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Ngaiza AI, Yahaya JJ, Mwakimonga AK, Vuhahula E, Mnango L, Mwakigonja AR, Kawishe GJ, Ng D. Histologic detection of Helicobacter pylori by the immunohistochemical method using anti-Helicobacter pylori polyclonal antibody: A cross-sectional study of patients with gastric pathologies at the Muhimbili National Hospital in Dar-es-salaam, Tanzania. Arab J Gastroenterol 2022; 23:7-14. [PMID: 34840096 DOI: 10.1016/j.ajg.2021.11.002] [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: 12/10/2020] [Revised: 05/09/2021] [Accepted: 11/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND STUDY AIM Immunohistochemistry is one of the superior methods and is regarded as the gold standard for the detection of Helicobacter pylori. We aimed to detect the presence of Helicobacter pylori in gastric biopsies among patients at the Muhimbili National Hospital from January 2012 to December 2016. Also, we determined the predictors of Helicobacter pylori infection. PATIENTS AND METHODS Retrospectively, we retrieved the tissue blocks of gastric biopsies at the Central Pathology Laboratory of the patients with different gastric pathologies at the Muhimbili National Hospital from January 2012 to December 2016. Helicobacter pylori were detected using anti-Helicobacter pylori polyclonal antibodies. Binary logistic regression analysis was done to determine the predictors of Helicobacter pylori infection. A two-tailed p < 0.05 was considered significant. RESULTS The prevalence of detection of Helicobacter pylori was 37.1% (63/170) using immunohistochemistry compared to 32.4% (55/170) using histology. Peptic ulcer disease, the absence of gastric cancer, and chronic gastritis were the predictors of Helicobacter pylori infection in our study (AOR = 0.2, 95% CI = 0.06-0.70, p = 0.011, AOR = 3.23, 95% CI = 1.02-10.29, p = 0.047, AOR = 0.32, 95% CI = 0.12-0.87, p = 0.025, respectively). CONCLUSION In this study, Helicobacter pylori infection was associated with the presence of peptic ulcer disease, chronic gastritis, and the absence of gastric cancer. The rate of detection of Helicobacter pylori infection was higher in tissue blocks of elderly patients than in those of young patients. Also, gastric cancer was more prevalent in old female patients.
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Affiliation(s)
- Advera I Ngaiza
- Department of Pathology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salaam, Tanzania.
| | - James J Yahaya
- Department of Biomedical Science, College of Health Sciences (CHS), The University of Dodoma, Dodoma, Tanzania
| | - Angela K Mwakimonga
- Department of Pathology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salaam, Tanzania
| | - Edda Vuhahula
- Department of Anatomical Pathology, Muhimbili National Hospital (MNH), Dar-es-salaam, Tanzania
| | - Leah Mnango
- Department of Pathology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-salaam, Tanzania
| | - Amos R Mwakigonja
- Department of Anatomical Pathology, Muhimbili National Hospital (MNH), Dar-es-salaam, Tanzania
| | - Gerald J Kawishe
- Department of Molecular Biology and biotechnology, University of Dar-es-salaam, Dar-es-salaam, Tanzania
| | - Dianna Ng
- Department of Pathology, University of California, USA
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Akeel M, Elhafey A, Shehata A, Elmakki E, Aboshouk T, Ageely H, Mahfouz MS. Efficacy of immunohistochemical staining in detecting <em>Helicobacter pylori</em> in Saudi patients with minimal and atypical infection. Eur J Histochem 2021; 65. [PMID: 34284564 PMCID: PMC8314390 DOI: 10.4081/ejh.2021.3222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022] Open
Abstract
Gastric Helicobacter pylori infection is diagnosed based on histopathological evaluation of gastric mucosal biopsies, urease test, urea breath test, H. pylori culturing, or direct detection using polymerase chain reaction (PCR). This study aimed to evaluate the efficacy of immunohistochemical (IHC) staining in detecting H. pylori in gastric biopsies from patients with chronic gastritis and minimal or atypical infection. Gastric biopsies from 50 patients with chronic gastritis were subjected to routine haematoxylin and eosin (H-E), modified Giemsa, and IHC staining. The results of staining were compared with those of quantitative real-time PCR (qRT-PCR). The qRT-PCR analysis identified 32 (64%) H. pylori-positive cases, whereas IHC, H-E, and modified Giemsa staining identified 29 (58%), 27 (54%), and 21 (42%) positive cases. The sensitivity of IHC staining (87.50%) was higher than that of H-E (59.38%) and modified Giemsa (43.75%) staining. The specificity of H-E, modified Giemsa, and IHC staining was 55.56%, 61.11%, and 94.44%, respectively. IHC staining exhibited the highest diagnostic accuracy (90%), followed by H-E (58%) and modified Giemsa (50%) staining. Active gastritis, intestinal metaplasia, and lymphoid follicles were detected in 32 (64%), 4 (8%), and 22 (44%) cases, respectively, and all of these cases were H. pylori positive. In contrast to routine H-E and modified Giemsa staining, IHC allows for the accurate H. pylori detection in cases with minimal or atypical infection. Moreover, IHC can be an alternative diagnostic method to qRT-PCR for detection of H. pylori in such cases.
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Affiliation(s)
- Mohammed Akeel
- Department of Anatomy, Faculty of Medicine, Jazan University.
| | - Ahmed Elhafey
- Department of Pathology, Faculty of Medicine, Jazan University.
| | - Atef Shehata
- Department of Microbiology and Immunology, Faculty of Medicine, Jazan University.
| | - Erwa Elmakki
- Department of Internal Medicine, Faculty of Medicine, Jazan University.
| | - Thanaa Aboshouk
- Department of Biochemistry, Faculty of Medicine, Jazan University.
| | - Hussein Ageely
- Department of Internal Medicine, Faculty of Medicine, Jazan University.
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3
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Sue S, Sasaki T, Kaneko H, Irie K, Kondo M, Maeda S. Helicobacter pylori rescue treatment with vonoprazan, metronidazole, and sitafloxacin in the presence of penicillin allergy. JGH OPEN 2021; 5:307-311. [PMID: 33553672 PMCID: PMC7857288 DOI: 10.1002/jgh3.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
Background and Aim To assess the efficacy and safety of 7‐day Helicobacter pylori rescue treatment consisting of a vonoprazan (VPZ), metronidazole (MNZ), and sitafloxacin (STFX) regimen (VPZ‐MNZ‐STFX therapy) in patients with penicillin allergy. Methods This was a registered prospective intervention study. Patients with penicillin allergy who were diagnosed with H. pylori infection and had a history of H. pylori eradication were eligible for inclusion. Seventeen patients were prospectively treated with VPZ 20 mg bid, MNZ 250 mg bid, and STFX 100 mg bid for 7 days. Safety was evaluated using a questionnaire on adverse effects. Results The eradication rate of 7‐day VPZ‐MNZ‐SFTX therapy was 88.2% (95% confidence interval: 63.6–98.5%; n = 17) in both intention‐to‐treat and per‐protocol analyses. On the questionnaire, 25% of patients reported experiencing diarrhea, with a score of 2 or 3. All patients undergoing VPZ‐MNZ‐STFX therapy completed 100% of their medication course. Conclusion Rescue H. pylori eradication with VPZ‐MNZ‐STFX therapy is effective and well tolerated in patients with penicillin allergy (UMIN000016335, jRCTs031180133).
