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Gao C, Zhang G, Zheng J, Zheng Y, Lin W, Xu G, You Y, Li D, Wang W. The value of LCI-based modified Kyoto classification risk scoring system in predicting the risk of early gastric cancer. Scand J Gastroenterol 2024:1-9. [PMID: 38578144 DOI: 10.1080/00365521.2024.2338443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To study and compare the value of the Kyoto classification risk scoring system and the modified Kyoto classification risk scoring system based on linked color imaging (LCI) in predicting the risk of early gastric cancer. METHODS One hundred and fifty patients with pathologically confirmed non-cardia early gastric cancer by endoscopic LCI and 150 non-gastric cancer patients matched for age and gender were included. Basic patient data and whole gastric endoscopic images under LCI were collected, and the images were scored according to the LCI-based Kyoto classification risk scoring system and the LCI-based modified Kyoto classification risk scoring system. RESULTS Compared with the LCI-based Kyoto classification risk scoring system, the LCI-based modified Kyoto classification risk scoring system had a higher AUC for predicting the risk of early gastric cancer (0.723 vs. 0.784, p = 0.023), with a score of ≥3 being the best cutoff value for predicting the risk of early gastric cancer (sensitivity 61.33%, specificity 86.00%), and scores of 3 to 5 were significantly associated with early gastric carcinogenesis significantly (OR = 9.032, 95% CI: 4.995-16.330, p < 0.001). CONCLUSIONS Compared with the LCI-based Kyoto classification risk scoring system, the LCI-based Kyoto modified classification risk scoring system has a better value for predicting the risk of early gastric cancer, and the score of 3 to 5 is a high-risk factor for the risk of early gastric cancer development, which is more strongly correlated with the risk of early gastric cancer.
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Affiliation(s)
- Chao Gao
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Guanpo Zhang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Jin Zheng
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Yunmeng Zheng
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Wulian Lin
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Guilin Xu
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Yixiang You
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Dazhou Li
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People's Liberation Army, Fuzhou, China
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Nishizawa T, Suzuki H, Sakitani K, Yamashita H, Yoshida S, Hata K, Kanazawa T, Fujiwara N, Kanai T, Yahagi N, Toyoshima O. Family history is an independent risk factor for the progression of gastric atrophy among patients with Helicobacter pylori infection. United European Gastroenterol J 2016; 5:32-36. [PMID: 28405319 DOI: 10.1177/2050640616642341] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/08/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM Risk factors for progression of gastric atrophy have not been fully elucidated. The aim of this study was to evaluate the risk factors for the development of atrophic gastritis in patients with Helicobacter pylori (H. pylori ) infection. METHODS We reviewed 206 H. pylori-infected patients retrospectively. Endoscopic gastric atrophy was classified into closed- and open-type. We conducted univariate and multivariate logistic regression analyses on the contribution of age, sex, body mass index, past history of cancer, the first-degree family history of gastric cancer, habitual smoking and alcohol drinking, and endoscopic findings of gastric ulcer or duodenal ulcer for open-type gastric atrophy. RESULTS On multivariate analysis, age (odds ratio = 1.079, 95% confidence interval = 1.048-1.11, p < 0.001), family history of gastric cancer (odds ratio = 3.967, 95% confidence interval = 1.414-10.6, p = 0.006) and duodenal ulcer (odds ratio = 0.834, 95% confidence interval = 0.711-0.977, p = 0.024) were the factors independently associated with open-type gastric atrophy. CONCLUSIONS A first-degree family history of gastric cancer, absence of duodenal ulcer, and old age were independent risk factors for the progression of gastric atrophy among H. pylori-infected patients. Careful examination with upper gastrointestinal endoscopy is necessary in patients with such risk factors.
