自制尿素试纸快速检测胃幽门螺旋菌的研究

本文以自制尿素试纸检测胃幽门螺旋菌(HP),其最适pH为6.5。共检测184例经胃镜和病理检测确诊的胃病患者,HP 阳性检出率为66.3%,敏感性为99.82%,特异性100%。与病理检测法对照,两者符合率为95.65%,检测结果15分钟内即可确定。认为自制尿素试纸是一种检测胃HP 的简易新方法。

胃幽门螺旋菌美兰染色法

胃幽门螺旋菌(Helicobacter Pytrids，HP)与慢性胃炎和消化性溃疡有密切关系，现被公认为是上述疾病的致病因素之一。检查HP现已有多种染色方法，如HE染色，Warthin-Starry银染色，改良Giemsa．碳酸复红染色，卟啶橙及阿的平荧光染色等。

中西医结合治疗幽门螺旋菌感染性慢性萎缩性胃炎64例临床疗效观察框架构建

目的:研究并分析中西医结合治疗幽门螺旋菌感染性慢性萎缩性胃炎64例临床疗效观察框架构建方式。方法:将2019年1月~2019年8月我院消化内科收治的幽门螺旋菌感染性慢性萎缩性胃炎纳入本组研究,针对对照组患者,应用西医常规三联疗法,对于中西医治疗组,在西医治疗基础上,应用中医疗法,对于对于湿热互结者,服用半夏泻心汤;对于肝胃气滞者,服用柴胡疏肝散合金铃于散;对于脾胃虚寒者,服用香砂六君子汤合附子理中丸;对于胃阴亏损者,服用叶氏养胃汤;对于瘀组胃络者,应用失笑散合活络效灵丹,总结疗效。结果:在治疗有效率上,中西医治疗组为93.8%,高于对照组的78.1%,在不良反应的发生情况上,中西医治疗组1例红疹、1例眩晕,对照组2例红疹、3例胃肠道不良反应、2例眩晕,在治疗有效率和不良反应发生率上,中西医治疗组在治疗有效率、不良反应发生率上,均更为理想,上述数据组间比较差异显著(p<0.05),差异有统计学意义。结论:对于幽门螺旋菌感染性慢性萎缩性胃炎患者,应用中西医结合疗法,在西医治疗基础,应用中医辨证疗法,根据患者临床症状分型治疗,疗效更加,临床研究显示,中药组方的应用能够调节胃蛋白酶活力,调节胃泌素水平,提高胃黏膜修复能力,共同改善患者消化道功能,值得进行推广。

CpG island methylator phenotype and Helicobacter pylori infection associated with gastric cancer

AIM： To investigate the association between the CpG island methylator phenotype （CIMP） and serum Helico- bacter pylori （H. pylori） levels for clinical prediction of gastric cancer （GC） progression. METHODS： We analyzed the serum ClMP status of 75 patients with GC using a methylation marker panel and a methylation-specific polymerase chain reaction. Serum samples from 40 healthy persons were examined at the same time. The genes examined were APC, WIF-1, RUNX-3, DLC-1, SFRP-1, DKK and E-cad. H. pylori infec- tion in serum was assayed with an anti-H, pylori immu- noglobulin G antibody test and a rapid urease test. RESULTS： The frequencies of high-level methylation in GC tissues for the seven genes were： 48% for APC, 57.33% for WIF-1, 56% for RUNX-3, 50.67% for DLC-1, 52% for SFRP-1, 54.67% for DKK, and 48% for E-cad.The frequencies in GC serum were 30.67% for APC, 34.67% for WIF-1, 37.33% for RUNX-3, 29.33% for DLC-1, 33.33% for SFRP-1, 32% for DKK, and 26.67% for E-cad. CIMP＋ （defined as ≥ 3 methylated genes） was associated with 47 （62.67%） GC tissue samples and 44 （58.67%） GC serum samples. CIMP＋ was not associated with non-neoplastic mucosal tissues or the serum of healthy persons. Of the 75 GC cases, 51 （68%） were H. pylori＋, and 24 （32%） were H. pylori-. Of the 51 H. pylori＋ cases, 36 were CIMP＋ and 15 were CIMP-. In contrast, for the 24 H. pylori- cases, 11 were CIMP＋, and 13 were CIMP-. The difference was signifi- cant between the H. pylori＋ and H. pylori- groups χ2 = 4.27, P 〈 0.05）. Of the 51 H. pylori＋ GC patients, 34 were CIMP＋ and 17 were CIMP-, while among the 24 H. pylori- GC cases, 10 were CIMP＋ and 14 were CIMP-. The difference was significant between the H. pylori＋ and H. pylori- groups （χ2 = 4.21, P 〈 0.05）. A 2-year follow-up showed significant difference in the rates of metastasis and recurrence between H. pylori＋/CIMP＋ cases and the H. pylori＋/CIMP- cases or CIMP- cases associated with H. pylori assayed in serum （P 〈 0.05）. However, there were no significant differences in sur- vival rates between the two groups. CONCLUSION： H. pylori＋/CIMP＋ cases are associ- ated with higher rates of metastasis and recurrence thanH, pylori＋/CIMP- cases. Serum may be useful for examining CIMP status.

