The natural course of Helicobacter pylori infection on endoscopic findings in a population during 17 years of follow-up: the Sørreisa gastrointestinal disorder study. Eur J Epidemiol. 2009;24:649-658. [PMID: 19629722 DOI: 10.1007/s10654-009-9371-6]

[Impact of primary duodenogastric reflux and Helicobacter pylori infection on gastritis and antibiotic resistance in children]

OBJECTIVES

To investigate the risk factors for Helicobacter pylori (HP) infection in children with primary duodenogastric reflux (DGR) and its impact on gastritis and antibioticresistance.

METHODS

A retrospective analysis was performed on the clinical data of 2 190 children who underwent upper gastrointestinal endoscopy in Wuxi Children's Hospital from January 2019 to February 2022, among whom 308 children were diagnosed with primary DGR. According to the presence or absence of HP infection, the children were classified to HP infection group (53 children) and non-HP infection group (255 children). The risk factors for HP infection and its impact on the incidence rate and severity of gastritis were analyzed. According to the presence or absence of primary DGR, 331 children with HP infection were classified to primary DGR group (29 children) and non-primary DGR group (302 children), and then the impact of primary DGR with HP infection on antibiotic resistance was analyzed.

RESULTS

The HP infection group had a significantly higher age than the non-HP infection group (P<0.05), and there was a significant difference in the age distribution between the two groups (P<0.05), while there were no significant differences in the incidence rate and severity of gastritis between the two groups (P>0.05). The multivariate logistic regression analysis showed that older age was a risk factor for HP infection in children with DGR (P<0.05). Drug sensitivity test showed that there were no significant differences in the single and combined resistance rates of metronidazole, clarithromycin, and levofloxacin between the primary DGR group and the non-primary DGR group (P>0.05).

CONCLUSIONS

Older age is closely associated with HP infection in children with DGR. Primary DGR with HP infection has no significant impact on gastritis and antibiotic resistance in children.

Prevalence of Histological Gastritis in a Community Population and Association with Epigastric Pain

BACKGROUND AND AIMS

Gastritis is a common histological diagnosis, although the prevalence is decreasing in developed populations, alongside decreasing prevalence of H. pylori infection. We sought to determine the prevalence of the etiology of gastritis in a Swedish population sample and to analyze any associations with symptoms, an area of clinical uncertainty.

METHODS

Longitudinal population-based study based in Östhammar, Sweden. A randomly sampled adult population completed a validated gastrointestinal symptom questionnaire (Abdominal Symptom Questionnaire, ASQ) in 2011 (N = 1175). Participants < 80 years of age and who were eligible were invited to undergo esophagogastroduodenoscopy (EGD) (N = 947); 402 accepted and 368 underwent EGD with antral and body biopsies (average 54.1 years, range 20-79 years; 47.8% male) with H. pylori serology.

RESULTS

Gastritis was found in 40.2% (148/368; 95% CI 35.2-45.2%). By rank, the most common histological subtype was reactive (68/148; 45.9%), then H. pylori (44/148; 29.7%), chronic non-H. pylori (29/148; 19.6%), and autoimmune (4/148; 2.7%). Gastritis was significantly associated with older age and H. pylori status (p < 0.01). Gastritis subjects were divided into three histological categories: chronic inactive inflammation, autoimmune gastritis, and active inflammation; there was no difference in the presence of upper gastrointestinal symptoms when categories were compared to cases with no pathological changes. Functional dyspepsia or gastroesophageal reflux were reported in 25.7% (38/148) of those with gastritis (any type or location) versus 34.1% (75/220) with no pathological changes (p = 0.32). Epigastric pain was more common in chronic H. pylori negative gastritis in the gastric body (OR = 3.22, 95% CI 1.08-9.62).

CONCLUSION

Gastritis is common in the population with a prevalence of 40% and is usually asymptomatic. Chronic body gastritis may be associated with epigastric pain, but independent validation is required to confirm these findings. Clinicians should not generally ascribe symptoms to histological gastritis.

Negative correlations between bile reflux gastritis and Helicobacter pylori infection

OBJECTIVE

There are a few articles to study the relationship between bile reflux gastritis (BRG) and H. pylori infection, and the results are debatable. This study set out to determine the relationship between BRG and Helicobacter pylori (H. pylori) infection.

