Colonization by Pseudomonas aeruginosa and Staphylococcus aureus of Antral Biopsy Specimens from Gastritis Patients Uninfected with Helicobacter Pylori

Purpose: Roles and incidence of some microorganisms that transiently or permanently colonize the human stomach are still unknown despite advances in gastroenterology. We aimed to examine the incidence of four microorganisms, Helicobacter pylori, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis, in the antral biopsy specimens of patients with gastroduodenal conditions. Patients and Methods: Patients (67 females, 33 males; mean age = 49.5 years) were initially examined and diagnosed by a gastroenterologist at the Mehrad Hospital, Tehran, Iran. We enrolled those who underwent the upper gastrointestinal endoscopy because of gastroduodenal conditions. Two antral biopsy samples were taken by endoscopy; the first sample was used for the “rapid urease test” to confirm H. pylori. The second was used for DNA extraction and PCR analyses with specific, corresponding primer sets to establish the presence of the four microorganisms. Our study was approved by the Ethics Committee at the Tarbiat Modares University, Tehran. Results: Based on pathology and endoscopy findings, we divided the patients into three groups: 62 presented with gastritis, 18 with duodenal ulcer, and 20 gastric ulcer. The number of patients with P. aeruginosa but without H. pylorisignificantly differed from the number of those co-infected with both microorganisms (P = 0.03). Additionally, a similar significance was found between the incidence of S. aureus in patients without H. pylori and those with both infections (P = 0.04). Our results indicated that a significant number of patients with gastritis were colonized with P. aeruginosa or S. aureus without being co-infected with H. pylori (P < 0.001). Interestingly, the incidence of colonization by P. aeruginosa of patients without H. pylori (45/49, 91.8%) was higher than that by S. aureus (28/49, 57%). Conclusion: The number of patients without H. pylori but with P. aeruginosa or with S. aureus infection significantly differed from that with both infections, respectively. Our study thus shows that patients without H. pylori infection are prone to be colonized by P. aeruginosa or S. aureus, indicating that targeted antibiotic regimens are necessary for clinically treating themThe authors would thank the research deputy of Tarbiat Modares University, Iran for financially supporting this project

Effect of Proton Pump Inhibitor Administration on Glycemic Parameters in Patients with Type 2 Diabetes Mellitus

Introduction: Proton pump inhibitors can influence glucose-insulin homeostasis by elevating plasma gastrin. Considering the few clinical trials and contradictory results of previous studies, we aimed to evaluate the effect of omeprazole, a proton pump inhibitor, on glucose-insulin homeostasis in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this before-after clinical trial, 40 patients with T2DM received omeprazole treatment for 12 weeks. Patients were asked to continue their diet, lifestyle, and physical activity throughout the study period. Glycosylated hemoglobin (HbA1c), fasting plasma sugar (FBS), insulin level, C-peptide and 2 hours post prandial blood sugar (2hppBS) were measured at baseline and after 12 weeks. Homeostatic model assessment of Insulin resistance (HOMA-IR) and homeostatic model assessment of β-cell dysfunction (HOMA-B) indices were also calculated at baseline and after 12 weeks of omeprazole administration. Results: After 12 weeks of omeprazole administration, there was a clear decrease in the mean HbA1C before (8.11±0.96) and after (7.13±0.68) the treatment (P&lt;0.001). Similarly, a decrease in mean FBS and 2HPPBS before and after treatment was observed, which was statistically significant for FBS (P=0.01) but not for 2HPPBS (P=0.1). There was a clear increase in the level of Insulin (P=0.001) and C-peptide (P=0.003). The mean activity index of HOMA-B before and after receiving omeprazole was 54.41 27.06 and 79.24 45.32, respectively (P=0.007). Also, HOMA-IR index was 5 before, and 6 after receiving omeprazole (P=0.001). Conclusion: Administration of omeprazole, increases insulin levels and decreases the levels of HbA1c, FBS, thus improving glycemic status and can be combined with other drugs used to manage DM, especially in patients with gastrointestinal problems; but more studies are needed

