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Chen C, Zhang D, Huang S, Zeng F, Li D, Zhang X, Chen R, Chen S, Wang J, Bai F. Comparison of vonoprazan dual therapy, quadruple therapy and standard quadruple therapy for Helicobacter pylori infection in Hainan: a single-center, open-label, non-inferiority, randomized controlled trial. BMC Gastroenterol 2024; 24:131. [PMID: 38609893 PMCID: PMC11010374 DOI: 10.1186/s12876-024-03225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To compare the potential efficacy and safety of dual therapy and quadruple therapy with vonoprazan (VPZ) as well as the standard quadruple therapy of proton pump inhibitor (PPI) for the eradication of Helicobacter pylori (Hp) infection in Hainan province. METHODS A single-centre, non-blinded, non-inferiority randomized controlled trial was conducted at the outpatient department of gastroenterology at the Second Affiliated Hospital of Hainan Medical University from June 2022 to February 2023. 135 patients aged 18-75 years with Hp infection were enrolled and randomized into three different groups (group V1: VPZ 20 mg twice a day and amoxicillin 1.0 g three times a day for 14 days V2: vonoprazan 20 mg, amoxicillin capsules 1.0 g, furazolidone 0.1 g and bismuth potassiulm citrate 240 mg, twice daily for 14 days;; group V3: ilaprazole 5 mg, Amoxicillin 1.0 g, Furazolidone 100 mg, bismuth potassiulm citrate 240 mg, twice a day for 14 days). Four weeks after the end of treatment, Hp eradication was confirmed by rechecking 13C-urea breath test (UBT). RESULTS The eradication efficacy of V1 and V3 was non-inferior to that of V2, which is consistent with the results obtained from the Kruskal-Wallis H test. The eradication rate by intentional analysis was 84.4% (38/45, 95%CI 73.4%-95.5%, P>0.05) for all the three groups. If analyzed by per-protocol, the eradication rates were 88.4% (38/43, 95%CI 78.4%-98.4%), 92.7% (38/41, 95%CI 84.4%-101.0%),88.4% (38/43,95%CI 78.4%-98.4%) in groups V1, V2 and V3, respectively, which did not show a significant difference (P > 0.05). The incidence of adverse effects was significantly lower in VPZ dual therapy compared to the other two treatment regimens (P < 0.05). VPZ dual therapy or quadruple therapy was also relatively less costly than standard quadruple therapy. CONCLUSION VPZ dual therapy and quadruple therapy shows promise of not being worse than the standard quadruple therapy by a clinically relevant margin. More studies might be needed to definitively determine if the new therapy is equally effective or even superior.
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Affiliation(s)
- Chen Chen
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Daya Zhang
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Shimei Huang
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Fan Zeng
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Da Li
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Xiaodong Zhang
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Runxiang Chen
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Shiju Chen
- Graduate School, Hainan Medical University, Haikou, 571199, China
| | - Jun Wang
- Department of Gastroenterology, The 986 Hospital of Xijing Hospital, Air Force Military Medical University, Xi'an, 710054, Shanxi, China.
| | - Feihu Bai
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Yehai Avenue, #368, Longhua District, Haikou, 570216, Hainan Province, China.
- The Gastroenterology Clinical Medical Center of Hainan Province, Haikou, 570216, China.
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Huang RJ, Huang ES, Mudiganti S, Chen T, Martinez MC, Ramrakhiani S, Han SS, Hwang JH, Palaniappan LP, Liang SY. Risk of Gastric Adenocarcinoma in a Multiethnic Population Undergoing Routine Care: An Electronic Health Records Cohort Study. Cancer Epidemiol Biomarkers Prev 2024; 33:547-556. [PMID: 38231023 PMCID: PMC10990787 DOI: 10.1158/1055-9965.epi-23-1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Gastric adenocarcinoma (GAC) is often diagnosed at advanced stages and portends a poor prognosis. We hypothesized that electronic health records (EHR) could be leveraged to identify individuals at highest risk for GAC from the population seeking routine care. METHODS This was a retrospective cohort study, with endpoint of GAC incidence as ascertained through linkage to an institutional tumor registry. We utilized 2010 to 2020 data from the Palo Alto Medical Foundation, a large multispecialty practice serving Northern California. The analytic cohort comprised individuals ages 40-75 receiving regular ambulatory care. Variables collected included demographic, medical, pharmaceutical, social, and familial data. Electronic phenotyping was based on rule-based methods. RESULTS The cohort comprised 316,044 individuals and approximately 2 million person-years (p-y) of observation. 157 incident GACs occurred (incidence 7.9 per 100,000 p-y), of which 102 were non-cardia GACs (incidence 5.1 per 100,000 p-y). In multivariable analysis, male sex [HR: 2.2, 95% confidence interval (CI): 1.6-3.1], older age, Asian race (HR: 2.5, 95% CI: 1.7-3.7), Hispanic ethnicity (HR: 1.9, 95% CI: 1.1-3.3), atrophic gastritis (HR: 4.6, 95% CI: 2.2-9.3), and anemia (HR: 1.9, 95% CI: 1.3-2.6) were associated with GAC risk; use of NSAID was inversely associated (HR: 0.3, 95% CI: 0.2-0.5). Older age, Asian race, Hispanic ethnicity, atrophic gastritis, and anemia were associated with non-cardia GAC. CONCLUSIONS Routine EHR data can stratify the general population for GAC risk. IMPACT Such methods may help triage populations for targeted screening efforts, such as upper endoscopy.
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Affiliation(s)
- Robert J Huang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Edward S Huang
- Department of Gastroenterology, Palo Alto Medical Foundation, San Jose, California
| | - Satish Mudiganti
- Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California
| | - Tony Chen
- Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California
| | - Meghan C Martinez
- Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California
| | - Sanjay Ramrakhiani
- Department of Gastroenterology, Palo Alto Medical Foundation, San Jose, California
| | - Summer S Han
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Latha P Palaniappan
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California
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Huang RJ, Wichmann IA, Su A, Sathe A, Shum MV, Grimes SM, Meka R, Almeda A, Bai X, Shen J, Nguyen Q, Amieva MR, Hwang JH, Ji HP. A spatially mapped gene expression signature for intestinal stem-like cells identifies high-risk precursors of gastric cancer. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.20.558462. [PMID: 37786704 PMCID: PMC10541579 DOI: 10.1101/2023.09.20.558462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Objective Gastric intestinal metaplasia (GIM) is a precancerous lesion that increases gastric cancer (GC) risk. The Operative Link on GIM (OLGIM) is a combined clinical-histopathologic system to risk-stratify patients with GIM. The identification of molecular biomarkers that are indicators for advanced OLGIM lesions may improve cancer prevention efforts. Methods This study was based on clinical and genomic data from four cohorts: 1) GAPS, a GIM cohort with detailed OLGIM severity scoring (N=303 samples); 2) the Cancer Genome Atlas (N=198); 3) a collation of in-house and publicly available scRNA-seq data (N=40), and 4) a spatial validation cohort (N=5) consisting of annotated histology slides of patients with either GC or advanced GIM. We used a multi-omics pipeline to identify, validate and sequentially parse a highly-refined signature of 26 genes which characterize high-risk GIM. Results Using standard RNA-seq, we analyzed two separate, non-overlapping discovery (N=88) and validation (N=215) sets of GIM. In the discovery phase, we identified 105 upregulated genes specific for high-risk GIM (defined as OLGIM III-IV), of which 100 genes were independently confirmed in the validation set. Spatial transcriptomic profiling revealed 36 of these 100 genes to be expressed in metaplastic foci in GIM. Comparison with bulk GC sequencing data revealed 26 of these genes to be expressed in intestinal-type GC. Single-cell profiling resolved the 26-gene signature to both mature intestinal lineages (goblet cells, enterocytes) and immature intestinal lineages (stem-like cells). A subset of these genes was further validated using single-molecule multiplex fluorescence in situ hybridization. We found certain genes (TFF3 and ANPEP) to mark differentiated intestinal lineages, whereas others (OLFM4 and CPS1) localized to immature cells in the isthmic/crypt region of metaplastic glands, consistent with the findings from scRNAseq analysis. Conclusions using an integrated multi-omics approach, we identified a novel 26-gene expression signature for high-OLGIM precursors at increased risk for GC. We found this signature localizes to aberrant intestinal stem-like cells within the metaplastic microenvironment. These findings hold important translational significance for future prevention and early detection efforts.
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Affiliation(s)
- Robert J. Huang
- Division of Gastroenterology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Ignacio A. Wichmann
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
- Division of Obstetrics and Gynecology, Department of Obstetrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, 8331150, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Pontificia Universidad Católica de Chile, Santiago, 8331150, Chile
| | - Andrew Su
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Anuja Sathe
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Miranda V. Shum
- Division of Gastroenterology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Susan M. Grimes
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Rithika Meka
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Alison Almeda
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Xiangqi Bai
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Jeanne Shen
- Department of Pathology, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Quan Nguyen
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Manuel R. Amieva
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA
| | - Joo Ha Hwang
- Division of Gastroenterology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Hanlee P. Ji
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, USA
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Musazadeh V, Nazari A, Faghfouri AH, Emami M, Kavyani Z, Zokaei M, Jamilian P, Zarezadeh M, Saedisomeolia A. The effectiveness of treatment with probiotics in Helicobacter pylori eradication: results from an umbrella meta-analysis on meta-analyses of randomized controlled trials. Food Funct 2023; 14:7654-7662. [PMID: 37540067 DOI: 10.1039/d3fo00300k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Background and aims: The purpose of this umbrella meta-analysis was to quantitatively summarize meta-analyses of randomized controlled trial (RCT) studies regarding the effects of probiotic supplementation on Helicobacter pylori (H. pylori) eradication. Methods: A thorough search of the electronic databases including PubMed, Web of Science, Embase, Scopus, and Google Scholar was carried out from the inception up to May 2022. For the evaluation of overall effect sizes, the pooled relative risk (RR) or odds ratio (OR) and their corresponding 95% confidence intervals (CI) were calculated. The random-effects model was used for the meta-analysis. Results: Overall, 18 eligible studies (47 278 participants in total) were included in the study. The findings revealed that probiotics have a beneficial impact on H. pylori eradication (pooled ESRR: 1.13; 95% CI: 1.11, 1.14, p < 0.01, and ESOR = 1.86, 95% CI: 1.70, 2.03, p < 0.01). Greater effects on H. pylori eradication were observed when higher doses (>10 × 1010 CFU) and mixed strains were supplemented. Conclusion: The present umbrella meta-analysis suggests that supplementation with probiotics may be considered as an efficient approach to ameliorate H. pylori complications, particularly probiotics with higher CFUs and mixed strains.
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Affiliation(s)
- Vali Musazadeh
- Student Research Committee, Tabriz University of Medical, Sciences, Tabriz, Iran
- School of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Nazari
- Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Faghfouri
- Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Emami
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeynab Kavyani
- Student Research Committee, Tabriz University of Medical, Sciences, Tabriz, Iran
- School of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Zokaei
- Department of Food Science and Technology, Faculty of Nutrition Science, Food Science and Technology/National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parmida Jamilian
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | - Meysam Zarezadeh
- Student Research Committee, Tabriz University of Medical, Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Attar-Neishaburi St., Golgasht Alley, Azadi Blvd., Tabriz, Iran.
| | - Ahmad Saedisomeolia
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, 21, 111 Lakeshore, Ste-Anne-de-Bellevue, Quebec, H9X 3 V9, Canada.
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Sotelo S, Manterola C, Otzen T, Morales E, Castillo I. Prevalence of Gastric Preneoplastic Lesions in First-Degree Relatives of Patients with Gastric Cancer: a Cross-Sectional Study. J Gastrointest Cancer 2023; 54:513-519. [PMID: 35488975 DOI: 10.1007/s12029-022-00827-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Worldwide, gastric cancer (GC) is the 5th cancer with the highest incidence and the 4th in mortality. To reduce it, one strategy is to diagnose preneoplastic lesions (PNL): atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia (DYS); to form risk groups on which to focus surveillance efforts as are first-degree relatives (FDR). The aim of this study was to determine prevalence of gastric PNL in FDR of patients with GC, and to study association with sex, age, and Helicobacter pylorii (Hp) infection. METHODS Cross-sectional study. One hundred and ten FDR, aged between 50 and 65 years, 54.5 female, obtained through convenience sampling, were studied. Biodemographic data survey and upper gastrointestinal endoscopy with histological study were applied according to Sidney protocol, and focal lesions found. Diagnosis of these lesions and condition of mucosa was carried out by applying OLGA and OLGIM systems. Descriptive statistics, estimation of prevalence, odds ratio (OR), and 95% confidence intervals (95CI) were calculated. RESULTS Median age of study group was 56.5 years. Prevalence of PNL, AG, IM, and DYS were 86.4%, 82.7%, 54.5%, and 12.7% respectively. Advanced stages of OLGA and OLGIM were verified in 18.0% and 16.3% respectively. No association with sex, age, and Hp infection were found ([OR 3.10; 95CI 1.0; 9.64]; [OR 0.74; 95CI 0.26; 2.14]; [OR 0.58; 95CI 0.12; 2.77]) respectively. CONCLUSION FDR of patients with GC have a high prevalence of PNL, which makes them a risk group in which endoscopic surveillance should be applied.
