Pylori Eradication Group Research Articles

Comparison of Efficacy of Conventional Triple Therapy and Non Bismuth Quadruple Therapy for Helicobacter Pylori Eradication

Objective: To compare the efficacy of conventional triple therapy and non bismuth quadruple therapy for helicobacter pylori eradication. Setting: Gastroenterology Department, Lady Reading Hospital Peshawar. Study Design: Randomized control trial. Duration: 6 months 15th August, 2018 to 15th February 2019. Materials and Methods: In this study a total of 111 patients were observed. Patients were put in two groups, group A triple Helicobacter pylori eradication therapy and group B non-bismuth quadruple Helicobacter pylori eradication therapy. Randomization of patients to either treatment group was done through lottery method. All patients were worked up with detailed history and clinical examination to look for any known allergy to drugs used in this study, to document any comorbidity and to exclude alarm features, baseline investigations including complete blood count, Random blood sugar, liver function tests and renal function tests. H pylori stool antigen was reported from Lady Reading Hospital laboratory at time of inclusion and four weeks after completion of therapy. The purpose and benefits of study was explained to patients and written consent for participation in study was obtained. Patients were asked on follow up about adherence to the treatment. Results: In this study mean age in Group A was 44 years with SD ± 2.77. Whereas mean age in Group B was 42 years with SD ± 3.12. In Group A 55% patients were male and 45% patients were female. Where as in Group B 58% patients were male and 42% patients were female. More over Group A (triple Helicobacter pylori eradication therapy) was effective in 75% patients. Where as Group B (non-bismuth quadruple Helicobacter pylori eradication therapy) was effective in 94% patients and was not effective in 6% patients. Conclusion: Our study concludes that non bismuth quadruple therapy is more effective than triple therapy in the treatment of Helicobacter pylori eradication. Keywords: Conventional triple therapy, Non-bismuth quadruple therapy, Helicobacter pylori eradication

Is intestinal metaplasia the point of no return in the progression of gastric carcinogenesis?

Is intestinal metaplasia the point of no return in the progression of gastric carcinogenesis?

The effect of Helicobacter pylori eradication on prognosis of postoperative early gastric cancer: a multicenter study

ObjectiveTo investigate the effect of Helicobacter pylori (H. pylori) eradication on the prognosis of postoperative early gastric cancer (EGC).MethodsThis is a retrospective study based on data from 6 hospitals. We identified 429 patients with EGC who underwent curative gastrectomy from January 2010 to December 2016. All of the patients were tested for H. pylori. Patients were divided into two groups, the successful H. pylori eradication group (group A, 268 patients) and the non-H. pylori eradication group (group B, 161 patients), for calculating the disease-free survival (DFS) and overall survival (OS) of each group.ResultPositive node metastasis (hazard ratio (HR), 3.13; 95% confidence interval (CI), 1.84–5.32; P < 0.001), undifferentiated type (HR, 2.54; 95% CI, 1.51–4.28; P < 0.001), and non-H. pylori eradication (HR, 1.73; 95% CI, 1.08–2.77; P = 0.023) were statistically significantly independent risk factors of recurrence. Patient’s age ≥60 years old (HR, 3.32; 95% CI, 2.00–5.53; P < 0.001), positive node metastasis (HR, 3.71; 95% CI, 2.25–6.12; P < 0.001), undifferentiated type (HR, 3.06; 95% CI, 1.79–5.23; P < 0.001), and non-H. pylori eradication (HR, 1.83; 95% CI, 1.11–3.02; P = 0.018) were statistically significantly independent risk factors of overall survival.ConclusionH. pylori eradication treatment could prevent the recurrence of postoperative EGC to prolong the overall survival of patients with EGC.

A multicenter randomized controlled study of bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang in the treatment of patients newly diagnosed with Helicobacter pylori infection and dyspepsia