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Affiliation(s)
- Soichiro Sue
- Department of Gastroenterology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Tomohiko Sasaki
- Department of Gastroenterology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Hiroaki Kaneko
- Department of Gastroenterology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Kuniyasu Irie
- Department of Gastroenterology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Masaaki Kondo
- Department of Gastroenterology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Shin Maeda
- Department of Gastroenterology Yokohama City University Graduate School of Medicine Yokohama Japan
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Lock JY, Carlson TL, Yu Y, Lu J, Claud EC, Carrier RL. Impact of Developmental Age, Necrotizing Enterocolitis Associated Stress, and Oral Therapeutic Intervention on Mucus Barrier Properties. Sci Rep 2020; 10:6692. [PMID: 32317678 PMCID: PMC7174379 DOI: 10.1038/s41598-020-63593-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 02/24/2020] [Indexed: 12/12/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease of incompletely understood pathophysiology predominantly affecting premature infants. While NEC is associated with microbial invasion of intestinal tissues, and mucus modulates interactions between microbes and underlying tissues, variations in mucus barrier properties with NEC-associated risk factors have not been investigated. This study explored differences in mucus composition (total protein, DNA, mucin content, sialic acid, and immunoregulatory proteins), as well as structural and transport properties, assessed by tracking of particles and bacteria (E. coli and E. cloacae) with developmental age and exposure to NEC stressors in Sprague Dawley rats. Early developmental age (5 day old) was characterized by a more permeable mucus layer relative to 21 day old pups, suggesting immaturity may contribute to exposure of the epithelium to microbes. Exposure to NEC stressors was associated with reduced mucus permeability, which may aid in survival. Feeding with breastmilk as opposed to formula reduces incidence of NEC. Thus, NEC-stressed (N-S) rat pups were orally dosed with breastmilk components lysozyme (N-S-LYS) or docosahexaenoic acid (N-S-DHA). N-S-LYS and N-S-DHA pups had a less permeable mucus barrier relative to N-S pups, which suggests the potential of these factors to strengthen the mucus barrier and thus protect against disease.
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Affiliation(s)
- Jaclyn Y Lock
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Taylor L Carlson
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Yueyue Yu
- Department of Pediatrics, Section of Neonatology, University of Chicago, Chicago, Illinois, USA
| | - Jing Lu
- Department of Pediatrics, Section of Neonatology, University of Chicago, Chicago, Illinois, USA
| | - Erika C Claud
- Department of Pediatrics, Section of Neonatology, University of Chicago, Chicago, Illinois, USA
- Department of Medicine, Section of Gastroenterology, University of Chicago, Chicago, Illinois, USA
| | - Rebecca L Carrier
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts, USA.
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5
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Abstract
This manuscript presents a review of infectious causes of gastritis aimed at the practicing anatomic pathologist. We shall highlight unique histologic findings and clinical attributes that will assist those analyzing endoscopically obtained mucosal biopsies of the stomach or resection specimens.
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6
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Lock JY, Carlson TL, Carrier RL. Mucus models to evaluate the diffusion of drugs and particles. Adv Drug Deliv Rev 2018; 124:34-49. [PMID: 29117512 DOI: 10.1016/j.addr.2017.11.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/12/2017] [Accepted: 11/01/2017] [Indexed: 12/22/2022]
Abstract
Mucus is a complex hydrogel that acts as a natural barrier to drug delivery at different mucosal surfaces including the respiratory, gastrointestinal, and vaginal tracts. To elucidate the role mucus plays in drug delivery, different in vitro, in vivo, and ex vivo mucus models and techniques have been utilized. Drug and drug carrier diffusion can be studied using various techniques in either isolated mucus gels or mucus present on cell cultures and tissues. The species, age, and potential disease state of the animal from which mucus is derived can all impact mucus composition and structure, and therefore impact drug and drug carrier diffusion. This review provides an overview of the techniques used to characterize drug and drug carrier diffusion, and discusses the advantages and disadvantages of the different models available to highlight the information they can afford.
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Yamada S, Okamura T, Kobayashi S, Tanaka E, Nakayama J. Reduced gland mucin-specific O-glycan in gastric atrophy: A possible risk factor for differentiated-type adenocarcinoma of the stomach. J Gastroenterol Hepatol 2015; 30:1478-84. [PMID: 25967588 DOI: 10.1111/jgh.13000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS O-glycans exhibiting terminal α1,4-linked N-acetylglucosamine (αGlcNAc) are attached to MUC6 in gastric gland mucins and serve as a tumor suppressor for gastric adenocarcinoma. Gastric atrophy is associated with risk for gastric cancer. However, the significance of αGlcNAc expression in pyloric glands of chronic atrophic gastritis remains unknown. Here, we asked whether reduced αGlcNAc expression in chronic atrophic gastritis is associated with risk for gastric cancer. METHODS We quantitatively analyzed expression of αGlcNAc relative to MUC6 in pyloric glands by immunohistochemistry in 67 patients with normal mucosa, 70 with chronic atrophic gastritis, 68 with intramucosal differentiated-type adenocarcinoma, and 11 with intramucosal undifferentiated-type adenocarcinoma. We also compared the Ki-67 labeling index in gastric epithelial cells between chronic atrophic gastritis and normal gastric mucosa with respect to αGlcNAc reduction. RESULTS In normal pyloric mucosa, αGlcNAc was co-expressed with MUC6. By contrast, in chronic atrophic gastritis, pyloric gland αGlcNAc expression was significantly reduced relative to MUC6. In intramucosal gastric cancer, αGlcNAc expression in pyloric glands found just beneath differentiated-type adenocarcinoma was also reduced relative to MUC6. However, pyloric glands present beneath undifferentiated-type adenocarcinoma exhibited no αGlcNAc decrease. The Ki-67 labeling index in chronic atrophic gastritis showing αGlcNAc reduction was significantly increased relative to that in normal gastric mucosa. CONCLUSIONS Because αGlcNAc prevents the gastric cancer development, reduced αGlcNAc expression in chronic atrophic gastritis is a possible risk factor for differentiated-type adenocarcinoma of the stomach.
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Affiliation(s)
- Shigenori Yamada
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuma Okamura
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Kobayashi
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Gastroenterology, Iiyama Red Cross Hospital, Iiyama, Japan
| | - Eiji Tanaka
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Nakayama
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
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8
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Carrasco G, Corvalan AH. Helicobacter pylori-Induced Chronic Gastritis and Assessing Risks for Gastric Cancer. Gastroenterol Res Pract 2013; 2013:393015. [PMID: 23983680 PMCID: PMC3745848 DOI: 10.1155/2013/393015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/25/2013] [Indexed: 12/19/2022] Open
Abstract
Chronic gastritis is an inflammation of the gastric mucosa and has multiple etiologies. Here we discuss the pathological alterations induced by Helicobacter pylori (HP) leading to chronic gastritis and the epigenetic bases underlying these changes. We review the histology of the normal gastric mucosa and overview the role of HP in the multistep cascade of GC. We attempt to define the role of the Operative Link for Gastritis Assessment (OLGA) staging system in assessing the risk of GC. The epigenetic bases of chronic gastritis, mainly DNA methylation, are presented through examples such as (i) the methylation of the promoter region of E-cadherin in HP-induced chronic gastritis and its reversion after HP eradication and (ii) the association of methylation of the promoter region of Reprimo, a p53-mediated cell cycle arrest gene, with aggressive HP strains in high risk areas for GC. In addition, we discuss the finding of RPRM as a circulating cell-free DNA, offering the opportunity for noninvasive risk assessment of GC. Finally, the integration of OLGA and tissue biomarkers, by systems pathology approach, suggests that severe atrophy has a greater risk for GC development if, in addition, overexpressed p73. This trial is registered with ClinicalTrials.gov NCT01774266.
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Affiliation(s)
- Gonzalo Carrasco
- Department of Pathology, Mount Sinai School of Medicine, 1425 Madison Ave, New York, NY 10029, USA
| | - Alejandro H. Corvalan
- Centre for Translational Research in Oncology (CITO) and Department of Hematology and Oncology, Pontificia Universidad Catolica de Chile, Marcoleta 391, 8330074 Santiago, Chile
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9
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Gibson JA, Odze RD. Pathology of diseases that cause upper gastrointestinal tract bleeding. Gastrointest Endosc Clin N Am 2011; 21:583-96. [PMID: 21944412 DOI: 10.1016/j.giec.2011.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Acute and chronic bleeding from the upper gastrointestinal tract is a common indication for endoscopy and hospitalization and is associated with significant morbidity and mortality. The causes of upper gastrointestinal bleeding are numerous and can result in both acute and chronic hemorrhage. The aim of this article is to examine the pathologic features of various diseases associated with upper gastrointestinal tract bleeding.
