Pylori-positive Patients Research Articles

Study on the value of antibiotic-resistant gene detection in Helicobacter pylori in China.

The aim of the present study was to explore the value of detecting antibiotic-resistant genes in Helicobacter pylori (H. pylori) and the association between genotype and antibiotic resistance. Two gastric mucosa samples from each H. pylori-positive patient were collected. Each patient's H. pylori sample was cultured in vitro, and the agar plate dilution method was conducted. In addition, all patient samples were analyzed for the detection of antibiotic resistance-related mutant genes and VacA gene genotypes. The association between VacA genotypes and antibiotic resistance was also determined and the value of mutant gene detection in predicting H. pylori resistance to antibiotics was evaluated. In total, 133 H. pylori-positive patients were enrolled. A total of 22 strains of H. pylori failed to grow in in vitro culture and 25 strains were negative in a H. pylori gene test. Among 108 strains detected by PCR, a total of 39 VacA s1m1 strains, 69 VacA s1m2 strains and no VacA s2 strain were identified. There was no significant association between VacA genotypes and antibiotic resistance. The mutation rates of G616A in the rdxA gene, T87A, G91A, A91G and G91T in the gyrA gene and A2143G and A2142G in the 23S rRNA gene were 32.1, 32.3, 22.6, 12.9, 6.5, 81.8 and 0.0%, respectively. Among these mutant sites, the mutation coincidence rates were as follows, according to the agar plate dilution method: rdxA G616A (81.8%), gyrA G91T (66.7%), gyrA G91A (54.5%), 23 S rRNA A2143G (49.1%), gyrA T87A (45.5%), gyrA A91G (33.3%), penicillin-binding protein 1 (PBP1) C556G (0.0%), PBP1 A562T (0.0%), PBP1 A562G (0.0%) and 16 S rRNA 926-927 (AT-GT) (0.0%). VacA m subtypes were not associated with H. pylori antibiotic resistance. In conclusion, the present findings suggested that the detection of related mutant genes had a clinical application value in predicting the antibiotic resistance of H. pylori, particularly resistance to clarithromycin and levofloxacin.

High level of resistance to metronidazole and clarithromycin among Helicobacter pylori clinical isolates in Qazvin province, Iran

The treatment of patients with Helicobacter pylori infection has many limitations, especially because of antibiotic resistance. We aimed to investigate the prevalence and mechanism of antibiotic resistance to metronidazole and clarithromycin in H. pylori isolates collected from patients with gastrointestinal symptoms in Qazvin, Iran. In this cross-sectional study, antibiotic susceptibility testing to clarithromycin and metronidazole was performed among 80 clinical strains isolated from H. pylori-positive dyspeptic patients referred to Qazvin hospital from July 2018 to November 2018. Polymerase chain reaction (PCR) and sequencing tests were performed to determine the type of mutations in the rdxA gene in metronidazole-resistant isolates, and the 23SrRNA gene in clarithromycin-resistant isolates. Thirteen (40.6%) and Twenty-one (65.6%) isolates were resistant to clarithromycin and metronidazole, respectively. 37.5% and 59.4% of clarithromycin and metronidazole resistant isolates had MIC>256. In clarithromycin-resistant isolates, mutations in the 23SrRNA gene was seen at A2143G (15.6%), A2142G (9.4%), C2195T (6.3%), C2244T (3.1%), and G2212A (3.1%) locations. In one isolate, three simultaneous mutations were recorded in locations A2143G, G2110A, and C2121T. Mutations in the rdxA gene in metronidazole-resistant isolates, were missense. High resistance to metronidazole and clarithromycin antibiotics were seen in H. pylori isolates in Qazvin province. This is the first report of new mutation sites G2212A, G2110A, and C2121T on the 23SrRNA gene in clarithromycin-resistant isolates. It is necessary to evaluate the current situation in terms of resistance and identify the mechanisms involved in its occurrence for the successful treatment of infections caused by this organism.

Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis

ObjectiveFunctional dyspepsia (FD) is a chronic disorder that is difficult to treat. Helicobacter pylori may contribute to its pathophysiology. A Cochrane review from 2006 suggested that eradication therapy was beneficial,...

Pepsinogen II in gastritis and Helicobacter pylori infection.

