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Okamura T, Ito A, Iwaya Y, Nagaya T, Hirayama A, Ota H, Akamatsu T. Long-term evaluation of Helicobacter pylori screening in school health checkups: an 11-year study in Japan. J Gastroenterol 2025; 60:696-704. [PMID: 40053109 PMCID: PMC12095338 DOI: 10.1007/s00535-025-02236-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/23/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND The eradication of Helicobacter pylori (H. pylori) at a younger age is considered effective in preventing gastric cancer. Toward this goal, we introduced primary H. pylori screening into routine high school health screenings in 2007. The present study aimed to elucidate the clinicopathological characteristics of H. pylori-infected students and evaluate the effectiveness of H. pylori screening in high school populations. METHODS Primary screening using a urinary anti-H. pylori antibody test was conducted on high school students from 2007 to 2017. Students who tested positive for this examination were recommended secondary screening by esophagogastroduodenoscopy (EGD), with eradication therapy for those with confirmed H. pylori infection. We analyzed data from 2007 to 2011 as the early period and from 2012 to 2017 as the late period. RESULTS Over 11 years, 5178 of 5193 (99.7%) subjects received primary screening, among which 184 students (3.6%) tested positive. The primary screening-positive rate decreased significantly from 4.7% in the early period to 2.8% in the late period (p < 0.01). EGD as secondary screening in 103 students (56%) revealed nodular gastritis (83.3%) as the most common endoscopic finding. H. pylori infection was diagnosed in 90 students (87.4%). The resistance rate of H. pylori to clarithromycin was 41.1%. The initial eradication therapy success rate by treatment selection according to H. pylori susceptibility was 96.5%. CONCLUSIONS The introduction of H. pylori screening into school health checkups achieved high participation rates and appeared useful for identifying and treating H. pylori infection in young populations.
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Affiliation(s)
- Takuma Okamura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Akihiro Ito
- Department of Gastroenterology, Matsumoto Municipal Hospital, Matsumoto, Japan
| | - Yugo Iwaya
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tadanobu Nagaya
- Endoscopic Examination Center, Shinshu University Hospital, Matsumoto, Japan
| | - Atsuhiro Hirayama
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroyoshi Ota
- Department of Biomedical Laboratory Sciences, School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Taiji Akamatsu
- Endoscopy Center, Nagano Prefectural Shinshu Medical Center, Suzaka, Japan
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Fukuda S, Watanabe K, Fujimori S, Komatsu T, Yoshida T, Kuramitsu T, Shimodaira Y, Matsuhashi T, Iijima K. Comparison of Cancer Worries for Gastric Cancer by Helicobacter Pylori Infection Status at Health Check-Up Setting in Japan. TOHOKU J EXP MED 2025; 266:29-36. [PMID: 39384374 DOI: 10.1620/tjem.2024.j108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Abstract
Helicobacter pylori (HP) infection is the major cause of gastric cancer (GC). No reports have been published on the effects of HP infection on anxiety for GC, although the majority of HP-positive subjects received eradication therapy intending to reduce their risk of GC in Japan. This study aimed to investigate the relationship between cancer worry (CW) for GC and participants' HP infection status. The original study was a quantitative, self-administered questionnaire survey to investigate CW for esophageal cancer in Barrett's esophagus. The present study used the same dataset on CW against GC. Participants were recruited between May 2021 and March 2022 from three health screening facilities in Akita Prefecture, Japan. The Cancer Worry Scale was used to quantitatively assess the fear of developing cancer. Logistic regression analyses were used to investigate factors associated with excessive CW (defined as ≥ 13). A total of 303 respondents were included. Excessive CW accounted for 63.0% (92/146) in HP-negative, 55.0% (11/20) in HP-positive, and 71.5% (98/137) in HP-eradicated patients. While the presence of upper gastrointestinal symptoms and subnormal mental health quality were significantly associated with excessive CW, the status of HP infection did not affect it. There is a significant discrepancy between CW for GC and actual GC risk, defined as their HP infection status, among those undergoing GC screening. It may be necessary to provide appropriate patient education when introducing risk-based (mainly HP-based) stratified screening for GC shortly in Japan.
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Affiliation(s)
- Sho Fukuda
- Department of Gastroenterology, Akita University Graduate School of Medicine
| | - Kenta Watanabe
- Department of Gastroenterology, Akita University Graduate School of Medicine
| | | | - Taiga Komatsu
- Department of Anesthesiology, Honjo-Daiichi Hospital
| | - Tatsuki Yoshida
- Department of Gastroenterology, Akita University Graduate School of Medicine
| | - Taira Kuramitsu
- Department of Gastroenterology, Akita University Graduate School of Medicine
| | - Yosuke Shimodaira
- Department of Gastroenterology, Akita University Graduate School of Medicine
| | - Tamotsu Matsuhashi
- Department of Gastroenterology, Akita University Graduate School of Medicine
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine
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Farinati F, Pelizzaro F. Gastric cancer screening in Western countries: A call to action. Dig Liver Dis 2024; 56:1653-1662. [PMID: 38403513 DOI: 10.1016/j.dld.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
Gastric cancer is a major cause of cancer-related death worldwide, despite the reduction in its incidence. The disease is still burdened with a poor prognosis, particularly in Western countries. The main risk factor is the infection by Helicobacter pylori, classified as a class I carcinogen by the IARC, and It is well-known that primary prevention of gastric cancer can be achieved with the eradication of the infection. Moreover, non-invasive measurement of pepsinogens (PGI and PGI/PGII ratio) allows the identification of patients that should undergo upper gastrointestinal (GI) endoscopy. Gastric non-cardia adenocarcinoma is indeed preceded by a well-defined precancerous process that involves consecutive stages, described for the first time by Correa et al. more than 40 years ago, and patients with advance stages of gastric atrophy/intestinal metaplasia and with dysplastic changes should be followed-up periodically with upper GI endoscopies. Despite these effective screening and surveillance methods, national-level screening campaigns have been adopted only in few countries in eastern Asia (Japan and South Korea). In this review, we describe primary and secondary preventive measures for gastric cancer, discussing the need to introduce screening also in Western countries. Moreover, we propose a simple algorithm for screening that could be easily applied in clinical practice.
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Affiliation(s)
- Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 2, Padova 35128, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Via Giustiniani 2, Padova 35128, Italy.
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 2, Padova 35128, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, Via Giustiniani 2, Padova 35128, Italy
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Xu J, Liao J, Yan Q, Jiao J, Hu N, Zhang W, Shi L, Deng M, Huang S, Tang X. Trends analysis of cancer incidence, mortality, and survival for the elderly in the United States, 1975-2020. Cancer Med 2024; 13:e70062. [PMID: 39082934 PMCID: PMC11289898 DOI: 10.1002/cam4.70062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 07/02/2024] [Accepted: 07/20/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Cancer burden from the elderly has been rising largely due to the aging population. However, research on the long-term epidemiological trends in cancer of the elderly is lacking. METHODS Registry data of this population-based cross-sectional study were from the Surveillance, Epidemiology, and End Results (SEER) database. The study population aged 65 years or more, from geographically distinct regions. Joinpoint regression and JP Surv method were used to analyze cancer trends and survival. RESULTS Mortality rate during 1975-2020 decreased from 995.20 to 824.99 per 100,000 elderly persons, with an average annual decrease of 0.421% (95% CI, 0.378-0.464). While overall incidence increased with no significance. Prostate (29%) and breast (26%) cancer were the most common malignancies, respectively, in elderly males and females, and the mortality for both of the two (prostate 15%, breast 14%) ranked just behind lung and bronchus cancer, which had the highest mortality rates in males (29%) and females (23%). Many cancers showed adverse trends in the latest follow-up periods (the last period calculated by the Joinpoint method). For intrahepatic cholangiocarcinoma, incidence (male Annual Percentage Change [APC] = 7.4*; female APC = 6.7*) and mortality (male APC = 3.0*; female APC = 3.3*) increased relatively fast, and its survival was also terrible (3-year survival only 10%). Other cancers with recent increasing mortality included cancer of anus, anal canal and anorectum, retroperitoneum, pleura, peritoneum, etc. Most cancers had favorable trends of survival during the nearest follow-up period. CONCLUSION Against the background of overall improvement, many cancers showed adverse trends. Further research for the underlying mechanisms and targeted implements towards adverse trends is also urgent.