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Affiliation(s)
- Joanna A Gibson
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Asaka M, Kato M, Takahashi SI, Fukuda Y, Sugiyama T, Ota H, Uemura N, Murakami K, Satoh K, Sugano K. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter 2010; 15:1-20. [PMID: 20302585 DOI: 10.1111/j.1523-5378.2009.00738.x] [Citation(s) in RCA: 286] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. Accordingly, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan. MATERIALS AND METHODS Four meetings of guidelines preparation committee were held from July 2007 to December 2008. In the new guidelines, recommendations for treatment have been classified into five grades according to the Minds Recommendation Grades, while the level of evidence has been classified into six grades. The Japanese national health insurance system was not taken into consideration when preparing these guidelines. RESULTS Helicobacter pylori eradication therapy achieved a Grade A recommendation, being useful for the treatment of gastric or duodenal ulcer, for the treatment and prevention of H. pylori-associated diseases such as gastric cancer, and for inhibiting the spread of H. pylori infection. Levels of evidence were determined for each disease associated with H. pylori infection. For the diagnosis of H. pylori infection, measurement of H. pylori antigen in the feces was added to the tests not requiring biopsy. One week of proton-pump inhibitor-based triple therapy (including amoxicillin and metronidazole) was recommended as second-line therapy after failure of first-line eradication therapy. CONCLUSION The revised Japanese guidelines for H. pylori are based on scientific evidence and avoid the administrative restraints that applied to earlier versions.
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Affiliation(s)
- Masahiro Asaka
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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SATO T, FUJINO MA, KOJIMA Y, KITAHARA F, NAKAMURA T, MOROZUMI A, NAGATA K, SEKIGUCHI T, NAKAMURA M, HOSAKA H. Immunological Rapid Urease Test for Detecting
Helicobacter pylori:
Comparative Study of Biopsy Specimens and Gastric Mucus. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1999.tb00190.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Tadashi SATO
- *First Department of Internal Medicine, Yamanashi Medical University, Yamanashi, Japan
| | | | - Yuichiro KOJIMA
- *First Department of Internal Medicine, Yamanashi Medical University, Yamanashi, Japan
| | - Fumiaki KITAHARA
- *First Department of Internal Medicine, Yamanashi Medical University, Yamanashi, Japan
| | - Toshiya NAKAMURA
- *First Department of Internal Medicine, Yamanashi Medical University, Yamanashi, Japan
| | - Atsuro MOROZUMI
- *First Department of Internal Medicine, Yamanashi Medical University, Yamanashi, Japan
| | - Kumiko NAGATA
- **Department of Bacteriology, Hyogo College of Medicine, Hyogo, Japan
| | | | - Michihiro NAKAMURA
- *First Department of Internal Medicine, Yamanashi Medical University, Yamanashi, Japan
| | - Hidehiro HOSAKA
- *First Department of Internal Medicine, Yamanashi Medical University, Yamanashi, Japan
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Minami M, Ohta M, Ohkura T, Ando T, Torii K, Hasegawa T, Goto H. Use of a combination of brushing technique and the loop-mediated isothermal amplification method as a novel, rapid, and safe system for detection of Helicobacter pylori. J Clin Microbiol 2006; 44:4032-7. [PMID: 17088368 PMCID: PMC1698373 DOI: 10.1128/jcm.00898-06] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gastric mucosal biopsy is widely used in the detection of Helicobacter pylori but is associated with a number of problems, including false-negative results due to sampling error and massive bleeding after biopsy. Given the extended period required to culture H. pylori, detection would be further improved by the use of rapid detection methods such as PCR. Here, we developed a rapid, safe, and convenient method for collecting H. pylori which combines endoscopic brushing with the loop-mediated isothermal amplification (LAMP) method. The specificity and sensitivity of LAMP were examined using nine urease-generating non-H. pylori bacterial species, Escherichia coli, Clostridium perfringens, Campylobacter jejuni, Helicobacter hepaticus, and 51 H. pylori strains. Results showed that H. pylori-specific LAMP primers amplified H. pylori DNA only and that the lowest detection limit of the LAMP reaction was 10(2) CFU. Brushing and biopsy samples taken from 200 patients with peptic ulcer at Nagoya University Hospital and a regional health care center were subjected to both LAMP and culturing. No adverse effects such as severe bleeding or penetration occurred during the procedure. By LAMP assay, 123 patients were confirmed as H. pylori positive when brushing technique samples were assayed, whereas only 100 were positive when biopsy samples were assayed. Culture assay detected H. pylori in 117 patients when it was combined with the brushing technique and in 96 when it was combined with biopsy. Combination of the endoscopic brushing technique with LAMP is considered a useful and safe system for identifying H. pylori infection.
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Affiliation(s)
- Masaaki Minami
- Department of Bacteriology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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13
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Kubota S, Yamauchi K, Kumagai T, Sugano M, Kawasaki K, Tozuka M, Akamatsu T, Matsuzawa K, Sugiyama A, Kurihara M, Katsuyama T, Ota H. Quantitative determination of gland mucous cells-type mucin using a monoclonal antibody, HIK1083: its pathophysiological changes in human gastric juice. Clin Chim Acta 2006; 377:261-7. [PMID: 17134689 DOI: 10.1016/j.cca.2006.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 10/04/2006] [Accepted: 10/13/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pathological alteration in gastric mucosa is caused by Helicobacter pylori infection and is detectable by histological analysis. In particular, the alteration of gland mucous cells (GMCs)-type mucin, which plays a protective role against H. pylori infection, is critical in the pathogenesis of H. pylori-related gastritis. We established an assay for GMCs-type mucin and quantitatively assessed the pathophysiological changes in its content in human gastric juice samples. METHODS The assay method for GMCs-type mucin was based on ELISA using a monoclonal antibody (HIK1083), and was used it to measure GMCs-type mucin in gastric juice obtained from patients with or without H. pylori infection. RESULTS All the basic characteristics of the current method were satisfactory to quantify the GMCs-type mucin content in gastric juice. The GMCs-type mucin content, but not total mucin content, was significantly higher in patients with H. pylori infection (n=17; 437+/-476 U, mean+/-SD) than in those without H. pylori infection (n=55; 168+/-322 U, p<0.05). CONCLUSIONS The current method is suitable for the quantitative analysis of GMCs-type mucin in gastric juice. The change in GMCs-type mucin content in gastric juice may be possibly implicated in the pathophysiology of the gastric mucosa and in the patient's gastric mucosal lesions.
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Affiliation(s)
- Seiko Kubota
- Department of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto 390-8621, Japan
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Akamatsu T, Mochizuki T, Okiyama Y, Matsumoto A, Miyabayashi H, Ota H. Comparison of localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma with and without Helicobacter pylori infection. Helicobacter 2006; 11:86-95. [PMID: 16579838 DOI: 10.1111/j.1523-5378.2006.00382.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical features and clinical course of Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue (MALT) lymphoma are unclear and a treatment strategy has not yet been established. AIM To clarify the clinical differences between H. pylori-positive and H. pylori-negative gastric MALT lymphoma, we compared these two types of gastric MALT lymphoma. MATERIALS AND METHODS Fifty-seven patients with localized gastric MALT lymphoma were studied. H. pylori infection was present in 41 and absent in 16. Treatment consisted of antibiotic therapy and/or 30 Gy radiation therapy. Response assessment was performed every 3-6 months by esophagogastroduodenoscopy including gathering biopsy samples, endoscopic ultrasonography, clinical examination, and various imaging procedures. The median follow-up period was 37 months. RESULTS There were no significant differences between H. pylori-positive and H. pylori-negative gastric MALT lymphoma patients in terms of sex, age, stage, gross phenotype, affected area of the stomach, or the presence of monoclonality. Complete regression was achieved with antibiotic therapy against H. pylori-negative gastric MALT lymphoma in one of nine patients (11.1%), compared to 28 of 38 patients (73.7%) with H. pylori-positive gastric MALT lymphoma (p < .001). Radiation therapy showed high effectiveness for the local control of H. pylori-negative or antibiotic-resistant gastric MALT lymphoma (92.9%), although distant recurrence was recognized in three of 14 patients (21.4%). Two of 16 patients (12.5%) with H. pylori-negative gastric MALT lymphoma died because of the transformation of the disease into diffuse large B-cell lymphoma. There was a significant difference in both the overall and cause-specific survival rate between the two groups (p = .038). CONCLUSION Radiation therapy is the effective treatment for H. pylori-negative or antibiotic-resistant localized gastric MALT lymphoma. However, careful systemic follow-up for distant involvement should be required. Transformation into diffuse large B-cell lymphoma is thought to be the important cause of death in patients with gastric MALT lymphoma.
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Affiliation(s)
- Taiji Akamatsu
- Department of Endoscopy, Shinshu University Hospital, Matsumoto, Japan.
