Helicobacter pylori infection with atrophic gastritis: An independent risk factor for colorectal adenomas

BACKGROUND The significance of Helicobacter pylori(H.pylori)infection and atrophic gastritis(AG)in the prevalence of colorectal adenomas has been examined in a limited number of studies.However,these studies reported disputed conclusions.AIM To investigate whether H.pylori infection,AG,and H.pylori-related AG increase the risk of colorectal adenomas.METHODS This retrospective cross-sectional study included 6018 health-check individuals.The relevant data for physical examination,laboratory testing,13C-urea breath testing,gastroscopy,colonoscopy and histopathological examination of gastric and colorectal biopsies were recorded.Univariate and multivariate logistic regression analyses were performed to determine the association between H.pylori-related AG and colorectal adenomas.RESULTS Overall,1012 subjects(16.8%)were diagnosed with colorectal adenomas,of whom 143(2.4%)had advanced adenomas.Among the enrolled patients,the prevalence of H.pylori infection and AG was observed as 49.5%(2981/6018)and 10.0%(602/6018),respectively.Subjects with H.pylori infection had an elevated risk of colorectal adenomas(adjusted odds ratio[OR]of 1.220,95%confidence interval(CI):1.053-1.413,P=0.008)but no increased risk of advance adenomas(adjusted OR=1.303,95%CI:0.922-1.842,P=0.134).AG was significantly correlated to an increased risk of colorectal adenomas(unadjusted OR=1.668,95%CI:1.352-2.059,P<0.001;adjusted OR=1.237,95%CI:0.988-1.549,P=0.064).H.pylori infection accompanied by AG was significantly associated with an increased risk of adenomas(adjusted OR=1.491,95%CI:1.103-2.015,P=0.009)and advanced adenomas(adjusted OR=1.910,95%CI:1.022-3.572,P=0.043).CONCLUSION H.pylori-related AG was associated with a high risk of colorectal adenomas and advanced adenomas in Chinese individuals.

Late-onset Juvenile Myoclonic Epilepsy or Frontal Lobe Epilepsy with Myoclonus

To the Editor：The term myoclonus refers to a form of fast,transient,lightning-like muscle twitch that originates in the nervous system.It is usually a manifestation of neurological dysfunction or intractable epilepsy and is clinically divided into cortical myoclonus,spinal myoclonus,physiological myoclonus,etc.It is also categorized as epileptic myoclonus or nonepileptic myoclonus.Juvenile myoclonic epilepsy （JME） is the most common form of epileptic myoclonus,while frontal lobe epilepsy （FLE） with myoclonus is relatively rare.The clinical manifestations of these two forms of epilepsy include shock-like muscle activity appearing in the upper limbs or involving the shoulder and arms together,with irregular and arrhythmic clonus in the morning after waking up that typically results in an involuntary hurtling of objects held in the hands.It is hard to make a distinction between the two conditions clinically.Herein,we report a case of FLE with myoclonus to provide clues to distinguish between the two.