Risultati per: Trattamento dell'infezione da Helicobacter Pylori

This randomized clinical trial evaluates the effects of Helicobacter pylori stool antigen assessment plus fecal immunochemical testing (FIT), vs FIT alone, on gastric cancer incidence and mortality among adults in Taiwan.

Gastric cancer is a leading cause of cancer death globally. Although endoscopy-based screening has led to a decrease in gastric cancer mortality in Eastern Asian countries with populations at high risk, lack of risk stratification and the cost of health care infrastructure and trained personnel limit its use in most of the world. Availability of noninvasive biomarkers for the identification of high-risk individuals could optimize endoscopy-based screening programs for a more general application, including in regions where gastric cancer rates in the general population are low.

Introduction
Helicobacter pylori is a type of Gram-negative microaerobic bacteria that inhabits the gastric mucosal epithelium. It can cause various gastrointestinal diseases including gastritis, peptic ulcer and gastric cancer. White blood cells (WBC) are common immune cells, the increase in whose countoften indicates the presence of an infection. Currently, the relationship between H. pylori and WBC count remains full of controversy. This study aims to further elucidate the effects of H. pylori on WBC count in a population undergoing physical examination.

Methods and analysis
A total of 864 participants who underwent physical examination and 14C urea breath test (UBT) were retrospectively enrolled in this study from January to June 2021. The overall population was divided into H. pylori-negative (Hp–) and H. pylori-positive (Hp+) groups based on the disintegration per minute (DPM) value detected by UBT. Spearman’s correlation analysis was used to assess the correlation between DPM and WBC count. General linear regression models were applied to assess the potential factors contributing to the increase in WBC count. Generalised additive model (GAM) was performed to identify the non-linear relationship between DPM and WBC count. Additionally, a piecewise linear regression was used to examine the threshold effect of the DPM on WBC count.

Results
403 subjects were diagnosed with H. pylori infection. The WBC and platelet (PLT) counts in the Hp+ group were significantly higher than those in the Hp– group. Additionally, the prevalence of H. pylori infection gradually increased with the WBC count quartiles (38.89% and 54.67% in quartile 1 and quartile 4, respectively). Spearman’s correlation analysis showed that the DPM value significantly correlated with WBC count (r=0.089, p=0.009) and PLT count (r=0.082, p=0.017). The linear model revealed a positive independent association of H. pylori infection and DPM with WBC count (βHp+=0.398 (95% CI 0.170, 0.625), p

We thank Bornschein et al for their interest in the British Society of Gastroenterology guidelines on the management of functional dyspepsia (FD).1 2 They raise issues regarding the role of repeated Helicobacter pylori testing and eradication in patients with uninvestigated dyspepsia, as part of a ‘test and treat’ approach, which is the most effective strategy for managing the condition.3 However, they extrapolate this to cover FD, although most patients with uninvestigated dyspepsia will have FD as the cause of symptoms.4 We agree that H. pylori leads to severe complications including peptic ulcer or gastric cancer. There is unequivocal evidence that eradicating the bacterium in patients with peptic ulcer leads to a highly significant reduction in the risk of ulcer recurrence, with a number needed to treat of two or three.5 There is also evidence that treating infected patients after…

Among other changes, the 2024 version of these guidelines suggests that clinicians use clarithromycin and levofloxacin to treat H. pylori only if susceptibility is proven.

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