In the gastric mucosa, pepsinogen II (PgII) is produced/secreted by glands in the mucus-secreting antral and cardia compartments, but also by the chief cells and the oxyntic glands. Increasing PgII serum levels are associated with the whole spectrum of gastric inflammatory diseases, including gastritis induced by Helicobacter pylori (H. pylori). This review critically addresses the clinical value of PgII serology for assessing gastric mucosal inflammation, and as a marker of H. pylori status, in both H. pylori-positive patients and after eradication therapy. A search in PubMed/Scopus records yielded 39 out of 1190 published scientific studies meeting the selection criteria for this study. In the studies considered, PgII levels were significantly associated with non-atrophic gastric inflammatory lesions (p-values: 0.025-0.0001). H. pylori-positive patients had significantly higher PgII levels than H. pylori-negative individuals (p-values: 0.o5-0.0001). While a significant drop in serum PgII levels is consistently reported in H. pylori-eradicated patients (p-values: from 0.05 to 0.0001), inconsistencies in the related negative and positive predictive values significantly lower the clinical reliability of PgII testing by comparison with other available non-invasive tests. PgII serology may provide clinically useful information on gastric inflammatory diseases, particularly if they are non-atrophic. PgII serology is inconsistent, however, for the purposes of distinguishing patients whose H. pylori eradication therapy is successful from those who remain infected.

Differences in community structure of gastrointestinal tract between Helicobacter pylori positive patients and negative patients with gastric cancer.

Gastric cancer is one of the most severe cancers, while the relationship between Helicobacter pylori (H. pylori) and gastric cancer are still in dispute, and little work has been done to explore the microbial diversity between H. pylori positive patients and negative patients. In the present work, a total of 43 gastric cancer patients and 10 healthy 53 participants were enrolled to compare the microbial differences in community structure in gastrointestinal tract between H. pylori positive patients and negative patients with gastric cancer. Our results indicated that the abundance and diversity of gastrointestinal microbiota was slight lower in gastric cancer patients than that in healthy participants especially in intestine, while the abundance of some potential pathogens, e.g. Streptococcus, Lactobacillus, Akkermansia and Halomones were higher in H. pylori positive patients than H. pylori negative patients. Therefore, our work suggests the various microbial diversity between H. pylori positive patients and H. pylori negative patients with gastric cancer, which contribute to deepen the understanding of the role of H. pylori in gastric carcinogenesis and progression.

Helicobacter pylori infection and disease severity in multiple sclerosis patients: Is there a link with HLA alleles?

Backgrounds: Environmental factors such as bacterial infections, as well as genetic factors—in particular the human leukocyte antigen (HLA) alleles—have been implicated in the etiology of multiple sclerosis (MS). This study aims to explore the relationship between Helicobacter pylori infection, HLA alleles, and disease severity in Iranian MS patients. Methods: The study population comprised 125 MS patients and 153 ethnically matched healthy controls. Stool antigen test was used to detect H. pylori, and the expanded disability status scale (EDSS) scores were assessed in the patients. HLA-DRB1 and DQB1 alleles and haplotypes were determined in both the patients and the controls. The relationships between H pylori infection, HLA alleles, and EDSS were also analyzed. Results: HLA-DRB1*15 and DQB1*06 alleles families and the DRB1*15~DQB1*06 haplotype were significantly more frequent in MS patients, whereas HLA-DRB1*14 and DRB1*14~DQB1*05 haplotype were less frequent. Of the 125 MS patients, 38 were diagnosed with active H. pylori infection. We found lower frequencies of HLA-DRB1*15 (P = .08) and DRB1*16 (P = .05) alleles and a higher frequency of DQB1*02 (P = .06) in the H. pylori-positive patients. HLA-DRB1*07 was more prevalent in patients with EDSS≤3.0 (P = .06). More severe MS cases (EDSS>3.0) were linked to H pylori positivity (P = .02), disease chronicity (P = .001), receiving non-steroidal anti-inflammatory drugs (P = .02), and female gender (P = .05). Conclusion: These preliminary findings suggest a link between H. pylori infection and the severity of MS H. pylori-positive patients regardless of the type of HLA carriage.

