1
|
Uchiyama K, Ando T, Kishimoto E, Nishimura T, Imamoto E, Takagi T, Ishikawa T, Naito Y, Itoh Y. Correlation of gastrointestinal symptom rating scale and frequency scale for the symptoms of gastroesophageal reflux disease with endoscopic findings. Scand J Gastroenterol 2024:1-9. [PMID: 39301940 DOI: 10.1080/00365521.2024.2406537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 09/10/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Gastroesophageal Reflux Disease (GERD) is caused by the reflux of gastric contents into the esophagus and has a 13% global prevalence that is increasing. GERD symptoms negatively impact physical, social, and emotional quality of life. The Frequency Scale for the Symptoms of GERD (FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS) determine the efficacy of treatment but may not correlate with endoscopically estimated esophageal mucosal injury severity. We aimed to probe the correlation between FSSG, GSRS, and esophageal injury severity to evaluate whether these scores can predict GERD severity. METHODS A total of 2962 patients who underwent physical examinations, including upper gastrointestinal endoscopy, at the Kyoto Kuramaguchi Medical Center, Japan, were enrolled in this study. Upper gastrointestinal endoscopy was used to diagnose fundic mucosal atrophy, reflux esophagitis based on the Los Angeles (LA) classification, gastroesophageal flap value function (GEFV) based on Hill's classification, and Barrett's esophagus. Endoscopic diagnoses were examined for correlations with FSSG and GSRS scores. RESULTS In reflux esophagitis, FSSG and GSRS scores correlated with LA-B and LA-C endoscopic diagnosis but not with LA-M and LA-A endoscopic findings. Multiple regression analysis results were similar. FSSG scores reflected advanced fundic gland mucosal atrophy, while GSRS scores associated with high grade of GEFV. CONCLUSIONS This is the first report to examine the correlation between FSSG and GSRS scores and endoscopic findings in a relatively large patient population. Our findings suggest that these scores can diagnose the severity of reflux esophagitis.
Collapse
Affiliation(s)
- Kazuhiko Uchiyama
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Etsuko Kishimoto
- Center for Health Promotion, Japanses Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | | | | | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department for Medical Innovation and Translational Medical Science, Graduate School of Medical Science, Kyoto, Japan
| | - Takeshi Ishikawa
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Human Immunology and Nutrition Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
2
|
Zhao W, Han Y, Xiao Y, Liu Y, Zhang Z, Liao L, Wei J, Li X, Gao M, Lu J. Relationship between Helicobacter pylori infection and digestive tract diseases and analysis of risk factors: a cross-sectional study based on 3867 Chinese patients. Aging (Albany NY) 2024; 16:11917-11925. [PMID: 39177658 PMCID: PMC11386919 DOI: 10.18632/aging.206065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 08/02/2024] [Indexed: 08/24/2024]
Abstract
Helicobacter pylori (H. pylori) infect nearly half of the global population, contributing to upper digestive tract diseases. This 2019 cross-sectional study included 3,867 patients undergoing esophagogastroduodenoscopy (EGD) and 2,875 undergoing both colonoscopy and EGD. Subjects were categorized into H. pylori positive and negative groups by rapid urease test (RUT). In addition to exploring the relationship between H. pylori infection and upper gastrointestinal diseases, this study further revealed that H. pylori infection was closely related to lower digestive tract diseases, including colorectal polyp (63.28%) and colorectal cancer (75.76%), as well as upper and lower gastrointestinal comorbidities, including chronic atrophic gastritis with colorectal polyp (79.85%), peptic ulcer with colorectal polyp (79.72%), gastric polyp with colorectal polyp (66.24%), and chronic atrophic gastritis with colorectal cancer (92.86%). Besides, a univariate logistic regression analysis was conducted to compare the differences between the two groups (including gender, nationality, marital status, smoking history, drinking history, living area, age, BMI, glycosylated hemoglobin, fasting blood glucose, total cholesterol, and triglyceride levels), the results identified marital status and age as independent risk factors for H. pylori infection (OR, 1.435; 95% CI, 1.042 to 1.977; OR, 1.007; 95% CI, 1.001 to 1.013). Further clarification of the correlation between the prevalence of gastrointestinal diseases and H. pylori infection will be important for H. pylori infection management strategies and the treatment and prevention of gastrointestinal diseases.
Collapse
Affiliation(s)
- Wang Zhao
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Yanzhi Han
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Yizhi Xiao
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Yuan Liu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Zhenling Zhang
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Lijuan Liao
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Jinqi Wei
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Xiaofeng Li
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Minzhao Gao
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Jing Lu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| |
Collapse
|
3
|
Han YM, Chung SJ, Yoo S, Yang JI, Choi JM, Lee J, Kim JS. Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology. World J Gastroenterol 2022; 28:853-867. [PMID: 35317098 PMCID: PMC8900577 DOI: 10.3748/wjg.v28.i8.853] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/29/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) infection is known to prevent the occurrence of gastroesophageal reflux disease (GERD) by inducing gastric mucosal atrophy. However, little is known about the relationship between atrophic gastritis (AG) and GERD.
AIM To confirm the inverse correlation between AG and the occurrence and severity of GERD.
METHODS Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included. The grade of reflux esophagitis was evaluated according to the Los Angeles classification. Endoscopic AG (EAG) was categorized into six grades. Serologic AG (SAG) was defined as pepsinogen I ≤ 70 ng/mL and pepsinogen I/II ratio ≤ 3.0. The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.
RESULTS In total, 4684 individuals with GERD were compared with 21901 healthy controls. In multivariate logistic regression analysis, advanced age, male sex, body mass index > 23 kg/m2, presence of metabolic syndrome, current smoking, and alcohol consumption were associated with an increased risk of GERD. Seropositivity for H. pylori immunoglobulin G antibodies was associated with a decreased risk of GERD. There was an inverse correlation between the extent of EAG and occurrence of GERD: Odds ratio (OR), 1.01 [95% confidence interval (CI): 0.90-1.14] in C1, 0.87 (0.78-0.97) in C2, 0.71 (0.62-0.80) in C3, 0.52 (0.44-0.61) in O1, 0.37 (0.29-0.48) in O2, and 0.28 (0.18-0.43) in O3. Additionally, the extent of EAG showed an inverse correlation with the severity of GERD. The presence of SAG was correlated with a reduced risk of GERD (OR = 0.49, 95%CI: 0.28-0.87, P = 0.014).
CONCLUSION The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD. AG followed by H. pylori infection may be independently protect against GERD.
Collapse
Affiliation(s)
- Yoo Min Han
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, South Korea
| | - Su Jin Chung
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, South Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jong In Yang
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, South Korea
| | - Ji Min Choi
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, South Korea
| | - Jooyoung Lee
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, South Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| |
Collapse
|
4
|
Toki Y, Yamauchi R, Kayashima E, Adachi K, Kishi K, Suetsugu H, Wada T, Endo H, Yamada H, Osaga S, Kamiya T, Nakada K, Iwakiri K, Haruma K, Joh T. Predictive Factors for Future Onset of Reflux Esophagitis: A Longitudinal Case-control Study Using Health Checkup Records. J Neurogastroenterol Motil 2022; 28:86-94. [PMID: 34980691 PMCID: PMC8748855 DOI: 10.5056/jnm20237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background/Aims Although risk factors of reflux esophagitis (RE) have been investigated in numerous cross-sectional studies, little is known about predictive factors associated with future onset of RE. We investigated time courses of clinical parameters before RE onset by a longitudinal case-control study using health checkup records. Methods We used health checkup records between April 2004 and March 2014 at 9 institutions in Japan. A multivariate logistic regression analysis was performed to evaluate associations of baseline clinical parameters with RE. The time courses of the clinical parameters of RE subjects were compared with those of non-RE subjects by the mixed-effects models for repeated measures analysis or longitudinal multivariate logistic analysis. Results Initial data were obtained from 230 056 individuals, and 2066 RE subjects and 4132 non-RE subjects were finally included in the analysis. Body mass index, alanine aminotransferase, smoking, acid reflux symptoms, hiatal hernia, and absence of atrophic gastritis at baseline were independently associated with RE. The time courses of body mass index, fasting blood sugar, triglyceride, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, percentages of acid reflux symptoms, feeling of fullness, and hiatal hernia in the RE group were significantly worse than in the non-RE group. Conclusions The RE group displayed a greater worsening of the clinical parameters associated with lifestyle diseases, including obesity, diabetes, hyperlipidemia, and fatty liver for 5 years before RE onset compared with the non-RE group. These results suggest that RE is a lifestyle disease and thus lifestyle guidance to at-risk person may help to prevent RE onset.
Collapse
Affiliation(s)
- Yuzuru Toki
- Department of Internal Medicine, Hidaka Hospital, Takasaki, Gunma, Japan
| | - Ryo Yamauchi
- Department of Internal Medicine, Mitsubishi Mihara Hospital, Mihara, Hiroshima, Japan
| | - Eizo Kayashima
- Junpukai Health Maintenance Center, Okayama, Okayama, Japan
| | - Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Matsue, Shimane, Japan
| | - Kiyohiko Kishi
- Department of Internal Medicine, Meiwa Hospital, Nishinomiya, Hyogo, Japan
| | - Hiroshi Suetsugu
- Department of Preventive Medicine, Matsue Red Cross Hospital, Matsue, Shimane, Japan
| | - Tsuneya Wada
- Public Health Center, Okazaki City Medical Association, Okazaki, Aichi, Japan
| | - Hiroyoshi Endo
- Department of Internal Medicine, Saiseikai Karatsu Hospital, Karatsu, Saga, Japan
| | - Hajime Yamada
- Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Hyogo, Japan
| | - Satoshi Osaga
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| |
Collapse
|
5
|
Kim JY, Shin IS, Min YW, Kim K, Lee H, Min BH, Lee JH, Kim JJ, Rhee PL. Endoscopic Prediction for Acid Reflux in Patients without Hiatus Hernia. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 76:134-141. [PMID: 32969361 DOI: 10.4166/kjg.2020.76.3.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 11/03/2022]
Abstract
Background/Aims A diagnosis of gastroesophageal reflux disease is challenging in patients who have reflux symptoms but do not respond to proton pump inhibitors nor have reflux esophagitis and hiatal hernia (HH) on endoscopy. This study examined the predictive role of the endoscopic findings, including the flap valve grade for pathologic acid exposure (PAE) to establish an endoscopic prediction model in patients with neither reflux esophagitis nor HH. Methods Five hundred seventy-eight patients who underwent upper endoscopy and 24 hours pH monitoring for reflux esophageal symptoms without evidence of reflux esophagitis and HH were analyzed. The gastroesophageal flap valve (GEFV), esophageal metaplasia, and chronic atrophic gastritis were assessed. The association between the endoscopic parameters and PAE was evaluated. Results Four hundred ninety-four patients were enrolled. The most common complaint was chest discomfort (42.3%) followed by globus (31.8%), dysphagia (7.9%), and heartburn (7.7%). PAE was present in 43 patients (8.7%). Multivariable analysis revealed PAE to be associated with the GEFV grade (p<0.001) and inversely associated with the chronic atrophic gastritis grade (p=0.005). Using these features, a predictive model was established and showed an area under the receiver operating characteristic curve of 0.705 (95% CI 0.619-0.790). The cutoff value of 12.0 had a sensitivity and specificity of 44.0% and 84.0%, respectively. Conclusions A loosened GEFV is associated with a risk of PAE in patients with neither reflux esophagitis nor HH, while atrophic gastritis is preventive. On the other hand, the endoscopic predictive model revealed a low sensitivity for detecting PAE. Thus, reflux testing needs to be performed further when gastroesophageal reflux disease is suspected, even without endoscopic evidence.
