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Chen Z, Zheng Y, Fan P, Li M, Liu W, Yuan H, Liu X, Zhang Z, Wu Z, Wang Y, Ji R, Guo Q, Ye Y, Zhang J, Li X, An F, Lu L, Li Y, Wang X, Zhang J, Guan Q, Li Q, Liu M, Ren Q, Hu X, Lu H, Zhang H, Zhao Y, Gou X, Shu X, Wang J, Hu Z, Xue S, Liu J, Zhou Y. Risk factors in the development of gastric adenocarcinoma in the general population: A cross-sectional study of the Wuwei Cohort. Front Microbiol 2023; 13:1024155. [PMID: 36713177 PMCID: PMC9878447 DOI: 10.3389/fmicb.2022.1024155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
Several risk factors have been identified for the development of gastric adenocarcinoma (GAC), where the control group was usually a healthy population. However, it is unclear at what stage known risk factor exert their influence toward the progression to cancer. Based on the Wuwei Cohort, we enrolled 1,739 patients with chronic non-atrophic gastritis (no-CAG), 3,409 patients with chronic atrophic gastritis (CAG), 1,757 patients with intestinal metaplasia (IM), 2,239 patients with low-grade dysplasia (LGD), and 182 patients with high-grade dysplasia (HGD) or GAC to assess the risk factors between each two consecutive stages from no-CAG to GAC/HGD using adjusted logistic regression. We found that different groups of risk factors were associated with different stages. Age, occupation of farmer, low annual family income, Helicobacter pylori (H. pylori) infection, drinking, eating hot food, histories of gastritis and peptic ulcer were associated with the development of CAG. Age, illiteracy, H. pylori infection, smoking, eating hot food, eating quickly, and histories of gastritis and gallbladder diseases were associated with the progression to IM from CAG. Male, occupation of farmer and history of peptic ulcer were associated with the development of LGD from IM. Age, male and polyp history appeared to be risk factors associated with the development of GAC/HGD from LGD. In conclusion, it seems that most risk factors function more as a set of switches that initiated the GAC carcinogenesis. H. Pylori eradication and control of other risk factors should be conducted before IM to decrease the incidence of GAC.
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Affiliation(s)
- Zhaofeng Chen
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ya Zheng
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ping Fan
- Gansu Wuwei Tumor Hospital, Wuwei, Gansu, China
| | - Min Li
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Wei Liu
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Hao Yuan
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xin Liu
- Department of Gastroenterology, The 940th Hospital of Joint Service Logistics Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, China
| | - Zhiyi Zhang
- Gansu Wuwei Tumor Hospital, Wuwei, Gansu, China
| | - Zhengqi Wu
- Gansu Wuwei Tumor Hospital, Wuwei, Gansu, China
| | - Yuping Wang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Rui Ji
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Qinghong Guo
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yuwei Ye
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jinhua Zhang
- Gansu Second Provincial People’s Hospital, Lanzhou, Gansu, China
| | - Xiaohua Li
- Wuwei Liangzhou Hospital, Wuwei, Gansu, China
| | - Feng An
- Wuwei People's Hospital, Wuwei, Gansu, China
| | - Linzhi Lu
- Gansu Wuwei Tumor Hospital, Wuwei, Gansu, China
| | - Youpeng Li
- Minqin People's Hospital, Minqin, Gansu, China
| | - Xiang Wang
- Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jun Zhang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Quanlin Guan
- Surgical Oncology Department, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Qiang Li
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Min Liu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Qian Ren
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiaobin Hu
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Hong Lu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hongling Zhang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yue Zhao
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xi Gou
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiaochuang Shu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jun Wang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zenan Hu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Siqian Xue
- Interventional Radiology Department, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jiankang Liu
- Harvard Medical School, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, United States
| | - Yongning Zhou
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, Gansu, China,*Correspondence: Yongning Zhou, ✉
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Razuka-Ebela D, Polaka I, Daugule I, Parshutin S, Santare D, Ebela I, Rudzite D, Vangravs R, Herrero R, Young Park J, Leja M. Lifestyle and dietary factors associated with serologically detected gastric atrophy in a Caucasian population in the GISTAR study. Eur J Cancer Prev 2022; 31:442-450. [PMID: 35131967 DOI: 10.1097/cej.0000000000000723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify dietary and lifestyle factors associated with decreased pepsinogen levels indicative of gastric atrophy. METHODS Participants aged 40 to 64 from the "Multicentric randomized study of H. pylori eradication and pepsinogen testing for prevention of gastric cancer mortality (GISTAR study)" in Latvia tested for serum pepsinogen, as well as for Helicobacter pylori infection by 13 C-urea breath test or serology were included. Data on sex, age, education, employment, diet, smoking, alcohol and proton pump inhibitor use were obtained by survey and compared for participants with and without serologically detected gastric atrophy defined as pepsinogen I/pepsinogen II ≤ 2 and pepsinogen I ≤ 30 ng/mL. RESULTS Of 3001 participants (median age 53, interquartile range, 11.0, 36.9% male) 52.8% had H. pylori and 7.7% had serologically detected gastric atrophy. In multivariate analysis, increasing age, consumption of alcohol, coffee, and onions were positively, while H. pylori , former smoking, pickled product and proton pump inhibitor use were inversely associated with gastric atrophy. Pepsinogen values were higher in smokers and those with H. pylori . Pepsinogen ratio was lower in those with H. pylori . When stratifying by H. pylori presence, significantly higher pepsinogen levels remained for smokers without H. pylori . CONCLUSION Several dietary factors and smoking were associated with serologically detected gastric atrophy. Pepsinogen levels differed by smoking and H. pylori status, which may affect the serologic detection of gastric atrophy. There seems to be a complicated interaction between multiple factors. A prospective study including atrophy determined by both serology and histology is necessary.
