Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?

AIM:To investigate the effects of Helicobacter pylori (H pylori)eradication therapy for treatment of peptic ulcer on the incidence of gastric cancer. METHODS:A multicenter prospective cohort study was conducted between November 2000 and December 2007 in Yamagata Prefecture,Japan.The study included patients with H pylori-positive peptic ulcer who decided themselves whether to receive H pylori eradication(eradication group)or conventional antacid therapy(non-eradication group).Incidence of gastric cancer in the two groups was determined based on the results of annual endoscopy and questionnaire surveys,as well as Yamagata Prefectural Cancer Registry data,and was compared between the two groups and by results of H pylori therapy.RESULTS:A total of 4133 patients aged between 13 and 91 years(mean 52.9 years)were registered,and 56 cases of gastric cancer were identified over a mean follow-up of 5.6 years.The sex-and age-adjusted incidence ratio of gastric cancer in the eradication group, as compared with the non-eradication group,was 0.58 (95%CI:0.28-1.19)and ratios by follow-up period(<1 year,1-3 years,>3 years)were 1.16(0.27-5.00),0.50 (0.17-1.49),and 0.34(0.09-1.28),respectively.Longer follow-up tended to be associated with better prevention of gastric cancer,although not to a significant extent.No significant difference in incidence of gastric cancer was observed between patients with successful eradication therapy(32/2451 patients,1.31%)and those with treatment failure(11/639 patients,1.72%).Among patients with duodenal ulcer,which is known to be more prevalent in younger individuals,the incidence of gastric cancer was significantly less in those with successful eradication therapy(2/845 patients,0.24%)than in those with treatment failure(3/216 patients,1.39%). CONCLUSION:H pylori eradication therapy for peptic ulcer patients with a mean age of 52.9 years at registration did not significantly decrease the incidence of gastric cancer.

Lewis blood genotypes of peptic ulcer and gastric cancer patients in Taiwan

AIM: The Lewis b (Leb) antigen has been implicated as a possible binding site for attachment of Helicobacter pylori (H pylori)to gastric mucosa. However, studies both supporting and denying this association have been reported in the literature. Differences in secretor (Se)genotype have been suggested as a possible reason for previous discrepancies. Therefore, we investigated the relationship between Le and Se genotypes and H pylori infection rates in people with peptic ulcer or gastric cancer.METHODS: Peripheral blood samples were obtained from 347 patients with endoscopic evidence of peptic ulcer disease (235 cases of duodenal ulcer, 62 of gastric ulcer,and 50 of combined duodenal ulcer/gastric ulcer) and 51patients with gastric cancer on endoscopy. Peripheral blood specimens from 101 unrelated normal volunteers were used as controls. Lewis phenotype was determined using an antibody method, whereas Le and Se genotypes were determined by DNA amplification and restriction enzyme analysis. Gastric or duodenal biopsies taken from patients with endoscopic evidence of peptic ulcer or gastric cancer were cultured for H pylori. Isolates were identified as H pylori by morphology and production of urease and catalase. The H pylori infection status was also evaluated by rapid urease test (CLO test), and urea breath test (13C-UBT). Results of studies were analyzed by chi-square test (taken as significant).RESULTS: H pyloriwas isolated from 83.7% (303/347)of patients with peptic ulcer disease. Statistical analysis did not show any significant difference in Lewis phenotype or genotype between patients with and without H pylori infection. No significant association was found between Lewis genotype and peptic ulcer or gastric cancer.CONCLUSION: Lewis blood genotype or phenotype may not play a role in the pathogenesis of H pyloriinfection.However, bacterial strain differences and the presence of more than one attachment mechanism may limit the value of epidemiological studies in elucidating this matter.

