Cases Of Chronic Atrophic Gastritis Research Articles

Clinical and morphological characteristics of patients with chronic gastritis and high risk of gastric cancer

The purpose of this study is to conduct a clinical and morphological analysis of cases of chronic gastritis with a high risk of gastric cancer (GC). Materials and methods. The study included 26 cases of chronic atrophic gastritis of stages 3 and 4 with a high risk of developing GC according to the assessment using the OLGA system (Operative Link for Gastritis Assessment). The cases were diagnosed on material of gastric tissue biopsy in 2022. In total, 678 histological studies were performed during the year. Cases of chronic gastritis with a high risk of developing GC accounted for 3.8% of all chronic gastritis. Results. Cases of chronic gastritis with a high risk of developing GC were more often observed in older men (average age 67±12 years, ratio 2.25:1). Multifocal atrophic gastritis was in the first place in frequency of occurrence (61.5%), the connection with helicobacter infection was confirmed only in a third of cases (34.6%). Morphological changes were characterized by a predominant lesion of the antrum of the stomach and mixed complete and incomplete intestinal metaplasia. With the exception of one case in which pseudopancreatic metaplasia was detected in the antrum of the stomach, all cases of autoimmune gastritis (n=26) were assigned to stage 2 with a low risk of developing GC, which seems controversial to us. Conclusion. The results of our study showed a high percentage of pre-existing tumor lesions of the stomach in the group of chronic gastritis with a high risk of developing GC. Dysplasia was diagnosed in 5 out of 26 cases, GC with previously performed mucosectomy in 3 out of 26 cases. In addition, the patients had other tumor and precancerous lesions of the gastrointestinal tract. These data show the validity and practical value of using the OLGA system to identify high-risk groups for the development of tumors not only of the stomach, but also of gastrointestinal tumors of other localizations.

CDX2 protein distribution in the gastric mucosa in chronic gastritis by a semi-quantitative index and its reproducibility

Introduction The Cdx2 gene provides an intestinal differentiation of epithelial cells and plays an oncosupressive role. An indirect method of the Cdx2 gene expression assessment is the immunohistochemical study of its product, the CDX2 protein. Therefore, the common approach to the immunohistochemical study of the CDX2 protein hasn’t been developed yet. A semi-quantitative CDX2 index based on the percentage of CDX2-positive cells in the tissue specimen, the staining intensity and an expression pattern has been proposed.The purpose of the study was to assess the reproducibility of the semi-quantitative CDX2 index calculation in chronic atrophic gastritis stages I-IV.Materials and methods 20 chronic atrophic gastritis cases (5 cases for each stage of the gastritis according to the Operative link for gastritis assessment system) were taken according to the Maastricht V protocol and examined by the immunohistochemical method (CDX2, clone EPR2764Y, ready to use). The reproducibility of the CDX2 semi-quantitative index was assessed by five pathologists. An agreement between observed raters was measured by the kappa statistics.Results The Cohen’s κ value is 0,8 for unweighted κ and 0,97 for weighted κ (extremely high level of agreement) for the semi-quantitative CDX2 index calculation.Discussion The least reproducible parameter used for the semi-quantitative CDX2 index calculation the percentage of CDX2-positive cells because of the subjective assessment. The Cohen’s weighted κ value was higher compared to the unweighted κ because of the close yet not similar CDX2 semi-quantitative index values calculated by pathologists.Conclusion The semi-quantitative CDX2 index can be used to rank CDX2 expression and has a high level of reproducibility.

Assessment of the content of neuroendocrine cells in the gastric mucosa in patients with autoimmune gastritis