METHODS

In this retrospective study, patients from January, 1st 2013 to January, 1st, 2021 were divided into two groups based on whether they had BRG. The control group was got by 1:1 propensity-score matching (PSM) based on age and sex. Then, the relationship between BRG and H. pylori in patients was analyzed via Chi-squared test and Phi (φ) detection.

RESULTS

26449 patients were included in this study, and there were 1918 patients in each group after age and sex matching. patients with HP were responsible for 35% (9345/26449) and patients with BRG were 7% (1918/26449). Further relationship exploration, there is a negative, but weak, the relationship between BRG and HP infection (X² = 45.62, p < .001, Phi (φ)= -0.109).

CONCLUSION

Patients with bile reflux may have less likely to get HP infection. HP eradication is an important thing for the prevention of gastric cancer and this study serves as a foundation and may provide directions for future research.

Worldwide Prevalence and Risk Factors of Helicobacter pylori Infection in Children

Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori infection prevalence of approximately 50%. The most important risk factors in America include being male, poor adherence or difficult access to treatment, and the lack of in-home water service. Despite the descending trend in prevalence worldwide, the overall prevalence in Africa remains very high (70%). Nevertheless, the prevalence of H. pylori in children without gastrointestinal who underwent screening was reported to be only 14.2%. The main risk factors in Africa are having a traditional pit or no toilet, poverty, birth order, source of drinking water, or being a farmer. Asia seems to have the widest variations in terms of H. pylori prevalence. Several risk factors were reported in Asia to be associated with this infection, such as lower income and educational level, house crowding, rural residence, ethnicity, the use of tanks as water supplies, alcohol drinking, active smoking, eating spicy food or raw uncooked vegetables, poor living conditions and sanitation. The overall prevalence of H. pylori infection in European children is almost 25%. Portugal has the highest prevalence of all European countries at 66.2% in children 13 years of age. The risk factors in European individuals consist of living in rural areas, eating unwashed fruits and vegetables, not washing hands after school, low parental education and unemployment, and short education duration. Further studies are required to identify the precise mechanisms involved in the discrepancies of H. pylori prevalence worldwide.

Helicobacter pylori infection over bile reflux: No influence on the severity of endoscopic or premalignant gastric lesion development

Helicobacter (H.) pylori infection and duodenogastric reflux (DGR) are both linked to endoscopic and premalignant gastric lesion development, but it is still unclear whether they are independent or have a causal relationship. This study investigated the histologic gastric changes in patients with primary DGR and H. pylori infection, as well as their endoscopic findings, symptoms, drug consumption, and social behavior in comparison with patients presenting only DGR. The study included 560 patients with primary DGR on endoscopy divided into two groups, according to the presence/absence of H. pylori infection on biopsy (utilizing usual stainings and immunohistochemical methods). There was no significant difference in terms of age and sex, nor in the frequency of diabetes or esophagitis between the studied groups. Epigastric pain was associated with H. pylori-positive biopsies in multivariate logistic regression analysis (P=0.005). Although without statistical significance, severe endoscopic lesions and premalignant gastric lesions were more frequent in the H. pylori group (45.1 vs. 28.4% and 37.4 vs. 32.3%, respectively). In patients with DGR, the final multivariate model revealed a positive association between smoking and immunohistochemically confirmed H. pylori infection (P=0.02, OR=1.88, 95% confidence intervals (CI)=1.10 to 3.21), but a negative effect of proton pump inhibitor consumption (P<0.001, OR=0.50, 95% CI=0.35 to 0.73). In conclusion, in patients with H. pylori infection and DGR, epigastric pain was the main reason for the endoscopic investigation. H. pylori infection over DGR did not influence the severity of endoscopic or premalignant gastric lesion development. Furthermore, smoking is directly related to immunohistochemically assessed active H. pylori infection in patients with bile reflux.

SOX2 interferes with the function of CDX2 in bile acid-induced gastric intestinal metaplasia

Background

Intestinal metaplasia (IM) is a premalignant lesion associated with gastric cancer. Both animal and clinical studies have revealed that bile acid reflux and subsequent chronic inflammation are key causal factors of IM. Previous studies indicated that SOX2, the key transcription factor in gastric differentiation, was downregulated during IM development while CDX2, the pivotal intestine-specific transcription factor was upregulated significantly. However, it remains unclear whether the downregulation of SOX2 promotes gastric IM emergence or is merely a concomitant phenomenon. In addition, the underlying mechanisms of SOX2 downregulation during IM development are unclear.