Polymorphism of -765G > C COX-2 is a risk factor for gastric adenocarcinoma and peptic ulcer disease in addition to H pylori infection:A study from northern India

AIM: To investigate -765G > C COX-2 polymorphism and H pylori infection in patients with gastric adenocarcinoma, peptic ulcer disease (PUD) and non- ulcer dyspepsia (NUD). METHODS: We enrolled 348 adult patients (62 gastric adenocarcinoma, 45 PUD and 241 NUD) undergoing upper gastrointestinal endoscopy at two referral centers between September, 2002 and May, 2007. H pylori infection was diagnosed when any of the four tests (RUT, culture, histopathology and PCR) were positive. Genotyping for -765G > C polymorphism of COX-2 was performed by PCR-RFLP analysis. RESULTS: Frequency of C carrier had significantassociation with gastric adenocarcinoma as compared to NUD [77.4% vs 29%, P < 0.001, odds ratio (OR) 8.20; 95% confidence interval (95% CI), 4.08-16.47] and PUD (77.4% vs 31.1%, P < 0.001; OR 8.04; 95% CI, 3.25-19.90). Risk of gastric adenocarcinoma was significantly higher in patients having C carrier with (OR 7.83; 95% CI 3.09-19.85) and without H pylori infection (OR 7.06; 95% CI, 2.61-19.09). Patients with C carrier and H pylori infection had significant risk for the development of PUD (P < 0.001; OR 5.65; 95% CI, 2.07-15.34). CONCLUSION: -765G > C COX-2 polymorphism with or without H pylori could be a marker for genetic susceptibility to gastric adenocarcinoma. COX-2 polymorphism in presence of H pylori infection might be useful in predicting the risk of PUD.

Association of Helicobacter pylori babA2 with peptic ulcer disease and gastric cancer

AIM: To investigate the association between babA2 gene and peptic ulcer disease (PUD) and gastric cancer (GC) in Helicobacter pylori -infected populations. METHODS: We evaluated the relationship between babA2 and clinical outcomes (PUD and GC) using a meta-analysis. A literature search was performed using the PubMed and Web of Science databases for relevant case-control studies that met the defined inclusion criteria. The ORs and 95%CIs were calculated to estimate the association between babA2 genotype and clinical outcomes. A fixed-effect or random-effect model was performed depending on the absence or presence of significant heterogeneity. RESULTS: A total of 25 articles with 38 studies met the inclusion criteria and were finally included in this metaanalysis. The results showed that the babA2 genotype was significantly associated with an increased risk of PUD (OR = 2.069, 95%CI: 1.530-2.794, P < 0.001) and especially in the subgroup of duodenal ulcer (OR = 1.588, 95%CI: 1.141-2.209, P = 0.006). Moreover, a significant association between babA2 gene and PUD and duodenal ulcer (OR = 2.739, 95%CI: 1.860-4.032, P < 0.001; OR = 2.239, 95%CI: 1.468-3.415, P < 0.001, respectively) was observed in western countries but not in Asian countries. CONCLUSION: We demonstrated that the presence of babA2 may be associated with increased risks for PUD, especially duodenal ulcer, in western countries.

Gastric emptying and plasma levels of gastrointestinal hormones in patients with peptic ulcer

ＧａｓｔｒｉｃｅｍｐｔｙｉｎｇａｎｄｐｌａｓｍａｌｅｖｅｌｓｏｆｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌｈｏｒｍｏｎｅｓｉｎｐａｔｉｅｎｔｓｗｉｔｈｐｅｐｔｉｃｕｌｃｅｒＣＨＥＮＪｉａｎ，ＬＩＪｕｎＭａｎ，ＬＩＸｕｅＨｕｉ，ＨＡＯＨｏｎｇＳｈｅｎｇａｎ...

The new proof of neuro-endocrine-immune network-expression of islet amyloid polypeptide in plasma cells in gastric mucosa of peptic ulcer patients

INTRODUCTION Peptic ulcer,as a common disease,seriouslyaffected people’s,work and life.Its occurrence,development and change have close relationshipwith the change of people’s moods.Animalexperiment proved that significant changes occurredin the endocrine system of the gastric ulcer rats.

Changes of Gastric Mucosal Blood Flow in the Healing Process of Peptic Ulcers

Changes of gastro-duodenal mucosal blood flow (GDMBF) in the healingprocess of 82 patients with gastric ulcer,130 with duodenal ulcer and 9 with active ul-cer induced by gastric polypectomy were studied by endoscopic laser Doppler flowme-try.In 108 normal subjects,the mucosal blood flow at the angle and antrum of the les-ser curvature and on the anterior wall of the duodenal bulb was the smallest (P【0.01).In patients with gastric ulcer,gastric mucosal blood flow (GMBF)significantly decrea-Sed at the active stage and increased at the healing stage (P【0.01 ).GDMBF significan-tly increased (P【0.01) at the active stage and returned to normal at the healing stage ofduodenal ulcer.GDMBF was unchanged in the healing process of the active ulcer inducedby gastric polypectomy.The mucosal blood flow at ulcer centre and margins significan-tly decreased at the active stage and markedly increased at the healing stage as compa-red with that of surrounding mucosa.We conclude that GMBF plays an importantrole in the developing and healing process of peptic ulcers.

