Reversal of gastric atrophy after Helicobacter pylori eradication: is it possible or not?

Correlation between the Chemiluminescent Activity of Neutrophilic Granulocytes and the Lipid Peroxidation-Antioxidant Defense System in Gastric Cancer Associated with Helicobacter pylori Infection

AIM

To study the processes of lipid peroxidation and the activity of antioxidant defense enzymes depending on the chemiluminescent activity of neutrophilic granulocytes in patients with gastric cancer associated with H. pylori infection, depending on the stage.

MATERIALS AND METHODS

A total of 39 patients with stage I-II gastric cancer and 30 patients with stage III-IV gastric cancer were examined. A study of the chemiluminescent activity of neutrophilic granulocytes was carried out and the parameters of the lipid peroxidation system and antioxidant protection in plasma were determined using the spectrophotometric method. Statistical data processing was performed using the Statistica 7.0 software package (StatSoft, St Tulsa, OK, USA).

RESULTS

In patients with gastric cancer associated with H. pylori infection, regardless of stage, the proportion of neutrophilic granulocytes with normal activity did not exceed 1/3 of the total number of patients, and the remaining 2/3 of patients had altered chemiluminescent activity of neutrophilic granulocytes. In patients with gastric cancer, by I-II stage of the disease, the majority revealed a reduced function of neutrophilic granulocytes, and in patients with gastric cancer in stage III-IV of the disease, the majority showed increased chemiluminescent activity of neutrophilic granulocytes.

CONCLUSIONS

In all patients with gastric cancer associated with H. pylori infection, regardless of the stage of the disease, an increase in lipid peroxidation processes with activation of antioxidant defense enzymes was detected. At the same time, there were no statistically significant differences between the indicators of the system lipid peroxidation-antioxidant protection depending on the stage of gastric cancer and the chemiluminescent activity of neutrophilic granulocytes, which likely indicates that all reactive oxygen species produced by neutrophilic granulocytes in the respiratory burst are consumed locally, minimally affecting the development of oxidative stress in the blood plasma.

The Role of Immunoglobulin G (IgG), IgA and IgE-Antibodies against Helicobacter pylori in the Development of Oxidative Stress in Patients with Chronic Gastritis

Aim: To study the predominant serum responses (antibodies IgG, IgA, IgE) against H. pylori in relation to the indicators of the system “lipid peroxidation−antioxidant system” in various pathogenetic variants of chronic gastritis (CG). Materials and Methods: Sixty patients with CG, 33 patients with chronic atrophic gastritis (CAG) and 31 patients with chronic allergic gastritis (CALG) were examined. The values of the system of lipid peroxidation and antioxidant protection in plasma were determined in the serum of patients using a spectrophotometric method. Statistical data processing was carried out using the Statistica 7.0 software package (StatSoft, Tulsa, OK, USA). Results: With serum responses “antibodies IgG > IgA” and “high concentrations of IgE antibodies”, we found unidirectional changes in the form of an increase in the amount of diene conjugates, malondialdehyde and an increase in the activity of all enzymes: superoxide dismutase, catalase, glutathione-S-transferase and glutathione peroxidase. With a serum response with low concentrations of IgG, IgA antibodies, multidirectional changes were found in the form of an increase in the amount of diene conjugates, malondialdehyde and a decrease in the activity of all enzymes: superoxide dismutase, catalase, glutathione-S-transferase and glutathione peroxidase relative to the control group. Conclusions: The obtained data testify to the balance of lipid peroxidation and antioxidant system processes and depend on the characteristics of the immune response to H. pylori infection.

Rejuvenation of Helicobacter pylori-Associated Atrophic Gastritis Through Concerted Actions of Placenta-Derived Mesenchymal Stem Cells Prevented Gastric Cancer

Chronic Helicobacter pylori infection causes gastric cancer via the progression of precancerous chronic atrophic gastritis (CAG). Therefore, repairing gastric atrophy could be a useful strategy in preventing H. pylori-associated gastric carcinogenesis. Although eradication of the bacterial pathogen offers one solution to this association, this study was designed to evaluate an alternative approach using mesenchymal stem cells to treat CAG and prevent carcinogenesis. Here, we used human placenta-derived mesenchymal stem cells (PD-MSCs) and their conditioned medium (CM) to treat H. pylori-associated CAG in a mice/cell model to explore their therapeutic effects and elucidate their molecular mechanisms. We compared the changes in the fecal microbiomes in response to PD-MSC treatments, and chronic H. pylori-infected mice were given ten treatments with PD-MSCs before being sacrificed for end point assays at around 36 weeks of age. These animals presented with significant reductions in the mean body weights of the control group, which were eradicated following PD-MSC treatment (p < 0.01). Significant changes in various pathological parameters including inflammation, gastric atrophy, erosions/ulcers, and dysplastic changes were noted in the control group (p < 0.01), but these were all significantly reduced in the PD-MSC/CM-treated groups. Lgr5+, Ki-67, H⁺/K⁺-ATPase, and Musashi-1 expressions were all significantly increased in the treated animals, while inflammatory mediators, MMP, and apoptotic executors were significantly decreased in the PD-MSC group compared to the control group (p < 0.001). Our model showed that H. pylori-initiated, high-salt diet-promoted gastric atrophic gastritis resulted in significant changes in the fecal microbiome at the phylum/genus level and that PD-MSC/CM interventions facilitated a return to more normal microbial communities. In conclusion, administration of PD-MSCs or their conditioned medium may present a novel rejuvenating agent in preventing the progression of H. pylori-associated premalignant lesions.