Collapse
Affiliation(s)
- Jun Young Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Seub Shin
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Yucel O. Interactions between Helicobacter pylori and gastroesophageal reflux disease. Esophagus 2019; 16:52-62. [PMID: 30151653 DOI: 10.1007/s10388-018-0637-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023]
Abstract
Interactions between Helicobacter Pylori (HP) and gastroesophageal reflux disease (GERD) are a complex issue. Several pathophysiological factors influence the development and the course of GERD, HP infection might be only one of these. Many studies emphasize the co-existence of these diseases. HP infection could contribute to GERD through both a protective and an aggressive role. Gastric acid secretion is a key factor in the pathophysiology of reflux esophagitis. Depending on the type of gastritis related to HP, acid secretion may either increase or decrease. Gastritis in corpus leads to hypoacidity, while antrum gastritis leads to hyperacidity. In cases of antral gastritis and duodenal ulcers which have hyperacidity, the expectation is an improvement in pre-existing reflux esophagitis after eradication of HP. In adults, HP infection is often associated with atrophic gastritis in the corpus. Atrophic gastritis may protect against GERD. Pangastritis which leads to gastric atrophy is commonly associated with CagA strains of HP and it causes more severe gastric inflammation. In case of HP-positive corpus gastritis in the stomach, pangastritis, and atrophic gastritis, reflux esophagitis occurs frequently after eradication of HP. Nonetheless, as a predisposing disease of gastric cancer, HP should be treated. In conclusion, as the determinative factors affecting GERD involving in HP, detailed data on the location of gastric inflammation and CagA positivity should be obtained by the studies at future.
Collapse
Affiliation(s)
- Oya Yucel
- Pediatric Department, Baskent University, Istanbul Education and Research Hospital, Cemil Topuzlu Cad. Yuvam Apt. N0:32/12 Ciftehavuzlar, Kadıkoy, 34726, Istanbul, Turkey.
| |
Collapse
|
7
|
Miftahussurur M, Doohan D, Nusi IA, Adi P, Rezkitha YAA, Waskito LA, Fauzia KA, Bramantoro T, Maimunah U, Thamrin H, Masithah SI, Sukadiono S, Uchida T, Lusida MI, Yamaoka Y. Gastroesophageal reflux disease in an area with low Helicobacter pylori infection prevalence. PLoS One 2018; 13:e0205644. [PMID: 30427843 PMCID: PMC6241118 DOI: 10.1371/journal.pone.0205644] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Abstract
The association between gastroesophageal reflux disease (GERD) prevalence and its risk factors in an area with low Helicobacter pylori prevalence is important to clarify. We analyzed the prevalence of GERD and risk factors in an area of Indonesia with low prevalence of H. pylori infection. We recruited 104 dyspeptic patients who underwent endoscopy in Surabaya. Patients were diagnosed with GERD based on the Los Angeles classification. We evaluated gastric biopsy specimens and measured serum pepsinogen levels. Interleukin polymorphisms were evaluated by polymerase chain reaction-restriction fragment length polymorphism. Of 104 patients, 56 (53.8%) were endoscopically found to have GERD, with most categorized as grade A; 48 (46.2%) were classified as non-GERD. Higher economic status, smoking, and a history of proton-pump inhibitor use significantly increased the risk of GERD. GERD Questionnaire scores showed a positive correlation with GERD (P < 0.001). An association was found between antral atrophic gastritis and GERD (P = 0.030), and patients with GERD more frequently had severe antral atrophy than nonerosive reflux disease (P = 0.018). We found an association between pepsinogen I/II levels and GERD (P = 0.047), but with low accuracy. IL-1β -511 TT and CT were predominant among the IL-1β -511 genotypes, and IL-8-251 AT and TT were predominant among the IL-8-251 genotypes. In conclusion, we found a high prevalence of GERD in an area with low prevalence of H. pylori infection, which could be associated with acid reflux. Smoking, history of proton-pump inhibitor use, and higher economic group significantly increased the risk of GERD.
Collapse
Affiliation(s)
- Muhammad Miftahussurur
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Dalla Doohan
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Iswan Abbas Nusi
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Pangestu Adi
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Yudith Annisa Ayu Rezkitha
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
- Muhammadiyah University of Surabaya, Surabaya, Indonesia
| | - Langgeng Agung Waskito
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Kartika Afrida Fauzia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Taufan Bramantoro
- Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ummi Maimunah
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Husin Thamrin
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Tomohisa Uchida
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Japan
| | - Maria Inge Lusida
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Yoshio Yamaoka
- Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
- Department of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States of America
| |
Collapse
|
8
|
El‐Zimaity H, Di Pilato V, Novella Ringressi M, Brcic I, Rajendra S, Langer R, Dislich B, Tripathi M, Guindi M, Riddell R. Risk factors for esophageal cancer: emphasis on infectious agents. Ann N Y Acad Sci 2018; 1434:319-332. [DOI: 10.1111/nyas.13858] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/30/2018] [Accepted: 04/24/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | - Vincenzo Di Pilato
- Department of Clinical and Experimental MedicineUniversity of Florence Florence Italy
| | - Maria Novella Ringressi
- Department of Surgery and Translational MedicineUniversity of Florence Florence Italy
- Gastrointestinal Surgery UnitFlorence Careggi University Hospital Florence Italy
| | - Iva Brcic
- Institute of PathologyMedical University of Graz Graz Austria
| | - Shanmugarajah Rajendra
- Gastro‐Intestinal Viral Oncology GroupIngham Institute for Applied Medical Research, Liverpool Sydney New South Wales Australia
- South Western Sydney Clinical SchoolUniversity of New South Wales, Kensington Sydney New South Wales Australia
- Department of Gastroenterology & HepatologyBankstown‐Lidcombe Hospital, South Western Sydney Local Health Network, Bankstown Sydney New South Wales Australia
| | - Rupert Langer
- Institute of PathologyUniversity of Bern Bern Switzerland
| | - Bastian Dislich
- Institute of PathologyKantonsspital Baselland Liestal Switzerland
| | - Monika Tripathi
- Cambridge University HospitalsNHS Foundation Trust Cambridge UK
| | - Maha Guindi
- Department of Pathology and laboratory MedicineCedars‐Sinai Medical Center Los Angeles California
| | - Robert Riddell
- Department of Pathology and Laboratory MedicineMount Sinai Hospital Toronto Ontario Canada
| |
Collapse
|
9
|
Kim YS, Kim N, Kim GH. Sex and Gender Differences in Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2016; 22:575-588. [PMID: 27703114 PMCID: PMC5056567 DOI: 10.5056/jnm16138] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 12/13/2022] Open
Abstract
It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area.
Collapse
Affiliation(s)
- Young Sun Kim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nayoung Kim
- Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| |
Collapse
|
10
|
Bashashati M, Sarosiek I, McCallum RW. Epidemiology and mechanisms of gastroesophageal reflux disease in the elderly: a perspective. Ann N Y Acad Sci 2016; 1380:230-234. [PMID: 27526197 DOI: 10.1111/nyas.13196] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 12/18/2022]
Abstract
Gastroesophageal reflux disease (GERD) seems to be more common in older individuals. Disturbed esophageal motility; anatomical disorders, such as hiatal hernia, increased obesity, defective mucosal integrity, and alteration in salivary secretion; and concomitant medications all attribute to the higher rate of GERD in the elderly. In this review, we discuss the underlying mechanisms that could explain this higher rate of GERD in the elderly.
Collapse
Affiliation(s)
- Mohammad Bashashati
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Irene Sarosiek
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Richard W McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.
| |
Collapse
|
11
|
Adachi K, Mishiro T, Tanaka S, Kinoshita Y. Analysis of negative result in serum anti- H. pylori IgG antibody test in cases with gastric mucosal atrophy. J Clin Biochem Nutr 2016; 59:145-148. [PMID: 27698543 PMCID: PMC5018573 DOI: 10.3164/jcbn.16-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/08/2016] [Indexed: 12/12/2022] Open
Abstract
The purpose is to elucidate factors related to negative results of anti-H. pylori antibody test in cases with gastric mucosal atrophy. A total of 859 individuals without past history of eradication therapy for H. pylori (545 males, 314 females; mean age 52.4 years) who underwent an upper GI endoscopy examination and serological test were enrolled as subjects. Serological testing was performed using SphereLight H. pylori antibody J®, and endoscopic findings of gastric mucosal atrophy by the classification of Kimura and Takemoto and post-eradication findings were analyzed. The positive rates for the anti-H. pylori antibody test in subjects with and without gastric mucosal atrophy were 85.6% and 0.9%, respectively. In analysis of subjects with gastric mucosal atrophy, a low positive rate and serum titer was observed in subjects with C1, C2 and O3 atrophy. When the analysis was performed separately in male and female subjects, low positive rate was observed in males with O3 atrophy and females with C2 atrophy. Suspected post-eradication endoscopic findings were more frequently observed in cases with C2 atrophy. In conclusion, negative result of anti-H. pylori antibody test was frequently observed in middle-aged subjects with C1, C2 and O3 gastric mucosal atrophy.
Collapse
Affiliation(s)
- Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Koshibara 1-4-6, Matsue, Shimane 690-0012, Japan
| | - Tomoko Mishiro
- Health Center, Shimane Environment and Health Public Corporation, Koshibara 1-4-6, Matsue, Shimane 690-0012, Japan
| | - Shino Tanaka
- Health Center, Shimane Environment and Health Public Corporation, Koshibara 1-4-6, Matsue, Shimane 690-0012, Japan
| | - Yoshikazu Kinoshita
- Second Department of Internal Medicine, Shimane University Faculty of Medicine, Enya-cho 89-1, Izumo, Shimane 693-8501, Japan
| |
Collapse
|
12
|
Asanuma K, Iijima K, Shimosegawa T. Gender difference in gastro-esophageal reflux diseases. World J Gastroenterol 2016; 22:1800-10. [PMID: 26855539 PMCID: PMC4724611 DOI: 10.3748/wjg.v22.i5.1800] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/07/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of esophageal adenocarcinoma (EAC) has risen sharply in western countries over the past 4 decades. This type of cancer is considered to follow a transitional process that goes from gastro-esophageal reflux disease (GERD) to Barrett's esophagus (BE, a metaplastic condition of the distal esophagus), a precursor lesion and ultimately adenocarcinoma. This spectrum of GERD is strongly predominant in males due to an unidentified mechanism. Several epidemiologic studies have described that the prevalence of GERD, BE and EAC in women is closely related to reproductive status, which suggests a possible association with the estrogen level. Recently, we revealed in an in vivo study that the inactivation of mast cells by the anti-inflammatory function of estrogen may account for the gender difference in the GERD spectrum. Other studies have described the contribution of female steroid hormones to the gender difference in these diseases. Estrogen is reported to modulate the metabolism of fat, and obesity is a main risk factor of GERDs. Moreover, estrogen could confer esophageal epithelial resistance to causative refluxate. These functions of estrogen might explain the approximately 20-year delay in the incidence of BE and the subsequent development of EAC in women compared to men, and this effect may be responsible for the male predominance. However, some observational studies demonstrated that hormone replacement therapy exerts controversial effects in GERD patients. Nevertheless, the estrogen-related endocrine milieu may prevent disease progression toward carcinogenesis in GERD patients. The development of innovative alternatives to conventional acid suppressors may become possible by clarifying the mechanisms of estrogen.