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Affiliation(s)
- Jia Xu
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Jingyuan Liao
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Qiong Yan
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Jiang Jiao
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Nan Hu
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Wei Zhang
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Lei Shi
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Mingming Deng
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
| | - Shu Huang
- Department of GastroenterologyLianshui County People' HospitalHuaianChina
- Department of GastroenterologyLianshui People' Hospital of Kangda College Affiliated to Nanjing Medical UniversityHuaianChina
| | - Xiaowei Tang
- Department of GastroenterologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan ProvinceLuzhouChina
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Takahashi S, Watanabe K, Fukuda S, Yoshida T, Dohmen T, Fujiwara J, Matsuyama M, Fujimori S, Funaoka M, Shirayama K, Horikawa Y, Fushimi S, Uchikoshi S, Onochi K, Okubo R, Hoshino T, Horii T, Kuramitsu T, Sakaki K, Ishii T, Komatsu T, Yoshida Y, Shirane K, Ono T, Shimodaira Y, Matsuhashi T, Iijima K. Helicobacter pylori Eradication Does Not Adversely Affect the Clinical Course of Gastric Cancer: A Multicenter Study on Screening Endoscopic Examination in Japan. Cancers (Basel) 2024; 16:733. [PMID: 38398125 PMCID: PMC10887210 DOI: 10.3390/cancers16040733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Since gastric cancers (GCs) detected after Helicobacter pylori (HP) eradication present with different morphological characteristics from conventional HP-positive GCs, delayed detection of early-stage GCs may be observed. This study aimed to investigate the clinical impact of HP eradication on diagnosing GC during screening endoscopy. METHODS Eleven health checkup institutions in Japan participated in the present study. All GC cases newly diagnosed by screening endoscopy between January 2016 and December 2020 were included. After propensity score matching, multivariable regression analysis was performed to estimate the effect of HP eradication on deep tumor invasion among HP-eradicated and HP-positive GC cases. RESULTS A total of 231 patients with GCs (134 HP-eradicated and 97 HP-positive cases) were enrolled. After propensity score matching, there were 81 cases in each group. The distribution of the depth of tumor invasion (pT1a, pT1b1, pT1b2, and pT2) between the HP-eradicated group and HP-positive group was similar (p = 0.82). In the propensity analysis, with HP-positive as the reference value, HP eradication was not significantly associated with T1b-T4-GCs and T1b2-T4-GCs, with odds ratios (95% confidence intervals) of 1.16 (0.48-2.81) and 1.16 (0.42-3.19), respectively. CONCLUSIONS HP eradication does not adversely affect the clinical course of GCs, supporting the recommendation of HP eradication in screening programs to reduce the total number of GC cases without delaying diagnosis.
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Affiliation(s)
- So Takahashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
- Department of Gastroenterology, Yuri Kumiai General Hospital, 38 Ienoushiro, Kawaguchi, Yurihonjo 015-8511, Akita, Japan
| | - Kenta Watanabe
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Sho Fukuda
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Tatsuki Yoshida
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Takahiro Dohmen
- Department of Gastroenterology, Yuri Kumiai General Hospital, 38 Ienoushiro, Kawaguchi, Yurihonjo 015-8511, Akita, Japan
| | - Junichi Fujiwara
- Department of Gastroenterology, Yuri Kumiai General Hospital, 38 Ienoushiro, Kawaguchi, Yurihonjo 015-8511, Akita, Japan
| | - Mari Matsuyama
- Department of Gastroenterology, Yuri Kumiai General Hospital, 38 Ienoushiro, Kawaguchi, Yurihonjo 015-8511, Akita, Japan
| | - Shusei Fujimori
- Department of Gastroenterology, Yokote Municipal Hospital, 5-31 Negishi, Yokote 013-8602, Akita, Japan
| | - Masato Funaoka
- Department of Gastroenterology, Yokote Municipal Hospital, 5-31 Negishi, Yokote 013-8602, Akita, Japan
| | - Kodai Shirayama
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
- Department of Gastroenterology, Yokote Municipal Hospital, 5-31 Negishi, Yokote 013-8602, Akita, Japan
| | - Yohei Horikawa
- Department of Gastroenterology, Hiraka General Hospital, 3-1 Yatsukuchi, Maego, Yokote 013-8610, Akita, Japan; (Y.H.)
| | - Saki Fushimi
- Department of Gastroenterology, Hiraka General Hospital, 3-1 Yatsukuchi, Maego, Yokote 013-8610, Akita, Japan; (Y.H.)
| | - Shu Uchikoshi
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
- Department of Gastroenterology, Hiraka General Hospital, 3-1 Yatsukuchi, Maego, Yokote 013-8610, Akita, Japan; (Y.H.)
| | - Kengo Onochi
- Department of Gastroenterology, Omagari Kosei Medical Center, 8-65 Omagaritori, Daisen 014-0027, Akita, Japan
| | - Ryo Okubo
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
- Department of Gastroenterology, Omagari Kosei Medical Center, 8-65 Omagaritori, Daisen 014-0027, Akita, Japan
| | - Takao Hoshino
- Department of Gastroenterology, Akita Kosei Medical Center, 1-1-1 Nishibukuro, Iijima, Akita 011-0948, Akita, Japan
| | - Toru Horii
- Department of Gastroenterology, Akita Kosei Medical Center, 1-1-1 Nishibukuro, Iijima, Akita 011-0948, Akita, Japan
| | - Taira Kuramitsu
- Department of Gastroenterology, Akita Kosei Medical Center, 1-1-1 Nishibukuro, Iijima, Akita 011-0948, Akita, Japan
| | - Kotaro Sakaki
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
- Department of Gastroenterology, Akita Kosei Medical Center, 1-1-1 Nishibukuro, Iijima, Akita 011-0948, Akita, Japan
| | - Toru Ishii
- Department of Gastroenterology, Akita Red Cross Hospital, 222-1 Nawashirosawa, Kamikitatesaruta, Akita 010-1495, Akita, Japan
| | - Taiga Komatsu
- Department of Gastroenterology, Honjo-Daiichi Hospital, 110 Iwabuchishita, Yurihonjo 015-8567, Akita, Japan
| | - Yuko Yoshida
- Department of Gastroenterology, Honjo-Daiichi Hospital, 110 Iwabuchishita, Yurihonjo 015-8567, Akita, Japan
| | - Kenji Shirane
- Department of Gastroenterology, Shirane Hospital, 5-29 Kyokuhokusakae, Akita 010-0922, Akita, Japan
| | - Tsuyoshi Ono
- Department of Gastroenterology, Omori Municipal Hospital, 245-205 Sugouta, Omori, Yokote 013-0525, Akita, Japan
| | - Yosuke Shimodaira
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
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Noiri Y, Nagata R. Current status of gastric and oral infection/diseases caused by Helicobacter pylori. ORAL SCIENCE INTERNATIONAL 2023; 20:182-189. [DOI: 10.1002/osi2.1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/17/2023] [Indexed: 01/06/2025]
Abstract
AbstractHelicobacter pylori is found in the stomach, which is its optimal habitat, and is considered an important factor in various serious diseases, including stomach cancer. The World Health Organization has identified H. pylori as a causative agent of gastric cancer, as confirmed by animal experiments in rodents. The fact that H. pylori can live in the harsh environment of stomach acid was the greatest hindrance to the discovery of H. pylori. It was not so long ago, in 1983, that it was successfully isolated and cultured. Subsequently, H. pylori eradication therapy was established, and it became possible to control gastric cancer to some extent. However, the mechanism, route, and mode of H. pylori infection still remain unclear. Furthermore, currently, the prevention of first‐episode gastric cancer and control of recurrent gastric cancer are not perfect. One of the reasons for this may be that the status of H. pylori in the oral cavity, which is the entry point for the organism (the beginning of the digestive system: the first route of infection), is still unknown. Therefore, we reviewed the current status of H. pylori infection in the stomach and oral cavity, focusing on (1) the mechanism of infection, (2) pathogenic factors, (3) the actual status of eradication therapy, and (4) control strategies.