H pylori infection and other risk factors associated with peptic ulcers in Turkish patients: A retrospective study

AIM: To identify and evaluate the relative impact of H pylori infection and other risk factors on the occurrence of gastric ulcer (GU), duodenal ulcer (DU) and gastritis in Turkish patients. METHODS: A total of 4471 patients (48.3% female) out of 4863 attended the Samatya hospital in Istanbul (June 1999 - October 2003) were included. The records of H pylori status (CLO-test), endoscopic f indings of GU, DU and gastritis, personal habits (smoking, alcohol intake) and medication [non-steroidal anti-inflammatory drugs (NSAIDs), aspirin intake] were analyzed using multi-way frequency analysis. RESULTS: We have found that GU in the presence of H pylori had significant association with aspirin (P = 0.0001), alcohol (P = 0.0090) and NSAIDs (P = 0.0372). DU on the other hand had significant association with aspirin/ smoking/NSAIDs (P = 0.0259), aspirin/alcohol (P = 0.0002) and aspirin/smoking (P = 0.0233), also in the presence of H pylori. In the absence of H pylori GU had significant association with alcohol/NSAIDs (P = 0.0431), and NSAIDs (P = 0.0436). While DU in the absence of H pylori had significant association with smoking/alcohol/ NSAIDs (P = 0.0013), aspirin/NSAIDs (P = 0.0334), aspirin/alcohol (P = 0.0360). CONCLUSION: In the presence of H pylori, aspirin, alcohol and NSAIDs intake act as an independent risk factors that had an augmenting impact on the occurrence of GU and only together on the occurrence of DU in Turkish patients.

Serum positive cagA in patients with non-ulcer dyspepsia and peptic ulcer disease from two centers in different regions of Turkey

AIM: To investigate and compare frequencies of serum positive cagA in patients from two separate regions of Turkey who were grouped according to the presence of peptic ulcer disease or non-ulcer dyspepsia.METHODS: One hundred and eighty Helicobacter pyloripositive patients with peptic ulcer disease or non-ulcer dyspepsia were included in the study. One hundred and fourteen patients had non-ulcer dyspepsia and 66 had peptic ulcer disease (32 with gastric ulcers and/or erosions and 34with duodenal ulcers). Each patient was tested for serum antibody to H. pylori cagA protein by enzyme immunoassay.RESULTS: The total frequency of serum positive cagA in the study group was 97.2 %. The rates in the patients with peptic ulcers and in those with non-ulcer dyspepsia were 100% and 95.6%, respectively. These results were similar to those reported in Asian studies, but higher than those that have been noted in other studies from Turkey and Western countries.CONCLUSION: The high rates of serum positive cagA in these patients with peptic ulcer disease and non-ulcer dyspepsia were similar to results reported in Asia. The fact that there was high seroum prevalence regardless of ulcer status suggests that factors other than cagA might be responsible for ulceration or other types of severe pathology in H. pylori-positive individuals.

Accuracy of Helicobacter pylori serology in two peptic ulcer populations and in healthy controls

AIM: To estimate the test characteristics of Heli- cobacter pylori (Hpylori) serology and of C14-urea breath test (C14-UBT) in two different peptic ulcer populations and in community controls. Second, the aim was to explore the association between the level of H pylori IgG antibodies and severity of inflammation as to active peptic ulceration in the same populations. METHODS: Vagotomized (n= 83), medically treated peptic ulcer patients (n=73) and one reference group of community controls (n=88) were gastroscoped. H pylori status was determined by histology, bacterial growth, C14-UBT and serology. Based on the updated Sydney System, cumulative scores from biopsies from the prepyloruos, incisura angularis, corpus and fundus were calculated. RESULTS: The prevalence of H pylori infection varied from 70% to 79%. The C14-UBT had high accuracycompared to the serology test. The sensitivity of the serology test was good, but the specificity was low (41%-71%). The association between H pylori IgG antibodies and scores of gastric mucosal inflammation and current or previous peptic ulcer were weak. CONCLUSION: The accuracy of C14-UBT to diagnose H pylori infection was good, and the clinical utility of a negative H pylori serology test was substantial, while the gain in clinical information of a positive test was meagre. Positive H pylori titres could not distinguish between subjects with or those without active peptic ulceration.