Collapse
|
13
|
Chaturvedi R, de Sablet T, Asim M, Piazuelo MB, Barry DP, Verriere TG, Sierra JC, Hardbower DM, Delgado AG, Schneider BG, Israel DA, Romero-Gallo J, Nagy TA, Morgan DR, Murray-Stewart T, Bravo LE, Peek RM, Fox JG, Woster PM, Casero RA, Correa P, Wilson KT. Increased Helicobacter pylori-associated gastric cancer risk in the Andean region of Colombia is mediated by spermine oxidase. Oncogene 2015; 34:3429-40. [PMID: 25174398 PMCID: PMC4345146 DOI: 10.1038/onc.2014.273] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/16/2014] [Accepted: 07/19/2014] [Indexed: 12/11/2022]
Abstract
Helicobacter pylori infection causes gastric cancer, the third leading cause of cancer death worldwide. More than half of the world's population is infected, making universal eradication impractical. Clinical trials suggest that antibiotic treatment only reduces gastric cancer risk in patients with non-atrophic gastritis (NAG), and is ineffective once preneoplastic lesions of multifocal atrophic gastritis (MAG) and intestinal metaplasia (IM) have occurred. Therefore, additional strategies for risk stratification and chemoprevention of gastric cancer are needed. We have implicated polyamines, generated by the rate-limiting enzyme ornithine decarboxylase (ODC), in gastric carcinogenesis. During H. pylori infection, the enzyme spermine oxidase (SMOX) is induced, which generates hydrogen peroxide from the catabolism of the polyamine spermine. Herein, we assessed the role of SMOX in the increased gastric cancer risk in Colombia associated with the Andean mountain region when compared with the low-risk region on the Pacific coast. When cocultured with gastric epithelial cells, clinical strains of H. pylori from the high-risk region induced more SMOX expression and oxidative DNA damage, and less apoptosis than low-risk strains. These findings were not attributable to differences in the cytotoxin-associated gene A oncoprotein. Gastric tissues from subjects from the high-risk region exhibited greater levels of SMOX and oxidative DNA damage by immunohistochemistry and flow cytometry, and this occurred in NAG, MAG and IM. In Mongolian gerbils, a prototype colonizing strain from the high-risk region induced more SMOX, DNA damage, dysplasia and adenocarcinoma than a colonizing strain from the low-risk region. Treatment of gerbils with either α-difluoromethylornithine, an inhibitor of ODC, or MDL 72527 (N(1),N(4)-Di(buta-2,3-dien-1-yl)butane-1,4-diamine dihydrochloride), an inhibitor of SMOX, reduced gastric dysplasia and carcinoma, as well as apoptosis-resistant cells with DNA damage. These data indicate that aberrant activation of polyamine-driven oxidative stress is a marker of gastric cancer risk and a target for chemoprevention.
Collapse
Affiliation(s)
- Rupesh Chaturvedi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thibaut de Sablet
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohammad Asim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M. Blanca Piazuelo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel P. Barry
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas G. Verriere
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J. Carolina Sierra
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana M. Hardbower
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alberto G. Delgado
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Barbara G. Schneider
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dawn A. Israel
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Judith Romero-Gallo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Toni A. Nagy
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas R. Morgan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tracy Murray-Stewart
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luis E. Bravo
- Department of Pathology, Universidad del Valle School of Medicine, Cali, Colombia
| | - Richard M. Peek
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James G. Fox
- Division of Comparative Medicine, Massachusetts lnstitute of Technology, Cambridge, MA, USA
| | - Patrick M. Woster
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robert A. Casero
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pelayo Correa
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keith T. Wilson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
14
|
Abstract
BACKGROUND Esophageal cancer (EC) is the eighth most prevalent malignant tumor and the sixth leading cause of cancer mortality throughout the world. Despite the technical developments in diagnosis and treatment, the 5-year survival rate is still low. The etiology of EC remains poorly understood; multiple risk factors may be involved and account for the great variation in EC incidence in different geographic regions. SUMMARY Infection with carcinogenetic pathogens has been proposed as a risk factor for EC. This review explores the recent studies on the association of human papillomavirus (HPV), Epstein-Barr virus (EBV), Helicobacter pylori and esophageal bacterial biota with EC. KEY MESSAGE Among the above-mentioned pathogens, HPV most likely contributes to esophageal squamous cell carcinoma (ESCC) in high-risk populations. New techniques are being applied to studies on the role of infection in EC, which will inevitably bring novel ideas to the field in the near future. PRACTICAL IMPLICATIONS Multiple meta-analyses support the finding of a higher HPV detection rate in regions associated with high risk for ESCC compared to low-risk areas. A potential role of HPV in the rise of esophageal adenocarcinoma (EAC) was proposed recently. However, further studies are required before a firm conclusion can be drawn. Less work has been done in studying the association between EBV and ESCC, and the results are quite controversial. H. pylori infection is found to be inversely related to EC, which is probably due to the reduced incidence of gastroesophageal reflux disease. Analysis of the esophageal bacterial biota revealed distinct clusters of bacteria in normal and diseased esophagi. A type II microbiome rich in Gram-negative bacteria potentially contributes to EAC by inducing chronic inflammation. Novel findings from such studies as these may benefit public health by justifying anti-infection measures to prevent EC.
Collapse
Affiliation(s)
- Wenji Xu
- Unit of Herpesvirus and Molecular Virology, Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Zhongshu Liu
- Unit of Herpesvirus and Molecular Virology, Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Quncha Bao
- Unit of Herpesvirus and Molecular Virology, Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Zhikan Qian
- Unit of Herpesvirus and Molecular Virology, Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| |
Collapse
|
15
|
Helicobacter pylori Infection in Gastroesophageal Reflux Disease in the Asian Countries. Gastroenterol Res Pract 2015; 2015:985249. [PMID: 25642246 PMCID: PMC4302361 DOI: 10.1155/2015/985249] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/23/2014] [Indexed: 12/17/2022] Open
Abstract
Helicobacter pylori infection, a common infection in many countries, is related to the clinical course of upper gastrointestinal diseases. Gastroesophageal reflux disease (GERD) is a common esophageal disease in Western countries and its prevalence is increasing in Asian countries. The pathophysiology of GERD is multifactorial. Although no single factor has been isolated as the cause of GERD, a negative association between the prevalence of H. pylori and the severity of GERD, including Barrett's esophagus, has been demonstrated in epidemiological studies. The high prevalence of H. pylori infection affects the incidence of GERD in Asian countries. In the subjects with East Asian CagA-positive strains, acid injury may be minimized by hypochlorhydria from pangastritis and gastric atrophy. Additionally, host genetic factors may affect the development of GERD. The interactions between genetic factors and the virulence of H. pylori infection may be the reason for the low prevalence of GERD in Asian countries. H. pylori eradication is not considered pivotal in GERD exacerbation based on evidence from Western studies. A recent meta-analysis demonstrated that eradication therapy of H. pylori was related to a higher risk of developing de novo GERD in Asian studies. H. pylori infection remains an inconclusive and important issue in GERD in Asian countries.
Collapse
|
16
|
Adachi K, Mishiro T, Tanaka S, Hanada K, Kinoshita Y. Gender differences in the time-course changes of reflux esophagitis in Japanese patients. Intern Med 2015; 54:869-73. [PMID: 25876565 DOI: 10.2169/internalmedicine.54.4083] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Obesity is related to an increased prevalence of reflux esophagitis and gastroesophageal reflux disease symptoms. This study was performed to clarify the influence of gender on time-course changes in the rate of a high BMI and incidence of reflux esophagitis in Japanese subjects. METHODS The subjects included individuals who visited a medical center for medical checkups between April 2000 and March 2001, April 2005 and March 2006 and April 2010 and March 2011. At each examination, the subjects underwent upper gastrointestinal endoscopy to determine the presence of reflux esophagitis, size of the diaphragmatic hiatus and degree of gastric mucosal atrophy. A body mass index (BMI) of ≥ 25 kg/m(2) was defined as a high BMI. RESULTS A multiple logistic regression analysis showed that a high BMI, milder degree of gastric mucosal atrophy and larger size of diaphragmatic hiatus were significant predictive factors for the presence of reflux esophagitis in both men and women. The number of male subjects with reflux esophagitis and a high BMI increased during the 10-year examination period. In contrast, the number of individuals with reflux esophagitis and a high BMI was not increased among women. For both men and women, the proportions of patients with a large diaphragmatic hiatus and mild gastric mucosal atrophy increased during the 10-year period. CONCLUSION The prevalence of reflux esophagitis in the female subjects remained constant over 10 years, different from that observed in the men. A lack of change in BMI may be an important factor accounting for the constant prevalence of reflux esophagitis in women.
Collapse
Affiliation(s)
- Kyoichi Adachi
- Health Center, Shimane Environment and Health Public Corporation, Japan
| | | | | | | | | |
Collapse
|
17
|
Hanada K, Adachi K, Mishiro T, Tanaka S, Takahashi Y, Yoshikawa K, Kinoshita Y. Relationship between esophageal cardiac glands and gastroesophageal reflux disease. Intern Med 2015; 54:91-6. [PMID: 25742998 DOI: 10.2169/internalmedicine.54.3179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The role of esophageal cardiac glands has not been fully determined. This study was performed to clarify the protective role of esophageal cardiac glands against the development of gastroesophageal reflux disease (GERD). METHODS The subjects included 2,656 Japanese individuals who visited our institution for a detailed medical checkup. GERD symptoms were assessed using the Japanese version of the Carlsson-Dent self-administered questionnaire (QUEST) and an upper gastrointestinal endoscopy examination in each subject. The presence of reflux esophagitis, size of diaphragmatic hiatus, degree of gastric mucosal atrophy and existence of visible esophageal cardiac glands in the distal esophagus, based on the detection of yellowish elevated areas, were determined using endoscopy. RESULTS Esophageal cardiac glands were observed in 355 cases (13.4%). Reflux esophagitis was significantly less frequent in the cases with esophageal cardiac glands than in those without. The esophageal cardiac glands were mainly located on the left-posterior side of the esophageal wall of the distal esophagus. A multiple regression analysis showed that the presence of esophageal cardiac glands was an independent factor for preventing reflux esophagitis. On the other hand, the existence of these glands did not correlate with the presence of GERD symptoms (QUEST score of 6 or more). CONCLUSION The presence of visible esophageal cardiac glands may have a protective role against the development of reflux esophagitis.
Collapse
Affiliation(s)
- Kozue Hanada
- Health Center, Shimane Environment and Health Public Corporation, Japan
| | | | | | | | | | | | | |
Collapse
|
18
|
Al-Haddad S, El-Zimaity H, Hafezi-Bakhtiari S, Rajendra S, Streutker CJ, Vajpeyi R, Wang B. Infection and esophageal cancer. Ann N Y Acad Sci 2014; 1325:187-96. [PMID: 25266025 DOI: 10.1111/nyas.12530] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on infection and cancer, and includes commentaries on the influence of bacterial infections on mucin expression and cancer risk; the role of esophageal bacterial biota in the incidence of esophageal disease; the association between human papilloma virus (HPV) and esophageal squamous cell carcinoma; the role of HPV in esophageal adenocarcinoma; the role of Helicobacter pylori in cardiac carcinoma; and the role of Epstein-Barr virus infection in esophageal cancer.
