الفهرس 
2.1.1. Microbiological aspectsOnly 14 pages are availabe for public view
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Abstract
We have studied the occurrence and significance of H. pylori infection in the peptic ulcer disease, chronic gastritis, esophagitis with gastroesophageal reflux disease, portal hypertension, gastric cancer and in patients after gastric resection. Diagnosis of H. pylori infection was established depending on the results of histological staining and culture of the gastric biopsies; the pati-ent was considered to be positive for H. pylori infection if the organism was detected by histology and/or culture. We assessed the accuracy of histological staining, culture and anti-14. pylori IgG anti body detection for diagnosis of’ I I. pylori infection. Efficacy and accuracy of omeprazole-amox ycillin as well as omeprazole-clarithromycin combinations were also evaluated. We concluded that: 0 Histological staining is more sensitive than culture and anti-H. pylori IgG antibody detection (97% versus 71 % and 87%, respectively), with higher overall accuracy rate (97% versus 75% and 86%). Q Anti-H. pylori IgG antibody detection is more sensitive than culture (87% versus 71%) with lower false negative rate (12% versus 40%), but it is less specific (52% versus 100%) with higher false positive rates (13% versus 0). €3 Diagnosis of H. pylori infection dependmg on the results of hstolo~cal staining and culture is more sensitive and specific than if the diagnosis based on the result of histological staining alone, IgG antibody detection alone or the combination of both. We suggest that hlstologcal staining combined with culture of the gastric biopsies could be considered the most accurate method for hagnosis of H. pylori infection. 0 We agree with the other investigators that chronic H. pylori infection and its associated gastritk is a major cause for peptic ulcer disease. However, we found that - the association between H. pylori infection and duodenal ulcer is stronger than its association with gastric ulcer. O We suggested that gastric colonization with H. pylori can participate indirectly in the pathogenesis of esophagitis with gastroesophageal reflux. Moreover, since we have isolated H. pylori from the esophageal biopsies in 20% of our esophagitis patients, we can not exclude the possible direct role of H. pylori infection in the pathogenesi s of esophagi ti s with gastroesophageal ref1 11s disease. O We found that H. pylori infection in the portal hypertensive patients is relatively less frequent than in the control group (38% versus 47%). However, in the patients with portal hypertensive gastropathy, H. pylori infection was significantly less frequent than in portal hypertensive patients without gastropathy as well as the control group (25.5% versus 50% and 47% respectively, P<0.05). We supposed that the congested gastric mucosa of the patients with portal hypertensive gastropathy may be responsible for the significant decrease in the prevalence of H. pylori infection, by creating unsuitable environment for H. pylori survival. from our results we can conclude that the role of H. pylori infection in the pathogenesis of congestive gastropathy seems to be unlikely. O In the gastric cancer patients, H. pylori infection is relatively more frequent than in the control group (64% versus 47%), this dfference could be related to the significant dfference in the mean age between both groups (62.52 2.2 versus 48.55 2.3, P<0.001). We found also, a tendency to H. pylori negativity in the presence of gastric precancerous changes. Our results do not support the relationship between H. pylori infection and gastric cancer, however, because the -. number of our patients was relatively small, and diagnosis of H. pylori infection was established depending on histology and culture which determine the present H. pylori status. So, we recommend reevaluation of the relationship between H. pylori infection and gastric cancer on a larger number of patients with measurement of anti-H. pylori antibodies to assess the long standng H. pylori status as well.