Diagnostic Efficacy of 24-hr Esophageal pH Monitoring in Patients with Refractory Gastroesophageal Reflux Disease

BACKGROUND: Gastric reflux is one of the most important causes of the referral of patients to the internal clinic, which in some cases causes problems for patients due to resistance to common treatments. Therefore, timely diagnosis and treatment of this group of patients are very important.AIM: The purpose of the present study was to determine the off-proton pump inhibitor (off-PPI) 24 h pH-impedance analyses in patients with refractory gastroesophageal reflux disease (GERD) attending to Taleghani Hospital since 2009 to 2017.METHODS: In this observational descriptive-comparative off-PPI study, 572 patients with refractory GERD who were referred to Taleghani Hospital in Tehran from 2009 to 2017 were selected, and the results of 24 h pH Impedance analysis were then assessed.RESULTS: The results of 24h pH-impedance indicated that 7% of cases belonged to Pure Acid Reflux followed by weakly Acid (1%), non-acid (0.3%), mixed &amp; gas (5.2%), functional (58.4%) and oesophagal hypersensitivity (28%). Furthermore, weakly acid plus acid was also found to be 8% and Weakly Acid + Acid + Non-Acid were determined as 8.3%.CONCLUSIONS: Our findings suggested that nearly more than half of the patients with refractory GERD would have a functional disorder in the 24h pH-impedance analysis

ERCPMP: An Endoscopic Image and Video Dataset for Colorectal Polyps Morphology and Pathology

In the recent years, artificial intelligence (AI) and its leading subtypes, machine learning (ML) and deep learning (DL) and their applications are spreading very fast in various aspects such as medicine. Today the most important challenge of developing accurate algorithms for medical prediction, detection, diagnosis, treatment and prognosis is data. ERCPMP is an Endoscopic Image and Video Dataset for Recognition of Colorectal Polyps Morphology and Pathology. This dataset contains demographic, morphological and pathological data, endoscopic images and videos of 191 patients with colorectal polyps. Morphological data is included based on the latest international gastroenterology classification references such as Paris, Pit and JNET classification. Pathological data includes the diagnosis of the polyps including Tubular, Villous, Tubulovillous, Hyperplastic, Serrated, Inflammatory and Adenocarcinoma with Dysplasia Grade & Differentiation. The current version of this dataset is published and available on Elsevier Mendeley Dataverse and since it is under development, the latest version is accessible via: https://databiox.com

FadA-positive Fusobacterium nucleatum is prevalent in biopsy specimens of Iranian patients with colorectal cancer

Fusobacterium nucleatum has been increasingly implicated as a causative agent of various diseases, such as inflammatory bowel disease. Moreover, the gastrointestinal tracts of patients with colorectal cancer (CRC) also have been shown to be colonized by this bacterium. We aimed to determine the prevalence of F. nucleatum among CRC and non-CRC Iranian patients and to investigate potential associations between fadA-positive F. nucleatum and diagnosed CRC cases. Eighty patients admitted to two main hospitals in Tehran, Iran, were enrolled. The patients were aged between 20 and 75 and were diagnosed by a gastroenterologist. A trained surgeon used standard surgical protocols to collect two CRC biopsy samples per patient. One of the samples was used for pathologic examination, and the other was subjected to DNA extraction and PCR. Lesion colonization by F. nucleatum and expression of its major virulence factor, fadA, were investigated. The fadA-positive F. nucleatum strain was absent in all the lesions obtained from non-CRC patients. All patients with lesions that were colonized with fadA-positive F. nucleatum were diagnosed as CRC (p < 0.05); selected patients were sent for further intensive treatment. We found a significant association between the presence of F. nucleatum colonization and lesions from CRC patients (p 0.0001; odds ratio, 6.74; 95% confidence interval, 2.5-18.07). Our study confirmed colonization of the fadA-positive F. nucleatum on lesions from 80 Iranian CRC patients. New therapeutic strategies to achieve eradication of F. nucleatum are necessary for clinical management of patients suspected of having or prone to developing CRC.Financially supported by the research deputy of Tarbiat Modares University, Tehran, Iran

Identification of Helicobacter pylori in tumor biopsies obtained from patients with colorectal cancer: Indication for a prophylactic vaccine?

