Introdução: O câncer gástrico é a segunda causa mais comum de mortes relacionadas à neoplasia no mundo. Apesar de o Helicobacter pylori ser classificado como um carcinógeno grupo I, a presença dessa infecção não é um fator que, isoladamente, possa levar ao desenvolvimento de câncer gástrico, sendo que, entre as possíveis justificativas, está a existência de diferentes linhagens de Helicobacter pylori com diferentes graus de virulência. Material e métodos: Foram pareados, por sexo e por idade, 29 pacientes com adenocarcinoma gástrico distal e 58 pacientes submetidos à endoscopia digestiva alta, cujo diagnóstico não fosse câncer gástrico. Em todos os pacientes, foi pesquisado o status da infecção por Helicobacter pylori (através de teste da urease, histopatológico e PCR para os genes ureA e 16S-rRNA), além de determinação do status de infecção por linhagem cagApositiva do Helicobacter pylori (através de PCR para o gene cagA). Resultados: A porcentagem de pacientes com infecção por Helicobacter pylori foi idêntica nos dois grupos (68,9%). Quando avaliamos a presença de infecção pelo Helicobacter pylori linhagem cagA-positiva, verificamos que a freqüência desta é significativamente mais alta no grupo caso, quando comparado com o grupo controle, ocorrendo em 62,1% e 29,3% desses, respectivamente (OR=3,95; IC 95% 1,543-10,096). Ao avaliarmos apenas os pacientes Helicobacter pylori-positivos, a freqüência de infecção por linhagem cagApositiva também é mais elevada no grupo caso (90%), quando comparado com o grupo controle (42,5%) (OR=12,18; IC 95% 2,71-52,9). Conclusões: Existe associação entre infecção por Helicobacter pylori linhagem cagApositiva e adenocarcinoma gástrico distal, independente do status de infecção pelo Helicobacter pylori. / Background: Gastric cancer is the second most common cause of cancer related death worldwide. Although Helicobacter pylori has been classified by the World Health Organization as a class I carcinogen, the presence of the infection is not a factor that alone is able to lead to gastric cancer, and one of the possible explanations for this is the existence of different strains of Helicobacter pylori with different degrees of virulence. Materials and methods: 29 patients with gastric cancer were matched by sex and age (+/- 5 years) with 58 patients without gastric cancer, submitted to upper gastrointestinal endoscopy. All patients were evaluated for the status of infection by Helicobacter pylori (through urease test, histological analysis and PCR for the genes ureA and 16S-rRNA) and for the status of infection by cagA-positive strain (through PCR for the gene cagA) Results: evaluating the presence of infection by cagA-positive Helicobacter pylori, it was verified that the rate of infection was significantly higher in the group with gastric cancer when compared with the matched controls, occurring in 62,1% and 29,3%, respectively (OR=3,95; IC 95% 1,543-10,096). Evaluating only Helicobacter pylori-positive patients, the rate of infection by cagA-positive strains was also significantly higher in the group with gastric cancer (OR=12,18; IC 95% 2,71-52,9). Conclusions: There is association between cagA-positive Helicobacter pylori and risk of gastric cancer, independent of the status of infection by Helicobacter pylori.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Helicobacter pylori à uma bactÃria que infecta cerca de 50% da populaÃÃo mundial constituindo um dos principais fatores de risco para o desenvolvimento de cÃncer gÃstrico. O aparecimento deste tipo de cÃncer està associado à presenÃa da bactÃria e a uma soma de elementos de risco, tais como os hÃbitos alimentares, a predisposiÃÃo genÃtica e fatores ambientais. O presente trabalho teve como objetivo avaliar o efeito de componentes da dieta nordestina (sal, vinagre, pimenta e sumo de batata), extratos e Ãleos essenciais no crescimento de H. pylori. No estudo foram utilizadas uma cepa padrÃo e uma clÃnica. O mÃtodo escolhido para a realizaÃÃo da triagem foi o teste da zona de inibiÃÃo e para determinaÃÃo da ConcentraÃÃo InibitÃria MÃnima (CIM) foi o de diluiÃÃo em