Risk Of Peptic Ulcer Disease Research Articles

Different Risk of Common Gastrointestinal Disease Between Groups Undergoing Hemodialysis or Peritoneal Dialysis or With Non-End Stage Renal Disease: A Nationwide Population-Based Cohort Study.

Peritoneal dialysis (PD) is one type of renal replacement therapy, but potential peritoneal damage and gastrointestinal (GI) tract adverse effects during long-term exposure to bio-incompatible dialysate remain a concern. Although GI disease frequently occurs in dialysis patients, whether the risk of GI diseases differs among PD and hemodialysis (HD) or non-uremic groups is still uncertain.In this retrospective cohort study, data were obtained from the National Health Insurance Research Database, which includes almost all dialysis patients in Taiwan. Between 2000 and 2009, a total of 1791 PD and 8955 HD incident patients were enrolled and matched for age and sex or for propensity score. In addition, a comparison cohort of 8955 non-uremic patients was also selected. Individuals were monitored for the occurrence of common GI diseases until 2010, and data were analyzed using several different models.Generally speaking, the results showed that the risk of gastroesophageal reflux, intestinal obstruction or adhesions, and abdominal hernia was significantly higher in the PD group, whereas the risk of peptic ulcer disease and lower GI diverticula and bleeding was significantly greater in the HD group. Meanwhile, the risk of mesenteric ischemia, liver cirrhosis, and acute pancreatitis was higher in dialysis patients, but was not significantly different between the PD and HD groups; moreover, the risk of appendicitis in the PD group appeared to be lower than that in the HD group.In conclusion, dialysis patients have a higher risk of most common GI diseases, and PD and HD modalities are associated with different GI diseases.

Peptic Ulcer Disease in Healthcare Workers: A Nationwide Population-Based Cohort Study.

Health care workers (HCWs) in Taiwan have heavy, stressful workloads, are on-call, and have rotating nightshifts, all of which might contribute to peptic ulcer disease (PUD). We wanted to evaluate the PUD risk in HCWs, which is not clear. Using Taiwan’s National Health Insurance Research Database, we identified 50,226 physicians, 122,357 nurses, 20,677 pharmacists, and 25,059 other HCWs (dieticians, technicians, rehabilitation therapists, and social workers) as the study cohort, and randomly selected an identical number of non-HCW patients (i.e., general population) as the comparison cohort. Conditional logistical regression analysis was used to compare the PUD risk between them. Subgroup analysis for physician specialties was also done. Nurses and other HCWs had a significantly higher PUD risk than did the general population (odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.433–1.521 and OR: 1.328; 95% CI: 1.245–1.418, respectively); pharmacists had a lower risk (OR: 0.884; 95% CI: 0.828–0.945); physicians had a nonsignificantly different risk (OR: 1.029; 95% CI: 0.987–1.072). In the physician specialty subgroup analysis, internal medicine, surgery, Ob/Gyn, and family medicine specialists had a higher PUD risk than other physicians (OR: 1.579; 95% CI: 1.441–1.731, OR: 1.734; 95% CI: 1.565–1.922, OR: 1.336; 95% CI: 1.151–1.550, and OR: 1.615; 95% CI: 1.425–1.831, respectively). In contrast, emergency physicians had a lower risk (OR: 0.544; 95% CI: 0.359–0.822). Heavy workloads, long working hours, workplace stress, rotating nightshifts, and coping skills may explain our epidemiological findings of higher risks for PUD in some HCWs, which might help us improve our health policies for HCWs.

