Helicobacter pylori in gastric biopsies of Taiwanese patients with gastroduodenal diseases

Declining trends of prevalence of Helicobacter pylori infection and incidence of gastric cancer in Taiwan: An updated cross-sectional survey and meta-analysis

BACKGROUND

We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan.

MATERIALS AND METHODS

Adults naive to H. pylori eradication received ¹³ C-urea breath test (¹³ C-UBT), H. pylori stool antigen test, and serology test during 2019-2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received ¹³ C-UBT for H. pylori screening. We also conducted a systematic review and meta-analysis to assess the secular trend of prevalence of H. pylori from 1990 to 2020 in Taiwan. The secular trends of age-standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry.

RESULTS

A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection by ¹³ C-UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age-standardized prevalence of active H. pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta-analysis, the pooled prevalence of H. pylori infection decreased from 63.8% (95% CI: 55.9%-71%) in 1990-2000 to 28.2% (95% CI:21.8%-35.6%) in 2016-2020. The age-standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019.

CONCLUSIONS

The prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age-standardized incidence and mortality of gastric cancer in Taiwan.

The association of ABO blood group with the asymptomatic COVID-19 cases in India

The COVID-19 pandemic resulted in multiple waves of infection worldwide. The large variations in case fatality rate among different geographical regions suggest that the human susceptibility against this virus varies substantially. Several studies from different parts of the world showed a significant association of ABO blood group and COVID-19 susceptibility. It was demonstrated that individuals with blood group O are at the lower risk of coronavirus infection. To establish the association of ABO blood group in SARS-CoV-2 susceptibility, we for the first time analysed SARS-CoV-2 neutralising antibodies among 509 individuals, collected from three major districts of Eastern Uttar Pradesh region of India. Interestingly, we found neutralising antibodies in a significantly higher percentage of people with blood group AB (0.36) followed by B (0.31), A (0.22) and lowest in people with blood group O (0.11). We further estimated that people with blood group AB are at comparatively higher risk of infection than other blood groups. Thus, among the asymptomatic SARS-CoV-2 recovered people blood group AB has highest, whilst individuals with blood group O has lowest risk of infection.

Association of blood groups on the risk of COVID-19 infection, morbidity, and mortality

OBJECTIVE:

We aimed to compare the effects of blood groups and Rh factor on the development of coronavirus-19 disease (COVID-19) with all aspects such as clinical course, inflammatory parameters, and organ-specific biochemical parameters with a significant number of patients.

METHODS:

This multicenter study was carried out retrospectively on 3551 patients hospitalized with the diagnosis of COVID-19 and whose blood groups were recorded during the time of hospitalization. As control groups, 22133 individuals’ medical data who were admitted to the blood bank affiliated with our hospitals during the last year was used. The differences between the blood groups and clinical characteristics were analyzed.

RESULTS:

Of the 3551 patients, A Rh (+) blood group was found to be in a higher ratio in the case group than controls, with increased risk to be infected (case: 41.3% vs. control: 38.8%), (OR 1.113; 95% CI: 1.036–1.197; p=0.003). Meanwhile O Rh (+) blood group ratios were significantly lower in the case group than in the control group (case: 26% vs. control: 28.3%) (OR 0.862; 95% CI: 0.823–0.966; p=0.005). There was no significant difference between blood groups in terms of admission to the intensive care units and mortality, it was observed that patients with AB Rh (+) blood group have a greater risk for intubation than others (OR: 1.467; 95% CI: 1.040–2.071; p=0.028).

CONCLUSION:

We demonstrated that people with blood group A Rh (+) more susceptible to COVID-19, whereas blood group 0 Rh (+) have a protective effect against the infection. Once a person has been infected with severe acute respiratory syndrome coronavirus 2, we should be mindful that patients with blood group AB Rh (+) would be prone to intubation more than other blood groups.

ABO blood group and COVID-19: an updated systematic literature review and meta-analysis

BACKGROUND

Following the first reports in the literature, the association between the ABO blood group and SARS-CoV-2 infection has been investigated by a number of studies, although with varying results. The main object of this systematic review was to assess the relationship between the ABO blood group and the occurrence and severity of COVID-19.

MATERIALS AND METHODS

A systematic literature search using appropriate MeSH terms was performed through Medline and PubMed. The outcomes considered were the prevalence of the blood group O vs non-O types in SARS-CoV-2 infected and non-infected subjects, and the severity of SARS-CoV-2 infection according to ABO group. The methodological quality of the studies included in the analysis was assessed with the Newcastle-Ottawa Scale, and the overall quality of the available evidence using the GRADE system. Benchmarks used to evaluate the effect size were odd ratios (ORs) for case control studies and risk ratios (RRs) for cohort studies.