Ãgar descrito pelo CLSI. As cepas foram inoculadas em meio de cultura apropriado contendo diferentes concentraÃÃes das substÃncias testadas. A leitura foi determinada macroscopicamente e o crescimento confirmado atravÃs da realizaÃÃo da microscopia pelo mÃtodo de Gram e provas bioquÃmicas. Foi verificado que o sal nÃo inibiu o crescimento de H. pylori e nem alterou a sua morfologia, contudo, foi capaz de influenciar na aÃÃo de um antimicrobiano, in vitro. O vinagre e a pimenta nÃo apresentaram aÃÃo antimicrobiana. O sumo de batata foi capaz de promover o crescimento bacteriano mesmo que em pequena proporÃÃo. Os extratos etanÃlicos de erva-cidreira (Lippia alba Mill. N.E.B quimiotipos I, II, III) e macela (Egletes viscosa L.) foram ativos contra a bactÃria. Os Ãleos essenciais de alfavaca verde (Ocimum gratissimum L.) e roxa (Ocimum sp), aroeira (Myracrodruom urundeuva All.), erva-cidreira (L. alba Mill. N.E.B quimiotipos I, II, III) e macela (E. viscosa L.) tambÃm foram ativos contra H. pylori. A caracterizaÃÃo quÃmica confirmou os constituintes majoritÃrios das plantas. H. pylori constitui, hoje, uma vasta fonte de pesquisa em diversos campos investigativos. Estudos de transmissÃo, prevalÃncia, resistÃncia a drogas antimicrobianas, novas alternativas terapÃuticas e desenvolvimento de vacinas sÃo necessÃrios e bastantes promissores. / Helicobacter pylori is a bacteria that infects about 50% of the world population constituting one of the principal risk factors for the development of gastric cancer. The emergence of this cancer type is associated to the presence of the bacteria and risk elements, such as the alimentary habits, the genetic predisposition and environmental factors. The present work had as objective evaluates the effect of components of the Northeastern diet (salt, vinegar, pepper and potato juice), extracts and essential oils on H. pylori growth. In the study a reference and a clinic strain were used. The chosen method for the accomplishment of the screening test was the inhibitory-zone testing and for determination of the Minimum Inhibitory Concentrations (MIC) it was used the agar dilution method as described by Clinical and Laboratory Standards Institute (CLSI). The strains were inoculated in appropriate culture medium containing different concentrations of the tested substances. The reading was determined macroscopically and the growth confirmed through the accomplishment of the microscopy by the Gram method and biochemical tests. It was verified that the salt did not inhibit the growth and morphology of H. pylori, however, it was able to influence the antimicrobial effect, in vitro. The vinegar and the pepper did not show antimicrobial activity. The potato juice was shown to promote the bacterial growth. The ethanolic extracts of Lippia alba Mill. N.E.B chemotypes I, II, III) and Egletes viscosa L. were active against the bacteria. The essential oils of Ocimum gratissimum L., Ocimum sp, Myracrodruom urundeuva All., L. alba Mill. N.E.B chemotypes I, II, III and E. viscosa L. were also active against H. pylori. The chemical characterization confirmed the majority constituents of the plants. H. pylori constitute, today, a vast research source in several areas. Related studies the transmission prevalence, resistance antimicrobial, new therapeutic alternatives and development of vaccines they are necessary and plenty promising.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-06-19T18:29:46Z No. of bitstreams: 2 Dissertação - Ludimila Aparecida Cavalcante Wosnjuk Carvalho - 2014.pdf: 2513524 bytes, checksum: 5ad4e1e6478e62a6aee4bf01e2c6a7c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Cláudia Bueno (claudiamoura18@gmail.com) on 2017-07-07T18:07:01Z (GMT) No. of bitstreams: 2 Dissertação - Ludimila Aparecida Cavalcante Wosnjuk Carvalho - 2014.pdf: 2513524 bytes, checksum: 5ad4e1e6478e62a6aee4bf01e2c6a7c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-07-07T18:07:02Z (GMT). No. of bitstreams: 2 Dissertação - Ludimila Aparecida Cavalcante Wosnjuk Carvalho - 2014.pdf: 2513524 bytes, checksum: 