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Affiliation(s)
- Toshihiro Nishizawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan; Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department Of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Kosuke Sakitani
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan; Division of Gastroenterology, The Institute for Adult Disease, Asahi Life Foundation, Tokyo, Japan
| | - Hiroharu Yamashita
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan; Department of Gastrointestinal Surgery, The University of Tokyo, Tokyo, Japan
| | - Shuntaro Yoshida
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Hata
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan; Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Takamitsu Kanazawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan; Department of Surgery, The Fraternity Memorial Hospital, Tokyo, Japan
| | - Naoto Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department Of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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Gao QY, Wang ZH, Cui Y, Sheng JQ, Zhang KH, Shi RH, Xu JM, Chen WC, Zuo XL, Li SD, Chen YX, Song YY, Fang JY. Evaluation and clinical significance of the stomach age model for evaluating aging of the stomach-a multicenter study in China. BMC Clin Pathol 2014; 14:29. [PMID: 25057261 PMCID: PMC4096444 DOI: 10.1186/1472-6890-14-29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 06/23/2014] [Indexed: 01/26/2023] Open
Abstract
Background A higher prevalence of chronic atrophic gastritis (CAG) occurs in younger adults in Asia. We used Stomach Age to examine the different mechanisms of CAG between younger adults and elderly individuals, and established a simple model of cancer risk that can be applied to CAG surveillance. Methods Stomach Age was determined by FISH examination of telomere length in stomach biopsies. Δψm was also determined by flow cytometry. Sixty volunteers were used to confirm the linear relationship between telomere length and age while 120 subjects were used to build a mathematical model by a multivariate analysis. Overall, 146 subjects were used to evaluate the validity of the model, and 1,007 subjects were used to evaluate the relationship between prognosis and Δage (calculated from the mathematical model). ROC curves were used to evaluate the relationship between prognosis and Δage and to determine the cut-off point for Δage. Results We established that a tight linear relationship between the telomere length and the age. The telomere length was obvious different between patients with and without CAG even in the same age. Δψm decreased in individuals whose Stomach Age was greater than real age, especially in younger adults. A mathematical model of Stomach Age (real age + Δage) was successfully constructed which was easy to apply in clinical work. A higher Δage was correlated with a worse outcome. The criterion of Δage >3.11 should be considered as the cut-off to select the subgroup of patients who require endoscopic surveillance. Conclusion Variation in Stomach Age between individuals of the same biological age was confirmed. Attention should be paid to those with a greater Stomach Age, especially in younger adults. The Δage in the Simple Model can be used as a criterion to select CAG patients for gastric cancer surveillance.
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Affiliation(s)
- Qin-Yan Gao
- GI Division, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai Institution of Digestive Disease, 145 Middle Shandong Rd, Shanghai 200001, China ; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao-Tong University, 145 Middle Shandong Rd, Shanghai 200001, China ; State Key Laboratory of Oncogene and Related Genes, 145 Middle Shandong Rd, Shanghai 200001, China
| | - Zhen-Hua Wang
- GI Division, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai Institution of Digestive Disease, 145 Middle Shandong Rd, Shanghai 200001, China ; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao-Tong University, 145 Middle Shandong Rd, Shanghai 200001, China ; State Key Laboratory of Oncogene and Related Genes, 145 Middle Shandong Rd, Shanghai 200001, China
| | - Yun Cui
- GI Division, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai Institution of Digestive Disease, 145 Middle Shandong Rd, Shanghai 200001, China ; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao-Tong University, 145 Middle Shandong Rd, Shanghai 200001, China ; State Key Laboratory of Oncogene and Related Genes, 145 Middle Shandong Rd, Shanghai 200001, China
| | - Jian-Qiu Sheng
- The Military General Hospital of Beijing PLA, 5 East sishitiao nanmencang, Beijing 100700, China
| | - Kun-He Zhang
- The First Affiliated Hospital of NanChang University, 17 Yongwaizheng Street, Nanchang 330006, China
| | - Rui-Hua Shi
- The First Affiliated Hospital of NanJing Medical University, 300 Guangzhou Rd, Nanjing 210029, China
| | - Jian-Ming Xu
- The First Affiliated Hospital of Anhui University, 218 Jixi Rd, Hefei 230022, China
| | - Wei-Chang Chen
- The First Affiliated Hospital of SooChow University, 188 Shizi Street Suzhou 215006, China
| | - Xiu-Li Zuo
- Qilu Hospital of Shandong University, 107 West Wenhua Rd, Jinan 250012 China
| | - Shu-De Li
- Second Military Medical University Changhai Hospital, 168 Changhai Rd, Shanghai 200433, China
| | - Yue-Xiang Chen
- Second Military Medical University Changzheng Hospital, 415 Fengyang Rd, Shanghai 200003, China
