Helicobacter pylori infection is a leading cause of gastric cancer, which is the second-most common cancer-related death in the world. The chronic inflammatory environment in the gastric mucosal epithelia during H. pylori infection stimulates intracellular signaling pathways, namely inflammatory signals, which may lead to the promotion and progression of cancer cells. We herein report two important signal transduction pathways, the LPS-TLR4 and CagA-MET pathways. Upon H. pylori stimulation, lipopolysaccharide (LPS) binds to toll-like receptor 4 (TLR4) mainly on macrophages and gastric epithelial cells. This induces an inflammatory response in the gastric epithelia to upregulate transcription factors, such as NF-κB, AP-1, and IRFs, all of which contribute to the initiation and progression of gastric cancer cells. Compared with other bacterial LPSs, H. pylori LPS has a unique function of inhibiting the mononuclear cell (MNC)-based production of IL-12 and IFN-γ. While this mechanism reduces the degree of inflammatory reaction of immune cells, it also promotes the survival of gastric cancer cells. The HGF/SF-MET signaling plays a major role in promoting cellular proliferation, motility, migration, survival, and angiogenesis, all of which are essential factors for cancer progression. H. pylori infection may facilitate MET downstream signaling in gastric cancer cells through its CagA protein via phosphorylation-dependent and/or phosphorylation-independent pathways. Other signaling pathways involved in H. pylori infection include EGFR, FAK, and Wnt/β-Catenin. These pathways function in the inflammatory process of gastric epithelial mucosa, as well as the progression of gastric cancer cells. Thus, H. pylori infection-mediated chronic inflammation plays an important role in the development and progression of gastric cancer.

No description available.

The mucosal immunity of the gastrointestinal (GI) tract is constituted by a complex, highly specialized and dynamic system of immune components that aim to protect the gut from external threats. The sustained exposure of the mucosal immune system of the GI tract to an enormous number of lumen antigens, requires the constant upkeep of a highly regulated balance between initiation of immune responses against harmful agents and the generation of immune tolerance towards innocuous antigens. Therefore, the regulatory component is key to preserve tissue homeostasis and a normal functioning of the system. Indeed, defective regulatory responses lead to the development of pathological conditions, including unresolved infections, and inflammatory diseases. In this study, we aim to elucidate novel mechanisms involved in host-pathogen interactions during Helicobacter pylori and Clostridium difficile infections. Indeed, this work integrates preclinical in vivo and in vitro experimental approaches together with a bioinformatics pipeline to identify and characterize novel regulatory mechanisms and molecular targets of the mucosal immune system during enteric infections. Firstly, we identified a novel regulatory mechanism during H. pylori infection mediated by a specific subset of IL10-producing tissue resident macrophages. Secondly, we employed an ex vivo H. pylori co-culture with bone marrow derived macrophages, that together with a global transcriptomic analysis and a bioinformatics pipeline, lead to the discovery of promising regulatory genes based on expression kinetics. Lastly, we characterized the innate inflammatory responses induced during the course of C. difficile infection and identified IL-1ß, and its subsequent induction of neutrophil recruitment, as a key mediator of C. difficile-induced effectors responses. The characterized regulatory mechanisms in this work show promise to lead the generation of new host-centered therapeutics through the modulation of the immune response as promising alternative treatments for infectious diseases. / Doctor of Philosophy / The immune system is responsible for protecting the human body from external threats. To achieve this goal, it must differentiate between harmless and harmful agents to only fight the latter. To combat these dangerous agents, the immune system induces highly controlled, inflammatory processes that aim to eliminate the external threat while minimizing the damage of human tissues and organs. The gastrointestinal tract is exposed to an enormous number of molecules, mostly harmless molecules from both the ingested food and the beneficial bacteria inhabiting the gut, but also from harmful bacteria and agents, only separated from the internal body structures by a thin layer called the epithelial barrier of the gut. The immune system responsible for the protection of the gastrointestinal tract includes an important regulatory component critical to maintain a proper gut function. This regulatory component regulates the generation of inflammatory processes to fight the dangerous agents, while blocking the responses against the inoffensive agents and preventing excessive tissue damage to maintain the integrity of the epithelial barrier. Indeed, a failure in the regulatory component results in severe consequences for the body's health, such as the inability to resolve infections. In this study, we aim to investigate the interaction between the human body and the enteric bacteria Helicobacter pylori and Clostridium difficile, to bring new insights in the regulatory component of the immune system of the gut. Moreover, the new mechanisms discovered in the regulatory system, might allow the development of new treatments for infectious diseases.