5ad4e1e6478e62a6aee4bf01e2c6a7c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2014-09-30 / Helicobacter pylori is a gran-negative bacteria known as the leading cause of gastritis, peptic ulcer, gastric lymphoma and tissue lymphoma associated to gastric mucosa, which are responsible for almost 9% of cancer deaths in the world. Its mode of transmission is unclear, but it is suggested that the oral-oral, fecal-oral routes in addition to transmission through contaminated food, water, human milk and through animals. Many of these transmission channels related with the water and, therefore, have given importance to develop methodologies capable of detecting bacteria in water samples, since the bacterium in an aquatic environment becomes a state coccoid (known to be viable but not culturable). Thus, the common detection methods based on culture are not as effective in these circumstances. The most widely used techniques in recent years for detecting Helicobacter pylori in water consist of filtration for the concentration of samples, DNA extraction and amplification of genetic material through the Polymerase Chain Reaction (PCR). The study objective was to reproduce these techniques with samples of treated water coming from the public supply of treated water system from the city of Goiânia - Goiás - Brazil. To this end, in partnership with SANEAGO (sanitation company of Goiás), 102 samples of treated water (accounting for 18 points of the distribution network supplied by Meia Ponte River) were collected and analyzed samples for the water temperature , associated with the storage environment, the local climate, the amount of residual chlorine and the presence of Helicobacter pylori DNA in the period from June to November 2013. Those samples were collected during the rainless period, the temperature ranged from 22 ° C, and 33 ° C and the water temperature between 21 ° C and 25 ° C. The residual chlorine was between 0.77 and 1.7. And no positive samples for the presence of DNA of Helicobacter pylori were found. It is therefore concluded the absence of Helicobacter pylori in the samples. / Helicobacter pylori é uma bactéria gran-negativa conhecida como a maior causadora de gastrite, úlcera péptica, linfoma gástrico, linfoma tecidual associado a mucosa gástrica, que são responsáveis por praticamente 9% das mortes por câncer no mundo. Seu modo de transmissão ainda não é claro, mas sugere-se as vias oral-oral, oral-fecal, além da transmissão por alimentos contaminados, por água contaminada, por leite materno e por animais. Muitas dessas vias de transmissão se relacionam com a água e, por isso, têm se dado importância ao desenvolvimento de metodologias capazes de detectar a bactéria em amostras de água, visto que em ambiente aquático a bactéria se transforma num estado cocoide (conhecido por ser viável, porém não cultivável). Desta maneira, os comuns métodos de detecção baseados em cultura não são tão eficazes nessas circunstâncias. As técnicas mais utilizadas nos últimos anos para detecção de Helicobacter pylori em água consistem em filtração para a concentração das amostras, extração de DNA e amplificação de material genético através da Reação em Cadeia da Polimerase (PCR). O objetivo do estudo foi reproduzir essas técnicas com amostras de água tratada advindas do sistema de abastecimento público de água tratada da cidade de Goiânia – Goiás – Brasil. Para tal, em parceria com a SANEAGO (empresa de saneamento de Goiás), 102 amostras de água tratada (representando 18 pontos da rede de distribuição abastecida pelo Rio Meia Ponte) foram coletadas e analisadas quanto a temperatura da água e do ambiente de estocagem, ao clima da região, ao valor de cloro residual e a presença de DNA de Helicobacter pylori entre os meses de junho à novembro de 2013. As amostras foram coletadas no período sem chuvas da região, a temperatura ambiente variou entre 22°C e 33°C e a temperatura da água entre 21°C e 25°C. O cloro residual foi entre 0,77 e 1,7. E não foram encontradas amostras positivas com relação a presença de DNA de Helicobacter pylori. Concluiu-se assim a ausência de Helicobacter pylori nas amostras analisadas.