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Fujimori K, Shimodaira S, Akamatsu T, Furihata K, Katsuyama T, Hosaka S. Effect of Helicobacter pylori eradication on ongoing mutation of immunoglobulin genes in gastric MALT lymphoma. Br J Cancer 2005; 92:312-9. [PMID: 15655559 PMCID: PMC2361844 DOI: 10.1038/sj.bjc.6602262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Gastric low-grade mucosa-associated lymphoid tissue (low-grade MALT) lymphomas has been associated with Helicobacter pylori (H. pylori) infection. Although infiltrating T cells with specificity for H. pylori are known to stimulate the development of MALT lymphomas, the effect of H. pylori eradication on rearranged immunoglobulin heavy chain (IgH) genes of low-grade gastric MALT lymphomas is unclear. Gastric biopsies from five cases were investigated by cloning and sequence analysis of rearranged IgH genes before and after the treatment for H. pylori. In all cases, IgH genes were mutated from their germline counterpart. The frequency of intraclonal sequence heterogeneity before the eradication of H. pylori varied from 0.25 to 0.49%. Clones obtained from the tumours before the eradication of H. pylori in cases 1 and 2 showed a tendency to display a mutation pattern by positive antigen selection and their monoclonarity disappeared after the eradication. The frequency of intraclonal sequence heterogeneity of the clones obtained from cases 3, 4 and 5 (0.12% in case 3, 0.10% in 4 and 0.18% in 5) after the eradication of H. pylori was lower than that in tumours before the eradication (0.30% in case 3, 0.49% in 4 and not determined in 5). These findings suggest that low-grade gastric MALT lymphomas expand due to the persistent presence of H. pylori in vivo. The characteristic feature of tumour clones obtained from the tumours after the eradication of H. pylori is a very low intraclonal heterogeneity, which may potentially be independent of H. pylori.
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Affiliation(s)
- K Fujimori
- The Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Shimodaira
- The Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Akamatsu
- Department of Endoscopy, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Furihata
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Katsuyama
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Hosaka
- Department of Internal Medicine, Maruko General Hospital, 335-5 Maruko-machi, Chisagata-gun, Nagano-ken 386-0493, Japan
- Department of Internal Medicine, Maruko General Hospital, 335-5 Maruko-machi, Chisagata-gun, Nagano-ken 386-0493, Japan. E-mail:
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Matsuo T, Ikura Y, Ohsawa M, Ogami M, Kayo S, Yoshimi N, Hai E, Naruko T, Ohishi M, Higuchi K, Arakawa T, Ueda M. Mast cell chymase expression inHelicobacter pylori-associated gastritis. Histopathology 2003; 43:538-49. [PMID: 14636254 DOI: 10.1111/j.1365-2559.2003.01731.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To study the role of mast cell chymase in the inflammatory processes of human chronic gastritis. Experimental studies have shown that mast cell chymase stimulates inflammatory cell accumulation, and contributes to angiotensin II formation. METHODS AND RESULTS Tissue sections from human stomachs with Helicobacter pylori-associated gastritis (surgery/autopsy n = 20; biopsy n = 16) and normal stomachs (n = 10) were studied using immunohistochemical single and double labelling techniques. Monoclonal antibodies used were directed against mast cell chymase, tryptase, neutrophils (CD66b, elastase, and myeloperoxidase), macrophages, T-lymphocytes, and interleukin (IL)-4. The expression of angiotensin-converting enzyme and angiotensin II type 1 receptor was investigated using immunohistochemical analysis and the reverse transcription-polymerase chain reaction. The number of chymase-positive mast cells was significantly higher (P < 0.0001) in H. pylori-associated gastritis than in normal stomachs. Increased expression of chymase in inflamed mucosa was closely related to an increase in the accumulation of neutrophils, macrophages, T-lymphocytes, and IL-4-positive cells. The expression of angiotensin-converting enzyme and angiotensin II type 1 receptor was not altered in gastritis specimens. CONCLUSIONS These observations suggest that mast cell chymase may be an important mediator in the inflammatory processes of human H. pylori-associated gastritis.
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Affiliation(s)
- T Matsuo
- Department of Pathology, Osaka City University Graduate School of Medicine, Japan
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17
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Van de Bovenkamp JHB, Mahdavi J, Korteland-Van Male AM, Büller HA, Einerhand AWC, Borén T, Dekker J. The MUC5AC glycoprotein is the primary receptor for Helicobacter pylori in the human stomach. Helicobacter 2003; 8:521-32. [PMID: 14535999 DOI: 10.1046/j.1523-5378.2003.00173.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Helicobacter pylori shows a characteristic tropism for the mucus-producing gastric epithelium. In infected patients, H. pylori colocalizes in situ with the gastric secretory mucin MUC5AC. The carbohydrate blood-group antigen Lewis B (LeB) was deemed responsible for the adherence of H. pylori to the gastric surface epithelium. We sought to determine if MUC5AC is the carrier of LeB, and thus if MUC5AC is the underlying gene product functioning as the main receptor for H. pylori in the stomach. METHODS We studied three types of human tissue producing MUC5AC: Barrett's esophagus (BE), normal gastric tissue, and gastric metaplasia of the duodenum (GMD). Tissue sections were immuno-fluorescently stained for MUC5AC or LeB, and subsequently incubated with one of three strains of Texas red-labeled H. pylori, one of which was unable to bind to LeB. We determined the colocalization of MUC5AC or LeB with adherent H. pylori. RESULTS The binding patterns for the two LeB-binding strains to all tissues were similar, whereas the strain unable to bind to LeB did not bind to any of the tissues. In normal gastric tissue, the LeB-binding strains always bound to MUC5AC- and LeB-positive epithelial cells. In four nonsecretor patients, colocalization of the LeB-binding strains was found to MUC5AC-positive gastric epithelial cells. In BE, the LeB-binding H. pylori strains colocalized very specifically to MUC5AC-positive cells. MUC5AC-producing cells in GMD contained LeB. Yet, LeB-binding H. pylori not only colocalized to MUC5AC or LeB present in GMD, but also bound to the LeB-positive brush border of normal duodenal epithelium. CONCLUSIONS Mucin MUC5AC is the most important carrier of the LeB carbohydrate structure in normal gastric tissue and forms the major receptor for H. pylori.
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Matsuda M, Noda Y, Takemori Y. Novel diagnostic method of testing for Helicobacter pylori infection using the rapid leukocyte strip test, Leukostix. J Gastroenterol Hepatol 2003; 18:1196-201. [PMID: 12974908 DOI: 10.1046/j.1440-1746.2003.03150.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM A characteristic of gastric mucosa infected with Helicobacter pylori is infiltration of inflammatory cells, mainly consisting of neutrophils. The present study aimed to detect neutrophils in homogenates of biopsied gastric mucosa semiquantitatively using the rapid leukocyte strip test, Leukostix. The authors then investigated the association of these results with H. pylori status. METHODS The authors studied 342 patients undergoing endoscopy. Of these, 160 were treated for eradication of H. pylori infection and were reassessed after treatment. For the definitive diagnosis of H. pylori infection, quantitative culture, the rapid urease test and immunohistostaining were performed. Additionally, serum antibody against H. pylori was determined at the initial examination, and the 13C-urea breath test was performed after treatment. With the use of Leukostix, homogenates of biopsied gastric mucosa were spotted onto strips and judged 2 min later. RESULTS There was a significant correlation between the positive reaction of Leukostix and the number of neutrophils in gastric tissues determined by microscopic observation. The sensitivity and specificity of Leukostix at the initial examination were 97.9% and 76.9%, respectively, while those after eradication treatment were 100% and 97.2%, respectively. There was a significant positive correlation between the degree of reaction of Leukostix and the amount of H. pylori determined by quantitative culture. CONCLUSIONS The Leukostix test, using biopsied samples of gastric mucosa, was excellent for quantitative determination of neutrophils and useful for diagnosis of H. pylori infection and early assessment of treatment efficacy. Positive gradations of Leukostix results corresponded closely with the amount of H. pylori in gastric tissues.
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Affiliation(s)
- Mitsuru Matsuda
- Department of Internal Medicine, Toyama Rosai Hospital, Uozu, Japan.
