Effect of Helicobacter pylori eradication on gastric hyperplastic polyposis in Cowden’s disease

FANCA D1359Y mutation in a patient with gastric polyposis and cancer susceptibility: A case report and review of literature

Gastric polyposis is a rare disease. Not all polyps progress to cancer. Monoallelic mutation in Fanconi anemia (FA) genes, unlike biallelic gene mutations that causes typical FA phenotype, can increase risks of cancers in a sporadic manner. Aberrations in the FA pathway were reported in all molecular subtypes of gastric cancer. We studied a patient with synchronous gastric cancer from gastric polyposis by conducting a 13-year long-term follow up. Via pathway-driven massive parallel genomic sequencing, a germline mutation at FANCA D1359Y was identified. We identified several recurrent mutations in DNA methylation (TET1, V873I), the β-catenin pathway (CTNNB1, S45F) and RHO signaling pathway (PLEKHG5, R203C) by comparing the genetic events between benign and malignant gastric polyps. Furthermore, we revealed gastric polyposis susceptible genes and genetic events promoting malignant transformation using pathway-driven targeted gene sequencing.

[Cowden syndrome]

INTRODUCTION

Cowden syndrome is rare; oral symptoms are not always diagnosed. This case of Cowden syndrome was revealed by gingival hypertrophy.

OBSERVATION

A 21-year-old female patient consulted for gingival hypertrophy and multiple papules in the mouth. She had a history of thyroid lobectomy due to a goiter. The gingival papillomatosis and the goiter suggested a Cowden syndrome. The diagnosis was confirmed clinically by facial skin papules.

DISCUSSION

Cutaneous and oral lesions are usually the first symptoms of the syndrome. Diffuse gingival papillomatosis may suggest a Cowden syndrome and should lead to screen for associated symptoms. A high-risk diagnosis of breast and thyroid cancer is associated to Cowden syndrome and the patient should have a yearly follow-up.

Association between helicobacter pylori infection and serum iron profile

BACKGROUND

It is clear that Helicobacter pylori (H. pylori) is a spiral bacterium that infects human and causes gastritis and peptic ulcer. The aim of this study was to determine the relationship between H .pylori infection and the iron status of the body.

METHODS

This study was conducted in Shahid Beheshti Hospital of Babol University of Medical Sciences, Babol, Iran from August 2007 to July 2008. The study group consisted of 35 patients with H. pylori and 35 matched healthy subjects as the control group. The members of both groups were enrolled in the study voluntarily. Serum iron and total iron- binding capacity were measured by Darman-kav Standard kit. Ferritin was measured by Padtan-e-Elm Standard kit. The Collected data were analyzed by SPSS version 16. p-value of <0.05 was considered significant.

RESULTS

The serum iron and total iron-binding capacity in H. pylori positive group were lower than in the control group (108.67±31.26 vs. 110.92±28.45 µg/dL, p=0.578) and (327.88±81.39 vs. 342.51±79.45 µg/dL, p=0.153) respectively. The mean of ferritin was significantly lower in H.pylori positive group (210.51±132.01 ng/ml, p=0.047) than H.pylori negative group (265.03±170.79 ng/mL, p=0.047).

CONCLUSION

The results of the present study show that serum iron and total iron binding capacity in H.pylori infected group was lower than the control group. H.pylori may impair iron metabolism. It is possible that H.pylori may both directly compete with the host for available iron by impairing its uptake.

Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition

BACKGROUND

Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. Accordingly, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan.

MATERIALS AND METHODS

Four meetings of guidelines preparation committee were held from July 2007 to December 2008. In the new guidelines, recommendations for treatment have been classified into five grades according to the Minds Recommendation Grades, while the level of evidence has been classified into six grades. The Japanese national health insurance system was not taken into consideration when preparing these guidelines.

RESULTS

Helicobacter pylori eradication therapy achieved a Grade A recommendation, being useful for the treatment of gastric or duodenal ulcer, for the treatment and prevention of H. pylori-associated diseases such as gastric cancer, and for inhibiting the spread of H. pylori infection. Levels of evidence were determined for each disease associated with H. pylori infection. For the diagnosis of H. pylori infection, measurement of H. pylori antigen in the feces was added to the tests not requiring biopsy. One week of proton-pump inhibitor-based triple therapy (including amoxicillin and metronidazole) was recommended as second-line therapy after failure of first-line eradication therapy.

CONCLUSION

The revised Japanese guidelines for H. pylori are based on scientific evidence and avoid the administrative restraints that applied to earlier versions.

Isolated diffuse hyperplastic gastric polyposis presenting with severe anemia

Introduction

Gastric polyps exist in a wide variety of types, most of which are small and often benign. Discovery of gastric polyps during Endoscopy necessitates biopsies.

Case presentation

We present a case report of an isolated diffuse hyperplastic gastric polyposis in a 26 years old Hispanic female when she was investigated for profound anemia. The Esophagogastroduodenoscopy revealed numerous gastric polyps filling the entire stomach. She was treated with near-total gastrectomy and her anemia resolved

Conclusion

Isolated diffuse hyperplasic gastric polyposis with normal gastrin level is a rare entity and can present with severe anemia.