Objective: To investigate the Helicobacter pylori (H. pylori) eradication rate and improvement of dyspepsia in patients who were newly diagnosed with H. pylori infection and dyspepsia and treated by bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang(JHWK). Methods: Patients who were newly diagnosed with dyspepsia and H. pylori infection and treated in 16 medical centers in China between December 1, 2017 and September 30, 2019 were randomly divided into two groups. The experimental group received bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days), followed by JHWK (30 days), and the course of treatment was 44 days in total. In the control group, the administration regimen was bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days). The main outcome measure was H. pylori eradication rate, while the secondary outcome measures were dyspepsia symptom changes and adverse events during the treatment and the 1st month after treatment. Results: A total of 1 054 patients were included in the study. There were 522 cases enrolled in the experimental group, including 224(42.91%) men and 298(57.09%) women, and the age was 53(26, 73) years old; 532 cases enrolled in the control group, including 221(41.54%) men and 311(58.46%) women, and the age was 46(22, 71) years old. Based on PP analysis, it was found that the H. pylori eradication rate in the experimental group was significantly higher than those in the control group (93.85% vs 87.88%, P=0.001). In the group of all enrolled patients, the symptom dyspepsia after H. pylori eradication was significantly improved compared with that before treatment [4(4, 7) vs 15(10, 22), P<0.001], so was the superior and middle abdominal pain [1(1, 4) vs 4(1, 8), P<0.001], the postprandial fullness [1(1, 4) vs 4(4, 9), P<0.001], the early satiety [1(1, 1) vs 4(1, 4), P<0.001], and the heartburn [1(1, 1) vs 1(1, 4), P<0.001]. The symptom dyspepsia after treatment was significantly improved compared with that before treatment in the experimental, the control groups, the successful and the unsuccessful H. pylori eradication groups. The superior and middle abdominal pain after treatment was signifcantly improved than that before treatment [1(1, 2) vs 1(1, 4), P<0.001], so were the postprandial fullness [1(1, 3) vs 1(1, 4), P=0.002] and the dyspepsia[4(4, 7) VS 7(4, 10), P<0.001]. There was no statistically significant difference in the incidence of adverse events between the experimental group and the control group (1.34% vs 0.38%, P=0.09). Conclusions: Compared with bismuth-containing quadruple therapy, bismuth-containing quadruple therapy followed by JHWK significantly improves the H. pylori eradication rate without increasing the incidence of adverse events. H. pylori eradication therapy can improve symptoms of patients with H. pylori infection and dyspepsia.

Eradication of Helicobacter pylori infection decreases risk for dyslipidemia: A cohort study.

Previous studies have suggested a relationship between Helicobacter pylori infection and dyslipidemia; however, large-scale longitudinal studies have not elucidated this association. This study assessed the longitudinal effects of H. pylori infection and eradication on lipid profiles in a large cohort. This cohort study included 2,626 adults without dyslipidemia at baseline, who participated in a repeated, regular health-screening examination, which included upper gastrointestinal endoscopy, between January 2009 and December 2018. The primary outcome was incident dyslipidemia at follow-up. During the 10,324 person-years of follow-up, participants with persistent H. pylori infection had a higher incidence rate (130.5 per 1,000 person-years) of dyslipidemia than those whose infections had been successfully controlled (98.1 per 1,000 person-years). In a multivariable model adjusted for age, sex, waist circumference, smoking status, alcohol intake, and education level, the H. pylori eradication group was associated with a lower risk of dyslipidemia than the persistent group (HR, 0.85; 95% CI, 0.77-0.95; p=0.004). The association persisted after further adjustment for baseline levels of low-density and high-density lipoprotein cholesterol (HR, 0.87; 95% CI, 0.79-0.97; p=0.014). H. pylori infection may play a pathophysiologic role in the development of dyslipidemia, whereas H. pylori eradication might decrease the risk of dyslipidemia.

Usefulness of vessel plus surface classification system for the diagnosis of early gastric cancer after Helicobacter pylori eradication.

BackgroundIt has been reported that it is sometimes difficult to make a diagnosis of gastric cancer detected after Helicobacter pylori (H. pylori) eradication. Therefore, we conducted a study to determine the usefulness of magnifying endoscopy using vessel plus surface classification system for making a diagnosis of early gastric cancer after H. pylori eradication.MethodUsefulness of the markers of the vessel plus surface classification system for diagnosing gastric cancer using magnifying endoscopy with narrow-band imaging was investigated for gastric cancer detected after H. pylori eradication (H. pylori-eradicated group) vs. H. pylori-positive gastric cancer (H. pylori-positive group).Results85 lesions were included in this study. The H. pylori-eradicated group comprised 27 lesions, whereas the H. pylori-positive group comprised 58 lesions. As for magnified endoscopic findings based on the vessel plus surface classification system, the respective positivity rates in the H. pylori-eradicated group vs. those in the H. pylori-positive group were as follows: demarcation line, 100% (27/27) vs. 100% (58/58); irregular microvascular pattern, 100% (27/27) vs. 100% (58/58); and irregular microsurface pattern, 78% (21/27) vs. 95% (55/58). There was no significant difference in the positivity rates of the demarcation line and irregular microvascular pattern between the groups. The positivity rate of the irregular microsurface pattern was significantly lower in the H. pylori-eradicated group than in the H. pylori-positive group (P=0.03).ConclusionWe presume that the microvascular pattern is more useful than the microsurface pattern as a diagnostic marker in cases of gastric cancer detected after H. pylori eradication.