E-cadherin in gastric cancer

Cadherin is an adhesion molecule and a superfamily of calcium-mediated membrane glycoproteins. E-cadherin is the prototype of the class E-cadherin that links to catenins to form the cytoskeleton. Recent evidence has shown that E-cadherin not only acts as an adhesive, but also plays important roles in growth development and carcinogenesis. It has been recently viewed as an invasion as well as a growth suppressor gene. This review summarizes the recent discoveries on E-cadherin and its role in gastric cancer. In particular, our work on E-cadherin in gastric cancer, including its relation with Helicobacter pylori and clinical applications, are described in detail.

Bacterial flora concurrent with Helicobacter pylori in the stomach of patients with upper gastrointestinal diseases

AIM： To investigate the non-He/icobacterpy/ori （H. pylori） bacterial flora concurrent with H. pylori infection.METHODS： A total of 103 gastric biopsy specimens from H. pylori positive patients were selected for bacterial culture. All the non-H, pylori bacterial isolates were identified by matrix assisted laser desorption ionization time-of-flight mass spectrometry （MALDI-TOF MS）.RESULTS： A total of 201 non-H, pyiori bacterial isolates were cultivated from 67 （65.0%） of the 103 gastric samples, including 153 isolates identified successfully at species level and 48 at genus level by MALDI-TOF MS. The dominant species were Streptococcus, Neisseria, Rothla and Staphylococcus, which differed fromthe predominantly acid resistant species reported previously in healthy volunteers. The prevalence of non-H. pylori bacteria was higher in non-ulcer dyspepsia group than in gastric ulcer group （100% vs 42.9%, P 〈 0.001）. Six bacterial species with urease activity （Staphylococcus epidermidis, Staphylococcus warneri, Staphylococcus capitis, Staphylococcus aureus, Brevibacteriurn spp. and Klebsiella pneumoniae） were also isolated.CONCLUSION： There is a high prevalence of the non-H, pylori bacteria concurrent with H. pylori infection, and the non-H, pylori bacteria may also play important as-yet-undiscovered roles in the pathogenesis of stomach disorders.

Relatedness of Helicobacter pylori populations to gastric carcinogenesis

Helicobacter pylori （H. pylorl） is a Gram-negative bac- terium that infects half of the human population. The infection is associated with chronic inflammation of the gastric mucosa and peptic ulcers. It is also a major risk factor for gastric cancer. Phylogenetic analysis of global strains reveals there are seven populations of H. pylori, including hpAfrical, hpAfrica2, hpEastAsia, hpEurope, hpNEAfrica, hpAsia2 and hpSahul. These populations are consistent with their geographical origins, and pos- sibly result from geographical separation of the bac- terium leading to reduced bacterial recombination in some populations. For each population, H. pylori has evolved to possess genomic contents distinguishable from others. The hpEurope population is distinct in that it has the largest genome of 1.65 mbp on average, and the highest number of coding sequences. This confers its competitive advantage over other populations but at the cost of a lower infection rate. The large genomic size could be a cause of the frequent occurrence of the deletion of the cag pathogenicity island in H. pylori strains from hpEurope. The incidence of gastric cancer varies among different geographical regions. This can be attributed in part to different rates of infection of H. pylori. Recent studies found that different popula- tions of H, pylori vary in their carcinogenic potential and contribute to the variation in incidence of gastric cancer among geographical regions. This could be related to the ancestral origin of H, pylori. Further studies are indi- cated to investigate the bacterial factors contributing to differential virulence and their influence on the clinical features in infected individuals.

