الفهرس 
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Abstract
Helicobacter pylori infect nearly half of the global population, with a higher prevalence in developing countries. The infection is acquired mainly during childhood and may persist in the gastric environment throughout the life of the host, despite the immune and humoral response
Helicobacter pylori infection, a major cause of chronic gastritis, is associated with duodenal and gastric ulcers, lymphoma, and cancer. Furthermore, H-pylori has also been linked to extra gastric diseases such as type 2 diabetes mellitus (T2DM).
The role of H-pylori infection in glucose metabolism and T2DM development has not been fully established. Although it has been reported that patients with chronic H-pylori infection have an increased risk of developing T2DM, some studies have not found a correlation between this infection and glycemic levels in diabetic patients.
The impact of H-pylori infection on other organs could be mediated by increased levels of inflammatory markers such as IL-6 and tumor necrosis factor-a (TNF-a), all of which are also involved in the development of insulin resistance and T2DM.
These cytokines could induce the phosphorylation of serine residues in the insulin receptor substrate, preventing their interaction with insulin receptors, leading to systemic disruption of insulin sensitivity and impaired glucose homeostasis.
Few studies have investigated the association between prediabetes and H-pylori infection; they found that gastric H-pylori infection is associated with the risk of diabetes mellitus but not prediabetes.
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Whether H-pylori-related factors or host factors are associated with the disturbance of glycated hemoglobin levels needs investigation. Therefore, the aim of this study was to asses IL-10, HA1C & endoscopic examination of infected patients of H-pylori.
This cross-sectional study was conducted on 132 children in which they were divided in 2 groups’ cases and control in National liver institute during the period from January 2022 to July 2023. We excluded Patients with Diabetes, chronic consumptive disease (cancer and AIDS), gastric surgery patients, chronic renal failure patients on hemodialysis, patients with recent blood transfusion. Control was chosen after normal complete stool analysis & negative H-pylori antigen in stool. Patients previously treated for H-pylori eradication, and patients who had been medicated with H2 receptor antagonists or proton pump inhibitors within 2 weeks or antibiotics within 2 weeks prior to testing were also excluded.
All cases incorporated in this study were subjected to clinical assessment which includes full history & data concerned with general and abdominal examination, investigations as CBC , PT , PTT, complete stool analysis, stool H-pylori antigen test (pre &post treatment), upper GIT endoscopy for all patients with positive H-pylori antigen test with considering biopsy for histopathology examination to confirm diagnosis& patients with confirmed H-pylori infection were tested for base line serum HA1C and IL 10 level prior and after receiving medical treatment. Also, control group had IL-10 & HA1C levels to be compared to cases.
These data were analyzed, tabulated and ROC curves were constructed to detect the prognostic performances IL-10, HA1C & H-pylori antigen in stool diagnostic &prognostic tools of cases of H-pylori.
Results of this study revealed that:
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A total of 132 children (66 cases & 66 control) were included in the study.
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The case group included (47% male, 53% female correspondingly while
the control group included (45.4% male, 54.5% female). The mean age of children in the group of cases was 10.27 ± 4.23 years &was 9.29 ± 4.40 years in the control group. The percent of rural children in our study was (87.9% &81.8 %) in cases &control respectively. Among studied cases (34.4%) were born to consangious marriage. As regards family history (25.8%) of cases showed positive family history of H-pylori while (95.5%) of control showed negative family history of H-pylori with statically significant difference <0.05 .
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All cases (100%) were presented by recurrent abdominal pain, dyspepsia and affected appetite while 95.5% of cases were presented by vomiting & nausea. Whereas 33.3% were presented by constipation, meanwhile 31.8% were presented by regurgitation. However, only 10.6% suffered from history of melena & history of hematemesis.
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Hematological investigations of both studied groups. Values of mean & SD of TLC and fasting blood sugar in cases were higher than control. Meanwhile, values of mean & SD of Hb in cases was lower than control group with statically significant difference as p value was < 0.05.
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Complete stool analysis and H-pylori antigen in the group of cases. All the studied cases (100%) had positive H-pylori antigen in the stool. As regards complete stool analysis, it revealed that 63.6% of cases had Entamoeba histolytica, 24.2% had Giardia lamblia, and 9.1% had Ascaris respectively.
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H-pylori antigen in stool, IL10 and HA1C in studied cases before and after treatment. Values of mean & SD of IL-10 & HA1C in cases before treatment were higher than cases after treatment with statically significant difference < 0.05.
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Values of mean & SD of IL-10 & HA1C were higher in cases before treatment than control with statically significant difference < 0.05.
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Endoscopic examination revealed hyperemia in all cases (100%) while 10.6% of cases showed ulceration. Whereas, all cases (100%) showed antrum predominant pan gastritis and duodentitis. Meanwhile, 66.7% of cases showed nodularity and only 6.1% showed hiatus hernia.
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Pathological examination revealed lymphoid follicle in (57.6%) of cases while degree of inflammation as classified to 1, 2&3 was represented in (18.2%), (33.3) & (48.5%) of cases respectively. For sure H-pylori was found in (100%) of cases by H, E and gimmesa stain. Furthermore atrophy, metaplasia and dysplasia were absent in studied cases.
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Values of mean & SD of HA1C were higher in negative patients after H-pylori treatment than positive one after treatment with statically significant difference as p value < 0.
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A cut off value of IL-10 is >116.12(pg\dl) can predict response to treatment of H-Pylori cases with sensitivity (92.31%), specificity (85.71%), PPV (41.40%) and NPV (99.00%).
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Values of mean & SD of HA1C in cases with history of hematemesis were higher than cases without history of hematemesis with statically significant difference as p value was < 0.05.
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No correlation between degree of inflammation according to updated Sydney classification and presence of hiatus hernia & nodularity in upper GIT endoscopy with no statically significant difference as p value was > 0.05.
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No correlation between activity according to updated Sydney
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classification and presence of hiatus hernia & nodularity in upper
GIT endoscopy with no statically significant difference as p value was > 0.05.
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Values of mean & SD of IL-10 before & after treatment; meanwhile mean & SD of HA1C were higher in patients with parasitic infestations than non-infected patients with statically significant difference as p value.
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Values of mean & SD of IL-10 pretreatment & after treatment and HA1C post treatment in positive patients higher than negative patients with statically significant difference as p value was < 0.05.
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Values of mean & SD of hemoglobin were lower in patients with history of hematemesis than patients without history of hematemesis with statically significant difference as p value was < 0.05.
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Values of mean & SD of HA1C pretreatment were higher in in patients with history of hematemesis than patients without history of hematemesis with statically significant difference as p value was < 0.05.
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We concluded that IL-10 has significant performance of predicating response of cases to treatment of H-pylori in absence of parasitic
infection&HA1C has prognostic properties in diagnosis and treatment of H-pylori other than diabetes mellitus. We recommend use of different antibiotic strategies according to anti-bacterial sensitivity test (AST) to overcome bacterial resistance.
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We recommended treatment of parasitic infection with correlation of treatment of H-pylori infection.
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Further studies involving larger samples are recommended to be established to confirm applicability across different settings.
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We recommended use of IL-10 in prediction of treatment response in infected patients with H-pylori.
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We recommended use of HA1C as follow up of H-pylori infected children after treatment.