The aim of the study was to evaluate the content of neuroendocrine cells in immunohistochemically stained preparations and determine differences in the number of neuroendocrine cells (NEC) in the body of the stomach in autoimmune gastritis (AIG) and other forms of gastritis. Material and methods. The study included 27 cases of AIG and 9 cases of chronic atrophic gastritis not associated with autoimmune mechanisms of disease. The age of the patients ranged from 36 to 77 years and averaged 54.9 years. Biopsies were taken according to accepted protocols: 2–3 biopsies from the antrum and 2 biopsies from the body of the stomach. An immunohistochemical reaction was carried out with an antibody to chromogranin A on an automatic Bond Max immunostainer (Leica, Germany). The slides were digitized on an Aperio AT2 scanner (Leica, Germany), and QuPath v.0.3.0 software for viewing and analyzing digital images of slides was used for morphometric analysis of digital images and counting. The results were processed in the Jamovi program, Version 1.6 ( https://www.jamovi.org ). Results. According to the results of counting in the group of patients with AIG, there was an increase in the quantity of NEC. Ranges of hyperplasia of neuroendocrine cells were revealed: 648–1736 cells per 1 mm2 square were detected for AIG, 416–605 cells per 1 mm2 for other forms of gastritis. In the AIG group median is 925 cells per 1 mm2, the 1st quartil is 877 cells per 1 mm2, 3rd quartil is 1172 cells per 1 mm2, interquartile range is 295 cells per 1 mm2 (asymmetrical distribution). In the group with other forms of gastritis arithmetic mean is 522±23 cells per millimeter square (normal distribution). Conclusion. The obtained results allowed to confirm NEC hyperplasia in patients with AIG. A statistically significant difference was found in the number of NEC in the body of the stomach in the group of AIG and other gastritis (p≤0,01), which can be proposed as an additional morphological criteria for diagnosing AIG.

Clinical Observation on 50 Cases of Chronic Atrophic Gastritis Treated by Traditional Chinese Medicine

Clinical Observation on 50 Cases of Chronic Atrophic Gastritis Treated by Traditional Chinese Medicine

Acupuncture based on meridian diagnosis for chronic atrophic gastritis

To compare the efficacy between acupoint selection of meridian diagnosis and regular acupoint selection for chronic atrophic gastritis (CAG). A total of 70 cases of CAG were randomly divided into an observation group (35 cases, 5 cases dropped off) and a control group (35 cases, 5 dropped off). In the observation group, according to the hand diagnosis of meridians and the results of 80-channels energy determinator, based on the principle of child-mother relation acupoint combination, the luo-connecting point and back-shu points were added for excess syndrome, and the yuan-primary point, front-mu points and he-sea point of foot meridians were added for deficiency syndrome; in addition, the acupoints of the eight extraordinary meridians were added based on the nature of acupoints. In the control group, Zhongwan (CV 12), Neiguan (PC 6), Zusanli (ST 36) and Gongsun (SP 4) were selected as the primary acupoints, and additional acupoints were added according to syndrome differentiation. The two groups were treated twice a week (Tuesday and Thursday, respectively), totally for 6 months. Six months after treatment, the follow-up was conducted. The clinical symptom score, gastroenteropathy patient reported outcomes (PRO) scale score before treatment, after treatment and during follow-up as well as the score of pathological changes of gastric mucosa before and after treatment were compared between the two groups. After treatment and during follow-up, the clinical symptom scores and gastroenteropathy PRO scale scores were decreased in the two groups (P<0.01, P<0.001); at the follow-up, the gastroenteropathy PRO scale score in the observation group was lower than that in the control group (P<0.01). After treatment, the scores of pathological changes of gastric mucosa in the two groups were decreased (P<0.01), and the score in the observation group was lower than that in the control group (P<0.05). The acupoint selection of meridian diagnosis is superior to regular acupoint selection for CAG, which has better efficacy, more significant improvement on gastric mucosa pathology, and more stable long-term effect.

Significance of Serological Gastric Biopsy in Different Gastric Mucosal Lesions: an Observational Study.