Foram estudados 83 pacientes com esofagite erosiva graus I e II, pela classificação de Savary-Miller modificada, divididos em 3 grupos. Um sem Helicobacter pylori, dois outros com Helicobacter pylori, com e sem o gene cagA. Avaliou-se a participação da bactéria e de seu gene cagA, associados à estudo histopatológico de antro e corpo e à gastrinemia basal, na cicatrização da mucosa do esôfago após tratamento com pantoprazol 40 mg ao dia por 6 semanas. Verificou-se que a presença do Helicobacter pylori, independentemente da presença do gene cagA, facilita a cicatrização esofágica. Indivíduos com gastrinemias maiores também tendem a cicatrizar melhor. Não houve relação do resultado do estudo histopatológico com a resposta terapêutica / Eighty three patients with grade I-II of the modified Savary-Miller classification have been studied. They were divided in three groups. One without Helicobacter pylori infection, two with the bacterium, one with and other without the cagA gene. We verified the influence of cagA status, histopathology of antrum and body of the stomach and gastrinemia in the esophageal healing rates after treatment with pantoprazole 40 mg once a day for six weeks. Helicobacter pylori presence but not cagA status and gastrinemia led to better healing rates. Histopathology of the gastric mucosa did not influence the response

Orientador: Marcelo Lima Ribeiro / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-23T02:53:02Z (GMT). No. of bitstreams: 1 Alvarez_MarisaClaudia_D.pdf: 3342763 bytes, checksum: ef7082f8bb653fcdcf965415a79b4d30 (MD5) Previous issue date: 2012 / Resumo: A infecção por Helicobacter pylori e usualmente adquirida durante a infância e persiste durante toda a vida caso não seja tratada. A bactéria induz uma resposta inflamatória crônica, que esta associada com alterações hipergenéticas em oncogenes, genes supressores tumorais, e genes de reparo ao DNA. O Objetivo deste estudo foi avaliar a influencia da infecção por H. pylori no padrão de metilação de genes envolvidos na carcinogenese gástrica. O perfil de metilação de 106 genes foi caracterizado em biopsias provenientes de 5 pacientes adultos (1 Helicobacter pylori negativo, 3 com gastrite crônica infectados com linhagens de diferentes toxicidades e 1 com câncer gástrico) e em DNA proveniente de células epiteliais gástricas infectadas por H. pylori. Para estas analises foram utilizados o Promoter methylation array system, e o Gastric Cancer Methyl--Profiler DNA PCR Array. Os resultados destas análises mostraram que 20 % dos genes se encontravam metilados na amostra de câncer gástrico e 16 % dos genes na amostra de gastrite crônica, entretanto a analise comparativa entre estas amostras mostrou que compartilhavam 8,5 % dos genes metilados. A analise de metilação apos cocultura mostrou 12% dos genes metilados. Entre estes genes foram selecionados os seguintes: THBS1, HIC1, GATA--4, GATA--5 e MLH1 e MGMT, os quais foram avaliados em 239 amostras de biopsias gástricas, provenientes de 50 crianças e 97 adultos infetados ou não pela bactéria e de 92 adultos com câncer gástrico. O padrão de metilação foi avaliado por metilação PCR especifica (MSP--PCR). Os resultados obtidos neste trabalho mostraram que não houve metilação da região promotora de MLH1, MGMT e HIC1, nas amostras provenientes de crianças, independente do estado de infecção. Os maiores níveis de metilação entre as amostras oriundas de adultos com gastrite crônica infectados foram observados em GATA--4 e THBS1 (p<0.05), MGMT e GATA--5 (p<0.001). Nos pacientes com câncer gástrico os maiores níveis de metilação foram observados em MGMT e GATA--5 (p<0.05, p<0.001, respectivamente). Foi verificado um aumento da instabilidade microssatelites nas amostras de câncer gástrico (p<0.03) e o mesmo foi associado com um aumento nos níveis de metilação de MLH1 e sua consequente diminuição de RNAm. Foi realizado in vitro a analise de expressão de GATA--5 e TFF1 apos cocultura de diferentes linhagens de H. pylori e células AGS, que revelou um aumento nos níveis de RNAm de GATA--5 as 6, 24 e 48h apos infecção, e aumento de TFF1 apos 48h. Estes aumentos foram independentes da presença de cag PAI. O aumento na expressão de GATA--5 foi observado em camundongos C57BL/6 apos 6 meses de infecção. Foi observado in vivo que nas amostras metiladas em GATA--5 apresentavam níveis diminuídos de TFF1. Estes resultados nos permitem sugerir que a metilação acontece precocemente na mucosa gástrica dos pacientes pediátricos e esta associada com a infecção por H. pylori. Entretanto alguns loci como MGMT e MLH1 a metilação