瑞巴派特联合三联疗法治疗老年消化性胃溃疡的临床效果分析

目的探讨老年消化性胃溃疡采用瑞巴派特联合三联疗法治疗的临床效果。方法选择丹徒区人民医院2020年4月至2023年10月收治的老年消化性胃溃疡患者94例,按随机数表法分为两组,各47例。对照组采用常规三联疗法,观察组在此基础上加用瑞巴派特。对比两组临床治疗效果、症状改善时间、胃黏膜形态学与不良反应。结果较之对照组,观察组治疗总有效率更高,差异有统计学意义(P<0.05)。较之对照组,观察组恶心、嗳气、反酸及腹痛症状改善时间均更短,差异有统计学意义(P<0.05)。观察组治疗后胃黏膜厚度、腺体密度评分均较对照组低,差异有统计学意义(P<0.05)。两组不良反应总发生率对比,差异无统计学意义(P>0.05)。结论采用瑞巴派特联合三联疗法治疗老年消化性胃溃疡的效果确切、安全性高,对患者症状、胃黏膜形态的改善效果明显。

儿童消化性溃疡临床特征及危险因素分析

目的分析儿童消化性溃疡的临床特征及相关危险因素。方法选取2020年3月至2023年3月南阳医学高等专科学校第一附属医院收治的260例消化性溃疡患儿(设为溃疡组),以及260名健康儿童(设为健康组)作为研究对象,收集研究对象性别、年龄、家族史、饮食喜好以及患儿临床症状(呕吐、恶心、反酸、嗳气等)及体征(上腹压痛等)等情况,分析儿童消化性溃疡的临床特征,并采用多因素Logistic回归分析儿童消化性溃疡的相关危险因素。结果儿童消化性溃疡患儿中男性(8423%)多于女性(1577%),年龄以学龄期儿童(4692%)和青春期儿童(4077%)为主,溃疡类型以十二指肠溃疡(7115%)和单发溃疡(7269%)为主,主要临床表现为腹痛(7115%)、呕吐(6308%)和黑便(4885%),且腹痛部位主要为剑突下、脐周和上腹部,其中仅2212%表现为与进食相关。多因素Logistic回归分析结果显示,有家族史、喜好冷食、喜好酸辣、经常吃外卖、幽门螺杆菌感染、心理障碍、家庭不和睦、住校/小餐桌是儿童消化性溃疡的独立危险因素(95%CI为1848~32710、1040~3659、1334~11937、1182~11257、1499~9424、1935~20817、1188~6046、1178~4867,P=0005、0037、0013、0024、0004、0002、0017、0015)。结论儿童消化性溃疡以学龄期和青春期男性儿童为主,溃疡类型主要为十二指肠溃疡,临床表现主要为腹痛、呕吐和黑便;有家族史、喜好冷食、喜好酸辣、经常吃外卖、幽门螺杆菌感染、心理障碍、家庭不和睦、住校/小餐桌是儿童消化性溃疡的独立危险因素。

泮托拉唑联合胃镜喷洒血凝酶在消化性溃疡出血患者中的应用效果

目的:分析泮托拉唑联合胃镜喷洒血凝酶治疗消化性溃疡出血的疗效及安全性。方法:选取2022年1月—2023年1月莒南县人民医院收治的消化性溃疡出血患者88例为研究对象,随机分为对照组和研究组,各44例。对照组给予泮托拉唑治疗,研究组在对照组基础上给予胃镜喷洒血凝酶治疗。比较两组治疗总有效率、胃功能、血红蛋白、血氧饱和度和不良反应发生情况。结果:研究组治疗总有效率高于对照组,差异有统计学意义(P=0.013);治疗后,两组胃泌素水平低于治疗前,空腹胃酸pH值高于治疗前,研究组优于对照组,差异有统计学意义(P<0.05);治疗后,两组血红蛋白水平和血氧饱和度均高于治疗前,研究组高于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率低于对照组,差异有统计学意义(P=0.020)。结论:应用泮托拉唑与胃镜喷洒血凝酶联合治疗消化性溃疡出血,可有效改善患者胃功能,提高血红蛋白及血氧饱和度水平,且不良反应较少,安全性高。