RESULTS

Twenty-one studies were included in the analysis. Overall, individuals with group O had a lower infection rate compared to individuals of non-O group (OR: 0.81; 95% CI: 0.75, 0.86). However, the difference in the effect size was significantly lower in cohort studies compared to case control studies. No evidence was found indicating an effect of the O type on the disease severity in the infected patients.

DISCUSSION

We have found low/very low evidence that group O individuals are less susceptible to SARS-CoV-2 infection compared to those in the non-O group. No evidence was found indicating an effect of the O type on disease severity in SARS-CoV-2 infection.

Relationship between blood group and risk of infection and death in COVID-19: a live meta-analysis

The relationship between ABO blood group and the incidence of coronavirus disease 2019 (COVID-19) infection and death has been investigated in several studies. The reported results were controversial, so the objective of the present study was to assess the relationship between different blood groups and the onset and mortality of COVID-19 infection using a meta-analysis method. We searched relevant databases using appropriate MeSH terms. We screened articles on the bases of titles, abstracts and full text, and articles that met the inclusion criteria were selected. Quality assessment was done with the Newcastle-Ottawa scale checklist. The estimated frequency of COVID-19 infection and death in terms of ABO blood group and the overall estimate of the odds ratio between blood group with COVID-19 infection and death was calculated with 95% confidence interval. The pooled frequency of blood groups A, B, O and AB among COVID-19-infected individuals was estimated as 36.22%, 24.99%, 29.67% and 9.29% respectively. The frequency of blood groups A, B, O and AB among patients who died of COVID-19 infection was estimated as 40%, 23%, 29% and 8% respectively. The odds ratio of COVID-19 infection for blood group A versus the other blood groups was estimated as 1.16 (95% confidence interval (CI), 1.02-1.33). The corresponding figures for blood groups O and AB versus other blood groups were estimated as 0.73 (95% CI, 0.60-0.88) and 1.25 (95% CI, 0.84-1.86) respectively. This meta-analysis showed that individuals with blood group A are at higher risk for COVID-19 infection while those with blood group O are at lower risk. Although the odds ratio of death for AB blood group was nonsignificant, it was considerable.

Effects of Anti-Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases

BACKGROUND & AIMS

Helicobacter pylori induces immune tolerance and is associated with a lower risk for immune-mediated disorders, such as autoimmune and inflammatory bowel diseases (IBD). We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease and IBD.

METHODS

We collected data from the National Health Insurance Research Database in Taiwan on patients younger than 18 years old without a prior diagnosis of autoimmune disease or IBD. Patients with peptic ulcer disease (PUD) with treatment of H pylori infection (PUD+HPRx), PUD without H pylori treatment (PUD-HPRx), a urinary tract infection (UTI) treated with cephalosporin, or without PUD (controls) were matched for age, sex, insurance, and Charlson's comorbidity index score.

RESULTS

Of the 1 million patients we collected data from in 2005, we included 79,181 patients in the study. We compared the effects of treatment for H pylori infection on the risk of autoimmunity or IBD and found that PUD+HPRx has the highest adjusted hazard risk (aHR) for autoimmunity or IBD (aHR, 2.36), compared to PUD-HPRx (aHR, 1.91) or UTI (aHRs, 1.71) (P < .001). The increased risk of autoimmune disease was not completely accounted for by antibiotic therapy alone, because PUD+HPRx had a higher aHR than UTI (P < .001). A small but significant increase in mortality was observed in the PUD+HPRx cohort (aHR, 1.11; P = .001).

CONCLUSION

In an analysis of data from the National Health Insurance Research Database in Taiwan, we found that treatment for H pylori infection is associated with a significant increase in the risk for autoimmune disease, including IBD.

Relation between ABO blood groups and Helicobacter pylori infection in symptomatic patients

Epidemiological studies have demonstrated higher frequencies of the O blood group and the nonsecretor phenotype of ABH antigens among patients suffering from peptic ulcers. Since Helicobacter pylori has been established as the main etiological factor in this disease, controversies about the associations of the ABO and Lewis blood group phenotypes and secretor and nonsecretor phenotypes in relation to susceptibility towards infection by this bacillus have been presented. The aim of this study was to verify the frequencies of ABO and Rhesus (Rh) blood groups in H. pylori seropositive symptomatic patients. The study included (n = 1108) patients with dyspepsia symptoms referred from an outpatient clinic in Erbil city for investigation. Age, sex, and residency were recorded as a routine laboratory framework. Patients underwent SD Bioline (Standard Diagnostics Inc, Kyonggi-do, South Korea) and enzyme-linked immunosorbent assay serologic tests for H. pylori. ABO blood group phenotypes were determined by a standard hemagglutination test. Results showed that 64.8% of patients (n = 718/1108) were seropositive for H. pylori infection, and (35.2%) (n = 390/1108) were seronegative. Of the seropositive patients, 40.8% (n = 293/718) were male and 59.2% (n = 425/718) were female; while of the seronegative patients, 46.7% (n = 182/390) were male and 53.3% (n = 208/390) were female. The mean age for seropositives and seronegatives was (38.0 ± 14.6) years and (37.6 ± 15.7) years respectively. The frequency of the ABO and Rh-positive (Rh+) blood groups among seropositive patients was (A = 32.0%, B = 19.5%, AB = 6.7%, O = 41.8%, and Rh+ = 92.5%) and was (A = 32.3%, B = 28.2%, AB = 8.0%, O = 31.5%, and Rh+ = 92.5%) in seronegatives. The results of this study suggest that ABO blood groups, age, and gender influence seropositivity for H. pylori infection.