Risk Factors for Gastric Cancer after the Eradication of &lt;i&gt;Helicobacter pylori&lt;/i&gt; Evaluated Based on the Background Gastric Mucosa: A Propensity Score-matched Case-control Study

Objective The eradication of Helicobacter pylori (H. pylori) reduces the risk for gastric cancer (GC) development, but it cannot prevent GC completely. We investigated the risk factors of early GC development after the eradication of H. pylori, based on the histological characteristics of gastric mucosa. Methods Sixty-one patients who underwent endoscopic submucosal dissection for early GC after successful H. pylori eradication (Group A) and 122 patients without developing a gastric neoplasm over 3 years after successful H. pylori eradication (Group B) were analyzed. We compared the histological findings of the patients enrolled in Group A and Group B before and after the propensity score-matching. Results Comparing the characteristics of two the groups, Group A consisted predominantly of males, had significantly more elderly patients, and the years after successful eradication tended to be longer. We performed score matching for these three factors to reduce the influence of any confounding factors. After matching, the scores of inflammation for Group A (n=54) was significantly higher than those of Group B (n=54) at the greater curvature of the antrum, the lesser curvature of the corpus, and the greater curvature of the corpus. According to a multivariate analysis, inflammation of the greater curvature of the antrum and lesser curvature of the corpus were found to be independent risk factors. The risk ratio and 95% CI were 5.92 (2.11-16.6) (p<0.01), and 3.56 (1.05-13.2) (p=0.04), respectively. Conclusion A continuous high level of inflammation of the background gastric mucosa may be a risk factor for gastric cancer onset after H. pylori eradication.

Relationship between time-varying status of reflux esophagitis and Helicobacter pylori and progression to long-segment Barrett\u2019s esophagus: time-dependent Cox proportional-hazards analysis

BackgroundReflux esophagitis (RE) and absence of Helicobacter pylori (non-H. pylori) are considered to be associated with the progression to long-segment Barrett’s esophagus (LSBE). However, it is difficult to assess this association because RE and H. pylori status can change during follow-up. Additionally, the association between H. pylori eradication and LSBE remains unclear.MethodsA total of 11,493 asymptomatic Japanese subjects who underwent medical check-ups and were endoscopically diagnosed with short-segment Barrett’s esophagus (SSBE) between May 2006 and December 2015 were enrolled. The hazards of progression to LSBE were compared between time-varying RE and H. pylori infection/eradication by time-dependent multivariable Cox proportional hazards models.ResultsA total of 7637 subjects who underwent additional medical check-ups after being diagnosed with endoscopic SSBE were analyzed. Subjects with RE and without current/past H. pylori infection were strongly associated with a higher rate of progression to LSBE (adjusted hazard ratio [HR]: 7.17, 95% confidence interval [CI]: 2.48–20.73, p < 0.001 for RE and non-H. pylori vs. non-RE and H. pylori groups). Subjects with H. pylori had a lower rate of progression to LSBE (adjusted HR: 0.48, 95% CI: 0.22–1.07, p = 0.07 for H. pylori vs. non-H. pylori). Hazards of progression to LSBE were still lower in the H. pylori eradication group than that of the non-H. pylori group (adjusted HR: 0.51, 95% CI: 0.18–1.46, p = 0.21).ConclusionsRE and non-H. pylori were associated with the progression to LSBE, considering the changes in exposures. H. pylori infection was associated with the prevention of the development of LSBE irrespective of RE. The environment preventive of the development of LSBE persists for at least a few years after H. pylori eradication.