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Affiliation(s)
- Sergio Sotelo
- PhD Program in Medical Sciences, Universidad de La Frontera, Temuco, Chile
- Faculty of Medicine, Universidad Católica del Maule, Talca, Chile
- Hospital Regional de Talca, Talca, Chile
| | - Carlos Manterola
- Center of Morphological and Surgical Studies (CEMyQ), and PhD Program in Medical Sciences, and Millennium Nucleus on Sociomedicine, Universidad de La Frontera, Manuel Montt 115, 54-D, Temuco, Chile.
| | - Tamara Otzen
- Center of Morphological and Surgical Studies (CEMyQ), and PhD Program in Medical Sciences, and Millennium Nucleus on Sociomedicine, Universidad de La Frontera, Manuel Montt 115, 54-D, Temuco, Chile
| | - Erik Morales
- Faculty of Medicine, Universidad Católica del Maule, Talca, Chile
- Hospital Regional de Talca, Talca, Chile
| | - Iván Castillo
- Faculty of Medicine, Universidad Católica del Maule, Talca, Chile
- Hospital Regional de Talca, Talca, Chile
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Galoș F, Boboc C, Ieșanu MI, Anghel M, Ioan A, Iana E, Coșoreanu MT, Boboc AA. Antibiotic Resistance and Therapeutic Efficacy of Helicobacter pylori Infection in Pediatric Patients-A Tertiary Center Experience. Antibiotics (Basel) 2023; 12:antibiotics12010146. [PMID: 36671347 PMCID: PMC9854557 DOI: 10.3390/antibiotics12010146] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
One of the most widespread bacterial infections worldwide, Helicobacter pylori is thought to affect almost half of the world's population. Due to rising antibiotic resistance, treatment should be tailored according to antibiotic susceptibility testing (AST). This study aims to evaluate Helicobacter pylori antibiotic resistance and its therapeutic efficacy in children. We conducted a prospective, single-center study, that evaluated 68 children referred for upper gastrointestinal endoscopy (UGE) following chronic dyspeptic syndrome. Each patient underwent multiple biopsies to perform bacterial cultures with AST and histopathological examinations for the diagnosis. Patients without antibiotic resistance or negative cultures received a 10-day sequential therapy, while the others had the antibiotic regimen tailored based on AST. Fifty-nine patients with a positive biopsy-based diagnosis (24 males) were finally included. Bacterial cultures with AST were positive for 13 patients (22.03%) and the antibiotic resistance for clarithromycin was 15.38%. Fifty-seven patients were administered sequential therapy with an eradication rate of 94.73%. Clarithromycin-resistant patients were successfully treated with 10-day triple therapy of esomeprazole, amoxicillin, and metronidazole. Although bacterial cultures had a low positivity rate, sequential therapy had a successful eradication rate. Further studies are necessary to better assess Helicobacter pylori antibiotic resistance to provide tailored treatment and identify children that need closer monitoring.
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Affiliation(s)
- Felicia Galoș
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Cătălin Boboc
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Mara-Ioana Ieșanu
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence:
| | - Mălina Anghel
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Andreea Ioan
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Elena Iana
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Maria Teodora Coșoreanu
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Anca Andreea Boboc
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatrics, Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania
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Jove AG, Holmes HM, Tan MC, El-Serag HB, Thrift AP. Inverse Association Between Gluteofemoral Obesity and Risk of Non-Cardia Gastric Intestinal Metaplasia. Clin Gastroenterol Hepatol 2023; 21:64-71. [PMID: 35569739 PMCID: PMC9653509 DOI: 10.1016/j.cgh.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/25/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is unclear whether obesity confers increased risk of non-cardia gastric adenocarcinoma and its precursor, gastric intestinal metaplasia. Here, we examined whether various dimensions of adiposity independently predispose to the development of non-cardia gastric intestinal metaplasia. METHODS We compared data from 409 non-cardia gastric intestinal metaplasia cases and 1748 controls without any gastric intestinal metaplasia from a cross-sectional study at the VA Medical Center in Houston, Texas. Participants completed standardized questionnaires, underwent anthropometric measurements, and underwent a study endoscopy with gastric mapping biopsies. Non-cardia gastric intestinal metaplasia cases included participants with intestinal metaplasia on any non-cardia gastric biopsy. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression models. RESULTS Increasing body mass index (BMI) was not associated with risk of non-cardia gastric intestinal metaplasia (per unit BMI adjusted OR, 0.98; 95% CI, 0.96-1.00). Similarly, we found no associations with increase in waist circumference (per 10-cm increase adjusted OR, 0.94; 95% CI, 0.87-1.03) and waist-to-hip ratio (WHR) (per unit WHR adjusted OR, 2.34; 95% CI, 0.37-14.7). However, there was a significant inverse association with gastric intestinal metaplasia and increasing hip circumference, reflecting gluteofemoral obesity (per 10-cm increase adjusted OR, 0.89; 95% CI, 0.80-0.98). The inverse association was observed for both extensive and focal gastric intestinal metaplasia. CONCLUSIONS The independent dimensions of adiposity (BMI, waist circumference) are not associated with increased risk of non-cardia gastric intestinal metaplasia. The inverse association between gluteofemoral obesity and risk of gastric intestinal metaplasia warrants additional study.
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Affiliation(s)
- Andre G Jove
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hudson M Holmes
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mimi C Tan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.
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Zullo A, Germanà B, Galliani E, Iori A, de Pretis G, Manfredi G, Buscarini E, Ciuffi M, Ignomirelli O, Farinati F, Savarino E, Pallini P, Milan L, Conigliaro R, Grande G, Cannizzaro R, Maiero S, Pisani A, Marangi S, Manta R, Morelli O, Peralta S, Mantia AL, Rossano Buonocore M, Monica F. Real-time gastric juice analysis with EndoFaster for H. pylori diagnosis: a large, multicentre study. Eur J Gastroenterol Hepatol 2022; 34:1121-1124. [PMID: 36170680 DOI: 10.1097/meg.0000000000002429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Helicobacter pylori infection is the main cause of the most frequent gastroduodenal diseases. Because its prevalence is decreasing in developed countries, gastric biopsies are negative in several patients. By measuring ammonium in the gastric juice, EndoFaster allows to exclude H. pylori infection during endoscopy. This study aimed to assess the accuracy of device versions working with either 6 ml or 3 ml of gastric juice. STUDY DESIGN This prospective study involved 12 endoscopic units. During endoscopy, EndoFaster testing was performed and standard five gastric biopsies were taken. The accuracy was calculated by considering histological assessment as the gold standard for H. pylori diagnosis. RESULTS Gastric juice analysis was attempted in 1279 patients, but it failed in 131 (15.5%) and in 10 (2.3%), with the 6 ml and the 3 ml device, respectively (P < 0.001). Overall, EndoFaster detected H. pylori infection with an 86.3% sensitivity, 83.3% specificity, 52.7% positive predictive value, 96.6% negative predictive value and 83.8% accuracy. The performance was not affected either by ongoing proton pump inhibitor therapy or a previous H. pylori eradication. No significant difference in accuracy emerged between the two versions of the device. CONCLUSION The novel version of the EndoFaster device operating with 3 ml gastric juice may be performed in virtually all patients, and it allows excluding H. pylori infection with a very high accuracy. Gastric biopsies can be avoided in a definite portion of cases without endoscopic lesions or other clinical indications.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology Unit, 'Nuovo Regina Margherita' Hospital, Rome
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, 'San Martino' Hospital, Belluno
| | | | - Andrea Iori
- Gastroenterology and Digestive Endoscopy Unit,' Santa Chiara' Hospital, Trento
| | - Giovanni de Pretis
- Gastroenterology and Digestive Endoscopy Unit,' Santa Chiara' Hospital, Trento
| | - Guido Manfredi
- Gastroenterology and Digestive Endoscopy Unit, 'Maggiore' Hospital, Crema
| | | | | | | | | | | | - Paolo Pallini
- Gastroenterology Unit, 'San Bortolo' Hospital, Vicenza
| | - Luisa Milan
- Gastroenterology Unit, 'San Bortolo' Hospital, Vicenza
| | | | | | | | | | - Antonio Pisani
- Gastroenterology Unit, 'Saverio De Bellis' Research Hospital, Castellana Grotte
| | - Stefania Marangi
- Gastroenterology Unit, 'Saverio De Bellis' Research Hospital, Castellana Grotte
| | - Raffaele Manta
- Gastroenterology Unit, 'Santa Maria della Misericordia' Hospital, Perugia
| | - Olivia Morelli
- Gastroenterology Unit, 'Santa Maria della Misericordia' Hospital, Perugia
| | | | | | | | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, 'Cattinara' Academic Hospital, Trieste, Italy
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9
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Huang RJ, Epplein M, Hamashima C, Choi IJ, Lee E, Deapen D, Woo Y, Tran T, Shah SC, Inadomi JM, Greenwald DA, Hwang JH. An Approach to the Primary and Secondary Prevention of Gastric Cancer in the United States. Clin Gastroenterol Hepatol 2022; 20:2218-2228.e2. [PMID: 34624563 PMCID: PMC8983795 DOI: 10.1016/j.cgh.2021.09.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Gastric cancer (GC) remains a leading cause of mortality among certain racial, ethnic, and immigrant groups in the United States (US). The majority of GCs are diagnosed at advanced stages, and overall survival remains poor. There exist no structured national strategies for GC prevention in the US. METHODS On March 5-6, 2020 a summit of researchers, policy makers, public funders, and advocacy leaders was convened at Stanford University to address this critical healthcare disparity. After this summit, a writing group was formed to critically evaluate the effectiveness, potential benefits, and potential harms of methods of primary and secondary prevention through structured literature review. This article represents a consensus statement prepared by the writing group. RESULTS The burden of GC is highly inequitably distributed in the US and disproportionately falls on Asian, African American, Hispanic, and American Indian/Alaskan Native populations. In randomized controlled trials, strategies of Helicobacter pylori testing and treatment have been demonstrated to reduce GC-specific mortality. In well-conducted observational and ecologic studies, strategies of endoscopic screening have been associated with reduced GC-specific mortality. Notably however, all randomized controlled trial data (for primary prevention) and the majority of observational data (for secondary prevention) are derived from non-US sources. CONCLUSIONS There exist substantial, high-quality data supporting GC prevention derived from international studies. There is an urgent need for cancer prevention trials focused on high-risk immigrant and minority populations in the US. The authors offer recommendations on how strategies of primary and secondary prevention can be applied to the heterogeneous US population.
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Affiliation(s)
- Robert J Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California
| | - Meira Epplein
- Department of Population Health Sciences, Duke University, and Cancer Risk, Detection, and Interception Program, Duke Cancer Institute, Durham, North Carolina
| | | | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Eunjung Lee
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Dennis Deapen
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope National Comprehensive Cancer Center, Duarte, California
| | - Thuy Tran
- Division of Surgical Oncology, Department of Surgery, City of Hope National Comprehensive Cancer Center, Duarte, California
| | - Shailja C Shah
- Gastroenterology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California; Division of Gastroenterology and Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - David A Greenwald
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California.
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10
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Kligman E, Ali H, Chen E, Peng F, Szafron D, Staggers K, Tan MC, Patel K, Othman MO. Ethnicity Is an Important Consideration in Screening for Gastric Intestinal Metaplasia. Dig Dis Sci 2022; 67:4509-4517. [PMID: 34981309 DOI: 10.1007/s10620-021-07326-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 11/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gastric intestinal metaplasia (GIM) is a precursor to gastric adenocarcinoma, making it an attractive target for early detection by endoscopy. The aim of this study was to determine the prevalence, risk factors, and associated histologic findings of GIM among patients undergoing endoscopy in a diverse US population. METHODS We conducted a retrospective, cross-sectional study of patients undergoing elective endoscopy with gastric biopsies at 6 academic and community centers in Houston, Texas. GIM prevalence was estimated with a 95% confidence interval (CI), and patient demographic and clinical characteristics were summarized using mean with standard deviation, or frequency with percentage. Generalized estimating equations (GEE) were used to compare characteristics between those with and without GIM. RESULTS Our final cohort consisted of 2685 patients, including 216 cases with GIM and 2469 controls. The prevalence of GIM in our cohort was 8.04% (95% CI 7.07%, 9.14%). The mean age of GIM cases was higher than in the control group (59.8 vs 54.7 years, p < 0.0001). The prevalence of GIM in Asians, Hispanic, Black and Non-Hispanic Whites (NHW) was 14.7%, 11.7%, 9.8% and 5.8%, respectively. On multivariable analysis, factors associated with GIM include age (adj. OR 1.32 per 10 year increase, p < 0.0001), habitual smoking (adj. OR 1.68, p < 0.0001), and race (compared to NHW: Asian, adj. OR 2.34, p = 0.010; Hispanic, adj. OR 2.15, p < 0.001; Black, adj. OR 1.61, p < 0.001). CONCLUSION Asians, Hispanics, and African Americans have higher rates of GIM than NHW. Ethnicity should be an important consideration on determining who to screen for GIM in the US.
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Affiliation(s)
- Eugene Kligman
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge Street. Suite 8A, Houston, TX, 77030, USA
| | - Hiba Ali
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ellie Chen
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Frederick Peng
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - David Szafron
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kristen Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Mimi C Tan
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge Street. Suite 8A, Houston, TX, 77030, USA
| | - Kalpesh Patel
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge Street. Suite 8A, Houston, TX, 77030, USA
| | - Mohamed O Othman
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge Street. Suite 8A, Houston, TX, 77030, USA. .,Baylor St Luke's Medical Center, Houston, TX, USA.