Collapse
Affiliation(s)
- Sahar Al-Haddad
- Department of Laboratory Medicine, St. Michael's Hospital and the University of Toronto, Toronto, Canada
| | | | | | | | | | | | | |
Collapse
|
19
|
Zenda T, Hamazaki K, Oka R, Hagishita T, Miyamoto S, Shimizu J, Inadera H. Endoscopic assessment of reflux esophagitis concurrent with hiatal hernia in male Japanese patients with obstructive sleep apnea. Scand J Gastroenterol 2014; 49:1035-43. [PMID: 25048181 DOI: 10.3109/00365521.2014.926984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The pathogenetic relationship underlying the high prevalence of gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnea (OSA) remains unclear. In addition, GERD has not been adequately assessed by endoscopy in patients with OSA. The purpose of this study was to use endoscopy to investigate potential interactions among reflux esophagitis, hiatal hernia (HH) and OSA. MATERIAL AND METHODS A total of 243 consecutive male Japanese participants who underwent both overnight ambulatory polygraphic monitoring and esophagogastroduodenoscopy were retrospectively evaluated in a cross-sectional study. The prevalence and severity of HH and reflux esophagitis were assessed according to the Los Angeles classification and the Makuuchi classification, respectively. Associations among reflux esophagitis, HH and OSA were examined by univariate and multivariate analyses. RESULTS OSA was diagnosed in 98 individuals (40.3%). Endoscopy-confirmed esophagitis (p = 0.027) and HH (p < 0.001) were significantly more prevalent among patients with OSA. Multivariate regression model analysis adjusted for age, body mass index, visceral obesity represented by waist circumference, presence of OSA, concurrence of OSA and HH, smoking, and alcohol consumption yielded OSA as the only variable significantly associated with HH (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.35-4.99; p = 0.004), while concurrence of OSA and HH was related to reflux esophagitis (OR, 3.59; CI, 1.87-6.92; p < 0.001). CONCLUSIONS OSA was associated with HH and concurrent OSA and HH with reflux esophagitis in male Japanese patients with OSA. Our results support the hypothesis that complicating HH may link reflux esophagitis to OSA.
Collapse
Affiliation(s)
- Takahiro Zenda
- Department of Internal Medicine, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers , Toyama , Japan
| | | | | | | | | | | | | |
Collapse
|
20
|
Schwizer W, Menne D, Schütze K, Vieth M, Goergens R, Malfertheiner P, Leodolter A, Fried M, Fox MR. The effect of Helicobacter pylori infection and eradication in patients with gastro-oesophageal reflux disease: A parallel-group, double-blind, placebo-controlled multicentre study. United European Gastroenterol J 2014; 1:226-35. [PMID: 24917966 DOI: 10.1177/2050640613484020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/01/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study aimed to resolve controversy regarding the effects of Helicobacter pylori eradication therapy and H. pylori infection in gastro-oesophageal reflux disease. DESIGN A randomized, double-blind, multicentre trial was performed in patients presenting with reflux symptoms. H. pylori-positive patients were randomized to receive either antibiotics or placebo for 7 days. H. pylori-negative patient controls received placebo. All received esomeprazole 20 mg b.d. for 7 days, followed by 40 mg o.d. to complete an 8-week course, and were followed up for 32 weeks by telephone. RESULTS In this study, 198/589 (34%) patients were H. pylori-positive and 113 H. pylori-negative patients served as controls. Baseline endoscopy revealed 63% Los Angeles grade 0A and 37% Los Angeles grade BCD oesophagitis with no difference between patient groups. Symptom improvement on esomeprazole was seen in 89%. H. pylori eradication was successful in 82%. H. pylori eradication had no effect on symptomatic relapse (hazard ratio 1.15, 95% CI 0.74-1.8; p = 0.5). Overall, H. pylori-positive patients had a lower probability of relapse compared to H. pylori-negative controls (hazard ratio 0.6, 95% CI 0.43-0.85; p = 0.004). Relapse hazard was modulated also by oesophagitis grade (BCD vs. 0A, hazard ratio 2.1, 95% CI 1.5-3.0). CONCLUSION Relapse of gastro-oesophageal reflux disease symptoms after a course of high dose acid suppression took longer for H. pylori-positive patients than H. pylori-negative controls; however eradication therapy had no effect on the risk of relapse; ClincialTrials.gov number, NCT00574925.
Collapse
Affiliation(s)
- Werner Schwizer
- University Hospital Zürich, Zürich, Switzerland ; Zurich Center for Integrative Human Physiology (ZIHP), Zurich, Switzerland
| | | | | | | | | | | | | | - Michael Fried
- University Hospital Zürich, Zürich, Switzerland ; Zurich Center for Integrative Human Physiology (ZIHP), Zurich, Switzerland
| | - Mark R Fox
- University Hospital Zürich, Zürich, Switzerland ; Zurich Center for Integrative Human Physiology (ZIHP), Zurich, Switzerland ; NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Nottingham, UK
| |
Collapse
|
21
|
Chaturvedi R, Asim M, Piazuelo MB, Yan F, Barry DP, Sierra JC, Delgado AG, Hill S, Casero RA, Bravo LE, Dominguez RL, Correa P, Polk DB, Washington MK, Rose KL, Schey KL, Morgan DR, Peek RM, Wilson KT. Activation of EGFR and ERBB2 by Helicobacter pylori results in survival of gastric epithelial cells with DNA damage. Gastroenterology 2014; 146:1739-51.e14. [PMID: 24530706 PMCID: PMC4035375 DOI: 10.1053/j.gastro.2014.02.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The gastric cancer-causing pathogen Helicobacter pylori up-regulates spermine oxidase (SMOX) in gastric epithelial cells, causing oxidative stress-induced apoptosis and DNA damage. A subpopulation of SMOX(high) cells are resistant to apoptosis, despite their high levels of DNA damage. Because epidermal growth factor receptor (EGFR) activation can regulate apoptosis, we determined its role in SMOX-mediated effects. METHODS SMOX, apoptosis, and DNA damage were measured in gastric epithelial cells from H. pylori-infected Egfr(wa5) mice (which have attenuated EGFR activity), Egfr wild-type mice, or in infected cells incubated with EGFR inhibitors or deficient in EGFR. A phosphoproteomic analysis was performed. Two independent tissue microarrays containing each stage of disease, from gastritis to carcinoma, and gastric biopsy specimens from Colombian and Honduran cohorts were analyzed by immunohistochemistry. RESULTS SMOX expression and DNA damage were decreased, and apoptosis increased in H. pylori-infected Egfr(wa5) mice. H. pylori-infected cells with deletion or inhibition of EGFR had reduced levels of SMOX, DNA damage, and DNA damage(high) apoptosis(low) cells. Phosphoproteomic analysis showed increased EGFR and erythroblastic leukemia-associated viral oncogene B (ERBB)2 signaling. Immunoblot analysis showed the presence of a phosphorylated (p)EGFR-ERBB2 heterodimer and pERBB2; knockdown of ErbB2 facilitated apoptosis of DNA damage(high) apoptosis(low) cells. SMOX was increased in all stages of gastric disease, peaking in tissues with intestinal metaplasia, whereas pEGFR, pEGFR-ERBB2, and pERBB2 were increased predominantly in tissues showing gastritis or atrophic gastritis. Principal component analysis separated gastritis tissues from patients with cancer vs those without cancer. pEGFR, pEGFR-ERBB2, pERBB2, and SMOX were increased in gastric samples from patients whose disease progressed to intestinal metaplasia or dysplasia, compared with patients whose disease did not progress. CONCLUSIONS In an analysis of gastric tissues from mice and patients, we identified a molecular signature (based on levels of pEGFR, pERBB2, and SMOX) for the initiation of gastric carcinogenesis.
Collapse
Affiliation(s)
- Rupesh Chaturvedi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohammad Asim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - M Blanca Piazuelo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fang Yan
- Division of Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Barry
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Johanna Carolina Sierra
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alberto G Delgado
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Salisha Hill
- Mass Spectrometry Research Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Casero
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luis E Bravo
- Department of Pathology, Universidad del Valle School of Medicine, Cali, Colombia
| | | | - Pelayo Correa
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D Brent Polk
- Division of Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
| | - M Kay Washington
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristie L Rose
- Mass Spectrometry Research Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin L Schey
- Mass Spectrometry Research Center, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biochemistry, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas R Morgan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard M Peek
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keith T Wilson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
22
|
Kinoshita Y, Miwa H, Sanada K, Miyata K, Haruma K. Clinical characteristics and effectiveness of lansoprazole in Japanese patients with gastroesophageal reflux disease and dyspepsia. J Gastroenterol 2014; 49:628-37. [PMID: 23653056 DOI: 10.1007/s00535-013-0812-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/07/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with gastroesophageal reflux disease (GERD) frequently have symptoms of dyspepsia in addition to reflux symptoms. Treatment options for dyspepsia are not standardized. The aim of this study was to clarify the therapeutic effect of lansoprazole on dyspepsia in Japanese patients with GERD. METHODS GERD patients with dyspepsia were enrolled and treated with lansoprazole 15 or 30 mg once daily for 4 weeks. Reflux and dyspeptic symptoms were assessed by questionnaires before treatment, and 2 and 4 weeks after the start of lansoprazole treatment. RESULTS In the effectiveness analysis set (n = 12,653), heartburn was reported by 91.6 % of patients at study enrollment. Postprandial fullness was the most frequently reported dyspepsia symptom at the start of the study, reported by 79.0 % of enrolled patients. After 4 weeks of lansoprazole treatment, heartburn symptoms were improved in 75.7 % of patients and symptoms of postprandial fullness were improved in 68.7 % of patients. The therapeutic effect of low and high doses of lansoprazole on dyspepsia, as well as on reflux symptoms, was approximately 10 % higher in patients with endoscopy-confirmed erosive esophagitis (60.1-82.2 %), than in patients with non-erosive reflux diseases (53.0-73.3 %). Lansoprazole was well tolerated. CONCLUSION In this large-scale clinical study, lansoprazole effectively relieved dyspepsia in addition to reflux symptoms in patients with GERD.
Collapse
Affiliation(s)
- Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan,
| | | | | | | | | |
Collapse
|
23
|
Meta-analysis: eradication of Helicobacter pylori infection is associated with the development of endoscopic gastroesophageal reflux disease. Eur J Gastroenterol Hepatol 2013; 25:1195-205. [PMID: 23839160 DOI: 10.1097/meg.0b013e328363e2c7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The role of Helicobacter pylori infection in the pathogenesis of gastroesophageal reflux disease (GORD) is controversial. We aimed to confirm the negative association between H. pylori infection and endoscopic GORD and further determine whether eradication of the infection is associated with the development of endoscopic GORD. MATERIALS AND METHODS Case-control studies comparing the prevalence of H. pylori infection between patients with and those without GORD, type A cohort studies comparing the incidence of GORD between patients with and those without anti-H. pylori eradication therapy, and type B cohort studies comparing the incidence of GORD between H. pylori-positive patients with and those without successful eradication were included. Moreover, the effects of H. pylori eradication on the development of GORD in randomized-controlled trials were also analyzed. RESULTS Overall, 43 studies were analyzed. Case-control studies showed a lower prevalence of H. pylori infection in patients with GORD [odds ratio 0.64, 95% confidence interval (CI) 0.49-0.83]. Type A cohort studies showed an increased incidence of GORD in patients whose H. pylori infection was successfully eradicated [risk ratio (RR) 2.50, 95% CI 1.46-4.26]. Type B cohort studies showed that patients whose H. pylori had been eradicated had a higher risk of GORD (RR 1.70, 95% CI 1.30-2.23). Moreover, randomized-controlled trials showed that H. pylori eradication leads to a higher risk of GORD (RR 1.99, 95% CI 1.23-3.22); subanalyses showed that the risk existed especially in Asian studies (RR 4.53, 95% CI 1.66-12.36). CONCLUSION H. pylori infection shows a negative association with the development of endoscopic GORD. Eradication of the infection may be a risk factor for de-novo endoscopic GORD, especially in Asian populations.