The Effect of Helicobacter pylori Eradication in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis of Randomized Controlled Studies

Aim: Helicobacter pylori infection has been established as a definite risk factor for gastric cancer. However, the consequence of H. pylori eradication on the progression of gastroesophageal reflux disease (GERD) remains controversial. The purpose of our study was to investigate the relationship between H. pylori eradication and the development of GERD. Methods: A comprehensive, English literature search was performed from January 1990 to April 2019. Only randomized controlled trials (RCT) that evaluated the effect of H. pylori eradication on GERD were included. Meta-analysis of pooled OR was performed using Review Manger 5.1.7. Results: Seventeen articles with 6,889 subjects (intention-to-treat) that fulfilled the inclusion criteria were finally included in the analysis. Of them, 8 RCTs have the similar study design and inclusion criterion, which included patients with H. pylori infection but without GERD at baseline. The OR for the development of erosive GERD after H. pylori eradication was 1.67 (95% CI 1.12–2.48, p = 0.01). The OR for the development of GERD-related symptoms after H. pylori eradication in eradication group compared with control group was 1.04 (95% CI 0.84–1.29, p = 0.71). In addition, 9 RCTs included patients with both baseline H. pylori infection and GERD. The OR for the healing rates and relapse rates after H. pylori eradication in the H. pylori eradication group vs. control group was 0.92 (95% CI 0.47–1.82, p = 0.82) and 1.12 (95% CI 0.60–2.09, p = 0.71), respectively. Conclusions: Our meta-analyses showed H. pylori eradication may lead to the development of new erosive GERD. However, eradication of H. pylori may affect neither the healing rates nor relapse rates of preexisting GERD.

Does Helicobacter pylori Eradication Reduce the Incidence of Metachronous Gastric Cancer After Curative Endoscopic Resection of Early Gastric Cancer: A Systematic Review and Meta-Analysis.

Whether Helicobacter pylori eradication could reduce the risk of metachronous gastric cancer remain controversial. In the present study, we performed a systematic review and meta-analysis to evaluate the preventive effect of H. pylori eradication on the occurrence of metachronous gastric cancer after curative endoscopic resection of early gastric cancer. The related studies were identified by searching PubMed and Embase databases. According to the H. pylori infection status and subsequent treatment, all patients were classified into H. pylori negative group, H. pylori eradication group and noneradication group. The relevant data were extracted and pooled effect size was assessed using a fixed effect model or a random effect model. A total of 11 retrospective cohort studies and 3 randomized controlled trials were included in this meta-analysis. The results based on the cohort studies indicated that the risk of metachronous gastric cancer was significantly lower in H. pylori eradication group than in noneradication group (hazard ratios: 0.65, 95% confidence interval: 0.50-0.86, P=0.002; I=0%). The pooled result of 2 randomized controlled trials demonstrated that the patients receiving anti-H. pylori treatment had a lower risk of metachronous gastric cancer than those who did not receive H. pylori eradication treatment (hazard ratios: 0.43, 95% confidence interval: 0.26-0.70, P=0.001; I=0%). In addition, the occurrence of metachronous gastric cancer in H. pylori eradication group was not significantly different from that in H. pylori negative group. Successful H. pylori eradication may be useful for the prevention of metachronous gastric cancer after curative endoscopic resection of early gastric cancer. Thus, anti-H. pylori treatment should be considered for those patients with H. pylori infection after curative endoscopic resection.

Helicobacter pylori Eradication Can Reverse the Methylation-Associated Regulation of miR-200a/b in Gastric Carcinogenesis.

Background/AimsEpigenetic change is one of the mechanisms that regulates the expression of microRNAs (miRNAs) and is known to play a role in Helicobacter pylori-associated gastric carcinogenesis. We aimed to evaluate the epigenetic changes of miR-200a/b in H. pylori-associated gastric carcinogenesis and restoration after eradication.MethodsThe expression and methylation levels of miR-200a/b were evaluated in gastric cancer (GC) cell lines, human gastric mucosa of H. pylori-negative and -positive controls, and H. pylori-positive GC patients. Next, the changes in the expression and methylation levels of miR-200a/b were compared between H. pylori-eradication and H. pylori-persistence groups at 6 months. Real-time reverse transcription-polymerase chain reaction was conducted to investigate the miRNA expression levels, and MethyLight was performed to assess the methylation levels.ResultsIn the GC cell lines, the level of miR-200a/b methylation decreased and the level of expression increased after demethylation. In the human gastric mucosa, the miR-200a/b methylation levels increased in the following group order: H. pylori-negative control group, H. pylori-positive control group, and H. pylori-positive GC group. Conversely, the miR-200a/b expression levels decreased in the same order. In the H. pylori-persistence group, no significant changes were observed in the methylation and expression levels of miR-200a/b after 6 months, whereas the level of methylation decreased and the level of expression of miR-200a/b increased significantly 6 months in the H. pylori-eradication group.ConclusionsEpigenetic alterations of miR-200a/b may be implicated in H. pylori-induced gastric carcinogenesis. This field defect for cancerization is suggested to be improved by H. pylori eradication.