| | - Yan-Yan Song
- Department of Statistics, Shanghai Jiao-Tong University School of Medicine, 227 South Chongqing Rd, Shanghai 200025, China
| | - Jing-Yuan Fang
- GI Division, Renji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai Institution of Digestive Disease, 145 Middle Shandong Rd, Shanghai 200001, China ; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao-Tong University, 145 Middle Shandong Rd, Shanghai 200001, China ; State Key Laboratory of Oncogene and Related Genes, 145 Middle Shandong Rd, Shanghai 200001, China
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HONG JUNBO, XIA LIANG, ZUO WEI, WANG ANJIANG, XU SHAN, XIONG HUIFANG, CHEN YOUXIANG, ZHU XUAN, LU NONGHUA. Risk factors for intestinal metaplasia in concomitant gastric and duodenal ulcer disease. Exp Ther Med 2014; 7:929-934. [PMID: 24669253 PMCID: PMC3964929 DOI: 10.3892/etm.2014.1507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/23/2014] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to estimate the prevalence and risk factors of intestinal metaplasia (IM) in concomitant gastric and duodenal ulcer (CGDU) disease by retrospectively reviewing consecutive patients who had undergone esophagogastroduodenal endoscopy. Patients who received the endoscopic diagnosis of CGDU disease were selected for analysis and the recorded demographic, endoscopic, clinical and outcome data, including data on the development of IM, were extracted. Associations of the various parameters with IM were estimated by logistic regression analysis and described by the odds ratio (OR) with a 95% confidence interval (CI). Among the total 204,073 consecutive patients screened, 2,397 (1.2%) were diagnosed with CGDU disease. Following application of the exclusion criteria, a total of 2,149 cases were included in the study. The IM prevalence was 8.4%, represented by 153 mild cases, 26 moderate cases and one severe case. Multivariate analysis identified age ≥50 years (OR=2.606, 95% CI=1.889-3.597, χ2=34.000, P<0.001), ulcer at the gastric incisura (OR=2.644, 95% CI=1.926-3.630, χ2=36.142, P<0.001) and Helicobacter pylori (H. pylori) infection (OR=2.338, 95% CI=1.573-3.474, χ2=17.648, P<0.001) as independent risk factors for the development of IM. In addition, the moderate and severe IM grades were more frequently detected in males than in females (18.8% vs. 5.8%; OR=3.769, 95% CI=1.083-13.121, χ2=4.887, P=0.036). IM in patients with CGDU disease is not uncommon. CGDU patients with ongoing H. pylori infection, gastric incisura involvement, older age and/or male gender may be at a higher risk of IM.
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Affiliation(s)
- JUN-BO HONG
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - LIANG XIA
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - WEI ZUO
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - AN-JIANG WANG
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - SHAN XU
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - HUI-FANG XIONG
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - YOU-XIANG CHEN
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - XUAN ZHU
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - NONG-HUA LU
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
- Correspondence to: Professor Nong-Hua Lu, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwai Zheng Street, Nanchang, Jiangxi 330006, P.R. China, E-mail:
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Arismendi-Morillo G, Hernández I, Mengual E, Abreu N, Molero N, Fuenmayor A, Romero G, Lizarzábal M. [Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2013; 78:135-43. [PMID: 23538133 DOI: 10.1016/j.rgmx.2013.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/14/2013] [Accepted: 01/21/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Severity of chronic gastritis associated with Helicobacter pylori infection (CGAHpI) could play a role in evaluating the potential risk to develop gastric cancer. Our aim was to estimate the risk for gastric cancer in a clinical setting, according to histopathologic criteria, by applying the gastric cancer risk index (GCRI) METHODS: Histopathologic study of the gastric biopsies (corpus-antrum) from consecutive adult patients that underwent gastroesophageal duodenoscopy was carried out, and the GCRI was applied in patients presenting with CGAHpI. RESULTS One hundred eleven patients (77% female) with a mean age of 38.6±13.1 years were included. Active Helicobacter pylori infection (aHpi) was diagnosed in 77 cases (69.40%). In 45% of the cases with aHpi, pangastritis (23%) or corpus-predominant gastritis (22%) was diagnosed. Nine cases were diagnosed with intestinal metaplasia (8%), 7 of which (77.70%) were in the aHpi group. Twenty one percent of the patients with aHpi had a GCRI of 2 (18.10%) or 3 (2.50%) points (high risk index), while 79.10% accumulated a GCRI of 0 or 1 points (low risk index). Of the patients with no aHpi, none of them had 3 points (p=0.001). Of the 18 patients that accumulated 2 or 3 points, 6 (33.30%) presented with intestinal metaplasia (all with pangastritis and corpus-predominant gastritis), of which 4 cases (66.60%) had aHpi. CONCLUSIONS The estimated gastric cancer risk in patients with CGAHpI in the clinical setting studied was relatively low and 5% of the patients had a histopathologic phenotype associated with an elevated risk for developing gastric cancer.