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11
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Ma S, Guo X, Wang C, Yin Y, Xu G, Chen H, Qi X. Association of Barrett's esophagus with Helicobacter pylori infection: a meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221117971. [PMID: 36034104 PMCID: PMC9403448 DOI: 10.1177/20406223221117971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Barrett’s esophagus (BE) is the only recognized precursor for esophageal
adenocarcinoma. Helicobacter pylori (H.
pylori) infection is a major contributing factor towards upper
gastrointestinal diseases, but its relationship with BE remains
controversial. Some previous studies suggested that H.
pylori infection negatively correlated with BE, while others
did not. This may be attributed to the difference in the selection of
control groups among studies. The present meta-analysis aims to clarify
their association by combining all available data from well-designed
studies. Methods: The PubMed, EMBASE, and Cochrane
Library databases were searched. Odds ratios (ORs) with 95%
confidence intervals (CIs) were pooled by a random-effects model.
Heterogeneity was evaluated using the Cochran’s Q test and
I2 statistics. Meta-regression, subgroup,
and leave-one-out sensitivity analyses were employed to explore the sources
of heterogeneity. Results: Twenty-four studies with 1,354,369 participants were included. Meta-analysis
found that patients with BE had a significantly lower prevalence of
H. pylori infection than those without (OR = 0.53, 95%
CI = 0.45–0.64; p < 0.001). The heterogeneity was
statistically significant (I² = 79%;
p < 0.001). Meta-regression, subgroup, and leave-one-out
sensitivity analyses did not find any source of heterogeneity. Meta-analysis
of 7 studies demonstrated that CagA-positive H. pylori
infection inversely correlated with BE (OR = 0.25, 95% CI = 0.15–0.44;
p = 0.000), but not CagA-negative H.
pylori infection (OR = 1.22, 95% CI = 0.90–1.67;
p = 0.206). Meta-analysis of 4 studies also
demonstrated that H. pylori infection inversely correlated
with LSBE (OR = 0.39, 95% CI = 0.18–0.86; p = 0.019), but
not SSBE (OR = 0.73, 95% CI = 0.30–1.77; p = 0.484). Conclusion: H. pylori infection negatively correlates with BE. More
experimental studies should be necessary to elucidate the potential
mechanisms in future.
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Affiliation(s)
| | | | | | | | - Guangqin Xu
- Department of Gastroenterology, General
Hospital of Northern Theater Command, Shenyang, China
- Graduate School, Dalian Medical University,
Dalian, China
| | - Hongxin Chen
- Department of Gastroenterology, General
Hospital of Northern Theater Command, Shenyang, China
- Graduate School, Liaoning University of
Traditional Chinese Medicine, Shenyang, China
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12
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Li Y, Li X, Tan Z. Basic Traditional Chinese Medicinal Compound for Adjuvant Treatment of Helicobacter pylori-Related Gastritis: Implication for Anti- H. pylori-Related Gastritis Drug Discovery. Nat Prod Commun 2022. [DOI: 10.1177/1934578x221113968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study was aimed at evaluating the efficacy of traditional Chinese medicine (TCM) in the adjuvant treatment of Helicobacter pylori-associated gastritis (HPAG) and exploring the molecular mechanism underlying the action of the basic TCM compounds against HPAG. Eight representative Chinese and British databases were combed for pertinent literature. In light of the basic principle of evidence-based medicine, this work rigorously stuck to the inclusion and exclusion of criteria so as to plump for qualified articles. Also, the data mining method was adopted to help determine the basic TCM compound for HPAG treatment. Furthermore, a network pharmacology-based strategy was used to uncover the underlying mechanisms of the basic TCM compound against HPAG. Ultimately, molecular docking was used for preliminary verification. TCM combined with triple or quadruple therapy against HPAG possessed more advantages in improving the total effective rate and H. pylori eradication rate than triple or quadruple therapy alone. The basic TCM plant materials against HPAG consisted of Citrus reticulata Blanco, Glycyrrhiza uralensis Fisch, Pinellia ternata (Thunb.) Breit, Coptis chinensis Franch, and Poria cocos (Schw.) Wolf. Quercetin, kaempferol, naringenin, baicalein, nobiletin, and hederagenin were determined as the key active ingredients of the basic TCM preparation against HPAG. Moreover, these ingredients played a therapeutic role by acting on AKT1, TP53, interleukin (IL)-6, VEGFA, CASP3, MAPK3, JUN, TNF, and MAPK8 via Pathways in cancer, PI3K-Akt signaling pathway, TNF signaling pathway, and MAPK signaling pathway. The results of molecular docking indicated that the key ingredients could bind stably with the core targets. The efficacy of the TCM in the adjuvant treatment of HPAG is worthy of affirmation. Compatible use of the key ingredients of the basic TCM compound is a novel idea of drug research with profound clinical significance and research value in the development of anti- H. pylori drugs.
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Affiliation(s)
- Yuli Li
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Xiaoya Li
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Zhoujin Tan
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan Province, China
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13
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Li RJ, Qin C, Huang GR, Liao LJ, Mo XQ, Huang YQ. Phillygenin Inhibits Helicobacter pylori by Preventing Biofilm Formation and Inducing ATP Leakage. Front Microbiol 2022; 13:863624. [PMID: 35572695 PMCID: PMC9097866 DOI: 10.3389/fmicb.2022.863624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
With the widespread use and abuse of antibiotics, Helicobacter pylori (H. pylori) has become seriously drug resistant. The development of new antibiotics is an important way to solve H. pylori's drug resistance. Screening antibacterial ingredients from natural products is a convenient way to develop new antibiotics. Phillygenin, an effective antibacterial component, was selected from the natural product, forsythia, in this study. Its minimal inhibitory concentration (MIC) for 18 H. pylori strains was 16-32 μg/ml. The minimum bactericidal concentration (MBC) of H. pylori G27 was 128 μg/ml; the higher the drug concentration and the longer the time, the better the sterilization effect. It was non-toxic to gastric epithelial cell (GES)-1 and BGC823 cells at the concentration of 100 μg/ml. It presented a better antibacterial effect on H. pylori in an acidic environment, and after 24 days of induction on H. pylori with 1/4 MIC of phillygenin, no change was found in the MIC of H. pylori. In the mechanism of action, phillygenin could cause ATP leakage and inhibit the biofilm formation; the latter was associated with the regulation of spoT and Hp1174 genes. In addition, phillygenin could regulate the genes of Nhac, caggamma, MATE, MdoB, flagellinA, and lptB, leading to the weakening of H. pylori's acid resistance and virulence, the diminishing of H. pylori's capacity for drug efflux, H. pylori's DNA methylation, the initiation of human immune response, and the ATP leakage of H. pylori, thus accelerating the death of H. pylori. In conclusion, phillygenin was a main ingredient inhibiting H. pylori in Forsythia suspensa, with a good antibacterial activity, high safety, strong specificity, better antibacterial effect under acidic conditions, and low risk of resistance development by H. pylori. Its mechanism of action was mainly associated with inhibiting the biofilm formation and resulting in ATP leakage. In addition, phillygenin was shown to be able to reduce the acid resistance and virulence of H. pylori.
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Affiliation(s)
- Ru-Jia Li
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infecting, Youjiang Medical University for Nationalities, Baise, China
| | - Chun Qin
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infecting, Youjiang Medical University for Nationalities, Baise, China
| | - Gan-Rong Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infecting, Youjiang Medical University for Nationalities, Baise, China
| | - Li-Juan Liao
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infecting, Youjiang Medical University for Nationalities, Baise, China
| | - Xiao-Qiang Mo
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infecting, Youjiang Medical University for Nationalities, Baise, China
| | - Yan-Qiang Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infecting, Youjiang Medical University for Nationalities, Baise, China
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14
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Huang RJ, Park S, Shen J, Longacre T, Ji H, Hwang JH. Pepsinogens and Gastrin Demonstrate Low Discrimination for Gastric Precancerous Lesions in a Multi-Ethnic United States Cohort. Clin Gastroenterol Hepatol 2022; 20:950-952.e3. [PMID: 33434656 DOI: 10.1016/j.cgh.2021.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
Early identification of gastric precancerous lesions, including atrophic gastritis (AG) and intestinal metaplasia (IM), may improve gastric cancer detection and prevention. Because AG and IM are generally asymptomatic, many of the estimated 15 million Americans who carry these lesions remain undiagnosed.1 AG and IM are associated with either active or prior Helicobacter pylori (Hp) infection. Hp infection leads to perturbations in the serum concentration of gastric hormones pepsinogen I (PGI), pepsinogen II, the pepsinogen I/II ratio (PGR), gastrin-17 (G-17), and Hp IgG.2,3 In East Asia and other regions with high burden of Hp infection and gastric cancer, these biomarkers have been used as screening tools for AG and IM.4 However, there exists limited data on the sensitivity and discrimination of these serologic markers in low-Hp-prevalence populations, such as the United States.
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Affiliation(s)
- Robert J Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California.
| | - Sungho Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California
| | - Jeanne Shen
- Department of Pathology, Stanford University, Stanford, California
| | - Teri Longacre
- Department of Pathology, Stanford University, Stanford, California
| | - Hanlee Ji
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California
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15
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Tsang SH, Avilés-Santa ML, Abnet CC, Brito MO, Daviglus ML, Wassertheil-Smoller S, Castañeda SF, Minnerath S, Talavera GA, Graubard BI, Thyagarajan B, Camargo MC. Seroprevalence and Determinants of Helicobacter pylori Infection in the Hispanic Community Health Study/Study of Latinos. Clin Gastroenterol Hepatol 2022; 20:e438-e451. [PMID: 33667677 PMCID: PMC8410907 DOI: 10.1016/j.cgh.2021.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Helicobacter pylori infection is the primary known risk factor for gastric cancer. Despite the global decline in H. pylori prevalence, this infection remains a major public health concern in developing areas, including Latin America. Our study aimed to determine H. pylori seroprevalence and identified its determinants among Hispanics/Latinos living in the United States (U.S.). METHODS The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a population-based sample of self-identified Hispanics/Latinos (n = 16,144) in four U.S. communities, aged 18 to 74 years, recruited from randomly selected households using a stratified two-stage area probability sample design based on sampling households within sampled census block groups weighted for differential response rates. Anti-H. pylori immunoglobulin G antibodies were measured by an enzyme-linked immunosorbent assay using plasma samples. We calculated adjusted seroprevalence (i.e., predicted margins) from multivariable logistic regression models. RESULTS The overall weighted H. pylori seroprevalence was 57% among HCHS/SOL participants, with 38% and 62% seropositivity among U.S.-born and non-U.S.-born individuals, respectively. Age-adjusted prevalence varied by self-reported Hispanic/Latino background, ranging from 47% in Puerto Rican to 72% in Central American backgrounds. Adjusted H. pylori seroprevalence was higher in the following groups: older age, male sex, lower education, non-U.S. born status, smoking, greater number of missing teeth, fewer doctor visits, lower ferritin level, and hepatitis A seropositivity. CONCLUSIONS H. pylori seroprevalence in Hispanics/Latinos remains high and differed significantly by Hispanic/Latino background. H. pylori seropositivity is strongly associated with poor socioeconomic conditions. These findings highlight the ongoing importance of this bacterial infection in the U.S.
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Affiliation(s)
- Sabrina H Tsang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
| | - M Larissa Avilés-Santa
- Division on Clinical and Health Services Research, National Institute on Health and Health Disparities, Rockville, Maryland
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Maximo O Brito
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois
| | | | - Sheila F Castañeda
- Department of Psychology, San Diego State University, San Diego, California
| | - Sharon Minnerath
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, California
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - M Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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16
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Osadchuk MA, Svistunov AA, Balashov DV, Osadchuk MM. Functional dyspepsia: a multifaceted problem in gastroenterology. TERAPEVT ARKH 2022; 93:1539-1544. [DOI: 10.26442/00403660.2021.12.201190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 11/22/2022]
Abstract
The article presents the views on dyspepsia in world practice, data on the difficulties of diagnosis and the problem of the effectiveness of various therapy regimens. Particular attention is paid to the use of fixed forms of drugs for functional dyspepsia, in particular Omez DSR.
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17
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Li RJ, Dai YY, Qin C, Huang GR, Qin YC, Huang YY, Huang ZS, Luo XK, Huang YQ. Application of traditional Chinese medicine in treatment of Helicobacter pylori infection. World J Clin Cases 2021; 9:10781-10791. [PMID: 35047590 PMCID: PMC8678867 DOI: 10.12998/wjcc.v9.i35.10781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) has a high rate of infection and antibiotic resistance and poses a serious threat to human life. One of the main strategies to overcome drug resistance is to develop new treatment plans. Traditional Chinese medicine (TCM) that is commonly used to treat many diseases in China can reduce drug resistance and increase the eradication rate of H. pylori. In this paper, we review the research progress on TCM in the treatment of H. pylori infection. The mechanism of action of TCM is reviewed and research and applications of TCM in the treatment of H. pylori are demonstrated. Finally, we discuss problems confronting the use of TCM for the treatment of H. pylori infection and propose possible solutions. In addition, the plans of TCM in H. pylori treatment were also screened: Dampness-heat syndrome in the spleen and stomach, deficiency of spleen and stomach, and cold-heat complicated syndrome, and the effective components therein are studied. The antibacterial effect of TCM is relatively slow; for rapid improvement of the treatment effect of refractory H. pylori gastritis, we provide an appropriate treatment regime combining TCM and Western medicine with immune-regulatory and synergistic antibacterial effects.