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Affiliation(s)
- Danute Razuka-Ebela
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Inese Polaka
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Ilva Daugule
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Sergei Parshutin
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Daiga Santare
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
| | | | - Dace Rudzite
- Institute of Clinical and Preventive Medicine, University of Latvia
- Riga East University Hospital, Riga, Latvia
| | - Reinis Vangravs
- Institute of Clinical and Preventive Medicine, University of Latvia
| | - Rolando Herrero
- International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomedicas, Fundación INCIENSA, Costa Rica
| | - Jin Young Park
- International Agency for Research on Cancer, Lyon, France
| | - Marcis Leja
- Faculty of Medicine
- Institute of Clinical and Preventive Medicine, University of Latvia
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Di Mario F, Crafa P, Barchi A, Franzoni L, Franceschi M, Russo M, Bricca L, Brozzi L, Rodriguez Castro K, Rugge M. Pepsinogen II in gastritis and Helicobacter pylori infection. Helicobacter 2022; 27:e12872. [PMID: 34997989 DOI: 10.1111/hel.12872] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM In the gastric mucosa, pepsinogen II (PgII) is produced/secreted by glands in the mucus-secreting antral and cardia compartments, but also by the chief cells and the oxyntic glands. Increasing PgII serum levels are associated with the whole spectrum of gastric inflammatory diseases, including gastritis induced by Helicobacter pylori (H. pylori). This review critically addresses the clinical value of PgII serology for assessing gastric mucosal inflammation, and as a marker of H. pylori status, in both H. pylori-positive patients and after eradication therapy. RESULTS A search in PubMed/Scopus records yielded 39 out of 1190 published scientific studies meeting the selection criteria for this study. In the studies considered, PgII levels were significantly associated with non-atrophic gastric inflammatory lesions (p-values: 0.025-0.0001). H. pylori-positive patients had significantly higher PgII levels than H. pylori-negative individuals (p-values: 0.o5-0.0001). While a significant drop in serum PgII levels is consistently reported in H. pylori-eradicated patients (p-values: from 0.05 to 0.0001), inconsistencies in the related negative and positive predictive values significantly lower the clinical reliability of PgII testing by comparison with other available non-invasive tests. CONCLUSIONS PgII serology may provide clinically useful information on gastric inflammatory diseases, particularly if they are non-atrophic. PgII serology is inconsistent, however, for the purposes of distinguishing patients whose H. pylori eradication therapy is successful from those who remain infected.