parece ser dependente do tempo de infecção. Foi observado que os níveis de metilação aumentaram conforme a idade dos pacientes sugerindo que o maior tempo de exposição induz maiores níveis de metilação / Abstract: Helicobacter pylori infection is usually acquired in childhood and persists into adulthood if untreated. It is known that the bacterium induces a chronic inflammatory response, which is associated with epigenetic alterations in oncogenes, tumor suppressor genes and DNA repair genes. The aim of this study was to evaluate the influence of Helicobacter pylori infection on the methylation pattern of genes related to gastric carcinogenesis. The methylation pattern of 106 genes was characterized in gastric biopsies samples from 5 adult patients (1 H. pylori negative, 3 chronic gastritis infected with strains of different toxicities, and 1 gastric cancer) and DNA extracted from co--cultured cells infected with H. pylori. These analyses were performed with Promoter methylation array system, and Gastric Cancer Methyl--Profiler DNA PCR Array. The results showed that 20 % of genes were methylated in gastric cancer mucosa and 16% were hyper methylated in the mucosa of the chronic gastritis patients. The comparative analysis showed that 8,5 % of genes were methylated in both samples. The results from the co culture showed that 12% of genes were methylated. Among them the following genes were selected: THBS1, HIC1, GATA--4, GATA--5 e MLH1 e MGMT and evaluated in 239 gastric biopsies samples from 50 children and 97 adults infected or uninfected by H. pylori, and 92 adults with gastric cancer. The methylation pattern was analyzed by methylation specific PCR (MSP--PCR). The results from pediatric samples showed no methylation for MLH1, MGMT and HIC1 genes, independent of the infection status. Among the infected adults samples the higher levels of methylation were observed for GATA--4 e THBS1 (p<0.05), MGMT e GATA--5 (p<0.001). Higher levels of methylation were observed for MGMT e GATA--5 (p<0.05, p<0.001, respectively) in gastric cancer samples. It was observed an increase in microsatellite instability among gastric cancer samples, related to hyper methylation of MLH1. The expression levels of GATA--5 and TFF1 was analyzed in vitro. The results from infected cells showed an up regulation at 6, 24, and 48 for GATA-5 and at 48 h for TFF1. This increase was independent of cagPAI status. In an animal model an up regulation of GATA--5 was observed after six months of infection. A decrease in TFF1 mRNA levels was observed in infected children and adults samples methylated in GATA--5 promoter region. These data suggest that promoter hyper methylation occurs in gastric mucosa of children in association with H. pylori infection, however for some loci as MGMT and MLH1 this event seems to be dependent on the time of exposure. Furthermore it was observed an increase in methylation frequencies in adults samples compared to pediatric samples suggesting that the duration of the infection is related to methylation levels / Doutorado / Genetica Animal e Evolução / Doutora em Genética e Biologia Molecular

Le rôle majeur de l’Helicobacter pylori dans l’étiopathogénie des maladies gastroduodénales (gastrite, ulcère gastrique et duodénal, lymphome gastrique) est bien établi aujourd’hui. L’OMS l’a reconnue comme jouant un rôle important dans la survenue des lésions cancéreuses gastriques. La prévalence de l’infection à H. pylori varie selon les pays de 20% à 90% avec des taux supérieurs à 60% dans les pays en développement, dont le Bénin. Les méthodes usuelles de diagnostic sont soit invasives nécessitant une endoscopie gastrique avec biopsies (test rapide à l’urée, histologie, culture et PCR), soit non-invasives (test respiratoire à l’urée marquée au carbone, sérologie, et détection de l’antigène dans les selles). La trithérapie associant un inhibiteur de la pompe à protons (IPP) et deux antibiotiques choisis parmi l’amoxicilline, la clarithromycine et le métronidazole est recommandée pour son traitement. La survenue de résistance des souches H. pylori aux différents antibiotiques devient une cause majeure de l’échec des régimes d’éradication.<p>Afin d’évaluer l’applicabilité et l’efficacité des régimes thérapeutiques recommandés en pratique courante, et à partir d’une étude de cohorte prospective, nous avons étudié la prévalence de l’infection à H. pylori chez les patients consultant à la clinique de Gastroentérologie de l’hôpital universitaire Erasme à Bruxelles, déterminé son taux de résistance primaire aux antibiotiques, et évalué le taux d’éradication d’H. pylori par la trithérapie. Nous avons aussi évalué la performance du test de détection de l’antigène d’H. pylori dans les selles pour le diagnostic chez l’adulte (avant traitement) comparé avec les méthodes de référence (culture, histologie), également dans le contrôle de l’éradication.