The gastrointestinal mucosal immune system has the daunting task of maintaining immune homeostasis by eliminating potentially harmful microorganisms and limiting tissue injury while inducing tolerogenic responses to luminal antigens including innocuous food, commensal bacteria and self-antigens. This carefully orchestrated system depends on elaborate down-regulating mechanisms that mediate and maintain a state of tolerance under normal conditions. Changes in such delicate balance are linked to the development of gastrointestinal pathology as well as systemic disease states. Despite the rapid increase in our appreciation of the gastrointestinal immune system, there is still a major disconnect between the description of how mucosal immune responses are organized and controlled and an insufficient mechanistic understanding of how such responses shape and influence disease outcome and pathogenesis. By using model enteric microorganisms Helicobacter pylori and Clostridium difficile, this dissertation presents a systematic effort to generate novel mechanistic hypothesis based on computational predictions and experimentally elucidate the mechanisms of action underlying mucosal immune responses and pathology in the gut. In this thesis I present i) an overview on mucosal immunology and the need to develop novel therapeutics that limit the pathogenic effects of invading bacteria while maintaining their protective functions, ii) the role of miRNAs in the modulation of immune responses to enteric pathogens, iii) the mechanisms by which Helicobacter pylori is able to limit effector inflammatory responses required for bacterial clearance thus favoring tolerance over immunity, iv) intracellular mechanisms of immune evasion that contribute to bacterial persistence and chronic infection. The knowledge generated throughout this dissertation exemplifies how a combination of computational modeling, immunoinformatics and experimental immunology holds enormous potential for discovering unforeseen targets and developing novel vaccines and cures for infectious, allergic and immune-mediated diseases. / Ph. D.

Bakgrund: Helicobacter pylori är en viktig bakterie som kan leda till magcancerutveckling, då den ökar risken för magcancer med 4–6 gånger. År 2020 rapporterades över en miljon Helicobacter pylori-relaterade magcancer och runt 800 000 dödsfall. Från 2014 har världshälsoorganisationen rekommenderat att Helicobacter pylori ska utrotas för att minska antal dödsfall av magcancer över hela världen. Behandling av Helicobacter pylori består oftast av två olika antibiotika och protonpumpshämmare. Flera kliniska studier visade att probiotika som komplement till standard eradikeringsbehandling av Helicobacter pylori ökar eradikeringsfrekvens och minskar biverkningar till följd av antibiotikabehandling. Syfte: Studien syftar till att granska och analysera publicerade kliniska prövningar för att studera effekten av probiotika som komplement till standardterapi på eradikering av Helicobacter pylori.Metod: Fem randomiserade, placebo-kontrollerade kliniska prövningar granskades. Sökningen av studier gjordes i januari 2024 med hjälp av PubMed och Google Scholar databaser. Resultat: Fyra av fem studier visade statistiskt signifikant skillnad i Helicobacterpylori eradikeringsfrekvens hos patienter som behandlades med probiotika, som komplement till eradikeringsbehandling, jämfört med placebo. Två av fem studier visade statistiskt signifikant skillnad i antibiotikaassocierade biverkningar hos interventiongruppen jämfört med placebo.Slutsats: Probiotika som komplement till standarderadikeringsbehandling är effektiv på att öka Helicobacter pylori eliminering och utrotningshastigheten.

