Abstract
BackgroundBoth H. pylori infection and diabetes increase the risk of gastric cancer. This study investigated whether patients with type 2 diabetes mellitus (T2DM) and H. pylori infection had more severe corpus gastric inflammation and higher prevalence of precancerous lesions than non-diabetic controls.MethodsA total of 797 patients with type 2 diabetes mellitus were screened for H. pylori, of whom 264 had H. pylori infection. Of these patients, 129 received esophagogastroduodenoscopy to obtain topographic gastric specimens for gastric histology according to the modified Updated Sydney System, corpus-predominant gastritis index (CGI), Operative Link on Gastritis Assessment, and Operative Link on Gastric Intestinal Metaplasia Assessment. Non-diabetic dyspeptic patients who had H. pylori infection confirmed by esophagogastroduodenoscopy were enrolled as controls.ResultsThe male as well as total T2DM patients had higher acute/chronic inflammatory and lymphoid follicle scores in the corpus than non-diabetic controls (p < 0.05). In contrast, the female T2DM patients had higher chronic inflammatory scores in the antrum than the controls (p < 0.05). In T2DM patients, the males had significantly higher rates of CGI than the females (p < 0.05). Multivariate logistic regression analysis showed that male patients (odds ratio: 2.28, 95% confidence interval: 1.11–4.69, p = 0.025) and non-insulin users (odds ratio: 0.33, 95% confidence interval: 0.15–0.74, p = 0.007) were independent factors for the presence of CGI in the H. pylori-infected patients with type 2 diabetes mellitus.ConclusionsPatients with type 2 diabetes mellitus and H. pylori infection had more severe corpus gastric inflammation than non-diabetic controls. Moreover, male gender and non-insulin users of T2DM patients were predisposed to have corpus-predominant gastritis after H. pylori infection.Trial registrationClinicalTrial: NCT02466919, retrospectively registered may 17, 2015.
Highlights
Both H. pylori infection and diabetes increase the risk of gastric cancer
H. pylori infection is known to increase the risk of gastric cancers [1, 2], and both chronic atrophic gastritis and intestinal metaplasia have been reported to be precancerous lesions that can potentially develop into gastric adenocarcinoma [3, 4]
Our recent previous study further disclosed that the corpus-predominant gastritis index (CGI) can be used to identify H. pylori-infected patients currently without intestinal metaplasia who are at an increased risk of gastric cancer earlier than the Operative link on gastritis assessment (OLGA) and Operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems [7]
Summary
Both H. pylori infection and diabetes increase the risk of gastric cancer. This study investigated whether patients with type 2 diabetes mellitus (T2DM) and H. pylori infection had more severe corpus gastric inflammation and higher prevalence of precancerous lesions than non-diabetic controls. Our recent previous study further disclosed that the corpus-predominant gastritis index (CGI) can be used to identify H. pylori-infected patients currently without intestinal metaplasia who are at an increased risk of gastric cancer earlier than the OLGA and OLGIM staging systems [7]. Several recent studies have shown that patients with DM who live in areas with a higher prevalence of H. pylori and gastric cancer and those with a longer duration of diabetes and poor glycemic control are predisposed to an increased risk of gastric cancer [17,18,19]. The early detection and prompt treatment of H. pylori infection should be a priority to reduce the risk of gastric cancer in patients with T2DM
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