The effect of statins on the occurrence of peptic ulcer

BackgroundThis study was to determine the association between the use of statins and the occurrence of peptic ulcer diseases (PUD). MethodsUsing the National Health Insurance Research Database to conduct a population-based cohort study. We identified 48,562 patients who were newly diagnosed with hyperlipidemia during the period of 1998 to 2011 and who were divided into two groups based on their use of statins. The non-statin cohort (without statin treatment, 24,139 patients) were 1:1 frequency matched with sex, age, year of diagnosis of hyperlipidemia and index-year to the statin cohort (24,423 patients). The relative risk of patients with and without statins treatment on the occurrence of PUD and concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin were analyzed using the univariable and multivariable Cox proportional hazards regression model. ResultsThe incidence of PUD increased with age in both cohorts and female had a higher occurrence rate than male in both cohorts. Compared with the non-statin cohort, the statin cohort was associated with a significant lower risk of PUD for all age group. The concomitant use of aspirin and/or NSAIDs had higher incidence of PUD than those without in both cohorts. Analyzing the cumulative defined daily dose (DDD) of statins indicated that high-dose groups (≧575 DDD) exhibited significantly decreased risk compared with non-statin users. ConclusionThe results of the present study indicated that statins might be associated with the protection of peptic ulcer in a dose-respondent manner.

Increased Subsequent Risk of Peptic Ulcer Diseases in Patients With Bipolar Disorders.

Previous studies have reported that patients with bipolar disorders (BDs) exhibit increased physical comorbidity and psychological distress. Studies have shown that schizophrenia and anxiety increase the risk of peptic ulcer diseases (PUDs). Therefore, we conducted this study to determine the association between these 2 diseases and examine the possible risk factors. We used patients diagnosed with BDs from the Taiwan National Health Insurance Research Database. A comparison cohort comprising patients without BDs was frequency matched by age, sex, and comorbidities, and the occurrence of PUDs was evaluated in both the cohorts. The BD and non-BD cohort consisted of 21,060 patients with BDs and 84,240 frequency-matched patients without BDs, respectively. The incidence of PUDs (hazard ratio, 1.51; 95% confidence interval, 1.43-1.59; P < 0.001) was higher among the patients with BDs than the control patients. Cox models showed that irrespective of comorbidities, BDs were an independent risk factor for PUDs. Patients with BDs exhibit a substantially higher risk for developing PUDs. According to our data, we suggest that, following a diagnosis of BD, practitioners could notice the occurrence of PUD and associated prevention. Further prospective clinical studies investigating the relationship between BDs and PUDs are warranted.

Polymorphisms of the IL-6, IL-8 and IL-10 genes and the risk of gastric pathology in patients infected with Helicobacter pylori.

Helicobacter pylori-induced gastric mucosal inflammation is mediated by proinflammatory and anti-inflammatory cytokines. Polymorphisms in genes that code cytokines influence cytokine secretion levels and appear to contribute to the risk of gastric diseases. In this sense, we performed this study to identify the polymorphisms in the IL-6, IL-8, and IL-10 genes and their associations with H. pylori infection and gastric pathologies. Gastric biopsy samples of 151 patients infected with H. pylori and 76 uninfected individuals were used. Helicobacter pylori infection was diagnosed by histological examination and the detection of the ureA and glmM genes. The polymorphisms in the IL-6 (at position -174), IL-8 (at position -251), and IL-10 (at position -819) were detected by polymerase chain reaction-restriction fragment length polymorphism. Among the genetic polymorphisms studied, we observed that only the presence of the A allele at position -251 of the IL-8 gene was significantly associated with H. pylori infection. In addition, patient carriers of the A/A genotype at position -251 of the IL-8 gene and carriers of the T allele at position -819 of the IL-10 gene had an increased risk of peptic ulcer disease in the presence of H. pylori infection. We did not find a correlation between polymorphisms in the IL-6, IL-8, and IL-10 genes and a higher risk of gastric carcinoma. We demonstrated that polymorphisms in the IL-8 gene was significantly associated with H. pylori infection. Furthermore, polymorphisms in the IL-8 and IL-10 genes were associated with an enhanced risk of peptic ulcer disease in H. pylori-positive patients.

Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease - a prospective study of 233 093 men in Sweden.

Psychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre-dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated. To assess if stress resilience in adolescence is associated with subsequent PUD risk. The participants comprised of 233 093 men resident in Sweden, born 1952-1956 and assessed for compulsory military conscription during 1969-1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi-structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence. In total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61-2.10) and 1.23 (1.09-1.38) for low and moderate stress resilience, respectively. Stress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.

