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Arch Hellen Med, 18(1), January-Febuary 2001, 58-63


Upper gastrointestinal bleeding in hereditary hemorrhagic disorders
The role of Helicobacter pylori

1Hemostatic Unit, 1st Propedeutic Department of Internal Medicine,
2Department of Immunology, AHEPA Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece

OBJECTIVE The aim of this study was to evaluate the role of Helicobacter pylori (HP) infection and the dental status in upper gastrointestinal bleeding (GB) in patients (pts) with hereditary hemorrhagic disorders (HHD).

METHOD The study included 37 pts with HHD, mean age 42±16 years [18-17 males (M), one female (F) with and 19-12 M, 7 F without upper GB history, respectively], and 26 control pts without HHD, who came for elective gastroscopy, due to dyspeptic symptoms, mean age 61±16 years (16 M, 10 F). Endoscopy was performed in all pts with GB and in controls. ELISA was used to detect (a) IgG (Pharmacia & Upjohn, normal <10 U/mL), (b) αντι-Cag-A (RADIM, normal<10 RU/mL) and (c) IgA (Novum Diagnostica, normal<20 NU/mL) serum and saliva HP-antibodies of pts and controls. The dental status was assessed using the decayed/missing/filled teeth index (DMFT) in pts and controls. x2 test was used for statistical analysis.

RESULTS HP-IgG antibodies were positive in 27/34 (64.8%) pts and 17/26 (65.4%) controls (P<0.1, NS) while 20/37 (54.05%) pts and 9/26 (34.6%) controls had serum αντι-Cag-A positive (NS). However, 15/18 (83%) and 5/19 (26.3%) HHD pts with and without GB respectively, had serum αντι-Cag-A positive (P<0.01), while serum HP-IgG was positive in 13/18 (72%) and 11/19 (58%), respectively (NS). Furthermore, saliva HP antibodies and the DMFT calculated index did not differ between the two subgroups.

CONCLUSIONS Although no statistical significant difference was found in HP infection between HHD pts and controls, the Cag-A strain appeared more frequently in those HHD pts with upper GB. Due to the increased risk of bleeding complications, αντι-Cag-A screening and therapy is recommended to all HHD pts.

Key words: Cag-A, Congenital hemorrhagic disorders, Gastrointestinal hemorrhage.

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