Evaluation of the Gastric Microbiome in Patients with Chronic Superficial Gastritis and Intestinal Metaplasia

ObjectiveTo evaluate the gastric microbiome in patients with chronic superficial gastritis (CSG) and intestinal metaplasia (IM) and investigate the influence of Helicobacter pylori (H. pylori) on the gastric microbiome. MethodsGastric mucosa tissue samples were collected from 54 patients with CSG and IM, and the patients were classified into the following four groups based on the state of H. pylori infection and histology: H. pylori-negative CSG (n=24), H. pylori-positive CSG (n=14), H. pylori-negative IM (n=11), and H. pylori-positive IM (n=5). The gastric microbiome was analyzed by 16S rRNA gene sequencing. ResultsH. pylori strongly influenced the bacterial abundance and diversity regardless of CSG and IM. In H. pylori-positive subjects, the bacterial abundance and diversity were significantly lower than in H. pylori-negative subjects. The H. pylori-negative groups had similar bacterial composition and bacterial abundance. The H. pylori-positive groups also had similar bacterial composition but different bacterial relative abundance. The relative abundance of Neisseria, Streptococcus, Rothia, and Veillonella were richer in the I-HP group than in G-HP group, especially Neisseria (t=175.1, P<0.001). ConclusionsThe gastric microbial abundance and diversity are lower in H. pylori- infected patients regardless of CSG and IM. Compared to H. pylori-positive CSG group and H. pylori-positive IM, the relative abundance of Neisseria, Streptococcus, Rothia, and Veillonella is higher in H. pylori-positive patients with IM than in H. pylori-positive patients with CSG, especially Neisseria.

Evaluation of Lipid Profile and Inflammatory Marker in Patients with Gastric Helicobacter pylori Infection, Ethiopia.

IntroductionH. pylori are gram-negative, microaerophilic helical-shaped bacteria with multiple flagella and commonly exist in the stomach. This infection may cause significant mucosal inflammation and damage, leading to ulcers in the stomach. It can also affect organ systems external to the gastrointestinal tract. To assess cardiovascular risk factors and to predict cardiovascular disorders, we are evaluating and comparing lipid profile and inflammatory marker between H. pylori-positive and negative patients.ObjectiveTo evaluate and compare lipid profile (TC; TG; LDL; HDL) and inflammatory marker (hs-CRP) in dyspeptic patients with and without H. pylori infection.MethodsComparative cross-sectional study was conducted from September 2020 to January 2021 at Debre Markos Referral Hospital, Debre Markos Health Center, and Hidassie Health Center, Ethiopia. Each of 50 H. pylori-positive and negative dyspeptic patients were studied. The data were checked for completeness and analyzed by SPSS version 25.0 Software. A p-value < 0.05 was considered statistically significant.ResultsSerum mean high-density lipoprotein (HDL) values were 37.54 ± 7.98 mg/dL and 43.12 ± 7.86 mg/dL (p < 0.05) for H. pylori-positive and negative dyspeptic patients, respectively, and median serum high sensitive C reactive protein (hs-CRP) levels were 6.29 mg/L (1.66–41.34) and 3.35 mg/L (0.39–10.01) (p < 0.05) for H. pylori-positive and negative dyspeptic patients, respectively.ConclusionH. pylori infection significantly alters serum high-density lipoprotein (HDL) and high sensitive C reactive protein (hs-CRP) levels in dyspeptic patients, as a result, increase the potential risk of cardiovascular diseases.

Helicobacter Pylori Infections among Patients with Type 2 Diabetes Mellitus in Benghazi, Libya

Background: Diabetes Mellitus is the most common endocrine disease, diabetic patients also suffer more frequently from [complicated] infections compared with non-diabetic patients one of them is Helicobacter pylori infection, it is a major health aliment in developing countries. Aim of the study: To determine the prevalence of Helicobacter pylori [H. pylori] infection in Type 2 diabetic Patients. Methods: A cross sectional study recruited three hundred patient two hundred out of them were type 2 diabetics from Benghazi diabetic center and one hundred healthy individuals or non-diabetic patients which served as control group was taken from Benghazi medical center and Elhiaa clinic . Their ages ranged between 25 to 70 years, from the period of 2015 -2019. All members of the study were investigated for serum H.pylori -IgG by Elisa, blood glucose levels and HbA1c and Parasitic tests were also done for all patients. Socio demographic characteristics were taken during the interview. Results: The results revealed that the overall prevalence of infection with Helicobacter pylori among Type2 diabetic patients were 144 [72.0%] with highly significant difference [p=0.000] compared to 49% of the non-diabetic group. Our results show that there was no statistical difference in H. pylori positivity according to gender smoking history and education level in diabetic and non-diabetic while presence of parasitic infestation and gastrointestinal symptoms in H. pylori positive patients were statistically different between diabetic and non-diabetic group being higher in diabetics. H. pylori was statistically more prevalent in diabetic with higher fasting plasma glucose and HbA1c. Diabetes duration was not predictor for H. pylori infection

Does waterpipe smoking increase the risk of Helicobacter pylori infection?