Risk of gastric cancer and peptic ulcers in relation to ABO blood type: a cohort study

Blood group A was found to be associated with gastric cancer in the 1950s. Strikingly, for peptic ulcers an increased risk has been shown for blood group O. However, previous investigations have generally been poorly conducted and have failed to take a unifying approach to these observations. Using the Scandinavian Donations and Transfusions (referred to as "SCANDAT") database, the authors established a cohort of Swedish and Danish blood donors with known blood type and followed these for the occurrence of gastric cancer and peptic ulcers through December 31, 2002. Cases were ascertained by using nationwide cancer and hospital registers. Altogether, 1,089,022 donors were followed for up to 35 years, during which 688 gastric cancer cases and 5,667 peptic ulcer cases accrued. Poisson regression analyses confirmed an increased risk of gastric cancer among individuals with blood group A (incidence rate ratio = 1.20, 95% confidence interval: 1.02, 1.42) and conversely that peptic ulcer risk was instead highest among those with blood group O. In this large, population-based cohort study, the authors have confirmed the association between blood group A and gastric cancer. In addition, they give further support to the notion that individuals with blood group O have a higher risk of peptic ulcers than those with other blood groups.

Soroprevalência da infecção por Helicobacter pylori em crianças de diferentes níveis sócio-econômicos em Porto Velho, Estado de Rondônia

O estudo investigou a soroprevalência de infecção pelo Helicobacter pylori em 200 (subdivididas em 2 grupos) crianças da Cidade de Porto Velho, Rondônia. A prevalência da soropositividade variou consideravelmente de acordo com o nível sócio-econômico, onde 51% das crianças de baixo nível e 24% de classe média eram positivas. As características da população infantil relacionadas ao sexo, raça e dieta alimentar não representaram fatores de risco para a aquisição da infecção; porém, a maioria das infectadas pertencia à faixa etária de cinco ou mais anos, independente do nível sócio-econômico. A distribuição fenotípica dos grupos sanguíneos ABO, entre os indivíduos infectados e não infectados, mostrou4 que a sororeatividade ao Helicobacter pylori foi maior entre as crianças do grupo sanguíneo O, sugerindo que há uma maior susceptibilidade genética destas crianças para a infecção pelo Helicobacter pylori.

Polymorphism of CYPIA1 and GSTM1 genes associated with susceptibility of gastric cancer in Shandong Province of China

AIM: To explore whether polymorphisms of the CYPIA1 and GSTM1 genes are associated with susceptibility of stomach cancer.

METHODS: A total of 102 stomach cancer cases and 62 healthy persons were diagnosed by pathology in 1998-2000 in the Qilu Hospital of Shandong University. Gene polymorphisms were detected by the PCR using sequence-specific primers. Data analysis of the case-control study was carried out using the unconditional logistic method.

RESULTS: After adjustment for age, sex, educational levels, and occupation, the risk factors for stomach cancer were shown to be smoking, Helicobacter pylori (H pylori), and presence of the CYPIM G/G and GSTM1 O/O genotypes. Interaction was observed between the combined genotypes of either CYPIA1 G/G and GSTM1 O/O or H pylori infection, or GSTM1 O/O and H pylori infection or smoking.

CONCLUSION: Polymorphisms of the CYPIA1 and GSTM1 genes, H pylori infection and smoking are related to susce-ptibility to stomach cancer.

Seroprevalence of Helicobacter pylori in school-aged Chinese in Taipei City and relationship between ABO blood groups

AIM: To explore the seropositive rate of antibodies against H. pylori (anti-HP) in Taipei City and to compare the relationship of ABO blood groups and H. pylori infection.

METHODS: In 1993, high school students in Shih-Lin District were randomly selected for blood samplings by their registration number at school. In addition, similar procedures were performed on the well-children clinics of Taipei Veterans General Hospital. Besides, randomly selected sera from the adults who took the physical examination were recruited for evaluation. Informed consents were obtained from all the subjects before blood samplings and parents were simultaneously informed for those who were younger than 18-year-old. Blood tests for anti-HP and ABO blood groupings were performed by enzyme-linked immunosorbent assay. Chi square tests were used for the comparisons between seroprevalence of H. pylori and ABO blood groups.