Gastric juice acidity in upper gastrointestinal diseases

AIM: To search the independent factors determining gastric juice acidity and to investigate the acidity of gastric juices in various benign and malignant upper gastrointestinal diseases. METHODS: Fasting gastric juice acidity of 165 healthysubjects and 346 patients with esophageal ulcer (n = 21), gastric ulcer (n = 136), duodenal ulcer (n = 100) or gastric cancer (n = 89) were measured and compared. Additionally, gastric specimens were taken from the antrum and body for rapid urease test and histological examination. RESULTS: Multivariate analysis revealed that bile stain of gastric juice, high acute inflammatory score of the corpus, and atrophy of the corpus were independent risk factors for the development of gastric hypoacidity with odds ratios of 3.1 (95% CI: 1.3-7.3), 3.1 (95% CI: 1.2-7.9) and 3.5 (95% CI: 1.3-9.2). Esophageal ulcer and duodenal ulcer patients had a lower pH level (1.9 and 2.1 vs 2.9, both P < 0.05) of gastric juices than healthy subjects. In contrast, gastric ulcer and gastric cancer patients had a higher pH level (3.4 and 6.6 vs 2.9, both P < 0.001) than healthy controls. Hypoacidity existed in 22%, 5%, 29%, 5% and 88% of healthy subjects, esophageal ulcer, gastric ulcer, duodenal ulcer and gastric cancer patients, respectively. CONCLUSION: Bile reflux, atrophy and dense neutrophil infiltrate of the corpus are three independent factors determining the acidity of gastric juice.

Update of Aetiological Patterns of Adult Gastric Outlet Obstruction in Accra, Ghana

Background: The aetiology of gastric outlet obstruction globally has evolved from benign to malignant causes, but there seem to be no recent data on the trends in Ghana. The aim was, therefore, to identify the current patterns in the aetiology of gastric outlet obstruction in the adult population in Ghana. Methodology: This was a retrospective review of all confirmed cases of gastric outlet obstruction in the last decade, spanning from June 2004 to May 2014, that were managed at the Korle Bu Teaching Hospital. Results: A total of 107 patients were managed for gastric outlet obstruction with a male to female ratio of 2.15:1 and most of the patients making 71.3% of cases belonged to the age range of 40 to 60 years. The predominant aetiology for gastric outlet obstruction was found to be gastric cancer (55.140%), followed by peptic ulcer disease (27.103%). Conclusion: The aetiology of gastric outlet obstruction in Ghana has evolved from benign to malignant causes, following current global trends. Gastric cancer is now the most important cause of gastric outlet obstruction in Ghana, followed by peptic ulcer disease which predominates as the commonest benign cause.

Helicobacter pyloriin gastric corpus of patients 20 years after partial gastric resection

AIM: To determine the long-term prevalence of Helicobacter pylori (H pylori) gastritis in patients after partial gastric resection due to peptic ulcer, and to compare the severity of Hpylori-positive gastritis in the corpus mucosa between partial gastrectomy patients and matched controls.METHODS: Endoscopic biopsies were obtained from 57 patients after partial gastric resection for histological examination using hematoxylin/eosin and Warthin-Starry staining. Gastritis was graded according to the updated Sydney system. Severity of corpus gastritis was compared between H pylori-positive partial gastrectomy patients and H pylori-positive duodenal ulcer patients matched for age and gender.RESULTS: In partial gastrectomy patients, surgery was performed 20 years (median) prior to evaluation. In 25 patients (43.8%) H pyloriwas detected histologically in the gastric remnant. Gastric atrophy was more common in H pylori-positive compared to H pylori-negative partial gastrectomy patients (P<0.05). The severity of corpus gastritis was significantly lower in H pylori-positive partial gastrectomy patients compared to duodenal ulcer patients (P<0.01). There were no significant differences in the activity of gastritis, atrophy and intestinal metaplasla between the two groups.CONCLUSION: The long-term prevalence of H pylori gastritis in the gastric corpus of patients who underwent partial gastric resection due to peptic ulcer disease is comparable to the general population. The expression of Hpylori gastritis in the gastric remnant does not resemble the gastric cancer phenotype.

