Prevention Of Gastric Cancer Research Articles

Gastric microbiota: an emerging player in gastric cancer.

Gastric cancer (GC) is a common cancer worldwide with a high mortality rate. Many microbial factors influence GC, of which the most widely accepted one is Helicobacter pylori (H. pylori) infection. H. pylori causes inflammation, immune reactions and activation of multiple signaling pathways, leading to acid deficiency, epithelial atrophy, dysplasia and ultimately GC. It has been proved that complex microbial populations exist in the human stomach. H. pylori can affect the abundance and diversity of other bacteria. The interactions among gastric microbiota are collectively implicated in the onset of GC. Certain intervention strategies may regulate gastric homeostasis and mitigate gastric disorders. Probiotics, dietary fiber, and microbiota transplantation can potentially restore healthy microbiota. In this review, we elucidate the specific role of the gastric microbiota in GC and hope these data can facilitate the development of effective prevention and therapeutic approaches for GC.

Abstract 5890: Distinct differences in microbial enrichment and diversity identified between gastric and gastroesophageal junction adenocarcinoma

Abstract Objective: The microbiome is associated with the pathogenesis and progression of disease in gastric cancer (GC). Eradication of Helicobacter pylori has reduced overall GC incidence, however, gastroesophageal cancer (GEJC) continues to increase. While there are oncologic differences between GEJC and GC, distinctions based on microbial profiles are unknown. In this study, we characterize differences in the microbial profiles of GEJC and GC. Methods: 562 patients with microsatellite stable GC (n=303) and GEJC (n=259) who had an institutional Integrated Mutation Profiling of Actionable Cancer Targets assay on the primary tumor were included in the study. A validated microbiome bioinformatics pipeline that is generalizable across multiple next generation sequencing platforms was utilized to compare microbial enrichment and alpha diversity between GC and GEJC, defined by type 1-3 Siewert classification. Results: Over 20 unique microbial species were enriched in GC when compared to GEJC, including Helicobacter and Lymphocryptovirus (Table 1). Prevotella had increased incidence in GEJC (OR:1.57,95%CI:1.02,2.41). Siewert type 2 and 3 GEJC had a significantly lower alpha diversity compared to GC. There was no significant difference in alpha diversity between GC and Siewert type 1 GEJC. Conclusion: There are distinct differences in microbial enrichment and alpha diversity between GEJC and GC. Helicobacter and Lymphocryptovirus, the genus family for Epstein Bar Virus, were noted to have the highest odds ratios in the GC group. Our findings showing the reduced incidence of microbes in GEJC which are the current targets of GC screening, prevention, and therapy, have implications in evaluating optimal preventative and treatment strategies in GEJC. Table 1. Microbes with enrichment in gastric cancer (GC) when compared to gastroesophageal cancer (GEJC) Microbes OR (95% Confidence Interval) p-value Helicobacter 85.40 (5.191, 1404.81) 0.002 Lymphocryptovirus 6.83 (2.3120,.17) 0.001 Pelagibacterium 6.01 (1.71, 21.06) 0.005 Gluconacetobacter 5.14 (1.70, 15.53) 0.004 Myxococcus 5.14 (1.70, 15.53) 0.004 Kribbella 4.48 (1.46, 13.74) 0.009 Celeribacter 3.46 (1.43, 8.37) 0.006 Halomonas 3.46 (1.43, 8.37) 0.006 Nakamurella 3.35 (1.46, 7.71) 0.004 Nitrobacter 2.91 (1.40, 6.05) 0.004 Pseudogulbenkiania 2.80 (1.30, 6.03) 0.009 Mycobacteroides 2.78 (1.33, 5.81) 0.006 Polaromonas 2.70 (1.49, 4.90) 0.001 Meiothermus 2.54 (1.41, 4.57) 0.002 Sphingopyxis 2.44 (1.33, 4.46) 0.004 Mesorhizobium 2.38 (1.32, 4.30) 0.004 Staphylococcus 2.23 (1.37, 3.62) 0.001 Thermus 2.13 (1.22, 3.70) 0.008 Mycolicibacterium 1.99 (1.29, 3.07) 0.002 Mycobacterium 1.95 (1.23, 3.08) 0.005 Lactobacillus 1.94 (1.17, 3.22) 0.01 Citation Format: Miseker Abate, Harrison Drebin, Shoji Shimada, Santosh Vardhana, Smita Sihag, Vivian E. Strong, Chad Vanderbilt. Distinct differences in microbial enrichment and diversity identified between gastric and gastroesophageal junction adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5890.