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Affiliation(s)
- Yuichiro Noiri
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences Niigata University Niigata Japan
| | - Ryoko Nagata
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences Niigata University Niigata Japan
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Thrift AP, Wenker TN, El-Serag HB. Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol 2023; 20:338-349. [PMID: 36959359 DOI: 10.1038/s41571-023-00747-0] [Citation(s) in RCA: 308] [Impact Index Per Article: 154.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
Gastric cancer remains a major cause of cancer-related mortality worldwide. The temporal trends for this malignancy, however, are dynamic, and reports from the past decade indicate important declines in some regions and demographic groups, as well as a few notable exceptions in which gastric cancer rates are either stable or increasing. Two main anatomical subtypes of gastric cancer exist, non-cardia and cardia, with different temporal trends and risk factors (such as obesity and reflux for cardia gastric cancer and Helicobacter pylori infection for non-cardia gastric cancer). Shifts in the distribution of anatomical locations have been detected in several high-incidence regions. H. pylori is an important aetiological factor for gastric cancer; importantly, the anticipated long-term findings from studies examining the effect of H. pylori eradication on the risk of (re)developing gastric cancer have emerged in the past few years. In this Review, we highlight the latest trends in incidence and mortality using an evidence-based approach. We make the best possible inferences, including clinical and public health inference, on the basis of the quality of the evidence available, and highlight burning questions as well as gaps in knowledge and public health practice that need to be addressed to reduce gastric cancer burden worldwide.
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Affiliation(s)
- Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Theresa Nguyen Wenker
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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8
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Park E, Nishimura M, Simoes P. Endoscopic advances in the management of gastric cancer and premalignant gastric conditions. World J Gastrointest Endosc 2023; 15:114-121. [PMID: 37034969 PMCID: PMC10080555 DOI: 10.4253/wjge.v15.i3.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/17/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023] Open
Abstract
Gastric cancer is the fifth most common cancer and in 2018, it was the third most common cause of cancer-related deaths worldwide. Endoscopic advances continue to be made for the diagnosis and management of both early gastric cancer and premalignant gastric conditions. In this review, we discuss the epidemiology and risk factors of gastric cancer and emphasize the differences in early vs late-stage gastric cancer outcomes. We then discuss endoscopic advances in the diagnosis of early gastric cancer and premalignant gastric lesions. This includes the implementation of different imaging modalities such as narrow-band imaging, chromoendoscopy, confocal laser endomicroscopy, and other experimental techniques. We also discuss the use of endoscopic ultrasound in the diagnosis and staging of early gastric cancer. We then discuss the endoscopic advances made in the treatment of these conditions, including endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid techniques such as laparoscopic endoscopic cooperative surgery. Finally, we comment on the current suggested recommendations for surveillance of both gastric cancer and its premalignant conditions.
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Affiliation(s)
- Erica Park
- Division of Gastroenterology and Hepatology, Mount Sinai Morningside and West, New York, NY 10025, United States
| | - Makoto Nishimura
- Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Priya Simoes
- Division of Gastroenterology and Hepatology, Mount Sinai Morningside and West, New York, NY 10025, United States
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Kim YH, Jung YM, Park TY, Jeong SJ, Kim TH, Lee J, Park J, Kim TO, Park YE. Comparisons of pathologic findings and outcomes of gastric cancer patients younger and older than 40: a propensity score matching study in a single center of Korea. JGH Open 2023; 7:118-127. [PMID: 36852144 PMCID: PMC9958344 DOI: 10.1002/jgh3.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/18/2022] [Accepted: 01/01/2023] [Indexed: 01/17/2023]
Abstract
Background and Aim Gastric cancer (GC) is one of the most common cancers worldwide, with a high incidence rate in Korean men. However, comparative studies are scarce on the pathologic findings and treatment effects of GC in patients aged less than 40 years. We evaluated the characteristics and pathologic findings of GC patients aged younger and older than 40 years. Methods We retrospectively analyzed 2307 patients diagnosed with GC between January 2010 and May 2018. Eighty-eight (3.8%) and 2219 (96.2%) patients were younger and older than 40 years, respectively. The patients were divided into younger (n = 70) and older (n = 62) age groups through propensity matching. Results Overall, compared to the younger group, the older group (n = 2219) had a significantly higher proportion of male patients (66.7% vs 39.8%; P < 0.001) and patients who underwent endoscopic submucosal dissection (ESD) (2.3% vs 23.1%; P < 0.001). However, young patients more often underwent operations compared to older patients (78.4% vs 60.1%; P = 0.001). In the propensity-matched group, older patients more often showed differentiated carcinoma, including well-differentiated (5.7% vs 11.3%) and moderately differentiated (1.4% vs 32.3%). However, younger patients more often showed signet ring cell carcinoma (SRC) (70.0% vs 25.8%). In multivariate analysis, Helicobacter pylori infection (odds ratio, 12.643; 95% confidence interval, 1.068-1449.665; P = 0.044) independently correlated with SRC risk. Conclusions Patients below 40 years were more likely to undergo surgery compared to ESD, and pathologic findings were more common in SRC. Therefore, more active screening and H. pylori eradication are needed even in patients aged less than 40 years.
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Affiliation(s)
- Yo H Kim
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Yu M Jung
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Tae Y Park
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Su J Jeong
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Tae H Kim
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Tae O Kim
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
| | - Yong E Park
- Division of Gastroenterology, Department of Internal MedicineInje University School of Medicine, Haeundae Paik HospitalBusanRepublic of Korea
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10
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Kim N, Yoon H. Atrophic Gastritis and Intestinal Metaplasia. HELICOBACTER PYLORI 2023:641-659. [DOI: 10.1007/978-981-97-0013-4_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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11
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A Population-Based Helicobacter pylori Eradication Strategy Is More Cost-Effective than Endoscopic Screening. Dig Dis Sci 2022; 68:1735-1746. [PMID: 36565366 PMCID: PMC10133360 DOI: 10.1007/s10620-022-07795-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Helicobacter pylori (HP) eradication therapy is an efficient primary prevention method to reduce gastric cancer development. In Japan, biennial endoscopic screening for individuals aged 50 years and older is currently conducted as a national gastric cancer prevention program. AIMS We aimed to evaluate which strategy was the most optimal and cost-effective among HP eradication strategy, annual, biennial, and triennial endoscopic screening, and no screening as a national gastric cancer prevention program. METHODS We developed a state-transition model for HP eradication strategy, annual, biennial, and triennial endoscopic screening, and no screening using a healthcare payer perspective and a lifetime horizon. We targeted a hypothetical cohort of the Japanese population in their 20 s to 80 s. The main outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, gastric cancer cases, and deaths from gastric cancer. We performed one-way, two-way, and probabilistic sensitivity analyses. RESULTS HP eradication strategy was more cost-effective than endoscopic screening at any interval in all age groups. Cost-effectiveness was sensitive to HP infection rate. Cost-effective acceptability curves by Monte Carlo simulations for 10,000 trials demonstrated that HP eradication strategy was 100% cost-effective at a willingness-to-pay threshold of US$50,000 per QALY gained in all age groups. Over a lifetime, HP eradication strategy saves US$28.07 billion, increases 37.16 million QALYs, prevents 4.47 million gastric cancer cases, and saves 319,870 lives from gastric cancer. CONCLUSION A population-based HP eradication strategy is optimal and cost-effective for a national gastric cancer prevention program in Japan, replacing the current secondary prevention-focused biennial endoscopic screening.