InIncidence and clinical features of endoscopic ulcers developing after gastrectomy

AIM： To determine the precise incidence and clinica features of endoscopic ulcers following gastrectomy. METHODS： A consecutive series of patients who un- derwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed. A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled. We analyzed differences in patient age, sex, size of the le- sions, method of operation, indications for gastric resec- tion, and infection rates of Helicobacterpylor/（H. pylor/~ between the nonulcer and ulcer groups. RESULTS： The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%. Ulcers were more common in patients with Billroth l] anastomosis and pre-existing conditions forpeptic ulcer disease （PUD）. Infection rates of H. pylori- did not differ significantly between the two groups. The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission. CONCLUSION： H. pylori was not an important factor in ulcerogenesis following gastrectomy. For patients who underwent surgery for PUD, clinical course of mar- ginal ulcers was more severe.

Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus

AIM： To investigate the clinicopathologic features which predict surgical overall survival in patients with proxima gastric carcinoma involving the esophagus （PGCE）. METHODS： Electronic pathology database established in the Department of Pathology of the Nanjing Drum Tower Hospital was searched for consecutive resection cases of proximal gastric carcinoma over the period from May 2004 through July 2009. Each retrieved pa- thology report was reviewed and the cases with tumors crossing the gastroesophageal junction line were se- lected as PGCE. Each tumor was re-staged, following the guidelines on esophageal adenocarcinoma, accord- ing to the 7th edition of the American Joint Commission on Cancer Staging Manual. All histology slides were studied along with the pathology report for a retrospec- tive analysis of 13 clinicopathologic features, i.e., age, gender, Helicobacter pylori （H. pylon} infection, surgical modality, Siewert type, tumor Bormann＇s type, size, dif- ferentiation, histology type, surgical margin, lympho- vascular and perineural invasion, and pathologic stage in relation to survival after surgical resection. Prognos- tic factors for overall survival were assessed with uni- and multi-variate analyses. RESULTS： Patients＇ mean age was 65 years （range： 47-90 years）. The male： female ratio was 3.3. The 1-, 3- and 5-year overall survival rates were 87%, 61% and 32%, respectively. By univariate analysis, age, male gender, H. pylori, tumor Bormann＇s type, size, histology type, surgical modality, positive surgical margin, lym- phovascular invasion, and pT stage were not predictive for overall survival; in contrast, perineural invasion （P = 0.003）, poor differentiation （P = 0.0003）, 〉 15 to- tal lymph nodes retrieved （P = 0.008）, positive lymph nodes （P = 0.001）, and distant metastasis （P = 0.005） predicted poor post-operative overall survival. Celiac axis nodal metastasis was associated with significantly worse overall survival （P = 0.007）. By multivariate analysis, ≥ 16 positive nodes （P = 0.018）, lymph node ratio 〉 0.2 （P = 0.003）, and overall pathologic stage （P= 0.002） were independent predictors for poor overa survival after resection. CONCLUSION： Patients with PGCE showed worse over- all survival in elderly, high nodal burden and advanced pathologic stage. This cancer may be more accurately staged as gastric, than esophageal, cancer.

Analysis of ABC (D) stratification for screening patients with gastric cancer

AIM:To evaluate the value of ABC(D) stratification [combination of serum pepsinogen and Helicobacter pylori(H.pylori) antibody]of patients with gastric cancer.METHODS:Ninety-five consecutive patients with gastric cancer were enrolled into the study.The serum pepsinogenⅠ(PGⅠ) /pepsinogenⅡ(PGⅡ) and H.pylori antibody levels were measured.Patients were classified into five groups of ABC(D) stratification according to their serological status.Endoscopic findings of atrophic gastritis and histological differentiation were also analyzed in relation to the ABC(D) stratification.RESULTS:The mean patient age was(67.9±8.9) years.Three patients(3.2%) were classified into group A,7 patients(7.4%) into group A',27 patients(28.4%) into group B,54 patients(56.8%) into group C,and 4patients(4.2%) into group D,respectively.There were only three cases in group A when the patients taking acid proton pump inhibitors and those who had undergone eradication therapy for H.pylori(group A') were excluded.These three cases had mucosal atrophy in the grey zone according to the diagnostic manual of ABC(D) stratification.Histologically,the mean age of the patients with well differentiated adenocarcinoma was significantly higher than that of the patients with poorly differentiated adenocarcinoma(P<0.05) .There were no differences in the pattern of atrophy in the endoscopies between the well differentiated and poorly differentiated groups.CONCLUSION:ABC(D) stratification is a good method for screening patients with gastric cancers.Endoscopy is needed for grey zone cases to check the extent of mucosal atrophy.