Cette thèse présente la découverte de nouveaux inhibiteurs de l’amidotranférase ARNt-dépendante (AdT), et résume les connaissances récentes sur la biosynthèse du Gln-ARNtGln et de l’Asn-ARNtAsn par la voie indirecte chez la bactérie Helicobacter pylori. Dans le cytoplasme des eucaryotes, vingt acides aminés sont liés à leur ARNt correspondant par vingt aminoacyl-ARNt synthétases (aaRSs). Ces enzymes sont très spécifiques, et leur fonction est importante pour le décodage correct du code génétique. Cependant, la plupart des bactéries, dont H. pylori, sont dépourvues d’asparaginyl-ARNt synthétase et/ou de glutaminyl-ARNt synthétase. Pour former le Gln-ARNtGln, H. pylori utilise une GluRS noncanonique nommée GluRS2 qui glutamyle spécifiquement l’ARNtGln ; ensuite, une AdT trimérique, la GatCAB corrige le Glu-ARNtGln mésapparié en le transamidant pour former le Gln-ARNtGln, qui lira correctement les codons glutamine pendant la biosynthèse des protéines sur les ribosomes. La formation de l’Asn-ARNtAsn est similaire à celle du Gln-ARNtGln, et utilise la même GatCAB et une AspRS non-discriminatrice. Depuis des années 2000, la GatCAB est considérée comme une cible prometteuse pour le développement de nouveaux antibiotiques, puisqu’elle est absente du cytoplasme de l’être humain, et qu’elle est encodée dans le génome de plusieurs bactéries pathogènes. Dans le chapitre 3, nous présentons la découverte par la technique du « phage display » de peptides cycliques riches en tryptophane et en proline, et qui inhibent l’activité de la GatCAB de H. pylori. Les peptides P10 (CMPVWKPDC) et P9 (CSAHNWPNC) inhibent cette enzyme de façon compétitive par rapport au substrat Glu-ARNtGln. Leur constante d’inhibition (Ki) est 126 μM pour P10, et 392 μM pour P9. Des modèles moléculaires ont montré qu’ils lient le site actif de la réaction de transmidation catalysée par la GatCAB, grâce à la formation d’une interaction π-π entre le résidu Trp de ces peptides et le résidu Tyr81 de la sous-unité GatB, comme fait le A76 3’-terminal de l’ARNt. Dans une autre étude concernant des petits composés contenant un groupe sulfone, et qui mimiquent l’intermédiaire de la réaction de transamidation, nous avons identifié des composés qui inhibent la GatCAB de H. pylori de façon compétitive par rapport au substrat Glu-ARNtGln. Cinq fois plus petits que les peptides cycliques mentionnés plus haut, ces composés inhibent l’activité de la GatCAB avec des Ki de 139 μM pour le composé 7, et de 214 μM pour le composé 4. Ces inhibiteurs de GatCAB pourraient être utiles pour des études mécanistiques, et pourraient être des molécules de base pour le développement de nouvelles classes d’antibiotiques contre des infections causées par H. pylori. / This thesis describes the discovery of inhibitors of a tRNA-dependent amidotransferase (AdT) and summarizes the present state of our knowledge about the two-step biosynthesis of Gln-tRNAGln and Asn-tRNAAsn in Helicobacter pylori. In eukaryotic cytoplasm, twenty amino acids (aa) are generally attached to their cognate tRNAs by twenty corresponding aminoacyl-tRNA synthetases (aaRSs). These enzymes have a high specificity, and their function is important to the proper decoding of mRNA. However, in a number of bacteria including H. pylori, GlnRS and/or AsnRS are absent. To synthesize Gln-tRNAGln, H. pylori first uses a noncanonical GluRS2 which is specific for tRNAGln to form Glu-tRNAGln; then the trimeric AdT (GatCAB) transforms Glu-tRNAGln into Gln-tRNAGln which is proper for protein biosynthesis. In a similar manner, the biosynthesis of Asn-tRNAAsn also takes place in H. pylori by using the same GatCAB and a canonical nondiscriminating AspRS. The widespread use of these indirect pathways among prominent human pathogens, and their absence in the mammalian cytoplasm, identify AdT as a promising target for the development of new and highly specific antimicrobial agents. By using phage display, we discovered several cyclic peptides rich in tryptophan and proline that inhibit H. pylori GatCAB. Peptides P10 (CMPVWKPDC) and P9 (CSAHNWPNC) are competitive inhibitors of GatCAB with respect to its substrate Glu-tRNAGln. The inhibition constants (Ki) of P10 and P9 are 126 and 392 μM, respectively. Their docking models revealed that they bind to the transamidation active site of GatB via π-π stacking interactions with Tyr81, as does the 3’-terminal A76 of tRNA. We also discovered two small dipeptide-like sulfone-containing inhibitors of H. pylori GatCAB by mimicking the intermediate of its transamidation reaction. Although they are much smaller than the cyclic peptides mentioned above, they are competitive inhibitors of GatCAB with respect to GlutRNAGln, with Ki values of 139 μM for compound 7 and 214 μM for compound 4. These inhibitors could be useful not only to study the reaction mechanisms of GatCAB, but also could be lead compounds for the development of a new class of antibiotics to treat infections caused by H. pylori.