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12
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Shih CA, Shie CB, Hsu PI. Update on the first-line treatment of Helicobacter pylori infection in areas with high and low clarithromycin resistances. Therap Adv Gastroenterol 2022; 15:17562848221138168. [PMID: 36458050 PMCID: PMC9706057 DOI: 10.1177/17562848221138168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
Current international consensuses on Helicobacter pylori eradication therapy recommend that only regimens that reliably produce eradication rates of ⩾90% should be used for empirical treatment. The Real-world Practice & Expectation of Asia-Pacific Physicians and Patients in Helicobacter Pylori Eradication Survey also showed that the accepted minimal eradication rate in H. pylori-infected patients was 91%. According to efficacy prediction model, the per-protocol eradication rates of 7-day and 14-day standard triple therapies fall below 90% when clarithromycin resistance rate ⩾5%. Several strategies including bismuth-containing, non-bismuth-containing quadruple therapies (including sequential, concomitant, hybrid and reverse hybrid therapies), high-dose dual therapy and vonoprazan-based triple therapy have been proposed to increase the eradication rate of H. pylori infection. According to efficacy prediction model, the eradication rate of 14-day concomitant therapy, 14-day hybrid therapy and 7-day vonoprazan-based triple therapy is less than 90% if the frequency of clarithromycin-resistant strains is higher than 90%, 58% and 23%, respectively. To meet the recommendation of the consensus report and patients' expectation, local surveillance networks for resistance of H. pylori to clarithromycin are required to select appropriate eradication regimens in each geographic region. In areas with low (<5%) clarithromycin resistance (e.g. Sweden, Philippine, Myanmar and Bhutan), 7-day and 14-day standard triple therapies can be adopted for the first-line treatment of H. pylori infection with eradication rates of ⩾90%. In areas with high (⩾5%) clarithromycin resistance (most other countries worldwide) or unknown clarithromycin resistance, 14-day hybrid, 14-day reverse hybrid, 14-day concomitant and 10- to 14-day bismuth quadruple therapy can be used to treat H. pylori infection.
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Affiliation(s)
- Chih-An Shih
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Antai Medical Care Corporation, Antai
Tian-Sheng Memorial Hospital, Pingtung County
- Department of Nursing, Meiho University,
Pingtung County
| | - Chang-Bih Shie
- Division of Gastroenterology, Department of
Internal Medicine, An Nan Hospital, China Medical University, No. 66, Sec.
2, Changhe Rd., Annan Dist., Tainan City, 70965
| | - Ping-I Hsu
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, An Nan Hospital, China Medical University,
No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan City, 70965
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13
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Muacevic A, Adler JR. Gastric Cancer After Helicobacter pylori Eradication for Nodular Gastritis in an Adolescent. Cureus 2022; 14:e29984. [PMID: 36381762 PMCID: PMC9637437 DOI: 10.7759/cureus.29984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
A 16-year-old girl underwent esophagogastroduodenoscopy (EGD) after the detection of Helicobacter pylori (H. pylori) antibodies in her urine during a school health screening, which revealed nodular gastritis (NG). She was diagnosed as having H. pylori infection histologically and by biopsy culture specimens and soon commenced eradication therapy. Eight weeks later, eradication was confirmed by a urea breath test. At the age of 19, however, she was referred to our hospital with epigastralgia and lower back pain. EGD revealed ulcerative lesions with enlarged folds at the greater curvature of the gastric body. Biopsy specimens of the lesions revealed poorly differentiated adenocarcinoma and signet ring cell carcinoma. The cancer was classified as stage IV with pancreatic invasion. Although NG with pangastritis is considered a high-risk factor for diffuse-type gastric carcinoma, the course of NG after eradication remains unknown. Careful histological assessment before eradication by endoscopic biopsy and close follow-up after eradication are therefore recommended, even in young patients.
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14
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Saeed N, Mahjabeen I, Hakim F, Hussain MZ, Mehmood A, Nisar A, Ahmed MW, Kayani MA. Role of Chk1 gene in molecular classification and prognosis of gastric cancer using immunohistochemistry and LORD-Q assay. Future Oncol 2022; 18:2827-2841. [PMID: 35762179 DOI: 10.2217/fon-2021-1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aim of the current study was to assess the prognostic value of the Chk1 gene in the DNA damage response pathway in gastric cancer (GC). Methods: Expression levels of the Chk1 were measured in 220 GC tumor tissues and adjacent healthy/noncancerous tissues using real-time PCR and immunohistochemical staining. Genomic instability in GC patients was measured using the long-run real-time PCR technique for DNA-damage quantification assay and comet assay. Results: Significantly downregulated expression of Chk1 was observed at the mRNA level (p < 0.0001) and protein level (p < 0.0001). Significantly increased frequency of lesions/10 kb and comets was observed in tumor tissues compared with control tissues. Conclusion: The data suggest that downregulated expression of Chk1 and positive Heliobacter pylori infection status may have prognostic significance in GC.
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Affiliation(s)
- Nadia Saeed
- Cancer genetics and epigenetic lab, Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Ishrat Mahjabeen
- Cancer genetics and epigenetic lab, Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Farzana Hakim
- Department of Biochemistry, Foundation University Medical College, Islamabad, Pakistan
| | | | - Azhar Mehmood
- Cancer genetics and epigenetic lab, Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Asif Nisar
- Cancer genetics and epigenetic lab, Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Malik Waqar Ahmed
- Cancer genetics and epigenetic lab, Department of Biosciences, COMSATS University, Islamabad, Pakistan.,Pakistan Institute of Rehabilitation Sciences (PIRS), Isra University Islamabad Campus, Islamabad, Pakistan
| | - Mahmood Akhtar Kayani
- Cancer genetics and epigenetic lab, Department of Biosciences, COMSATS University, Islamabad, Pakistan
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15
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Huang Y, Gui Q, Li H, Long X, Liang X, Lu H. Age is the only predictor for upper gastrointestinal malignancy in Chinese patients with uncomplicated dyspepsia: a prospective investigation of endoscopic findings. BMC Gastroenterol 2021; 21:441. [PMID: 34814828 PMCID: PMC8609854 DOI: 10.1186/s12876-021-01951-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background Dyspepsia is a common cause of physician visits. If and when endoscopy should be performed depend on the regions and the populations. This study aimed to identify the current risk factors predictive of upper gastrointestinal malignancy or peptic ulcer in China with high prevalence of gastric cancer. Methods A questionnaire was conducted among consecutive outpatients undergoing their first esophagogastroduodenoscopy for dyspepsia. Symptoms other than alarm symptoms in this study were defined as uncomplicated dyspepsia. Results 4310 outpatients (mean age 44, median 42, range 14–86) were included in the final analyses. Significant pathology was found in 13.8% (595/4310) patients including peptic ulcer (12.3%) and upper gastrointestinal malignancy (1.5%). Age, male sex and alarm symptoms were significantly associated with malignancy. The age cut-off identified for upper gastrointestinal malignancy was 56 years among patients with uncomplicated dyspepsia, which was similar to the combined cutoff of age and gender. Conclusions Age should be considered as the primary predictor for upper gastrointestinal malignancy in Chinese patients with uncomplicated dyspepsia. 56 could probably be the optimal age to identify those lesions in this population. Trial registration: Chictr.org (ChiCTR2000040775). Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01951-x.
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Affiliation(s)
- Yu Huang
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Qian Gui
- Department of Emergency; RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huiyi Li
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Xiaohua Long
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Xiao Liang
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Hong Lu
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai, 200001, China.
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16
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Empiric Versus Clarithromycin Resistance-Guided Therapy for Helicobacter pylori Based on Polymerase Chain Reaction Results in Patients With Gastric Neoplasms or Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Randomized Controlled Trial. Clin Transl Gastroenterol 2021; 11:e00194. [PMID: 33094958 PMCID: PMC7494145 DOI: 10.14309/ctg.0000000000000194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We investigated to compare the effect of empirical therapy vs clarithromycin resistance–guided tailored therapy (tailored therapy) for eradication of Helicobacter pylori.
