Sabrina Nicoleta Munteanu1, Andreea Raluca Cozac-Szőke2, Simona Mocan3, Tania Mihaela Zait1, Răzvan Iacob Rus1, Răzvan Emil Petri4, Anca Negovan5
1. Internal Medicine Department, Emergency County Hospital, Targu Mures, Romania
2. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Pathology Department, Emergency County Hospital, Targu Mures, Romania
4. Gastroenterology Department, Emergency County Hospital, Targu Mures, Romania
5. Department of Clinical Science-Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
Objective: The objective of the present study is to clarify the value of clinic, endoscopic, and histologic variables that may predict anemia in patients performing esophagogastroduodenoscopy for gastrointestinal complaints in the absence of bleeding signs or lower digestive disease. Methods: This study included 654 patients referred for endoscopy that were divided based on biological parameters performed in the same day in the study group (306 patients diagnosed with anemia) and the control group (348 patients without anemia). Results: Anemia is frequent in elderly patients, especially in the presence of premalignant gastric lesions, and it is associated with multiple comorbidities. In two multivariate regression models antivitamin K oral anticoagulants were found to be independently associated with anemia (p = 0.01), but not with antiplatelet therapy, or with non-antivitamin K anticoagulants. Multiple regression models support that epigastric pain and heartburn are inversely associated with anemia, while weight loss remained an independent predictor for simultaneous anemia and premalignant lesions. Non-infectious chronic gastritis (p<0.001) is an independent predictor for anemia and premalignant gastric lesions, increasing the odds of anemia by 2.2 times, while reactive gastropathy is inversely associated. Gastric erosions and ulcer remained independent predictors for concomitant anemia and premalignant lesions. Conclusions: Chronic inactive gastritis and premalignant gastric histologic lesions are predictors for anemia in endoscopic population, while active H. pylori infection is not. Dyspeptic symptoms, epigastric pain (p<0.001,OR 0.2-0.5) and heartburn (p<0.001,OR 0.07-0.3) are inversely associated with anemia alone or associated with premalignant gastric lesions.
1 Clinic of Gastroenterology, Faculty of Medicine, UMPh Târgu Mureş
2 1st Medical Clinic, Faculty of Medicine, UMPh Târgu Mureş
3 Targu Mures County Clinical Emergency Hospital
Background: The incidence of adenocarcinoma of the esophagus has dramatically increased during the last 2 decades and so has the incidence of Barrett’s esophagus, one of the most important risk factors for esophageal adenocarcinoma.
Aim: The aim of this study was to determine whether infection with Helicobacter pylori is associated with a lower risk of Barrett’s esophagus development in our area, and if there is a direct correlation between hiatal hernia and Barrett’s esophagus.
Material and method: We studied a series of 4359 patients who were investigated by upper endoscopy in the Gastroenterology and Endoscopy Unit of Targu Mures County Clinical Emergency Hospital between the 1st of January 2009 and 31st of December 2009. Barrett’s esophagus was defined as the presence of specialized columnar epithelium with goblet cells in the esophagus. We compared the patients with Barrett’s esophagus with a similar serie with patients without reflux disease.
Results: In 33 patients a diagnosis of Barrett’s esophagus was established. There was a strong predominance of males. The mean age at diagnosis was 64.18 years. Helicobacter pylori was present in 17 cases (51.51%) in the control patients compared to 42.42% in patients with Barrett’s esophagus (p 0.622, Odds Ratio: 0.69 95% CI: 0.26-1.83). Hiatal hernia was present in patients with Barrett’s esophagus in 21 cases (63.63%), and in patients without reflux disease only in 5 cases (15.15%) (p<0.001, Odds Ratio: 9.8: 95% CI: 2.99-32.18).
Conclusions: A significant correlation between hiatal hernia and Barrett’s esophagus was demonstrated in our study (p<0.001).
1 Pediatric Department II, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș
2 Pediatric Department I, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș
3 Epidemiology – Preventive Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureş
4 Ginecology Department II , Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș
Introduction: The role of Helicobacter pylori in gastroesophageal reflux disease remains controversial, particularly in children, since there are limited published data. More than half of the world’s population carries this infection. Infection rates vary among the developed and developing countries of the world.
The aim of our study was to determine the role of Helicobacter pylori infection in the development of gastroesophageal reflux disease in a pediatric population.
