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O'Connor HJ. Forty years of Helicobacter pylori infection and changes in findings at esophagogastroduodenoscopy. Helicobacter 2023; 28:e13026. [PMID: 37818739 DOI: 10.1111/hel.13026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND It is 40 years since the discovery of Helicobacter pylori infection. Over that time major changes have occurred in esophagogastroduodenoscopy (EGD) findings. The aim of this review is to describe these changes, and the important role H. pylori infection has played in their evolution. METHODS References were identified through searches of PubMed using the search terms-endoscopy time trends, peptic ulcer disease, gastroesophageal reflux disease, upper gastrointestinal cancer, gastric polyps, H. pylori, eosinophilic gastrointestinal disorders, and celiac disease, from 1970 through December 2021. RESULTS The prevalence of H. pylori infection has fallen and consequently, H. pylori-positive peptic ulcer disease has become rare. Gastroesophageal reflux disease is now the commonest disorder diagnosed at EGD, and Barrett's esophagus has increased in parallel. Cancer of the distal stomach has fallen while esophageal adenocarcinoma and reflux-related cardia cancer have risen. Gastric polyps have changed from hyperplastic and adenomas to sporadic fundic gland polyps. Antimicrobial resistance has made H. pylori infection more difficult to eradicate. Eosinophilic gastrointestinal disorders, particularly eosinophilic esophagitis, have emerged as important new allergic disorders. Celiac disease has changed and increased. CONCLUSIONS EGD findings appear to have changed from features suggesting a H. pylori-positive "phenotype" 40 years ago to a H. pylori-negative "phenotype" today. These changes have major implications for the management of gastrointestinal disorders.
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Affiliation(s)
- Humphrey J O'Connor
- Trinity Academic Gastroenterology Group, Trinity Centre for Health Sciences, The University of Dublin, Tallaght University Hospital, Dublin, Ireland
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2
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Zolnikova O, Dzhakhaya N, Bueverova E, Sedova A, Kurbatova A, Kryuchkova K, Butkova T, Izotov A, Kulikova L, Yurku K, Chekulaev P, Zaborova V. The Contribution of the Intestinal Microbiota to the Celiac Disease Pathogenesis along with the Effectiveness of Probiotic Therapy. Microorganisms 2023; 11:2848. [PMID: 38137992 PMCID: PMC10745538 DOI: 10.3390/microorganisms11122848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
The development of many human disorders, including celiac disease (CD), is thought to be influenced by the microbiota of the gastrointestinal tract and its metabolites, according to current research. This study's goal was to provide a concise summary of the information on the contribution of the intestinal microbiota to the CD pathogenesis, which was actively addressed while examining the reported pathogenesis of celiac disease (CD). We assumed that a change in gluten tolerance is formed under the influence of a number of different factors, including genetic predisposition and environmental factors. In related investigations, researchers have paid increasing attention to the study of disturbances in the composition of the intestinal microbiota and its functional activity in CD. A key finding of our review is that the intestinal microbiota has gluten-degrading properties, which, in turn, may have a protective effect on the development of CD. The intestinal microbiota contributes to maintaining the integrity of the intestinal barrier, preventing the formation of a "leaky" intestine. On the contrary, a change in the composition of the microbiota can act as a significant link in the pathogenesis of gluten intolerance and exacerbate the course of the disease. The possibility of modulating the composition of the microbiota by prescribing probiotic preparations is being considered. The effectiveness of the use of probiotics containing Lactobacillus and Bifidobacterium bacteria in experimental and clinical studies as a preventive and therapeutic agent has been documented.