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Koga T, Sato K, Shimada Y, Takahashi K, Kikuchi I, Okazaki Y, Katsuta M, Iwata M. Essential role of magnesium ion in water for colonization of Helicobacter pylori in 2-week-old miniature pigs. Microbiol Res 2003; 158:69-75. [PMID: 12608582 DOI: 10.1078/0944-5013-00180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study was designed to determine whether magnesium ion in water would influence the colonization of Helicobacter pylori in 2-week-old miniature pigs. Groups A (2 pigs) and B (1 pig) were both fed a milk diet dissolved in drinking water, Group C (2 pigs) was fed a milk diet dissolved in deionized distilled water (DDW), and Group D (1 pig) was fed a milk diet dissolved in DDW supplemented with MgCl2. Groups B, C, and D were all challenged with H. pylori, and Group A was not. Necropsy was performed on the pigs on postinfection Day 5, and biopsy specimens were taken from 16 sites of the stomach. H. pylori were recovered from 11 of 16 sites in Group B, 1 of 32 sites in Group C, and 13 of 16 sites in Group D. On the other hand, the degree of lymphocyte infiltration increased in the order of Group A < Group B < Group C < Group D. These observations suggest that magnesium ion in drinking water is essential for the colonization of H. pylori in the pig stomach. Possible mechanisms for the lymphocyte infiltration are discussed.
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Affiliation(s)
- Tetsufumi Koga
- Biological Research Laboratories, Sankyo Co., Ltd., Shinagawa-ku, Tokyo, Japan.
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Shirasaka D, Aoyama N, Sakashita M, Kuroda K, Maekawa S, Wambura CM, Miyamoto M, Tamura T, Yahiro K, Wada A, Kurazono H, Hirayama T, Kasuga M. Relationship between gastric ulcer and Helicobacter pylori VacA detected in gastric juice using bead-ELISA method. Helicobacter 2002; 7:281-6. [PMID: 12390207 DOI: 10.1046/j.1523-5378.2002.00097.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND VacA is an important pathogenetic factor produced by Helicobacter pylori. VacA has often been detected in supernatants of liquid cultures or lysates of whole bacterial cells. However, no studies have ever tried to assay VacA produced in the human stomach. We applied a very sensitive and simple method, bead-ELISA, to detect VacA in gastric juice. MATERIALS AND METHODS Forty-eight H. pylori-positive patients (16 nonulcer dyspepsia, 16 gastric ulcer, and 16 duodenal ulcer) and four H. pylori-negative nonulcer dyspepsia patients had endoscopy performed and gastric juice were aspirated. Polystyrene beads coated with the antibody to VacA, were used in this bead-ELISA method. The nucleotide sequences of vacA in the signal and middle regions were investigated. RESULTS Of the 48 samples that were positive for H. pylori, 21 [43.8%] were found to be VacA positive in gastric juice. The average and maximum concentrations of detected VacA in gastric juice were 143.2 +/- 216.5 and 840 pg/ml, respectively. The average density of VacA from gastric ulcer patients (227.5 +/- 276.7 pg/ml) was higher than that found in nonulcer dyspepsia (51.8 +/- 39.8 pg/ml) and duodenal ulcer (49.2 +/- 21.5 pg/ml) patients. There was no relationship between VacA in gastric juice and vacA genotype. CONCLUSIONS VacA in gastric juice could be directly detected by bead-ELISA. In this study, the diversity of disease outcome was associated with not the quality but the quantity of VacA. Therefore, not only the quality but also the quantity of VacA is important etiological factors in the pathogenesis of mucosal damage.
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Affiliation(s)
- Daisuke Shirasaka
- Division of Diabetes, Digestive, and Kidney Disease, Department of Clinical Molecular Medicine, Kobe University School of Medicine, Kobe, Hyogo, Japan
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Vinall LE, King M, Novelli M, Green CA, Daniels G, Hilkens J, Sarner M, Swallow DM. Altered expression and allelic association of the hypervariable membrane mucin MUC1 in Helicobacter pylori gastritis. Gastroenterology 2002; 123:41-9. [PMID: 12105832 DOI: 10.1053/gast.2002.34157] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Infection with Helicobacter pylori causes chronic gastritis, and this confers a risk of gastric cancer. Short alleles of the membrane-bound mucin MUC1, which has a large extracellular highly glycosylated domain and is highly polymorphic due to variation in the number of tandemly repeated (TR) 20-amino acid units, have been shown to be associated with gastric cancer. Our aim was to investigate the involvement of MUC1 in chronic gastritis and, by implication, gastric cancer. METHODS Immunohistochemical analysis was performed on endoscopic biopsy specimens from 95 patients. Gastritis was classified using the Sydney System, and H. pylori status was determined. MUC1 was detected with antibodies against different epitopes of the TR region and the cytoplasmic tail. Southern blot analysis of the MUC1 gene was performed on 57 Northern European patients to determine TR allele lengths. RESULTS With the TR antibodies, apical staining and some perinuclear staining was seen in 34 of 41 biopsy specimens classified as histologically normal and H. pylori negative. None of the 36 biopsy specimens with gastritis and current H. pylori infection showed apical staining. In contrast, the cytoplasmic tail antibody detected apical staining in both groups. Comparison of the MUC1 allele length distributions between Northern European patients with H. pylori infection and those without H. pylori gastritis showed a statistically significant difference in distribution, with shorter alleles associated with H. pylori gastritis. CONCLUSIONS Our results suggest that H. pylori interacts with MUC1 and that there are functional allelic differences that affect susceptibility to gastritis.
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Affiliation(s)
- Lynne E Vinall
- Galton Laboratory, Department of Biology, University College London, London, England
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22
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Gotoh A, Akamatsu T, Shimizu T, Shimodaira K, Kaneko T, Kiyosawa K, Ishida K, Ikeno T, Sugiyama A, Kawakami Y, Ota H, Katsuyama T. Additive effect of pronase on the efficacy of eradication therapy against Helicobacter pylori. Helicobacter 2002; 7:183-91. [PMID: 12047324 DOI: 10.1046/j.1523-5378.2002.00079.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) colonizes not only the surface of the surface mucous cells but also the surface mucous gel layer (SMGL). Thus, we examined the possible value of pronase, a mucolytic agent, as a potential eradication therapy. MATERIALS AND METHODS One hundred and thirty-five patients were randomly assigned to two treatment groups. Sixty-eight patients received 30 mg of lansoprazole once daily, 500 mg of amoxicillin and 250 mg of metronidazole thrice daily for 2 weeks (LAM group), while the other 67 patients received the same dosage of those agents plus 18,000 tyrosine units of pronase thrice daily for 2 weeks (LAMP group). Eradication was assessed 4-6 weeks after treatment by immunohistochemical tests and cultures. We also determined the in vitro activity of pronase against H. pylori, and evaluated the synergistic effects between pronase and the other three drugs. To investigate the effect of pronase on the structure of the SMGL, surgically removed stomachs obtained from patients who had taken pronase were examined histopathologically. RESULTS The cure rates for H. pylori infection in the LAMP group were significantly higher than those in the LAM group (intention to treat analysis: 94.0 vs. 76.5%, p =.0041). Pronase exhibited no antibacterial activity against H. pylori., and no in vitro synergistic effects were observed. In the patients who took pronase before surgery, the SMGL was thinner than in the patients who did not take pronase, and the structure of the SMGL was markedly disrupted. CONCLUSIONS Pronase has an additive effect in curing H. pylori infection. Pronase has no apparent in vitro activity against H. pylori, but may improve the local delivery of antibiotics by virtue of its removal and disruption of the SMGL.