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Affiliation(s)
- Ru-Jia Li
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yuan-Yuan Dai
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Chun Qin
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Gan-Rong Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yan-Chun Qin
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yong-Yi Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Zan-Song Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Xian-Ke Luo
- National Hospital of Guangxi Zhuang Autonomous Region, Nanning 530001, Guangxi Zhuang Autonomous Region, China
| | - Yan-Qiang Huang
- Research Center for the Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
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18
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Yang TJ, Dhanasekar K, Bhandari R, Muraleedharan D, Chirindoth SS, Kaur H, Goswami R, Maiyani P, Desai M, Moradiya DV, Devani H, Patel AA. Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study. Cureus 2021; 13:e19315. [PMID: 34900489 PMCID: PMC8650630 DOI: 10.7759/cureus.19315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) plays an important role in causing peptic ulcer disease (PUD) in the general population. However, the role of H. pylori in cirrhotic patients for causing PUD is obscure. There are various studies evaluating H. pylori association with PUD in cirrhotic patients, but the results have been controversial. We sought to analyze the association of H. pylori with the development of PUD in cirrhotic patients from the largest United States population-based database. METHODS We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2017. Adult hospitalizations due to cirrhosis were identified by previously validated ICD-10-CM codes. PUD and H. pylori were identified with the presence of ICD-10-CM codes in primary and secondary diagnosis fields, respectively. We performed weighted analyses using Chi-Square and paired Student's t-test to compare the groups. Multivariable survey logistic regression was performed to find an association of H. pylori with PUD in cirrhotic patients. RESULTS Our study showed that the prevalence of H. pylori infection was 2.2% in cirrhotic patients with PUD. In regression analysis, H. pylori was found to be associated with PUD in cirrhotic patients (OR 15.1; 95% CI: 13.9-16.4; p <0.001) and non-cirrhotic patients (OR 48.8; 95% CI: 47.5-50.1; p <0.001). In the studied population, H. pylori was more commonly seen in the age between 50 and 64 years (49.4% vs 44.1%; p <0.0001), male (63.4% vs 59.9%; p <0.0413), African American (16.3% vs 10.6%; p <0.0001), and Hispanic (26.2% vs 14.9%; p <0.0001). H. pylori is more likely to be associated with complicated PUD hospitalizations (51.2% vs 44.2%; p <0.0067). Alcoholism and smoking were more common in H. pylori group compared to those without (43.6% vs 35.8%; p <0.0001 and 33.7% vs 24.8% p <0.0001, respectively). Factors associated with increased odds of H. pylori infection include African American (OR 2.3, 95% CI: 1.5-3.6), Hispanic (OR 2.6, 95% CI: 1.7-4.0), and smoking (OR 1.5, 95% CI: 1.1-2.2). CONCLUSION H. pylori are associated with PUD and concurrent cirrhosis, although it is less prevalent than general population. African American, Hispanic, and smoking were independently associated with increased odds of H. pylori infection. Further studies are required to better understand the epidemiology and confirm our findings.
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Affiliation(s)
- Tsu Jung Yang
- Hospital Medicine, MultiCare Good Samaritan Hospital, Puyallup, USA
| | | | - Renu Bhandari
- Medicine, Manipal College of Medical Sciences, Kaski, NPL
| | | | | | - Harpreet Kaur
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Ruchir Goswami
- Epidemiology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Prakash Maiyani
- Internal Medicine, Gold Coast University Hospital, Southport, AUS
| | - Maheshkumar Desai
- Internal Medicine, Hamilton Medical Center, Medical College of Georgia/Augusta University, Augusta, USA
| | | | - Hiteshkumar Devani
- Dental Medicine, University of Pittsburgh School of Dental Medicine, Pittsburgh, USA
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Du YL, Duan RQ, Duan LP. Helicobacter pylori infection is associated with reduced risk of Barrett's esophagus: a meta-analysis and systematic review. BMC Gastroenterol 2021; 21:459. [PMID: 34876031 PMCID: PMC8650239 DOI: 10.1186/s12876-021-02036-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Helicobacter pylori (Hp) is a class I carcinogen in gastric carcinogenesis, but its role in Barrett's esophagus (BE) is unknown. Therefore, we aimed to explore the possible relationship. METHODS We reviewed observational studies published in English until October 2019. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for included studies. RESULTS 46 studies from 1505 potential citations were eligible for inclusion. A significant inverse relationship with considerable heterogeneity was found between Hp (OR = 0.70; 95% CI, 0.51-0.96; P = 0.03) and BE, especially the CagA-positive Hp strain (OR = 0.28; 95% CI, 0.15-0.54; P = 0.0002). However, Hp infection prevalence was not significantly different between patients with BE and the gastroesophageal reflux disease (GERD) control (OR = 0.99; 95% CI, 0.82-1.19; P = 0.92). Hp was negatively correlated with long-segment BE (OR = 0.47; 95% CI, 0.25-0.90; P = 0.02) and associated with a reduced risk of dysplasia. However, Hp had no correlated with short-segment BE (OR = 1.11; 95% CI, 0.78-1.56; P = 0.57). In the present infected subgroup, Hp infection prevalence in BE was significantly lower than that in controls (OR = 0.69; 95% CI, 0.54-0.89; P = 0.005); however, this disappeared in the infection history subgroup (OR = 0.88; 95% CI, 0.43-1.78; P = 0.73). CONCLUSIONS Hp, especially the CagA-positive Hp strain, and BE are inversely related with considerable heterogeneity, which is likely mediated by a decrease in GERD prevalence, although this is not observed in the absence of current Hp infection.
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Affiliation(s)
- Yan-Lin Du
- Department of Gastroenterology, Peking University Third Hospital, No. 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Ru-Qiao Duan
- Department of Gastroenterology, Peking University Third Hospital, No. 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Li-Ping Duan
- Department of Gastroenterology, Peking University Third Hospital, No. 49 North Garden Rd., Haidian District, Beijing, 100191, China.
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20
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Genta RM, Singhal A, Turner KO, Sonnenberg A. Lymphocytic gastritis and its relationships with other gastrointestinal disorders. Aliment Pharmacol Ther 2021; 54:1170-1178. [PMID: 34587312 DOI: 10.1111/apt.16621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lymphocytic gastritis (LyG) is a histopathologic finding of unknown clinical relevance. AIMS To explore the clinical epidemiology of LyG and its associations with Helicobacter pylori (Hp) infection, coeliac disease (CD) and microscopic colitis (MC) METHODS: In a cross-sectional study, the demographic, clinical, and histopathologic data of patients with and without LyG were compared. Between 2008 and 2020, 1.5 million patients with endoscopic biopsies of the gastroduodenal mucosa were extracted from a database. LyG diagnoses were reviewed to collect detailed information regarding its topographic distribution within the stomach. In a large subgroup of 400 000 patients, tissue samples from the colon were also available. RESULTS Of 1 481 336 patients, 341 had LyG with Hp and 2697 had Hp-negative LyG (with an overall prevalence of 0.21%). In patients with Hp-negative LyG, 450 (17%) had corpus-predominant LyG, 1068 antrum-predominant LyG (40%), and 1179 pangastric LyG (44%). LyG was more common in males and in subjects aged 50-70 years. There was no significant ethnic variation. Anaemia, diarrhoea, and weight loss were more common in patients with than without LyG. In 35% and 19% of patients, LyG was associated with CD and MC, respectively. All 72 patients with Hp-positive LyG and 280 of 310 patients with Hp-negative LyG with follow-up biopsies became free of LyG within a year. CONCLUSIONS Most cases of LyG may represent a self-limited expression, frequently associated with other GI conditions, such as Hp infection, CD, and MC. In most patients, LyG is likely to resolve within a year after its initial diagnosis.
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Affiliation(s)
- Robert M Genta
- Inform Diagnostics, Irving, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | | | | | - Amnon Sonnenberg
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, USA.,Gastroenterology Section, Portland VA Medical Center, Portland, OR, USA
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21
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Genta RM, Turner KO, Morgan CJ, Sonnenberg A. Collagenous gastritis: Epidemiology and clinical associations. Dig Liver Dis 2021; 53:1136-1140. [PMID: 33824091 DOI: 10.1016/j.dld.2021.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND the rare occurrence of collagenous gastritis (CG) makes its epidemiology difficult to investigate. We designed a study to determine the demographic and clinical characteristics as well as the associations of CG with other upper gastrointestinal diseases in a large national clinicopathological database. METHODS from the IDEA database we extracted all patients with histopathologically documented CG and, in a case-control study, we compared 168 subjects with and 1,286,165 subjects without CG using odds ratios (OR) with their 95% confidence intervals (CI). RESULTS the prevalence of CG was 13 per 100,000 EGDs. CG was significantly more common among female than male patients (OR: 1.69, 95% CI: 1.20-2.39) and was characterized by a bi-modal age distribution (first peak in patients aged 10-19, second peak primarily in females aged >60 years). CG patients presented with diarrhea (18%), anemia (12%), weight loss (11%), and vomiting (10%). CG was significantly associated with other lymphocytic disorders of the upper gastrointestinal tract, including celiac sprue (2.12, 1.55-2.88), duodenal intraepithelial lymphocytosis (3.71, 2.30-5.98), and lymphocytic gastritis (23.2, 10.9-49.5). CG persisted in 69% of patients who underwent multiple consecutive endoscopies. CONCLUSIONS the epidemiologic features of collagenous gastritis reflect on different etiologies contributing to its occurrence in children and adults.
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Affiliation(s)
- Robert M Genta
- Inform Diagnostics, Irving, TX, United States; Baylor College of Medicine, Houston, TX, United States.
| | | | | | - Amnon Sonnenberg
- Division of Gastroenterology, Portland VA Medical Center and Oregon Health and Science University, United States
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22
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Aumpan N, Vilaichone RK, Pornthisarn B, Chonprasertsuk S, Siramolpiwat S, Bhanthumkomol P, Nunanan P, Issariyakulkarn N, Ratana-Amornpin S, Miftahussurur M, Mahachai V, Yamaoka Y. Predictors for regression and progression of intestinal metaplasia (IM): A large population-based study from low prevalence area of gastric cancer (IM-predictor trial). PLoS One 2021; 16:e0255601. [PMID: 34379655 PMCID: PMC8357097 DOI: 10.1371/journal.pone.0255601] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background Gastric intestinal metaplasia (IM) can lead to gastric cancer. Until now, there have been limited studies of predictors for regression and progression of IM. This study aimed to determine risk factors associated with regression or progression of IM for guiding proper management and prevention of gastric cancer. Methods 2,025 patients undergoing gastroscopy in Thammasat University Hospital, Thailand were enrolled during September 2017-August 2019. Patients’ data including baseline characteristics, laboratory results, and histopathology of gastric biopsies from University medical database were extensively reviewed. Results 2,025 patients had mean age of 61.3 years and 44.2% were males. Overall H. pylori prevalence was 47.5%. There were 1,551(76.6%) patients with chronic gastritis and 361(17.8%) with IM. Of 400 patients with chronic gastritis having follow-up endoscopy and repeated gastric biopsies, 104(26%) had persistent H. pylori infection and 27(26%) developed IM during mean follow-up time of 24 months. Persistent H. pylori infection was significantly associated with development of IM (OR 3.16, 95%CI 1.56–6.39, p = 0.001). Regression, persistence, and progression of IM were demonstrated in 57.3%, 39.2%, and 3.5% of patients, respectively. Age >65 years, persistent H. pylori infection, and diabetes mellitus were significantly associated with persistent IM or progression to dysplasia with OR 2.47(95%CI 1.33–4.61, p = 0.004), OR 2.64(95%CI 1.13–6.18, p = 0.025), and OR 2.54(95%CI 1.16–5.54, p = 0.019), respectively. Patients without H. pylori infection had more IM regression than patients with persistent infection (60.4%vs.39.4%, p = 0.035). Patients with persistent H. pylori infection significantly had higher IM progression to dysplasia (15.2%vs.2.1%; OR 11.15, 95%CI 1.18–105.24, p = 0.035) than noninfected. During 24 months of study, 30 patients (1.5%) were diagnosed with gastric cancer. Conclusion Regression of IM could be achieved by successful H. pylori eradication. Persistent H. pylori infection was significantly associated with development and progression of IM to dysplasia. Age >65 years and diabetes mellitus were also significant predictors for IM progression.