Influence of obesity and bariatric surgery on gastric cancer

Esophageal and gastric cancer(GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.

CD74 in antigen presentation,inflammation,and cancers of the gastrointestinal tract

CD74 is a protein whose initial role in antigen presentation was recognized two decades ago. Recent studies have revealed that it has additional functions as a receptor for macrophage migration inhibitory factor and as a receptor for an important human pathogen, Helicobacter pylori （H pylon）. The role of CD74 as a receptor is important because after binding of migration inhibitory factor or H pylori, NF-κB and Erkl/2 activation occurs, along with the induction of proinflammatory cytokine secretion. This review provides an up-to-date account of the functions of CD74 and how it might be involved in inflammation and cancer within the gastrointestinal tract.

Helicobacter pyloristrain-specific modulation of gastric inflammation in Mongolian gerbils

AIM: The cag pathogenicity island (PAI) is one of potential virulence determinants of Helicobacter pylori. The Mongolian gerbil is a suitable experimental animal for the screening of virulence factors of H pylori.METHODS: Five-week-old Mongolian gerbils were inoculated with a standard H pylori strain (ATCC 43504)possessing the cag PAI or a clinical isolate lacking the genes' cluster (OHPC-0002). The animals were killed at 2, 4, 8, 24 and 48 wk after inoculation (n = 5 each), and macroscopic and histopathological findings in the stomachs were compared.RESULTS: In gerbils infected with ATCC 43504, a more severe degree of infiltration of polynuclear and mononuclear cells and lymphoid follicles was observed from 4 wk after inoculation compared to gerbils infected with OHPC-0002 especially in the antrum and transitional zone from the fundic to pyloric gland area. In addition,glandular atrophy, intestinal metaplasia, gastric ulcer and hyperplastic polyps were noted in gerbils infected with ATCC 43504, whereas only mild gastric erosions occurred in those infected with OHPC-0002.CONCLUSION: Our results indicate that the cag PAI could be directly involved in gastric immune and inflammatory responses in the Mongolian gerbils, leading to a more advanced gastric disease.

Gastric dysplasia may be an independent risk factor of an advanced colorectal neoplasm

AIM: To evaluate the relationship between gastric dysplasia and Helicobacter pylori (H pylori) and the occurrence of colorectal adenoma, and to defi ne the necessity for colonoscopy in patients with gastric dysplasia or H pylori infection.METHODS: From May 2005 to February 2008, 133 patients with established gastric dysplasia by gastroduo-denoscopy (EGD) were additionally investigated by colonoscopy. The authors compared results with those of 213 subjects who underwent both EGD and colonoscopy during the same period at the author’s Health Promotion Center as a control group. H pylori infection was evaluated in both the gastric dysplasia and control groups.RESULTS: The mean age of all 346 study subjects was 54.1 ± 10.5 years, and there were 258 (73%) men and 87 (27%) women. No signif icant difference was found between the H pylori positive and negative subjects in terms of the prevalence of colorectal adenoma and advanced colorectal adenoma (P = 0.261). Patients with gastric dysplasia showed no elevated risk of colorectal adenoma (OR = 0.910, 95% CI: 0.587-1.411, P = 0.738), but had a signif icantly higher risk of having advanced colorectal adenoma (OR = 3.382, 95% CI: 1.700-6.342, P = 0.000).CONCLUSION: The study emphasizes the need for colon surveillance in patients with gastric dysplasia, regardless of H pylori infection.