The association between H. pylori infection and colorectal cancer (CRC) has been controversial, and despite the undisputed roles of H. pylori in the etiology of gastric cancer, its involvement as a causative agent of CRC is unknown. We aimed to investigate the potential associations between H. pylori infection and CRC in biopsy samples taken from tumors of Iranian patients. Patients (n = 49; aged 38–79 years, mean age = 49) with diagnosed CRC were enrolled. Biopsies from control (n = 10) and suspected CRC patients were collected from March 2017 to 1 August 2019 at the Mehrad Hospital, Tehran, Iran. The diagnosis of CRC was confirmed by pathology and colonoscopic examinations. An expert gastroenterologist performed the colonoscopic surgery and sample collection. DNA was extracted from the samples, and H. pylori infection was detected and confirmed by PCR using the glmM sequence as the species-specific gene. SPSS version 18 was used to determine the significant associations by using the two-tailed Fisher's exact test. Eighteen (46.1%) and 6 (60%) patients were female in the CRC and control groups, respectively. No significant associations were observed between H. pylori infection and family history of cancer, age, or gender. Thirty-one (79%) CRC samples showed severe inflammation. Out of the 31 CRC samples with severe inflammation, 18 (58%) were positive for H. pylori (P < 0.05). We conclude that H. pylori may be involved in the CRC pathogenesis or progression. Our findings suggest that a prophylactic vaccine against H. pylori may be promising in reducing the CRC incidence.The authors acknowledge the research deputy of Tarbiat Modares University, Iran, for financially supporting this project

Helicobacter heilmannii Colonization Is Associated With High Risk for Gastritis

Introduction. We aimed to study potential associations between colonization by four common non-pylori Helicobacter species and gastroduodenal diseases by comparing samples from patients infected with H. pylori with samples from non-infected subjects. Materials and Methods. Patients (n 5 190) who were subjected to upper gastrointestinal endoscopy because of gastroduodenal conditions were enrolled in this cross-sectional study. Antral biopsy samples were taken from patients in two major hospitals (Mehrad and Imam-Hossein) in Tehran, Iran, during 2017e2018. DNA was isolated from the biopsy specimens, and PCR amplification was used to identify the Helicobacter species by using their corresponding specific primer sets. Results. Out of 120 cases positive for H. pylori, 46 (38%) were patients with gastritis, 23 (19%) with duodenal ulcer, 11 (9%) with gastric cancer, and 40 (33.3%) with gastric ulcer. Overall, 70 (36%) patients were negative for H. pylori. H. pylori cases were uninfected by any of the other tested Helicobacter species. Among the 70 patients without H. pylori, 34 had gastritis—31 (94%) of these were positive also for H. heilmannii ( p 5 0.001, Odds Ratio: 51.6; 95% Confidence Intervals: 11.8e225.6). We did not find any patient carrying mixed Helicobacter infections with any non-pylori Helicobacter species in this cohort. Conclusions. Given our evidence about the possibility of involvement of H. heilmannii in patients suffering from gastritis and nonexistence of mixed non-pylori Helicobacter infections, bacteriological testing of subjects negative for H. pylori becomes clinically relevant and important.The present study was financially supported by the grant 94014027 by the Iran National Science Foundation (INSF)

Isolation of dupA-positive and clarithromycin-resistant Helicobacter pylori from Iranian patients with duodenal ulcer