A cyclohexadepsipeptide from entomogenous fungi Metarhizium anisopliae inhibits the Helicobacter pylori induced pathogenesis through attenuation of vacuolating cytotoxin-A activity

Infection with Helicobacter pylori in the gastric mucosa is thought to be increased the risk of peptic ulcer disease and gastric cancer. Vacuolating cytotoxin A (VacA) was an important bacterial virulence factor and was closely associated with H. pylori-induced pathogenesis. Upon H. pylori infection, the VacA can be transferred directly from bacteria into the host cells where can stimulate vacuolar-type ATPase (V-ATPase) proton pump and induce the formation of vacuoles in gastric epithelial cells followed by intoxication of cells. Destruxin B (Dtx-B), a cyclodepsipeptide from the fungus Metarhizium anisopliae bearing insecticidal and anticancer effects. In this study, Dtx-B demonstrated inhibitory effects against H. pylori VacA-induced vacuolization in gastric epithelial cells. Our data further showed that attenuation of H. pylori-induced vacuolization in gastric epithelial cells by Dtx-B is mediated through inhibition of V-ATPase activity rather than VacA expression levels. The results from this study reveal a novel role for Dtx-B in the modulation of H. pylori VacA-induced pathogenesis.

Peptic ulcer disease in liver cirrhosis and chronic hepatitis: impact of portal hypertension

Objective. The pathophysiology of peptic ulcer disease (PUD) in liver cirrhosis (LC) and chronic hepatitis has not been established. The aim of this study was to assess the role of portal hypertension from PUD in patients with LC and chronic hepatitis. Materials and methods. We analyzed the medical records of 455 hepatic vein pressure gradient (HVPG) and esophagogastroduodenoscopy patients who had LC or chronic hepatitis in a single tertiary hospital. The association of PUD with LC and chronic hepatitis was assessed by univariate and multivariate analysis. Results. A total of 72 PUD cases were detected. PUD was associated with LC more than with chronic hepatitis (odds ratio [OR]: 4.13, p = 0.03). In the univariate analysis, taking an ulcerogenic medication was associated with PUD in patients with LC (OR: 4.34, p = 0.04) and smoking was associated with PUD in patients with chronic hepatitis (OR: 3.61, p = 0.04). In the multivariate analysis, taking an ulcerogenic medication was associated with PUD in patients with LC (OR: 2.93, p = 0.04). However, HVPG was not related to PUD in patients with LC or chronic hepatitis. Conclusion. According to the present study, patients with LC have a higher risk of PUD than those with chronic hepatitis. The risk factor was taking ulcerogenic medication. However, HVPG reflecting portal hypertension was not associated with PUD in LC or chronic hepatitis (Clinicaltrial number NCT01944878).

75-Year-Old Man With Abdominal Pain and Reflux

75-Year-Old Man With Abdominal Pain and Reflux

Peptic Ulcer Disease Risk in Chronic Kidney Disease: Ten-Year Incidence, Ulcer Location, and Ulcerogenic Effect of Medications

ObjectivesWe aimed at determining peptic ulcer disease (PUD) incidence among chronic kidney disease (CKD) patients during 1998–2008, compared to patients without CKD, and at examining associations between CKD and PUD.MethodsData for 1998–2008 were extracted from the National Health Insurance Research Database in Taiwan. The annual PUD incidence (cases per thousand persons per year) was calculated separately for patients with and without CKD. Characteristics of patients with newly diagnosed PUD (n = 16322) were compared to those of a control group without PUD (n = 32644). The 2 groups were matched for age, sex, and index year. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression.ResultsOver the 10-year period, the PUD incidence was ∼10–12 times higher in CKD patients than in those without CKD. Its incidence in elderly CKD patients increased rapidly over time. For CKD patients, most PUD events (>95%) were managed during hospitalization. Peptic ulcer risk, adjusted for all potential confounders, was much higher in CKD patients undergoing hemodialysis (adjusted OR, 9.74; 95% CI, 7.11–13.31). Maintenance hemodialysis patients were 2 times more likely to have gastric ulcers than duodenal ulcers, while CKD patients not on dialysis had similar risks for both. There were no significant interactions between medications and CKD status on the peptic ulcer risk. Unlike CKD patients on nonsteroidal anti-inflammatory drugs and clopidogrel, those on aspirin did not have a higher peptic ulcer risk (adjusted OR, 0.88; 95% CI, 0.44–1.77).ConclusionsCKD patients have a substantially increased PUD risk, and the majority of CKD patients with PUD require hospital management. Further, peptic ulcer risk is affected by hemodialysis therapy, patient status (inpatient vs. outpatient), and ulcerogenic medications.

