Background and Objectives: Helicobacter pylori is a genetically diverse gastric pathogen that chronically infects billions of people worldwide, typically beginning in infancy and lasting for decades. It is a major cause of peptic ulcers and it is an early risk factor for gastric cancer which is the most frequently lethal malignancy globally. This project was designed to genotype H. pylori isolates isolated from patients with NUD, DU, GU and GC by the polymerase chain reaction (PCR)-based on Randomly Amplified Polymorphic DNA (RAPD) fingerprinting technique.Material and Methods: Eighty patients admitted to the gastroenterology unit at Sharyati hospital in Iran were included in this study. Gastric biopsy specimens were inoculated onto selective medium then were cultured for 3 to 5 days at 37°C under microaerobic conditions. Genomic DNA was extracted using a commercially available Qiagen kit. RAPD-PCR was used to genotype isolates.Results: Six different RAPD patterns (A-F) were seen in more than one isolate which were as follow; pattern A: 9 (16.98%), B: 6 (11.33%), C: 5 (9.43%), D: 3 (5.66%), E: 2 (3.77%) and F: 2 (3.77%). Twenty six (49.06%) of 53 isolates showed a unique RAPD pattern that were not similar to each other. A significant relationship was not seen between a single RAPD pattern and a gastric disorder (P>0.05). Conclusion: The results of this study suggest a high level of DNA sequence diversity among H. pylori isolates and it is better to use sequencing method for surveying of Helicobacter pylori genome rather than RAPD-PCR.

Background: Non Ulcer Dyspepsia (NUD) is among the most common causes of referring to gastroenterologists, which has unknown etiology. The role of Helicobacter Pylori infection in NUD and the effects of therapy are not obvious, and review of literature has shown deep controversies in this field. The present study has been conducted with the aim of determining the prevalence of Helicobacter Pylori infection and also the effects of therapy on symptoms removal in patients with NUD referring to Shohada-e – Tajrish hospital since 1996till 1998.Materials and methods: To determine the role of Helicobacter Pylori infection in NUD, a case-control study was conducted over 124 individuals (83 as the case and 41 as the control group), whereas, to survey the effects of therapy, an experimental study was performed over 36 individuals (18 as the case and 18 as the control group). The case group was received triple therapy of Bismuth sub citrate + Metronidazole + Amoxicillin, and the control was given Ranitidin + Antiacid. Then, the clinical features before and after the therapy was cOlllpared in both groups. The efficacy of therapy was assessed a month later with endoscopy and urease test.Results: The prevalence of Helicobacter Pylori infection was reported 43.3% and 19.5% in the case and control group, respectively. (p<0.01) Helicobacter Pylori infection has increased the risk of NUD incidence by 3.2. In the second phase, 36 patients with NUD were distributed in two groups of case (18) and control (18). They have been compared regarding the symptoms' severity after two and six weeks. At the end of the 2ndweek, nocturnal epigastria pain was the only symptom shown greater decrease in the case group (p<0.08), whereas, at the end of the 6thweek, both nocturnal and daily epigastric pain shown greater decrease in the case group. (p<0.05) Other symptoms have shown no significant difference between the two groups. Eradication of Helicobacter Pylori revealed to be successful in 66.6%.Conclusion: Patients with NUD are 3.2 times as likely as normal individuals to be infected with Helicobacter Pylori. Triple therapy seems to be effective in patients with NUD, especially for removal of nocturnal and daily epigastric pain.

