Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national incidence rates of H. pylori antimicrobial resistance. Of 347 clinical H. pylori isolates collected from December 1998 through 2002, 101 (29.1%) were resistant to one antimicrobial agent, and 17 (5%) were resistant to two or more antimicrobial agents. Eighty-seven (25.1%) isolates were resistant to metronidazole, 45 (12.9%) to clarithromycin, and 3 (0.9%) to amoxicillin. On multivariate analysis, black race was the only significant risk factor (p < 0.01, hazard ratio 2.04) for infection with a resistant H. pylori strain. Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk populations may be important for future clinical practice.

This multicentre study sought to estimate the incidence of upper gastrointestinal (UGI) bleeding in haemophiliacs and its relationship to use of non-steroidal anti-inflammatory drugs (NSAIDs). Cox models were used to estimate relative hazards (RH) with 95% confidence intervals (CI) for postulated risk factors. Conditional logistic regression and stored sera were used to assess UGI bleeding risk with Heliobacter pylori seropositivity in cases compared with closely matched controls. During a mean of 17.4 months (range 2-34), 2285 participants, ages 13-89 (mean 36.5) were followed for 3309 person-years (py). Forty-two experienced a UGI bleeding event (incidence 1.3 per 100 py), most from ulcer (11), gastritis (four), varices (five) and Mallory Weiss tears (eight). RH was significantly increased with traditional NSAID use for <1 month (OR: 3.66; 95% CI: 1.1-11.9), but not with coxibs use. RH was significantly and independently increased with age >46 years (3.5; 95% CI: 1.1-10.6) and hepatic decompensation (4.4; 95% CI: 1.7-11.6). Likelihood of bleeding was substantially but not significantly increased (OR: 4.6; 95% CI: 0.3-83.9) with H. pylori seropositivity. These findings suggest that coxibs are a safer alternative than traditional NSAIDs in the treatment of haemophilic arthropathy.

No abstract

These results support the reliability, validity, and responsiveness of both versions of the PGSQ. The instruments should be useful for clinical studies.

Objectives. To determine seroprevalence of H. pylori infection in non-Native educators residing in urban or rural settings in Alaska, and to determine potential risk factors associated with infection in this population. Study design. A cross-sectional survey of non-Native educators residing in urban or rural settings in Alaska. Methods. Participants completed a questionnaire detailing aspects of residential life; H. pylori antibody status was determined by a commercial assay. Results. Of the 203 non-Native participants, 49 (24%) had antibody to H. pylori. Univariate analysis demonstrated that the mean age of seropositive participants was higher than of seronegatives (48 vs. 42 years, respectively, p=.001). In addition, participants who had experienced childhood crowding were more likely to test seropositive for H. pylori (p=.058). On multivariate analysis, only age ≥ 40 was associated with infection. No difference in median hemoglobin or ferritin levels were noted among seropositive and seronegative participants. There was no increased risk of seropositivity among participants who had lived in an Alaska Native village or in a developing country for > 6 months. Conclusions. Overall, 24% of non-Native educators residing in rural Alaska tested positive by serology for H. pylori. Age ≥ 40 years was associated with infection. Median hemoglobin or ferritin levels did not differ significantly among seropositive and seronegative participants.