Late gastrointestinal morbidity in patients with stage I–II testicular seminoma treated with radiotherapy

ObjectivesTo define the incidence and risk factors for late gastrointestinal (GI) morbidity in patients with testicular seminoma treated with radiotherapy (RT). Methods and materialsA retrospective review was conducted of 251 patients with stage I or II testicular seminoma treated with curative-intent RT at our institution from 1974 to 2009. All patients underwent orchiectomy and postoperative external beam RT to the involved nodal basin or at-risk nodal basin or both. Potential late GI morbidities that were assessed included endoscopically confirmed peptic ulcer disease (PUD), small bowel obstruction (SBO), and biopsy-confirmed malignancy of the GI tract. The probabilities of these GI morbidities were estimated with the Kaplan-Meier method. Univariate analyses were performed to examine for associated predictive factors using the Cox proportional hazards model. ResultsMedian age at diagnosis was 36 years (range 18–80). Clinical stage was I (n = 199) or II (n = 52). Median abdominopelvic RT dose was 26Gy (interquartile range = 25–30). Median follow-up was 15 years (range = 0.1–38). PUD risk at 10, 20, and 30 years was 4%, 7%, and 9%, respectively. Age at diagnosis (per y, HR = 1.05, 95% CI 1.00–1.09, P = 0.04) and RT dose (per Gy, HR = 1.20, 95% CI 1.09–1.31, P<0.01) were associated with risk of PUD. SBO risk at 10, 20, and 30 years was 2%, 2%, and 3%, respectively. History of inflammatory bowel disease was associated with risk of SBO (HR = 43, 95% CI 7–325, P<0.01). GI second malignancy risk at 10, 20, and 30 years was 0.5%, 3% and 16%, respectively. Age at RT was associated with risk of GI malignancy (per y, HR = 1.07, 95% CI 1.02–1.14, P = 0.01). ConclusionsIn this patient population, late GI morbidity was relatively uncommon, but clinically significant. Refinements of treatment strategies may reduce this risk.

Helicobacter pylori CagA and VacA genotypes and gastric phenotype

CagA+ and vacuolizing cytotoxin (VacA)-specific strains of Helicobacter pylori have been associated with different risks for developing gastric lesions. We aim to summarize a possible association between these genotypes and the risk for developing different gastric phenotypes. A MEDLINE database (PubMed) search was performed and a meta-analysis conducted. Forty-four studies were retrieved, all with either a case-control (n=13) or cross-sectional (n=31) design, including 17 374 patients. CagA positivity was associated with an increased risk for gastric cancer [odds ratio (OR) 2.09 (95% confidence interval (CI), 1.48-2.94)] compared with that in individuals without gastric lesions [OR 2.44 (95% CI 1.27-4.70)] and in those with previously identified gastritis. In addition, there was an increased risk for peptic ulcer disease [OR 1.69 (95% CI 1.12-2.55)]. Individuals harboring the H. pylori strains VacA s1 (vs. s2), m1 (vs. m2), s1m1 (vs. s1m2), and s1m1 (vs. s2m2) had an increased risk for development of cancer [OR of 5.32 (95% CI 2.76-10.26), 2.50 (95% CI 1.67-3.750), 2.58 (95% CI 1.24-5.38), and 4.36 (95% CI 2.08-9.10), respectively]. s1m1 strains (vs. s2m2) were also associated with peptic ulcer disease [OR 2.04 (1.01-4.13)]. Our results indicate that individuals infected with CagA+ H. pylori strains and those infected with VacA s1 and m1 strains have an increased risk for gastric cancer. Cohort studies are welcome to integrate this information in the management of at-risk individuals such as those with precancerous cancer conditions and/or a family history of gastric cancer.