Controlling Gastric Cancer in a World of Heterogeneous Risk

Gastric cancer (GC) is a leading cause of global mortality but also a cancer whose footprint is highly unequal. This review aims to define global disease epidemiology, critically appraise strategies of prevention and disease attenuation, and assess how these strategies could be applied to improve outcomes from GC in a world of variable risk and disease burden. Strategies of primary prevention focus on improving the detection and eradication of the main environmental risk factor, Helicobacter pylori. In certain countries of high incidence, endoscopic or radiographic screening of the asymptomatic general population has been adopted as a means of secondary prevention. By contrast, identification and targeted surveillance of individuals with precancerous lesions (such as intestinal metaplasia) is being increasingly embraced in nations of low incidence. This review also highlights existing knowledge gaps in GC prevention as well as the role of emerging technologies for early detection and risk stratification.

Xiaojianzhong decoction prevents gastric precancerous lesions in rats by inhibiting autophagy and glycolysis in gastric mucosal cells

Gastric precancerous lesions (GPL) precede the development of gastric cancer (GC). They are characterized by gastric mucosal intestinal metaplasia and dysplasia caused by various factors such as inflammation, bacterial infection, and injury. Abnormalities in autophagy and glycolysis affect GPL progression, and their effective regulation can aid in GPL treatment and GC prevention. Xiaojianzhong decoction (XJZ) is a classic compound for the treatment of digestive system diseases in ancient China which can inhibit the progression of GPL. However, its specific mechanism of action is still unclear. To investigate the therapeutic effects of XJZ decoction on a rat GPL model and the mechanisms underlying its effects on autophagy and glycolysis regulation in GPLs. Wistar rats were randomly divided into six groups of five rats each and all groups except the control group were subjected to GPL model construction for 18 wk. The rats' body weight was monitored every 2 wk starting from the beginning of modeling. Gastric histopathology was examined using hematoxylin-eosin staining and Alcian blue-periodic acid-Schiff staining. Autophagy was observed using transmission electron microscopy. The expressions of autophagy, hypoxia, and glycolysis related proteins in gastric mucosa were detected using immunohistochemistry and immunofluorescence. The expressions of the following proteins in gastric tissues: B cell lymphoma/Leukemia-2 and adenovirus E1B19000 interacting protein 3 (Bnip-3), microtubule associated protein 1 light chain 3 (LC-3), moesin-like BCL2-interacting protein 1 (Beclin-1), phosphatidylinositol 3-kimase (PI3K), protein kinase B (AKT), mammalian target of rapamycin (mTOR), p53, AMP-activated protein kinase (AMPK), and Unc-51 like kinase 1 (ULK1) were detected using western blot. The relative expressions of autophagy, hypoxia, and glycolysis related mRNA in gastric tissues was detected using reverse transcription-polymerase chain reaction. Treatment with XJZ increased the rats' body weight and improved GPL-related histopathological manifestations. It also decreased autophagosome and autolysosome formation in gastric tissues and reduced Bnip-3, Beclin-1, and LC-3II expressions, resulting in inhibition of autophagy. Moreover, XJZ down-regulated glycolysis-related monocarboxylate transporter (MCT1), MCT4, and CD147 expressions. XJZ prevented the increase of autophagy level by decreasing gastric mucosal hypoxia, activating the PI3K/AKT/mTOR pathway, inhibiting the p53/AMPK pathway activation and ULK1 Ser-317 and Ser-555 phosphorylation. In addition, XJZ improved abnormal gastric mucosal glucose metabolism by ameliorating gastric mucosal hypoxia and inhibiting ULK1 expression. This study demonstrates that XJZ may inhibit autophagy and glycolysis in GPL gastric mucosal cells by improving gastric mucosal hypoxia and regulating PI3K/AKT/mTOR and p53/ AMPK/ULK1 signaling pathways, providing a feasible strategy for the GPL treatment.