Collapse
|
24
|
Sakamoto Y, Oho K, Toyonaga A, Kumamoto M, Haruta T, Inoue H, Emori K, Tsuruta O, Sata M. Effect of Helicobacter pylori infection on esophagogastric variceal bleeding in patients with liver cirrhosis and portal hypertension. J Gastroenterol Hepatol 2013; 28:1444-9. [PMID: 23577833 DOI: 10.1111/jgh.12221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Bleeding from esophageal and gastric varices is a fatal event in patients with liver cirrhosis and portal hypertension. However, the effects of Helicobacter pylori (H. pylori) infection on esophagogastric variceal bleeding are not known. The present study was aimed to elucidate the role of H. pylori infection in esophagogastric variceal bleeding. METHODS The subjects were 196 cirrhotic patients who were admitted to the Kurume University Hospital to treat their esophagogastric varices consisted of 95 with acute bleeding and 101 with nonbleeding but high risk of bleeding. For the diagnosis of H. pylori infection, a (13) C-urea breath test was used, and serum pepsinogen (PG) I and II levels and the PG I/II ratio were also measured. RESULTS Esophagogastric variceal bleeding was seen in 34.9% (n = 30) of the H. pylori-infected patients (n = 86) and in 59.1% (n = 65) of the noninfected patients (n = 110) (P < 0.0007). There was no significant difference in the infection rate between the bleeding sites of the esophagus and the stomach. The serum PG I and II levels and the PG I/II ratio were 65.6 ng/dL, 14.7 ng/dL, and 4.4, respectively, for the bleeding patients (n = 95), and 43.7 ng/dL, 17.7 ng/dL, and 3.1 for the nonbleeding patients (n = 101). Thus, the nonbleeding patients had significantly higher rate of H. pylori infection and lower acid secretion than bleeding patients (0.001). In addition, multivariate logistic regression analysis showed a significant negative association between H. pylori infection and esophagogastric variceal bleeding. CONCLUSIONS These results suggest that H. pylori infection has a protective effect against esophagogastric variceal bleeding through the induction of gastric mucosal atrophy and concomitant hypoacidity.
Collapse
Affiliation(s)
- Yoshihiro Sakamoto
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Division of GI Endoscopy, Digestive Disease Center, Kurume University Hospital, Kurume, Fukuoka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Xinias I, Maris T, Mavroudi A, Panteliadis C, Vandenplas Y. Helicobacter pylori infection has no impact on manometric and pH-metric findings in adolescents and young adults with gastroesophageal reflux and antral gastritis: eradication results to no significant clinical improvement. Pediatr Rep 2013; 5:e3. [PMID: 23667732 PMCID: PMC3649742 DOI: 10.4081/pr.2013.e3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/08/2013] [Accepted: 02/01/2013] [Indexed: 12/12/2022] Open
Abstract
The relationship between Helicobacter pylori (Hp) gastritis and gastroesophageal reflux disease (GERD) remains controversial. The aim was to investigate the association between Hp infection and gastroesophageal reflux (GER) and the impact of Hp eradication on esophageal acid exposure and motility in adolescents and young adults with Hp gastritis and GERD. Sixty-four patients with symptoms suggestive for GERD, of which 40 Hp-positive (group A) and 24 Hp-negative (group B), underwent endoscopy-biopsy, esophageal manometry and 24-hour pH-metry. All group A patients received eradication treatment and were re-evaluated six months later again with 24-hour pH-metry, esophageal manometry, endoscopy-biopsy and clinical assessment. At inclusion, there were no significant differences between the two groups regarding sex, age, grade of endoscopic esophagitis, manometric and pH-metry findings. All Hp-positive patients had an antral predominant gastritis. Eradication of Hp was successful in all patients, and gastritis and esophagitis were healed in all patients. The mean lower esophageal sphincter pressure (LESP) increased significantly from 11.25 mmHg before to 11.71 mmHg after eradication (P<0.05). A significant decrease in reflux index was observed (mean RI 6.02% before versus 4.96% after eradication (P<0.05). However clinical symptoms of GER improved not significantly after 6 months follow up. Conclusively, in children and young adults with GER symptoms and GERD, the presence or absence of Hp has no impact on manometric and pH-metric findings. Eradication of Hp infection results in increase in LESP with a consequent decrease in esophageal acid exposure but not significant clinical improvement.
Collapse
Affiliation(s)
- Ioannis Xinias
- Third Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | | | | | | | | |
Collapse
|
26
|
Mahdi BM. The relationship between helicobacter pylori infection and gastro-esophageal reflux disease. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:142-5. [PMID: 22540080 PMCID: PMC3336901 DOI: 10.4297/najms.2011.3142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gastro-esophageal reflux disease is a common condition, affecting 25%-40% of the population. Increasing attention has been paid to the relationship between Helicobacter pylori infection and reflux esophagitis. AIM The aim of this study was to investigate the association between CagA+ H. pylori and endoscopically proven gastro-esophageal reflux disease. PATIENTS AND METHODS The study group included 60 hospital patients with gastro-esophageal reflux disease between 2007 and 2009 as compared with 30 healthy patients from a control group that was age and sex matched. Helicobacter pylori CagA+ was identified by an immunological test (Immunochromatography test) (ACON, USA). RESULTS Helicobacter pyloriCagA+ was present in 42/60 (70%) of the patients with gastro-esophageal reflux disease and in 11/30 (36.6%) patients in the control group (p=0.002). The Odds ratio = 0.8004 with 95% Confidence Interval = from 0.3188 to 2.0094. The relative risk=1.35 that indicates an association between Helicobacter pylori and disease. CONCLUSIONS The presence of Helicobacter pylori is significantly increased in patients with gastro-esophageal reflux disease as compared with the control group.
Collapse
Affiliation(s)
- Batool M Mahdi
- Department of Microbiology, Al-Kindi College of Medicine Baghdad University, AL-Nahda Square, Baghdad, Iraq
| |
Collapse
|
27
|
Chaturvedi R, de Sablet T, Peek RM, Wilson KT. Spermine oxidase, a polyamine catabolic enzyme that links Helicobacter pylori CagA and gastric cancer risk. Gut Microbes 2012; 3:48-56. [PMID: 22555547 PMCID: PMC3337125 DOI: 10.4161/gmic.19345] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We have recently reported that Helicobacter pylori strains expressing the virulence factor cytotoxin-associated gene A (CagA) stimulate increased levels of spermine oxidase (SMO) in gastric epithelial cells, while cagA⁻ strains did not. SMO catabolizes the polyamine spermine and produces H₂O₂ that results in both apoptosis and DNA damage. Exogenous overexpression of CagA confirmed these findings, and knockdown or inhibition of SMO blocked CagA-mediated apoptosis and DNA damage. The strong association of SMO, apoptosis, and DNA damage was also demonstrated in humans infected with cagA⁺, but not cagA⁻ strains. In infected gerbils and mice, DNA damage was CagA-dependent and only present in epithelial cells that expressed SMO. We also discovered SMO (high) gastric epithelial cells from infected animals with dysplasia that are resistant to apoptosis despite high levels of DNA damage. Inhibition of polyamine synthesis or SMO could abrogate the development of this cell population that may represent precursors for neoplastic transformation.
Collapse
Affiliation(s)
- Rupesh Chaturvedi
- Division of Gastroenterology, Hepatology, and Nutrition; Department of Medicine; Vanderbilt University Medical Center; Nashville, TN USA
- Veterans Affairs; Tennessee Valley Healthcare System; Nashville, TN USA
| | - Thibaut de Sablet
- Division of Gastroenterology, Hepatology, and Nutrition; Department of Medicine; Vanderbilt University Medical Center; Nashville, TN USA
- Veterans Affairs; Tennessee Valley Healthcare System; Nashville, TN USA
| | - Richard M. Peek
- Division of Gastroenterology, Hepatology, and Nutrition; Department of Medicine; Vanderbilt University Medical Center; Nashville, TN USA
- Veterans Affairs; Tennessee Valley Healthcare System; Nashville, TN USA
- Department of Cancer Biology; Vanderbilt University Medical Center; Nashville, TN USA
| | - Keith T. Wilson
- Division of Gastroenterology, Hepatology, and Nutrition; Department of Medicine; Vanderbilt University Medical Center; Nashville, TN USA
- Veterans Affairs; Tennessee Valley Healthcare System; Nashville, TN USA
- Department of Cancer Biology; Vanderbilt University Medical Center; Nashville, TN USA
- Department of Pathology, Microbiology, and Immunology; Vanderbilt University Medical Center; Nashville, TN USA
| |
Collapse
|
28
|
Chung SJ, Lim SH, Choi J, Kim D, Kim YS, Park MJ, Yim JY, Kim JS, Cho SH, Jung HC, Song IS. Helicobacter pylori Serology Inversely Correlated With the Risk and Severity of Reflux Esophagitis in Helicobacter pylori Endemic Area: A Matched Case-Control Study of 5,616 Health Check-Up Koreans. J Neurogastroenterol Motil 2011; 17:267-73. [PMID: 21860818 PMCID: PMC3155062 DOI: 10.5056/jnm.2011.17.3.267] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 04/06/2011] [Accepted: 04/15/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIMS The role of Helicobacter pylori in gastroesophageal reflux disease remains still controversial and the effect of the organism on severity of reflux esophagitis have been rarely issued. The aim of this study was to investigate the relationship between H. pylori infection and reflux esophagitis, and especially the severity of reflux esophagitis. METHODS We performed a cross-sectional case-control study of 5,616 subjects undergoing both upper endoscopy and H. pylori serology during health Check-up (2,808 cases vs age- and sex-matched controls). Smoking, alcohol, body mass index and waist circum - ference were added to a multiple regression model. RESULTS Prevalence of H. pylori infection was lower in cases with reflux esophagitis than in controls (38.4% vs 58.2%, P < 0.001) and negative associations with H. pylori infection continued across the grade of esophagitis (46.7% in Los Angeles classification M [LA-M], 34.3% in LA-A or LA-B and 22.4% in LA-C or LA-D, P < 0.001). Positive serology for H. pylori independently reduced the risk of reflux esophagitis (adjusted OR, 0.44; 95% CI, 0.39-0.49). Notably, the negative associations continued across the grade of esophagitis with adjusted ORs of 0.63 in LA-M, 0.36 in LA-A or LA-B and 0.20 in LA-C or LA-D (P < 0.001). CONCLUSIONS In a age-sex matched Korean, H. pylori seropositivity was independently and inversely associated with the risk and severity of reflux esophagitis, suggesting the organism may have a protective role against gastroesophageal reflux disease.
Collapse
Affiliation(s)
- Su Jin Chung
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Wu JCY. Does Helicobacter pylori infection protect against esophageal diseases in Asia? Indian J Gastroenterol 2011; 30:149-53. [PMID: 21870139 DOI: 10.1007/s12664-011-0124-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 08/12/2011] [Indexed: 02/04/2023]
Abstract
The speculations on the protective role of Helicobacter pylori against gastroesophageal reflux disease (GERD) originated from epidemiological observations. These studies have shown that the rising trend of GERD is coincident with declining prevalence of H. pylori and peptic ulcer disease in Asia. Furthermore, most case-control and population-based studies suggest a negative association between H. pylori infection and GERD. It is generally believed that the preponderance of cagA+ and vacA+ virulent strains and proinflammatory interleukin-1 beta polymorphism increase the risk of hypochlohydria and protects against the development of GERD in Asian population. Recovery of gastric acid secretion and emergence of reflux esophagitis has been reported after H. pylori eradication in patients with corpus gastritis and atrophic gastritis. Recent studies have also reported that H. pylori eradication leads to recovery of ghrelin secreting cells in the gastric corpus and a rise in plasma ghrelin levels, which may contribute to obesity through its appetite-stimulating action and predispose to GERD. The prevalence of H. pylori infection is generally lower in younger Asians who enjoy improved socioeconomic status and sanitation compared with their older counterparts. The Asian population is probably facing a rising generation with high gastric acid and ghrelin secretion rates. These physiological changes may contribute to increased dietary calorie intake, obesity and increased prevalence of GERD.