Is there a relationship between Helicobacter Pylori Eradication and Blood Group?

Is there a relationship between Helicobacter Pylori Eradication and Blood Group?

1230 Helicobacter pylori Eradication and Its Association With Metachronous Gastric Cancer Recurrence and Pre-Neoplastic Lesions: A Systematic Review and Meta-Analysis

INTRODUCTION: Gastric cancer is the 4th leading cause of cancer deaths worldwide displaying global variation in incidence. Helicobacter pylori (H Pylori) is known risk factor for gastric cancer. The magnitude of benefit of H pylori eradication in preventing GC recurrence is unclear. We performed a systematic review (SR) and meta-analysis (MA) of available randomized clinical trials (RCTs) to investigate the impact of H Pylori eradication on GC recurrence and precancerous lesions. METHODS: A planned literature search of Medline, PubMed and Google Scholar databases was carried out from inception to 10 February 2019. Ten (RCTs) included for analysis had H Pylori eradication as intervention arm compared to placebo. Statistical analysis was performed using statistical software RevMan, version 5.3. Random effects model and Mantel-Haenszel method for the statistical analysis was used for dichotomous data to calculate the odds ratio (OR). Two sided P values of less than 0.05 was considered statistically significant. RESULTS: 10 RCTs with total of 7,098 patients were included for final comparison. There were 3548 subjects in H Pylori group and 3550 in the placebo arm. The primary outcome was development of metachronous GC after endoscopic mucosal resection (EMR) in patients with early stage GC. H pylori group showed significant reduction in incidence of metachronous GC compared to placebo OR = 0.47, 95% confidence interval (CI) = 0.33– 0.67, P &lt; 0.0001, I2 = 0%]. Incidence of GC in high risk patients without GC at baseline showed no difference between two groups OR = 0.67, 95% CI = 0.42–1.07, P = 0.09, I2 = 0%). H Pylori eradication group showed statistically significant improvement in AG and IM from baseline compared to placebo group with OR = 2.10, 95% CI = 1.19–3.71, P = 0.01, I2 = 87% and OR = 2.08, 95% CI = 1.28–3.36, P = 0.003, I2 = 30% respectively. RCTs with mean duration of follow up &gt;5 years for GC incidence showed statistically significant reduction in GC incidence in H Pylori eradication group OR = 0.55, 95% CI = 0.40-0.76, P = 0.0003, I2 = 0%. CONCLUSION: Our meta-analysis showed the beneficial role of H Pylori eradication in decreasing GC recurrence for patients with early GC post EMR. H Pylori group also showed improvement in AG and IM grades compared to placebo. There was no difference in GC incidence in asymptomatic patients without GC at baseline between the two groups. More studies are needed from the North America, Europe and other non-Asian countries to better understand the differences in geographical regions.

Helicobacter pylori Eradication Therapy for Functional Dyspepsia: A Meta-Analysis by Region and H. pylori Prevalence.

Background: Previous studies on the effect of Helicobacter pylori eradication on functional dyspepsia (FD) are conflicting. We performed a comprehensive meta-analysis on this issue according to region and prevalence of H. pylori. Methods: Randomized controlled trials (RCTs) evaluating the effect of eradication of H. pylori on functional dyspepsia up to December 2018 were searched through PubMed, EMBASE, and the Cochrane Library. Subgroup analyses by the outcome measure, region, and prevalence of H. pylori were performed. All data were analyzed with Review Manager 5.3. Results: Eighteen RCTs were included in our meta-analysis. Overall, the H. pylori eradication group showed significant improvement of symptoms compared with the control group (risk ratio (RR) = 1.18; 95% confidence interval (CI): 1.07–1.30, p < 0.01). There was moderate heterogeneity among studies (I2 = 34%) and the number needed to treat (NNT) was 15.0. Helicobacter pylori eradication improved dyspeptic symptoms both in low (<50%) and high (≥50%) H. pylori prevalence regions (RR = 1.21 and 1.17; 95% CI: 1.02–1.44 and 1.06–1.29, I2 = 49% and 5%, respectively.) In the analysis of studies from Asia, however, the effect of eradication on improvement of dyspepsia was not significant (RR = 1.14; 95% CI: 0.99–1.33, p = 0.08, I2 = 37%). Conclusion: Overall, H. pylori eradication provides significant improvement of symptoms in functional dyspepsia patients regardless of H. pylori prevalence. However, in the analysis of studies from Asia, the eradication did not significantly improve dyspeptic symptoms. In this region, eradication for dyspepsia can be individualized.