Alterations in bacterial community dynamics from noncancerous to Gastric cancer.

Gastric microbiome has been shown to contribute to gastric carcinogenesis, understanding how alterations in gastric microbiome is helpful to the prevention and treatment of gastric cancer (GC). However, few studies have focused on the change of microbiome during the gastric carcinogenesis. In this study, the microbiome of gastric juice samples from healthy control (HC), gastric precancerous lesions (GPL) and gastric cancer (GC) was investigated by 16S rRNA gene sequencing. Our results showed that the alpha diversity of patients with GC was significantly lower than other groups. Compared to other groups, some genera in GC group were shown to be up-regulated (e.g., Lautropia and Lactobacillus) and down-regulated (e.g., Peptostreptococcus and Parvimonas). More importantly, the emergence of Lactobacillus was closely related to the occurrence and development of GC. Moreover, the microbial interactions and networks in GPL exhibited higher connectivity, complexity and lower clustering property, while GC showed the opposite trend. Taken together, we suggest that changes in the gastric microbiome are associated with GC and perform a key function in maintaining the tumor microenvironment. Therefore, our findings will provide new ideas and references for the treatment of GC.

Gastric microbiota in gastric cancer and precancerous stages: Mechanisms of carcinogenesis and clinical value.

Gastric cancer (GC) is a globally important disease. The discovery of Helicobacter pylori (H.pylori) demonstrated that the human stomach is not a sterile environment, and recent advances in molecular biology have led to the detection of large populations of microorganisms in the stomach. A growing number of studies have elucidated differences in the microbiota of patients at various stages of GC development. Evidence from insulin-gastrin transgenic (INS-GAS) and human gastric microbiota-transplanted mouse models have further demonstrated the potential causality of microbiota in the development of GC. To date, H.pylori is still thought to be the strongest risk factor for GC. H.pylori interacts with non-H.pylori commensals and affects the composition of the gastric microbiota. This review provides an overview of the relationship between the gastric microbiota and GC, including the mechanisms of microbe-associated carcinogenesis, the clinical value of the microbiota as a GC biomarker, and the potential of modulating the microbiota for GC prevention or therapy.

Anti cancer molecular mechanism of Actinidia chinensis Planch in gastric cancer based on network pharmacology and molecular docking

Purpose: To determine the anti-tumor effects of Actinidia chinensis Planch (ACP) root extract as well as its mechanism of action against gastric cancer (GC) using network pharmacology.Methods: The bioactive compounds and targets of ACP, as well as GC-related genes were identified from a series of public databases. Functional enrichment analysis was conducted to find relevant biological processes and pathways. The survival analysis was conducted using GEPIA tool. Autodock was used to carry out molecular docking between the ingredients and their targets.Results: A total of 20 bioactive compounds with 209 corresponding targets were identified for ACP, and a total of 871 GC-related genes were obtained. Forty-nine (49) targets of ACP were identified as candidate genes for the prevention of GC, and the PPI network with 584 interactions among these genes was constructed. The data demonstrated that the candidate targets were involved in multiple biological processes such as oxidative stress response, apoptosis, and proliferation. Moreover, these candidate targets were significantly associated with cancer-related pathways and signal transduction pathways. The compound-target-pathway network containing 16 bioactive compounds, 49 targets and 10 pathways was constructed and visualized, and the top 3 targets with a higher degree value were AKT1, MYC, and JUN, respectively. Survival analysis revealed significant associations between GC prognosis and several targets (PREP, PTGS1, AR, and PTGS2). Molecular docking further revealed good binding affinities between bioactive compounds and the prognosis-related targets, indicating the potential roles of these ingredient-target interactions in GC protection.Conclusion: Taken together, this study has provided novel clues for the determination of the antigastric cancer mechanism of ACP.

Russian consensus on prevention, diagnosis and treatment of gastric cancer

The Russian consensus on prevention, diagnostic and treatment of gastric cancer was prepared on the initiative of the Moscow clinical scientific center named after A. S. Loginov according to the Delphi method. Its aim was to clarify and consolidate the opinions of specialists on the most relevant issues of prevention, diagnosis and treatment of gastric cancer. An interdisciplinary approach was provided by the participation of leading gastroenterologists, oncologists and surgeons.

