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Price A, Graham DY, Tan MC. Controversies regarding management of Helicobacter pylori infections. Curr Opin Gastroenterol 2023; 39:482-489. [PMID: 37678189 PMCID: PMC10592071 DOI: 10.1097/mog.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW The recognition that Helicobacter pylori should be considered and treated as an infectious disease has yet to fundamentally change diagnostic and treatment practices and has resulted in many controversies. RECENT FINDINGS We discuss the following controversies: whether the current 'per-patient' approach to H. pylori testing based on symptoms should be expanded to include achieving population-level H. pylori eradication, whether H. pylori should be approached as an infectious gastrointestinal disease similar to that of other infectious diseases of similar severity and outcome, whether treatment of H. pylori should be primarily empiric or based on antibiotic susceptibility and locally proven successful therapies as are other infectious diseases, whether it is necessary to obtain confirmation of treatment success in every patient treated for H. pylori , and whether potassium-competitive acid blockers should replace proton pump inhibitors in H. pylori therapy. SUMMARY Available guidelines and meta-analyses do not yet address H. pylori as an infectious disease. The diagnosis and management and treatment success of H. pylori infections trails behind that of other important infectious diseases. We provide new insights and propose changes in the traditional understanding required to modernize the management of H. pylori infections.
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Affiliation(s)
- Alyssa Price
- Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - David Y. Graham
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Mimi C. Tan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Simkin J, Nash SH, Barchuk A, O'Brien DK, Erickson AC, Hanley B, Hannah H, Corriveau A, Larsen IK, Skovlund CW, Larønningen S, Dummer TJB, Bruce MG, Ogilvie G. Stomach Cancer Incidence and Mortality Trends among Circumpolar Nations. Cancer Epidemiol Biomarkers Prev 2021; 30:845-856. [PMID: 33627381 DOI: 10.1158/1055-9965.epi-20-1618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stomach cancer incidence and mortality rates are declining across circumpolar nations, but the burden may not be distributed equally across subpopulations, including Indigenous peoples. Our objective was to examine stomach cancer incidence and mortality trends across circumpolar populations. METHODS Cancer incidence and mortality data from 1999-2016 were obtained from the Canadian Cancer Registry, Canadian Vital Statistics, CDC WONDER, NORDCAN, Northwestern Russian cancer registries, and National Cancer Reports. The direct method was used to calculate 10-year rolling age-standardized incidence and mortality rates to the world (WHO 2000-2025) and 2011 Canadian standard populations. Standardized incidence rate ratios (SRR) were calculated. Data were stratified by sex, year, and region. U.S. data were broken down by race [White; American Indian/Alaska Native (AIAN)]. Race data were not available from non-U.S. cancer registries. RESULTS Most populations showed declining incidence and mortality rates over time. Incidence rates among Greenland males and females, Alaska AIAN males and females, and Northern Canadian both sexes were elevated compared with regional counterparts and remained stable. The largest male SRR was observed among Alaska AIAN versus Alaska Whites [SRR = 3.82; 95% confidence interval (95% CI), 2.71-5.37]. The largest female SRR was observed among Alaska AIAN versus Alaska Whites (SRR = 4.10; 95% CI, 2.62-6.43). CONCLUSIONS Despite stomach cancer incidence and mortality rates declining overall, some northern and Indigenous populations experience elevated and stable incidence and mortality rates. IMPACT There is a need to address disparities observed among circumpolar subpopulations. Given similarities in incidence, mortality, and risk factor prevalence across circumpolar regions, addressing disparities could benefit from coordinated international action.
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Affiliation(s)
- Jonathan Simkin
- Cancer Control Research, BC Cancer, British Columbia, Canada. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Sarah H Nash
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Anton Barchuk
- European University at Saint Petersburg, Saint Petersburg, Russia.,NN Petrov National Cancer Research Medical Center of Oncology, Saint Petersburg, Russia
| | - David K O'Brien
- Alaska Cancer Registry, Health Analytics and Vital Records Section (HAVRS), Alaska Department of Health and Social Services, Anchorage, Alaska
| | - Anders C Erickson
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Brendan Hanley
- Office of the Chief Medical Officer of Health, Department of Health and Social Services, Government of Yukon, Whitehorse, Yukon Territory, Canada
| | - Heather Hannah
- Department of Health and Social Services, Government of Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Andre Corriveau
- Department of Health and Social Services, Government of Northwest Territories, Yellowknife, Northwest Territories, Canada
| | | | | | | | - Trevor J B Dummer
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada.,Centre of Excellence in Cancer Prevention, School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Gina Ogilvie
- Cancer Control Research, BC Cancer, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, British Columbia, Canada.,Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, British Columbia, Canada
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Miernyk KM, Bruden D, Rudolph KM, Hurlburt DA, Sacco F, McMahon BJ, Bruce MG. Presence of cagPAI genes and characterization of vacA s, i and m regions in Helicobacter pylori isolated from Alaskans and their association with clinical pathologies. J Med Microbiol 2020; 69:218-227. [PMID: 32011229 PMCID: PMC10874806 DOI: 10.1099/jmm.0.001123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction. Gastric cancer is a health disparity in the Alaska Native people. The incidence of Helicobacter pylori infection, a risk factor for non-cardia gastric adenocarcinoma, is also high. Gastric cancer is partially associated with the virulence of the infecting strain.Aim. To genotype the vacA s, m and i and cag pathogenicity island (cagPAI) genes in H. pylori from Alaskans and investigate associations with gastropathy.Methodology. We enrolled patients with gastritis, peptic ulcer disease (PUD) and intestinal metaplasia (IM) in 1998-2005 and patients with gastric cancer in 2011-2013. Gastric biopsies were collected and cultured and PCR was performed to detect the presence of the right and left ends of the cagPAI, the cagA, cagE, cagT and virD4 genes and to genotype the vacA s, m and i regions.Results. We recruited 263 people; 22 (8 %) had no/mild gastritis, 121 (46 %) had moderate gastritis, 40 (15%) had severe gastritis, 38 (14 %) had PUD, 30 (11 %) had IM and 12 (5 %) had gastric cancer. H. pylori isolates from 150 (57%) people had an intact cagPAI; those were associated with a more severe gastropathy (P≤0.02 for all comparisons). H. pylori isolates from 77 % of people had either the vacA s1/i1/m1 (40 %; 94/234) or s2/i2/m2 (37 %; 86/234) genotype. vacA s1/i1/m1 was associated with a more severe gastropathy (P≤0.03 for all comparisons).Conclusions. In this population with high rates of gastric cancer, we found that just over half of the H. pylori contained an intact cagPAI and 40 % had the vacA s1/i1/m1 genotype. Infection with these strains was associated with a more severe gastropathy.
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Affiliation(s)
- Karen M. Miernyk
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Karen M. Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Debby A. Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Frank Sacco
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Michael G. Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
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