Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2018; 24(13): 1419-1428
Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1419
Helicobacter pylori infection in subjects negative for high titer serum antibody
Osamu Toyoshima, Toshihiro Nishizawa, Masahide Arita, Yosuke Kataoka, Kosuke Sakitani, Shuntaro Yoshida, Hiroharu Yamashita, Keisuke Hata, Hidenobu Watanabe, Hidekazu Suzuki
Osamu Toyoshima, Toshihiro Nishizawa, Masahide Arita, Yosuke Kataoka, Kosuke Sakitani, Shuntaro Yoshida, Hiroharu Yamashita, Keisuke Hata, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 1570066, Japan
Hidenobu Watanabe, Department of Pathology, Pathology and Cytology Laboratory Japan, Tokyo 1660003, Japan
Hidekazu Suzuki, Medical Education Center, Keio University School of Medicine, Tokyo 1608582, Japan
Author contributions: All authors were involved in designing the study; Toyoshima O, Nishizawa T and Suzuki H prepared the manuscript; Watanabe H was involved with histological diagnoses; Toyoshima O contributed to statistical analyses.
Institutional review board statement: This retrospective study was approved by the Ethical Review Committee of Hattori Clinic on September 7, 2017.
Informed consent statement: Written informed consents were obtained from the participants.
Conflict-of-interest statement: During the last five years, Toyoshima O received personal fees from Otsuka Pharmaceutical Co., Ltd. and Takeda Pharmaceutical Co., Ltd. outside of the submitted work; Suzuki H received scholarship funds for the research from Astellas Pharma Inc., Astra-Zeneca K.K., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Zeria Pharmaceutical Co., Ltd. and received service honoraria from Astellas Pharma, Inc., Astra-Zeneca K.K., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Zeria Pharmaceutical Co., Ltd.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Osamu Toyoshima, MD, Director, Department of Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 1570066, Japan. t@ichou.com
Telephone: +81-3-54299555 Fax: +81-3-54299511
Received: February 25, 2018
Peer-review started: February 25, 2018
First decision: March 9, 2018
Revised: March 13, 2018
Accepted: March 18, 2018
Article in press: March 18, 2018
Published online: April 7, 2018
ARTICLE HIGHLIGHTS
Research background

Patients who test negative but in the negative-high titer range of serum anti-Helicobacter pylori (H. pylori) antibodies are at a high risk for gastric cancer, especially the intestinal type, and sometimes have H. pylori infection. Patients with negative-high titers with H. pylori infection have higher risk for gastric cancer than do those without H. pylori infection.

Research motivation

The clinicopathological features including H. pylori infection rate in the negative-high titer patients are unclear.

Research objectives

The objective of this research was to elucidate the clinicopathological features of the negative-high titer patients.

Research methods

The antibody titers were measured using antigens derived from Japanese individuals, E-plate Eiken. 13C-urea breath test (UBT)-positive individuals were defined as having H. pylori infection. We investigated the demographic characteristics, laboratory data, endoscopic findings including Kyoto classification of gastritis, and histology in negative-high titer patients without history of H. pylori eradication therapy.

Research results

Of the 136 subjects enrolled, 23 (17%) had H. pylori infection. Kyoto classification had an excellent area under the receiver operating characteristics curve (0.886) for predicting H. pylori infection, with a cut-off value of 2. Further, Kyoto classification had high accuracy (89.7%). Kyoto classification was independent of the demographic and laboratory parameters in multivariate analysis.

Research conclusions

In this study, 17% of patients with negative-high titer had H. pylori infection. Endoscopic Kyoto classification of gastritis with a score of 2 or more could predict H. pylori infection in negative high-titer patients. Further investigations including UBT should be considered in these patients.

Research perspectives

Long-term prospective studies are expected to investigate the role of serum antibody titer and Kyoto classification of gastritis in predicting not only H. pylori infection but also the risk of gastric cancer.