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Affiliation(s)
- G Arismendi-Morillo
- Laboratorio de Investigaciones Gastrointestinales, Instituto de Investigaciones Biológicas, Maracaibo, Venezuela.
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Sakitani K, Hirata Y, Watabe H, Yamada A, Sugimoto T, Yamaji Y, Yoshida H, Maeda S, Omata M, Koike K. Gastric cancer risk according to the distribution of intestinal metaplasia and neutrophil infiltration. J Gastroenterol Hepatol 2011; 26:1570-5. [PMID: 21575058 DOI: 10.1111/j.1440-1746.2011.06767.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Gastritis and intestinal metaplasia (IM) have long been known to be risk factors for and precursors of gastric cancer. We aimed to elucidate the association between gastric cancer risk and the distribution of precancerous lesions in the stomach by histological analyses. METHODS We analyzed patients from whom two biopsy specimens (one from the antrum and one from the corpus) were obtained by upper gastrointestinal endoscopy. Specimens were assessed for Helicobacter pylori, IM, and neutrophil infiltration (NI). Patients were classified into three groups based on the presence of IM. Patients were also classified into four groups based on the presence of NI. The prevalence of gastric cancer was compared between groups. RESULTS A total of 1395 patients were analyzed. Of these, 54 had gastric cancer (34 intestinal and 20 diffuse type). A multivariate analysis showed that male sex and the distribution of IM were independent risk factors for intestinal-type cancer. Compared with patients without IM (n = 1005), the odds ratio (OR) for patients with IM in the antrum only (n = 240) was 2.34 (95% confidence interval: 1.08-4.96), and that for patients with IM in the corpus (n = 150) was 5.84 (2.92-11.8). However, NI was related to diffuse-type cancer. Compared with patients without NI (n = 899), the OR for patients with NI in the corpus only (n = 122) was 3.66 (1.02-12.2). CONCLUSIONS The histological pattern and distribution of gastric mucosal change assessed by two biopsy specimens were related to gastric cancer.
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Affiliation(s)
- Kosuke Sakitani
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Soltermann A, Koetzer S, Eigenmann F, Komminoth P. Correlation of Helicobacter pylori virulence genotypes vacA and cagA with histological parameters of gastritis and patient's age. Mod Pathol 2007; 20:878-83. [PMID: 17541440 DOI: 10.1038/modpathol.3800832] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The histological parameters of Helicobacter pylori (H. pylori) gastritis are dependent on the virulence factor profile of the microbe, which includes the cytotoxins vacA (vacuolating cytotoxin A) and cagA (cytotoxin-associated gene A) as well as the duration of infection. The virulence factor genotypes vacA and cagA were assessed by the line probe reverse hybridization assay INNO-LiPA and correlated with the histological parameters of H. pylori infection, in particular intestinal metaplasia (IM) as well as with the patient's age. A total of 120 patients were analyzed; 47 patients with IM in the antrum and 73 control patients without this alteration. The vacA s1 cagA+ genotype (high virulence) correlated with the presence of antral IM, a more intense acute inflammation in both antrum and corpus and the formation of ulcer. The vacA m1 genotype (high virulence) correlated with a more intense acute inflammation in only the corpus as well as more prominent Russell bodies in the antrum. H. pylori strains with the vacA s2 m2 cagA- genotype (low virulence) were rarely found in these conditions (all P <0.05). No correlation with the virulence status was found for the type and extent of IM, the intensity of chronic inflammation, the formation of lymphoid follicles and the microbial density. Furthermore, patients with IM were 7 years older than their counterparts without (P<0.05). Finally, there was a trend for more virulent vacA s1 m1 cagA+ strains to be found in younger individuals (P>0.05). The virulence genotype of the microbe is an important determinant for the severity of the gastritis and the formation of antral IM. Age is an additional factor for the development of IM.