Ces dernières années de nombreuses recherches ont montré l’importance des petits ARN dans la régulation de l’expression des gènes, chez tous les organismes vivants, des bactéries aux mammifères. Le projet de cette thèse était de recherche et d’identifier des petits ARN chez une bactérie pathogène pour l’homme, Helicobacter pylori (Hp). Cette bactérie colonise exclusivement l’estomac humain, un organe qui pendant longtemps a été considéré comme étant stérile, en raison du pH parfois très acide qui y règne. L’infection persistante de l’estomac humain causée par Hp est associée avec plusieurs pathologies gastriques tels que les gastrites, les ulcères peptiques, les cancers gastriques et les lymphomes du MALT. La moitié de la population est infectée par Hp, qui est responsable d’environ 1 million de décès par an à travers le monde, et de 6000 nouveaux cas de cancers gastrique par an en France. Au cours de ma thèse, j’ai travaillé en étroite collaboration avec le groupe du Pr. Jörg Vogel (RNA Biology, MPI, Berlin, Allemagne) pour développer une méthode rapide et efficace d’analyse du transcriptome complet d’Hp, en s’appuyant sur une nouvelle sur une technologie émergente de pyroséquençage haut-débit (HTPS 454 technology, Life Science, USA). Notre méthode de séquençage du transcriptome d’Hp à partir de banques enrichies en transcrits primaires (dRNA-seq), nous a permis d’identifier les sites d’initiation de la transcription (TSS) de milliers de d’ARN. Plus de la moitié de ces TSS ont été associés à des petits ARN non codants, de courte taille (de 50 à 250 nucléotides en moyenne), qui n’avaient jamais été découverts jusqu’alors, et dont les gènes sont localisés dans des régions intergéniques (sRNA) ou en antisens (asRNA) par rapport aux ORF précédemment annotées dans le génome d’Hp. Nos travaux ont également permis de mettre en évidence une forte activité de transcription antisens sur l’ensemble du génome de la bactérie, un phénomène déjà observé chez E. coli et les eucaryotes. Ainsi, au moins un TSS est localisé sur le brin opposé à 46 % des ORF et à 28% des régions « leaders » des précurseurs des ARNr 23S et 16S, et des ARNt. Enfin, l’approche dRNA-seq a permis l’identification de la première famille de toxines de type I (AapA) identifiée à ce jour chez Hp. Dans ces conditions normales de culture, la traduction de ces toxines est constitutivement réprimée par des petits ARN antisens (IsoA) qui ciblent les ARNm aapA par complémentarité de base. Malgré leur homologie avec des modules toxine-antitoxine identifiés chez d’autres bactéries, pour certaines impliquées dans la réponse aux stress, nous n’avons pas encore découvert les conditions dans lesquelles ces peptides aapA seraient exprimées chez Hp, et leur rôle biologique reste à élucider. / In the past few years, small regulatory RNAs have emerged as an important class of post-transcriptional regulators of gene expression. Indeed they have been identified and/or predicted to exist in all species ranging from bacteria to mammals. The project of this thesis was to search for small non coding RNAs in a human pathogen: Helicobacter pylori (Hp). This bacterium exclusively colonizes the human stomach, an organ that until recently was thought to be sterile due to its extreme acidity. It is now established that persistent colonization by Hp is associated with various gastric pathologies including gastritis, peptic ulcer, gastric cancer and MALT lymphoma. Half of the human population is infected by Hp that is responsible for about 1 million deaths per year and around 6000 cases of gastric cancer in France. During my thesis we , in a close collaboration with the group of Joerg Vogel (RNA biology, MPI, Berlin, Germany) developed a rapid and efficient method to reveal the whole transcriptome of Hp based on recent advances in high-throughput pyrosequencing technologies (HTPS 454 technology, Life Science, USA). By using specifically enriched libraries in primary transcripts, our strategy allowed us to map thousand (1907) of transcription start sites (TSS) on the Hp genome. More than half of these TSS correspond to new short transcripts (non coding RNAs, between 50 and 250 nucleotides in length) that have never been annotated in this genome and that are localized both in intergenic regions (sRNA) and in