Construction of Tongue Image-Based Machine Learning Model for Screening Patients with Gastric Precancerous Lesions.

Screening patients with precancerous lesions of gastric cancer (PLGC) is important for gastric cancer prevention. The accuracy and convenience of PLGC screening could be improved with the use of machine learning methodologies to uncover and integrate valuable characteristics of noninvasive medical images related to PLGC. In this study, we therefore focused on tongue images and for the first time constructed a tongue image-based PLGC screening deep learning model (AITongue). The AITongue model uncovered potential associations between tongue image characteristics and PLGC, and integrated canonical risk factors, including age, sex, and Hp infection. Five-fold cross validation analysis on an independent cohort of 1995 patients revealed the AITongue model could screen PLGC individuals with an AUC of 0.75, 10.3% higher than that of the model with only including canonical risk factors. Of note, we investigated the value of the AITongue model in predicting PLGC risk by establishing a prospective PLGC follow-up cohort, reaching an AUC of 0.71. In addition, we developed a smartphone-based app screening system to enhance the application convenience of the AITongue model in the natural population from high-risk areas of gastric cancer in China. Collectively, our study has demonstrated the value of tongue image characteristics in PLGC screening and risk prediction.

Risk Factors and Prevention of Gastric Cancer Development—What Do We Know and What Can We Do?

Gastric cancer (GC) is one of the most common causes of cancer-related deaths. Gastric tumors show a high aggressiveness, which, in turn, contributes to a low survival rate of fewer than 12 months. Considering the above, it was decided to review the current scientific studies that indicate the potential prevention of gastric cancer and clarify the relationship between gastric cancer and the composition of the microorganisms inhabiting the human body. Accordingly, a review paper was prepared based on 97 scientific sources from 2011 to 2022. Particular attention was paid to the most recent scientific studies from the last five years, which account for more than 80% of the cited sources. Taking care of one’s overall health, including undertaking treatment for Helicobacter pylori infection, and following a diet high in anti-inflammatory and immunomodulatory ingredients are the most important factors in reducing the risk of developing gastric cancer.

Dietary patterns and risk for gastric cancer: A case-control study in residents of the Huaihe River Basin, China.

Evidence linking dietary patterns and the risk of gastric cancer was limited, especially in Chinese populations. This study aimed to explore the association between dietary patterns and the risk of gastric cancer in residents of the Huaihe River Basin, China. The association between dietary patterns and the risk of gastric cancer was investigated through a case-control study. Dietary patterns were identified with factor analysis based on responses to a food frequency questionnaire (FFQ). Gastric cancer was diagnosed according to the International Classification of Diseases, 10th Revision (ICD 10). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated across the tertiles of dietary pattern scores using unconditional logistic regression models. A total of 2,468 participants were included in this study. Six main dietary patterns were extracted, and those patterns explained 57.09% of the total variation in food intake. After adjusting for demographic characteristics, lifestyle factors, individual disease history, family history of cancer and Helicobacter. Pylori (H. pylori) infection, comparing the highest with the lowest tertiles of dietary pattern scores, the multivariable ORs (95% CIs) were 0.786 (0.488, 1.265; P trend < 0.001) for the flavors, garlic and protein pattern, 2.133 (1.299, 3.502; P trend < 0.001) for the fast food pattern, 1.050 (0.682, 1.617; P trend < 0.001) for the vegetable and fruit pattern, 0.919 (0.659, 1.282; P trend < 0.001) for the pickled food, processed meat products and soy products pattern, 1.149 (0.804, 1.642; P trend < 0.001) for the non-staple food pattern and 0.690 (0.481, 0.989; P trend < 0.001) for the coffee and dairy pattern. The specific dietary patterns were associated with the risk of gastric cancer. This study has implications for the prevention of gastric cancer.

A Global Perspective on Gastric Cancer Screening: Which Concepts Are Feasible, and When?