Association of presence/absence and on/off patterns of Helicobacter pylori oipA gene with peptic ulcer disease and gastric cancer risks: a meta-analysis

BackgroundThere are increasing studies examining the relationship between the status of H. pylori oipA gene and peptic ulcer disease (PUD) and gastric cancer (GC) but the results turn out to be controversial. We attempted to clarify whether oipA gene status is linked with PUD and/or GC risks.MethodsA systematically literature search was performed through four electronic databases. According to the specific inclusion and exclusion criteria, seven articles were ultimately available for the meta-analysis of oipA presence/absence with PUD and GC, and eleven articles were included for the meta-analysis of oipA on/off status with PUD and GC.ResultsFor the on/off functional status analysis of oipA gene, the “on” status showed significant associations with increased risks of PUD (OR = 3.97, 95% CI: 2.89, 5.45; P < 0.001) and GC (OR = 2.43, 95% CI: 1.45, 4.07; P = 0.001) compared with gastritis and functional dyspepsia controls. Results of the homogeneity test indicated different effects of oipA “on” status on PUD risk between children and adult subgroups and on GC risk between PCR-sequencing and immunoblot subgroups. For the presence/absence analysis of oipA gene, we found null association of the presence of oipA gene with the risks of PUD (OR = 1.93, 95% CI: 0.60, 6.25; P = 0.278) and GC (OR = 2.09, 95% CI: 0.51, 8.66; P = 0.308) compared with gastritis and functional dyspepsia controls.ConclusionsTo be concluded, when oipA exists, the functional “on” status of this gene showed association with increased risks for PUD and GC compared with gastritis and FD controls. However, merely investigating the presence/absence of oipA would overlook the importance of its functional on/off status and would not be reliable to predict risks of PUD and GC. Further large-scale and well-designed studies concerning on/off status of oipA are required to confirm our meta-analysis results.

PP54 Ethnic differences in Upper Gastrointestinal Disease in Scotland

BackgroundThere is a paucity of data assessing ethnic variations in upper gastrointestinal (GI) disease: we sought to study the incidence of upper GI diseases using adequate measure of ethnicity in...

Socioeconomic disparities in the operative management of peptic ulcer disease

Over the last 60 years, there has been a nationwide decrease in the number of operations performed for peptic ulcer disease (PUD). In contrast, the experience at our university-based safety net hospital (SNH) was that ulcer operations are still performed frequently. We hypothesized that differences in frequency of PUD operation may occur in hospitals that serve different patient populations. The purpose of this study was to evaluate our experience with PUD and compare it with national trends. We received institutional review board approval and performed this retrospective study of patients undergoing operation for PUD between January 2008 and December 2011. Patient records at 2 hospitals (a private community hospital and a university SNH) with similar admission numbers and geographic catchment were examined for PUD risk factors, Helicobacter pylori status, insurance/income status, type of operation, and surgical outcomes. A case-matched control group of medically treated patients were identified after primary diagnosis of PUD by endoscopy at the SNH. Univariate and multivariate analyses were performed. The total number of operations for PUD performed at the SNH was greater than those performed at the private hospital from 2008 to 2011 (142 vs 24; P < .001). The private hospital followed national trends over the same time period with a decrease in operations for PUD of approximately 93% between 1967 and 2008 (115 to 8 operations per year nationally and 119 to 6 at the private hospital). In contrast with the national and local private hospital experience, the number of operations for PUD at SNH increased from 27 per year in 1985 to 36 per year in 2008. Additionally, 43% of patients at the SNH had no insurance, and 61% resided in the poorest quartile of zip codes compared with the 3% uninsured patient rate at the private hospital for a similar group of patients. At both hospitals, most operations were emergent (range, 83-92%) and treated with omental patch (45%), gastric wedge resection (15%), vagotomy and antrectomy (19%), or vagotomy and pyloroplasty (14%). At the SNH, the H pylori infection rate was less (48% vs 83%; P < .001) and nonsteroidal anti-inflammatory drug (NSAID) use was greater (76% vs 63%; P < .01) in the 142 surgical patients compared with the 320 medical controls. Adjusted risk ratios demonstrated insurance status, NSAID use, and lower socioeconomic class were all equally predictive of operative ulcer disease when compared with medical controls. Our study provides 2 observations. First, patients of lower socioeconomic standing may have increased rates of complicated PUD owing to multiple medical factors and other factors related to healthcare. Second, surgical care for PUD retains a clinically important role within this patient population.