Background and Purpose: Helicobacter pylori are a bacterial pathogen evolved to chronically colonize the gastric epithelium and causes gastritis, peptic ulcers, and even gastric malignancies in few infected humans. More recently, a pathogenicity island has been identified within the H pylori genome that contains a cluster of genes, including cagE. The aim of the current study was to investigate the prevalence of cagE genotypes of H pylori isolates from patients with NUD (Non Ulcer Dyspepsia), peptic ulcer and cancer.Materials and Methods: 150 Gastric biopsy specimens obtained from patients were inoculated onto a Brucella Columbia Agar containing 5% sheep for 3 to 5 days at 37°C under micro aerobic conditions (5% O2, 5% CO2, and 90% N2). After DNA extraction, genotyping of the cagE gene was performed by PCR amplification using the primers. PCR products were separated by 1% agarose gel electrophoresis and examined under UV illumination.Results: Of 92 positive cultures, 34, 28, 20, and 10 isolations were obtained from patients with NUD, duodenal ulcers (DU), gastric ulcers (GU) and gastric cancer (GC), respectively. The frequency of cagE gene was 88/24%, 100%, 85%, 100%and within isolates of patients with NUD, DU, GU and GC, respectively.Conclusion: The presence of cagE in patients with Helicobacter pylori infection is not a marker for predicting or diagnosing the resultant diseases.

Introduction: One of the etiological causes of nonulcer dyspepsia (NUD) is H. pylori infection. The role of H. pylori infection in dyspepsia and its accompaniment with hormonal disorders remain controversial. We studied the association between existence of H. pylori and variation of Colecystokinin (CCK) and gastrin in NUD patients.Methods: One hundred consecutive out patients with NUD that referred to Taleghani Hospital in Tehran from May 2002 to January 2003 were studied. Demographic and clinical examinations were fulfilled and basal serum gastrin and CCK level and IgG anti H. pylori were measured. After through endoscopic evaluation, gastric mucosal biopsies were taken from all patients for investigation of H. pylori (Rapid urease test (R.U.T), direct exam and IgG Anti H. pylori tests) and histological assessment.Results: 100 NUD patients including 48 (48%) male and 52(52%) female were studied. 11 patients were smoker. Fullness (62%) was the predominant symptoms in them. 59% of patients complained of abdominal pain, 57% of early satiety, 42% of anorexia, 17% of dysphagia, 46% of nausea and 20% of vomiting. 78 (78%) of patients were H. Pylori positive.In H. pylori positive group, the mean± SD of CCK was 1.06± 0.40 and gastrin was 6.68 ± 7.82. In H. pylori negative group the mean ± SD of CCK was 0.92 ± 0.31 and gastrin 8.20 ± 12.58. There was no significant difference in gastrin and CCK serum level between H. pylori positive and H. pylori negative in nonulcer dyspeptic patients. Conclusion: According to high frequency of H. pylori in NUD patients, the investigation of patients for the presence of H. pylori in patients is recommended. We didn’t find any relation between H. pylori infection and the serum level of gastrin and CCK in NUD patients.

Introduction: Helicobacter pylori colonize in gastric mucosa and causes some disorders in upper gastrointestine. The clinical outcome of Helicobacter pylori infection may be associated with or without CagA. Materials & Methods: To investigate presence of CagA gene in Helicobacter pylori strains among patients with NUD, Peptic Ulcer and Gastric Cancer, 150 gastric biopsy specimens were taken. Biopsy samples were cultured on selective media under microaerophilic condition. After incubation period, the colonies were diagnosed by biochemical tests. Finally, using unique primers, CagA gene was investigated among the H.pylori strains. Results: Among the samples, H.pylori was isolated in 92 cases by culture method. After PCR method was done on culture positive samples,it was found that the prevalence of CagA gene in strains isolated from patients with NUD, Duodenal ulcer, Gastric ulcer and Gastric Cancer was 64.7% (22 from 34 cases ), 100% (28 from 28 cases), 90% (18 from 20 cases) and 100% (10 from 10 cases) respectively. In this study, there was a significant different between association of CagA gene in strains isolated from patients with peptic ulcer and gastric cancer (P<0.05), but this difference was not significant among strains isolated from NUD patients (P>0.05).Conclusion: According to the findings, it is suggested that presence of CagA gene in strains of Helicobacter pylori may play an important role in aggrovating disorders in Iran.