<p>Au Bénin, nous avons évalué à partir d’une étude transversale prospective, la prévalence de l’infection à H. pylori dans une population en milieu urbain et rural. Nous avons déterminé la distribution par famille des sujets infectés, ainsi que l’influence des variables démographiques individuelles, et les caractéristiques socio-économiques familiales sur le risque de l’infection.<p>La prévalence de résistance primaire à la clarithromycine et au métronidazole fut observée respectivement dans 3% et 31% des souches isolées. Aucune résistance primaire à l’amoxicilline et à la tétracycline n’a été observée.<p>Les analyses en intention de traiter, ont montré que H. pylori a été éradiqué chez 80% des patients inclus dans l’étude thérapeutique. Le taux d’échec d’éradication fut de 20%. Comparé au 14C-TRU, le test HpSA avait une sensibilité de 100%, une spécificité de 91%, VPP de 69%, VPN de 100%. De même, la sensibilité du test HpSA par rapport aux deux méthodes usuelles (culture et histologie) est de 96.5% pour une spécificité de 91.2%, une VPP de 90.3% et une VPN de 96.8%. <p>Au Bénin, la prévalence de H. pylori était de 75.4% en ville et de 72.3% dans le village (p = 0.459). Aucune association n’a été observée avec l’âge, le sexe, le niveau d’instruction, la taille du ménage, l’activité économique ou le mode d’approvisionnement en eau potable. Le taux d’infection était plus élevé chez les enfants dont les parents étaient infectés et chez ceux ayant une mère H. pylori positive (p < 0.001). L’analyse multivariée par régression logistique a montré que la densité d’occupation des dortoirs [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), et le statut des mères dans le ménage ([OR (95%) = 3.85 (1.53-9.67)] p < 0.001) étaient les prédicteurs indépendants de l’infection par H. pylori. Le risque de l’infection chez les enfants était 13 fois plus élevé quand les deux parents sont simultanément positifs OR (95% CI) = 13.6 (3.63-51.22), il l’était respectivement de 5.3 (1.52-18.45); 2.7 (0.47-15.44), quand la mère et le père sont positifs p < 0.001. Aussi le risque d’infection à H. pylori comparé aux enfants qui dorment seul dans leur chambre, était élevé pour ceux qui dorment avec un ou deux personnes OR (95% CI) = 5.2 (1.08-25.16), p < 0.05, et plus élevé chez les enfants qui dorment à 4 ou plus OR (95% CI) = 16.6 (2.66-103.44), p < 0.005, comparé à ceux qui dorme seuls. Donc, le contact avec des personnes infectées au sein de la famille et la vie en promiscuité, étaient associés avec un risque d’infection plus élevé indiquant une transmission intrafamiliale de l’infection par H. pylori.<p>En conclusion, nos résultats montrent une séroprévalence encore élevée de l’infection à H. pylori dans la population béninoise. Une surveillance de l’épidémiologie accompagnée de mesures de prévention ciblées sur les facteurs potentiels de risque de l’infection doit être poursuivie. La validation du test de détection de l’antigène dans les selles avant traitement et dans le contrôle de l’éradication de la bactérie pour le suivi thérapeutique des patients infectés, est une alternative intéressante notamment au Bénin. Le taux de résistance primaire pour le métronidazole est actuellement stable en Belgique, alors que la prévalence de la résistance à la clarithromycine mérite d’être précisée par d’autres études multicentriques. La trithérapie classique à base d’inhibiteur de la pompe à protons–amoxicilline-clarithromycine reste recommandable en première intention. La surveillance épidémiologique de l’infection basée sur la prévalence locale des souches clarithro-résistantes et métronidazole-résistantes devrait être poursuivie.<p><p><p><p><p><p><p><p><p><p><p>SUMMARY OF THE THESIS<p>The major role of H. pylori in the etiopathogeny of various gastroduodenal diseases (gastritis, gastric and duodenal ulcers, gastric lymphoma) is well established today. The World Health Organization concluded that H. pylori plays a causal role in the chain of events leading to cancer of the stomach.