Background: Emergence of the antibiotic-resistant Helicobacter pylori strains has compelled the development of novel and complex therapeutic approaches. The duodenal-ulcer-promoting gene A (dupA), a virulence factor of H. pylori, is thought to be associated with a high risk of duodenal ulcerations but not gastric cancer. We propose that the association between clarithromycin resistance and presence of dupA may help clinicians formulate better therapeutic regimens. Methods: We thus investigated H. pylori colonization in 90 patients, including 27 with gastritis, 40 with duodenal ulcer, and 23 with gastric cancer. We used the E-test for determining the minimal inhibitory concentrations of clarithromycin according to standard protocols. Bacterial culturing and glmM-specific PCR were used to determine the prevalence of the relevant H. pylori strains. Results: dupA-Positive strains were not equally distributed among the three disease groups (gastritis 32.5%; duodenal ulcer 62.9%; gastric cancer 21.7%). We found a significant association between dupA-positive H. pylori strains and duodenal ulcer (P = 0.02; OR: 2.67; 0.95 CI: 1.09–6.49). We assessed the susceptibility to clarithromycin of the H. pylori isolates. Clarithromycin resistance was prevalent in 47% of the isolates. The dupA-positive H. pylori strains were more resistant to clarithromycin (P = 0.013; OR: 3.12; 0.95 CI: 1.20–8.11) than other strains. Conclusion: We conclude that dupA presence may be a marker for clarithromycin-resistant H. pylori strains among the patients with duodenal ulcer.The present study was partially supported by the Grant number 94014027 by the Iran National Science Foundation (INSF)

Liver Hydatid Cyst and Acute Cholangitis: a Case Report

Amongst the cause of cystic hepatic disease, hydatid cyst is common in the Asia, South America, and Africa. The definitive therapy for hepatic hydatid disease is surgical resection. Rupture of the hydatid cyst into the biliary tree can lead to serious cholangitis. In this report, a 22-year-old man is presented with the signs and symptoms of obstructive jaundice and cholangitis. Ultrasonography reported dilated common bile duct (CBD) with sludge and stones, a hydatid cyst adjacent to the gall bladder and mild thickening of gallbladder wall without a stone. MRCP revealed dilated CBD with a cyst in segment fifth of liver. Due to signs and symptoms of obstructive jaundice in addition to lab data and imaging modalities, the ruptured hydatid cyst into a biliary tree was considered, and surgical intervention was performed to extract daughter vesicles from the CBD. Post intervention, signs and symptoms and cholestasis enzymes were subsided

Biofeedback efficacy to improve clinical symptoms and endoscopic signs of solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. This study assessed the effect of biofeedback in decreasing the symptoms and the healing of endoscopic signs in SRUS patients. Before starting the treatment, endoscopy and colorectal manometry was performed to evaluate dyssynergic defecation. Patients were followed every four weeks, and during each visit their response to treatment was evaluated regarding to manometry pattern. After at least 50% improvement in manometry parameters, recipients underwent rectosigmoidoscopy. Endoscopic response to biofeedback treatment and clinical symptoms were investigated. Duration of symptoms was 43.11±36.42 months in responder and 63.9±45.74 months in non-responder group (P=0.22). There were more ulcers in non-responder group than responder group (1.50±0.71 versus 1.33±-0.71 before and 1.30 ± 0.95 versus 0.67±0.50 after biofeedback), although the difference was not significant (P=0.604, 0.10 respectively). The most prevalent symptoms were constipation (79%), rectal bleeding (68%) and anorectal pain (53%). The most notable improvement in symptoms after biofeedback occured in abdominal pain and incomplete evacuation, and the least was seen in mucosal discharge and toilet waiting as shown in the bar chart. Endoscopic cure was observed in 4 of 10 patients of the non-responder group while 8 patients in responder group experienced endoscopic improvement. It seems that biofeedback has significant effect for pathophysiologic symptoms such as incomplete evacuation and obstructive defecation. Improvement of clinical symptoms does not mean endoscopic cure; so to demonstrate remission the patients have to go under rectosigmoidoscopy