Background:In this study, we aimed to evaluate whether waterpipe smoking can be associated with the transmission of Helicobacter pylori infection or not.Materials and Methods:Between March 2018 and April 2019, 445 patients aged over 18 years old who were admitted to outpatient clinics with dyspeptic complaints were recruited for the study. Patients are divided into two groups – Group 1 is H. pylori-positive patients and Group 2 is negative. Waterpipe smoking, smoking, age, gender, and educational status were compared among groups.Results:Two hundred and sixty-one women (58%) and 184 men (42%), totally 445 patients, tested for H. pylori infection. Seventy-nine of 261 (30%) women and 60 of 184 (32%) men had H. pylori positive. One hundred and sixty-two of 445 (36%) patients were smoking cigarette and 66 of 445 (14%) patients were using waterpipe tobacco. Waterpipe smoking individuals were found to be associated with the H. pylori positivity (P < 0.001); whereas, age, gender, educational level, and smoking were not found to be statistically significant (all P > 0.05). In binary logistic regression analysis, waterpipe tobacco smoking was found to be the only independent predictor of H. pylori infection (P < 0.001, odds ratio = 5.51, confidence interval: 3.158–9.617).Conclusion:Waterpipe smoking seems to be an important risk factor for H. pylori infection and may be one of the reasons of high prevalence of H. pylori infection.

Comparação dos resultados da densidade capilar peripapilar radial de indivíduos com e sem infecção por Helicobacter pylori

Purpose: To evaluate the radial peripapillary capillary density using optical coherence tomography angiography in patients with and without Helicobacter pylori infection. Methods: This prospective, cross-sectional study comprised 52 patients (52 eyes: Group 1) and 38 patients (38 eyes: Group 2) with and without H. pylori infections, respectively. The radial peripapillary capillary density and retinal nerve fiber layer thickness in 4 equal quadrants and 2 equal hemispheres in the peripapillary region were calculated using optical coherence tomography angiography. The optic nerve head parameters of the patients were also assessed. Results: The groups were similar in terms of age, gender, and the optic nerve head parameters. The radial peripapillary capillary densities in the superior hemisphere and quadrant were significantly lower in Group 1 than in Group 2 (p=0.039 and p=0.028, respectively) and were positively correlated with the superior hemisphere’s retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). Similarly, the radial peripapillary capillary densities in the inferior hemisphere and quadrant were also significantly lower in Group 1 compared to Group 2 (p=0.03 and p=0.017, respectively) and were positively correlated with the inferior hemisphere’s retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). The retinal nerve fiber layer thickness in the nasal and temporal quadrants were significantly decreased in Group 1 when compared to Group 2 (p=0.013 and p=0.022) and were positively correlated with the corresponding radial peripapillary capillary densities of the 2 quadrants (p=0.002 and p=0.022). Conclusion: The decreased radial peripapillary capillary density in the H. pylori-positive patients suggests that H. pylori may play a role in the etiopathogenesis of glaucoma.

High prevalence of esophagitis in patients with severe ineffective esophageal motility: need for a new diagnostic cutoff.

BackgroundA new classification criterion for diagnosing ineffective esophageal motility (IEM) was proposed at the 2018 Stanford symposium, but limited data exists about the utility of this criterion.MethodsWe conducted a cross-sectional study among 3826 patients treated at the Institute of Gastroenterology and Hepatology, Hanoi, Vietnam, between March 2018 and May 2020. Patients were classified as having normal motility, mild IEM, severe IEM, or absent contractility based on the Chicago classification version 3.0 and the new IEM criterion (severe IEM was defined as having >70% ineffective swallows). We examined the association between these 4 motility subgroups and the presence of erosive esophagitis and Barrett’s esophagus, using multivariate logistic regression analysis.ResultsThe mean age of the study sample was 44.7 years and 66.3% were women. The prevalence of symptoms, hiatal hernia, and Helicobacter pylori-positive patients was similar in the 4 study groups. The 4-second integrated relaxation pressures and lower esophageal sphincter resting pressures were lower in patients with severe IEM and absent contractility. Severe IEM and absent contractility, but not mild IEM, were significantly associated with Los Angeles (LA) grade B-D esophagitis (relative risk ratio [RRR] for severe IEM 1.81, 95% confidence interval [CI] 1.17-2.80; and RRR for absent contractility 2.37, 95%CI 1.12-5.04). None of the hypomotility subgroups were associated with LA grade A esophagitis and Barrett’s esophagus.ConclusionsPatients with severe IEM have a high prevalence of severe erosive esophagitis. These findings suggest the need for a more meaningful classification criterion for IEM.