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17
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Kakiuchi T, Tanaka Y, Ohno H, Matsuo M, Fujimoto K. Helicobacter pylori infection-induced changes in the intestinal microbiota of 14-year-old or 15-year-old Japanese adolescents: a cross-sectional study. BMJ Open 2021; 11:e047941. [PMID: 34215607 PMCID: PMC8256750 DOI: 10.1136/bmjopen-2020-047941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The relationship between Helicobacter pylori and the intestinal microbiota has not yet been clearly demonstrated in children and adolescents. The present study aimed at evaluating how H. pylori infection could affect the intestinal microbiota in adolescents using genetic analysis. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We included subjects from a longitudinal project involving H. pylori screening and treatment of junior high school third-grade students (aged 14 or 15 years) in Saga Prefecture. The study included a control group (n=79) and an H. pylori group (n=80) tested negative and positive for the anti-H. pylori antibody in the urine and H. pylori antigen in stool specimens, respectively. INTERVENTIONS The intestinal microbiota was evaluated in stool specimens using 16S rRNA gene/DNA/amplicon sequencing with next-generation sequencing. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed alpha and beta diversity, just as well as relative abundances within the bacterial composition at the genus level in both groups. RESULTS As shown by the alpha diversity of the 16S rRNA gene/DNA/amplicon sequence data, the control group exhibited lower microbial species richness with lower alpha diversity compared with the H. pylori group (p<0.001). The beta diversity of the intestinal microbiota profile also differed between the two groups (p<0.01). The relative abundance of the Prevotella genus was higher in the H. pylori group (p<0.01) concomitant with a gain in body mass index (BMI) in the H. pylori group (p<0.01) compared with the control group. CONCLUSION H. pylori infection significantly affected the intestinal microbiota in Japanese adolescents. In addition, the prevalence of the Prevotella genus is concomitantly increased along with the BMI in H. pylori-infected students. TRIAL REGISTRATION NUMBER UMIN000028721.
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Affiliation(s)
| | - Yoshiki Tanaka
- R&D Center, Biofermin Pharmaceutical Co Ltd, Kobe, Hyogo, Japan
| | - Hiroshi Ohno
- R&D Center, Biofermin Pharmaceutical Co Ltd, Kobe, Hyogo, Japan
| | | | - Kazuma Fujimoto
- Department of Gastroenterology, International University of Health and Welfare, Ohkawa, Fukuoka, Japan
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18
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Abstract
In the United States, the incidence of gastric cancer has decreased over the past five decades. However, despite overall decreasing trends in incidence rates of gastric cancer, rates of noncardia gastric cancer among adults aged less than 50 years in the United States are increasing, and most cases of gastric cancer still present with advanced disease and poor resultant survival. Epidemiologic studies have identified the main risk factors for gastric cancer, including increasing age, male sex, non-White race, Helicobacter pylori infection, and smoking. This article summarizes the current epidemiologic evidence with implications for primary and secondary prevention of gastric cancer.
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Affiliation(s)
- Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Theresa H Nguyen
- Baylor Clinic, 6620 Main Street, MS: BCM620, Room 110D, Houston, TX, 77030, USA
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19
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Abstract
Gastric cancer is one of the most common cancers worldwide. Gastric cancer is a multifactorial disease, and the incidence varies widely by geographic region, with half of new cases occurring in East Asia. Population-based nationwide screening for gastric cancer has been implemented in some Eastern Asian countries such as South Korea and Japan. In these countries, endoscopic screening decreased gastric cancer mortality. Endoscopic screening seems to be a cost-effective modality in countries with high incidence of gastric cancer. However, the usefulness of population-based screening has not yet been proved in countries with low incidence of gastric cancer.
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Affiliation(s)
- Bokyung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
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20
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Graham DY, Lu H, Shiotani A. Vonoprazan-containing Helicobacter pylori triple therapies contribution to global antimicrobial resistance. J Gastroenterol Hepatol 2021; 36:1159-1163. [PMID: 32918832 DOI: 10.1111/jgh.15252] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/31/2020] [Accepted: 09/06/2020] [Indexed: 12/13/2022]
Abstract
Amoxicillin and proton pump inhibitor dual Helicobacter pylori therapy has proved not to be reliably highly effective primarily because of traditional proton pump inhibitors' inability to maintain a high intragastric pH. Clarithromycin and proton pump inhibitor H. pylori dual therapy failed in part because clarithromycin resistance emerged during therapy causing treatment failures. The combination of amoxicillin, clarithromycin, and proton pump inhibitor was subsequently undermined by increasing clarithromycin resistance. Although vonoprazan appeared to restore the effectiveness of triple therapy, the improvement was almost entirely to improved effectiveness of amoxicillin dual therapy component and resulted in the majority (>85% currently in Japan) of those receiving vonoprazan-amoxicillin plus a second antibiotic (e.g. clarithromycin, metronidazole, fluoroquinolone, or rifabutin) receiving no benefit from the second antibiotic. The results in somewhere between 2800 and 5600 kg of unnecessary clarithromycin per one million H. pylori treatment courses per year in Japan. The only contribution of the second antibiotic is to increase global antimicrobial resistance. There are now sufficient data to prove that optimized vonoprazan-amoxicillin dual therapy can reliably achieve cure rates ≥95%. This manuscript discusses use of the principles of antimicrobial stewardship to develop potassium-competitive acid blocker-containing H. pylori therapies that will reliably achieve high H. pylori cure rates with minimal or no use of excess antibiotics. Such therapies are urgently needed so that use of vonoprazan triple therapies can be curtailed while also improving overall H. pylori cure rates.
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Affiliation(s)
- David Y Graham
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Hong Lu
- GI Division, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Akiko Shiotani
- Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
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21
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Kakiuchi T, Yamamoto K, Imamura I, Hashiguchi K, Kawakubo H, Yamaguchi D, Fujioka Y, Okuda M. Gut microbiota changes related to Helicobacter pylori eradication with vonoprazan containing triple therapy among adolescents: a prospective multicenter study. Sci Rep 2021; 11:755. [PMID: 33436953 PMCID: PMC7804423 DOI: 10.1038/s41598-020-80802-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
Currently, it is unclear whether treating Helicobacter pylori (H. pylori) infection is safe among adolescents. This study aimed to evaluate the safety of H. pylori eradication therapy by examining gut microbiota changes in adolescents 3 months after the therapy. H. pylori-infected adolescents were enrolled in this study. Their stool samples were collected at the following three time points: before treatment, 1-2 days after completion of treatment, and time of eradication successful judgment. We assessed the relative abundance, alpha-diversity, and beta-diversity of the gut microbiota and adverse events. The number of isolated Actinobacteria decreased immediately after eradication therapy in the 16 students included in the study, and it returned to pretreatment condition at the eradication judgment point. There was no change in the relative abundance at genus level. The alpha-diversity was lost immediately after eradication therapy; however, it recovered at the time of eradication judgment, and it was restored to pretreatment condition. Meanwhile, none of the participants experienced serious adverse events. H. pylori eradication therapy is safe for adolescents with respect to gut microbiota changes associated with H. pylori eradication therapy. Therefore, further long-term evaluations of gut microbiota changes following eradication therapy are warranted.