Gastric cancer (GC) remains the fifth most common cancer and the third most common cause of cancer-related death globally. In 2022, GC fell into the scope of the updated EU recommendations for targeted cancer screening. Given the growing awareness of the GC burden, we aimed to review the existing screening strategies for GC in high-risk regions and discuss potentially applicable modalities in countries with low-to-intermediate incidence. The references for this Review article were identified through searches of PubMed with the search terms "gastric cancer", "stomach cancer", "Helicobacter pylori", and "screening" over the period from 1995 until August 2022. As Helicobacter pylori (H. pylori)-induced gastritis is the primary step in the development of GC, the focus on GC prevention may be directed toward testing for and treating this infection. Such a strategy may be appealing in countries with low- and intermediate- GC incidence. Other biomarker-based approaches to identify at-risk individuals in such regions are being evaluated. Within high-incidence areas, both primary endoscopic screening and population-based H. pylori "test-and-treat" strategies represent cost-effective models. Given the significant variations in GC incidence and healthcare resources around the globe, screening strategies for GC should be adjusted to the actual conditions in each region. While several proven tools exist for accurate GC diagnosis, a universal modality for the screening of GC populations remains elusive.

Cost-Effectiveness Analysis of Hp and New Gastric Cancer Screening Scoring System for Screening and Prevention of Gastric Cancer.

Gastric cancer is one of the most common gastrointestinal cancers. Early diagnosis can improve the 5-year survival rate. This study aimed to evaluate the cost-effectiveness of Helicobacter pylori (Hp) and a new gastric cancer screening scoring system (NGCS) in areas with a high incidence of gastric cancer. A decision-analytic Markov model was constructed based on the theory and method of cost-effectiveness analysis, which included three decisions: no screening, Hp screening, and NGCS screening. The uncertainty of each parameter in the model was determined using a one-way sensitivity analysis and probability sensitivity analysis. The results of the cost-effectiveness analysis revealed that the application of the NGCS had the highest cost-effectiveness, while the one-way sensitivity analysis revealed that the probability of intestinal metaplasia progression to dysplasia had the most significant effect on the incremental cost-effectiveness ratio. The probability sensitivity analysis concluded that the result of the NGCS having the highest cost-effectiveness was stable. Although the application of the NGCS will require upfront screening costs, it can significantly improve the detection rate of early gastric cancer and save the consequent long-term healthcare costs. It is practicable and can be popularized in China.

Anticancer applications of phytochemicals in gastric cancer: Effects and molecular mechanism.

Gastric cancer (GC) is the fourth most common malignant cancer and is a life-threatening disease worldwide. Phytochemicals have been shown to be a rational, safe, non-toxic, and very promising approach to the prevention and treatment of cancer. It has been found that phytochemicals have protective effects against GC through inhibiting cell proliferation, inducing apoptosis and autophagy, suppressing cell invasion and migration, anti-angiogenesis, inhibit Helicobacter pylori infection, regulating the microenvironment. In recent years, the role of phytochemicals in the occurrence, development, drug resistance and prognosis of GC has attracted more and more attention. In order to better understand the relationship between phytochemicals and gastric cancer, we briefly summarize the roles and functions of phytochemicals in GC tumorigenesis, development and prognosis. This review will probably help guide the public to prevent the occurrence and development of GC through phytochemicals, and develop functional foods or drugs for the prevention and treatment of gastric cancer.

