Helicobacter pylori-induced inflammation masks the underlying presence of low-grade dysplasia on gastric lesions

BACKGROUND Helicobacter pylori(H.pylori)infection has been associated with a long-term risk of precancerous gastric conditions(PGC)even after H.pylori eradication.AIM To investigate the efficacy of High-Resolution White-Light Endoscopy with Narrow-Band Imaging in detecting PGC,before/after H.pylori eradication.METHODS We studied 85 consecutive patients with H.pylori-related gastritis with/without PGC before and 6 mo after proven H.pylori eradication.Kimura-Takemoto modified and endoscopic grading of gastric intestinal metaplasia classifications,were applied to assess the endoscopic extension of atrophy and intestinal metaplasia.The histological result was considered to be the gold standard.The Sydney System,the Operative-Link on Gastritis-Assessment,and the Operative-Link on Gastric-Intestinal Metaplasia were used for defining histological gastritis,atrophy and intestinal metaplasia,whereas dysplasia was graded according to World Health Organization classification.Serum anti-parietal cell antibody and anti-intrinsic factor were measured when autoimmune atrophic gastritis was suspected.RESULTS After H.pylori eradication histological signs of mononuclear/polymorphonuclear cell infiltration and Mucosal Associated Lymphoid Tissue-hyperplasia,disappeared or decreased in 100%and 96.5%of patients respectively,whereas the Operative-Link on Gastritis-Assessment and Operative-Link on Gastric-Intestinal Metaplasia stages did not change.Low-Grade Dysplasia prevalence was similar on random biopsies before and after H.pylori eradication(17.6%vs 10.6%,P=0.19),but increased in patients with visible lesions(0%vs 22.4%,P<0.0001).At a multivariate analysis,the probability for detecting dysplasia after resolution of H.pylori-related active inflammation was higher in patients with regression or reduction of Mucosal Associated Lymphoid Tissue hyperplasia,greater alcohol consumption,and anti-parietal cell antibody and/or anti-intrinsic factor positivity[odds ratio(OR)=3.88,95%confidence interval(CI):1.31-11.49,P=0.01;OR=3.10,95%CI:1.05-9.12,P=0.04 and OR=5.47,95%CI:1.33-22.39,P<0.04,respectively].CONCLUSION High-Resolution White-Light Endoscopy with Narrow-Band Imaging allows an accurate diagnosis of Low-Grade Dysplasia on visible lesions after regression of H.pylori-induced chronic gastritis.Patients with an overlap between autoimmune/H.pylori-induced gastritis may require more extensive gastric mapping.

Chronic hemodynamic adaptations induced by resistance training with and without blood flow restriction in adults:A systematic review and meta-analysis

The purposes of this systematic review and meta-analysis of peer-reviewed literature were to examine the chronic effects of resistance training with blood flow restriction(RT-BFR)on hemodynamics,and to compare these adaptations to those induced by traditional resistance training(TRT)programs in adults(PROSPERO:Registry:CRD42022339510).A literature search was conducted across PubMed,Sports Discus,Scielo,and Web of Science databases.Two independent reviewers extracted study characteristics and blood pressure measures.Risk of bias(The Cochrane risk of bias tool for randomized controlled trials[RoB-2]),and the certainty of the evidence(Grading of Recommendations,Assessment,Development,and Evaluation[GRADE])were used.A total of eight studies met the inclusion criteria for systolic(SBP),diastolic(DBP),and mean arterial pressure(MAP).Regarding the comparison of RT-BFR vs.non-exercise,no significant differences favoring the exercise group were observed(p>0.05).However,when compared to TRT,RT-BFR elicited additional improvements on DBP(-3.35;95%CI-6.00 to-0.71;I^(2)=14%;z=-2.48,p=0.01),and on MAP(-3.96;95%CI-7.94 to 0.02;I^(2)=43%;z=-1.95,p=0.05).Results indicate that RT-BFR may elicit a decrease in DBP in comparison with TRT,but the lack of data addressing this topic makes any conclusion speculative.Future research on this topic is warranted.