AB1467-HPR Nsai and effectiveness of physiotherapy in the treatment of gonarthrosis

BackgroundGonarthrosis is a progressive chronic arthropatic disease of the knee which includes degenerative changes of the knee cartilage and hypertrophic changes of the bone tissue around of the articulare surface.ObjectivesThe...

Comparison of gastrointestinal adverse effects between cyclooxygenase-2 inhibitors and non-selective, non-steroidal anti-inflammatory drugs plus proton pump inhibitors

Dear Sirs, We read with great interest a systematic review and meta-analysis recently published in J Gastroenterol [1], in which Jarupongprapa and coauthors reported that use of cyclooxygenase-2 inhibitors (COX-2 inhibitors) is significantly associated with decreased risk of major gastrointestinal events, including perforation, obstruction, and bleeding [relative risk = 0.38, 95 % confidence interval (CI) = 0.25–0.56]. Similarly, Sakamoto and coauthors in Japan reported that use of celecoxib (a COX-2 inhibitor) for 2 weeks is less likely to develop gastroduodenal ulcers than use of loxoprofen (a non-selective, non-steroidal antiinflammatory drug [ns-NSAID]) [3]. However, in a cohort study recently published in the Kuwait Medical Journal [2], we found that use of COX-2 inhibitors has a higher incidence of peptic ulcer disease than non-use of COX-2 inhibitors (19.28 vs. 5.91 per 1000 person-years, incidence rate ratio = 3.26, 95 % confidence interval = 2.63–4.04). The subanalysis also demonstrated that use of celecoxib, meloxicam, nabumetone or nimesulide is significantly associated with increased risk of peptic ulcer disease, especially in those that are used for less than 3 months. Based on the review by Jarupongprapa et al., COX-2 inhibitors seem to be superior to NSAIDs plus proton-pump inhibitors in mitigating the risk of major gastrointestinal events. Moreover, our study indicates that all COX-2 inhibitors are associated with increased risk of peptic ulcer disease. That is, COX-2 inhibitors are comparatively safe rather than undoubtedly safe. Therefore, prescription of any COX-2 inhibitor needs to be cautious in clinical practice.

Association ofHelicobacter pyloribabA2 with peptic ulcer disease and gastric cancer

To investigate the association between babA2 gene and peptic ulcer disease (PUD) and gastric cancer (GC) in Helicobacter pylori-infected populations. We evaluated the relationship between babA2 and clinical outcomes (PUD and GC) using a meta-analysis. A literature search was performed using the PubMed and Web of Science databases for relevant case-control studies that met the defined inclusion criteria. The ORs and 95%CIs were calculated to estimate the association between babA2 genotype and clinical outcomes. A fixed-effect or random-effect model was performed depending on the absence or presence of significant heterogeneity. A total of 25 articles with 38 studies met the inclusion criteria and were finally included in this meta-analysis. The results showed that the babA2 genotype was significantly associated with an increased risk of PUD (OR = 2.069, 95%CI: 1.530-2.794, P < 0.001) and especially in the subgroup of duodenal ulcer (OR = 1.588, 95%CI: 1.141-2.209, P = 0.006). Moreover, a significant association between babA2 gene and PUD and duodenal ulcer (OR = 2.739, 95%CI: 1.860-4.032, P < 0.001; OR = 2.239, 95%CI: 1.468-3.415, P < 0.001, respectively) was observed in western countries but not in Asian countries. We demonstrated that the presence of babA2 may be associated with increased risks for PUD, especially duodenal ulcer, in western countries.