Abstract B049: Perceptions of gastric cancer screening in Asian Americans

Abstract Background: Endoscopy of the upper gastrointestinal tract is an effective way to screen for gastric cancer (GC) and benefits of screening are evident in countries that have implemented nationwide screening. Despite being disproportionately affected by GC, Asian Americans lack knowledge of GC risk factors and resources to make informed decision on GC screening. Experts recommend shared decision making between providers and patients regarding endoscopy for GC screening. However, we lack decision support tools for providers and patients at high risk for GC. Objective: This qualitative study aims to 1) explore patient experiences and perspectives on GC screening with endoscopy on concepts such as perceived GC risk, risk factors, early detection methods, and healthcare navigation, 2) explore provider knowledge, beliefs, and practice patterns regarding GC screening and GC prevention, and 3) develop a decision aid to support shared decision making for GC screening in the Asian American population. Methods: We interviewed primary care providers [PCP] and gastroenterologists in medical networks in Southern California that primarily serve Asian American communities, and patient populations in these medical networks with an initial focus on Korean and Vietnamese Americans who face the highest risk of GC among Asian Americans. Qualitative data was collected using one-on-one interviews with patients and providers. The interview was then transcribed and coded following reflexive thematic analysis. Results: To date, we have interviewed 6 patients and 5 providers and data collection continues. Several key themes were identified during the interviews: Among patients there is a lack of understanding of Helicobacter pylori (H. pylori) as a risk factor for GC, while dietary factors were frequently perceived as risk factors. Providers found GC screening to be beneficial for Korean and Vietnamese populations, and recommended GC screening simultaneous to screening colonoscopy, to reduce patient burden and cost. Patients who had experience with upper endoscopy found it to be acceptable. On the other hand, patients’ desired costs for upper endoscopy were much lower than market out-of-pocket costs of endoscopy. A preliminary decision aid was developed and edited in response to the results. The decision aid presents educational information including risk of GC in Korean and Vietnamese American relative to the general U.S. population, risk factors of GC, GC screening procedures, and risks and benefits of screening. The decision aid offers opportunity to assess personal attitudes towards GC screening, and allows for patients to indicate their intentions for GC screening for discussion with their providers. The decision aid will be further refined with additional qualitative data. Conclusion: Perceptions towards GC screening is generally positive among Asian patients and providers, but the costs of screening are a concern. Patients need education on H. pylori as a risk factor for GC. Citation Format: Simon Kim, Christie Y. Jeon, Celina Shirazipour. Perceptions of gastric cancer screening in Asian Americans [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B049.

PRMT7 Inhibits the Proliferation and Migration of Gastric Cancer Cells by Suppressing the PI3K/AKT Pathway via PTEN.

Protein arginine methyltransferase 7 (PRMT7) plays a crucial role in tumor occurrence and development; however, its expression pattern, biological function, and specific mechanism in gastric cancer (GC) remain poorly defined. The present study aimed to investigate the role of PRMT7 during GC carcinogenesis and its underlying mechanism. We found that PRMT7 is expressed at low levels in GC tissues, and this low expression is associated with tumor size, differentiation degree, lymph node metastasis, and TNM stage. Functionally, PRMT7 inhibits GC cell proliferation and migration. Mechanistically, PRMT7 induces PTEN expression and suppresses the downstream PI3K/AKT signaling cascade. Finally, we confirmed that PRMT7 interacts with PTEN protein and promotes PTEN arginine methylation. Taken together, our findings suggest that PRMT7 can inhibit PI3K/AKT signaling pathway activation by regulating PTEN, thereby inhibiting GC cell proliferation and migration. PRMT7 may be a promising therapeutic target for the prevention of GC.

Current role of narrow band imaging in diagnosing gastric intestinal metaplasia: a systematic review and meta-analysis of its diagnostic accuracy.

Gastric intestinal metaplasia (GIM) can be missed by random gastric biopsies taken during white light endoscopy. Narrow band imaging (NBI) may potentially improve the detection of GIM. However, pooled estimates from prospective studies are lacking and the diagnostic accuracy of NBI in detecting GIM needs to be more precisely defined. The aim of this systematic review and meta-analysis was to study the diagnostic performance of NBI in detecting GIM. PubMed/Medline and EMBASE were screened for studies examining GIM in relation to NBI. Data from each study were extracted and calculations of pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios (DORs), and areas under the curve (AUCs) were performed. Fixed or random effects models, were used as appropriate, depending on the presence of significant heterogeneity. We included 11 eligible studies in the meta-analysis, comprising 1672 patients. NBI showed a pooled sensitivity of 80% (95% confidence interval [CI] 69-87), specificity of 93% (95%CI 85-97), DOR 48 (95%CI 20-121), and AUC of 0.93 (95%CI 0.91-0.95) in detecting GIM. This meta-analysis showed that NBI is a reliable endoscopic means of detecting GIM. NBI with magnification performed better than NBI without magnification. However, better designed prospective studies are needed to precisely determine the diagnostic role of NBI, especially in high-risk populations where early detection of GIM can impact gastric cancer prevention and survival.

Health economic evaluation on population-based Helicobacter pylori eradication and endoscopic screening for gastric cancer prevention.

Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of cancer, and most of the patients in China are diagnosed at advanced stages, resulting in poor prognoses. Effective strategies to reduce the burden of gastric cancer include primary prevention through testing and treatment of Helicobacter pylori (H. pylori) and secondary prevention by screening and early detection. Although many countries have issued management guidelines and consensus reports concerning these strategies, the limited availability of healthcare resources often precludes their widespread implementation. Therefore, assessing the costs, benefits, and harms of population-based intervention measures through health economic evaluation is necessary for informed health policy decisions. Accordingly, we synthesize management approaches from different countries on H. pylori eradication and endoscopic screening, and also summarize recent advancements in health economic evaluations on population-based preventive strategies. The goal of the review is to provide empirical evidence supporting optimal resource allocation, maximizing benefits for the population, and ultimately reducing the burden of gastric cancer.

Analysis of high risk factors for chronic atrophic gastritis.

Screening for chronic atrophic gastritis (CAG) is crucial for the prevention and early detection of gastric cancer. Endoscopy is the main method of CAG diagnosis, with high training requirements and limited accuracy, making it difficult to popularize. The study attempts to improve the positive rate and accuracy of CAG screening through non-invasive testing. A total of 2564 patients who underwent gastroscopy were included in this study. The results of gastroscopic evaluation, histological biopsy results (including H. pylori biopsy), urea breath test (UBT) results, serum pepsinogen, and testosterone were statistically analyzed. We found significant differences in the diagnosis of CAG between endoscopy and histological biopsy. Pepsinogen II and pepsinogen I/II ratio were more useful for the diagnosis of CAG compared with pepsinogen I. The risk of CAG was increased when pepsinogen II exceeded 11.05 μg/L, and the pepsinogen I/II ratio was less than 3.75. CAG positivity was higher in patients with positive H. pylori infection on UBT screening. In addition, higher levels of testosterone, SHBG and HSD17B2, and lower level of GNRH1 were found in CAG mucosa. Patients with high serum testosterone had a higher risk of CAG. CAG screening should be combined with endoscopic evaluation, biopsy, and other non-invasive tests. Non-invasive tests include the combination of serum pepsinogen II protein and pepsinogen I/II ratio and high level of serum testosterone. UBT combined with serum pepsinogen testing may improve the positive rate of CAG and reduce gastric mucosal damage from multiple biopsies.

Clinical Practice Guidelines of Russian Gastroenterological Association, Scientific Society for the Clinical Study of Human Microbiome, Russian Society for the Prevention of Non-Communicable Diseases, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy for &lt;i&gt;H. pylori&lt;/i&gt; Diagnostics and Treatment in Adults

Aim: bring to the attention of practitioners indications for anti-Helicobacter therapy, methods and procedure for diagnostics and eradication therapy of Н. pylori infection.Key points. Chronic gastritis caused by Н. pylori infection, including asymptomatic persons, may be considered as an indication for eradication therapy of Н. pylori as etiological therapy and opportunistic screening for gastric cancer prevention. Indications, for obligatory anti-Helicobacter therapy include peptic ulcer, gastric MALT lymphoma, early gastric cancer (EGC) with endoscopic resection. H. pylori primary diagnostics methods include 13C-urea breath test, H. pylori stool antigen lab test, rapid urease test and serological method. The serological method cannot be used after anti-Helicobacter therapy.In Russia H. pylori strains' resistance to clarithromycin does not exceed 15 % in most regional studies. The first line therapy for Н. pylori infection eradication is the standard triple therapy including a proton pump inhibitor (PPI), clarithromycin and amoxicillin, enhanced with bismuthate tripotassium dicitrate. A classic four-component therapy based on bismuthate tripotassium dicitrate or quadrotherapy without bismuth drug products which includes PPI, amoxicillin, clarithromycin and metronidazole, may be used as alternative to the first line eradication therapy. The standard triple therapy may be prescribed for 14 days only in those regions, where it has been proven to be effective. Quadrotherapy with bismuthate tripotassium dicitrate is also used as main second line therapy in case of standard triple therapy, bismuth enhanced standard triple therapy or combined therapy failure. Another second line therapy includes PPI, levofloxacin and amoxicillin, to which a bismuth-containing drug product may be added. The third line therapy is selected individually based on previously used treatment settings.Conclusion. In each case of H. pylori infection the decision for eradication therapy should be made, which is especially relevant as eradication of H. pylori has been recognized as an effective measure for the prevention of gastric cancer.