Methods

Gastric cell lines were treated with deoxycholic acid (DCA) in a dose-dependent manner. The expression of CDX2 and miR-21 in gastric tissue microarray were detected by immunohistochemistry and in situ hybridization. Coimmunoprecipitation and immunofluorescence were performed to ascertain the interaction of SOX2 and CDX2. Luciferase reporter assays were used to detect the transcriptional activity of CDX2, and confirm miR-21 binding to SOX2 3′-UTR. The protein level of SOX2, CDX2 and downstream IM-specific genes were investigated using western blotting. mRNA level of miR-21, SOX2, CDX2 and downstream IM-specific genes were detected by qRT-PCR.

Results

Bile acid treatment could suppress SOX2 expression and simultaneously induce expression of CDX2 in gastric cell lines. Furthermore, we demonstrated that SOX2 overexpression could significantly inhibit bile acid- and exogenous CDX2-induced IM-specific gene expression, including KLF4, cadherin 17 and HNF4α expression. In contrast, SOX2 knockdown had the opposite effect. A dual-luciferase reporter assay demonstrated that SOX2 overexpression could significantly suppress CDX2 transcriptional activity in HEK293T cells. CDX2 and SOX2 could form protein complexes in the nucleus. In addition, bile acid induced the expression of miR-21. The inhibition of SOX2 in bile acid-treated gastric cell lines was rescued by miR-21 knockdown.

Conclusions

These findings suggested that SOX2 can interfere with the transcriptional activity of CDX2 in bile acid-induced IM and that miR-21 might play a key role in this process, which shed new lights in the prevention of gastric cancer.

Electronic supplementary material

The online version of this article (10.1186/s12935-019-0739-8) contains supplementary material, which is available to authorized users.

Value of the "Test & Treat" Strategy for Uninvestigated Dyspepsia at Low Prevalence Rates of Helicobacter pylori in the Population

BACKGROUND AND AIM

In populations with a low prevalence rate of Helicobacter pylori (H. pylori) infection from Western countries, guidelines for the management of uninvestigated dyspepsia generally recommend that the "test and treat" strategy should be avoided in favor of empiric proton-pump inhibitor therapy in younger patients (on average < 50 years of age) without alarm symptoms and signs. The prevalence of H. pylori infection has fallen from about 30% to about 10% in Sweden and other countries. We aimed to explore whether the rationale for test and treat is relevant in contemporary clinical practice.

MATERIALS AND METHODS

In settings with an infection rate in the adult population of 30% and 10%, we modeled the positive and negative predictive values for indirect (nonendoscopy) tests on current H. pylori infection with a presumed sensitivity and specificity of 95%. We then calculated the difference in false-negative and false-positive test outcome, and eradication prescription rates in the two scenarios.

RESULTS

While the positive predictive value for the test decreased from 0.89 to 0.68 when the prevalence of H. pylori fell from 30% to 10%, there were only 1% more false-negative tests and 1% less false-positive tests. The eradication prescription rate would decrease by 18% with a 10% prevalence rate.

CONCLUSION

The recommendation to stop applying "test and treat" at lower prevalence rates of H. pylori should be reconsidered. The test and treat strategy is the preferred approach for most patients who present with dyspepsia.

Towards a healthy stomach? Helicobacter pylori prevalence has dramatically decreased over 23 years in adults in a Swedish community

BACKGROUND

In Western countries the prevalence of Helicobacter pylori (H. pylori) infection may be declining but there is a lack of recent longitudinal population studies. We evaluated the changing epidemiology over a 23-year period in Sweden.

MATERIALS AND METHODS

In 1989, the validated Abdominal Symptom Questionnaire (ASQ) was mailed to a random sample of inhabitants (ages 22-80 years) in a Swedish community, and 1097 (87%) responded. H. pylori serology was analysed in a representative subsample (n = 145). Twenty-three years later, the ASQ was mailed again using similar selection criteria, and 388 out of 1036 responders had an upper endoscopy with assessment of H. pylori and corpus atrophy status.