Surveillance strategies for precancerous gastric conditions after Helicobacter pylori eradication: There is still need for a tailored approach.

Prevailing evidence declares that Helicobacter pylori (H. pylori) eradication therapy could shift precancerous gastric conditions (PGC) and positively confines gastric cancer (GC) risk during long-term endoscopic follow-up. Nonetheless, there is a yet unsolved controversy regarding the best-individualized surveillance strategies following H. pylori eradication, based on malignant risk stratification. This last dispute is due to the uncertainty of contemporary evidence and the role of H. pylori inflammatory changes in underestimating PGC at the index endoscopy. However, the current state of the art suggests that it is reasonable that high-quality endoscopy with histological assessment for the most accurate diagnosis of PGC may be delayed in selected high-risk patients without alarm signs for malignancy, following the eradication of H. pylori. Notwithstanding, these aspects need to be further examined in the next future to establish and optimize the most beneficial and cost-effective strategies for recognizing and managing H. pylori-positive patients with PGC in the short- and long-term follow-up. Accordingly, additional studies are yet required to sharpen the hazard stratification of patients with the greatest chance of GC evolution, also recognizing the evolving racial, ethnic, immigration factors and the necessity of novel biomarkers to limit GC development or accomplish a diagnosis of malignancy at an early stage.

A Link Between Platelet-to-Lymphocyte Ratio and Helicobacter pylori Infection

Abstract Background: Gastritis is a progressive disease that evolves from a non-atrophic to an atrophic state and progresses through intestinal metaplasia, even leading to gastric cancer. Gastritis is defined by an inflammatory process of the mucosal lining of the stomach. Aim: We aimed to identify any association between Helicobacter pylori (H. pylori)-positive gastritis and simple inflammatory markers derived from a complete blood count such as the platelet-to-lymphocyte ratio (PLR). Material and Methods: We performed a retrospective case-control study in which we included patients who underwent an upper digestive endoscopy with biopsy between January 2019 and December 2020 and were diagnosed with gastritis. H. pylori status was determined from the histopathological examination, and complete blood count was performed from venous blood samples. The final study group included 125 patients with H. pylori-positive chronic gastritis, and the control group was made up by 207 patients without H. pylori infection. Results: We found a higher value of the PLR in H. pylori-positive patients than in the control group, but the difference was not significant statistically. Conclusions: PLR levels could be a predictor of inflammation in H. pylori infection, but an extensive study is needed to confirm this theory.

Efficacy of Lactobacillus reuteri Supplementation in Eradication of H. pylori: A Comparison Study with Triple Drug Therapy

Helicobacter pylori (H. pylori) infections affect roughly one-half of the world’s population. Although many standard regimens, including triple-drug therapy, eradicate H. pylori, the success rate and efficacy have been declining due to associated side effects and symptom severity. The addition of probiotics to a standard regimen can considerably increase eradication rates. The objective is to find the efficacy of a probiotic Lactobacillus reuteri (L. reuteri) in eradicating human H. pylori infection and effect on symptoms regression and side effects associated with triple therapy. This prospective interventional study was conducted in 90 H. pylori-positive patients. 45 patients received standard triple treatment (group-I) for 14 days. Another 45 patients received a combination of standard triple therapy and L. reuteri (group-II) for 14 days. After the completion of treatment, H. pylori status was evaluated using a 13-C Urea-Breath Test (UBT). Each subject is interviewed with a validated Gastrointestinal Symptoms Rating Scale (GSRS) questionnaire to record symptoms and symptom severity before and after the therapy. Group-II patients showed a significantly higher eradication rate (86.67%) than group-I patients (66.67%). The absolute values of 13C-UBT (group-I: 14.02± 5.4, group-II: 11.9±3.73) revealed that a more substantial reduction in H. Pylori load was observed in group II. Statistical analysis proved that group II patients had a significant reduction in GSRS mean scores (baseline score: 15.39±4.52 to end score: 5.33±2.34) compared to group-I patients (baseline score: 14.47±3.67 to end score: 9.86±4.78). Addition of L. reuteri has reduced side effects associated with triple drug therapy except bloating. In conclusion, supplementation of L. reuteri to standard triple drug therapy significantly improved the eradication rate of H. pylori, reduced intensity of gastrointestinal symptoms and also treatment related side effects.