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Affiliation(s)
- Toshihiko Kakiuchi
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan.
| | - Kentaroh Yamamoto
- Department of Gastroenterology, Yamamoto Memorial Hospital, Imari, Japan
| | - Ichiro Imamura
- Department of Gastroenterology, Imamura Hospital, Tosu, Japan
| | | | - Hiroharu Kawakubo
- Department of Gastroenterology, ImariArita Kyoritsu Hospital, Nishimatsuura, Japan
| | - Daisuke Yamaguchi
- Department of Gastroenterology, Ureshino Medical Center, Ureshino, Japan
| | | | - Masumi Okuda
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
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22
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Kaji E, Yoden A, Otani M, Okuhira T, Aomatsu T, Tamai H, Ashida A. Helicobacter pylori test-and-treat strategy for second-year junior high school students aimed at the prevention of gastric cancer in Takatsuki City. Helicobacter 2020; 25:e12696. [PMID: 32352203 DOI: 10.1111/hel.12696] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND More than 90% of gastric cancer cases are caused by Helicobacter pylori infections. To prevent gastric cancer, an H pylori test-and-treat strategy targeting young people has been implemented in various places in Japan. In this study, we evaluated the effectiveness of an H pylori test-and-treat strategy for second-year junior high school students in Takatsuki City. MATERIALS AND METHODS In 2014-2017, a urine-based H pylori test was used for initial screening. The final infection status was determined by a 13 C-urea breath test (13 C-UBT). Successful H pylori eradication was confirmed by 13 C-UBT 3 months after treatment. First-line eradication therapy was changed from 10 mg of rabeprazole, 750 mg of amoxicillin, and 200 mg of clarithromycin twice daily for 7 days in 2014 to 20 mg of vonoprazan, 750 mg of amoxicillin, and 200 mg of clarithromycin twice daily for 7 days in 2015-2017. Second-line eradication therapy included 10 mg of rabeprazole, 750 mg of amoxicillin, and 250 mg of metronidazole twice daily for 7 days. RESULTS In total, 8067 of 13 055 students participated this project and 206 students were diagnosed with H pylori infection. The success rate of first-line therapy was 45.9% in 2014 and 83.8% after the revised first-line therapy was administered. The final eradication rate was 98.5%. There were no severe side effects. CONCLUSION Our results support the use of the H pylori test-and-treat strategy for junior high school students as a safe approach for the prevention of gastric cancer. H pylori eradication therapy with vonoprazan could be a standard therapy in children.
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Affiliation(s)
- Emiri Kaji
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Atsushi Yoden
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Masano Otani
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Takeru Okuhira
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Tomoki Aomatsu
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
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Sasaki T, Saito R, Oyama M, Takeuchi T, Tanaka T, Natsume H, Tamura M, Arata Y, Hatanaka T. Galectin-2 Has Bactericidal Effects against Helicobacter pylori in a β-galactoside-Dependent Manner. Int J Mol Sci 2020; 21:ijms21082697. [PMID: 32295066 PMCID: PMC7215486 DOI: 10.3390/ijms21082697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/11/2020] [Indexed: 12/12/2022] Open
Abstract
Helicobacter pylori is associated with the onset of gastritis, peptic ulcers, and gastric cancer. Galectins are a family of β-galactoside-binding proteins involved in diverse biological phenomena. Galectin-2 (Gal-2), a member of the galectin family, is predominantly expressed in the gastrointestinal tract. Although some galectin family proteins are involved in immunoreaction, the role of Gal-2 against H. pylori infection remains unclear. In this study, the effects of Gal-2 on H. pylori morphology and survival were examined. Gal-2 induced H. pylori aggregation depending on β-galactoside and demonstrated a bactericidal effect. Immunohistochemical staining of the gastric tissue indicated that Gal-2 existed in the gastric mucus, as well as mucosa. These results suggested that Gal-2 plays a role in innate immunity against H. pylori infection in gastric mucus.
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Affiliation(s)
- Takaharu Sasaki
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Saitama 350-0295, Japan; (T.S.); (R.S.); (M.O.); (T.T.); (T.T.); (H.N.)
| | - Rei Saito
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Saitama 350-0295, Japan; (T.S.); (R.S.); (M.O.); (T.T.); (T.T.); (H.N.)
| | - Midori Oyama
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Saitama 350-0295, Japan; (T.S.); (R.S.); (M.O.); (T.T.); (T.T.); (H.N.)
| | - Tomoharu Takeuchi
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Saitama 350-0295, Japan; (T.S.); (R.S.); (M.O.); (T.T.); (T.T.); (H.N.)
| | - Toru Tanaka
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Saitama 350-0295, Japan; (T.S.); (R.S.); (M.O.); (T.T.); (T.T.); (H.N.)
| | - Hideshi Natsume
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Saitama 350-0295, Japan; (T.S.); (R.S.); (M.O.); (T.T.); (T.T.); (H.N.)
| | - Mayumi Tamura
- Faculty of Pharma-Science, Teikyo University, 2–11–1 Kaga, Itabashi-ku, Tokyo 173–8605, Japan; (M.T.); (Y.A.)
| | - Yoichiro Arata
- Faculty of Pharma-Science, Teikyo University, 2–11–1 Kaga, Itabashi-ku, Tokyo 173–8605, Japan; (M.T.); (Y.A.)
| | - Tomomi Hatanaka
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Saitama 350-0295, Japan; (T.S.); (R.S.); (M.O.); (T.T.); (T.T.); (H.N.)
- Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259–1193, Japan
- Correspondence: ; Tel.: +81-49-271-7675
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Thrift AP, El-Serag HB. Burden of Gastric Cancer. Clin Gastroenterol Hepatol 2020; 18:534-542. [PMID: 31362118 PMCID: PMC8859863 DOI: 10.1016/j.cgh.2019.07.045] [Citation(s) in RCA: 947] [Impact Index Per Article: 189.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Abstract
Gastric cancer is a global health problem, with more than 1 million people newly diagnosed with gastric cancer worldwide each year. Despite its worldwide decline in incidence and mortality over the past 5 decades, gastric cancer remains the third leading cause of cancer-related death. Knowledge of global as well as regional epidemiology and risk factors for gastric cancer is essential for the practicing gastroenterologist to make personalized decisions about risk stratification, screening, and prevention. In this article, we review the epidemiology of gastric cancer as well as screening and prevention efforts to reduce global morbidity and mortality from gastric cancer. First, we discuss the descriptive epidemiology of gastric cancer, including its incidence, mortality, survival, and secular trends. We combine a synthesis of published studies with an analysis of data from the International Agency for Research on Cancer GLOBOCAN project to describe the global burden of gastric cancer and data from the US Cancer Statistics registry to discuss the change in incidence of gastric cancer in the United States. Next, we summarize current knowledge of risk factors for gastric cancer. Finally, we discuss prevention strategies and screening efforts for gastric cancer.
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Affiliation(s)
- Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Hashem B. El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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25
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Abstract
Helicobacter pylori can infect the gastric mucosa and cause chronic inflammation, resulting in various diseases, including gastric cancer. Eradication of H. pylori in all infected subjects is recommended; however, the number of H. pylori strains with antibiotic resistance has increased, and the eradication rate has decreased. Vonoprazan, a potassium-competitive acid blocker, produces a stronger acid-inhibitory effect than proton pump inhibitors (PPIs). The H. pylori eradication rate with vonoprazan was found to be higher than that with PPIs. The H. pylori eradication rate with vonoprazan-based triple therapy (vonoprazan, amoxicillin, and clarithromycin) was approximately 90% and had an incidence of adverse events similar to that of PPIs. We review the current situation of H. pylori eradication in Japan, the first country in which vonoprazan was made available.
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Affiliation(s)
- Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Japan
| | - Jun Nishikawa
- Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Japan
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Xu J, Chen X, Wang X, Zhu C, Hu Y, Yang X, Xu C, Shen X. Preoperative Hyponatremia And Hypocalcemia Predict Poor Prognosis In Elderly Gastric Cancer Patients. Cancer Manag Res 2019; 11:8765-8780. [PMID: 31632136 PMCID: PMC6775496 DOI: 10.2147/cmar.s211603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/29/2019] [Indexed: 12/28/2022] Open
Abstract
Background Hyponatremia and hypocalcemia are common in patients with cancer, but their prognostic impact in patients who underwent gastric cancer (GC) surgery has not been investigated. Therefore, this study aimed to determine the postoperative prognostic impact of hyponatremia and hypocalcemia in patients undergoing curative gastrectomy by age group. Materials and methods GC patients preoperatively diagnosed with hyponatremia or hypocalcemia who underwent elective radical gastrectomy were retrospectively evaluated. The patients were divided into the elderly group (≥60 years) and the young group (<60 years), and then further based on their sodium and calcium levels. The effect of preoperative hyponatremia or hypocalcemia on postoperative complications (PCs) by age was determined using univariate and multivariate analyses. Overall survival (OS) was compared between the two groups using log rank test and Cox proportional hazards regression. Results Of the 842 patients evaluated, 36 (4.3%) were categorized into the younger hyponatremia group; 64 (7.6%), the elderly hyponatremia group; 48 (5.7%), the young hypocalcemia group; and 128 (15.2%), the elderly hypocalcemia group. Hyponatremia (P=0.001) and hypocalcemia (P=0.038) were independent risk factors for PCs in the elderly group. Further, hypocalcemia (hazard ratio (HR), 0.676; P=0.037) was independently associated with shorter OS. Conclusion Preoperative hyponatremia and hypocalcemia predict poor outcomes in the elderly, but not in young GC patients. Further, hyponatremia and hypocalcemia in elderly GC patients should be corrected in the earliest time possible to obtain better clinical outcomes.