Screening and timely treatment of precancerous gastric cancer diseases or of gastric cancer in the early stages has important significance in reducing the incidence and mortality of gastric cancer. Gastroscopy and histopathological biopsy are still the gold standards for the diagnosis of gastric diseases. But the application of astroscopy for the screening and diagnosis of gastric diseases is limited. In recent years, serum pepsinogen (PG), gastrin, and Helicobacter pylori (H. pylori) IgG antibodies have become indicators for "serological biopsy" of the gastric mucosa. From January 2016 to January 2018, a total of 2,394 patients with digestive tract symptoms underwent gastroscopy. According to the endoscopic examination and pathological diagnosis, there were four case groups: 1,376 cases of chronic non-atrophic gastritis, 708 cases of chronic atrophic gastritis, 265 cases of gastric ulcer, and 45 cases of gastric cancer. Serological gastric biopsies were performed and analyzed. The serum levels of PGI in the chronic atrophic gastritis group was significantly lower than that in the chronic non-atrophic gastritis group, gastric ulcer group, and gastric cancer group (p < 0.05). The serum levels of PGII and G-17 in the gastric cancer group were significantly higher than those in the chronic non-atrophic Gastritis group, chronic atrophic gastritis group, and gastric ulcer group (p < 0.05). The PGR in the gastric cancer group was significantly lower than that in the chronic non-atrophic gastritis group, chronic atrophic Gastritis group, and gastric ulcer group (p < 0.05). The H. pylori positive rates in the chronic atrophic gastritis group and gastric cancer group were higher than those in the chronic non-atrophic gastritis group and gastric ulcer Group (p < 0.05). Serological gastric biopsy is closely correlated to gastric mucosal disease and can be used as a Screening tool in gastric disease.

Validating traditional Chinese syndrome features in varied stages of chronic gastritis malignant transformation: study protocol for a cross-sectional study

IntroductionThe transition from chronic non-atrophic gastritis (CNAG) to chronic atrophic gastritis (CAG) and gastric carcinoma (GC) is regarded as a representative disease model of gastric mucosa malignant transformation led by...

The expression and significance of vascular endothelial growth factor in gastric adenocarcinoma and chronic atrophic gastritis with low grade intraepithelial neoplasia

Objective To investigate the expression and significance of vascular endothelial growth factor (VEGF) in gastric adenocarcinoma, normal gastric mucosa and chronic atrophic gastritis with low grade intraepithelial neoplasia. Methods Immunohistochemical streptavid-in-peroxidase (SP) method was used to detect the expression levels of VEGF in 65 cases of gastric cancer tissues, 50 cases of chronic atrophic gastritis with low grade intraepithelial neoplasia, and 35 cases of normal gastric mucosa (GM). The clinical data were reviewed in 65 patients with gastric adenocarcinoma. Results VEGF overexpression was seen in 2 cases of GM (2/35, 5.7%), 18 cases of chronic atrophic gastritis with low grade intraepithelial neoplasia (18/50, 36.0%), and 36 cases of gastric adenocarcinoma (36/65, 55.4%). Overexpression rate of VEGF in chronic atrophic gastritis with low grade intraepithelial neoplasia and gastric adenocarcinoma was significantly higher than that in the normal GM (P=0.001). Conclusion VEGF protein may play a certain role in the progression of gastric adenocarcinoma. It may also have significantly positive association with the oncegenesis and prognosis of the gastric cancer. Key words: Normal gastric mucosa; Gastric carcinoma; Vascular endothelial growth factor

Mining analysis and experience summary for chronic atrophic gastritis cases treated by Professor LIU Feng-bin

To summarize Professor LIU Feng-bin's clinical experience and theoretical thoughts on chronic atrophic gastritis (CAG), the study group designed a retrospective study on his case series and expert interview. First of all, the data of CAG patients treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine between 2009 and 2013, e. g. herbs, diseases, syndrome type, prescription amount and number of herbs, was collected and processed. The statistical description and binary logistic regression were used to determined the syndrome type, initial basic remedy and modification. During the statistics, a complete and sub-group analysis was performed simultaneously. After the expert interview, the syndrome type and medication were finalized. As a result, a total of 228 CAG patients aged at (50.30 ± 10.18) were collected, including 151 males (66.23%). Of them, the TCM diagnosis and syndrome type were extracted from the information of 157 patients, including 115 cases with gastric stuffiness, 23 cases with gastric pain, 19 missing cases, 2 cases with spleen-stomach weakness syndrome, 57 cases with spleen deficiency and dampness-heat syndrome, 18 cases with spleen-stomach disharmony syndrome, 23 cases with syndrome of liver depression syndrome, 21 cases with liver qi invading stomach syndrome and 26 qi and yin deficiency syndrome, respectively. All of the 228 patients used totally 104 herbs, while the subgroups with 157 patients used 94 herbs. The most frequently used 15 herbs used in each groups were analyzed to determine the initial basic remedy and modification. Subsequently, based on the information of the sub-groups with 157 patients, with the syndrome type as the dependent variable, the logistic regression analysis was made on the most frequently used 32 herbs, in order to determined the modification in herbs for different syndrome types. After experts reviewed and modified, they believed the main causes of CAG were dietary irregularities, moodiness and weak constitution; the pathogenesis of CAG was spleen deficiency with qi stagnation, heat depression and blood stasis in the stomach meridian. The above six syndrome types and 12 herbs were determined, including Pseudostellariae Radix, Poria, Atractylodismacrocephalae Rhizoma, Glycyrrhizae Radix et Rhizoma, Fritillariae Thunbergii Bulbus, Sepiae Endoconcha, Arecae Pericarpium, Aurantii Fructus, Perillae Caulis, Herba Hedyotis Diffusae, Scutellariae Barbatae Herba, Curcumae Rhizoma. This study summarized Professor LIU Feng-bin's clinical experience and theoretical thoughts of chronic atrophic gastritis based on clinical practice data and expert interview, with a rigorous design and good scientificity and practicability.