Collapse
Affiliation(s)
- Justin C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
30
|
Zou D, He J, Ma X, Liu W, Chen J, Shi X, Ye P, Gong Y, Zhao Y, Wang R, Yan X, Man X, Gao L, Dent J, Sung J, Wernersson B, Johansson S, Li Z. Helicobacter pylori infection and gastritis: the Systematic Investigation of gastrointestinaL diseases in China (SILC). J Gastroenterol Hepatol 2011; 26:908-15. [PMID: 21198827 DOI: 10.1111/j.1440-1746.2010.06608.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Helicobacter pylori infection remains common in East Asia, though its prevalence is decreasing in Western countries. H. pylori-related atrophic gastritis (AG) may reduce the likelihood of gastroesophageal reflux disease (GERD). We investigated the prevalence of H. pylori infection and AG and their association with endoscopic findings and symptom-defined GERD in Shanghai. METHODS A representative random sample of 3600 Shanghai residents aged 18-80 years was invited to complete a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire, to provide blood samples for H. pylori serology and pepsinogen (PG) I/II assay (to detect AG, defined as PGI < 70 µg/L and/or PGI/PGII < 7), and to undergo endoscopy. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multivariate logistic regression. RESULTS A total of 1022 Shanghai residents underwent endoscopy and were valid for inclusion in the study. Of these, 71.7% tested positive for H. pylori, 63.8% had AG and 30.5% had moderate/severe AG (PGI < 50 µg/L and/or PGI/PGII < 5). Helicobacter pylori infection was equally common in all age groups. Severity of AG increased with age in women. Reflux esophagitis was inversely associated with AG (OR, 0.23 [CI, 0.09-0.55] for moderate/severe AG compared with no H. pylori or gastritis). However, symptom-defined GERD showed no clear association with AG. CONCLUSIONS Helicobacter pylori infection and AG are very common in Shanghai, and the infection is acquired early in life. Atrophic gastritis is inversely associated with reflux esophagitis but is not significantly associated with symptom-defined GERD.
Collapse
Affiliation(s)
- Duowu Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Goh KL. Gastroesophageal reflux disease in Asia: A historical perspective and present challenges. J Gastroenterol Hepatol 2011; 26 Suppl 1:2-10. [PMID: 21199509 DOI: 10.1111/j.1440-1746.2010.06534.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Gastroesophageal reflux disease (GERD), previously uncommon in Asia, has now become an important disease in the region. Although much variability exists between studies, most endoscopy-based studies show a prevalence of erosive esophagitis of more than 10%. Symptom-based studies also show a prevalence of 6-10%. Two longitudinal follow-up studies on GERD symptoms have shown an increase with time, and several endoscopy-based time trend studies have also shown a significant increase in erosive reflux esophagitis. Studies on Barrett's esophagus have been confounded by the description of short (SSBE) and long segment (LSBE) Barrett's esophagus. Great variation in prevalence rates has been reported. SSBE vary from 0.1% to more than 20% while LSBE vary from 1-2%. Of the putative causative factors, obesity has been the most important. Many studies have linked GERD-esophagitis as well as occurrence of reflux symptoms with an increase in body mass index (BMI), obesity, especially visceral or central obesity, and metabolic syndrome. A decline in Helicobacter pylori infection with growing affluence in Asia has been broadly thought to result in healthier stomachs and a higher gastric acid output resulting in reflux disease. However, variable results have been obtained from association and H. pylori eradication studies.
Collapse
Affiliation(s)
- Khean-Lee Goh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| |
Collapse
|
32
|
Takahashi M, Katayama Y. Reversal of the tolerance phenomenon by the intermittent administration of a histamine H2-receptor antagonist. J Gastroenterol Hepatol 2010; 25:1493-7. [PMID: 20796145 DOI: 10.1111/j.1440-1746.2010.06308.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM The attenuated antisecretory activity of H2-receptor antagonists (H2RA) during continuous administration is referred to as the tolerance phenomenon. A previous study indicated that Helicobacter pylori (H. pylori) infection prevents the occurrence of tolerance to H2RA. In the present study, we investigated whether intermittent (every other day) administration prevents the tolerance phenomenon in H. pylori-negative patients. METHODS Ten H. pylori-negative, healthy volunteers were included in the study. All of the patients underwent two courses of H2RA (lafutidine) administration: 21-day continuous administration (every day), followed by 21-day intermittent administration (every other day), with at least a 21-day lafutidine-free period between the first and second courses. All of the patients were examined by ambulatory intragastric pH monitoring five times: before medication, and on days 1 and 21 of the first (continuous) and second (intermittent) courses of lafutidine (10 mg b.d.) in a crossover fashion. RESULTS The continuous administration of lafutidine had a significantly attenuated, acid-suppressing effect in H. pylori-negative patients, and showed evidence of the tolerance phenomenon. However, the tolerance phenomenon was not observed through intermittent administration. CONCLUSIONS These results demonstrated that in H. pylori-negative patients, tolerance to H2RA, induced by continuous lafutidine administration, was reversed by subsequent intermittent administration.
Collapse
Affiliation(s)
- Morio Takahashi
- Department of Gastroenterology and Hepatology, Dokkyo Medical University, Koshigaya Hospital, Saitama, Japan.
| | | |
Collapse
|
33
|
Gao L, Weck MN, Rothenbacher D, Brenner H. Body mass index, chronic atrophic gastritis and heartburn: a population-based study among 8936 older adults from Germany. Aliment Pharmacol Ther 2010; 32:296-302. [PMID: 20456301 DOI: 10.1111/j.1365-2036.2010.04334.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity and overweight have been positively related to gastro-oesophageal reflux disease (GERD). It has been suggested that this relationship is as a consequence of an increased gastric acid reflux, which is caused by an enhanced intra-abdominal pressure. AIM To assess potential interaction of the association between body mass index (BMI) and GERD by chronic atrophic gastritis, which goes along with decreased acid production. METHODS In the baseline examination of ESTHER, a study conducted in 9953 older adults in Saarland, information on frequency of heartburn, potential risk factors and medical history was obtained by self-administered standardized questionnaire. Serological measurements of pepsinogen I and II were taken for definition of chronic atrophic gastritis. RESULTS In total, 2565 (28.7%) of the included subjects experienced heartburn within the previous 4 weeks. A pronounced dose-response relationship was observed between BMI and heartburn occurrence (P < 0.001) among people without chronic atrophic gastritis, but not among people with chronic atrophic gastritis (P-value for interaction = 0.018). Obese/overweight people with chronic atrophic gastritis had a much lower risk of heartburn compared with obese/overweight people without chronic atrophic gastritis (OR = 0.31, 95% CI = 0.24-0.40). CONCLUSION Our results are consistent with the hypothesis that BMI is related positively to GERD symptoms by its impact on acid reflux.
Collapse
Affiliation(s)
- L Gao
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Württemberg, Germany.
| | | | | | | |
Collapse
|
34
|
Helicobacter pylori status and esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis. J Gastroenterol 2010; 45:515-22. [PMID: 20084526 DOI: 10.1007/s00535-009-0196-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 12/15/2009] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study was to elucidate the impact of Helicobacter pylori infection on esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis (HD). METHODS An upper endoscopy and the (13)C-urea breath test were performed in 198 patients on maintenance HD. Clinical features, serum pepsinogen levels and esophagogastroduodenal mucosal lesions were compared between H. pylori-positive and H. pylori-negative patients. Risk factors associated with esophagogastroduodenal mucosal lesion were determined by multivariate analyses. RESULTS The upper endoscopy revealed that gastric erosion was the most frequent (58%) type of esophagogastroduodenal mucosal lesion, followed by duodenal erosion (18%), gastric ulcer (14%), gastroesophageal reflux disease (10%), and duodenal ulcer (7%). Of the 198 patients enrolled in the study, 81 were positive and 117 patients were negative for H. pylori infection. The time duration after the introduction of HD was significantly longer and serum pepsinogen I/II ratio was significantly higher in H. pylori-negative patients than in H. pylori-positive patients. Multivariate analyses revealed that the H. pylori infection was an independent, protective factor for gastric erosion (odds ratio 0.38; 95% confidence interval 0.21-0.70), while the infection was unrelated to other mucosal lesions. CONCLUSIONS The most common mucosal lesion observed in our study cohort, all of whom were patients on maintenance HD, was gastric erosion. The high prevalence of this type of lesion may be explained partly by the cure of H. pylori infection during the clinical course of maintenance HD.
Collapse
|
35
|
Kawai T, Yamamoto K, Fukuzawa M, Yamagishi T, Yagi K, Fukuzawa M, Kataoka M, Kawakami K, Itoi T, Sakai Y, Moriyasu F, Takagi Y, Aoki T. Helicobacter pylori infection and reflux esophagitis in young and middle-aged Japanese subjects. J Gastroenterol Hepatol 2010; 25 Suppl 1:S80-5. [PMID: 20586872 DOI: 10.1111/j.1440-1746.2010.06228.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Helicobacter pylori infection rates are reported to be high in people over the age of 40 years, but are decreasing in younger age groups. A negative correlation has been reported between H. pylori infection and reflux esophagitis (RE). METHODS The subjects were 418 patients who underwent esophagogastroduodenoscopy and measurement of serum immunoglobulin G H. pylori antibodies examined as part of their routine health checks. Their mean age was 39.2 +/- 8.3 years (range 22-58). We analyzed the RE findings (Los Angeles classification: A, B, C, D). RESULTS The total H. pylori infection rate was 33.7% (141/418). By age group, infection rates were 15.7% in the 20-29 years group, 28.0% in the 30-39 group, 34.3% in the 40-49 group and 69.1% in the 50-59 group. The proportion of H. pylori-negative subjects with RE was 23.5% (20-29, 22.9%; 30-39, 31.7%; 40-49, 32.4%; 50-59, 41.7%), significantly higher than that (12.1%) in H. pylori-positive subjects (20-29, 0%; 30-39, 16.7%; 40-49, 12.2%; 50-59, 10.5%). The severity of RE increased with advancing age in H. pylori-positive subjects, but not in H. pylori-negative subjects. CONCLUSION In this study, higher rates of RE were seen in H. pylori-negative subjects. It may be, however, that the presence of H. pylori infection influences the progression of RE.
Collapse
Affiliation(s)
- Takashi Kawai
- Endoscopy Center, Tokyo Medical University, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Shimatani T, Hirokawa S, Tawara Y, Hamai K, Matsumoto M, Tazuma S, Inoue M. Comparing the acid-suppressive effects of three brands of generic lansoprazole with the original: pharmacokinetic bioequivalence tests do not necessarily guarantee pharmacodynamic equivalence. Dig Dis Sci 2009; 54:2385-90. [PMID: 19093205 DOI: 10.1007/s10620-008-0634-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 11/12/2008] [Indexed: 12/09/2022]
Abstract
Generic drugs contain the same active ingredient as an original drug and have their bioequivalence proved by pharmacokinetic tests. However, few studies have been reported on whether these bioequivalence studies infer pharmacodynamic equivalence. In this study, in eight healthy Helicobacter pylori-negative CYP2C19 extensive metabolizers, we compared the acid-suppressive effects of repeated administration of 15 mg of three brands of generic lansoprazole, Taiproton, Tapizol, and Lansoral, with those of the original lansoprazole, Takepron. Median intragastric pH value for 24-h and % pH > 4 for daytime (08:00-20:00 h) and night-time were significantly higher with any lansoprazole formulation, compared with the control (P < 0.05, Wilcoxon signed-rank test). However, during the daytime, % pH > 4 with Tapizol was significantly lower than the original (P < 0.05). Compared with the original, no significantly larger, but no small range of inter-subject variations were observed in these two parameters for each of the three brands of generic lansoprazole (Bartlett test). Pharmacokinetic bioequivalence tests do not necessarily guarantee pharmacodynamic equivalence.