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Affiliation(s)
- Natsuda Aumpan
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Ratha-korn Vilaichone
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Chulabhorn International College of Medicine (CICM), Thammasat University, Pathumthani, Thailand
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | - Bubpha Pornthisarn
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Soonthorn Chonprasertsuk
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sith Siramolpiwat
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Chulabhorn International College of Medicine (CICM), Thammasat University, Pathumthani, Thailand
| | - Patommatat Bhanthumkomol
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pongjarat Nunanan
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Navapan Issariyakulkarn
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sarita Ratana-Amornpin
- Center of Excellence in Digestive Diseases and Gastroenterology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Muhammad Miftahussurur
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Varocha Mahachai
- Chulabhorn International College of Medicine (CICM), Thammasat University, Pathumthani, Thailand
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
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23
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Singh SP, Ahuja V, Ghoshal UC, Makharia G, Dutta U, Zargar SA, Venkataraman J, Dutta AK, Mukhopadhyay AK, Singh A, Thapa BR, Vaiphei K, Sathiyasekaran M, Sahu MK, Rout N, Abraham P, Dalai PC, Rathi P, Sinha SK, Bhatia S, Patra S, Ghoshal U, Poddar U, Mouli VP, Kate V. Management of Helicobacter pylori infection: The Bhubaneswar Consensus Report of the Indian Society of Gastroenterology. Indian J Gastroenterol 2021; 40:420-444. [PMID: 34219211 DOI: 10.1007/s12664-021-01186-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/20/2021] [Indexed: 02/04/2023]
Abstract
The Indian Society of Gastroenterology (ISG) felt the need to organize a consensus on Helicobacter pylori (H. pylori) infection and to update the current management of H. pylori infection; hence, ISG constituted the ISG's Task Force on Helicobacter pylori. The Task Force on H. pylori undertook an exercise to produce consensus statements on H. pylori infection. Twenty-five experts from different parts of India, including gastroenterologists, pathologists, surgeons, epidemiologists, pediatricians, and microbiologists participated in the meeting. The participants were allocated to one of following sections for the meeting: Epidemiology of H. pylori infection in India and H. pylori associated conditions; diagnosis; treatment and retreatment; H. pylori and gastric cancer, and H. pylori prevention/public health. Each group reviewed all published literature on H. pylori infection with special reference to the Indian scenario and prepared appropriate statements on different aspects for voting and consensus development. This consensus, which was produced through a modified Delphi process including two rounds of face-to-face meetings, reflects our current understanding and recommendations for the diagnosis and management of H. pylori infection. These consensus should serve as a reference for not only guiding treatment of H. pylori infection but also to guide future research on the subject.
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Affiliation(s)
- Shivaram Prasad Singh
- Department of Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753 007, India.
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Medical Centre, No. 1 Ramachandra Nagar, Porur, Chennai, 600 116, India
| | - Amit Kumar Dutta
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, 632 004, India
| | - Asish K Mukhopadhyay
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, 700 010, India
| | - Ayaskanta Singh
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001, India
| | - Babu Ram Thapa
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Superspeciality of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Kim Vaiphei
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India
| | - Malathi Sathiyasekaran
- Department of Pediatric Gastroenterology, Kanchi Kamakoti Childs Trust Hospital, Chennai, 600 034, India
| | - Manoj K Sahu
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001, India
| | - Niranjan Rout
- Department of Pathology, Acharya Harihar Post Graduate Institute of Cancer, Manglabag, Cuttack, 753 007, India
| | - Philip Abraham
- P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Cadel Road, Mahim, Mumbai, 400 016, India
| | - Prakash Chandra Dalai
- Gastro and Kidney Care Hospital, IRC Village, Nayapalli, Bhubaneswar, 751 015, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and B Y L Nair Charitable Hospital, Dr Anandrao Laxman Nair Marg, Mumbai, 400 008, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Shobna Bhatia
- Department of Gastroenterology and Hepatobiliary Sciences, Sir HN Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Prarthana Samaj, Girgaon, Mumbai, 400 004, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Patrapada, Bhubaneswar, 751 019, India
| | - Ujjala Ghoshal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605 006, India
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Hur C. Gastric Cancer:: An Update on the Rapidly Changing Characteristics and Evolving Opportunities for Interventions. Gastrointest Endosc Clin N Am 2021; 31:xv-xviii. [PMID: 34053643 DOI: 10.1016/j.giec.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Chin Hur
- Director, Healthcare Innovations Research and Evaluation (HIRE) Professor, Columbia University, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th Street, PH9-105C, New York, NY 10032, USA.
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Abstract
Gastric cancer (GC) remains a leading cause of cancer morbidity and mortality worldwide. Outcomes from GC remain poor, especially in Western nations where cancer diagnosis is usually at advanced stages where curative resection is not possible. By contrast, nations of East Asia have adopted methods of population-level screening with improvements in stage of diagnosis and survival. In this review, the authors discuss the epidemiology of GC in Western populations, highlight at-risk populations who may benefit from screening, overview screening modalities, and discuss promising approaches to early GC detection.
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Affiliation(s)
- Robert J Huang
- Division of Gastroenterology and Hepatology, Stanford University, 300 Pasteur Drive, Alway Building M211, Stanford, CA 94305, USA.
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, 300 Pasteur Drive, Alway Building M211, Stanford, CA 94305, USA
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Yang C, Liu L, Majaw JK, Liang L, Chen Y. Efficacy of Lactobacillus reuteri supplementation therapy for Helicobacter pylori eradication: A meta-analysis of randomised controlled trials. MEDICINE IN MICROECOLOGY 2021. [DOI: 10.1016/j.medmic.2021.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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High-risk individuals for gastric cancer would be missed for surveillance without subtyping of intestinal metaplasia. Virchows Arch 2021; 479:679-686. [PMID: 33990867 DOI: 10.1007/s00428-021-03116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
The use of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Assessment based on Intestinal Metaplasia (OLGIM) staging system is recommended for identifying subjects at risk for developing gastric cancer; usually high-risk lesions are considered only as stages III and IV. Accumulating evidence suggests that incomplete intestinal metaplasia (IM) is important in the development of gastric cancer. Our aim has been to identify the prevalence of incomplete IM in patients with low-risk OLGA/OLGIM stages among a high-risk general population. Healthy adult volunteers aged 40-64 years were invited to undergo upper endoscopy within a regional GISTAR pilot study in Kazakhstan (n = 166). Gastric lesions were staged according to OLGA/OLGIM staging system. High iron diamine-alcian blue (HID-AB) was used for subtyping IM. IM prevalence overall was 45.8%. Incomplete IM was present in 52.6% (type II in 30.3% and type III in 22.3%), whereas complete IM was found in 47.4% individuals. The prevalence of OLGIM I and II stage were 39.8 and 4.8%, respectively, whereas OLGIM III was observed in 1.2%. The prevalence of incomplete IM in patients stratified to OLGIM I was 54.5% (type II in 31.8% and type III in 22.7%). High prevalence of incomplete IM was detected not only in subjects with extensive IM, but in those stratified as at the OLGIM I stage. Without IM subtyping, patients with high risk of gastric cancer development would be missed for surveillance.
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Turner KO, Genta RM, Sonnenberg A. The Meaning of Incidental Goblet Cells at the Gastroesophageal Junction. Dig Dis Sci 2021; 66:1588-1592. [PMID: 32495255 DOI: 10.1007/s10620-020-06357-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/20/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS The causes for the occurrence of goblet cells at the gastroesophageal junction (GEJ-GC) are unknown. The aim of our study was to compare the concurrent histologic changes of the stomach in (1) patients with GEJ-GC, but without Barrett's esophagus (BE) to those in (2) patients with BE and in (3) controls without GEJ-GC or BE. METHODS We used an electronic database of histopathologic records from 1.3 million individual patients, who underwent esophago-gastro-duodenoscopy (EGD) in 2009-2018. We compared the prevalence of Helicobacter pylori-positive gastritis (HpG), gastric intestinal metaplasia (G-IM), chronic inactive gastritis (CIG), and reactive gastropathy (RG) among the 3 patient groups, using odds ratios and their 95% confidence intervals. RESULTS Of all EGD patients, 4.0% harbored BE and 2.4% GEJ-GC. The average age of patients with GEJ-GC (60 ± 14) was significantly younger than the age of patients with BE (63 ± 12) and significantly older than the age of controls (55 ± 17). Female subjects were more common among GEJ-GC (54%) than BE (37%), but less common than among controls (63%). The 3 gastric histopathology changes associated with H. pylori were significantly more common in GEJ-GC than BE (for HpG 2.42, 2.29-2.56; for G-IM 1.82, 1.73-1.92; for CIG 1.31, 1.22-1.41). The corresponding differences between GEJ-GC and controls were less striking (for HpG 0.97, 0.93-1.01; for G-IM 1.15, 1.11-1.19; for CIG 0.90, 0.85-0.95). RG was slightly less common in GEJ-GC than BE (0.89, 0.86-0.92) and controls (0.94, 0.91-0.96). CONCLUSIONS With respect to its demographic and histopathologic features, GEJ-GC likely represents gastric intestinal metaplasia as opposed to BE and should prompt gastric intestinal metaplasia screening and management.
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Affiliation(s)
| | - Robert M Genta
- Inform Diagnostics, Irving, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Amnon Sonnenberg
- Division of Gastroenterology, Portland VA Medical Center and Oregon Health & Science University, P3-GI, Portland, OR, 97239, USA.
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Franklin MM, Schultz FA, Tafoya MA, Kerwin AA, Broehm CJ, Fischer EG, Gullapalli RR, Clark DP, Hanson JA, Martin DR. A Deep Learning Convolutional Neural Network Can Differentiate Between Helicobacter Pylori Gastritis and Autoimmune Gastritis With Results Comparable to Gastrointestinal Pathologists. Arch Pathol Lab Med 2021; 146:117-122. [PMID: 33861314 DOI: 10.5858/arpa.2020-0520-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT.— Pathology studies using convolutional neural networks (CNNs) have focused on neoplasms, while studies in inflammatory pathology are rare. We previously demonstrated a CNN differentiates reactive gastropathy, Helicobacter pylori gastritis (HPG), and normal gastric mucosa. OBJECTIVE.— To determine whether a CNN can differentiate the following 2 gastric inflammatory patterns: autoimmune gastritis (AG) and HPG. DESIGN.— Gold standard diagnoses were blindly established by 2 gastrointestinal (GI) pathologists. One hundred eighty-seven cases were scanned for analysis by HALO-AI. All levels and tissue fragments per slide were included for analysis. The cases were randomized, 112 (60%; 60 HPG, 52 AG) in the training set and 75 (40%; 40 HPG, 35 AG) in the test set. A HALO-AI correct area distribution (AD) cutoff of 50% or more was required to credit the CNN with the correct diagnosis. The test set was blindly reviewed by pathologists with different levels of GI pathology expertise as follows: 2 GI pathologists, 2 general surgical pathologists, and 2 residents. Each pathologist rendered their preferred diagnosis, HPG or AG. RESULTS.— At the HALO-AI AD percentage cutoff of 50% or more, the CNN results were 100% concordant with the gold standard diagnoses. On average, autoimmune gastritis cases had 84.7% HALO-AI autoimmune gastritis AD and HP cases had 87.3% HALO-AI HP AD. The GI pathologists, general anatomic pathologists, and residents were on average, 100%, 86%, and 57% concordant with the gold standard diagnoses, respectively. CONCLUSIONS.— A CNN can distinguish between cases of HPG and autoimmune gastritis with accuracy equal to GI pathologists.
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Affiliation(s)
- Michael M Franklin
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Fred A Schultz
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Marissa A Tafoya
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Audra A Kerwin
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Cory J Broehm
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Edgar G Fischer
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Rama R Gullapalli
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Douglas P Clark
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - Joshua A Hanson
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
| | - David R Martin
- From the Department of Pathology, University of New Mexico School of Medicine, Albuquerque. Hanson and Martin are co-senior authors on the manuscript
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Gastric Intestinal Metaplasia: Demographic and Epidemiological Characterization in Puerto Rican Hispanics (2012-2014). Gastroenterol Res Pract 2021; 2021:9806156. [PMID: 33688342 PMCID: PMC7925026 DOI: 10.1155/2021/9806156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background and Aims Gastric cancer is the 5th leading cause of cancer mortality worldwide and the leading infection-associated cancer. Helicobacter pylori is the most common chronic bacterial infection in humans and the major predisposing factor for the development of gastric intestinal metaplasia (GIM), the principal preneoplastic lesion in the gastric carcinogenesis pathway. GIM surveillance is now recommended for individuals among high-risk subgroups by three major gastroenterology societies in Europe, England, and U.S. Our objective was to provide the initial epidemiologic data for GIM among Hispanics in Puerto Rico. Methods Using a cross-sectional study design, we analyzed an extensive pathology database (n = 43,993) that captured approximately 50% of all endoscopy biopsies taken during 2012-2014 at academic, public, and private sectors in Puerto Rico. Prevalence estimates of GIM, GIM subgroups, and H. pylori status were estimated using logistic regression models. Results A total of 4,707 GIM cases were identified during the study period for a prevalence rate of 10.7%. H. pylori was detected in 26.9% (95% CI: 25.7-28.2) of the GIM cases. The majority of the pathology reports lacked information regarding the high-risk subtypes (99.6%) and extension (71.2%). Conclusions The prevalence of GIM among Hispanics living in Puerto Rico may be higher than in U.S. mainland non-Hispanic populations. The prevalence of H. pylori detected in our study population was comparable to the rates reported in the mainland U.S. Standardization of the endoscopy biopsy protocol and pathology reporting is needed to characterize and risk stratify GIM surveillance programs in Puerto Rico.
