates. In the in vivo experiments, 2MIX successfully eradicated the pathogen in 70% of the mice. We could not detect toxicity or altered cytokine and chemokine balance after in vivo treatments in mice. These results show that 2MIX is effective in reducing H. pylori colonization suggesting that this essential oil mixture has great potential as a new, effective, and safe therapeutic agent against H. pylori.…

PMID: 27578489

The escalating global prevalence of antibiotic-resistant <i>Helicobacter pylori</i> strains has undermined conventional eradication therapies, heightening the burden of associated conditions such as gastritis, peptic ulcers and gastric malignancies. Emerging non-antibiotic alternatives, including natural and synthetic compounds, probiotics and vaccine candidates, offer potential solutions to combat these infections effectively. Natural and synthetic compounds provide promising anti-<i>H. pylori</i> effects, primarily through bacterial membrane disruption, urease inhibition, virulence gene suppression and biofilm prevention. in vitro and in vivo studies support the robust activity of natural agents, while synthetic counterparts demonstrate potent bactericidal and anti-adherence capabilities, though rigorous clinical validation is still required. Probiotic strains enhance eradication rates when combined with antibiotics, reduce treatment-related adverse effects, modulate gut microbiota and attenuate gastric inflammation and carcinogenesis. Vaccine development encompasses whole-cell, subunit and DNA platforms targeting key virulence factors, showing immunogenicity and protective efficacy in preclinical models, yet is limited by variable clinical translation and insufficient large-scale trials. Despite promising advancements, challenges persist, including inconsistent efficacy and a need for more rigorous human studies. Future efforts should emphasize combinatorial therapies, refined delivery systems, and thorough safety evaluations to integrate these strategies into clinical practice, fostering sustainable management of <i>H. pylori</i> in a post-antibiotic era.…

PMID: 41943230

Dyspepsia is the medical term for difficult digestion. It consists of various symptoms in the upper abdomen, such as fullness, discomfort, early satiation, bloating, heartburn, belching, nausea, vomiting, or pain. The prevalence of dyspepsia in the western world is approximately 20% to 25%. Dyspepsia can be divided into 2 main categories: "organic" and "functional dyspepsia" (FD). Organic causes of dyspepsia are peptic ulcer, gastroesophageal reflux disease, gastric or esophageal cancer, pancreatic or biliary disorders, intolerance to food or drugs, and other infectious or systemic diseases. Pathophysiological mechanisms underlying FD are delayed gastric emptying, impaired gastric accommodation to a meal, hypersensitivity to gastric distension, altered duodenal sensitivity to lipids or acids, altered antroduodenojenunal motility and gastric electrical rhythm, unsuppressed postprandial phasic contractility in the proximal stomach, and autonomic nervous system-central nervous system dysregulation. Pathogenetic factors in FD are genetic predisposition, infection from Helicobacter pylori or other organisms, inflammation, and psychosocial factors. Diagnostic evaluation of dyspepsia includes upper gastrointestinal endoscopy, abdominal ultrasonography, gastric emptying testing (scintigraphy, breath test, ultrasonography, or magnetic resonance imaging), and gastric accommodation evaluation (magnetic resonance imaging, ultrasound, single-photon emission computed tomography, and barostat). Antroduodenal manometry can be used for the assessment of the myoelectrical activity of the stomach, whereas sensory function can be evaluated with the barostat, tensostat, and satiety test. Management of FD includes general measures, acid-suppressive drugs, eradication of H. pylori, prokinetic agents, fundus-relaxing drugs, antidepressants, and psychological interventions. This review presents an update on the diagnosis of patients presenting with dyspepsia, with an emphasis on the pathophysiological and pathogenetic mechanisms of FD and the differential diagnosis with organic causes of dyspepsia. The management of uninvestigated and FD, as well as the established and new pharmaceutical agents, is also discussed.…

PMID: 22327302

<h4>Background</h4>Since Japanese national insurance coverage was expanded to include <i>Helicobacter pylori</i> (<i>H. pylori</i>) gastritis in 2013, approximately 1.5 million patients have received eradication therapy annually. However, the prevalence and clinical features of uninvestigated dyspepsia in the post-eradication era remain unclear.<h4>Aim</h4>To evaluate the prevalence of dyspepsia and related endoscopic findings in the general population.<h4>Methods</h4>We analyzed data from a gastric cancer screening program using esophagogastroduodenoscopy in Sendai city between 2019 and 2021. Data regarding endoscopic findings, upper gastrointestinal symptoms, and history of <i>H. pylori</i> eradication were collected. Dyspepsia was defined as the presence of upper abdominal pain, bloating, or both. Multivariate logistic regression was used to identify independent factors associated with dyspepsia.<h4>Results</h4>Among 23250 participants, overall dyspepsia prevalence was 28.0%. It was 28.7% in the non-infected and post-eradication cohorts, and lower (25.8%, <i>P</i> < 0.05) in the currently infected or naturally eradicated cohort. In addition, 23.1% of participants reported heartburn. The following were independently associated with dyspepsia: Age < 60 years, female sex, gastric ulcers, duodenal ulcers, erosive esophagitis, a history of gastric surgery, and successful <i>H. pylori</i> eradication. Gastric or esophageal cancer showed no association.<h4>Conclusion</h4>Uninvestigated dyspepsia remains common even after successful <i>H. pylori</i> eradication. Dyspepsia was not considered a reliable indicator of gastric or esophageal cancer.…

