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Helicobacter pylori (HP) is a gram-negative flagellated pathogen acid-resistant bacterium; it belongs to the order Campylobacterales that is wide spread all over the world, infecting more than 50% of the world population. HP infection is etiologically associated with non-atrophic and atrophic gastritis, peptic ulcer and with 3 to 6-fold increased relative risk for developing gastric adenocarcinoma and mucosa-associated lymphoid tissue (MA LT) lymphoma. For this reason HP is recognized by the World Health Organization as a Class I human carcinogen. In the last years a lot of studies clarified the role of this pathogen in nutrition and metabolism; particularly, it has been shown that it is able to induce malabsorption of several nutrients like iron, cobalamin, vitamin C and vitamin E, with strong consequences on nutritional status. Interesting, this bacterium is able to produce different biological effects on hormones like ghrelin and leptin controlling both appetite and growth, mostly depending on the time of acquisition of the infection and of its treatment. In this review, the authors focused their attention on nutritional effects of HP infection and particularly on the role that diet, food, plants and specific nutrients can play in its treatment, considering that HP eradication rates, with standard triple-therapy, have fallen to a low level in the last years.

In this retrospective-observational study we investigated on the role of p-citrulline as a possible marker of dependence on PN with a cut-off of 20 µmol/l. Fasting p-citrulline was analyzed with Ion-Exchange HPLC in IICB patients enrolled in SC Dietetics and Clinical Nutrition. Inclusion criteria: small bowel length Data reported were expressed as median (range) or mean (± ds) as appropriate. Correlations and a multivariate analysis were performed between p-cit and age, intestinal features, eGFR and PN nutrition. Twenty-seven 21- 82 years old (14M/13F) patients participated in this study; small bowel length was 60 cm (2-200); percent of colon: 50% (0-100); ileo-cecal valve 1 yes/26 no; diagnosis: 11 pts mesenteric vasculopathy, 6 pts surgical outcome, 7 pts IBD, 3 pts other diseases. HPN duration 712 days (167-7239); PN energy: 69,6 %BEE (5-120); PN volume 1900 ml (1000-3600); BMI 21,8 kg/m2 (16-32,1); eGFR 78 ml/min/1,73m2 (43-141); p-cit (reference range 29.1-42.8 µmol/l): 24,5 µmol/l (5-49,6); 9 pts 29,1 µmol/l: 33,3 % of pts was below literature cut-off. Significant correlations were found for: age, r=0,418 (p ≤ 0,05); small bowel length, r = 0,48 (p ≤ 0,01); eGFR, r= −0,4 (p ≤ 0,05); PN-energy, r = −0,49 (p ≤ 0,01); PN volume, r= −0,48 (p≤0,01). The multivariate analysis confirms the correlation with the same variables (F = 4,26; P = 0,0079). The significant correlation between p-cit and small bowel length confirmed p-cit as a possible indicator of spontaneous bowel adaptation but different cut-off for PN dependence could be assessed beacause the 66,6% of pts in HPN had values > 20 µmol/l.