Clinical observation on combination therapy of Ninggan-Tiaozhong decoction and psychological intervention for 40 cases of chronic atrophic gastritis

Objective To survey the clinical effect of combination therapy of Ninggan-Tiaozhong decoction and psychological intervention for chronic atrophic gastritis (CAG).Methods 80 cases CAG were randomly divided into a treatment group (treated with Ninggan-Tiaozhong decoction and psychological intervention) and a control group (treated with Ninggan-Tiaozhong decoction),with 40 cases in each group and performed a therapy for 12 weeks.The clinical efficacy and the change of Symptom Checklist (SCL-90)and Self-Rating Anxiety Scale(SAS) before and after treatment were evaluated.Results After 12 weeks of treatment,the total effective rate was 90.0％ in the treatment group,and 74.4％ in the control group.The treatment group was better than the control group(x2=4.255,P＜0.05).After psychological intervention,SCL-90 and SAS score (39.5±4.3,1.3± 0.6)was significantly reduced in the treatment group than the control group (51.4±3.2,1.5±0.3),(P＜0.05).Conclusion The combination therapy of Ninggan-Tiaozhong decoction and psychological intervention used in CAG is effective to relieve symptoms and to improve life quality of patients. Key words: Chronic atrophic gastritis; Ninggan-Tiaozhong decoction; Psychological intervention; Symptom Checklist; Self-Rating Anxiety Scale

Association between selected oral pathogens and gastric precancerous lesions.

We examined whether colonization of selected oral pathogens is associated with gastric precancerous lesions in a cross-sectional study. A total of 119 participants were included, of which 37 were cases of chronic atrophic gastritis, intestinal metaplasia, or dysplasia. An oral examination was performed to measure periodontal indices. Plaque and saliva samples were tested with real-time quantitative PCR for DNA levels of pathogens related to periodontal disease (Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Actinobacillus actinomycetemcomitans) and dental caries (Streptococcus mutans and S. sobrinus). There were no consistent associations between DNA levels of selected bacterial species and gastric precancerous lesions, although an elevated but non-significant odds ratio (OR) for gastric precancerous lesions was observed in relation to increasing colonization of A. actinomycetemcomitans (OR = 1.36 for one standard deviation increase, 95% Confidence Interval = 0.87–2.12), P. gingivalis (OR = 1.12, 0.67–1.88) and T. denticola (OR = 1.34, 0.83–2.12) measured in plaque. To assess the influence of specific long-term infection, stratified analyses by levels of periodontal indices were conducted. A. actinomycetemcomitans was significantly associated with gastric precancerous lesions (OR = 2.51, 1.13–5.56) among those with ≥ median of percent tooth sites with PD≥3 mm, compared with no association among those below the median (OR = 0.86, 0.43–1.72). A significantly stronger relationship was observed between the cumulative bacterial burden score of periodontal disease-related pathogens and gastric precancerous lesions among those with higher versus lower levels of periodontal disease indices (p-values for interactions: 0.03–0.06). Among individuals with periodontal disease, high levels of colonization of periodontal pathogens are associated with an increased risk of gastric precancerous lesions.