PMID: 41025005

<i>Helicobacter pylori (H. pylori)</i> bacterial infections are moderately common clinical entities. They infect the mucosa lining of the antrum and cause pain and inflammation. The exact transmission of <i>H. pylori</i> remains unclear, though fecal-oral and oral-oral routes via contaminated food or water are considered common. Research over the past three decades has linked <i>H. pylori</i> infection to gastric cancer, micronutrient malabsorption, and malnutrition. Iron deficiency anemia is also often linked to <i>H. pylori</i> infection, where absorption is inadequate, or losses exceed absorption, eventually depleting iron stores and leading to anemia. Although the literature has widely studied this condition, diagnosing it upon clinical presentation may be challenging due to the various factors, causes, and tests required for an accurate diagnosis. We present the case of a 43-year-old female who initially presented to the clinic with nausea and fatigue, which turned out to be iron deficiency caused by <i>H. pylori</i>. An <i>H. pylori</i> breath test confirmed the infection and led to the prescription of a proton-pump inhibitor and a two-week course of an antibiotic called Prevpac. A repeat breath test one month later showed effective eradication of the bacterial infection and improvement in serum iron levels. This report highlights the diagnostic process and clinical considerations involved in identifying and managing the <i>H. pylori</i> infection.…

PMID: 42164228

Only few data have been published on Helicobacter pylori infection in adolescents in Sub-Saharan Africa, including Sudan. The aim of the present study was to investigate the prevalence and associated factors of H. pylori infection in asymptomatic adolescents schoolchildren (aged 10-19 years) in Sudan. A cross-sectional study was conducted from October to November 2022. The participants' sociodemographic and clinical characteristics were assessed using a questionnaire. The participants underwent a rapid H. pylori antibody test for the detection of H. pylori antibodies. Multivariate regression analyses were performed. Of the 368 enrolled adolescents, 155 (42.1%) and 213 (57.9%) were boys and girls, respectively. The median (interquartile range [IQR]) age of the total sample was 15.2 years (14.0‒16.4 years). The overall prevalence of H. pylori infection was 8.4%. In the multivariable regression analyses, only the female adolescents (adjusted odds ratio [AOR], 3.04; 95% confidence interval [CI], 1.24‒7.44) were associated with H. pylori infection. Age, parental education and occupation, and body mass index were not associated with contracting H. pylori infection. H. pylori infection was detected in one of 10 adolescents in Northern Sudan. Female adolescents were at a higher risk of contracting H. pylori infection. The introduction of interventional health programs such as awareness campaigns and improving personal hygiene could lead to the reduction of the risk of H. pylori infection at early ages, especially in girls, and ensure that adolescents are healthy in their present and later lives.…

PMID: 37985974

Esophageal squamous papilloma (ESP) is a rare benign epithelial tumor of the esophagus with an endoscopic prevalence of 0.01% to 0.43%. It is most commonly discovered incidentally during upper endoscopy in asymptomatic patients. Symptomatic presentation, particularly dysphagia, is uncommon and infrequently reported in the literature. We present the case of a 58-year-old female with a three-month history of progressive dysphagia to both solids and liquids, along with intermittent epigastric pain. Esophagogastroduodenoscopy (EGD) revealed a solitary 3 mm sessile polyp in the middle third of the esophagus, which was successfully resected using cold biopsy forceps. Histopathology confirmed ESP, demonstrating papillary proliferation of non-dysplastic stratified squamous epithelium with fibrovascular cores, variable parakeratosis, spongiosis, and mild basal cell hyperplasia. Following resection, the patient experienced complete resolution of her dysphagia. Concurrently, gastric biopsies revealed active <i>Helicobacter pylori</i> (<i>H. pylori</i>) gastritis, for which standard triple eradication therapy was initiated. This case highlights ESP as a rare but clinically important etiology in the workup of unexplained dysphagia, demonstrates the curative potential of endoscopic resection even for small lesions, and reinforces the need for awareness of this entity among clinicians evaluating upper gastrointestinal symptoms.…