regions antisense to annotated ORFs (asRNA). Analysis of associations between primary transcription start sites (pTSS) revealed more complexity in the Hp transcriptome than previously anticipated: around one third (27%) of pTSS belong to antisense transcripts (aTSS). The strikingly high degree of antisense transcription occurs, similar to E. coli and higher eukaryotes, across the entire Hp genome. Overall, at least one aTSS is linked to ~46% of all ORFs, ~28% of tRNAs, and the 5’ leaders of 23S and 16S rRNA precursors. Finally our dRNA-seq approach led us to identify the first family of putative type I toxins (AapA) in the Hp genome. Under normal growth conditions these toxins are constitutively repressed by a sophisticated antisense RNA-mediated (IsoA) mechanism. Despite their homology to other toxin-antitoxin modules previously described in other bacteria, we have not found physiological conditions under which these peptides are expressed and have yet to determine the biological significance (if any ?) of these suicide genes.

L’utilisation des nanoparticules Janus pour la délivrance de médicaments suscite un grand intérêt depuis quelques années. Cependant, beaucoup d’aspects sont encore à comprendre dans la préparation de tels systèmes, notamment en présence de principes actifs.Le but de cette thèse était d’étudier des nanoparticules compartimentées Janus (JNP) constituées d’excipients lipidiques, et principalement de glycérides polyoxyéthylénés. Les objectifs étaient, d’une part, une meilleure compréhension de la structure et de la physico-chimie de ces objets puis, d’autre part, leur utilisation contre Helicobacter pylori (H. pylori).Ces JNP sont produites facilement par un procédé d’homogénéisation haute pression qui a permis de fabriquer des lots allant de 10 mL à 1 L. Elles ont été caractérisées par cryo-microscopie, calorimétrie, diffraction des rayons X, diffusion quasi-élastique de la lumière notamment et ont montrées une très grande stabilité physique sur plus d’un an. Les résultats les plus intéressants ont été obtenus avec une formulation contenant 20% de phase lipidique (Labrafil® M1944CS ou Labrafil® M2125CS) et 3% d’un mélange de tensioactifs (Gelucire® 50/13 – Phospholipon® 90G 2:1 en masse). Diverses expériences autour de la formulation et du procédé ont permis d’identifier certains paramètres critiques, notamment la nature de la phase lipidique, l’ordre d’incorporation des excipients ou le taux de diesters de PEG 1500.Des essais d’encapsulation dans ces JNP et de protection d’un principe actif instable en milieu acide, l’érythromycine, ont également été menés. Les nanodispersions formées, physiquement stable pendant au moins 6 mois, avaient une taille de l’ordre de 150 nm et une distribution de taille unimodale. Des tests in vitro ont montré que l’érythromycine encapsulé gardait son efficacité anti-microbienne et était plus stable en milieu acide. Par contre, les nanoparticules ont perdu leur compartimentation en présence d’érythromycineEnfin, des études ont été menées pour comprendre l’influence de l’incorporation de principes actifs (API) sur le procédé. Ainsi, il a été montré que l’ajout de caféine, chloroxylénol, quercétine et tricloasan dans la formulation n’altérait pas la morphologie des JNP contrairement à l’érythromycine et à la dioxybenzone dans une moindre mesure.L’ensemble de ces résultats a montré que les nanoparticules compartimentées Janus sont des systèmes prometteurs de transport et de protection de principes actifs. / The use of Janus nanoparticles (JNPs) as constituent of drug delivery formulations has been a topic of considerable interest for the past several years. However, the formation of vesicles and nanoparticle-associated drug/active are still unclear.The aim of the present study was a physicochemical characterization of lipid nanodispersions based on polyoxylglycerides, especially focused on lipid-based JNPs. The experiments should lead to a better understanding of structure and behavior of the very interesting carrier system on Helicobacter pylori (the abbreviation is H. pylori).The multicompartment lipid-based JNPs were produced easily at small (10 to 50 ml/batch) and large scale (1 liter/batch) by hot high pressure homogenization method. Samples were very well long-time stable for at least