RESULTS

The prevalence of positive H. pylori serology decreased from 37.9% (1989) to 15.8% (2012), corresponding to a decrease in odds of 75% per decade (odds ratio (OR): 0.25; 95% confidence interval (CI): 0.11-0.59, p = 0.001) independent of age, gender, body mass index (BMI) and level of education, with a pattern consistent with a birth cohort effect. The prevalence increased with increasing age (p = 0.001). The prevalence of H. pylori on histology in 2012 was 11.4% (95% CI 8.6-15.0). The prevalence of corpus atrophy on serology and/or histology in 2012 was 3.2% (95% CI 1.8-5.5); all cases were ≥57 years old.

CONCLUSION

The stomach is healthier in 2012 compared with 1989. H. pylori prevalence in adults has decreased over the last two decades to a level where clinical management might be affected.

Incidence of gastric cancer among patients with gastric precancerous lesions: observational cohort study in a low risk Western population

OBJECTIVE

To accurately measure the incidence of gastric cancer among patients with gastric precancerous lesions, and to quantify the excess incidence in comparison with people with normal mucosa on endoscopy and a general population.

DESIGN

Population based cohort study.

SETTING

Population of Sweden using data from its national disease registers.

PARTICIPANTS

405,172 patients who had gastric biopsy samples taken for non-malignant indications between 1979 and 2011.

MAIN OUTCOME MEASURES

Incidence of gastric cancer, reported separately for patients with different mucosal changes in biopsy samples. Standardised incidence ratios provided estimation of the relative risk, using the general Swedish population as reference; and hazard ratios were derived from Cox regression modelling for internal comparisons with patients with normal gastric mucosa.

RESULTS

After excluding the first two years of follow-up, 1599 cases of gastric cancer were identified. The annual crude incidence of gastric cancer was 20 × 10(-5) for those in the normal mucosa group (standardised incidence ratio 1.0), 42 × 10(-5) for those with minor changes (1.5), 59 × 10(-5) for the gastritis group (1.8), 100 × 10(-5) for the atrophic gastritis group (2.8), 129 × 10(-5) for the intestinal metaplasia group (3.4), and 263 × 10(-5) for the dysplasia group (6.5). Cox regression modelling confirmed that excess risks increased monotonically with progressive severity of gastric lesions, with the highest hazard ratio of 10.9 (dysplasia versus normal mucosa, 95% confidence interval 7.7 to 15.4). The increased incidence was stable throughout the follow-up period, and the gaps between cumulative incidence curves grew continuously.

CONCLUSIONS

Among patients who undergo gastroscopy with biopsy for clinical indications, approximately 1 in 256 with normal mucosa, 1 in 85 with gastritis, 1 in 50 with atrophic gastritis, 1 in 39 with intestinal metaplasia, and 1 in 19 with dysplasia will develop gastric cancer within 20 years. These numbers, along with cost-benefit analyses, should guide future surveillance policies for these particular patient groups.

Antral atrophy, intestinal metaplasia, and preneoplastic markers in Mexican children with Helicobacter pylori-positive and Helicobacter pylori-negative gastritis

Chronic inflammation and infection are major risk factors for gastric carcinogenesis in adults. As chronic gastritis is common in Mexican children, diagnosis of Helicobacter pylori and other causes of gastritis are critical for the identification of children who would benefit from closer surveillance. Antral biopsies from 82 Mexican children (mean age, 8.3 ± 4.8 years) with chronic gastritis (36 H pylori+, 46 H pylori-) were examined for gastritis activity, atrophy, intestinal metaplasia (IM), and immunohistochemical expression of gastric carcinogenesis biomarkers caudal type homeobox 2 (CDX2), ephrin type-B receptor 4 (EphB4), matrix metalloproteinase 3 (MMP3), macrophage migration inhibitory factor (MIF), p53, β-catenin, and E-cadherin. Atrophy was diagnosed in 7 (9%) of 82, and IM, in 5 (6%) of 82 by routine histology, whereas 6 additional children (7%) (3 H pylori+) exhibited aberrant CDX2 expression without IM. Significant positive correlations were seen between EphB4, MMP3, and MIF (P<.0001). Atrophy and follicular pathology were more frequent in H pylori+ biopsies (P<.0001), whereas IM and CDX2 expression showed no significant correlation with H pylori status. Antral biopsies demonstrating atrophy, IM, and/or aberrant CDX2 expression were seen in 21.95% (18/82) of the children, potentially identifying those who would benefit from closer surveillance and preventive dietary strategies. Biomarkers CDX2, EphB4, MMP3, and MIF may be useful in the workup of pediatric gastritis.