Helicobacter pylori infection and eradication outcomes among Vietnamese patients in the same households: Findings from a non-randomized study.

Familial transmission can possibly influence the infection and treatment of Helicobacter pylori. This study aimed to describe the prevalence of H. pylori infection and outcomes of eradication treatment among Vietnamese patients who live in the same households. We conducted a prospective cohort study of Vietnamese household members with upper gastrointestinal complaints. Participants received esophagogastroduodenoscopy and H. pylori testing. The H. pylori-positive patients were treated and asked to return for follow-up within 4 months. To explore factors associated with H. pylori infection at baseline, we performed multilevel logistic regression to account for the clustering effect of living in the same households. To explore factors associated with eradication failure, we used Poisson regression with robust variance estimation to estimate the risk ratio. The prevalence of H. pylori infection was 83.5% and highest among children <12 years old (92.2%) in 1,272 patients from 482 households. There were variations in H. pylori infection across households (intraclass correlation = 0.14, 95% confidence interval (CI) 0.05, 0.33). Children aged <12 years had higher odds of H. pylori infection (odds ratio = 3.41, 95%CI 2.11, 5.50). At follow-up, H. pylori was eradicated in 264 of 341 patients (77.4%). The risk of eradication failure was lower for the sequential regimen with tetracycline. H. pylori infection was common among people living in the same households. Eradication success for H. pylori was higher for the tetracycline sequential regimen. More research should be focused on how family factors influence H. pylori infection and on eradication treatment.

Diagnosis of histological gastritis based on the Kyoto classification of gastritis in Japanese subjects – including evaluation of aging and sex difference of histological gastritis

Objectives The Kyoto classification of gastritis was established for diagnosing Helicobacter pylori (H. pylori) infection via endoscopic findings. We investigated the role of the Kyoto classification of gastritis in the diagnosis of H. pylori infection and histological gastritis in Japanese individuals. Moreover, the histological findings of gastritis in H. pylori infection were examined based on age and sex differences. Methods We selected 561 patients aged 20–79 years who underwent gastroduodenal endoscopy at our hospital between 2010 and 2018. Endoscopic biopsy specimens from the antrum and corpus were used to investigate H. pylori infection and histology. Endoscopic findings were based on the Kyoto classification of gastritis, and histological findings were based on the updated Sydney System. Results Endoscopic findings based on the Kyoto classification of gastritis (H. pylori positive, 303 patients; H. pylori negative, 258 patients, based on endoscopic findings) had 98.7% sensitivity and 98.4% specificity for histological gastritis. In addition, endoscopic findings in the three age groups (20–39, 40–59, and 60–79 years) had high sensitivity and specificity. Atrophy and intestinal metaplasia were found only in the H. pylori-positive group and progressed with age. Histological inflammation of pyloric mucosa in the younger age group of H. pylori-positive patients was significantly higher than that in the elderly group. Significant inflammation was observed in young women. Conclusions The Kyoto classification of gastritis can not only diagnose H. pylori infection but also detect histological gastritis. Histological gastritis has varying characteristics of inflammation, atrophy, and intestinal metaplasia, depending on age and sex.

Fusobacterium nucleatum colonization is associated with decreased survival of helicobacter pylori-positive gastric cancer patients.

