Disease trends after Helicobacter pylori eradication based on Japanese nationwide claims and the health check-up database

BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavorable effects of eradication therapy have also been reported in some diseases,such as gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),inflammatory bowel disease(IBD),allergic diseases,and metabolic diseases.Consequently,both positive and negative impacts should be considered when assessing the effects of H.pylori eradication therapy.AIM To compare the incidence of these diseases before and after H.pylori eradication and to comprehensively assess its effects.METHODS This retrospective cohort study used a Japanese nationwide health claims database(April 2009-March 2020),developed by the Japanese Ministry of Health,Labour and Welfare.The database contained almost all health insurance claims data issued in Japan,and specific health check-up data for individuals who took the check-ups.Descriptive statistics were used for the analyses.Patients who received primary eradication therapy were defined as those prescribed medication for H.pylori eradication.New diagnoses,defined as incidence of upper gastrointestinal diseases and IBD,and prevalence of allergic diseases were compared before and after eradication.The incidence and prevalence of each disease were also compared between the 3-year period before eradication(from the 4th to the 2nd year prior to the year of eradication)and the 3-year period after eradication(from the 1st to the 3rd year after the year of eradication)based on the age category and calendar year and month.Changes in body mass index and proportion of patients with metabolic syndrome(MS)were examined before and after eradication.RESULTS We identified 5219731 patients who received primary eradication therapy.The 65-69 years age group had the greatest number of patients in both sexes.There was no significant increase in the incidence of GERD after eradication when considering the effects of aging and reporting period.However,the incidence of BE was higher in the 3-year period after eradication than in the 3-year period before eradication for all age categories(0.02%-0.10%vs<0.01%-0.05%).The incidence of IBD and prevalence of allergic disease were also higher after eradication.In contrast,the incidence of gastric and duodenal ulcers and gastritis was reduced after eradication.In patients with at least one entry of health check-up data(1701111 patients),the percentage of patients with MS showed a slight increase following eradication(11.0%in the year of eradication and 12.2%after 5 years).CONCLUSION The results suggest that H.pylori eradication therapy reduces peptic ulcers and gastritis;however,it is associated with increased incidence of several other chronic diseases.

Aspirin-induced small bowel injuries and the preventive effect of rebamipide

AIM:To evaluate the influence of taking low-dose aspirin for 4 wk on small intestinal complications and to examine the preventive effect of rebamipide.METHODS:This study was conducted as a single-center,randomized,double-blind,cross-over,placebo-controlled study.Eleven healthy male subjects were enrolled.Each subject underwent video capsule endos-copy after 1 and 4 wk of taking aspirin and omepra-zole,along with either rebamipide or placebo therapy.The primary endpoint was to evaluate small bowel damage in healthy subjects before and after taking low-dose aspirin for 4 wk.RESULTS:The number of subjects with mucosal breaks(defined as multiple erosions and/or ulcers)were 1 at 1 wk and 1 at 4 wk on the jejunum,and 6 at 1 wk(P = 0.0061)and 7 at 4 wk on the ileum(P =0.0019).Rebamipide significantly prevented mucosal breaks on the ileum compared with the placebo group(P = 0.0173 at 1 wk and P = 0.0266 at 4 wk).CONCLUSION:Longer-term,low-dose aspirin adminis-tration induced damage in the small bowel.Rebamipide prevented this damage,and may be a candidate drug for treating aspirin-induced small bowel complications.

COVID-19 vaccination and liver disease

Various vaccines against severe acute respiratory syndrome coronavirus 2 have been developed in response to the coronavirus disease 2019(COVID-19)global pandemic,several of which are highly effective in preventing COVID-19 in the general population.Patients with chronic liver diseases(CLDs),particularly those with liver cirrhosis,are considered to be at a high risk for severe COVID-19 and death.Given the increased rates of disease severity and mortality in patients with liver disease,there is an urgent need to understand the efficacy of vaccination in this population.However,the data regarding efficacy and safety of COVID-19 vaccination in patients with CLDs is limited.Indeed,several organ-specific or systemic immune-mediated side effects following COVID-19 vaccination,including liver injury similar to autoimmune hepatitis,have been recently reported.Although the number of cases of vaccine-related liver injury is increasing,its frequency,clinical course,and mechanism remain unclear.Here,we review the current findings on COVID-19 vaccination and liver disease,focusing on:(1)The impact of COVID-19 in patients with CLD;(2)The efficacy,safety,and risk-benefit profiles of COVID-19 vaccines in patients with CLD;and(3)Liver injury following COVID-19 vaccination.