Epstein-Barr Virus and Helicobacter Pylori Co-Infection in Non-Malignant Gastroduodenal Disorders.

Ramsés Dávila-Collado,J Luis Espinoza,Oscar Jarquín-Durán,Le Thanh Dong

doi:10.3390/pathogens9020104

Ramsés Dávila-Collado, J Luis Espinoza + Show 2 more

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https://doi.org/10.3390/pathogens9020104

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Abstract

Epstein–Barr virus (EBV) and Helicobacter pylori (H. pylori) are two pathogens associated with the development of various human cancers. The coexistence of both microorganisms in gastric cancer specimens has been increasingly reported, suggesting that crosstalk of both pathogens may be implicated in the carcinogenesis process. Considering that chronic inflammation is an initial step in the development of several cancers, including gastric cancer, we conducted a systematic review to comprehensively evaluate publications in which EBV and H. pylori co-infection has been documented in patients with non-malignant gastroduodenal disorders (NMGDs), including gastritis, peptic ulcer disease (PUD), and dyspepsia. We searched the PubMed database up to August 2019, as well as publication references and, among the nine studies that met the inclusion criteria, we identified six studies assessing EBV infection directly in gastric tissues (total 949 patients) and three studies in which EBV infection status was determined by serological methods (total 662 patients). Due to the substantial methodological and clinical heterogeneity among studies identified, we could not conduct a meta-analysis. The overall prevalence of EBV + H. pylori co-infection in NMGDs was 34% (range 1.8% to 60%). A higher co-infection rate (EBV + H. pylori) was reported in studies in which EBV was documented by serological methods in comparison with studies in which EBV infection was directly assessed in gastric specimens. The majority of these studies were conducted in Latin-America and India, with most of them comparing NMGDs with gastric cancer, but there were no studies comparing the co-infection rate in NMGDs with that in asymptomatic individuals. In comparison with gastritis caused by only one of these pathogens, EBV + H. pylori co-infection was associated with increased severity of gastric inflammation. In conclusion, only relatively small studies testing EBV and H. pylori co-infection in NMGDs have been published to date and the variable report results are likely influenced by geographic factors and detection methods.

Highlights

Symptoms associated with upper gastrointestinal disorders such as epigastric pain and dyspepsia are common in general practice and represent a source of substantial morbidity, mortality, and health care cost [1]
1611 individuals with non-malignant gastroduodenal disorders (NMGDs) were included in the present systematic review
A few meta-analyses assessing the association of either H. pylori or Epstein–Barr virus (EBV) with gastric cancer have been published to date, and even a systematic review which revised articles reporting on co-infection rate with both pathogens in patients’ gastric cancer [12,27,59], to the best of our knowledge, this is the first study to systematically review the literature testing the association between H. pylori or EBV co-infection with NMGDs

Summary

Introduction

Symptoms associated with upper gastrointestinal disorders such as epigastric pain and dyspepsia are common in general practice and represent a source of substantial morbidity, mortality, and health care cost [1]. Dyspepsia refers to a spectrum of symptoms that include recurrent pain or discomfort in the epigastric region, postprandial epigastric distension, and nausea or vomiting. These symptoms may be acute or chronic and account for a large number of doctor visits in primary care [2]. The etiology of FD appears to be multifactorial, including H. pylori infection or gastrointestinal motility disorders that can be due to hypersensitivity to mechanical and chemical stimuli, immune activation, and elevated mucosal permeability in the proximal small intestine [4,5]

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