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Affiliation(s)
- Oxana Zolnikova
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (O.Z.); (N.D.); (E.B.); (A.S.); (A.K.); (P.C.)
| | - Natiya Dzhakhaya
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (O.Z.); (N.D.); (E.B.); (A.S.); (A.K.); (P.C.)
| | - Elena Bueverova
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (O.Z.); (N.D.); (E.B.); (A.S.); (A.K.); (P.C.)
| | - Alla Sedova
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (O.Z.); (N.D.); (E.B.); (A.S.); (A.K.); (P.C.)
| | - Anastasia Kurbatova
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (O.Z.); (N.D.); (E.B.); (A.S.); (A.K.); (P.C.)
| | - Kira Kryuchkova
- Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
| | - Tatyana Butkova
- Institute of Biomedical Chemistry, Biobanking Group, 109028 Moscow, Russia; (T.B.); (A.I.); (L.K.)
| | - Alexander Izotov
- Institute of Biomedical Chemistry, Biobanking Group, 109028 Moscow, Russia; (T.B.); (A.I.); (L.K.)
| | - Ludmila Kulikova
- Institute of Biomedical Chemistry, Biobanking Group, 109028 Moscow, Russia; (T.B.); (A.I.); (L.K.)
- Institute of Mathematical Problems of Biology RAS—The Branch of Keldysh Institute of Applied Mathematics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Kseniya Yurku
- State Research Center—Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, 123098 Moscow, Russia;
| | - Pavel Chekulaev
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (O.Z.); (N.D.); (E.B.); (A.S.); (A.K.); (P.C.)
| | - Victoria Zaborova
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (O.Z.); (N.D.); (E.B.); (A.S.); (A.K.); (P.C.)
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Civelek Z, Urgancı N, Usta M, Özgüven MB. Prevalence of <i>Helicobacter pylori</i> Infection in Pediatric Patients With Celiac Disease. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2021.2021-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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4
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Amlashi FI, Norouzi Z, Sohrabi A, Shirzad-Aski H, Norouzi A, Ashkbari A, Gilani N, Fatemi SA, Besharat S. A systematic review and meta-analysis for association of Helicobacter pylori colonization and celiac disease. PLoS One 2021; 16:e0241156. [PMID: 33657108 PMCID: PMC7928511 DOI: 10.1371/journal.pone.0241156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/12/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Based on some previous observational studies, there is a theory that suggests a potential relationship between Helicobacter pylori (H. pylori) colonization and celiac disease (CeD); however, the type of this relationship is still controversial. Therefore, we aimed to conduct a systematic review and meta-analysis to explore all related primary studies to find any possible association between CeD and human H. pylori colonization. DATA SOURCES Studies were systematically searched and collected from four databases and different types of gray literature to cover all available evidence. After screening, the quality and risk of bias assessment of the selected articles were evaluated. SYNTHESIS METHODS Meta-analysis calculated pooled odds ratio (OR) on the extracted data. Furthermore, heterogeneity, sensitivity, subgroups, and publication bias analyses were assessed. RESULTS Twenty-six studies were included in this systematic review, with a total of 6001 cases and 135512 control people. The results of meta-analysis on 26 studies showed a significant and negative association between H. pylori colonization and CeD (pooled OR = 0.56; 95% CI = 0.45-0.70; P < 0.001), with no publication bias (P = 0.825). The L'Abbé plots also showed a trend of having more H. pylori colonization in the control group. Among subgroups, ORs were notably different only when the data were stratified by continents or risk of bias; however, subgroup analysis could not determine the source of heterogeneity. CONCLUSIONS According to the meta-analysis, this negative association might imply a mild protective role of H. pylori against celiac disease. Although this negative association is not strong, it is statistically significant and should be further considered. Further investigations in both molecular and clinic fields with proper methodology and more detailed information are needed to discover more evidence and underlying mechanisms to clear the interactive aspects of H. pylori colonization in CeD patients. SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO) CRD42020167730 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167730.