RESULTS: Totally, 685 subjects were recruited (260 children aged 1-14 years, 425 high school students aged 15-18 years) were evaluated, and another 88 adult healthy volunteers were studied as well for comparison. The age-specific seropositive rate of anti-HP was 1.3% at age 1-5 years, 7.7% at age 6-10 years, and 11.5% at age 11-14 years. The seroprevalence of H. pylori infection was abruptly increased in young adolescence: 18.6% at age 15 years, 28.1% at age 16 years, 32.4% at age 17 years and 41.0% at age 18 years, respectively. In the 425 high school students, ABO blood groupings were performed, which disclosed 48.5% (206/425) of blood group O, 24% (102/425) of blood group A, 21.8% (93/425) of blood group B and 5.6% (24/425) of blood group AB. In comparison of the subjects with blood group O and the other blood groups, no statistical significance could be identified in the seroprevalence of H. pylori (P = 0.99).

CONCLUSION: The seroprevalence of H. pylori infection in Taipei City in adults is similar to the developed countries, and the abrupt increase of H. pylori during high school may be resulted from marked increase of interpersonal social activities. Although blood group O was reported to be related to H. pylori infection in previous literature, we found no association between H. pylori infection and ABO blood groups.

ABO, Lewis, secretor and non-secretor phenotypes in patients infected or uninfected by the Helicobacter pylori bacillus

CONTEXT

Epidemiological studies have demonstrated higher frequencies of the O blood group and the non-secretor phenotype of ABH antigens among patients suffering from peptic ulcers. Since Helicobacter pylori has been established as the main etiological factor in this disease, controversies about the associations of the ABO and Lewis blood group phenotypes and secretor and non-secretor phenotypes in relation to susceptibility towards infection by this bacillus have been presented.

OBJECTIVE

To verify the frequencies of ABO, Lewis blood group phenotypes, secretor and non-secretor phenotypes in patients infected or uninfected by H. pylori.

DESIGN

Cross-sectional study.

SETTING

Outpatient clinic.

PARTICIPANTS

One hundred and twenty patients with dyspeptic symptoms who underwent endoscopy.

MAIN MEASUREMENTS

ABO and Lewis blood group phenotypes were determined by a standard hemagglutination test and the secretor and non-secretor phenotypes were evaluated by saliva samples using the inhibitor hemagglutination test.

RESULTS

The diagnosis of infection, made via breath and urea tests and confirmed using polymerase chain reaction (PCR) in gastric biopsy fragments, showed the presence of H. pylori in 61.7% of the patients and absence in 38.3%. The differences between the frequencies of the ABO blood group phenotypes among infected (A 27.0%; B 12.2%; AB 4.0% and O 56.8%) and uninfected patients (A 58.7%; B 13.0%; AB 4.3% and O 24.0%) were significant. The Lewis blood type, secretor and non-secretor phenotypes showed homogeneous distribution between the groups of patients analyzed.

CONCLUSIONS

Our results suggest that the infection of H. pylori can be related to ABO blood groups but not to the Lewis blood group nor to secretor and non-secretor phenotypes.

Genetic analysis and clinical evaluation of vacuolating cytotoxin gene A and cytotoxin-associated gene A in Taiwanese Helicobacter pylori isolates from peptic ulcer patients

The aims of this study were to investigate the cytotoxin-associated gene A (cagA) and vacuolating cytotoxin gene A (vacA) subtype in Taiwanese H. pylori isolates from patients with gastroduodenal diseases and to assess the relationship between genotypes of isolates and clinical features. The vacA s1a allele was found in all isolates and vacA m1 allele was found in 15% of isolates. The cagA gene was found in 82.5% of isolates. The vacA s1a/m2 strains had a significantly higher prevalence rate than vacA s1a/m1 strains in Taiwan (p < 0.05). By aligning and comparing the nucleotide and amino acid sequences of vacA from the Taiwanese isolates, the signal sequence and N-terminal region were found to be highly conserved, but the middle region was found to be highly heterogeneous. Determining the relationship between the genotypes and clinical features, we found that the cagA gene was more closely associated with duodenal ulcer than with gastric ulcer and the vacA s1a/m2 strain was more closely associated with active chronic gastritis and atrophic gastritis than with chronic gastritis. Together, our results indicated that (i) the middle region of vacA gene in Taiwanese isolates was heterogeneous; (ii) s1a/m2 vacA strains had a high prevalence in Taiwanese peptic ulcers; and (iii) the cagA gene was significantly associated with duodenal ulcer.