Bancroft术式治疗十二指肠球部溃疡伴胃流出道梗阻5例临床诊治分析

目的探讨Bancroft术式在治疗十二指肠球部消化性溃疡致胃流出道梗阻病人中的优势,以提高该病的治疗效果。方法回顾性分析苏州大学附属第一医院2014年4月—2020年9月行Bancroft术治疗的十二指肠球部良性溃疡致胃流出道梗阻患者的临床资料。分析Bancroft术式治疗该病的优点以及国内外的相关经验。结果5例行Bancroft术式的病人均于术后7~10 d出院,在院期间未见相关并发症发生,1例病人在出院2周后出现胃窦残端关闭端外瘘,经保守治疗2个月后,再次入院行二次手术治愈出院。5例病人出院1个月后复查时体重均明显上升,无再次出现消化道梗阻。结论Bancroft术式治疗十二指肠球部消化性溃疡致胃流出道梗阻具有其明显的优势。

经消化内镜治疗胃溃疡十二指肠溃疡出血的临床效果评价

目的:探究消化内镜治疗胃溃疡十二指肠溃疡出血患者的临床效果。方法:选取安阳市人民医院2021年1月至2022年6月期间诊治的90例胃溃疡十二指肠溃疡出血患者,随机划分为对照组与观察组,各45例。常规药物方案用于对照组患者治疗,经消化内镜方案用于观察组患者治疗,比较两组患者临床观察指标、止血治疗效果和止血时间分布情况。结果:观察组患者的出血量和输血量均少于对照组,止血时间和住院时间均短于对照组,差异具有统计学意义(P<0.05);观察组患者止血率高于对照组,再出血发生率和手术治疗率均低于对照组,差异具有统计学意义(P<0.05);观察组患者止血时间12 h以内人数占比高于对照组,止血时间12~48 h人数占比、48 h后活动性出血率低于对照组,差异具有统计学意义(P<0.05)。结论:胃溃疡十二指肠溃疡出血患者给予经消化内镜治疗,效果比较理想,可以对患者出血状况进行有效控制。

EPIYA基序与幽门螺杆菌感染相关胃病关系的研究进展

幽门螺杆菌(Hp)是一种人类主要致病菌,人体在感染Hp后会引发慢性胃炎、消化性溃疡、胃癌等一系列胃肠道疾病。近年来,随着这些疾病的发病率升高,它们的病因及发病机制日益在世界范围内受到许多学者的关注。而Hp的毒力基因之一即细胞毒素相关基因A(CagA)的致病机制也因此受到重视,谷氨酸-脯氨酸-异亮氨酸-酪氨酸-丙氨酸组成的重复序列(EPIYA基序)与Hp感染相关胃病也成为目前研究的热点。该文就EPIYA基序与Hp感染相关胃病的关系作一简要综述。

新型黏膜保护剂聚普瑞锌临床应用专家共识

胃黏膜损伤的类型和修复结局是备受关注的临床热点问题。以促进胃黏膜结构和功能修复为主要治疗目的,或兼有对抗黏膜表面损伤因子、改善黏膜防御机制作用的药物统称为胃黏膜保护剂。聚普瑞锌作为新一代黏膜保护剂,在化学成分、药代动力学、作用机制等方面与其他同类药物存在明显差异,在临床使用的适应证、潜在不良反应等方面亦有其独特性。该药在中国内地地区新近准入,在临床合理应用方面尚缺乏我国专家共识意见。中华消化心身联盟组织国内关注消化道黏膜修复临床问题的有关专家,基于国内外研究进展和临床应用经验,就应用黏膜保护剂的必要性、胃黏膜保护剂的个体化选择应用要点,以及聚普瑞锌的药代动力学特点、作用机制和临床应用达成共识意见,为聚普瑞锌在消化道黏膜保护中的合理应用提供参考依据。