Helicobacter pylori and gastric cancer

Infection with Helicobacter pylori is established as the major risk factor for gastric cancer development. Damage of the mucosal barrier due to H. pylori-induced inflammation enhances the carcinogenic effect of other risk factors such as salt intake or tobacco smoking. The genetic disposition of both the bacterial strain and the host can increase the potential towards gastric cancer formation. Genetic variance of the bacterial proteins CagA and VacA is associated with a higher gastric cancer risk, as are polymorphisms and epigenetic changes in host gene coding for interleukins (IL1β, IL8), transcription factors (CDX2, RUNX3) and DNA repair enzymes. Application of high-throughput assays for genome-wide assessment of either genetic structural variance or gene expression patterns may lead to a better understanding of the pathobiological background of these processes, including the underlying signaling pathways. Understanding of the stepwise alterations that take place in the transition from chronic atrophic gastritis, via metaplastic changes, to invasive neoplasia is vital to define the 'point of no return' before which eradication of H. pylori has the potential to prevent gastric cancer. Currently, eradication as preventive strategy is only recommended for high-incidence regions in Asia; large population studies with an adequate follow-up are required to demonstrate the effectiveness of such an approach in Western populations.

Gastric carcinogenesis

INTRODUCTION

In most patients, gastric cancer is diagnosed in advanced stage. Curative treatment options are limited and the mortality is high. The process of gastric carcinogenesis is triggered by Helicobacter pylori-driven gastritis and is further characterized by its complexity of interaction with other risk factors. Health care systems are challenged for the improvement of prevention, early diagnosis, and effective treatments.

METHODS

An extensive literature research has been performed to elucidate the interplay between etiological factors involved in gastric carcinogenesis.

RESULTS

H. pylori is the most important carcinogen for gastric adenocarcinoma. Evidence is provided by experiments including animal studies as well as clinical observational and interventional studies in humans. Eradication has the potential to prevent gastric cancer and offers the greatest benefit if performed before premalignant changes of the gastric mucosa have occurred. Bacterial virulence factors are essential players in modulating the immune response involved in the initiation of the carcinogenesis in the stomach. Host genetic factors contribute to the regulation of the inflammatory response and in the aggravation of mucosal damage. The harmful role of environmental factors is restricted to salt intake and smoking of tobacco. The ingestion of fruit and vegetables has some protective effect.

CONCLUSION

Infection with H. pylori is the major risk factor for gastric cancer development, and thus, eradication of the Helicobacter offers a promising best option for prevention of the disease. Bacterial virulence, host genetic factors, and environmental influences are interacting in the multifactorial process of gastric carcinogenesis.

Anti-Helicobacter pylori immunoglobulin G (IgG) and IgA antibody responses and the value of clinical presentations in diagnosis of Helicobacter pylori infection in patients with precancerous lesions

AIM: To determine the prevalence of Helicobacter pylori (H. pylori) infection, the serum anti-H. pylori immunoglobulin G (IgG) and IgA antibody responses, and the value of clinical presentations in diagnosis of H. pylori infection in patients with gastric atrophy, intestinal metaplasia and dysplasia.

METHODS: H. pylori infection was detected by histology in 209 patients with mild chronic atrophic gastritis (CAG, n = 76), severe CAG (n = 22), mild intestinal metaplasia (IM, n = 22), severe IM (n = 58), or dysplasia (DYS, n = 31). Serum anti-H. pylori IgG and IgA were double sampled and evaluated by enzyme-linked immunoadsordent assays. 35 clinical presentations were observed and their relationship with H. pylori infection was analyzed by the k-means cluster method.