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Affiliation(s)
- Jingxuan Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiang Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ce Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yuanbo Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xinxin Yang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chongyong Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Yu L, Luo L, Long X, Liang X, Ji Y, Chen Q, Song Y, Li X, Graham DY, Lu H. Susceptibility-guided therapy for Helicobacter pylori infection treatment failures. Therap Adv Gastroenterol 2019; 12:1756284819874922. [PMID: 31523279 PMCID: PMC6734621 DOI: 10.1177/1756284819874922] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/30/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Empirical therapy of Helicobacter pylori frequently results in treatment failure due to unrecognized antimicrobial resistance. The aim of this study was to investigate the effectiveness of susceptibility-guided therapy for rescue treatment of H. pylori infection in China. METHODS This was a prospective study of consecutive 200 patients infected with H. pylori with one or more treatment failures. The therapy chosen was susceptibility based using the most effective, best-tolerated regimens first and a locally proven, reliably effective regimen for multidrug-resistant infections. All patients received 14-day triple therapy, i.e. esomeprazole 20 mg and amoxicillin 1 g twice a day plus clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day, or levofloxacin 500 mg daily, or, for multidrug-resistant infections, amoxicillin-containing bismuth quadruple therapy with esomeprazole 20 mg twice a day, bismuth 220 mg twice a day, amoxicillin 1 g three times a day, and metronidazole 400 mg four times a day. Antibiotic resistance was determined by agar dilution. RESULTS The eradication rate of susceptibility-guided therapy overall was 94.5% (189/200, 95% confidence interval: 90.4-97.2%). Around 28% (56/200) of patients carried strains susceptible to one of the tested antibiotics and were prescribed the triple therapy. A total of 144 multidrug-resistant patients received bismuth quadruple therapy. The eradication rates were all greater than 90%, i.e. 91.7% (11/12), 92.3% (12/13), and 93.5% (29/31) in those who received clarithromycin, metronidazole, and levofloxacin-containing triple therapy and 95.1% (137/144) for the bismuth quadruple therapy. There were no differences in eradication rates between the subgroups. CONCLUSIONS Although susceptibility-guided therapy proved high efficacious despite the high proportion of multidrug-resistant strains, the strategy suggested the best approach for this population would be empirical amoxicillin-containing bismuth quadruple therapy. ClinicalTrials.gov identifier: NCT03413020.
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Affiliation(s)
- Lou Yu
- Division of Gastroenterology and Hepatology, Key
Laboratory of Gastroenterology & Hepatology, Ministry of Health,
Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - Laisheng Luo
- Division of Gastroenterology and Hepatology, Key
Laboratory of Gastroenterology & Hepatology, Ministry of Health,
Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohua Long
- Division of Gastroenterology and Hepatology, Key
Laboratory of Gastroenterology & Hepatology, Ministry of Health,
Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - Xiao Liang
- Division of Gastroenterology and Hepatology, Key
Laboratory of Gastroenterology & Hepatology, Ministry of Health,
Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - Yingjie Ji
- Division of Gastroenterology and Hepatology, Key
Laboratory of Gastroenterology & Hepatology, Ministry of Health,
Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - Qi Chen
- Division of Gastroenterology and Hepatology, Key
Laboratory of Gastroenterology & Hepatology, Ministry of Health,
Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - Yanyan Song
- Department of Biostatistics, Institute of
Medical Sciences, Shanghai Jiao Tong University School of Medicine,
Shanghai, China
| | - Xiaobo Li
- Division of Gastroenterology and Hepatology, Key
Laboratory of Gastroenterology & Hepatology, Ministry of Health,
Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - David Y. Graham
- Department of Medicine, Michael E DeBakey
Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX,
USA
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Lin M, Gao M, Cavnar MJ, Kim J. Utilizing gastric cancer organoids to assess tumor biology and personalize medicine. World J Gastrointest Oncol 2019; 11:509-517. [PMID: 31367270 PMCID: PMC6657221 DOI: 10.4251/wjgo.v11.i7.509] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/25/2019] [Accepted: 06/13/2019] [Indexed: 02/05/2023] Open
Abstract
While the incidence and mortality of gastric cancer (GC) have declined due to public health programs, it remains the third deadliest cancer worldwide. For patients with early disease, innovative endoscopic and complex surgical techniques have improved survival. However, for patients with advanced disease, there are limited treatment options and survival remains poor. Therefore, there is an urgent need for more effective therapies. Since novel therapies require extensive preclinical testing prior to human trials, it is important to identify methods to expedite this process. Traditional cancer models are restricted by the inability to accurately recapitulate the primary human tumor, exorbitant costs, and the requirement for extended periods of development time. An emerging in vitro model to study human disease is the patient-derived organoid, which is a three-dimensional system created from fresh surgical or biopsy tissues of a patient’s gastric tumor. Organoids are cultured in plastic wells and suspended in a gelatinous matrix, providing a substrate for extension and growth in all dimensions. They are rapid-growing and highly representative of the molecular landscape, histology, and morphology of the various subtypes of GC. Organoids uniquely model tumor initiation and growth, including steps taken by normal stomach cells to transform into invasive, intestinal-type tumor cells. Additionally, they provide ample material for biobanking and screening novel therapies. Lastly, organoids are a promising model for personalized therapy and warrant further investigation in drug sensitivity studies for GC patients.
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Affiliation(s)
- Miranda Lin
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
| | - Mei Gao
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
| | - Michael J Cavnar
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
| | - Joseph Kim
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
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Oliveros R, Pinilla Morales RE, Facundo Navia H, Sánchez Pedraza R. Cáncer gástrico: una enfermedad prevenible. Estrategias para intervención en la historia natural. REVISTA COLOMBIANA DE GASTROENTEROLOGÍA 2019; 34:177-189. [DOI: 10.22516/25007440.394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
El cáncer gástrico es un problema de salud pública. Las cifras de mortalidad y supervivencia son impresentables en nuestro país. En Colombia no existe ningún programa ni estrategias de diagnóstico temprano, ni tampoco es priorizado como un problema de salud. Los trabajos existentes demuestran que la mayoría de los pacientes cuando son diagnosticados presentan estadios avanzados.
Un 90 % de los canceres gástricos se consideran consecuencia de un largo proceso inflamatorio sobre la mucosa gástrica. La infección por Helicobacter pylori es la principal etiología de la gastritis, la cual puede progresar a atrofia, metaplasia, displasia y cáncer. La atrofia gástrica establece un campo de cancerización más propenso a cambios moleculares y fenotípicos que terminan en un cáncer en crecimiento. Es claro que la historia natural proporciona un racional entendimiento clínico patológico para estrategias de prevención primaria y secundaria. Una evidencia bien establecida demuestra que la combinación de las estrategias primarias (erradicación del H. pylori) y secundarias (diagnóstico y seguimiento endoscópico de lesiones premalignas) pueden prevenir o limitar la progresión de la carcinogénesis gástrica. El riesgo de cáncer gástrico asociado con la gastritis por H. pylori puede ser estratificado de acuerdo con la gravedad y extensión de la atrofia de la mucosa gástrica. Esta aproximación está adaptada a diferentes países, de acuerdo con su incidencia específica de cáncer gástrico, condición socioeconómica y factores culturales, que requiere de la participación complementaria de los gastroenterólogos, los cirujanos, los oncólogos y patólogos.