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Affiliation(s)
- Alex Soltermann
- Department of Pathology, Institute of Surgical Pathology, University Hospital Zürich, Zürich, Switzerland.
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Kawade M, Joh T, Oshima T, Takahashi N, Ogawa K, Ohara H, Nomura T, Itoh M. Prevalence of gastric cancer decreases with age in long-living elderly in Japan, possibly due to changes in Helicobacter pylori infection status. J Gastroenterol Hepatol 2005; 20:1333-7. [PMID: 16105117 DOI: 10.1111/j.1440-1746.2005.03974.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The prevalence of Helicobacter pylori (Hp) infection and the development of gastric cancer are both believed to increase with age in Japan. However, no studies have investigated people older than 65 years in detail. In this study, we investigated the prevalence of Hp infection and gastric cancer in the elderly, and analyzed the influence of both factors on longevity. METHODS All patients investigated were 65 years old and over. A total of 1877 autopsy cases were used to investigate the prevalence of gastric cancer and colonic cancer. Serum samples were obtained from 644 patients with dyspepsia and analyzed for Hp-IgG antibodies. Of these 644 patients, 63 underwent upper gastrointestinal endoscopies. Five biopsies were obtained and evaluated for the following morphological variables: neutrophils, mononuclear cell, atrophy, and intestinal metaplasia. Hp infection was evaluated histologically and with the (13)C-urea breath test. RESULTS The prevalence of gastric cancer was significantly lower in subjects older than 85 years. The positive rate of serum Hp-IgG, and Hp infection as detected histologically and by the (13)C-urea breath test, also decreased with age. In Hp(+) patients, the neutrophil score significantly decreased with age. In Hp(-) patients, however, the intestinal metaplasia score significantly increased with age. CONCLUSIONS The non-infection of Hp itself is not related to longevity in Japanese elderly, because even Hp(-) patients appear to have been infected previously with Hp. The lower prevalence of gastric cancer in the elderly may be due to the disappearance of Hp colonization, which may contribute to longevity in Japanese elderly.
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Affiliation(s)
- Masaya Kawade
- Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, Japan
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Miyake K, Tatsuguchi A, Suzuki K, Ueki N, Shinji Y, Kusunoki M, Iizumi T, Hiratsuka T, Nishigaki H, Futagami S, Wada K, Tsukui T, Sakamoto C. Implications of corpus gastritis, atrophy and cyclooxygenase in the development of gastric erosions after curing Helicobacter pylori infection. Dig Liver Dis 2005; 37:394-401. [PMID: 15893277 DOI: 10.1016/j.dld.2004.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 12/28/2004] [Indexed: 12/11/2022]
Abstract
BACKGROUND Helicobacter pylori eradication decreases recurrence of peptic ulcers with marked improvement in histological inflammation, but gastric mucosal injuries may be developed even after eradication. PURPOSE To investigate the mechanisms responsible for the development of gastric erosions after eradication, we analysed the relationship between clinicopathological risk factors and the occurrence of gastric erosion after curing H. pylori infection. PATIENTS Sixty patients underwent endoscopy before, and 3, 6 and 12 months after the completion of H. pylori eradication. METHODS Risk factors associated with the development of gastric erosions after eradication were assessed by multivariate analysis, and cyclooxygenase-1 and -2 immunoreactivity was histologically examined in the gastric mucosa before and after eradication. RESULTS The cumulative prevalence of gastric erosions after H. pylori eradication was 38.3% within 1 year. Using multivariate analysis, corpus gastritis scores (inflammation score+activity score), corpus atrophy scores and an age of more than 50 years were found to be independent factors associated with the development of gastric erosion after eradication with odds ratios of 7.39, 0.13 and 5.00, respectively. Cyclooxygenase-2 immunoreactivity of the corpus was decreased for the non-erosion group after eradication, but not for the erosion group. CONCLUSIONS Severe gastritis or less severe atrophy in oxyntic glands but not in pyloric glands before eradication may be involved in the development of gastric erosions after curing H. pylori infection.