BACKGROUNDAn increased amount of Fusobacterium nucleatum (F. nucleatum) is frequently detected in the gastric cancer-associated microbiota of the Taiwanese population. F. nucleatum is known to exert cytotoxic effects and play a role in the progression of colorectal cancer, though the impact of F. nucleatum colonization on gastric cancer cells and patient prognosis has not yet been examined.AIMTo identify F. nucleatum-dependent molecular pathways in gastric cancer cells and to determine the impact of F. nucleatum on survival in gastric cancer.METHODSCoculture of F. nucleatum with a gastric cancer cell line was performed, and changes in gene expression were investigated. Genes with significant changes in expression were identified by RNA sequencing. Pathway analysis was carried out to determine deregulated cellular functions. A cohort of gastric cancer patients undergoing gastrectomy was recruited, and nested polymerase chain reaction was performed to detect the presence of F. nucleatum in resected cancer tissues. Statistical analysis was performed to determine whether F. nucleatum colonization affects patient survival.RESULTSRNA sequencing and subsequent pathway analysis revealed a drastic interferon response induced by a high colonization load. This response peaked within 24 h and subsided after 72 h of incubation. In contrast, deregulation of actin and its regulators was observed during prolonged incubation under a low colonization load, likely altering the mobility of gastric cancer cells. According to the clinical specimen analysis, approximately one-third of the gastric cancer patients were positive for F. nucleatum, and statistical analysis indicated that the risk for colonization increases in late-stage cancer patients. Survival analysis demonstrated that F. nucleatum colonization was associated with poorer outcomes among patients also positive for Helicobacter pylori (H. pylori).CONCLUSION F. nucleatum colonization leads to deregulation of actin dynamics and likely changes cancer cell mobility. Cohort analysis demonstrated that F. nucleatum colonization leads to poorer prognosis in H. pylori-positive patients with late-stage gastric cancer. Hence, combined colonization of F. nucleatum and H. pylori is a predictive biomarker for poorer survival in late-stage gastric cancer patients treated with gastrectomy.

Long-Term Clinical Outcomes of Gastric MALT Lymphoma: A Nationwide Multicenter Study in Korea.

BackgroundTreatment recommendations for gastric mucosa-associated lymphoid tissue (MALT) lymphoma are based on case series and expert opinions. Only a few previous studies have focused on the long-term outcomes of gastric MALT lymphoma, especially according to stage.MethodsPatients diagnosed with gastric MALT lymphoma from January 2000 to December 2018 at nine university hospitals in Korea were included. Clinical data of medical history, endoscopic features, histological diagnosis, results of Helicobacter pylori (H. pylori) testing, stage, treatment conditions, and outcomes were collected.ResultsA total of 1,163 patients was enrolled, and 97.6% (n=1,038) of patients were diagnosed as stage IE. 10-year overall survival (OS) for the entire population was 99.1% and was better for patients in stage IE compared with patients in stage III/IV (p=0.002). The 10-year OS for H. pylori-positive patients was better than that of H. pylori-negative patients (p=0.022). Multivariate analyses revealed initial stage III/IV as a prognostic factor associated with over-all survival.ConclusionThe majority of gastric MALT lymphoma patients are diagnosed at an early localized stage in Korea. The overall survival rate of gastric MALT lymphoma is excellent and is associated with the initial stage of the disease.

Elevated gaseous luminal nitric oxide and circulating IL-8 as features of Helicobacter pylori-induced gastric inflammation.

BackgroundGastric nitric oxide (NO) production in response to Helicobacter pylori via inducible nitric oxide synthase (iNOS) is suggested as a biomarker of inflammation and cytotoxicity. The aim of this study was to investigate relationships between gastric [NO], immunological biomarkers and histopathology.Materials and methodsEsophagogastroduodenoscopy was done in 96 dyspepsia patients. Luminal [NO] was measured by chemiluminescence. Biopsies were taken from gastric antrum and corpus for culture and histopathology. H. pylori IgG was detected by immunoblot assay. Biobanked plasma from 76 dyspepsia patients (11 H. pylori positives) was analyzed for 39 cytokines by multiplexed ELISA.ResultsH. pylori-positive patients had higher [NO] (336 ± 26 ppb, mean ± 95% CI, n = 77) than H. pylori-negative patients (128 ± 47 ppb, n = 19) (P < 0.0001). Histopathological changes were found in 99% of H. pylori-positive and 37% of H. pylori-negative patients. Histopathological concordance was 78–100% between corpus and antrum. Correlations were found between gastric [NO] and severity of acute, but not chronic, inflammation. Plasma IL-8 (increased in H. pylori positives) had greatest difference between positive and negative groups, with eotaxin, MIP-1β, MCP-4, VEGF-A, and VEGF-C also higher (P < 0.004 to P < 0.032). Diagnostic odds ratios using 75% cut-off concentration were 7.53 for IL-8, 1.15 for CRP, and 2.88 for gastric NO.ConclusionsOf the parameters tested, increased gastric [NO] and circulating IL-8 align most consistently and selectively in H. pylori-infected patients. Severity of mucosal inflammatory changes is proportional to luminal [NO], which might be tied to IL-8 production. It is proposed that IL-8 be further investigated as a blood biomarker of treatment outcomes.