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Affiliation(s)
- Fazel Isapanah Amlashi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Norouzi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ahmad Sohrabi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran
| | - Hesamaddin Shirzad-Aski
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- * E-mail: (HS-A); (SB)
| | - Alireza Norouzi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ali Ashkbari
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Naghme Gilani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Seyed Alireza Fatemi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sima Besharat
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- * E-mail: (HS-A); (SB)
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Gungor S, Köylü AA. Effects of Helicobacter Pylori Infection on Serology and Intestinal Mucosal Changes in Pediatric Patients With Celiac Disease: A Retrospective Cohort Study. Cureus 2020; 12:e11134. [PMID: 33240724 PMCID: PMC7682941 DOI: 10.7759/cureus.11134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Helicobacter pylori (HP) and celiac disease (CD) can cause similar mucosal damage to the duodenal mucosa. For this reason, the relationship between these two diseases has been the subject of research recently. Our study aims to investigate the effects of HP infection on serology and pathology in pediatric patients with CD or potential celiac disease (PCD). Methods It is a retrospective cohort study conducted in the third-level education and research hospital between July 2017 and May 2019. The serological and pathological data of patients diagnosed with CD or PCD were compared statistically according to the presence of HP. Results An analysis of the histopathological data of the endoscopic biopsy samples showed Helicobacter pylori in eight (50%) of PCD patients and 37 (41.6%) of CD patients. No significant difference was found between the two groups (P=0.531). We found that dokutransglutaminas antibody level (DTG) and endomysium antibody level (EMA) serology decreased significantly after HP eradication therapy in HP (+) PCD (P=0.002, P<0.001). Intestinal metaplasia was not present in PCH. However, intestinal metaplasia was present in five patients (13.5%) with HP (+) CD and two patients (3.8%) with HP (-) CD. However, that difference was not statistically significant between the two groups (P=0.095). Conclusion Our study demonstrated that HP may augment CD's serology and serological improvement is possible after HP treatment particularly in HP (+) PCD. Therefore, we recommend re-perform diagnostic studies after HP treatment before commencing a gluten-free diet in HP (+) suspected CD cases.
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Affiliation(s)
- Sukru Gungor
- Pediatric Gastroenterology Department, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaraş, TUR
| | - Ahmet Alpay Köylü
- Biochemistry Department, Necip Fazıl City Hospital Child Health and Diseases Unit, Kahramanmaraş, TUR
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Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
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Marsilio I, Maddalo G, Ghisa M, Savarino EV, Farinati F, Zingone F. The coeliac stomach: A review of the literature. Dig Liver Dis 2020; 52:615-624. [PMID: 32295740 DOI: 10.1016/j.dld.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/02/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
Beyond the small intestine, coeliac disease (CeD) may affect other gastrointestinal tracts, including the stomach. However, various studies have reported conflicting results regarding the association between CeD and gastric manifestations. The aim of this study was to analyze the existing literature on gastric involvement in CeD. A literature search was conducted in bibliographic databases of Embase, PubMed, Scopus, and Web of Science. Studies reporting the association between CeD and gastric disorders were examined in detail and are fully described in the review. Both in children and adults, a strong correlation between lymphocytic gastritis and CeD was found at CeD diagnosis, and lymphocytic gastritis seemed to improve on a gluten-free diet. Most of the literature described a lower risk of gastritis related to Helicobacter pylori infection in CeD subjects compared to controls. However, due to the discordance among studies in terms of study design and population, a clear association could not be determined. Finally, the relationship between CeD and reflux or dyspepsia has yet to be defined, as well as the association between CeD and autoimmune gastritis. CeD appears to be a multiform entity associated with different gastric disorders with a different degree of relationship. Thus, gastric biopsies should be routinely taken during upper endoscopy in CeD patients.
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Affiliation(s)
- Ilaria Marsilio
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua 35128, Italy
| | - Gemma Maddalo
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua 35128, Italy
| | - Matteo Ghisa
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua 35128, Italy
| | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua 35128, Italy
| | - Fabio Farinati
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua 35128, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua 35128, Italy.