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Kharel S, Bist A, Shrestha S, Homagain S. Helicobacter pylori healthy South Asians. JGH Open 2020; 4:1037-1046. [PMID: 33319035 PMCID: PMC7731813 DOI: 10.1002/jgh3.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/19/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
We aimed to estimate the pooled prevalence of Helicobacter pylori among asymptomatic South Asians based on available literature and highlight the importance of screening asymptomatic individuals and implementing preventive strategies for eradicating H. pylori. Electronic databases such as PubMed and Embase, a regional database of WHO South Asian Region, and gray literature sites were searched for relevant studies from 1983 to 5 May 2020. In addition, references of the included studies were thoroughly searched. The random-effect model was used to calculate the pooled prevalence with a 95% confidence interval (CI) along with subgroup analysis. Analysis of 19 studies showed a pooled prevalence of 56.5%, ranging from 10.3 to 91.7%. In subgroup analysis by country, the highest prevalence rate was reported from Bangladesh (86.3%, 95% CI: 0.806-0.921), whereas the lowest prevalence was from Sri Lanka (10.3%, 95% CI: 0.072-0.135). No differences were found between males and females. Prevalence among children and adolescents was 65.3% (95% CI: 0.529-0.777), greater than adults, 56.9% (95% CI: 0.353-0.785). The prevalence rate showed a decreasing trend upon comparison of studies conducted before and after 2000. Our analysis reveals the high prevalence of H. pylori infection among asymptomatic healthy populations in South Asia, particularly in children and adolescents. Public health awareness and sanitation interventions, pure drinking water, and respective strategies on a policy level to eradicate H. pylori and additional extensive multicentric cohort studies are necessary.
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Affiliation(s)
- Sanjeev Kharel
- Maharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu Nepal
| | - Anil Bist
- Maharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu Nepal
| | - Sushan Homagain
- Maharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu Nepal
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Helicobacter pylori Antigen But Not the Organism Is Occasionally Present Within Germinal Centers: Implications for Patient Management and Biology. Am J Surg Pathol 2020; 44:1528-1534. [PMID: 32657781 DOI: 10.1097/pas.0000000000001542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Helicobacter pylori infection is present in two thirds of the world's population and induces a myriad of human diseases, ranging from gastritis to gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. Detection is critical for treatment and may require immunohistochemical (IHC) staining when organisms are not visible on hematoxylin and eosin. We have encountered cases in which IHC for Helicobacter pylori failed to demonstrate curvilinear or coccoid organisms, but did show a reticular pattern of immunoreactivity involving the underlying germinal centers. We performed a systematic retrospective evaluation of the frequency of H. pylori germinal center immunoreactivity over a 54-month period through evaluation of 367 gastric specimens. H. pylori germinal center immunoreactivity was observed in 5% of cases with germinal centers. Nine of 11 (81%) patients with H. pylori germinal center immunoreactivity had concurrent or recent H. pylori infection, in comparison to 36% of patients with germinal centers present but no immunoreactivity (n=9 of 25 patients, P=0.03). None of the patients with germinal center immunoreactivity developed mucosa-associated lymphoid tissue lymphoma. In situ hybridization for H. pylori performed on 3 cases with positive germinal center IHC was negative for H. pylori nucleic acids within those germinal centers, demonstrating that only the antigen is present. This work demonstrates that H. pylori antigen, but not viable organisms, is present in germinal centers in 5% of gastric specimens, and is associated with recent or concurrent H. pylori infection. We advocate for reporting of all H. pylori germinal center immunoreactivity with a recommendation for ancillary H. pylori testing.
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Diaz LI, Mony S, Klapman J. Narrative review of the role of gastroenterologist in the diagnosis, treatment and palliation in gastric and gastroesophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1106. [PMID: 33145325 PMCID: PMC7575985 DOI: 10.21037/atm-20-4143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer (EC) and gastric cancer (GC) carry a high mortality rate. Unfortunately, a majority of patients are asymptomatic and at the time of diagnosis, the disease may invariably be in its advanced stages with limited curative options. Thus, it is imperative to recognize certain risk factors including gastroesophageal reflux disease (GERD), male gender, pre-existing Barrett’s esophagus, smoking history, obesity, Helicobacter pylori infection, atrophic gastritis among others for both EC and GC, intervene on time with screening and surveillance modalities if indicated and optimize treatment plans. With advances in endoscopic techniques, early neoplastic lesions are increasingly managed by gastroenterologists, offering an alternative to surgery. The gold standard for diagnosis of EC and GC is high definition endoscopy with adequate targeted biopsies. Endoscopic ultrasound (EUS) is a key in the staging of early cancers dictating the pathway for treatment options. We also play a key role in palliation cases with the aim to reduce the symptoms like nausea, vomiting and even when possible, restore oral intake and improve nutrition in both advanced GC and EC. This review article discusses the risk factors, diagnostic and endoscopic treatment modalities of early EC and GC and palliation of advanced cancer where gastroenterologists play a key role.
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Affiliation(s)
- Liege I Diaz
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Shruti Mony
- Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL, USA
| | - Jason Klapman
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
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Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
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Beware Pathological Findings of the Stomach in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2020; 31:337-342. [PMID: 33047288 DOI: 10.1007/s11695-020-05029-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
Abnormal anatomic findings are a major concern before performing bariatric surgery, while pathological changes are considered less often. The present study aimed to investigate the incidences of gastric lesions warranting follow-up in patients undergoing bariatric surgery. Meta-analyses were conducted to calculate the pooled incidences of gastric lesions in patients undergoing bariatric surgery. Fifty-nine studies including 32,789 patients were included: 26 on endoscopic biopsy, 26 on pathological findings of the excised specimen, five on the intraoperative exploration results, and two on both preoperative endoscopy and postoperative specimen. Generally, atrophic gastritis (3.05% (95% CI (confidence interval) 1.53-6.09)), intestinal metaplasia (2.44% (95% CI 1.76-3.25)), and GIST (gastrointestinal stromal tumor) (0.45% (95% CI 0.31-0.60)) were not rarely found. Routine preoperative endoscopy was applied in 16 studies, and the pooled incidences of atrophic gastritis and intestinal metaplasia were 2.64% (95% CI 0.78-8.9) and 2.70% (95% CI 0.9-5.42), respectively. Hp. (Helicobacter pylori) screening and eradication were routinely performed in 10 studies, and that was related to a reduced incidence of atrophic gastritis (0.94% (95% CI 0.03-2.92)) vs. 4.31% (95% CI 2.01-9.23). GIST was more likely to be found by intraoperative exploration than by preoperative endoscopy (0.68% (95% CI 0.50-0.93) vs. 0.23% (95% CI 0.11-0.52)). Patients undergoing bariatric surgery demonstrated non-negligible incidences of gastric pathologies warranting follow-up. Preoperative endoscopy and careful intraoperative exploration should be routinely performed, and Hp. screening and eradication are suggested before endoscopy. In condition that such findings are detected, sleeve gastrectomy may be preferred over Roux-en-Y gastric bypass.
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Aumpan N, Vilaichone RK, Nunanan P, Chonprasertsuk S, Siramolpiwat S, Bhanthumkomol P, Pornthisarn B, Uchida T, Vilaichone V, Wongcha-Um A, Yamaoka Y, Mahachai V. Predictors for development of complete and incomplete intestinal metaplasia (IM) associated with H. pylori infection: A large-scale study from low prevalence area of gastric cancer (IM-HP trial). PLoS One 2020; 15:e0239434. [PMID: 33002050 PMCID: PMC7529201 DOI: 10.1371/journal.pone.0239434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gastric intestinal metaplasia (IM) is precancerous lesion of gastric cancer related to H. pylori infection. There has been limited data about IM and associated risk factors. This study aimed to determine risk factors related to development of IM to guide proper management. Methods 1,370 patients undergoing UGI endoscopy at Thammasat University Hospital, Thailand were included between January 2018-August 2019. Patients’ data including baseline characteristics, laboratory results, and histopathology from medical database were extensively reviewed. Immunohistochemical staining for p53 expression from gastric biopsies was also performed. Results Overall H. pylori prevalence was 43.8%. Mean age was 60.7 years and 45% of whom were males. Chronic gastritis was observed in 1,064(77.7%) patients, while 223(16.3%) had IM. Of 223 patients with IM, 194(87%) patients had complete IM, while 29 (13%) had incomplete IM. In groups of complete and incomplete IM, current H. pylori infection rates were 66.5% and 58.6%, respectively. The BMI of incomplete IM group(27.4) was significantly higher than BMI of complete IM group (23.6). Overweight and obese patients (BMI ≥23 kg/m2) were significantly associated with higher risk for the development of incomplete IM (OR 3.25; 95%CI 1.14–9.27, p = 0.027). Males, age >50 years, and current H. pylori infection were significantly higher in IM than chronic gastritis group with OR 1.43 (95%CI 1.01–2.03, p = 0.048), OR 1.67 (95% CI 1.08–2.57, p = 0.021), and OR 3.14 (95% CI 2.29–4.30, p<0.001), respectively. During 20 months of study, there were 15 patients (1.1%) diagnosed with gastric cancer and 1-year survival rate was only 60%. Conclusions Males, age >50 years, and current H. pylori infection are significant predictors for the presence of intestinal metaplasia. BMI might be beneficial for using as a predictive risk factor to reduce the development of incomplete intestinal metaplasia. H. pylori eradication could be an effective way to prevent the development of gastric precancerous lesions.
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Affiliation(s)
- Natsuda Aumpan
- Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | - Ratha-Korn Vilaichone
- Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
- Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand
- Digestive Diseases Research Center (DRC), Thammasat University Hospital, Pathumthani, Thailand
- * E-mail:
| | - Pongjarat Nunanan
- Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | - Soonthorn Chonprasertsuk
- Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | - Sith Siramolpiwat
- Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
- Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand
| | - Patommatat Bhanthumkomol
- Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | - Bubpha Pornthisarn
- Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Japan
| | - Virunpat Vilaichone
- Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand
| | - Arti Wongcha-Um
- Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Varocha Mahachai
- Digestive Diseases Research Center (DRC), Thammasat University Hospital, Pathumthani, Thailand
- Gastrointestinal and Liver Center, Bangkok Medical Center, Bangkok, Thailand
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Mathews J, Malik P, Rai A, Lin J, Kim RS, Pan DH. A single centre experience of treatment outcomes for Helicobacter pylori infection among inner-city children and adolescents. Acta Paediatr 2020; 109:1860-1866. [PMID: 31880339 DOI: 10.1111/apa.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022]
Abstract
AIM This study assessed treatment outcomes of Helicobacter pylori (H pylori) infection among inner-city children. METHODS This was a retrospective study of patients aged 1-21 years who underwent initial treatment for H pylori infection from 2011 to 2015. We included patients who completed 2 weeks of treatment with documented adequate compliance after H pylori infection was diagnosed. Treatment outcomes were measured based on stool H pylori antigen and/or histology. RESULTS Of the total 261 patients diagnosed with H pylori, 239 completed the first-line treatment. The regimens used included amoxicillin/clarithromycin/proton pump inhibitor (PPI) in 207/239 patients (86.6%), amoxicillin/metronidazole/PPI in 14/239 patients (5.8%) and other regimens in 18/239 patients (7.5%). H pylori eradication status was tested in 111/207 (53.6%) patients treated with amoxicillin/clarithromycin/PPI, and the eradication was achieved in 84/111(75.7%) patients. The treatment success rates for amoxicillin/metronidazole/PPI and other regimens were 71.4% (5/7) and 63.6% (7/11), respectively. There was no statistical significance of post-treatment stool H pylori antigen results between PPI (n = 31) and no PPI (n = 43) users. CONCLUSION The study showed an eradication rate of 75.7% with the regimen amoxicillin/clarithromycin/PPI suggesting significant antibiotic resistance in our population. The use of PPI did not influence post-treatment stool H pylori antigen results.
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Affiliation(s)
- Jubin Mathews
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital at Montefiore, Bronx, New York
| | - Preeti Malik
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital at Montefiore, Bronx, New York
| | - Anjali Rai
- The Children's Hospital at Montefiore, Bronx, New York
| | - Juan Lin
- Albert Einstein College of Medicine, Bronx, New York
| | - Ryung S Kim
- Albert Einstein College of Medicine, Bronx, New York
| | - Debra H Pan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital at Montefiore, Bronx, New York
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Interaction Between Ethnicity and Helicobacter pylori Infection in the Occurrence of Reflux Disease. J Clin Gastroenterol 2020; 54:614-619. [PMID: 31651573 DOI: 10.1097/mcg.0000000000001274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Few reports are available to reliably assess the ethnic distribution of Barrett metaplasia and reflux esophagitis. The present study served to analyze the joint influence of Helicobacter pylori infection and patient demographics on the diagnoses of Barrett metaplasia and reflux esophagitis. METHODS The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the United States. In a case-control study of 52,096 cases with Barrett metaplasia, 189,235 cases with reflux esophagitis, and 152,322 controls without any signs or symptoms suggestive of gastroesophageal reflux disease, we assessed the influence of age, gender, ethnicity, and H. pylori status on occurrence of Barrett metaplasia or reflux esophagitis. RESULTS Barrett metaplasia was less common among East Asians (with odds ratio, 0.48; 95% confidence interval, 0.44-0.53) and Hispanics (0.60, 0.57-0.63) than other ethnic groups living in the United States. Reflux esophagitis was also less common among East Asians (0.86, 0.82-0.90), but more common among Hispanics (1.18, 1.14-1.21). Both types of esophageal disease were associated with a lower prevalence rates of gastric H. pylori infection than controls, with 0.48, 0.44-0.53 for Barrett metaplasia and 0.60, 0.57-0.63 for reflux esophagitis. The prevalence rates of gastric H. pylori and both esophageal diseases were greater in older than younger and male than female patients in all ethnic groups alike. CONCLUSIONS Gastric H. pylori infection, ethnicity, gender, and age all influence the occurrence of Barrett metaplasia, and reflux esophagitis.