<p>The prevalence of H. pylori infection varies by country from 20% to 90%, with higher prevalence rates over 60% observed in developing countries, including Bénin. The usual methods allowing the diagnosis of the gastric infection by H. pylori are either invasive, requiring a gastric endoscopy and biopsies (fast urease test, anatomopathological examination, culture and PCR), or noninvasive (breath test with 13C or 14C marked urea, serology and stool antigen detection). Triple therapy associating a proton pump inhibitor (PPI) with two antibiotics, chosen between amoxicillin, clarithromycin and metronidazole, is currently recommended. Resistance of H. pylori strains to antibiotics becomes a major determinant in the failure of eradication of regimens.<p>To evaluate the applicability and efficacy of the therapeutic recommendations in our pratice, based on a prospective study, we studied the prevalence of H. pylori infection in the outpatient population of the Gastroenterology clinic at the Erasme University hospital in Brussels, determined its rate of primary resistance to antimicrobial agents and evaluated the rate of eradication of H. pylori by triple therapy. We also evaluated the performance of a stool antigen detection test for the diagnosis of H. pylori infection in adults (before treatment) compared with reference methods (culture and histology) as well as in control of eradication.<p>In Benin, we evaluated by a cross-sectional study the prevalence of the infection with H. pylori in the population living in urban and rural environment. We determined the family distribution of infected subjects as well as the influence of individual demographic variables and of the socio-economic family characteristics on the risk of infection.<p>In Brussels, primary resistance to clarithromycin and metronidazole was observed in 3% and 31% of the isolates, respectively. No primary resistance to amoxicillin and tetracycline was observed. By intention to treat analysis, H. pylori was eradicated in 80% of patients included in the therapeutic study. The rate of eradication failure was 20%. In comparison with 14C-Urea breath test, the H. pylori Stool Antigen test showed a sensitivity of 100%, a specificity of 91 %, PPV of 69%, and NPV of 100%. Compared to the reference methods (culture and histology), the HpSA test had a sensitivity of 96.5% and a specificity of 91.2%. PPV of 90.3% and NPV of 96.8%. <p>In Benin, the prevalence of H. pylori antibodies was 75.4% in town and 72.3% in the village (P= 0.459). No association was found between infection and age, sex, education level, size of the household, economic activity or source of drinking water. The infection rate was higher in children of parents who were both infected and also in those whose mother was infected (p < 0.001). By logistic regression analysis, the density of occupation of dormitories (more than three persons sharing dormitory, [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), and mother status within the household ( [OR (95%) = 3.85 (1.53-9.67) ] p < 0.001), were independent predictors for H. pylori infection. The risk of H. pylori infection in children was 13 times higher when the two parents were simultaneously positive: OR (95% CI) = 13.6 (3.63-51.22) and it was respectively of 5.3 (1.52-18.45); 2.7 (0.47-15.44), when mother and father were positive p < 0.001. H. pylori infection risk in children was higher for a sharing a dormitory with one or two persons, OR (95% CI) = 5.2 (1.08-25.16), p < 0.05 and was even higher if a dormitory of 4 persons or more, OR (95% CI) = 16.6 (2.66-103.44), p < 0.005 as compared to sleeping alone. Family contact with infected persons and crowded living conditions were associated with increased risk of infection consistent with intrafamilial H. pylori transmission.<p>In conclusion, our results confirm a still high H. pylori seroprevalence in population in Benin. An epidemiolgic survey with prevention mesures targeted on potential risk predictors should be going on. Validation of antigen detection test in patients stools before treatment and for eradication control could be an interested alternative, notably in Benin. Primary resistance rate on metronidazole is stable today in Belgium, though the resistance prevalence on clarithromycin should be determined by other multicentric studies. Standard triple therapy by (PPI)-amoxicillin-clarithromycin is still recommended in first intention to treat. Epidemiological survey of infection based on local prevalence of claritromycin-resistant and metronidazole-resistant strains should be continued.