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

A 21-year-old woman with complaints of hematochezia was diagnosed as having Cowden's disease (CD), an autosomal dominant condition characterized by multiple hamartomas, since facial papules and gingival papillomas were identified. On endoscopy, multiple hyperplastic polyps were seen in the rectum and left-side colon. There were also esophageal glycogenic acanthosis and hyperplastic polyposis in the antrum accompanied by Helicobacter pylorirelated gastritis. Although gastric hyperplastic polyposis had by no means regressed with unsuccessful first-line eradication therapy for H pylori, following cure of the infection with salvage therapy consisting of rabeprazole,amoxicillin and metronidazole, the polyposis lesions almost disappeared. Follow-up gastroscopy 2 and 3 years after cessation of the second-line eradication therapy revealed almost complete regression of the polyposis lesions with no evidence of H pylori infection. We recommend eradication treatment for CD patients with gastric hyperplastic polyps and the infection, as the occurrence of gastric carcinoma among hyperplastic polyps has been described.

Study of Helicobacter pylori genotype status in saliva,dental plaques,stool and gastric biopsy samples

AIM:To compare genotype of Helicobacter pylori(H.pylori) isolated from saliva,dental plaques,gastric biopsy,and stool of each patient in order to evaluate the mode of transmission of H.pylori infection.METHODS:This cross-sectional descriptive study was performed on 300 antral gastric biopsy,saliva,dental plaque and stool samples which were obtained from patients undergoing upper gastrointestinal tract endoscopy referred to endoscopy centre of Hajar hospital of Shahrekord,Iran from March 2010 to February 2011.Initially,H.pylori strains were identified by rapid urease test(RUT) and polymerase chain reaction(PCR) were applied to determine the presence of H.pylori(ureC) and for genotyping of voculating cytotoxin gene A(vacA) and cytotoxin associated gene A(cagA) genesin each specimen.Finally the data were analyzed by using statistical formulas such as Chi-square and Fisher's exact tests to find any significant relationship between these genes and patient's diseases.P < 0.05 was considered statistically significant,RESULTS:Of 300 gastric biopsy samples,77.66% were confirmed to be H.pylori positive by PCR assay while this bacterium were detected in 10.72% of saliva,71.67% of stool samples.We were not able to find it in dental plaque specimens.The prevalence of H.pylori was 90.47% among patients with peptic ulcer disease(PUD),80% among patients with gastric cancer,and 74.13% among patients with none ulcer dyspepsia(NUD) by PCR assay.The evaluation of vacA and cagA genes showed 6 differences between gastric biopsy and saliva specimens and 11 differences between gastric and stool specimens.94.42% of H.pylori positive specimens were cagA positive and all samples had amplified band both for vacA s and m regions.There was significant relationship between vacA s1a/m1a and PUD diseases(P = 0.04),s2/m2 genotype and NUD diseases(P = 0.05).No statically significant relationship was found between cagA status with clinical outcomes and vacA genotypes(P = 0.65).The evaluation of vacA and cagA genes showed 6 differences between gastric biopsy and saliva specimens and 11 differences between gastric and stool specimens,CONCLUSION:Regard to high similarity in genotype of H.pylori isolates from saliva,stomach and stool,this study support the idea which fecal-oral is the main route of H.pylori transmission and oral cavity may serve as a reservoir for H.pylori,however,remarkable genotype diversity among stomach,saliva and stool samples showed that more than one H.pylori genotype may exist in a same patient.

Candida-associated gastric ulcer relapsing in a different position with a different appearance

An 87-year-old,Japanese woman was shown to have a submucosal tumor-like lesion with a deep,central ulceration covered with thick,whitish exudate in the stomach.Biopsy showed Candida tropicalis but not Helicobacter pylori(H.pylori).She had no predisposing factors or history of peptic ulcers nor had taken non-steroidal anti-inflammatory drugs(NSAIDs),diagnosed with Candida-associated gastric ulcer.Though cured of the lesion,she developed another ulcer in a different position,in which Candida was demonstrated but H.pylori was undetectable.This is the first case of recurrent Candida-associated gastric ulcer in the world.Detected in both the original and recurrent lesions in an H.pylori-negative patient with no antecedent ulcers who had not taken NSAIDs,Candida is considered,contrary to the prevailing opinion,to play an etiologic role in ulcer formation.