PMID: 42326080

Helicobacter pylori is a prevalent, global infectious disease that causes dyspepsia, peptic ulcer disease, and gastric cancer. The American College of Gastroenterology commissioned this clinical practice guideline (CPG) to inform the evidence-based management of patients with H. pylori infection in North America. This CPG used Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to systematically analyze 11 Population, Intervention, Comparison, and Outcome questions and generate recommendations. Where evidence was insufficient or the topic did not lend itself to GRADE, expert consensus was used to create 6 key concepts. For treatment-naive patients with H. pylori infection, bismuth quadruple therapy (BQT) for 14 days is the preferred regimen when antibiotic susceptibility is unknown. Rifabutin triple therapy or potassium-competitive acid blocker dual therapy for 14 days is a suitable empiric alternative in patients without penicillin allergy. In treatment-experienced patients with persistent H. pylori infection, "optimized" BQT for 14 days is preferred for those who have not been treated with optimized BQT previously and for whom antibiotic susceptibility is unknown. In patients previously treated with optimized BQT, rifabutin triple therapy for 14 days is a suitable empiric alternative. Salvage regimens containing clarithromycin or levofloxacin should only be used if antibiotic susceptibility is confirmed. The CPG also addresses who to test, the need for universal post-treatment test-of-cure, and the current evidence regarding antibiotic susceptibility testing and its role in guiding the choice of initial and salvage treatment. The CPG concludes with a discussion of proposed research priorities to address knowledge gaps and inform future management recommendations in patients with H. pylori infection from North America.…

PMID: 39626064

Evolving epidemiological data and increasing antibiotic resistance mandate an update of the European and North American Societies of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. Certainty of evidence and strength of recommendations were rated by experts according to the Grading of Recommendation Assessment, Development, and Evaluation approach. PICO (patient population, intervention, comparator, and outcome) questions were developed and voted on by the group. Recommendations were formulated using the Evidence to Decision framework. The current literature supports many of the previous recommendations and several new recommendations. Invasive testing with strain antimicrobial susceptibility analysis is recommended for the diagnosis and selection of eradication therapy for H. pylori infection. Molecular methods are acceptable for detection of infection and of antibiotic resistance in gastric biopsy specimens. Reliable, noninvasive tests can be used as a screening method for children with history of gastric cancer in a first-degree relative. When investigating causes of chronic immune thrombocytopenic purpura, testing for H. pylori is no longer recommended. When investigating other diseases such as inflammatory bowel disease, celiac disease, or eosinophilic esophagitis, specific diagnostic biopsies for H. pylori infection are not indicated. However, if H. pylori is an incidental finding, treatment may be considered after discussing the risks and benefits. Treatment should be based on antibiotic antimicrobial susceptibility testing and, if unavailable, regimens containing clarithromycin should be avoided. Due to decreasing prevalence of infection, increasing challenges with antibiotic resistance, and emerging evidence regarding complications of infection, clinicians must be aware of these recommended changes to appropriately manage H. pylori infection and its clinical sequelae in children.…

PMID: 39148213

Since the 2020 Korean guidelines for Helicobacter pylori treatment, clarithromycin resistance rates have risen from 17.8% to 33.3%, dual-priming oligonucleotide-based polymerase chain reaction-guided tailored therapy has been adopted, and potassium-competitive acid blockers (P-CABs) have become available. This fourth revision addressed these changes. Nine key questions were addressed through systematic review and meta-analysis. Thirteen recommendations were evaluated using a modified Delphi process involving 64 experts. Twelve recommendations achieved a first-round consensus; one required revision and achieved 73.9% agreement. Key changes included: 1) a dual-pillar strategy of tailored therapy and empirical quadruple therapy; 2) restricted use of empirical clarithromycin-based triple therapy under specific conditions; 3) removal of sequential therapy; 4) use of P-CABs as alternatives to proton pump inhibitors; 5) expansion of eradication indications to include gastric cancer prevention in H. pylori gastritis and regression of hyperplastic polyps ≤10 mm; and 6) positioning of bismuth quadruple therapy as a conditionally recommended first-line empirical option, with preference for reservation as salvage therapy, and introduction of modified bismuth quadruple therapy (addition of bismuth to conventional regimens) as an additional first-line empirical option. The revised guidelines provide updated evidence-based recommendations for the diagnosis and treatment of H. pylori infection, reflecting the rapidly changing antibiotic resistance landscape and the introduction of new diagnostic and therapeutic tools in Korea. These guidelines aim to assist clinicians, patients, policymakers, and medical educators in optimizing H. pylori management. They may differ from the current medical insurance standards and will be further revised based on emerging evidence.…

PMID: 42316523