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Ghosn Y, Hussein Kamareddine M, Tawk A, Bou-Ayash N, Bou-Ayash H, Mokamer N, Yared R, Aoun M, Khoury S, Cortas G, Jabbour G, Bedran K, Farhat S. Analysis of gastric and duodenal biopsy results in patients presenting with dyspepsia: a cross-sectional study in a middle eastern population. BMJ Open Gastroenterol 2019; 6:e000330. [PMID: 31645989 PMCID: PMC6781958 DOI: 10.1136/bmjgast-2019-000330] [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] [Received: 07/06/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Correa's cascade is a 'Model for Gastric Cancer Development' described by Peleyo Correa. The reversibility of Correa's cascade remains debatable. The literature contains insufficient data on the specific stage of the cascade during which Helicobacter pylori is detected, treated, and the effect on prognosis. Herein, we aim to determine the prevalence of various precancerous and cancerous gastric lesions in patients presenting with dyspepsia, the prevalence of gastritis and H. pylori infection, the prevalence of duodenal pathology in patients presenting with dyspepsia, identify the stage of H. pylori detection in relation to Correa's cascade, and investigate a possible relationship between H. pylori and celiac disease. DESIGN Retrospective cross-sectional study conducted on a middle eastern population at a Lebanese tertiary hospital centre. 1428 patients presenting with dyspepsia underwent gastroscopy with gastric and duodenal biopsies. Variables include age, sex, presence/absence of H. pylori infection, and histopathological analysis of gastric and duodenal biopsies. RESULTS Being above 40 years of age was associated with increased likelihood of exhibiting abnormal gastric biopsy result. Gastritis and metaplasia were detected more frequently than glandular atrophy (p<0.001) with gastritis being present the most (p<0.001). The presence of H. pylori and the gastric biopsy results were not associated with any of the duodenal biopsy results. CONCLUSION The burden of H. pylori infection in patients with dyspepsia was high. H. pylori was detected at various precancerous lesions with varying significance. The prevalence of duodenal adenocarcinoma in dyspeptic patients is unexpectedly high. No association between gastric and duodenal pathologies was found.
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Affiliation(s)
- Youssef Ghosn
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | | | - Antonios Tawk
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Naseem Bou-Ayash
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Haneen Bou-Ayash
- Faculty of Health and Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nader Mokamer
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Rawad Yared
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Mouna Aoun
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Salem Khoury
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - George Cortas
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Gide Jabbour
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Khalil Bedran
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Said Farhat
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
- Saint George Hospital University Medical Center, Beirut, Lebanon
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Bravo D, Hoare A, Soto C, Valenzuela MA, Quest AFG. Helicobacter pylori in human health and disease: Mechanisms for local gastric and systemic effects. World J Gastroenterol 2018; 24:3071-3089. [PMID: 30065554 PMCID: PMC6064966 DOI: 10.3748/wjg.v24.i28.3071] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/17/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is present in roughly 50% of the human population worldwide and infection levels reach over 70% in developing countries. The infection has classically been associated with different gastro-intestinal diseases, but also with extra gastric diseases. Despite such associations, the bacterium frequently persists in the human host without inducing disease, and it has been suggested that H. pylori may also play a beneficial role in health. To understand how H. pylori can produce such diverse effects in the human host, several studies have focused on understanding the local and systemic effects triggered by this bacterium. One of the main mechanisms by which H. pylori is thought to damage the host is by inducing local and systemic inflammation. However, more recently, studies are beginning to focus on the effects of H. pylori and its metabolism on the gastric and intestinal microbiome. The objective of this review is to discuss how H. pylori has co-evolved with humans, how H. pylori presence is associated with positive and negative effects in human health and how inflammation and/or changes in the microbiome are associated with the observed outcomes.
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Affiliation(s)
- Denisse Bravo
- Oral Microbiology Laboratory, Pathology and Oral Medicine Department, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Anilei Hoare
- Oral Microbiology Laboratory, Pathology and Oral Medicine Department, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Cristopher Soto
- Oral Microbiology Laboratory, Pathology and Oral Medicine Department, Faculty of Dentistry, Universidad de Chile, Santiago 8380492, Chile
| | - Manuel A Valenzuela
- Advanced Center for Chronic Diseases, Institute for Health-Related Research and Innovation, Faculty of Health Sciences, Universidad Central de Chile, Santiago 8380447, Chile
| | - Andrew FG Quest
- Advanced Center for Chronic Diseases, Center for Studies on Exercise, Metabolism and Cancer, Biomedical Science Institute, Faculty of Medicine, Universidad de Chile, Santiago 8380447, Chile
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