<p><p><p><p><p><p> / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Introduction: The diagnosis of Helicobacter pylori (H. pylori) infection can be performed by non-invasive and invasive methods. The identification through test of fecal antigen (FAT) method is a non-invasive, simple, and relatively inexpensive. The aim of this study was to determine the diagnostic performance of immunoassay FAT in the identification of H. pylori infection. Methods: H. pylori antigens were identified in the stools of dyspeptic patients undergoing upper gastrointestinal endoscopy (UGE). The identification of H. pylori antigens was carried out through the ImmunoCard STAT! HpSA. Histopathology and urease test were the gold standard. Results: We studied 100 patients, 80% women and 20% men, with mean age of 52.7±11.8 years. The prevalence of H. pylori infection was 48%. The FAT immunoassay showed the following measures of diagnostic performance: specificity of 96% (95%CI 89.1-98.9); sensitivity of 65% (95%C I 56.9-67.6); positive predictive value of 94% (95%CI 82.8-98.3) and negative predictive value of 75% (95%CI 69.1-76.8). The accuracy was 80% (95%CI 74-84) and the prevalence odds ratio was 45,6 (95%CI 10,7-188,5). Conclusion: The FAT immunoassay presented high specificity and high positive predictive value. However, due to low sensitivity it would be appropriate to test it in a post-treatment period to assess the eradication of H. pylori. / Introdução: O diagnóstico da infecção por Helicobacter pylori (H. pylori) pode ser realizado por métodos invasivos e não invasivos. A identificação através do teste do antígeno fecal (TAF) é um método não invasivo, simples, fácil e relativamente barato. O objetivo deste estudo foi determinar o desempenho diagnóstico do TAF imunocromatográfico na identificação da infecção pelo H. pylori. Métodos: A pesquisa de antígenos fecais do H. pylori foi realizada através do ImmunoCard STAT! HpSA em pacientes dispépticos submetidos à endoscopia digestiva alta (EDA) com coleta de biópsias para histopatologia e teste da urease, utilizados como padrão ouro. Resultados: Participaram do estudo 100 pacientes, 80% eram mulheres e 20% homens, com média de idade de 52,7±11,8 anos. A prevalência da infecção pelo H. pylori foi de 48%. O TAF imunocromatográfico apresentou as seguintes medidas de desempenho diagnóstico: especificidade 96,2% (IC95% 89,1-98,9), sensibilidade 64,6% (IC95% 56,9-67,6), valor preditivo positivo 93,9% (IC95% 82,8-98,3) e valor preditivo negativo 74,6% (IC95% 69,1-76,8). A acurácia foi de 80% (IC95% 74-84). A razão de chances de prevalência para TAF positivo foi 45,6 (IC95% 10,7-188,5). Conclusão: O TAF imunocromatográfico apresentou elevada especificidade e valor preditivo positivo. Porém, devido sua baixa sensibilidade seria adequado testá-lo em um período pós-tratamento na avaliação da erradicação do H. pylori.

Peu étudiée et méconnue, initialement décrite au début du XXe siècle, Helicobacter pylori fut redécouverte en 1982 par deux chercheurs australiens, JR Warren et BJ Marshall. Ils soutinrent que la plupart des ulcères gastro-duodénaux étaient causés par cette bactérie, et non par le stress ou la nourriture épicée, comme pensé auparavant. Cette découverte révolutionna le monde de la gastroentérologie et leur valut le prix Nobel de physiologie et de médecine 2005. Environ la moitié de la population mondiale est colonisée par H. pylori au niveau de l'estomac. Dans 10 à 20% des cas, l'infection peut évoluer vers un ulcère gastro-duodénal et dans certains cas vers une transformation maligne. Cette infection se soigne classiquement à l'aide d'une trithérapie associant 2 antibiotiques à un inhibiteur de la pompe à protons pour neutraliser l'acidité gastrique.<p>Notre travail de recherche a consisté à analyser la proportion de patients infectés par H. pylori dans une cohorte de plus de 22.000 patients, issus de divers groupes ethniques, vivant en Belgique. Ces souches de H. pylori, isolées dans notre laboratoire, à partir des biopsies gastriques, ont aussi servi à une étude pour suivre l'évolution de la résistance aux antibiotiques ces 20 dernières années afin de proposer des améliorations de la prise en charge thérapeutique de l'infection à H. pylori en Belgique. / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Reaction of BiPh3 or Bi(OtBu)3 with benzohydroxamic acid (H2-BHA) results in formation of novel mono- and di-anionic hydroxamato complexes; [Bi2(BHA)3]∞1, [Bi(H-BHA)3] 2, [Bi(BHA)(H-BHA)] 3, all of which display nM activity against Helicobacter pylori. Subsequent dissolution of [Bi2(BHA)3]∞ in DMSO/toluene results in hydrolysis to the first structurally authenticated {Bi34} oxido-cluster [Bi34O22(BHA)22(H-BHA)14(DMSO)6] 4. / Dieser Beitrag ist aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / "May 2007" Includes bibliographical references (leaves 181-192).