Background Data concerning the information on the prevalence and association of the Helicobacter pylori cytotoxinassociated gene A (CagA) with disease is still controversial. The aim of this study was to isolate and identify H. pylori by culture methode from biopsy specimens and its relationship with associated diseases by molecular techniques (PCR). Materials and Methods Gastric biopsy specimens obtained from 220 patients (aged 18 to 68 years) were evaluated for presence of H. pylori using PCR assay on isolates for CagA gene. Results From 220 patients that included in this study, 120 patients, 51 from PUD (38 duodenal ulcer and 13 gastric ulcer) and 69 from NUD patients (35 gastritis, 18 reflux disease without and 16 with esophagitis) yielded positive for H. pylori culture. Frequency of CagA gene in H. pylori isolated from patients with peptic ulcer diseases (PUD) and non-ulcer dyspepsia (NUD) was 82.3% and 59.4%, respectively. Conclusions Our data confirmed that CagA gene in H. pylori is a virulence factor with high frequency in PUD. Therefore, we suggest that detection of H. pylori gene expression may contribute in improving the diagnosis and understanding the pathogenesis of H. pylori infections. 

To clarify the effect of gd T cells and invariant Natural Killer T (iNKT) cells in pathophysiology of dyspeptic disorders, number of these two cells in patients with non-ulcer dyspepsia (NUD), peptic ulcer disease (PUD), and gastric cancer (GC) were compared. Patients with dyspepsia were divided into three groups of NUD, PUD, and GC according to their endoscopic and histopathological examinations. Helicobacter pylori infection was diagnosed by rapid urease test and histopathology. The number of peripheral blood CD3+TCRgd+ T cells and CD3+Va24Ja18+ iNKT cells were determined by flow cytometry. Immunohistochemistry (IHC) was also used for identifying the TCRgd+ cells. Forty two patients with NUD (31.6%), 44 with PUD (33.1%), and 47 with GC (35.3%) were included in the study. The frequency of CD3+TCRgd+ T cells in peripheral blood of patients with GC (2.71±0.25) was significantly lower than that in NUD (3.97±0.32, p<0.05) and PUD groups (3.87±0.32, p<0.05). However, there was no significant difference in CD3+TCRgd+ T cell percentage between the NUD and PUD groups. The frequency of TCRgd+ lymphocytes was significantly lower in tissue samples from patients with GC (4.81±0.53) than in NUD (11.09±1.09, p<0.0001) and PUD groups (11.11±1.01, p<0.0001). Also, we could not find any significant difference in the percentage of mucosal TCRgd+ cells between the NUD and PUD groups. The results showed no significant difference in iNKT cells percentage among the three groups of patients. The results suggest that decreasing number of gdT cells may be related to development and progression of gastric cancer.

Objectives: Duodenal Ulcer (DU) that appears with mucosal defect, is a common disease. About 10 percent of people suffer from DU and its complications during their life long. Recent hypothesis emphasis on Helicobacter pylori as the main pathogen. But some studies indicate that such a role can be a confounder. The main goal of this case-control study is the determination of Gastric metoplasia and Helicobacter pylori infection in DU and comparison with Non Ulcer Dyspepsia (NUD). Methods: Patients with endoscopically confirmed DU and NUD were undertaken Duodenal biopsy to determine gastric metaplasia and Ureas and ELIAS tests to recognition of Helicobacter pylori infection. A total of 77 patients (37 in group Du & 40 in group NUD) were studied (68.8% male & 31.2% female). Results: Helicobacter pylori infection and gastric metaplasia rate were 55.8% and 50.6% respectively. There was no difference in two groups H.pylori. On the other hand, gastric metaplasia was significantly higher in NUD group that DU group. H.pylori infection was more frequent among patients with gastric metaplasia. Conclusion: The results of this study indicate higher gastric metaplasia rate in NUD group. On the other hand, more Helicobacter pylori infection in patients with gastric metaplasia points to relation of this microorganism and gastric metaplasia than Duodenal ulcer. Although some studies confirm such a finding, there is a necessity to perform the vast studies in proof of the subject.