RESULTS: Both IgG and IgA levels in H. pylori positive patients were significantly higher than those negative for H. pylori (P < 0.001-0.01). The prevalence of H. pylori was highest in severe IM (84.5%), and lowest in mild CAG (51.3%) (P < 0.01). They were similar in severe CAG (68.2%), mild IM (72.7%), and DYS (67.7%). In H. pylori positive patients, the IgG levels in severe CAG were significantly higher than those in mild CAG (P < 0.01). In H. pylori negative patients, both IgG and IgA levels increased remarkably in severe IM, compared to those in mild IM (P < 0.01-0.05). H. pylori infection exhibited no association with patient’s gender (62.1% in males; 71.7% in females) and age (r = 0.0814, P = 0.241). The diagnostic accuracy based on 35 clinical presentations was 65.7%. It could be improved by 5.7% when only the assemblage of digestive symptoms were engaged, or by 8.6% when the pathogenic factors, general status and grossoscopy were combined. The diagnostic accuracy could be decreased when only the general symptoms were engaged, or when the pathogenic factors were accompanied with some common digestive symptoms.

CONCLUSION: H. pylori infection is a major risk factor for the process from atrophy, IM to DYS of gastric mucosa. Serum IgG and IgA are good indicators to evaluate this progress with a certain arrearage. Investigation on the effective assemblages of clinical presentations may provide a better understanding in the pathogenesis, diagnosis and treatment for H. pylori infection.

The long-term effects of cure of Helicobacter pylori infection on patients with atrophic body gastritis

BACKGROUND

Helicobacter pylori infection induces atrophic body gastritis, but the long-term effect of its cure on body atrophy is unclear.

AIM

To investigate the long-term effects of H. pylori cure on gastric morpho-functional parameters in patients with atrophic body gastritis.

METHODS

Forty patients with atrophic body gastritis were cured of H. pylori infection. Gastroscopy with biopsies, gastrin and pepsinogen I levels and basal and stimulated acid secretion were evaluated before and 6-12 months after treatment.

RESULTS

At eradication assessment (6-12 months), in eight of the 40 patients, body atrophy was no longer observed, whereas in 32 of the 40 it remained substantially unchanged (2.03 +/- 0.12 vs. 1.83 +/- 0.15). In the eight patients with reversed body atrophy, gastrinaemia decreased significantly with respect to pre-treatment values (265 +/- 59.9 pg/mL vs. 51.8. +/- 6.04 pg/mL), and basal and stimulated acid secretion increased significantly after cure. In the 32 patients still presenting body atrophy, gastrinaemia was similar topre-treatment values (457 +/- 76.04 pg/mL vs. 335.1 +/- 58.8 pg/mL). At follow-up (21-25 and 32-70 months), the eight patients with reversed body atrophy continued with normal gastrinaemia (35.3 +/- 10.1 pg/mL vs. 38.5 +/- 8.8 pg/mL), but in the 19 patients with continued atrophy, both corporal atrophy and intestinal metaplasia remained substantially unchanged.

CONCLUSIONS

Following successful treatment in patients with atrophic body gastritis and H. pylori infection, long-term histological investigations are crucial in order to detect reversed body damage or to confirm continued body atrophy.

Cure of Helicobacter pylori infection in atrophic body gastritis patients does not improve mucosal atrophy but reduces hypergastrinemia and its related effects on body ECL-cell hyperplasia

BACKGROUND

The effects of H. pylori eradication on atrophic body gastritis are controversial.

AIM

To investigate the effect of triple therapy on atrophic body gastritis in H. pylori-positive patients and its effect on morpho-functional gastric parameters.

METHODS

Thirty-five consecutive atrophic body gastritis patients with histological/serological evidence of H. pylori infection were treated. Before and 6 and 12 months after H. pylori eradication the patients were evaluated for fasting gastrinemia and pepsinogen I, basal and peak acid output, and detailed histological assessment including the ECL cell proliferative patterns.

RESULTS

Six months after treatment, 25 out of 32 patients were cured (78%). Cure of infection was associated with improvement in both basal (basal acid output mean 0.23 +/- 0.14 mmol/h vs. 1.75 +/- 0.7 mmol/h, P < 0.005) and stimulated acid secretion (peak acid output mean 3.0 +/- 1.06 mmol/h vs. 16.6 +/- 4.1 mmol/h, P=0.0017) as well as with reduction in hypergastrinemia (mean gastrin levels 444.1 +/- 110.7 pg/mL vs. 85.3. +/- 28 pg/mL; P < 0.005). In contrast, the eradication had no effect on body corporal atrophy and intestinal metaplasia, or pepsinogen I levels (mean 16.6 +/- 2.9 ng/mL vs. 14.2 +/- 2.1 ng/mL, N.S.). These results were confirmed at 12 months after eradication. A statistical inverse correlation was obtained (r=-0.3635, P < 0.05) between the corporal chronic infiltrate score and peak acid output values. A total of 53% of atrophic body gastritis patients showed a regression in severity of body ECL cell hyperplastic change.

CONCLUSION

Cure of H. pylori infection in patients with atrophic gastritis reverses some adverse effects on gastric function and ECL cell hyperplasia. H. pylori infection may be cured in atrophic body gastritis patients with partial reversion of its negative consequences on acid secretion and body ECL cell hyperplasia.