Pathology of gastric cancer and its precursor lesions

Gastric cancers are a histologically heterogenous group of neoplasms arising from unique epidemiologic and molecular backgrounds. There is accumulating evidence that the intestinal type of gastric adenocarcinoma develops through a multistep process beginning with chronic gastritis triggered primarily by Helicobacter pylori and progressing through atrophy, intestinal metaplasia, and dysplasia (intraepithelial neoplasia) to carcinoma. Loss of E-cadherin expression resulting from CDH1 gene alterations is the primary carcinogenetic event in hereditary diffuse gastric cancer. Proximal gastric adenocarcinomas likely result from either gastroesophageal reflux or H pylori gastritis. This article provides an update of the histologic, immunohistochemical, and molecular pathways of gastric cancer and its precursors.

Narrow band imaging versus white light gastroscopy in detecting potentially premalignant gastric lesions: a randomized prospective crossover study

BACKGROUND AND AIMS

Narrow band imaging (NBI) detects mucosal surface details (pit pattern) as well as the microvasculature pattern of mucosa. In premalignant conditions the pattern and regularity of pits and microvasculature are altered. We aimed to assess whether NBI is superior to conventional white light gastroscopy (WLG) in detecting potentially premalignant gastric lesions.

PATIENTS AND METHODS

We conducted a randomized prospective crossover study from January 2009 to July 2009. Patients above 45 years of age with dyspepsia in absence of alarm symptoms underwent gastric mucosal examination using WLG and NBI in the same session by different endoscopists who were blinded to each other's endoscopy findings. Biopsy was taken if required at the end of the second gastroscopy after a third observer reviewed reports of both scopists. The yield of gastric potentially premalignant lesions (atrophic gastritis, intestinal metaplasia, dysplasia, adenomatous polyp) was compared for both procedures.

RESULTS

Two hundred [mean age 52.3 (6.4) years, males-66 %] patients participated in the study. Thirty-two patients were diagnosed to have potentially premalignant lesions using both modalities. No patient had early gastric cancer. WLG detected lesions in 17 patients (atrophic gastritis in 12, atrophic gastritis with intestinal metaplasia in 5) and NBI in 31 patients (atrophic gastritis in 22, atrophic gastritis with intestinal metaplasia in 9). The sensitivity of lesion detection by NBI was significantly higher than WLG (p = 0.001).

CONCLUSIONS

NBI was superior to WLG for detection of atrophic gastritis and intestinal metaplasia.

Significant decrease in prevalence of Helicobacter pylori in the Czech Republic

AIM: To study possible decrease in prevalence of Helicobacter pylori (H. pylori) infection in the Czech Republic within a 10-year period.

METHODS: A total of 22 centres entered the study. The catchment areas of these centres covered cities and towns with more than 20 000 inhabitants, smaller towns (≤ 20 000 inhabitants) with surrounding villages and rural areas, and were spread over the whole country, corresponding well to the geographical distribution of the Czech population. A total of 1 837 subjects (aged 5-98 years) took part in the study, randomly selected out of 38 147 people from the general population. H. pylori infection was investigated by means of a ¹³C-urea breath test. Breath samples in duplicates were analysed using isotope ratio mass spectrometry. The cut-off point was 3.5. Social and demographic characteristics were based on data from self-completed questionnaires.

RESULTS: The overall prevalence of H. pylori infection was 23.5% (430/1826), and 4.8% (20/420) in children aged 15 or less. There was no statistically significant difference in prevalence between males (24.3%; 208/857) and females (22.9%, 222/969, P = 0.494). H. pylori infection was strongly associated with higher age, among subjects aged 55+ years, prevalence of H. pylori infection was 39.8% (252/633, P < 0.001). The highest prevalence of H. pylori infection was found among persons aged 55-64 years (43.9%, 97/221) and 75+ years (37.9%, 58/153). Among study subjects aged 15+ years, prevalence of H. pylori infection was significantly increased in those with lowest education (odds risk 3.19, 95% CI 1.87-5.47). Compared to never married (14.1%), the prevalence of H. pylori infection was statistically significantly higher among married (35.4%, 246/694, P < 0.001), divorced (36.8%, 49/133, P < 0.001) and widowed study subjects (40.2%, 45/112, P < 0.001), both in minimally and fully adjusted analysis. There was no significant difference in the prevalence of H. pylori infection between married and widowed subjects (35.4%, 246/694 vs 40.2%, 45/112, P = 0.389). There was little variation in smoking prevalence across categories of smoking and there was no evidence of an increased risk of H. pylori infection among current or past smokers in our data (odds risk 1.04 with 95% CI 0.78-1.40 for current smokers; odds ratio 0.83 with 95% CI 0.60-1.16 for former smokers). The current prevalence of H. pylori in 2011 was significantly lower compared to the prevalence reported from identical geographical areas in 2001 (23.5% vs 41.7%, P < 0.001).