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Lam SK, Lau G. Novel treatment for gastric intestinal metaplasia, a precursor to cancer. JGH Open 2020; 4:569-573. [PMID: 32782940 PMCID: PMC7411557 DOI: 10.1002/jgh3.12318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Gastric intestinal metaplasia (GIM) is precancerous with a worldwide prevalence of 25%. Eradicating Helicobacter pylori prevented about half of gastric cancers; failure to prevent the rest was attributed to GIM. GIM is irreversible and often extensive. There is no treatment. Existing endoscopic mucosal resection (EMR) is designed to treat early gastric cancer of usually <2 cm. We designed a two-endoscope technique of EMR for extensive lesions such as GIM. METHODS Forty patients with histologically confirmed moderate to severe GIM (operative link on GIM [OLGIM] classification) received the treatment in a daycare center. Chromoendoscopy with methylene blue was first performed to indicate the GIM. Submucosal saline injections were used to lift the stained mucosa to form multiple safety cushions, which were transformed into artificial polyps by suction and ligation, using a cap familiar to gastroenterologists for ligation of esophageal varices. EMRs were then achieved by snare polypectomy. By rotating two gastroscopes, one was designated to perform lift and snare and the other to perform suction and ligation; cycles of lift-ligate-snare were performed until all stained mucosa was removed. Assessment chromoendoscopy with ≥seven biopsies was performed at 6 months. RESULTS A total of 227 EMRs were performed, with a median of 3.5 per patient. Bleeding was uncommon and minimal. Gastric perforation ascribable to loss of a safety cushion occurred in one patient. Chromoendoscopy at 6 months in 36 willing patients showed no recurrence of GIM. CONCLUSION The two-endoscope technique of EMR for GIM was essentially safe and effective, with no recurrence at 6 months. It could be performed by endoscopists with standard skills.
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Affiliation(s)
- Shiu Kum Lam
- Humanity & Health GI & Liver Centre, Humanity & Health Medical GroupHong Kong SARChina
- Humanity & Health Clinical Trial CentreHumanity & Health Medical Group, Hong Kong SARChina
| | - George Lau
- Humanity & Health GI & Liver Centre, Humanity & Health Medical GroupHong Kong SARChina
- Humanity & Health Clinical Trial CentreHumanity & Health Medical Group, Hong Kong SARChina
- Liver Diseases & Transplant CentreThe Fifth Medical Centre of Chinese PLA General HospitalBeijingChina
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Zhu HM, Li BY, Tang Z, She J, Liang XY, Dong LK, Zhang M. Epidemiological investigation of Helicobacter pylori infection in elderly people in Beijing. World J Clin Cases 2020; 8:2173-2180. [PMID: 32548147 PMCID: PMC7281052 DOI: 10.12998/wjcc.v8.i11.2173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Helicobacter pylori (H. pylori) infection rate in China is approximately 50%. H. pylori is a pathogenic factor of peptic ulcer and chronic gastritis. In addition, H. pylori infection may also be associated with a variety of cardiovascular diseases in elderly people, such as arteriosclerosis, coronary heart disease, and cerebral infarction, having deleterious effect on their health. With the aging of the population, the disease characteristics of the elderly population have been increasingly valued by the whole society. We conducted an epidemiological survey of H. pylori infection among elderly people in Beijing to provide a basis for health management of H. pylori infection.
AIM To understand the epidemiological characteristics of H. pylori infection in elderly people in Beijing.
METHODS A total of 1090 elderly people aged more than 60 years from different parts of Beijing (urban and rural areas) were selected using the random cluster sampling method. Structured questionnaires were completed during home visits and the 13C-urea breath test was conducted for H. pylori detection.
RESULTS The prevalence of H. pylori infection was 46.5% (507/1090). The infection rate in men was 51.8%, which was significantly higher than that in women (42.5%; P < 0.05). The H. pylori infection rate in illiterate people was significantly higher than that in literate persons (53.5% vs 44.8%, P < 0.05). The total infection rate of H. pylori gradually increased with age and the difference was statistically significant (P < 0.01). The H. pylori infection rate in smokers was significantly higher than that in non-smokers and those who had quit smoking (P < 0.05).
CONCLUSION The prevalence of H. pylori infection among elderly people is 46.5% and the infection rate gradually increases with age. Sex, education level, age, and smoking were determined to be H. pylori infection risk factors. The relationship of H. pylori infection with region, occupation, drinking, and diet structure needs to be further studied.
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Affiliation(s)
- Hong-Ming Zhu
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Bang-Yi Li
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhe Tang
- National Geriatric Disease Clinical Medical Research Center, Xuanwu Hospital, Beijing 100053, China
| | - Jing She
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xue-Ying Liang
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Li-Kou Dong
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Mei Zhang
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Cost-Effectiveness Analysis of Helicobacter pylori Eradication Therapy for Prevention of Gastric Cancer: A Markov Model. Dig Dis Sci 2020; 65:1679-1688. [PMID: 31673902 DOI: 10.1007/s10620-019-05910-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) eradication can reduce the prevalence of gastric cancer. However, whether H. pylori eradication therapy should be performed in infected patients, especially in asymptomatic cases, is still controversial. AIMS The aims of this study were to determine whether H. pylori screening and eradication could prevent gastric cancer in a cost-effective way, and further whether eradication therapy should be administered to asymptomatic individuals. METHODS Cost-effectiveness analysis was performed using a Markov model. We established two groups, each with 10,000 hypothetical Chinese individuals at the age of 40 years. Clinical outcomes and cost of H. pylori eradication were compared between the eradication and control groups. RESULTS There was a lower morbidity with gastric cancer in the eradication group than in the control group, which was most significant after running the model for 15 years. The eradication group experienced an average of 34.64 quality-adjusted life years (QALYs) per person, and the average cost was US $1706.52 per person. The control group exhibited an average of 32.63 QALYs per person, and the average cost was US $2045.10 per person. The cost-effectiveness analysis showed that eradication saved $1539 per LY per person and $168.45 per QALY per person. CONCLUSIONS H. pylori screening and eradication therapy effectively reduces the morbidity of gastric cancer and cancer-related costs in asymptomatic infected individuals. Therefore, we believe that H. pylori eradication can prevent gastric cancer in a cost-effective way.
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Li RJ, Dai YY, Qin C, Li XH, Qin YC, Pan Y, Huang YY, Huang ZS, Huang YQ. Treatment strategies and preventive methods for drug-resistant Helicobacter pylori infection. World J Meta-Anal 2020; 8:98-108. [DOI: 10.13105/wjma.v8.i2.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
The infection and drug resistance rates of Helicobacter pylori (H. pylori) are high and must be prevented and treated by better strategies. Based on recent research advances in this field as well as the results from our team and those on traditional Chinese medicine, we review the causes of drug resistance, and prevention and treatment strategies for drug-resistant H. pylori infection, with an aim to make suggestions for the development of new drugs, such as establishment of new target identification and screening systems, modification of existing drug structures, use of new technologies, application of natural products, and using a commercial compound library. This article may provide reference for eradication of drug-resistant H. pylori.
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Affiliation(s)
- Ru-Jia Li
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yuan-Yuan Dai
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Chun Qin
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Hua Li
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yan-Chun Qin
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yong Pan
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yong-Yi Huang
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Zan-Song Huang
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yan-Qiang Huang
- Research Center for Prevention and Treatment of Drug Resistant Microbial Infections, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
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Yu X, Wang Z, Wang L, Meng X, Zhou C, Xin Y, Sun W, Dong Q. Gastric hyperplastic polyps inversely associated with current Helicobacter pylori infection. Exp Ther Med 2020; 19:3143-3149. [PMID: 32256802 DOI: 10.3892/etm.2020.8567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/30/2020] [Indexed: 12/26/2022] Open
Abstract
The incidence of gastric hyperplastic polyps (HPs) has been on the rise in recent years. The contribution of Helicobacter pylori infection to this trend has remained to be elucidated. The present study aimed to explore the association between HPs and H. pylori in China, an area with a high infection rate of H. pylori. In order to study trends of HPs and H. pylori infection over the past decades, cases encountered from 2009 to 2018 were assessed and a total of 109,150 consecutive patients who underwent esophagogastroduodenoscopy at Qingdao Municipal Hospital (Qingdao, China) were enrolled. The incidence of HPs and the prevalence of H. pylori were determined and their correlation was explored. Gastric HPs were detected in 1,497 patients (1.6%) who received gastric biopsies. The incidence of HPs exhibited a rising trend, with a ~4-fold increase in the annual detection rate from 2009 to 2018. The prevalence of H. pylori infection was inversely associated with the prevalence of HPs (adjusted odds ratio, 0.66). The prevalence of H. pylori in the examined cohort decreased with time (r=-0.76, P=0.011). The decreasing trend of H. pylori infection was negatively correlated with the rising trend of HPs (r=-0.64, P=0.048), further indicating an inverse association between them. The difference in the prevalence of HPs between H. pylori-negative and -positive patients increased with age (r=0.80, P=0.018). The age-associated increase was slower in H. pylori-infected patients. The decline in H. pylori infection with time appeared to not be associated with the birth cohort effect, suggesting the decline was not caused by exposure to environmental factors during an early period of life. The present results indicated that the incidence of gastric HPs increased with the decline in H. pylori infection, demonstrating an inverse association between the occurrence of HPs and the infection.
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Affiliation(s)
- XinJuan Yu
- Central Laboratories, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - ZhengQiang Wang
- Clinical Laboratory, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - LiLi Wang
- Central Laboratories, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - XinYing Meng
- Department of Health Care, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - ChangHong Zhou
- Department of Health Care, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - YongNing Xin
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - WeiLi Sun
- Central Laboratories, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China.,Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - QuanJiang Dong
- Central Laboratories, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China.,Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong 266000, P.R. China
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Du Y, Zhu H, Liu J, Li J, Chang X, Zhou L, Chen M, Lu N, Li Z. Consensus on eradication of Helicobacter pylori and prevention and control of gastric cancer in China (2019, Shanghai). J Gastroenterol Hepatol 2020; 35:624-629. [PMID: 31788864 DOI: 10.1111/jgh.14947] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM China is a country with high prevalence of Helicobacter pylori (H. pylori) infection, which in turn is closely related to the occurrence of gastric cancer. Therefore, the risks of H. pylori infection and gastric cancer are highly overlapping, and the prevention and treatment of H. pylori infection are necessary to prevent gastric cancer. METHODS Based on evidence-based medicine and the Delphi method, the National Clinical Medical Research Center for Digestive Disease along with the National Early Gastrointestinal Cancer Prevention and Treatment Center Alliance organized dozens of experts in the fields of digestive diseases, H. pylori research, gastric cancer surgery, epidemiology, health economics, and health management to discuss the relationship between H. pylori eradication and prevention and the treatment of gastric cancer. RESULTS A preliminary consensus on the relationship between H. pylori infection and gastric cancer, H. pylori eradication and gastric cancer prevention, and H. pylori screening and eradication strategy was reached. The consensus further clarified the relationship between H. pylori and gastric cancer and how to formulate future prevention and control strategies for gastric cancer. CONCLUSIONS This consensus could provide guidance on early detection, diagnosis, and treatment of H. pylori to reduce the occurrence of gastric cancer in China.
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Affiliation(s)
- Yiqi Du
- Department of Gastroenterology, Changhai Hospital of Naval Medical University, Shanghai, China
| | - Huiyun Zhu
- Department of Gastroenterology, Changhai Hospital of Naval Medical University, Shanghai, China
| | - Jiong Liu
- Department of Gastroenterology, Jinling Hospital, Nanjing, China
| | - Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
| | - Xin Chang
- Department of Gastroenterology, Changhai Hospital of Naval Medical University, Shanghai, China
| | - Liya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Nonghua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital of Naval Medical University, Shanghai, China
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Arismendi Sosa AC, Salinas Ibáñez AG, Pérez Chaca MV, Penissi AB, Gómez NN, Vega AE. Inflammatory response induced by Helicobacter pylori infection in lung. Microb Pathog 2020; 142:104103. [PMID: 32112810 DOI: 10.1016/j.micpath.2020.104103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Helicobacter pylori is a microorganism that in the last years has been associated with extragastric disorders such as respiratory diseases, however, its impact on lung is partially understood. The aim of this work was to study infection impact of H. pylori on the inflammatory markers expression at the pulmonary level using an animal model. Infection was performed by BALB/c wild type (WT) mice orotracheal instillation with 20 μl of 1 × 108H. pylori reference strain suspension once per day throughout 3 days. Inflammatory response was evaluated at 3, 7, 14, 21 and 30 days post infection. Lung was aseptically removed and pulmonary edema index values showed a significant change at 30 days of infection. Hematoxylin-Eosin (H-E) stain allowed to visualizing H. pylori presence in lung samples at 3 days of infection near the phagocytic cells or in the alveoli lumen. Bronchoalveolar lavage (BAL) was used for inflammatory response evaluation. Lactate dehydrogenase values showed a gradual increase in infected animals along infection time. Protein concentrations in mg/ml from BAL increased significantly at 7 days in infected animals. Macrophages viability obtained from BAL, decreased at the first moment of infection, maintaining constant values along contamination time. Results obtained demonstrate an inflammatory response in lung after orotracheal H. pylori infection and suggest that the pathogenic mechanism is strongly evidenced by tissue damage, endothelial dysfunction inflammatory mediators and markers expression at the pulmonary level.