Criteria of effective acid inhibition during antihelicobacter pharmacotherapy (according to the findings of express-gastro-pH-monitoring)

Objective — to establish the criteria of pH values of express-gastro-pH-monitoring for successful eradication of Helicobacter pylori).Materials and methods. The analysis has been performed for the results of express-gastro-pH-monitoring in 49 patients with H. pylori-infected,acid-depended diseases of esophagus, stomach and duodenum. The patients were administered three-component anti-helicobacter pharmacotherapy in standard doses twice a day: proton pump inhibitor + clarithromycin + amoxicillin or ornidazole. The course of treatment was 7 days. Express-gastro-pH-monitoring was carried out on 6.7 ± 0.6 day of administration of three-component scheme of H. pylori eradication using Acidogastrograph AG-1рН and gastrointestinal electrode system, created by medical engineering team under the guidance of V. M. Professor Chernobroviy. The results of control 13C-urea breath test (IRIS, Wagner, Germany) the patients were divided into two groups: group 1 consisted of 39 patients (23 men and 16 women) with successful H. pylori eradication, and group two, involving 10 patients (5 men and 5 women) with failed anti-helicobacter treatment. The mean age of group 1 was 41.7 ± 2.7 years, height 171.2 ± 1.5 cm, body mass 70.5 ± 2.2 kg. The mean age in the group 2 was 46.4 ± 5.8 years, height 169.6 ± 2.1 cm, body mass 68.8 ± 2.6 kg.Results. During the express-gastro-pH-monitoring, in the group with unsuccessful H. pylori eradication (group 2) the mean values of intragastric pH &gt; 5.0 units were observed only in 5 (12.5 %) measurement points (40, 41 cm during pH-microprobe insertion and 60, 59 and 58 cm during pH-microprobe removal), whereas in patients with successful H. pylori eradication (group 1) the mean values of intragastric pH &gt; 5,0 were observed in all measurement points during insertion of pH-microprobe as well as during its excretion from the stomach. In patients with failed H. pylori eradication (group 2), the significantly lower (p &lt; 0.05) indices of intragastric pH were observed comparing with patients with successful H. pylori eradication (group 1). In particular, min pH was (3.6 ± 0.45 vs 4.8 ± 0.33), max pH (of 5.6 ± 0.56 vs 6.8 ± 0.16), X pH (4.2 ± 0.61 vs 5.6 ± 0.28), Mo pH (3.9 ± 0.76 vs 5.7 ± 0.3) and Me pH (4.0 ± 0.55 vs 5.5 ± 0.3). The close correlation (р &lt; 0.03) has been established between the successful H. pylori eradication and intragastric max pH index (r = 0.3) during anti-helicobacter pharmacotherapy, and (р &lt; 0.05) between successful H. pylori eradication and mean intragastric pH X index (r = 0.27). Moreover, the correlation has been reveled (р &lt; 0.03) between successful H. pylori eradication and increased intragastric pH Mo (r = 0.3).Conclusions. Express-gastro-pH monitoring can be used as a screening method for monitoring of antisecretory action of the efficacy of hydrochloric acid secretion blockers and forecasting of the successfulness of H. pylori eradication. The parameters of intragastric pH (based on the results of express-gastro-pH monitoring) in the course ofantihelicobacter pharmacotherapy) should be: max pH 6.8, X pH 5,6 and Mo pH 5.7, due to the close correlation established for these parameters and successful H. pylori eradication.