Clinical efficacy analysis on clarithromycin combined with metronidazole and folic acid in treatment for 49 cases of chronic atrophic gastritis

Objectives To explore and analyze the clinical effects of clarithromycin combined with metronidazole and folic acid in treatment for 49 cases of chronic atrophic gastritis.Methods 98 cases of chronic atrophic gastritis received from March 2009 to March 2010 were randomly divided into two groups:control group and treatment group,49 cases for each group.The control group was given clarithromycin and metronidazole for treatment,and the treatment group used clarithromycin combined with metronidazole and folic acid.The clinical effect after treatment was compared in these two groups.Results As for the 49 cases of treatment group,26 cases were significantly effective,22 cases were effectual and 1 case was withont effect,with a total effective rate of 97.96％; as for the control group,there were 15 significant effective cases,29 cases effectual,and 5 with no effect respectively,and the total effective rate was 89.80％.There was statistical significant difference between the two groups (x2=6.58,P＜0.05).5 cases in treatment group had adverse effects,accounting for 10.20％,while 4 cases in control group had adverse effect,taking up 8.16％.There was no significant difference in incidence between the two groups (P＞0.05).Conclusions The therapy of clarithromycin combined with metronidazole and folic acid has great effect in curing chronic atrophic gastritis,with less adverse effects and worthy of clinical application. Key words: Clarithromycin; Metronidazole; Folic Acid; Chronic atrophic gastritis

Screening and identification of serum proteomic biomarkers for gastric adenocarcinoma.

The aim of the present study was to screen for possible serum biomarkers for gastric adenocarcinoma. Surface-enhanced laser desorption ionization time of flight mass spectrometry (SELDI-TOF-MS) was used to screen serum samples from 109 cases of gastric adenocarcinoma and 106 control subjects (60 healthy subjects, 30 patients with chronic superficial gastritis and 16 cases of chronic atrophic gastritis). The differentially expressed protein peaks were selected and isolated using high performance liquid chromatography (HPLC) and processed with enzyme prior to liquid chromatography-mass spectrometry tandem mass spectrometry (LC-MS/MS) analysis and data mining with software XCalibur program components BioWorks 3.2. Among the gastric cancer cases, three differentially expressed protein peaks were selected as potential serum biomarkers: the m/z peaks at 5,906.5 showed increased expression (8.53±4.33 in the cancer group, and 0.88±0.31 in the control group); the m/z peaks at 6,635.7 and 8,716.3 showed decreased expression (6.54±2.44 and 0.93±0.29, respectively, in the cancer group and 17.56±4.43 and 2.16±0.98, respectively, in the control group) (P<0.01). The m/z peaks at 5,906.5, 6,635.7 and 8,716.3, were identified as fibrinogen α-chain, apolipo-protein A-II and apolipoprotein C-I. The combined use of the three biomarkers distinguished the cancer group patients from the control group samples at a sensitivity of 93.85% (61/65) and a specificity of 94.34% (50/53). In conclusion, fibrinogen α-chain, apolipoprotein A-II and apolipoprotein C-I were identified as potential markers for gastric cancer and appear to have diagnostic value for clinical applications.

DNA repair gene polymorphisms and risk of chronic atrophic gastritis: a case-control study

BackgroundRecent studies have reported associations of DNA repair pathway gene variants and risk of various cancers and precancerous lesions, such as chronic atrophic gastritis (CAG).MethodsA nested case-control study within the German population-based ESTHER cohort was conducted, including 533 CAG cases and 1054 controls. Polymorphisms in eleven DNA repair genes (APEX1, ERCC1, ERCC2/XPD, PARP1 and XRCC1), in CD3EAP/ASE-1 and PPP1R13L were analysed.ResultsNo association was disclosed for any of the analysed polymorphisms. Nor did stratified analyses according to ages < 65 and ≥ 65 years show any significant association with CAG risk.ConclusionsThe results of this large German case-control study do not reveal associations of DNA repair pathway polymorphisms and risk of CAG. On the basis of a large number of CAG cases, they do not support associations of DNA repair pathway SNPs with CAG risk, but suggest the need of larger studies to disclose or exclude potential weak associations, or of studies with full coverage of candidate genes.