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Affiliation(s)
- Akira Gotoh
- The Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, 390-8621, Japan
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Asaka M, Satoh K, Sugano K, Sugiyama T, Takahashi S, Fukuda Y, Ota H, Murakami K, Kimura K, Shimoyama T. Guidelines in the management of Helicobacter pylori infection in Japan. Helicobacter 2001; 6:177-86. [PMID: 11683920 DOI: 10.1046/j.1523-5378.2001.00027.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In preparation of the approval of Helicobacter pylori therapy by the Japanese national health system, the board of directors of the Japanese Society for Helicobacter Research decided to prepare guidelines on the diagnosis and treatment of H. pylori infection for physicians in routine medical practice. METHODS A guidelines preparation committee was formed and six meetings were held. Then, in December 1999, a consensus meeting was held in Kobe to obtain the opinions of general practitioners as well as experts from Europe, North America, and Asia. RESULTS Helicobacter pylori eradication therapy is recommended in gastric or duodenal ulcer patients. Helicobacter pylori eradication therapy is recommended or gastric mucosa associated lymphoid tissue (MALT) lymphoma but it should be done at specialist institutions. The significance of H. pylori eradication therapy is still under evaluation in patients with hyperplastic polyps, chronic atrophic gastritis, non-ulcer dyspepsia and in patients after endoscopic mucosal resection of gastric cancer and after gastrectomy for gastric cancer. When diagnosing H. pylori infection, at least one of the tests requiring endoscopic biopsy (e.g. rapid urease test, histology, or culture) and tests not requiring biopsy (e.g. measurement of H. pylori antibody or urea breath test) should be used. Multiple tests are recommended to increase the accuracy. The drugs of first choice currently covered by the national health insurance system in Japan are: lansoprazole (30 mg) 1 capsule twice daily, amoxicillin (250 mg) 3 capsules twice daily, and clarithromycin (200 mg) 1-2 tablets twice daily. These three drugs should be administered after breakfast and dinner for 1 week. CONCLUSION These guidelines are intended for utilization in routine medical practice after the Japanese national health system begins to cover the management of H. pylori infection.
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Affiliation(s)
- M Asaka
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Ishihara S, Okuyama T, Ishimura N, Ono M, Hashimoto T, Kazumori H, Kaji T, Sato H, Fujishiro H, Adachi K, Fukuda R, Kinoshita Y. Intragastric distribution of Helicobacter pylori during short-term omeprazole therapy: study using Carnoy's fixation and immunohistochemistry for detection of bacteria. Aliment Pharmacol Ther 2001; 15:1485-91. [PMID: 11552923 DOI: 10.1046/j.1365-2036.2001.01067.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND There is controversy about the effect of acid-suppressive therapy on Helicobacter pylori density and the severity of histological gastritis in the corpus. AIM To evaluate the precise distribution of H. pylori, both on the surface mucus cells and in the surface mucus gel layer, by using Carnoy's fixation and immunostaining for the detection of bacteria. METHODS A total of 19 peptic ulcer patients with H. pylori infection were studied. All patients received a 6-week course of treatment with omeprazole (20 mg/day). Before and after the therapy, H. pylori density in Carnoy-fixed tissue sections was examined immunohistochemically. The effect of omeprazole therapy on the severity of gastritis was also evaluated. RESULTS H. pylori density and the grade of gastritis significantly decreased in the antrum after omeprazole therapy. In the corpus, however, there were no significant changes in H. pylori density or the severity of gastritis after omeprazole therapy. CONCLUSION Carnoy's fixation and immunostaining was found to be useful for the detection of H. pylori in the surface mucus gel layer as well as on the surface mucus cells in biopsy tissue sections. By using this method, H. pylori density decreased in the antrum, but remained unchanged in the corpus after a 6-week course of omeprazole therapy.
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Affiliation(s)
- S Ishihara
- Department of Internal Medicine II, Shimane Medical University, Izumo, Shimane, Japan.
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Fujisawa T, Kaneko T, Kumagai T, Akamatsu T, Katsuyama T, Kiyosawa K, Tachikawa T, Kosaka O, Machikawa F. Evaluation of urinary rapid test for Helicobacter pylori in general practice. J Clin Lab Anal 2001; 15:154-9. [PMID: 11344531 PMCID: PMC6807870 DOI: 10.1002/jcla.1019] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2001] [Accepted: 01/29/2001] [Indexed: 01/12/2023] Open
Abstract
There is increasing interest in noninvasive tests for the diagnosis of Helicobacter pylori (H. pylori) infection. One such test, a urine-based rapid test kit (RAPIRUN H. pylori Antibody, Otsuka Pharmaceutical Co., Ltd.) for detection of antibody to H. pylori, has been developed and is considered ideal. In addition to its noninvasiveness and safe handling-due to use of urine as a sample-the assay procedure used for the urinary rapid test is very simple. Only 10-20 minutes are required to complete an assay, and no instruments are needed. The aim of this study was to examine the clinical usefulness of this urine-based rapid test. A total of 189 patients, including 76 patients with gastroduodenal disease, were recruited. A pair of random single-void urine and serum samples was collected from each of the 189 patients, and antibody to H. pylori in the urine and serum samples was measured using the urine-based rapid test kit and three commercially available serum-based ELISA kits. For the patients with gastroduodenal disease, invasive diagnostic methods using endoscopic biopsy specimens such as culture, histology, and rapid urease test were also performed. The sensitivity, specificity, and accuracy of the urinary rapid test were evaluated on the basis of the three serum ELISA results or the invasive diagnostic results. In addition, various urinalyses were performed, and the effects of substances existing in urine on the urinary rapid test results were examined. Of the 189 patients, the urinary rapid test was positive for 110 (58.2%), negative for 78 (41.3%), and invalid for only one patient (0.5%). Based on the three serum-based ELISA results, the sensitivity, specificity, and accuracy of the urinary rapid test were 93.7, 88.9, and 92.2%, respectively. On the basis of the biopsy-based test results, the sensitivity of the urinary rapid test was 100% and its accuracy (95.2%) was equivalent or superior to that of each serum-based ELISA. In addition, no significant differences were observed between groups positive and negative on urinary rapid testing in any urinalysis parameter examined. The novel urinary rapid test kit evaluated in this study enables simple, rapid, and accurate diagnosis of H. pylori infection, and is an ideal test method for point-of-care testing.
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Affiliation(s)
- T Fujisawa
- Second Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan.
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Icatlo FC, Goshima H, Kimura N, Kodama Y. Acid-dependent adherence of Helicobacter pylori urease to diverse polysaccharides. Gastroenterology 2000; 119:358-67. [PMID: 10930371 DOI: 10.1053/gast.2000.9372] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The significance of acid-primed recognition of ligands by Helicobacter pylori urease is unknown. This study aimed to further characterize the specificity of urease adherence in vitro and verify whether specific inhibition will translate into in vivo suppression of colonization. METHODS A highly sensitive competitive enzyme-linked ligand capture assay was used to quantify the capacity of each test inhibitor to compete with labeled mucin for binding sites on immobilized native urease. A model polymer that strongly bound urease was used in an in vivo trial using euthymic hairless mice as an infection model. RESULTS The blockage of urease-gastric mucin interaction by certain inhibitors revealed an acid-functional lectin-like activity by urease, specifically recognizing bacterial lipopolysaccharides and certain species of polysaccharides, nonbacterial glycolipids, and glycoproteins. Dextran sulfate significantly (P < 0.01) suppressed colonization of mice by H. pylori when given before and/or after challenge. CONCLUSIONS The acid-driven high-affinity adherence of H. pylori urease to mucin and lipopolysaccharides contributes to gastric mucosal colonization by the bacterium based on in vivo targeting experiments using specific polysaccharides in a mouse model with acute infection. Acid-functional urease-homing polysaccharides that can interfere with urease-mucin or H. pylori whole cell-mucin interaction in vitro can significantly interfere with colonization by the bacterium in vivo.
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Affiliation(s)
- F C Icatlo
- Immunology Research Institute, Ghen Corp., Sano, Gifu City, Japan.
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Ichikawa T, Ishihara K, Kusakabe T, Hiruma H, Kawakami T, Hotta K. CGRP modulates mucin synthesis in surface mucus cells of rat gastric oxyntic mucosa. Am J Physiol Gastrointest Liver Physiol 2000; 279:G82-9. [PMID: 10898749 DOI: 10.1152/ajpgi.2000.279.1.g82] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We examined the effects of the calcitonin gene-related peptide (CGRP), including the possible participation of nitric oxide (NO), on mucin biosynthesis in the surface epithelium and remaining deep mucosa as well as the entire mucosa and compared the distribution of CGRP and NO synthase (NOS) using a combination of double immunofluorescence labeling and multiple dye filter. Pieces of tissue obtained from the corpus and antrum were incubated in a medium containing [(3)H]glucosamine and CGRP, with or without the NOS inhibitor. CGRP dose-dependently enhanced [(3)H]glucosamine incorporation into the corpus mucin but had no effect on antral mucin biosynthesis. The CGRP receptor antagonist, CGRP-(8-37), prevented the increase in (3)H-labeled corpus mucin. This stimulation of corpus mucin synthesis disappeared after removal of the surface mucus cell layer. CGRP activated the mucin biosynthesis in the surface mucus cells. In the full-thickness corpus mucosa, CGRP-induced activation was completely blocked by the NOS inhibitor. CGRP-immunoreactive fibers were intertwined within the surface mucus cell layer with type I NOS immunoreactivity. These results show that CGRP-stimulated mucin biosynthesis mediated by NO is limited to surface mucus cells of the rat gastric oxyntic mucosa.