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Affiliation(s)
| | - Pellegrino Crafa
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alberto Barchi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorella Franzoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marilisa Franceschi
- Endoscopy Unit, Department of Medicine, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso, Italy
| | - Michele Russo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ludovica Bricca
- Department of Medicine-DIMED, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Lorenzo Brozzi
- Endoscopy Unit, Department of Medicine, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso, Italy
| | - Kryssia Rodriguez Castro
- Endoscopy Unit, Department of Medicine, ULSS7 Pedemontana, Hospital AltoVicentino, Santorso, Italy
| | - Massimo Rugge
- Department of Medicine-DIMED, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy.,Registro Tumori del Veneto (RTV), Azienda Zero, Padova, Italy
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6
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Yin Z, Xiao S, Tian X, Yuan Z, Zhou L. The necessity and appropriate range of the diagnostic "gray zone" of 13C-urea breath test. Saudi J Gastroenterol 2022; 28:385-392. [PMID: 35259858 PMCID: PMC9752539 DOI: 10.4103/sjg.sjg_638_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The 13C-urea breath test (13C-UBT) is preferred for non-invasive detection of Helicobacter pylori (H. pylori); however, its accuracy drops when results fall between 2‰ and 6‰ (called the gray zone). This study aimed to evaluate the accuracy of 13C-UBT (cut-off point 4‰) between 2‰ and 6‰, find a more appropriate gray zone, and identify the factors influencing 13C-UBT. METHODS Patients with 13C-UBT results 2‰-6‰, over an eight-year period, were studied. H. pylori infection was diagnosed if patients were positive for either Warthin-Starry staining or quantitative real-time polymerase chain reaction (real-time PCR), and excluded if both were negative. Accuracy of 13C-UBT under different cut-off points was calculated, and the factors affecting 13C-UBT were analyzed. RESULTS A total of 208 patients were included, of whom 129 were H. pylori-positive. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 13C-UBT were 71.32%, 83.54%, 64.08%, and 87.62%, respectively. When the cut-off point was changed to 2.15‰, the NPV of 13C-UBT reached a maximum (76.47%); when the cut-off point was changed to 4.95‰, PPV reached its maximum (93.22%). Therefore, the original gray zone (2‰-6‰) was adjusted to 2‰-4.95‰. Gastric antral intestinal metaplasia (OR = 3.055, 95% CI: 1.003-9.309) was an independent risk factor for false-negative 13C-UBT. CONCLUSIONS Accuracy of 13C-UBT over 2‰-6‰ was poor, and the gray zone was changed to 2‰-4.95‰. 13C-UBT results over 2‰-4.95‰ should be interpreted with caution during mass screening of H. pylori, especially for patients with gastric antral intestinal metaplasia.
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Affiliation(s)
- Zhihao Yin
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China
| | - Shiyu Xiao
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China
| | - Xueli Tian
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China
| | - Ziying Yuan
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Liya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China; Beijing Key Laboratory of Helicobacter pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China,Address for correspondence: Prof. Liya Zhou, Department of Gastroenterology, Beijing Key Laboratory of Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China. E-mail:
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8
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Muhsen K, Sinnreich R, Merom D, Nassar H, Cohen D, Kark JD. Helicobacter pylori infection, serum pepsinogens as markers of atrophic gastritis, and leukocyte telomere length: a population-based study. Hum Genomics 2019; 13:32. [PMID: 31331390 PMCID: PMC6647065 DOI: 10.1186/s40246-019-0217-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/03/2019] [Indexed: 01/16/2023] Open
Abstract
Background Persistent infections that induce prolonged inflammation might negatively affect the leukocyte telomere length (LTL); however, the role in LTL of Helicobacter pylori (H. pylori) infection, which persistently colonizes the stomach, remains unknown. The study objective was to examine associations of sero-prevalence of H. pylori immunoglobulin G (IgG) antibody and serum pepsinogens (PGs), as markers of atrophic gastritis, with LTL. A cross-sectional study was performed among 934 Arab residents of East Jerusalem, aged 27–78 years, randomly selected from Israel’s national population registry. Sera were tested for H. pylori IgG and PG levels by ELISA. LTL was measured by southern blots. Multiple linear regression models were fitted to adjust for sociodemographic and lifestyle factors. Results LTL decreased significantly with age (p < 0.001) and was shorter in men than women (p = 0.032). The mean LTL was longer in H. pylori sero-positive persons than negative ones: mean difference 0.13 kb (95% CI 0.02, 0.24), p = 0.016. Participants with atrophic gastritis (PGI < 30 μg/L or a PGI: PGII < 3.0) had shorter LTL than did those without: mean difference − 0.18 (95% CI − 0.32, − 0.04). The difference was of larger magnitude between persons who had past H. pylori infection (sero-negative to H. pylori IgG antibody) and atrophic gastritis, compared to those who were H. pylori sero-negative and did not have atrophic gastritis: mean difference − 0.32 kb (95% CI − 0.55, − 0.10). This association remained significant after adjustment for age, sex, and religiosity: beta coefficient − 0.21 kb (95% CI − 0.41, − 0.001), p = 0.049. The results were similar after further adjustment for lifestyle factors. In bivariate analysis, mean LTL was longer in physically active persons than non-active ones, and shorter in persons with than without obesity; however, these differences were diminished and were not significant in the multivariable model. Conclusions H. pylori IgG sero-positivity per se was not related to reduced LTL. However, persons with past H. pylori infection (i.e., lacking H. pylori IgG serum antibody) and with serological evidence of atrophic gastritis, had a significantly shorter LTL than did those without atrophic gastritis. Electronic supplementary material The online version of this article (10.1186/s40246-019-0217-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University Ramat Aviv, Ramat Aviv, 6139001, Tel Aviv, Israel.
| | - Ronit Sinnreich
- Hadassah School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | - Dafna Merom
- Western Sydney University, Sydney, Australia
| | - Hisham Nassar
- St. Joseph Hospital, East Jerusalem and Department of Cardiology, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University Ramat Aviv, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Jeremy D Kark
- Hadassah School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
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