Polymorphisms in MUC1, MUC2, MUC5B and MUC6 genes are not associated with the risk of chronic atrophic gastritis

Mucins represent major components of the mucous layer in the stomach, protecting the underlying epithelium from acid, mechanical trauma, proteases and pathogenic bacteria. Previous studies have shown an association of neoplastic transformation in the stomach with aberrant mucin levels, suggesting a potential role of genetic variation in mucin genes in the development of gastric cancer (GC). We assessed the association of genetic variation in candidate single nucleotide polymorphisms (SNPs) in mucin genes with the risk of chronic atrophic gastritis (CAG), a well-established precursor of GC in the German population-based ESTHER study. We genotyped MUC1 T31T, MUC2 L58P, MUC2 V116M, MUC5B E34G, MUC5B R51W, MUC5B rs2014486 (intronic) and MUC6 V619M for 533 serologically defined CAG cases and 1054 age- and sex-matched controls. None of the analysed SNPs was associated with CAG. However, large studies are needed to disclose or exclude potential weak associations of these SNPs with CAG risk.

Incidence and risk factors for the development of chronic atrophic gastritis: Five year follow‐up of a population‐based cohort study

Chronic atrophic gastritis (CAG) is a well-established precursor of intestinal gastric cancer. However, data on incidence of CAG are rare, especially from population-based studies. The aim of this analysis was to estimate the incidence of CAG in a large population-based study among older adults from Germany and to identify major risk factors associated with its development. In the baseline and 5-year follow-up examinations of the ESTHER study, serological measurements of pepsinogen (PG) I and II and Helicobacter pylori antibodies were performed in 5,229 women and men, aged 50-74 years at baseline. Information on additional potential risk factors was obtained by questionnaire. CAG was defined by PGI < 70 ng/mL and PGI/PGII < 3. In total, there were 58 (1.1%) incident CAG cases. CAG incidence increased with increasing age from 0.5% in age group 50-54 years to 2.1% in age group 70-74 years. Seropositivity with H. pylori was strongly associated with CAG incidence, with adjusted odds ratios of 5.0 [95% confidence interval (CI): 1.6-15.8] and 11.3 (95% CI: 4.2-30.0) for participants with cytotoxin associated gene A (cagA) negative and cagA positive H. pylori infection at both baseline and follow-up compared to those without H. pylori infection, respectively. Gender, education, smoking, alcohol consumption and family history of gastric cancer were not significantly associated with CAG incidence. Incidence of CAG is rather low in the German population. Older age and infection with H. pylori are key risk factors for the development of CAG.

Grb2‐associated binder 1 (Gab1) genetic polymorphism, Helicobacter pylori infection, and chronic atrophic gastritis among older adults from Germany

Grb2-associated binder 1 (Gab1) plays an important role in the regulation of cell growth and transformation. A single nucleotide polymorphism (SNP) (rs3805246) in the Gab1 gene has been suggested to be related to the risk of Helicobacter pylori infection and chronic atrophic gastritis (CAG) in a study from Japan. We aimed to assess the associations in a population-based study from Germany. In the baseline examination of ESTHER, a population-based study conducted in Saarland, serum pepsinogen I and II and H. pylori serostatus were measured by ELISA. The Gab1 SNP (rs3805246) was genotyped in 351 serologically defined CAG cases and 351 age- and sex-matched non-CAG controls. A nonsignificant association was observed between the Gab1 SNP and CAG, with an adjusted odds ratio of 1.15 (0.85-1.55) for AA/AG carriers compared to GG carriers. The magnitude of the association did not change when the analysis was restricted to H. pylori seropositive subjects. Furthermore, no significant relation was found between the SNP and H. pylori seropositivity among non-CAG controls. We could not confirm a major association between Gab1 SNP (rs3805246) and the predisposition to H. pylori infection and CAG in this study population from Germany. Further studies with larger sample size are needed to clarify a potential modest effect of Gab1 genetic polymorphisms.