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Affiliation(s)
- K Miyake
- Third Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
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Abstract
Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treatment in the geriatric population are not well defined. The aims of the study were to characterize geriatric patients according to referral patterns and results of the 13C-urea breath test (13C-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The 13C-UBT was performed with 75 mg urea labeled with 13C. Physicians who ordered the test completed a questionnaire covering demographic data, indication for the test, chronic use of a proton pump inhibitor, or nonsteroidal anti-inflammatory drug, and type of eradiction therapy. The study sample consisted of 2128 patients, aged 70-102 years, 958 (45%) men, referred for 13C-UBT. The test was positive on 697 (33%). History of peptic disease was the main indication for referral, following by validation of successful eradication, Israeli origin screening for gastric cancer, treatment with regimen containing metronidazole, history of peptic disease, and recurrence of symptoms were predictive factors for a positive 13C-UBT. Multivariate logistic regression analysis revealed a significant influence of eradication therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for 13C-UBT. Our results are in accordance with the increase in metronidazole resistance of H. pylori stains and the cohort effect of H. pylori infection on the elderly Israeli-born population.
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Affiliation(s)
- Yaron Niv
- Helicobacter Pylori Central Laboratory, Clalit Health Services, Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, and Tel Aviv University, Israel.
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Abstract
Gastric atrophy and intestinal metaplasia are generally considered to be precancerous lesions of the stomach. Chronic Helicobacter pylori infection is one the most important factors in the development of these pre-malignant gastric lesions. In addition to bacterial factors, polymorphisms in the cytokine genes of the host that modulate inflammatory responses are found to have a synergistic effect in the development of gastric cancer as well as pre-neoplastic lesions. Recently, inappropriate activation of the intestine-specific transcription factor like the homeobox gene complex CDX1 and CDX2 are found to be an important contributing factor in the induction of intestinal metaplasia in the stomach. Aberrant expression of cyclooxygenase-2 and epigenetic changes are also frequently detected in pre-neoplastic gastric lesions. One of the most important questions relating to these pre-neoplastic gastric lesions is that whether H. pylori eradication could reverse these changes. However, most controlled studies showed no or just modest improvement in intestinal metaplasia after H. pylori eradication. Further studies should evaluate the role of other chemopreventive agents, particularly cyclooxygenase-2 inhibitor, on regression of pre-neoplastic lesions.
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Affiliation(s)
- Wai K Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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12
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Yamamoto M, Tsukamoto T, Sakai H, Hirata A, Yanai T, Masegi T, Hirano K, Furihata C, Tatematsu M. Gastric Carcinogenesis and Intestinalization Induced by N-methyl-N-nitrosourea in the Senescence-Accelerated Mouse(SAMP3). J Toxicol Pathol 2003. [DOI: 10.1293/tox.16.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Masami Yamamoto
- Division of Oncological Pathology, Aichi Cancer Center Research Institute
| | - Tetsuya Tsukamoto
- Division of Oncological Pathology, Aichi Cancer Center Research Institute
| | - Hiroki Sakai
- Department of Veterinary Pathology, Gifu University
| | | | - Tokuma Yanai
- Department of Veterinary Pathology, Gifu University
| | | | | | - Chie Furihata
- College of Science and Engineering, Aoyama Gakuin University
| | - Masae Tatematsu
- Division of Oncological Pathology, Aichi Cancer Center Research Institute
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13
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Abstract
The prevalence of Helicobacter pylori infection increases with age worldwide. However, the percentage of H. pylori-positive elderly patients who are tested and treated for their infection remains very low. We now have data that demonstrate the benefit of curing H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis. Furthermore, the cure of H. pylori may prevent progression of intestinal metaplasia and gastric atrophy. Studies are needed to clarify the role of eradication for elderly patients who have nonulcer dyspepsia, gastroesophageal reflux disease and who use nonsteroidal anti-inflammatory drugs. H. pylori infection may be easily diagnosed by histological evaluation, rapid urease test or culture performed on gastric biopsies taken during endoscopy. However, the biopsy site must be carefully selected in elderly patients. For noninvasive monitoring of H. pylori infection after treatment, the 13C-urea breath test has significantly higher accuracy than serology in the elderly. The role of the H. pylori stool antigen test in old age still needs to be clarified. One-week PPI-based triple therapy regimens including clarithromycin, amoxycillin and/or nitroimidazoles are highly effective and well tolerated in elderly patients. Low doses of both PPIs and clarithromycin (in combination with standard doses of amoxycillin or nitroimidazoles) are sufficient. Antibiotic resistance and low compliance are the main factors related to treatment failure at any age.