Effect of Helicobacter pylori eradication and high-density lipoprotein on the risk of de novo gastric cancer development

The effect of Helicobacter pylori eradication on de novo gastric cancer is controversial, although meta-analyses suggest a reduction in gastric cancer after eradication. The effect of high-density lipoprotein (HDL) on gastric cancer has been rarely reported. In this large retrospective cohort study, participants underwent endoscopy and H pylori testing from 2003 to 2011 and underwent follow-up endoscopy and H pylori testing until 2013. H pylori infection was detected using a rapid urease test or histologic test. The H pylori eradication group was defined as successful eradication, whereas the H pylori persistent group was defined as noneradication or eradication failure. The risk of cancer was measured with hazard ratios (HRs) and 95% confidence intervals (CIs). Among 10,328 healthy subjects (5951 men; mean age, 48.7 years), 31 gastric cancers were detected during a median follow-up of 5.5 years. De novo gastric cancer developed in 21 of 3508 subjects (.6%) in the noneradication group, 4 of 2050 subjects (.2%) in the successful eradication group, and 6 of 4770 participants (.13%) in the absence of H pylori group. In the adjusted analysis, H pylori eradication decreased de novo gastric cancer risk (HR, .29; 95% CI, .10-.86) compared with the persistent group. The risk of de novo gastric cancer in absence of H pylori was also much lower compared with the persistent group (HR, .24; 95% CI, .09-.60). Low serum HDL increased the risk of de novo gastric cancer (HR, 2.67; 95% CI, 1.14-6.16). Successful H pylori eradication reduced de novo gastric cancer, whereas low HDL increased its risk.

Correlation between macrophage migration inhibitory factor and autophagy in Helicobacter pylori-associated gastric carcinogenesis

The role of macrophage migration inhibitory factor (MIF) and autophagy in gastric cancer is not clear. We determined H. pylori infection status of the subjects and investigated the expression of MIF and autophagy markers (Atg5, LC3A and LC3B) in human gastric tissue at baseline. Then H. pylori eradication was done for H. pylori positive patients and MIF and Atg5 levels were investigated on each follow-up for both H. pylori-eradicated and H. pylori negative patients. Baseline tissue mRNA expression of MIF, Atg5, LC3A and LC3B was measured by real-time PCR in 453 patients (control 165, gastric dysplasia 82, and gastric cancer 206). Three hundred three patients (66.9%) had H. pylori infection at the time of enrollment. Only within H. pylori-positive group, MIF level was significantly elevated in patients with cancer than in control or dysplasia groups (P<0.05). LC3A and LC3B levels also showed significant differences within H. pylori-positive subgroups. H. pylori-positive dysplasia subgroup showed significantly lower (LC3A) (P<0.05) and higher (LC3B) mRNA levels (P<0.05) than in other subgroups. On follow-up, within H. pylori-eradicated group, Atg5 expression increased sequentially from control to dysplasia and cancer subgroups. Multiple linear regression showed autophagy markers (LC3A, LC3B, and Atg5) directly predicted MIF level (adjusted R2 = 0.492, P<0.001). Serial follow-up showed longitudinal increase in Atg5 level in general, with constantly higher levels in H. pylori-eradicated group than in -negative group. Intestinal metaplasia (IM) group initially showed higher Atg5 expression than the IM-negative group. However, it was reversed between the groups eventually because of the lower rate of increase in IM group. These results suggest a role of MIF and autophagy markers and their interaction in H. pylori-associated gastric carcinogenesis.

Gastric Cancer with Submucosal Invasion after Successful Helicobacter pylori Eradication: A Propensity Score-Matched Analysis of Patients with Annual Patient Endoscopic Survey

Background and Aim: The incidence of gastric cancer occurring after successful Helicobacter pylori eradication has been increasing. We aimed to clarify the influence of eradication therapy on the ability to diagnose early gastric cancer after successful H. pylori eradication in patients who underwent annual endoscopic screening. Methods: A total of 220 patients (179 men; mean age 71.0 years) had differentiated-type early gastric cancer that was discovered through annual endoscopic screening. Patients were categorized into 2 groups: the H. pylori-eradicated group (n = 81) and the non-eradicated control group (n = 139). After matching patients by propensity scores, we retrospectively analyzed the clinicopathological characteristics of 162 patients (81 patients in each group). Furthermore, we compared the characteristics of gastric cancer with submucosal invasion between the 2 groups. Results: The prevalence of early gastric cancer with submucosal invasion was significantly higher in the eradicated group than in the control group, both before propensity score matching (16.0 vs. 7.2%, respectively; p = 0.038) and after propensity score matching of 81 pairs (16.0 vs. 4.9%, respectively; p = 0.021). In the comparative analysis of gastric cancer with submucosal invasion, there was no difference between the 2 groups with respect to factors influencing the ability to diagnose its presence endoscopically. Conclusion: H. pylori eradication therapy increased the prevalence of differentiated-type gastric cancer with submucosal invasion despite patients’ completion of annual endoscopic screening after eradication.