over 12 months with respect to particle size, DSC, XRD, and special particle morphology characteristics. Especially for particles containing 20% of lipid phase (Labrafil® M1944CS or Labrafil® M2125CS) and surfactant mixture of Gelucire® 50/13 – Phospholipon® 90G (2:1), strong adhesion could be observed in the studies by cryo-TEM technique. By changing the formulation components and process parameters, data showed that the formation of the multicompartment lipid-based JNPs depended on the using of suitable oil phase with the surfactant mixture and the method to produce the vesicles under the identified conditions.We also successfully prepared the stable nanodispersions to protect a labile antibiotic, erythromycin. The mean diameter of the ERY-loaded nanodispersions was found approximately 150 nm, and the size distribution was unimodal. The system was physically stable at room temperature for over six months. The test of antimicrobial activity in vitro on H. pylori showed that not only the preparation process did not reduce the antimicrobial activity of erythromycin, but also the stability of erythromycin was also improved in acidic environment.Furthermore, the properties of APIs loaded into the blank vesicles also affected their particle morphologies. We achieved the nanoparticles like JNPs when loading caffeine, chloroxylenol, quercetin, and triclosan into the vesicles. These results demonstrated that the multicompartment lipid-based JNPs are a promising carrier to protect unstable APIs and enhance their stability and solubility, despite the changes in the structure of the JNPs when incorporating with erythromycin or dioxybenzone.

A HP1076 null mutant has been constructed to provide a better understanding of the biological significance of HP1076 in H. pylori . The DeltaHP1076 mutant displays impaired motility and resistance to the antibiotic drug metronidazole. Using a proteomic study, an overall of 40 differentially expressing proteins involved in metabolism and pH homeostasis for bacterial survival, adhesion for colonization, virulence factor to gastric epithelial cells and antigenic proteins have been identified. The virulence factor, Cag pathogenicity island protein (Cag 26) and urease UreA and UreB are confirmed to have enhanced and reduced expression in null mutants. These findings may provide new insight into the infection of H. pylori. / FliS is an export chaperone that binds to flagellin molecules in cytosol in order to prevent pre-mature polymerization. Disruption of FliS would result in formation of shorter flagella and impaired adhesion ability to epithelial cells. Previous yeast two-hybrid study has identified various FliS associated proteins in H. pylori, but with no known implications. Here, we have demonstrated the interaction of FliS and a hypothetical protein HP1076 by biochemical and biophysical methods. Moreover, HP1076 possesses anti-aggregation ability on insoluble FliS-mutants and chaperone activity. Thus, HP1076 is proposed to be a co-chaperone that promotes the folding and chaperone activity of FliS. FliS is demonstrated to have a broad range of substrate specificity that binds to flagellin and flagellar related proteins which may play a key role in flagellar export system different from other flagellated bacteria. / Helicobacter pylori is a pathogenic bacterium and adheres to the gastric mucosal cells. Chronic infection would lead to gastritis or peptic ulceration and is one of the leading causes of gastric cancer. Formation of functional flagella is essential for infection, that it aids in motility of bacteria and colonization on gastric epithelial cells. The process is complex and involves more than 50 proteins in assembly of structural proteins, regulatory proteins, an export apparatus, a motor and a sensory system. Cytosolic chaperones are required to bind to exported proteins in order to facilitate the export or prevent the aggregation of proteins in cytosol. Divergence is found in flagellar system H. pylori that may account for survival inside gastric environment. / The crystal structures of FliS, HP1076 fragment and FliS/HP1076 complex are determined at 2.7A, 1.8A and 2.7A resolution respectively to provide better understanding of their molecular interactions. FliS consists of four helices and HP1076 consists of helical rich bundle structure with three helices and three beta strands that share similar fold to that of a flagellin homologue, hook-associated protein and FliS, suggesting HP1076 is involved in flagellar system. The FliS/HP1076 complex reveals an extensive electrostatic and hydrophobic binding interface which is distinct from the flagellin binding pocket on FliS. HP1076 stabilizes two alpha helices of FliS and therefore the overall bundle structure. Our findings provide new insights into the flagellar export chaperones and other secretion chaperones in Type III secretion system. / Lam, Wai Ling. / Adviser: An Wing-Ngor. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 223-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

INTRODUÇÃO: A prevalência da úlcera péptica e outras afecções esofagogastroduodenais associadas à infecção pelo H. pylori foram alteradas em decorrência da erradicação desta infecção e uso de inibidores de secreção gástrica ácida. OBJETIVO: Determinar a prevalência da infecção pelo Helicobacter pylori associada às afecções diagnosticadas pela endoscopia digestiva alta e analisar fatores de risco. MÉTODOS: Foram analisados dados de 1478 pacientes, e as informações dos achados endoscópicos foram correlacionadas com resultado de teste de urease, faixa etária e gênero. Os pacientes com exame endoscópico normal foram considerados como grupo controle para análise estatística dos fatores de risco, perfazendo um total de 272 indivíduos. RESULTADOS: A prevalência da infecção por H. pylori foi de 53% (n=786), e maior na faixa etária entre 31 e 40 anos. Os achados endoscópicos mais frequentes foram gastrites (n=810; 54,8%), úlceras pépticas duodenais e gástricas (n=494; 33,4%), duodenites (n=287; 19,4%) e esofagites (n=217; 14,7%). Apenas a gastrite nodular e úlcera péptica foram associadas com infecção por H. pylori (p<0,05). Gastrite erosiva no antro (n=644, 78,5%) predominou em relação à pangastrite (n=166; 20,2%) e aquelas no corpo (n=19; 2,3%). Entre os casos de úlcera péptica, 103 (7%) foram gástricas, 343 (23,2%) foram duodenais e 48 (3,2%) foram gástrica e duodenal. A esofagite geralmente foi leve (grau A; 63,1%), 23,5% foram moderada (grau B) e 13,3% foram intensa (graus C e D). Infecção por H. pylori aumentou o risco de úlceras gástrica e duodenal em 1,9 e 1,6 vezes, respectivamente. Gênero masculino e maior idade foram riscos de todas as outras afecções. CONCLUSÃO: Infecção pelo H. pylori associada com maior idade e gênero masculino foram determinantes importantes para evolução de afecções gastrintestinais / Introduction: Peptic ulcer prevalence and other esophageal and gastroduodenal disorders associated with H. pylori infection changed as a consequence of its eradication and the use of gastric acid secretor inhibitors. Purpose: To establish H. pylori infection prevalence associated with clinical disorders diagnosed by upper gastrointestinal endoscopy, and determine the risk factors. Methods: Data from 1478 patients were analyzed, and the endoscopic findings were correlated with the urease test results, age and gender. Patients with normal endoscopy were considered control group for statistical analysis of the risk factors, comprising a total of 272 individuals. Results: The overall prevalence of H. pylori infection was 53% (n=786), being higher between 31 and 40 years old. The most frequent endoscopic findings were gastritis (n=810, 54.8%), peptic ulcer (n=494, 33.4%), duodenitis (n=287, 19.4%) and esophagitis (n=217, 14.7%). Only nodular gastritis and peptic ulcer were associated with H. pylori infection (p<0.05). Erosive gastritis (70%) in the antrum (n=644; 78.5%) predominated in relation to pangastritis (n=166, 20.2%) and the ones in the corpus (n=19, 2.3%). Among peptic ulcer cases, 103 (7%) were gastric, 343 (23.2%) were duodenal and 48 (3.2%) were gastric and duodenal. Esophagitis usually was mild (grade A in 63.1%), 23.5% were moderate (grade B) and 13.3% were intense (grades C and D). H. pylori infection increased the risk of gastric and duodenal ulcers by 1.9 and 1.6-fold, respectively. Male gender and being older were risks of all the other conditions. Conclusion: H. pylori infection associated with older age and male gender were important determinants to gastrointestinal diseases outcome