CONCLUSION: The overall prevalence of H. pylori infection in the general population has fallen substantially in the Czech Republic over the past 10 years.

Gastric intestinal metaplasia revisited: function and regulation of CDX2

Intestinal metaplasia of the stomach is a preneoplastic lesion that appears following Helicobacter pylori infection and confers increased risk for gastric cancer development. However, the molecular networks connecting infection to lesion formation and the cellular origin of this lesion remain largely unknown. A more comprehensive understanding of how intestinal metaplasia arises and is maintained will be a major breakthrough towards developing novel therapeutic interventions. Furthermore, after ascertaining the pivotal role of CDX2 in establishing and maintaining intestinal metaplasia, it becomes important to decipher the upstream molecular pathways leading to its ectopic expression. Here, we review the pathophysiology of intestinal metaplasia in the context of the molecular network involved in its establishment and maintenance, with emphasis on CDX2 function and regulation.

Impact of Helicobacter pylori infection and microscopic duodenal histopathological changes on clinical symptoms of patients with functional dyspepsia

AIM

To evaluate the microscopic histopathological changes in duodenal tissue and its relationship to the severity of symptoms in patients with functional dyspepsia while taking the effect of Helicobacter pylori (H. pylori) infection into account.

METHODS

Several gastric and duodenal biopsy specimens were obtained in 217 patients with functional dyspepsia and were evaluated for H. pylori infection and histopathological changes. Severity of symptoms was assessed by Leeds Dyspepsia Questionnaire (LDQ) and its relationship to histopathological changes and H. pylori infection status was assessed.

RESULTS

Helicobacter pylori infection was associated with presence and severity of microscopic duodenitis (p < 0.001). In H. pylori-infected patients, the presence of microscopic duodenitis was independent of microscopic gastritis (p = 0.74). Severity of dyspepsia symptoms was not higher in H. pylori-infected patients than non-infected patients (p = 0.15), but in the presence of H. pylori infection and microscopic gastritis, microscopic duodenitis significantly worsened the LDQ symptom severity score (p < 0.001). In multivariate analysis, the odds of experiencing severe symptoms in patients with severe microscopic duodenitis was 2.22 times greater than in individuals with very mild, mild, or moderate duodenitis.

CONCLUSIONS

Microscopic duodenitis in H. pylori-infected patients may play a major role in producing and aggravating symptoms in FD patients and may be a determinant factor to consider in whether to treat H. pylori infection in functional dyspepsia.

The Rotterdam Study: 2012 objectives and design update

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.

The Shanghai Changfeng Study: a community-based prospective cohort study of chronic diseases among middle-aged and elderly: objectives and design

The Shanghai Changfeng Study is a community-based prospective cohort study of chronic diseases ongoing since February 2009 in Shanghai, China. The study focuses on multiple chronic diseases, including obesity and metabolic syndrome, diabetes, osteoporosis, liver diseases, cardiovascular diseases and neurologic diseases. 15,000 subjects of 40 years or over are planned to be recruited. The rationale, objectives and design of this study are described in this paper.

Erosive esophagitis worsens reflux signs and symptoms in asthma patients without affecting pulmonary function tests

OBJECTIVES

To determine whether erosive esophagitis (EO) worsens reflux signs and symptoms and affects pulmonary function test in asthma patients.

METHODS

Sixty asthma patients with gastroesophageal and laryngopharyngeal reflux symptoms were included. Spirometry, reversibility test, esophagogastroscopy, laryngoscopy, and esophagogastroscopic biopsies were conducted.