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Affiliation(s)
- T Ichikawa
- Department of Biochemistry, Kitasato University School of Medicine, Japan.
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Ichikawa T, Endoh H, Hotta K, Ishihara K. Hepatocyte growth factor region specifically activates mucin synthesis in rat stomach. Eur J Pharmacol 2000; 392:87-91. [PMID: 10748276 DOI: 10.1016/s0014-2999(00)00111-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We investigated the effects of hepatocyte growth factor (HGF) on mucin biosynthesis and the expression of its receptor in distinct sites and layers of rat gastric mucosa. HGF stimulated the mucin biosynthesis in the surface and gland mucus cells of corpus, but not in the antrum, without its trophic effects. The HGF-receptor mRNA expression was high in the surface and deep corpus mucosa, but low in the antrum. These results demonstrate that HGF has distinct effects on mucin biosynthesis in a specific region of rat stomach, suggesting different regulatory mechanisms underlying the mucus metabolism of distinct mucus-producing cells.
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Affiliation(s)
- T Ichikawa
- Department of Biochemistry, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Japan
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29
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Miyabayashi H, Furihata K, Shimizu T, Ueno I, Akamatsu T. Influence of oral Helicobacter pylori on the success of eradication therapy against gastric Helicobacter pylori. Helicobacter 2000; 5:30-7. [PMID: 10672049 DOI: 10.1046/j.1523-5378.2000.00004.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The goal of this study was to see whether Helicobacter pylori (H. pylori) in the oral cavity might adversely affect the outcome of eradication therapy for gastric H. pylori. MATERIALS AND METHODS Forty-seven patients (36 males, 11 females) with gastric H. pylori infection were enrolled in this study. Gastric H. pylori infection was confirmed by both immunohistological staining with anti-H. pylori antibody and bacterial culture of biopsy specimens. The therapeutic regimen consisted of 30 mg/day lansoprazole, 750 mg/day metronidazole, and 400 mg/day clarithromycin administered for 2 weeks. A fragment of the H. pylori urease gene was amplified by nested PCR for DNA extracted from saliva and dental plaque from the same patients. We examined the correlation between the gastric eradication success rate and the prevalence of H. pylori in the oral cavity as determined by PCR before and after the eradication therapy. RESULTS The eradication success rate was significantly lower in the oral H. pylori-positive cases (12/23, 52.1%) than in the negative cases (22/24, 91.6%) at 4 weeks after the therapy (p =. 0028). Two years later, only 16 of the 23 (69.5%) oral H. pylori-positive cases were disease-free, as compared to 23 of the 24 (95.8%) oral H. pylori-negative cases (p =.018). CONCLUSIONS H. pylori in the oral cavity affected the outcome of eradication therapy and was associated with a recurrence of gastric infection. We recommend that oral H. pylori should be examined by nested PCR and, if positive, should be considered a causal factor in refractory or recurrent cases.
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Affiliation(s)
- H Miyabayashi
- Second Department of Internal Medicine and Department of Laboratory Medicine, Shinshu University School of Medicine, Nagano, Japan.
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30
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Ikeno T, Ota H, Sugiyama A, Ishida K, Katsuyama T, Genta RM, Kawasaki S. Helicobacter pylori-induced chronic active gastritis, intestinal metaplasia, and gastric ulcer in Mongolian gerbils. THE AMERICAN JOURNAL OF PATHOLOGY 1999; 154:951-60. [PMID: 10079274 PMCID: PMC1866409 DOI: 10.1016/s0002-9440(10)65343-6] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The establishment of persisting Helicobacter pylori infection in laboratory animals has been difficult, but in 1996 Hirayama reported the development of a successful Mongolian gerbil model. The present study was undertaken with two aims: to better characterize the normal histological structure and histochemical properties of the gastric mucosa of the Mongolian gerbil; and to evaluate the progression of the histopathological features of H. pylori-induced gastritis in this animal model for one year after the experimental infection. Seventy-five Mongolian gerbils were used. Mongolian gerbils were sacrificed at 2, 4, 8, 12, 26, 38, and 52 weeks after H. pylori inoculation. Sections prepared from stomachs immediately fixed in Carnoy's solution were stained with hematoxylin and eosin and Alcian blue at pH 2.5/periodic acid-Schiff, a dual staining consisting of the galactose oxidase-cold thionin Schiff reaction and paradoxical Concanavalin A staining, and with immunostaining for H. pylori and BrdU. H. pylori infection induced in the Mongolian gerbil a chronic active gastritis, in which a marked mucosal infiltration of neutrophils on a background of chronic inflammation became detectable 4 weeks after inoculation and continued up to 52 weeks. Intestinal metaplasia and gastric ulcers appeared after 26 weeks in some of the animals, whereas others developed multiple hyperplastic polyps. The Mongolian gerbil represents a novel and useful model for the study of H. pylori-induced chronic active gastritis and may lend itself to the investigation of the epithelial alterations that lead to intestinal metaplasia and gastric neoplasia.
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Affiliation(s)
- T Ikeno
- First Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
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31
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Makino M, Koga T, Ito K, Kawada H, Tabata K. Delayed healing of chronic gastric ulcer after Helicobacter pylori infection in mice. J Pharm Pharmacol 1998; 50:943-8. [PMID: 9751461 DOI: 10.1111/j.2042-7158.1998.tb04012.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It has been suggested that there is a close relationship between Helicobacter pylori and the onset or recurrence of gastroduodenal disease. The aim of this study was to examine the effect of H. pylori on the healing of chronic gastric ulcers induced in mice. H. pylori administered to nude mice delayed the healing of experimental acetic acid-induced gastric ulcers. Histological examination showed the occurrence of high densities of H. pylori on the surface of epithelial cells and in the ulcerated area. Repeated administration of amoxicillin (10 mgkg(-1) daily for 5 days) eradicated H. pylori and increased the rate of healing of gastric ulcers in H. pylori-infected mice, but metronidazole, which also eradicated the organisms, did not significantly affect the rate of healing. In conclusion, H. pylori-infection delayed the healing of gastric ulcers induced by the serosal application of acetic acid in mice, possibly by aggravation or prolongation of the mucosal inflammation. Amoxicillin eradicated H. pylori and promoted gastric ulcer healing in mice infected with H. pylori.
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Affiliation(s)
- M Makino
- Pharmacology and Molecular Biology Research Laboratories, Sankyo Co. Ltd, Tokyo, Japan
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32
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Hayashi S, Sugiyama T, Amano K, Isogai H, Isogai E, Aihara M, Kikuchi M, Asaka M, Yokota K, Oguma K, Fujii N, Hirai Y. Effect of rebamipide, a novel antiulcer agent, on Helicobacter pylori adhesion to gastric epithelial cells. Antimicrob Agents Chemother 1998; 42:1895-9. [PMID: 9687380 PMCID: PMC105706 DOI: 10.1128/aac.42.8.1895] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Helicobacter pylori is a major etiological agent in gastroduodenal disorders. The adhesion of H. pylori to human gastric epithelial cells is the initial step of H. pylori infection. Inhibition of H. pylori adhesion is thus a therapeutic target in the prevention of H. pylori infection. Experiments were performed to evaluate the effect of rebamipide, a novel antiulcer agent, on H. pylori adhesion to gastric epithelial cells. MKN-28 and MKN-45 cells, derived from human gastric carcinomas, were used as target cells. Ten H. pylori strains isolated from patients with chronic gastritis and gastric ulcer were used in the study. We evaluated the effect of rebamipide on H. pylori adhesion to MKN-28 and MKN-45 cells quantitatively using our previously established enzyme-linked immunosorbent assay. The adhesion of H. pylori to MKN-28 and MKN-45 cells was significantly inhibited by pretreatment of these cells with 100 microg of rebamipide per ml. However, the adhesion was not affected by the pretreatment of H. pylori with rebamipide. On the other hand, the viabilities of H. pylori, MKN-28 cells, and MKN-45 cells were not affected by rebamipide. Our studies suggest that rebamipide inhibits the adhesion of H. pylori to gastric epithelial cells.