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Affiliation(s)
- A C Arismendi Sosa
- Área Microbiología e Inmunología, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina.
| | - A G Salinas Ibáñez
- Área Microbiología e Inmunología, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina
| | - M V Pérez Chaca
- Área de Morfología, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina
| | - A B Penissi
- Instituto de Histología y Embriología "Dr. Mario H. Burgos" (IHEM-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - N N Gómez
- Área de Morfología, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina; Instituto Multidisciplinario de Investigaciones Biológicas (IMIBIO-SL), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), San Luis, Argentina
| | - A E Vega
- Área Microbiología e Inmunología, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis, San Luis, Argentina
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Low Prevalence of Helicobacter pylori-Positive Peptic Ulcers in Private Outpatient Endoscopy Centers in the United States. Am J Gastroenterol 2020; 115:244-250. [PMID: 31972622 DOI: 10.14309/ajg.0000000000000517] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES During the past decades, the prevalence of gastric and duodenal ulcers, as well as Helicobacter pylori infection, has markedly declined. We hypothesized that the decline in H. pylori prevalence has decreased the fraction of H. pylori-positive gastric and duodenal ulcers. The present study was designed to test this hypothesis in a large US population undergoing esophagogastro-duodenoscopy in community-based endoscopy centers. METHODS The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the United States. A cross-sectional study among 1,289,641 individual esophagogastro-duodenoscopy patients analyzed the prevalence of peptic ulcers stratified by age, sex, ethnicity, H. pylori status, year of diagnosis, and ulcer type. The joint influence of multiple predictor variables on the occurrence of gastric and duodenal ulcers was analyzed using multivariate logistic regression analysis. RESULTS Between 2009 and 2018, the general prevalence of H. pylori infection fell significantly from 11% to 9%. This decline was accompanied by a similar decline in the fraction of H. pylori-positive gastric ulcers from 17% to 14% and H. pylori-positive duodenal ulcers from 25% to 21%. Nowadays, only 17% of all patients with ulcer harbor H. pylori. The fraction of H. pylori-positive ulcers was significantly greater in duodenal than in gastric ulcers and in male than in female patients with ulcer. The prevalence of H. pylori was 2.6-fold higher among Hispanics and 3.2-fold higher among East Asians compared with the general population. The H. pylori prevalence fell from 24% to 22% among Hispanics and from 21% to 15% among East Asians. In East Asians and Hispanics, the fraction of H. pylori-positive gastric ulcers was 37% and 35%, respectively. DISCUSSION H. pylori infection continues to fall in the general population. Nowadays, even among patients with ulcer only a small minority harbors H. pylori infection.
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Wei X, Feng XP, Wang LY, Huang YQ, Liang LL, Mo XQ, Wei HY. Improved method for inducing chronic atrophic gastritis in mice. World J Gastrointest Oncol 2019; 11:1115-1125. [PMID: 31908717 PMCID: PMC6937435 DOI: 10.4251/wjgo.v11.i12.1115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chronic atrophic gastritis (CAG) is a common disease of the digestive system with pathological characteristics of a decreasing number, or disappearance, of inherent glands of the gastric mucosa. CAG has been defined as a precancerous condition of gastric cancer. Intestinal metaplasia or intraepithelial neoplasia accompanying atrophied glands of the stomach is regarded as one of the most important precancerous lesions of gastric cancer. As a common malignant tumour, gastric cancer remains without a satisfactory therapy and its pathogenesis remains unclear, seriously threatening human life. Therefore, some scholars have proposed to prevent the incidence of gastric cancer by avoiding precancerous lesions. If CAG can be reversed, the incidence of gastric cancer can be substantially reduced. To reverse and prevent CAG and study its pathogenesis and therapy, it is necessary to develop an ideal, safe, stable, animal model.
AIM To study a rapid, stable, and safe method of establishing a mouse model of human CAG.
METHODS Six-week-old Kunming mice were divided into a phosphate buffered solution control group, a Helicobacter pylori (H. pylori) group, an N-methyl-N'-nitroguanidine (MNNG) group, an ammonia water group, and a group combining H. pylori, MNNG, and ammonia water (hereinafter referred to as the combined group). The mice were administrated with drinking water containing ammonia or infected with H. pylori through gavage. At the 30th, 60th, 90th, and 120th day after the last H. pylori infection, mice were selected randomly to collect their gastric mucosa for hematoxylin eosin staining, terminal nick-end labelling staining detection, and immunohistochemical staining for Bax and Bcl-2. In addition, H. pylori was isolated, cultured, and identified, and its extent of colonisation calculated. Blood was collected to detect inflammatory factors interleukin (IL)-1β, IL-8, and tumor necrosis factor (TNF)-α and immune function markers CD4 and CD8 to confirm successful establishment of the CAG model.
RESULTS The combined group showed slight CAG at the 90th day and moderate CAG at the 120th day, while other groups did not show CAG at that time.
CONCLUSION The combination of H. pylori, MNNG, and ammonia is an effective method of developing a mouse model of human CAG.
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Affiliation(s)
- Xian Wei
- Breeding Base of Microbial Infection Key Laboratory in the West Guangxi, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Xue-Ping Feng
- Breeding Base of Microbial Infection Key Laboratory in the West Guangxi, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Lu-Yao Wang
- Breeding Base of Microbial Infection Key Laboratory in the West Guangxi, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Yan-Qiang Huang
- Breeding Base of Microbial Infection Key Laboratory in the West Guangxi, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Ling-Ling Liang
- Breeding Base of Microbial Infection Key Laboratory in the West Guangxi, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Qiang Mo
- Breeding Base of Microbial Infection Key Laboratory in the West Guangxi, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Hong-Yu Wei
- Breeding Base of Microbial Infection Key Laboratory in the West Guangxi, Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
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Mezmale L, Isajevs S, Bogdanova I, Polaka I, Krigere A, Rudzite D, Rudule A, Kikuste I, Parshutin S, Tazhedinov A, Mushinskiy D, Sametayev D, Belikhina T, Igissinov N, Park JY, Herrero R, Leja M. Prevalence of Atrophic Gastritis in Kazakhstan and the Accuracy of Pepsinogen Tests to Detect Gastric Mucosal Atrophy. Asian Pac J Cancer Prev 2019; 20:3825-3829. [PMID: 31870128 PMCID: PMC7173362 DOI: 10.31557/apjcp.2019.20.12.3825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/08/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Atrophic gastritis is considered precursor condition for gastric cancer. There is so far limited evidence on the performance of pepsinogens for atrophy detection in Central Asia. The aim of our study was to detect the prevalence of atrophic gastritis in the asymptomatic adult population in Kazakhstan as well as address the accuracy of pepsinogen testing in atrophy detection. METHODS Healthy individuals aged 40-64 were included. Upper endoscopy and pepsinogens (PG) evaluation were performed. PG were analysed in plasma by latex agglutination. Cut off values were used to define decreased PG values (PGR ≤ 3 and PG I ≤ 70 ng/mL); severely decreased PG values (PGR ≤ 2 and PG I ≤ 30 ng/mL). Biopsies were analyzed and obtained according to the updated Sydney System. PG test sensitivity, specificity and overall accuracy were assessed using the histological diagnosis as the "gold standard". RESULTS Altogether 157 individuals - female 40,1% and male 59,9% were included. Histologically, moderate to severe corpus atrophy, was present only in 1,3% cases. From all study subjects, 26,8% had decreased plasma PG values with cut-off values PGR ≤ 3 and PG I ≤ 70 ng/mL. The sensitivity of the PG test with this cut-off values was 50,0%, specificity 73,5%, overall accuracy 73,2% for detection of moderate to severe atrophy in the corpus. The sensitivity of PG test with cut-off values PGR ≤ 2 and PG I ≤30 ng/mL was 50,0%, specificity 90,9% and overall accuracy 90,4%. CONCLUSIONS The prevalence of gastric mucosal atrophy was low in the Kazakh population. Serological PG test screening nevertheless can play an important role in the diagnosis of gastric precancerous lesions. However, the diagnostic accuracy of the PG test is mainly dependent on the cut-off values for positive results.
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Affiliation(s)
- Linda Mezmale
- Institute of Clinical and Preventive Medicine,
- Faculty of Medicine, University of Latvia,
| | - Sergejs Isajevs
- Institute of Clinical and Preventive Medicine,
- Academic Histology Laboratory,
| | - Inga Bogdanova
- Institute of Clinical and Preventive Medicine,
- Academic Histology Laboratory,
| | | | | | | | - Aiga Rudule
- Institute of Clinical and Preventive Medicine,
| | - Ilze Kikuste
- Institute of Clinical and Preventive Medicine,
- Faculty of Medicine, University of Latvia,
- Digestive Disease Centre GASTRO, Riga, Latvia,
| | | | | | | | | | | | - Nurbek Igissinov
- Astana Medical University,
- Central Asian Cancer Institute, Nur-Sultan, Kazakhstan,
- International High School of Medicine,
- Eurasian Institute For Cancer Research, Bishkek, Kyrgyzstan,
| | - Jin Young Park
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France.
| | - Rolando Herrero
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France.
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine,
- Faculty of Medicine, University of Latvia,
- Digestive Disease Centre GASTRO, Riga, Latvia,
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Öner Rİ, Özdaş S. Histopathological Findings in Morbid Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Does H. pylori Infection Effective on Pathological Changes? Obes Surg 2019; 28:3136-3141. [PMID: 29663251 DOI: 10.1007/s11695-018-3250-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AıM: To determine the prevalence of histopathological findings requiring clinical follow-up in morbidly obese patients undergoing laparoscopic sleeve gastrectomy (LSG) and evaluate the relationship between these findings and Helicobacter pylori as well as to add more data to the published literature in this regard. MATERıAL AND METHODS: Overall, 161 morbidly obese patients with body mass index (BMI) > 40 kg/m2 who underwent LSG between May 1, 2014 and May 31, 2017 were retrospectively included in the study. The findings of the histopathological evaluation of the resected gastric material and the relationship between these findings and histopathologically detected H. pylori infection were investigated. RESULTS The study included 114 women (70.8%) and 47 men (29.2%). The mean age of the patients was 36.82 ± 10.41 years, and the mean BMI was 46.05 ± 3.76 kg/m2. H. pylori infection was detected in 103 (64%), chronic gastritis in 156, chronic active gastritis in 47, intestinal metaplasia in eight, and atrophy in seven patients. The rate of H. pylori-associated chronic gastritis was 64%, that of chronic active gastritis was 24.2%, that of lymphoid aggregation was 62.2%, and that of intestinal metaplasia and atrophy was 3.1%. There was a significant relationship between H. pylori infection and chronic gastritis, chronic active gastritis, and lymphoid aggregation; however, no significant relationship was found between intestinal metaplasia and atrophy. CONCLUSıON: Clinicians should be aware of the histopathological findings requiring clinical follow-up for LSG-treated patients. Given the complications of H. pylori infection such as lymphoma and malignancy, periodic follow-up of patients and eradication therapy may be a suitable approach for treating intestinal metaplasia and atrophic changes.
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Affiliation(s)
- Ramazan İlyas Öner
- Department of Internal Medicine, Faculty of Medicine, Adiyaman University, Yunus Emre Mah, Şifa Cad, 024000, Adiyaman, Turkey.
| | - Sabri Özdaş
- Department of General Surgery, Faculty of Medicine, Adiyaman University, Adıyaman, Turkey
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50
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Interleukin-21 (IL-21) Downregulates Dendritic Cell Cytokine Responses to Helicobacter pylori and Modulates T Lymphocyte IL-17A Expression in Peyer's Patches during Infection. Infect Immun 2019; 87:IAI.00237-19. [PMID: 31383743 DOI: 10.1128/iai.00237-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022] Open
Abstract
Interleukin-21 (IL-21), a cytokine produced by many subsets of activated immune cells, is critical for driving inflammation in several models. Using Helicobacter pylori infection as a model for chronic mucosal infection, we previously published that IL-21 is required for the development of gastritis in response to infection. Concomitant with protection from chronic inflammation, H. pylori-infected IL-21-/- mice exhibited limited Th1 and Th17 responses in their gastric mucosa. Here we report that H. pylori-infected IL-21-/- mice express significantly higher levels of IL-17A than H. pylori-infected wild-type (WT) mice in the Peyer's patches and mesenteric lymph nodes. This led us to hypothesize that IL-21 may indirectly regulate H. pylori-specific T cell responses by controlling dendritic cell (DC) functions in mucosa-associated lymphoid tissue. It was found that IL-21 treatment reduced the ability of dendritic cells to produce proinflammatory cytokines in response to H. pylori While H. pylori increased the expression of costimulatory proteins on DCs, IL-21 reduced the expression of CD40 in the presence of H. pylori Also, Th17 recall responses were intact when DCs were used as antigen-presenting cells in the presence of IL-21, but IL-21 did impact the ability of DCs to induce antigen-specific proliferation. These data suggest that IL-21, while proinflammatory in most settings, downregulates the proinflammatory cytokine microenvironment through modulating the cytokine expression of DCs, indirectly modifying IL-17A expression. Understanding how these proinflammatory cytokines are regulated will advance our understanding of how and why H. pylori infection may be tolerated in some individuals while it causes gastritis, ulcers, or cancer in others.
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