RESULTS

EO was diagnosed in 25% (n = 15) of the patients. The remaining 45 patients were placed into the non-erosive esophagitis (NEO) group. Of the 15 EO patients, grade 1 esophagitis was identified in 75% (n = 9), grade 2 in 12.5% (n = 3), and grade 3 in 12.5% (n = 3). Pulmonary function test results were not significantly different between the EO and NEO groups. Gastroesophageal and laryngopharyngeal reflux symptoms such as regurgitation, dysphagia, dyspnea, globus sensation, dysphonia, and sore throat were more frequent in EO patients than in the NEO group. The reflux finding score (RFS) was 7.33 and 4.55 in EO and NEO patients, respectively (p < .001). Posterior commissure hypertrophy was the most common laryngoscopic finding in both of the groups followed by diffuse laryngeal edema, erythema, and pseudosulcus.

CONCLUSIONS

Gastroesophageal and laryngopharyngeal reflux symptoms were more frequent in EO patients than in the NEO group. The laryngoscopic findings of laryngopharyngeal reflux were more severe and the RFS was significantly higher in EO patients than in NEO patients. The presence of EO seems to be associated with an increase in reflux without affecting pulmonary function as EO did not cause a significant decrease in pulmonary function tests.

Relevance of high virulence Helicobacter pylori strains and futility of CDX2 expression for predicting intestinal metaplasia after eradication of infection

OBJECTIVE

Different Helicobacter pylori genotypes are associated with distinct inflammatory responses and consequent development of pre-neoplastic lesions, namely intestinal metaplasia (IM), which is dependent on the expression of CDX2. We aimed to evaluate IM progression/regression in the context of H. pylori eradication, bringing into play the effect of the virulence of infecting H. pylori strains and the hypothesis that CDX2 expression might be a marker for later development of IM.

MATERIAL AND METHODS

Sixty-five male volunteers were evaluated by endoscopy before H. pylori eradication and after a median six-year follow-up. Histological diagnosis was performed at baseline and follow-up, and baseline H. pylori genotypes and CDX2 expression in non-metaplastic foci were also assessed.

RESULTS

Fifty-one individuals remained free from infection at follow-up. Six out of 27 who had no metaplastic lesions at baseline developed IM. CDX2 nuclear expression was observed in 15 of the 21 cases (71.4%) showing no progression to IM, and in three out of six cases (50%) with progression to IM (p = 0.367). Six of the 24 cases with IM at baseline showed regression to less severe outcomes, which was less frequent in those infected with high-virulence strains (7.7% vs. 50%, p = 0.047). In the latter there is a significant persistence of lymphoid follicles.

CONCLUSIONS

Our results support that under infection with high virulence H. pylori strains, IM is a point of difficult return in the gastric carcinogenic pathway. The appearance of CDX-expressing cells in non-metaplastic foci was not associated with the development of IM during the six-year follow-up.

Incidence and risk factors for the development of chronic atrophic gastritis: five year follow-up of a population-based cohort study

Chronic atrophic gastritis (CAG) is a well-established precursor of intestinal gastric cancer. However, data on incidence of CAG are rare, especially from population-based studies. The aim of this analysis was to estimate the incidence of CAG in a large population-based study among older adults from Germany and to identify major risk factors associated with its development. In the baseline and 5-year follow-up examinations of the ESTHER study, serological measurements of pepsinogen (PG) I and II and Helicobacter pylori antibodies were performed in 5,229 women and men, aged 50-74 years at baseline. Information on additional potential risk factors was obtained by questionnaire. CAG was defined by PGI < 70 ng/mL and PGI/PGII < 3. In total, there were 58 (1.1%) incident CAG cases. CAG incidence increased with increasing age from 0.5% in age group 50-54 years to 2.1% in age group 70-74 years. Seropositivity with H. pylori was strongly associated with CAG incidence, with adjusted odds ratios of 5.0 [95% confidence interval (CI): 1.6-15.8] and 11.3 (95% CI: 4.2-30.0) for participants with cytotoxin associated gene A (cagA) negative and cagA positive H. pylori infection at both baseline and follow-up compared to those without H. pylori infection, respectively. Gender, education, smoking, alcohol consumption and family history of gastric cancer were not significantly associated with CAG incidence. Incidence of CAG is rather low in the German population. Older age and infection with H. pylori are key risk factors for the development of CAG.