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Affiliation(s)
- S Hayashi
- Department of Microbiology, Jichi Medical School, Tochigi-ken 329-0498, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan.
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33
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Furuta T, Takashima M, Futami H, Arai H, Hanai H, Kaneko E. Amount of Helicobacter pylori in gastric mucus during anti-H. pylori treatment. J Gastroenterol Hepatol 1998; 13:511-5. [PMID: 9641650 DOI: 10.1111/j.1440-1746.1998.tb00678.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Helicobacter pylori is present in infected patients not only on the gastric epithelial cell surface but also in gastric mucus. We developed a competitive polymerase chain reaction (cPCR) method for quantitative measurement of H. pylori in gastric mucus. The aim of this study was to determine the number of H. pylori in gastric mucus before and after anti-H. pylori treatment. Patients with duodenal ulcer were treated with lansoprazole alone (n = 11) or lansoprazole and amoxycillin (n = 12). The amount of H. pylori in gastric mucus was measured over time by a cPCR assay. Helicobacter pylori infection was also tested for using histology, culture, and the rapid urease test (RUT). Although most patients treated with lansoprazole alone had become H. pylori-negative by the end of treatment when tested by histology, RUT, and culture, a large number of H. pylori organisms were found in the gastric mucus at that time by cPCR. These patients returned to being H. pylori positive 1 to 12 months later on the basis of histology, RUT, and culture. However, cPCR results indicated eradication of H. pylori by the end of treatment in eight of the 12 patients treated with lansoprazole and amoxicillin, and these patients remained H. pylori negative on histology, RUT, culture, and cPCR 1 to 12 months later. Testing for H. pylori in gastric mucus is thus useful for precise determination of the success or failure of H. pylori eradication therapy.
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Affiliation(s)
- T Furuta
- The First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu city, Japan
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Alarcón T, Domingo D, López-Brea M. Discrepancies between E-test and agar dilution methods for testing metronidazole susceptibility of Helicobacter pylori. J Clin Microbiol 1998; 36:1165-6. [PMID: 9542964 PMCID: PMC104716 DOI: 10.1128/jcm.36.4.1165-1166.1998] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Gotoh A, Kawakami Y, Akamatsu T, Katsuyama T. Interaction of drugs for eradication therapy against antibiotic-resistant strains of Helicobacter pylori. Microbiol Immunol 1998; 41:865-9. [PMID: 9444328 DOI: 10.1111/j.1348-0421.1997.tb01942.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To clarify the interactions of drugs for combination therapy of Helicobacter pylori infection, especially due to antibiotic-resistant strains, we have evaluated the in vitro effect of combining different drugs. Using a modified time-kill assay, we tested the effect of combining 2 drugs from 4 agents; amoxicillin (AMPC), clarithromycin (CAM), metronidazole (MTZ) and lansoprazole (a proton pump inhibitor). The H. pylori in the study consisted of 4 strains sensitive to the all drugs, 2 strains resistant only to CAM, 2 strains resistant only to MTZ, and 2 strains resistant to both CAM and MTZ. From the 6 different drug combinations, synergism was observed for 5 of the combinations, among which the combination of AMPC and CAM revealed such effects most frequently. However, all of the strains which showed synergism were sensitive to both of the drugs. In the case of the strains resistant to CAM and/or MTZ, no synergism was demonstrated in any of the combinations including CAM and/or MTZ. When a strain was resistant to one drug from a combination, no synergism was detected. Thus, the administration of a drug to which the strains are resistant may have no advantage in the eradication therapy of H. pylori. For a more effective and safer therapy, susceptibility testing should be performed before treatment.
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Affiliation(s)
- A Gotoh
- 2nd Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan
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36
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Misawa K, Kumagai T, Shimizu T, Furihata K, Ota H, Akamatsu T, Katsuyama T. A new histological procedure for re-evaluation of the serological test for Helicobacter pylori. Eur J Clin Microbiol Infect Dis 1998; 17:14-9. [PMID: 9512176 DOI: 10.1007/bf01584357] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To re-evaluate the accuracy of the serological test for Helicobacter pylori, fixation of biopsy specimens with Carnoy's solution (preserving the mucous layer in tissue preparations) followed by immunohistochemical staining (a new histological procedure) was used as the reference histological method instead of 10% formalin fixation followed by hematoxylin-eosin staining (the conventional histological procedure). Biopsy specimens (antrum and body) from 114 patients with gastritis (including non-ulcer dyspepsia) or gastric and/or duodenal ulcers were obtained by endoscopy and used for both bacteriological culture and histological examination. Serum samples were taken from all patients at the time of endoscopy. The serum levels of specific IgG and IgA antibodies for Helicobacter pylori were measured by commercial enzyme immunoassay kits. The reliability of the IgG and IgA measurements was evaluated by analyzing receiver operating characteristic curves obtained using the two histological procedures. With the conventional histological procedure as the reference, the sensitivity and specificity levels of the serological test were 87.2% and 82.1%, respectively. With the new histological procedure as reference, sensitivity and specificity were 94% and 96.7%, respectively. The insufficient accuracy reported for the serological test could be due to false-positive or false-negative results obtained when the conventional histological procedure is used as the reference. The new histological procedure used here revealed that the serological test for Helicobacter pylori is more reliable than previously thought.
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Affiliation(s)
- K Misawa
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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37
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Kawakami Y, Akahane T, Gotoh A, Okimura Y, Oana K, Katsuyama T. Successful development of air-dried microplates (HP-Plates) for susceptibility testing against Helicobacter pylori isolates. Microbiol Immunol 1997; 41:703-8. [PMID: 9343821 DOI: 10.1111/j.1348-0421.1997.tb01914.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We have successfully developed and evaluated a new susceptibility testing procedure against Helicobacter pylori strains using air-dried microplates "HP-Plates" containing eight serially-diluted anti-H. pylori agents. HP-Plate wells were reconstituted by the inoculation of 100 microliters of H. pylori cell suspensions. After incubation at 37 C for 48 hr under humidified microaerophilic conditions, HP-Plates were read visually with a circular mirror. We investigated the within-day reproducibility tests of HP-Plates using the six quality control (QC) strains we proposed. Of the 20 testings, determining the minimum inhibitory concentrations (MICs) of all the QC strains fell within +/- 1 log2 dilution ranges. When 200 clinical isolates were tested with HP-Plates and compared with the results obtained with the modified broth macrodilution method of NCCLS, more than 90% of the MICs also fell within +/- 1 log2 dilution ranges. We concluded that the HP-Plate susceptibility test method is a practical and easily applicable alternative of susceptibility testing for clinical microbiology laboratories in determining the MICs of H. pylori isolates.
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Affiliation(s)
- Y Kawakami
- Department of Medical Technology, School of Allied Medical Sciences, Shinshu University, Nagano, Japan.
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38
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Gotoh A, Kawakami Y, Akahane T, Akamatsu T, Shimizu T, Kiyosawa K, Katsuyama T. Susceptibility of Helicobacter pylori isolates against agents commonly administered for eradication therapy and the efficacy of chemotherapy. Microbiol Immunol 1997; 41:7-12. [PMID: 9087962 DOI: 10.1111/j.1348-0421.1997.tb01166.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although chemotherapy has been documented to be effective in the treatment of Helicobacter pylori-associated gastritis and gastroduodenal ulcers, some cases are known to have been unsuccessful in the attempt to eradicate this species. In this study, we examined the relation between the susceptibility of H. pylori isolates and the efficacy of chemotherapy. We utilized the modified agar plate dilution method to determine the minimum inhibitory concentrations (MICs) of 63 H. pylori strains isolated before treatment with several drugs routinely used during eradication chemotherapy. Among the drugs tested, amoxicillin (AMPC) and clarithromycin (CAM) demonstrated high degrees of activity with MIC99, 0.39 and 0.2 micrograms/ml, respectively. No highly resistant strain against AMPC was detected among the strains examined, while for CAM and metronidazole (MTZ), 9.5% and 7.9% of the strains, respectively, were resistant before treatment. It should be noted that all of the MICs of the strains from patients with successful therapy were lower than those from patients with unsuccessful therapy. These findings indicate that susceptibility tests should be carried out prior to the commencement of drug administration in order to provide safer and more effective chemotherapy.
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Affiliation(s)
- A Gotoh
- 2nd Department of Internal medicine, Shinshu University School of Medicine, Nagano, Japan
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