gastritis | Acta Medica Marisiensis

Background: It is generally recognized the role of Helicobacter pylori in the pathogenesis of peptic ulcer disease in adults and children. Some cases raise serious concern regarding the therapeutic approach because they do not heal with normal treatment schemes or have frequent relapses due to the fact that the microorganism has virulence factors that determine resistance to therapy.
The purpose of this work was to analyze the cases of gastritis due to H. pylori in children from our casuistry, which have not healed despite a properly conducted treatment to eradicate the bacteria.
Material and methods: This was a prospective study carried out on 1,041 children aged between 2 and 18 years, diagnosed with different types of gastritis in Ist Pediatric Clinic from Tîrgu Mureș, admitted between January 2001 and March 2010. We have had 539 cases of gastritis due to H. pylori; for these patients a specific treatment was prescribed in order to eradicate the infection and to cure gastritis (accor-ding to the current internationally accepted recommendations).
Results: The average age of patients in the study group was 12.9 years, with a higher incidence in the 7–12 (33.02%) and 13-18 years (62.89%) age group, predominantly among female patients (63.45%) and those from rural areas (55.84%). From the patients diagnosed with Helicobacter pylori gastritis, 478 cases presented for review; after proper treatment with anti-infectives in combination with proton pump inhibitors, clinical-histological healing of the disease after a month was found in 426 cases (89.12%); a number of 52 patients remained positive (10.87%). Two months after treatment the endoscopical and histopatological modifications persisted in 26 cases (5.43%); a total of six cases (1.25%) remained positive for Helicobacter pylori infection after therapy.
Conclusions: The resistance of Helicobacter pylori infection to therapy is caused by the continued action of favoring factors, the virulence of the microorganisms in association with a genetic predisposition present in some individuals.

Upper Digestive Mucosal Changes in Patients Taking Low-dose Aspirin

Negovan Anca¹, Băţagă Simona², Sabău M³, Cozlea L¹, Ţilea I¹, Sárkány Z³

1 3rd Medical Clinic, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Physiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The benefits of antiplatelet therapies for treatment and prevention of cardiovascular diseases have been demonstrated in the last years, but these therapies increase the risk of mucosal damage in the gastrointestinal tract. We aimed to evaluate endoscopic mucosal lesions in patients not referred for endoscopy, with a new recommendation for long term low-dose aspirin, who have not taken the drug before endoscopy and in patients taking long-term low-dose aspirin.
Material and methods: Two-hundred twenty-five patients who had accepted an endoscopy were included (90 with low-dose aspirin, 135 with recommendation for low-dose aspirin). With few exceptions, there were no statistically significant differences in patient groups regarding social habits, chronic diseases, ulcer history, concomitant drug or digestive symptoms.
Results: Severe Lanza scores were significantly more frequent in patients with low-dose aspirin than in patients without aspirin (60% vs. 30.4%, p<0.01). In patients with chronic low-dose aspirin, H. pylori infection was significantly less frequent than in patients not taking this therapy (38.9% vs. 50.4%, p=0.05), while gastric atrophy and/or intestinal metaplasia were more frequent (48.9% vs. 36.3%, p=0.04). Active infection with H. pylori in taken biopsies was associated with more severe lesions, including ulcers, in both groups, while gastric atrophy and/or intestinal metaplasia were significantly associated with severe endoscopic lesions in patients with low-dose aspirin.
Conclusions: Patients with recommendation for long term treatment with low-dose aspirin frequently present severe mucosal endoscopic lesions and multiple risk factors for gastrointestinal complications before starting the treatment. Patients taking low-dose aspirin on a daily basis present more severe endoscopic lesions when an active H. pylori infection and premalignant histological changes are present.