Role of Helicobacter pylori cagA EPIYA motif and vacAgenotypes for the development of gastrointestinal diseases in Southeast Asian countries: a meta-analysis

BackgroundInfection with cagA-positive, cagA EPIYA motif ABD type, and vacA s1, m1, and i1 genotype strains of Helicobacter pylori is associated with an exacerbated inflammatory response and increased risk of gastroduodenal diseases. However, it is unclear whether the prevalence and virulence factor genotypes found in Southeast Asia are similar to those in Western countries. Here, we examined the cagA status and prevalence of cagA EPIYA motifs and vacA genotypes among H. pylori strains found in Southeast Asia and examined their association with gastroduodenal disease.MethodsTo determine the cagA status, cagA EPIYA motifs, and vacA genotypes of H. pylori, we conducted meta-analyses of 13 previous reports for 1,281 H. pylori strains detected from several Southeast Asian countries.ResultsThe respective frequencies of cagA-positive and vacA s1, m1, and i1 genotypes among examined subjects were 93% (1,056/1,133), 98% (1,010/1,033), 58% (581/1,009), and 96% (248/259), respectively. Stratification showed significant variation in the frequencies of cagA status and vacA genotypes among countries and the individual races residing within each respective country. The frequency of the vacA m-region genotype in patients infected with East Asian-type strains differed significantly between the northern and southern areas of Vietnam (p < 0.001). Infection with vacA m1 type or cagA-positive strains was associated with an increased risk of peptic ulcer disease (odds ratio: 1.46, 95%CI: 1.01-2.12, p = 0.046 and 2.83, 1.50-5.34, p = 0.001, respectively) in the examined Southeast Asian populations.ConclusionsBoth Western- and East Asian-type strains of H. pylori are found in Southeast Asia and are predominantly cagA-positive and vacA s1 type. In Southeast Asia, patients infected with vacA m1 type or cagA-positive strains have an increased risk of peptic ulcer disease. Thus, testing for this genotype and the presence of cagA may have clinical usefulness.

Association between interleukin-8 gene −251 T/A polymorphism and the risk of peptic ulcer disease: A meta-analysis

It remains controversial regarding the association between interleukin-8 (IL-8) gene -251 T/A polymorphism and peptic ulcer disease (PUD) risk. Thus, a large-scale meta-analysis evaluating the precise association between this gene variant and PUD risk is required. We searched the PubMed, Embase, Web of Science, and Google Scholar until April 25, 2012. Additionally, hand searching of the references of identified articles were performed. All the statistical tests were performed using Stata 11.0. A total of eight studies (3105 subjects) were included in this meta-analysis. Overall, no significant association was found between IL-8 gene -251 T/A polymorphism and PUD risk (for A allele vs. T allele: OR = 1.17, 95% CI = 0.97-1.41, p = 0.094; for A/A vs. T/T: OR = 1.33, 95% CI = 0.94-1.90, p = 0.108; for A/A vs. A/T+T/T: OR = 1.22, 95% CI =0.97-1.52, p = 0.083; for A/A+A/T vs. T/T: OR = 1.26, 95% CI = 0.95-1.67, p = 0.113). However, in the subgroup analyses by ethnicity, H. pylori infection and the subtype of PUD, significant associations were found between IL-8 gene -251 T/A polymorphism and PUD risk in Asians, H. pylori+, duodenal ulcer disease (DUD) and gastric ulcer disease (GUD), respectively. In summary, the present meta-analysis suggests that IL-8 gene -251 T/A polymorphism is associated with increased PUD risk among Asians, and especially for the subgroups of H. pylori+, DUD and GUD.