Material and method: We retrospectively reviewed medical records of patients hospitalized in the Two Pediatric Clinic Târgu-Mureș, Gastroenterology Department, from 2009 to 2010. We included in the study 376 children between 1 and 18 years with clinical symptoms (epigastric pain, vomiting, nausea, anorexia, loss weight) and the outcome of endoscopy confirmed the Helicobacter pylori gastritis and gastroesophageal reflux disease.
Results: Among the 376 patients, 55.05% were positive for Helicobacter pylori and 12.5% were found to have gastroesophageal reflux disease. The prevalence of gastroesophageal reflux disease in the Helicobacter pylori positive population was 11.6 % compared to 13.61 % in the Helicobacter pylori negative population (p > 0.05). The biggest prevalence of this infection was in the 10–14 yrs age group (63.05%).
Conclusions: We found no significant difference in gastroesophageal reflux disease between children with and without Helicobacter pylori infection. Antral predominant nonatrophic gastritis is common in children.
1 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Internal Medicine Clinic, Bucharest
2 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Department of Internal Medicine, Bucharest
3 ”Carol Davila” University of Medicine and Pharmacy, ”Prof. Dr. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, Diabetes Clinic, Bucharest
Introduction: In the last few years many studies were focused on the implications of Helicobacter pylori infection in the evolution of patients with diabetes mellitus. Most of the results are controversial. Our aim was to study the prevalence of the bacterial infection and some of its epidemiological features in diabetic versus non-diabetic patients and the particularities of the association of Helicobacter pylori with diabetes mellitus.
Material and method: We studied 70 consecutive patients with dyspeptic syndrome evaluated with The Leeds Dyspepsia Questionnaire, divided in 2 groups: 35 diabetic and 35 non-diabetic patients.
Results: The prevalence of the Helicobacter pylori infection was similar in our groups (p >0.05). Inside each group, the prevalence of bacterial infection did not differ related to the determination method – serology vs. invasive test (p >0.05). In the diabetic patients we found a positive correlation between the bacterial infection and parameters like family size (>5) (p <0.01). The metabolic control of the diabetics was not influenced by the infection. Regarding diabetes complications, there is significant association of neuropathy with Helicobacter pylori. The eradication rate of infection was similar in diabetic and non-diabetic groups.
Conclusions: The prevalence of Helicobacter pylori infection did not differ in diabetics versus non-diabetics. Both determination me-thods proved similar efficacy for bacterial diagnosis, but is recommended an association of an indirect and a direct method. The bacteria did not influence the glycemic status. Neuropathy is strongly associated with Helicobacter pylori infection.
University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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.
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.
1 Department of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Internal Medicine I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Cellular Biology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
Introduction: Responsible for one the most frequent infections worldwide, Helicobacter pylori is involved in the pathogenesis of acute/chronic gastritis, peptic ulcer and gastric cancer. It has been suggested that patients infected with human immunodeficiency virus (HIV) register a lower frequency of Helicobacter pylori infection, due to extensive use of antibiotics for opportunistic infections.
Purpose: a comparison between the frequency of Helicobacter pylori infection in HIV-positive and HIV-negative patients, noting the differences between diagnostic methods.
Material and method: We performed a retrospective, analytical, case-control study, over a period of 40 months, by analyzing 1165 Helicobacter pylori tests (serology or stool antigen) performed in the Laboratory of Infectious Diseases from Clinical District Hospital Mures. Group A included 94 HIV-infected patients, while group B – 1071 non-HIV infected patients. Statistical analysis was performed (Chi2 test, Odds Ratio (OR) calculation) with the help of GraphPad programme.
Results: 45.74% HIV-infected patients and 62.5% HIV-negative subjects had positive Helicobacter pylori tests (either serology or stool antigen), which resulted in a statistically significant negative association between HIV and Helicobacter pylori infection, with p=0.0013 < α=0.05 and OR=0.5046. However, only 8.33% stool antigen tests in HIV-positive and 6.78% in HIV-negative patients were positive for Helicobacter pylori, while 51.21% serological tests were positive in HIV-infected subjects and 69.46% in HIV-negative patients.
Conclusions: Although HIV infection seems to be associated with less Helicobacter pylori positive tests, the clinician needs to consider the existing differences between diagnostic methods.
1 University of Medicine and Pharmacy, Tirgu Mures
2 Department of Gastroenterology, Mures County Hospital
Background and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pylori infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia.
Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings.
Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19).
Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies.
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