Collapse
Affiliation(s)
- Tomohiko Shimatani
- Division of Adult Nursing and Internal Medicine, Faculty of Nursing, Hiroshima International University, Kure 737-0112, Japan.
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
OBJECTIVES The role of Helicobacter pylori (H pylori) in gastroesophageal reflux disease (GERD) remains controversial, particularly in children, because there are limited published data. Adult studies suggested that H pylori infection may protect against GERD by causing atrophic gastritis, which leads to reduced gastric acid secretion. The objective of our study was to determine the role of H pylori infection in the development of GERD in a pediatric population. PATIENTS AND METHODS A retrospective analysis of 420 patients (M:F = 214:206) who underwent esophagogastroduodenoscopy (EGD) with biopsies between January 2000 and April 2006 was conducted. Patient demographics, clinical indications for EGD and the prevalence of reflux esophagitis (RE), the biomarker for GERD, in 2 groups, H pylori positive and H pylori negative, were reviewed. The prevalence of RE in the H pylori-positive and H pylori-negative groups was further analyzed on the basis of sex and age (<1 year, 1-10 years, >10 years). The mean age of the study population was 8.2 years (range 0-20 years). The clinical indications for EGD were as follows: recurrent abdominal pain (n = 186, 44%), malabsorption (n = 80, 19%), persistent vomiting (n = 80, 19%), suspected eosinophilic gastrointestinal disorders (n = 63, 15%), and others such as upper gastrointestinal bleeding or inflammatory bowel disease surveillance (n = 11, 3%). Statistical analysis was performed by using chi test, Fisher exact test, and multivariate logistical regression analysis. RESULTS Among the 420 patients, 16 patients (3.8%) were positive for H pylori and 167 patients (39.8%) were found to have RE. Thirteen patients with H pylori were found to have histologic evidence of RE. The prevalence of RE in the H pylori-positive population was 81.3% compared with 38.1% in the H pylori-negative population (P < or = 0.05). There were no patients with H pylori in the youngest age group. In the second age group (1-10 years), 100% of the H pylori-positive patients had RE, whereas 44.6% of the H pylori-negative patients had RE (P < or = 0.05). Both male and female patients with H pylori had a higher prevalence of RE, 77.8% and 85.7%, respectively. On a multivariate logistical regression, for the overall study cohort, H pylori-positive patients had an odds ratio of 5.79 of developing RE compared with H pylori-negative patients (P < or = 0.05). CONCLUSIONS Our study results indicate that there is a significantly higher prevalence of RE in an H pylori-infected cohort independent of age or sex. The findings suggest that H pylori infection in children is positively associated with RE.
Collapse
|
38
|
Koike T, Ohara S, Shimosegawa T. Role of gastric acid secretion in the pathogenesis of Barrett’s esophageal cancer in a Japanese population. Clin J Gastroenterol 2009; 2:143-148. [DOI: 10.1007/s12328-009-0082-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 04/01/2009] [Indexed: 12/17/2022]
|
39
|
Souza RCAD, Lima JHC. Helicobacter pylori and gastroesophageal reflux disease: a review of this intriguing relationship. Dis Esophagus 2009; 22:256-63. [PMID: 19425207 DOI: 10.1111/j.1442-2050.2008.00911.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A possible association between gastroesophageal reflux disease (GERD) and Helicobacter pylori (H. pylori) infection has been the subject of study and debate in recent years. This review discusses the pathophysiological and immunological mechanisms implicated in this relationship. Although gastric secretion in the majority of H. pylori-infected individuals is unaltered, this review considers how the bacteria may interfere with gastric acid production and what role it may play in GERD. We also identify the epidemiological evidence that confirms that GERD develops after the infection has been eradicated. Lastly, we clarify how the host's immune response and bacterial virulence factors interfere with this relationship, explaining the highly conflicting results in the literature.
Collapse
Affiliation(s)
- R Canzi Almada de Souza
- Department of Clinical Medicine, Division of Gastroenterology, Federal University of Paraná, Curitiba-PR-CEP, Brazil.
| | | |
Collapse
|
40
|
Pandolfino JE, Kwiatek MA, Kahrilas PJ. The pathophysiologic basis for epidemiologic trends in gastroesophageal reflux disease. Gastroenterol Clin North Am 2008; 37:827-43, viii. [PMID: 19028320 DOI: 10.1016/j.gtc.2008.09.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastroesophageal reflux disease (GERD) is defined by either subjective complaints indicative of problematic gastroesophageal reflux or objective complications directly attributable to reflux. Studies focused on GERD-related symptoms suggest a worldwide increase in prevalence of approximately 4% per year. Epidemiologic data indicate that possible contributing factors include increasing longevity, rising obesity rates, greater consumption of medications affecting esophageal function, and potentially changing prevalence rates of Helicobacter pylori infection. This article explores the interplay between pathophysiology and epidemiology by focusing on these risk factors and their potential effect on GERD pathogenesis.
Collapse
Affiliation(s)
- John E Pandolfino
- Division of Gastroenterology, Department of Medicine, Northwestern University's Feinberg School of Medicine, 676 North St. Clair Street, Suite 1400, Chicago, IL 60611, USA.
| | | | | |
Collapse
|
41
|
Abstract
The prevalence of gastroesophageal reflux disease (GERD) ranges from 2.5% to 7.1% in most population-based studies in Asia. There is evidence that GERD and its complications are rising, coinciding with a decline in Helicobacter pylori (H. pylori) infection. Asian GERD patients share similar risk factors and pathophysiological mechanisms with their Western counterparts. Possible causes for the lower prevalence of GERD include less obesity and hiatus hernia, a lesser degree of esophageal dysmotility, a high prevalence of virulent strains of H. pylori, and low awareness. Owing to the lack of precise translation for 'heartburn' in most Asian languages, reflux symptoms are often overlooked or misinterpreted as dyspepsia or chest pain. Furthermore, a symptom-based diagnosis with a therapeutic trial of the proton pump inhibitor (PPI) may be hampered by the high prevalence of H. pylori-related disease. The risk stratification for prompt endoscopy, use of a locally-validated, diagnostic symptom questionnaire, and response to H. pylori'test and treat' help improve the accuracy of the PPI test for diagnoses. PPI remain the gold standard treatment, and 'on-demand' PPI have been shown to be a cost-effective, long-term treatment. The clinical course of GERD is benign in most patients in Asia. The risk of progression from non-erosive reflux disease to erosive esophagitis is low, and treatment response to a conventional dose of PPI is generally higher. Although H. pylori eradication may lead to more resilient GERD in a subset of patients, the benefits of H. pylori eradication outweigh the risks, especially in Asian populations with a high incidence of gastric cancer.
Collapse
Affiliation(s)
- Justin C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
| |
Collapse
|
42
|
Corley DA, Kubo A, Levin TR, Block G, Habel L, Rumore G, Quesenberry C, Buffler P, Parsonnet J. Helicobacter pylori and gastroesophageal reflux disease: a case-control study. Helicobacter 2008; 13:352-60. [PMID: 19250510 PMCID: PMC2714194 DOI: 10.1111/j.1523-5378.2008.00624.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gastric colonization with Helicobacter pylori is a proposed protective factor against gastroesophageal reflux disease (GERD), but little population-based data exist and other data conflict. METHODS We conducted a case-control study within the membership of a large integrated health-care system that compared GERD-free subjects with two groups: subjects with a physician-assigned GERD diagnosis and randomly selected members with self-described weekly GERD symptoms. Subjects completed interviews, GERD questionnaires, and antibody testing for H. pylori and its cagA protein. RESULTS Serologic data were available for 301 physician-assigned GERD patients, 81 general membership subjects with GERD symptoms, and 175 general membership subjects without GERD symptoms. Physician-assigned GERD patients were less likely to have H. pylori antibodies than GERD-free member controls (odds ratio (OR) = 0.27, 95% confidence interval (CI) 0.15-0.47); there was also an inverse association between H. pylori and GERD symptom severity (OR = 0.18, 95% CI 0.08-0.41; severe or very severe symptoms) and GERD frequency (OR = 0.18, 95% CI 0.09-0.38; for symptoms at least weekly). The association was stronger among persons with erosive GERD and was similar between H. pylori-positive subjects with and without cagA. There was no association among persons who were cagA positive, but H. pylori negative. Similar findings were found in analyses of the general membership with self-described GERD symptoms. CONCLUSIONS H. pylori antibody status was inversely associated with a GERD diagnosis and GERD symptoms compared with a general membership population.
Collapse
Affiliation(s)
- Douglas A Corley
- Division of Research, Kaiser Permanente, Oakland, California 94612-2304, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Oridate N, Takeda H, Asaka M, Nishizawa N, Mesuda Y, Mori M, Furuta Y, Fukuda S. Acid-suppression therapy offers varied laryngopharyngeal and esophageal symptom relief in laryngopharyngeal reflux patients. Dig Dis Sci 2008; 53:2033-8. [PMID: 18080197 DOI: 10.1007/s10620-007-0114-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 11/05/2007] [Indexed: 02/07/2023]
Abstract
It is widely accepted that laryngopharyngeal reflux requires more aggressive and prolonged therapy than gastro-esophageal reflux disease. Otolaryngologists often observe that laryngopharyngeal symptoms, such as throat clearing, hoarseness, cough, and globus pharyngeus, are slower to resolve than esophageal symptoms, such as heartburn and regurgitation. The aim of this was to provide empirical evidence to support this observation and to carry out a detailed investigation of the differences between these symptoms. Forty-five patients with laryngopharyngeal and esophageal symptoms received acid-suppression therapy that involved the continuous administration of a proton-pump inhibitor for up to 6 months. We investigated the differences in response to acid-suppression therapy between patients suffering from laryngopharyngeal and esophageal symptoms, respectively, who received upper gastrointestinal endoscopy and were assayed for serum Helicobacter pylori antibodies. The significance of the rate of symptom improvement was estimated by Kaplan-Meier analysis and the logrank test. Laryngopharyngeal symptoms improved significantly more slowly than esophageal symptoms following acid-suppression therapy (49.8 vs. 78.3%, 60 days after the start of acid suppression; P = 0.003). These differences were observed both in patients with erosive esophagitis (P = 0.008) and in H. pylori-seronegative patients (P = 0.001).
Collapse
Affiliation(s)
- Nobuhiko Oridate
- Department of Otolaryngology, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Yamaguchi K, Iwakiri R, Hara M, Kikkawa A, Fujise T, Ootani H, Shimoda R, Tsunada S, Sakata H, Ushiyama O, Koarada S, Tada Y, Nagasawa K, Fujimoto K. Reflux esophagitis and Helicobacter pylori infection in patients with scleroderma. Intern Med 2008; 47:1555-9. [PMID: 18797112 DOI: 10.2169/internalmedicine.47.1128] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the possible effects of Helicobacter pylori (H. pylori) infection in reflux esophagitis with scleroderma. PATIENTS AND METHODS There were a total of 138 patients with scleroderma in our hospital between October 1998 and June 2005. Among these patients, 64 consecutive patients of scleroderma, who did not receive medication for gastrointestinal diseases, underwent endoscopy after informed consent. H. pylori was examined using an H. pylori IgG ELISA. The endoscopists graded esophageal mucosal breaks according to the Los Angeles Classification of Esophagitis. RESULTS Among the 64 patients, 37 patients (57.8%) were positive for H. pylori infection. Reflux esophagitis was observed in 10 of 37 H. pylori-positive patients and in 19 of 27 H. pylori-negative patients. Significantly fewer H. pylori-infected patients had reflux esophagitis than H. pylori-negative patients (p<0.01). The odds ratio for H. pylori infection and reflux esophagitis was 0.16 (95%CI; 0.052-0.47). CONCLUSION These findings suggest an important role for H. pylori infection in reflux esophagitis with scleroderma.