Effect of Helicobacter pylori eradication on the incidence of gastric cancer: a systematic review and meta-analysis.

Helicobacter pylori (H. pylori) is considered to be the most important risk factor for gastric cancer (GC). The International Agency for Research on Cancer reported that H. pylori eradication could reduce the risk of developing GC. Several clinical studies have investigated this relationship as well; however, their results are inconsistent owing to the varied inclusion criteria. To address the effect of H. pylori eradication on GC incidence, we conducted a comprehensive meta-analysis with several subgroup analyses to resolve these inconsistencies. We searched MEDLINE and Ichushi-Web to identify randomized control trial and cohort study articles (English or Japanese) through December 2016. Manual searches were also conducted to identify unlisted references in these databases. Eligible studies reported GC incidence as an outcome, with comparisons between H. pylori eradication and control groups. Subgroup analyses were conducted by country, conditions at baseline, and follow-up periods. We selected 28 studies among 1583 references in the databases and 4 studies by manual searches. The H. pylori eradication group showed significantly lower risk of GC [odds ratio (OR) 0.46; 95% confidence interval 0.39-0.55]. The subgroup analyses indicated that the beneficial effect of eradication was greater in Japan (OR 0.39; 95% CI 0.31-0.49), particularly among those with benign conditions (OR 0.32; 95% CI 0.19-0.54), although none of them was statistically significant. However, reduction of gastric cancer after eradication was significantly greater (p = 0.01) in the groups with long-term (5years or longer) follow-up (OR 0.32; 95% CI 0.24-0.43) as compared to those with shorter follow-up (less than 5years) (OR 0.55; 95% CI 0.41-0.72). Real world data showed that large-scale eradication therapy has been performed mostly for benign conditions in Japan. Since eradication effects in preventing gastric cancer are conceivably greater there, GC incidence may decline faster in Japan than expected from the previous meta-analyses data which were based on multi-national, mixed populations with differing screening quality and disease progression.

CLINICAL EVALUATION OF TRIPLE AND QUADRUPLE HELICOBACTER PYLORI ERADICATION THERAPY IN PEPTIC ULCER PATIENTS WITH DIFFERENT ABO BLOOD GROUP PHENOTYPES

Objective: This study aimed to examine the pathological changes in gastric mucosa of Helicobacter pylori-infected peptic ulcer patients carrying different ABO phenotypes and to study the response to the 14 days’ standard triple therapy and 10 days’ quadruple therapy in peptic ulcer patients according to their ABO phenotypes.Methods: Interventional prospective randomized-controlled open-label study was performed on newly diagnosed patients with PUD. The H. pylori-positive patients were allocated into two major study groups in which they are subdivided according to ABO blood group phenotypes: Group 1 received standard H. pylori eradication triple therapy and Group 2 received standard H. pylori eradication quadruple regimen. Patients were monitored after 2 months for successful H. pylori eradication.Results: Chronic active gastritis was significantly high in patients carrying blood Group O phenotype (81.25%), while the atrophic gastritis and intestinal metaplasia were significantly high in patients carrying blood Group A phenotype (25.00% and 16.67%), respectively. 14 days’ triple therapy showed significantly lower eradication rate in H. pylori-infected peptic ulcer patients carrying blood Group O phenotype (p&lt;0.01), meanwhile higher response was found among patients with blood Group B. 10 days’ quadruple therapy produced a significant high eradication rate in H. pylori-infected patients carrying blood Group O than those with blood Group A (p&lt;0.01), but still both showed lower response compared to that in patients carrying blood Group B and AB phenotypes. Elderly patients showed significantly less healing efficacy than younger patients (p&lt;0.01), and the least healing rate was noticed in female patients after both regimens.Conclusion: Lower eradication rate in H. pylori-infected was noticed in peptic ulcer patients carrying blood Group O mainly than those with other blood groups and particularly those with duodenal Ulceri. 10 days’ quadruple therapy showed significant higher eradication rate in H. pylori infection and a better ulcer healing efficacy.