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Affiliation(s)
- Alberto Pilotto
- Fisiopatologia Digestiva dell'Anziano, UO Geriatria, Ospedale San Bortolo, Vicenza, Italy.
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14
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Abstract
Gastric intestinal metaplasia, an intermediate step in Correa's cascade of gastric carcinogenesis, is generally regarded as a pre-malignant lesion. Epidemiological studies suggest that patients with intestinal metaplasia have more than a 10-fold increased risk of developing gastric cancer. Within the subclassification of intestinal metaplasia, incomplete or type III intestinal metaplasia appears to be associated with even higher malignant potential. The topographical distribution of intestinal metaplasia may also have prognostic implications. Certain genetic and epigenetic alterations have been demonstrated in gastric intestinal metaplasia which straddle into gastric cancer. These findings suggest that genetic changes occur early in the multistep gastric carcinogenesis process. Unlike Barrett's oesophagus and colonic polyp, which have well-defined surveillance guidelines, there is no widely accepted surveillance programme for gastric intestinal metaplasia. An annual surveillance programme may allow early detection of gastric cancer, which theoretically may improve survival. It remains elusive whether the treatment of Helicobacter pylori infection may reverse gastric intestinal metaplasia or reduce the subsequent risk of cancer development. Further controlled studies with longer follow-up are needed to resolve this controversy. The role of chemo-prophylactic agents, e.g. cyclo-oxygenase-2 inhibitor, should be investigated.
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Affiliation(s)
- W K Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
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15
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Yamamoto M, Furihata C, Ogiu T, Tsukamoto T, Inada KI, Hirano K, Tatematsu M. Independent variation in susceptibilities of six different mouse strains to induction of pepsinogen-altered pyloric glands and gastric tumor intestinalization by N-methyl-N-nitrosourea. Cancer Lett 2002; 179:121-32. [PMID: 11888666 DOI: 10.1016/s0304-3835(02)00013-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Strain differences in susceptibility regarding stomach carcinogenesis due to N-methyl-N-nitrosourea were examined in males of six strains of mice: BALB/cA (BALB), C57BL/6N (C57BL6), CBA/JN (CBA), C3H/HeN (C3H), DBA/2N (DBA/2), and CD-1 (ICR). The frequency of pepsinogen-altered pyloric glands (PAPGs), putative precancerous lesions, was highest (19.6+/-9.9%) in the BALB and lowest in the ICR (12.3+/-5.7%) mice (P<0.05). Incidences of adenocarcinomas at week 52 were 59.3% (16 of 27) and 18.5% (5 of 27), respectively (P<0.005). Invasion also tended to be deepest in BALB compared with the other strains. Intestinal alkaline phosphatase-positive intestinal type cells were observed heterogeneously in some hyperplasias, adenomas and adenocarcinomas consisting of gastric type cells. Thus, intestinalization appeared to occur at random in both non-neoplastic and monoclonal neoplastic lesions, making it unlikely that IAP-positive cells could be precursors of gastric tumors. In contrast, the data suggest a direct histogenetic role for the PAPG, a useful preneoplastic marker lesion in mouse strains.
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Affiliation(s)
- Masami Yamamoto
- Division of Oncological Pathology, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
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