Relationship between let-7a and gastric mucosa cancerization and its significance

To investigate let-7a expression and analyze the correlation between let-7a and progression of gastric mucosa cancerization. The tissue microarray was constructed previously in 52 cases of human gastric carcinoma, 17 cases of chronic atrophic gastritis (atypical hyperplasia) and 11 cases of normal gastric tissue, and tissue microarrays combined with in situ hybridization were used to detect the expression of let-7a. The positive rates of let-7a in normal gastric tissue, chronic atrophic gastritis and gastric carcinoma were 90.9%, 88.2% and 86.5%, respectively, without significant differences among the groups (P > 0.05). However, an intense signal of let-7a was observed in gastric epithelial cells, whereas a less intense signal was found in gastric atypical hyperplasia epithelial cells and a weak signal in gastric carcinoma epithelial cells. The expression of let-7a decreased along with the progression of gastric mucosa cancerization (P < 0.05). In the group of gastric carcinoma, the expression of let-7a was even significantly lower in gastric carcinomas with lymph node metastasis than in those without metastasis (P < 0.05). Gastric carcinoma has relatively lower expression of let-7a. Reduced let-7a may be a fundamental factor in the formation and lymph node metastasis of gastric carcinoma.

Helicobacter pylori Infection and Chronic Atrophic Gastritis

Helicobacter pylori infection is an established risk factor for chronic atrophic gastritis. However, estimates of the strength of this association have varied widely, possibly due to clearance of the infection in severe stages of chronic atrophic gastritis, which may lead to underestimation of the association. We assessed the association of H. pylori infection with chronic atrophic gastritis according to severity of disease. We measured serum pepsinogen I and II (as surrogates for chronic atrophic gastritis) and antibodies against H. pylori by ELISA in 9444 men and women aged 50-74 years in a population-based study in Saarland, a state of Germany. The association between H. pylori and chronic atrophic gastritis (defined as pepsinogen I <70 ng/mL and pepsinogen I/II-ratio <3) was analyzed after stratification of chronic atrophic gastritis cases by quintiles of pepsinogen I as proxy marker for severity of chronic atrophic gastritis. When all cases were included, the odds ratio for the association with Chronic atrophic gastritis for H. pylori infection alone was 2.9 (95% confidence interval 2.3-3.6); it was 4.1 (3.2-5.2), for H. pylori infection that was positive for the presence of Ig G antibodies specific to the cytotoxin-associated gene A (CagA) protein-a well-established virulence factor of H. pylori. These ORs ranged from 11 (5.2-22) and 16 (7.7-34) for the quintile of cases with highest pepsinogen I (least severe cases) to 1.0 (0.7-1.6) and 0.9 (0.5-1.5) for the quintile of cases with lowest pepsinogen I (most severe cases). Five of 7 cases with CagA-seropositivity but negative H. pylori serostatus (a pattern indicative of past infection) were in the group of most severe cases. Our results support the hypothesis of major underestimation of the association of H. pylori and chronic atrophic gastritis, due to clearance of the infection in advanced stages of the disease. These results suggest that the association is much stronger than estimated by most epidemiologic studies to date.

Inverse association between a pro-inflammatory genetic profile and Helicobacter pylori seropositivity among patients with chronic atrophic gastritis: Enhanced elimination of the infection during disease progression?

Background Helicobacter pylori infection is a key risk factor for chronic atrophic gastritis (CAG), an established precursor of gastric cancer. There is increasing evidence of frequent clearance of the infection during progression of CAG. We aimed to assess the association between host inflammatory polymorphisms and H. pylori seropositivity among CAG patients from Germany. Methods In the baseline examination of ESTHER, a population-based study conducted in Saarland, serum pepsinogens I and II and H. pylori serostatus were measured by ELISA, and selected genetic polymorphisms (IL1A C-889T, IL1B C-511T, IL1RN A9589T, IL8 T-251A, IL10 T-819C, IL10 A-1082G, LTA C+80A and TNFA G-308A) were assessed by Pyrosequencing™ for 534 serologically defined CAG cases. Results H. pylori seropositivity strongly decreased with disease severity, which is defined by quintiles of serum pepsinogen I, from higher than 90% in the least severe cases to hardly over 50% in the most severe cases. The pro-inflammatory genotypes IL10 -819CC and IL1RN 9589TT were significantly associated with decreased H. pylori seroprevalences with odds ratios of 0.45 (95% confidence interval (CI): 0.23–0.88) and 0.41 (95% CI: 0.18–0.92), respectively, after controlling for age, sex and disease severity. H. pylori seropositivity decreased with the number of pro-inflammatory genotypes ( p < 0.01). Conclusions Our results disclose a clear inverse association between a pro-inflammatory genetic profile and H. pylori seropositivity among cases with CAG, supporting suggestions of enhanced elimination of H. pylori during the development of the disease.