Background: CD1d presents glycolipid antigens to invariant natural killer T (iNKT) cells. The role of CD1d in the development of peptic ulcer and gastric cancer has not been revealed, yet.Objective: To clarify the expression of alternatively spliced variants of CD1d in peptic ulcer and gastric cancer.Methods: Patients with dyspepsia were selected and divided into three groups of non-ulcer dyspepsia (NUD), peptic ulcer disease (PUD), and gastric cancer (GC), according to their endoscopic and histopathological examinations.H. pylori infection was diagnosed by rapid urease test and histopathology. The expression levels of V2, V4, and V5 spliced variants of CD1d molecule were determined by quantitative Reverse Transcriptase PCR.Results: Relative gene expression levels of V4 were higher in GC patients (n=37) than those in NUD (n=49) and PUD (n=51) groups (p<0.05 and p<0.01, respectively). Moreover, GC patients showed higher expression levels of V5 compared to NUD and PUD groups (p<0.001 and p<0.001, respectively). Positive correlation coefficients were attained between V4 and V5 expression in patients with PUD (r=0.734, p<0.0001) and GC (r=0.423, p<0.01), but not in patients with NUD. Among NUD patients, the expression levels of V4, but not V5, were higher in H. pylori -positive patients than in H. pylori negative ones (p<0.01).Conclusion: Collectively, both membrane-bound (V4) and soluble (V5) isoforms of CD1d were over-expressed in gastric tumor tissues, suggesting that they are involved in anti-tumor immune responses.

Nonulcer dyspepsia (NUD) is one of the most common gastrointestinal disorders. The causes of dyspepsia include gastric acid oversecretion, gastrointestinal dysmotility, Helicobacter pylori infection, some diets and psychologic factors. Many drugs such as H2-blockers and Prokinetics are perscribed in NUD. We designed a randomized clinical trial in Shohadaye Haftome Tir Hospital, Tehran, Iran at 2000 to compare efficacy of cimetidine and Metoclopromide in NUD and their side effects. This study were designed as a double blind randomized clinical trial on 101 patients suffering from NUD in shohadaye Haftome Tir Hospital, Tehran, Iran at 2000. The patients with NUD were selected. The inclusion criteria were having at least one of the symptoms epigastric pain, bloating, heart burn (pyrosis), vomiting nausia, regurgitation, fullness and halitosis for 3 months. Then patients were examined physically and their ESR, CBC, FBS, BUN, Cr, Ca, P, Na, K, SGOT, SGPT, AlkPh, T3RIA, T4RIA, TSH, Stoole Exam(3 times) Abdominal Sonography and Electrocardiography were checked to rule out cardiac, pulmonary, hepatic, panceratic disease and electrolyte disorders. Endoscopy was done for each patient by gastroentrologist to rule out any lesion in esophagus, stomach and deodenum. Finally the patients who had not used any drugs since 2 weeks before and hadn’t had history of psycologic disorders, were selected. After illustration and taking agreement of this patients, they were devided into two groups randomly: group of Cimetidine (50 persons) and group of metoclopramide (51 patients). The drugs were similar in shape and size and color. Cimetidine were from chemidaru company 200mg 4 times daily and metoclopramide from hakim company 10mg 4 times daily. These drugs were administred while 2 weeks in two groups simultaneusly. Complete treatment was defined getting rid of all their symptoms. Partial treatment was defined reminding symptoms to less than 50% and finally no treatment was defined reminding more than 50% of their symptoms. Group of cimetidine included 26 males and 24 females while metoclopromide group 25 males and 26 females. In the cimetidine group, the mean of age was 28.4 with standard deviation of 7.84 years. In the other one, the mean of age was 33.02 years with standard deviation of 10.77 years. There were not any significant differences in age and sex between these two groups. In cimetidine group 14 persons (28%) were completely treated, 23 (46%) partially treated and 13 (26%) were not treated while in the metoclopromide group 19 persons (37.3%) were completely treated, 20(39.2) partially treated and 12 (23.5%) were not treated. There were not any significant differences in treatment of NUD between these two groups. Also there were not any significant differences in side effects of these drugs except drowsiness that was significantly more in metoclopromide group (P-value=0.01). In the metoclopromide group, Anxiety in females were significantly more than males (P-value=0.02). There were many risk factors in NUD, also there were many drugs with different mechanism for NUD. Therefore we need more studies to know whichone of these drugs are better and have less side effects.