Collapse
Affiliation(s)
- Kanako Yamaguchi
- Division of Gastroenterology, Department of Internal Medicine, Saga Medical School, Saga
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Iwakiri K, Tanaka Y, Hayashi Y, Kotoyori M, Kawami N, Kawakami A, Sakamoto C. Association between reflux esophagitis and/or hiatus hernia and gastric mucosal atrophy level in Japan. J Gastroenterol Hepatol 2007; 22:2212-6. [PMID: 18031383 DOI: 10.1111/j.1440-1746.2006.04726.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS The mechanisms involved in reflux esophagitis (RE) are mainly esophageal motor dysfunction and abnormal esophageal acid exposure. Therefore the extent of gastric mucosal atrophy (GMA), which is related to gastric acid secretion, is an important factor in the development of RE. The aim of this study was to evaluate the prevalence of RE and hiatus hernia (HH) according to level of GMA. METHODS A total of 1897 prospective, consecutive endoscopic examinations were performed by the same endoscopist to investigate the prevalence of RE and HH in patients with closed or open-type GMA. The patients were divided into four age groups: under 44, 45-54, 55-64 and over 65 years. RESULTS The prevalence of RE and HH in patients with closed-type GMA was significantly higher than that of open-type GMA in the 45-54, 55-64 and over 65 age groups. In patients with open-type GMA, the prevalence of RE in each age group was similar at 5.0-7.4%, and the prevalence of HH in the over 65 age group was significantly higher than that of the 55-64 age group. In patients with closed-type GMA, the prevalence of RE and HH in the over 65 age group was significantly higher than that of other age groups. CONCLUSIONS The existence of closed-type GMA and age over 65 years were important factors in the development of RE and HH.
Collapse
Affiliation(s)
- Katsuhiko Iwakiri
- Department of Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
BACKGROUND Risk factors of reflux esophagitis among Chinese in Taiwan are at present not clear and the role of Helicobacter pylori infection in the development of reflux esophagitis is still controversial. GOALS The aim of this study was to examine the prevalence of reflux esophagitis, and to identify risk factors associated with reflux esophagitis in a multivariate context and to evaluate if H. pylori is a predictive factor for reflux esophagitis. STUDY A total of 482 physical check-up subjects who underwent upper gastrointestinal endoscopy were investigated. The severity of esophagitis was evaluated by Los Angeles classification. H. pylori status was assessed by serology. RESULTS Twelve percent (58/482) demonstrated reflux esophagitis with 87% of grade A or B. Of those with reflux esophagitis, 48.3% had reflux symptoms whereas 17.4% of those with reflux symptoms had reflux esophagitis. Univariate analysis identified hiatal hernia, male sex, smoking, alcohol drinking, and overweight as risk factors associated with reflux esophagitis. Multivariable logistic regression showed that hiatal hernia [odds ratio (OR)=12.2, 95% confidence interval (CI)=5.0-29.9, P<0.0001], male sex (OR=4.2, 95% CI=1.9-9.0, P<0.001), and chronic obstructive pulmonary disease sufferers (OR=3.4, 95% CI=1.1-10.9, P<0.05) were 3 independent risk factors for development of reflux esophagitis. CONCLUSIONS The prevalence of reflux esophagitis in Taiwanese is 12% and most are mild grade and free from reflux symptoms. Hiatus hernia, male sex, and chronic obstructive pulmonary disease are 3 independent risk factors for development of reflux esophagitis. H. pylori infection did not protect subjects from reflux esophagitis.
Collapse
Affiliation(s)
- Tseng-Shing Chen
- Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan, Republic of China
| | | |
Collapse
|
47
|
Weck MN, Stegmaier C, Rothenbacher D, Brenner H. Epidemiology of chronic atrophic gastritis: population-based study among 9444 older adults from Germany. Aliment Pharmacol Ther 2007; 26:879-87. [PMID: 17767472 DOI: 10.1111/j.1365-2036.2007.03430.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Epidemiological data on chronic atrophic gastritis from general population samples are sparse in Germany. AIM To assess prevalence of chronic atrophic gastritis according to potential risk factors and clinical outcomes in a large-scale population-based study. METHODS In the baseline examination of ESTHER, a population-based cohort study conducted in Germany, serological measurements of pepsinogen (PG) I and II and Helicobacter pylori antibodies were taken in 9444 women and men aged 50-74 years. Information on potential risk factors and medical history were obtained by questionnaire. RESULTS With the definition used in the EUROGAST study (PG I < 25 ng/mL), prevalence of chronic atrophic gastritis increased from 4.8% in age group 50-54 to 8.7% in age group 70-74. An alternative definition of chronic atrophic gastritis (PG I < 70 ng/mL and PG I/PG II < 3), used in multiple studies from Japan, revealed a greater increase with age (from 2.7% to 9.1%) and a strong association with H. pylori infection (adjusted odds ratio: 2.9, 95% confidence interval: 2.4-3.7). With both definitions, a strong inverse association with heartburn was observed. CONCLUSIONS Overall chronic atrophic gastritis prevalence is low among older adults in Germany, but it strongly increases with age and H. pylori infection.
Collapse
Affiliation(s)
- M N Weck
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | | | | |
Collapse
|
48
|
Simán JH, Engstrand L, Berglund G, Forsgren A, Florén CH. Helicobacter pylori and CagA seropositivity and its association with gastric and oesophageal carcinoma. Scand J Gastroenterol 2007; 42:933-40. [PMID: 17613922 DOI: 10.1080/00365520601173863] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Helicobacter pylori infection is an established risk factor for non-cardia gastric adenocarcinoma. Infection with H. pylori strains harbouring the cagA pathology island may augment this association. H. pylori infection may at the same time reduce the risk for oesophageal carcinoma. However, prospective data on the association between CagA seropositivity and gastric or oesophageal carcinomas are limited. The purpose of this study was to investigate whether CagA seropositivity among H. pylori seropositive subjects is associated with gastric or oesophageal carcinomas. MATERIAL AND METHODS A nested case-control study was performed in the Malmö Preventive Medicine cohort consisting of 32,906 middle-aged subjects. Tumour cases were identified by the Swedish National Cancer Registry. The Western blot method Helicoblot 2.1 was used to detect H. pylori and CagA seropositivity. RESULTS Non-cardia gastric adenocarcinoma was associated with H. pylori seropositivity, odds ratio 17.8 (95% CI: 4.2-74.8; 67 cases). The odds ratio for CagA seropositivity among H. pylori seropositive subjects was 9.7 (95% CI: 1.5-infinity). No significant associations were found between cardia gastric adenocarcinoma and H. pylori or CagA seropositivity among H. pylori seropositive subjects; odds ratios were 1.5 (95% CI: 0.51-4.8) and 2.7 (95% CI: 0.38-infinity), respectively (24 cases). Oesophageal adenocarcinoma and oesophageal squamous cell carcinoma were not significantly associated with H. pylori seropositivity or with CagA seropositivity among H. pylori seropositive subjects; the odds ratios associated with oesophageal adenocarcinoma were 0.46 (95% CI: 0.07-2.6) and 0.38 (95% CI: 0.02-24), respectively. Corresponding odds ratios for oesophageal squamous cell carcinoma were 0.44 (95% CI: 0.15-1.2; 37 cases) and 2.0 (95% CI: 0.24-infinity), respectively. CONCLUSIONS CagA seropositivity among H. pylori seropositive subjects is a risk factor for non-cardia gastric adenocarcinoma.
Collapse
Affiliation(s)
- J Henrik Simán
- Department of Medicine, Malmö University Hospital, Lund University, Malmö, Sweden.
| | | | | | | | | |
Collapse
|
49
|
Popović D, Stanković-Popović V, Milosavljević T, Jovanović I, Pesko P, Simić A, Micev M, Milicić B, Kristić M. [The influence of Helicobacter pylori eradication on appearance of gastro-oesophageal reflux disease]. ACTA ACUST UNITED AC 2007; 53:41-8. [PMID: 17338199 DOI: 10.2298/aci0603041p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Gastro-oesophageal reflux disease (GERD) includes wide spectrum of symptoms caused by gastric acid regurgitation through the incompetent lower oesophageal sphincter in oesophagus. Etiopathogenesis of GERD is multifactorial. AIM OF THIS STUDY to establish the relationship between Helicobacter pylori eradication and appearance or aggravating of present GERD. If this relationship exist, the aim is to estimate its level and clinical consequences. MATERIAL AND METHODS 50 Helicobacter pylori positive patients with different endoscopic findings (ulcer disease, gastritis and non-ulcer dyspepsia) to whom eradication of Helicobacter pylori was done, were following next 6 months. Questionnaire, uppear GI endoscopy with verification changes of oesophagus in accordance to LA classification, histopathological examination of gastric and oesophageal mucosal biopsy specimens, and oesophageal manometry have been done to all patients. These examinations have been done before Helicobacter pylori eradication and one, three. six and none months after that. RESULTS non statistical significant difference was found among the appearance or aggravating of present GERD in all patients during the following period (Cochran Q test; p=0,408). Non statistical significant difference was found among the endoscopic types of oesophagitis (LA classification) in all patients during the following 6 months (Friedman test; p=0,058). Non statistical significant difference was found among the changes of histopathological findings on distal oesophagus, too (Friedman test; p=0,217). CONCLUSION Eradication od Helicobacter pylori infection does not cause the appearance or aggravating of present GERD. The presence of mildly form of GERD, or aggravating of present GERD is transitory, and haven't the statistical signification.
Collapse
Affiliation(s)
- D Popović
- Institut za bolesti digestivnog sistema, Klinika za gastroenterologiju i hepatologiju, Klinicki centar Srbije
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Shimatani T, Inoue M, Kuroiwa T, Moriwaki M, Xu J, Ikawa K, Morikawa N, Tazuma S. Which has superior acid-suppressive effect, 10 mg omeprazole once daily or 20 mg famotidine twice daily? Effects of single or repeated administration in Japanese Helicobacter pylori-negative CYP2C19 extensive metabolizers. Dig Dis Sci 2007; 52:390-5. [PMID: 17211705 DOI: 10.1007/s10620-006-9490-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2006] [Accepted: 06/14/2006] [Indexed: 12/29/2022]
Abstract
Low-dose omeprazole is superior to full-dose famotidine in maintenance therapy for gastroesophageal reflux disease, whereas "on-demand" famotidine is more effective for relief of episodes of heartburn. To explain this apparent discrepancy, intragastric pH was measured for 24-hr seven times in eight Japanese Helicobacter pylori-negative cytochrome P450 2C19 extensive metabolizers; on Days 1, 8, and 15 of repeated administration of 10 mg of omeprazole once daily and of 20 mg of famotidine twice daily and before medication. During repeated administration of omeprazole, mean intragastric pH and % time that intragastric pH > 4.0 were significantly higher and became greater. With famotidine, although these parameters were significantly higher, the degrees became smaller. Consequently, acid-suppressive effect was in the order; omeprazole < famotidine on Day 1, omeprazole approximately famotidine on Day 8, and omeprazole >famotidine on Day 15. This discrepancy possibly results from the "potentiation" of acid-suppressive effect of omeprazole and the "tolerance" phenomenon in respect to famotidine.
Collapse
Affiliation(s)
- Tomohiko Shimatani
- Department of General Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Hiroshima, Japan.
| | | | | | | | | | | | | | | |
Collapse
|