Frente a este problema de salud pública no hay ninguna acción por parte de las autoridades de salud ni del gremio médico. Por tanto, se revisan las estrategias de manejo que permitan intervenir la historia natural de la enfermedad con el objetivo de disminuir la incidencia y mortalidad.
La implementación y estandarización de estas estrategias de manejo en nuestro medio podrán beneficiar a los pacientes con riesgo incrementado para cáncer gástrico y pueden implementarse (en países sin programas de tamizaje) de una forma racional, similar a como se está haciendo con el cáncer colorrectal, en todo el mundo.
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30
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Kim GH. Endoscopic Findings of Kyoto Classification of Gastritis. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2019. [DOI: 10.7704/kjhugr.2019.19.2.88] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Kwon YJ, Kim N, Baek SM, Lee HS, Lee J, Hwang YJ, Yoon H, Shin CM, Park YS, Kim JW, Lee DH. The prevalence of histologic atrophy and intestinal metaplasia in the corpus has decreased over 15 years in females in the Korean population. Helicobacter 2019; 24:e12579. [PMID: 30920087 DOI: 10.1111/hel.12579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate the trends of atrophy and intestinal metaplasia (IM) in 2002 subjects without significant gastroduodenal diseases. MATERIALS AND METHODS A total of 2002 subjects were prospectively enrolled and divided into three periods (2003-2007, 2008-2012, and 2013-2018). Trends of H pylori and atrophy/IM scored by Updated Sydney System were analyzed according to sex, and multivariate logistic analysis was performed for the risk factors for atrophy/IM. RESULTS H pylori-negative and H pylori-positive subjects were 1220 (61.0%) and 782 (38.0%), respectively. H pylori positivity decreased from 149/303 (49.2%), 207/515 (40.2%) and 426/1184 (36.0%), in the three periods, respectively (P < 0.001). The prevalence of atrophy (P < 0.001) and IM in the corpus (P < 0.001) significantly decreased over 15 years in females, but not in males. The mean grade of atrophy and IM was higher in males (0.36 and 0.51) than in females (0.28 and 0.41) in the corpus (P = 0.027) and in the antrum (P = 0.006), respectively. Similarly, the mean grade of IM in males (0.34) was higher in females (0.19; P < 0.001) in the corpus. Multivariate analysis showed that old age, study period, and H pylori were statistically significant in atrophy of antrum and corpus, and IM in the corpus. In cases of IM of antrum, old age, H pylori, and smoking were statistically significant. CONCLUSION A significant decrease in atrophy and IM in the corpus in females over 15 years suggests sex- or gender-specific characteristics.
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Affiliation(s)
- Young Jae Kwon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Republic of Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea
| | - Sung Min Baek
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jaebong Lee
- Division of Statistics in Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young Jae Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University, Seoul, Republic of Korea.,Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, South Korea
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32
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Borges SS, Ramos AFPL, Moraes Filho AVD, Braga CADSB, Carneiro LC, Barbosa MS. [ARTICLE PARTIAL RETRACTION] PREVALENCE OF HELICOBACTER PYLORI INFECTION IN DYSPEPTIC PATIENTS AND ITS ASSOCIATION WITH CLINICAL RISK FACTORS FOR DEVELOPING GASTRIC ADENOCARCINOMA. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:66-70. [PMID: 31141074 DOI: 10.1590/s0004-2803.201900000-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/31/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Brazil, particularly in the underdeveloped localities, the prevalence of Helicobacter pylori (H. pylori) infections can range up to 90%. These rates are higher in older individuals and vary by country region. H. pylori infections are linked to the development of gastric pathologies, namely mild to moderate gastritis, gastroenteritis, peptic ulcer, intestinal metaplasia, and gastric cancer. In 1994, this organism was classified by the International Agency for Research on Cancer (IARC) as pertaining to the Group 1 carcinogen for gastric adenocarcinoma etiology. Gastric cancer represents a significant public health problem, being the fourth most common malignant tumor and the second largest cause of cancer-related deaths. OBJECTIVE To investigate the prevalence of H. pylori infection in dyspeptic patients and determine the link between clinical risk factors and gastric adenocarcinoma diagnosis. METHODS Polymerase chain reaction (PCR) analysis was employed for molecular diagnosis of gastric tissue biopsies collected from 113 dyspeptic patients at the University Hospital of Federal University of Goiás. Molecular analyses allowed the identification of H. pylori infections. Furthermore, histopathological examinations were performed to determine the clinical risks of developing gastric malignancies. RESULTS The test results identified 69 individuals older than 44 years, from 75 (66.4%) positive H. pylori infection samples. The prevalence of gastric adenocarcinoma in this study was 1.3%. Among the infected patients, six (8.2%) had high risk, and 67 (91.8%) had a low risk of developing gastric cancer (P<0.05). CONCLUSION This study shows a high prevalence of H. pylori infection and identifies its contribution to gastric inflammations, which in the long term are manifested in high-risk clinical factors for the development of gastric adenocarcinoma.
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Affiliation(s)
| | | | - Aroldo Vieira de Moraes Filho
- Universidade Federal de Goiás, Instituto de Ciências da Saúde, Programa de Pós-Doutorado em Ciências da Saúde, Goiânia, GO, Brasil
| | - Carla Afonso da Silva Bitencourt Braga
- Universidade Federal de Goiás, Faculdade de Farmácia, Goiânia, GO, Brasil.,Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
| | - Lilian Carla Carneiro
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
| | - Mônica Santiago Barbosa
- Universidade Federal de Goiás, Faculdade de Farmácia, Goiânia, GO, Brasil.,Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
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33
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Stowell CP, Stowell SR. Biologic roles of the ABH and Lewis histo-blood group antigens Part I: infection and immunity. Vox Sang 2019; 114:426-442. [PMID: 31070258 DOI: 10.1111/vox.12787] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022]
Abstract
The ABH and Lewis antigens were among the first of the human red blood cell polymorphisms to be identified and, in the case of the former, play a dominant role in transfusion and transplantation. But these two therapies are largely twentieth century innovations, and the ABH and related carbohydrate antigens are not only expressed on a very wide range of human tissues, but were present in primates long before modern humans evolved. Although we have learned a great deal about the biochemistry and genetics of these structures, the biological roles that they play in human health and disease are incompletely understood. This review and its companion, to appear in a later issue of Vox Sanguinis, will focus on a few of the biologic and pathologic processes which appear to be affected by histo-blood group phenotype. The first of the two reviews will explore the interactions of two bacteria with the ABH and Lewis glycoconjugates of their human host cells, and describe the possible connections between the immune response of the human host to infection and the development of the AB-isoagglutinins. The second review will describe the relationship between ABO phenotype and thromboembolic disease, cardio-vascular disease states, and general metabolism.
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Affiliation(s)
- Christopher P Stowell
- Blood Transfusion Service, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Sean R Stowell
- Center for Apheresis, Center for Transfusion and Cellular Therapies, Emory Hospital, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
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34
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Lee JW, Kim N, Nam RH, Lee SM, Kwon YH, Sohn SD, Kim JM, Lee DH, Jung HC. Favorable outcomes of culture-based Helicobacter pylori eradication therapy in a region with high antimicrobial resistance. Helicobacter 2019; 24:e12561. [PMID: 30632237 DOI: 10.1111/hel.12561] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The eradication rate of Helicobacter pylori has declined, mainly due to antimicrobial resistance. To overcome resistance-associated treatment failure, the efficacy of culture-based, susceptibility-guided therapy was demonstrated as the first-line eradication therapy for H pylori infection. AIMS To evaluate the efficacy of culture-based therapy as the first-line eradication therapy in regions with high levels of antimicrobial resistance. METHODS Helicobacter pylori-positive patients without previous eradication treatment history were recommended to undergo culture to determine the minimal inhibitory concentration (MIC). If they consented, 7-day clarithromycin-containing PPI triple; 7-day esomeprazole, moxifloxacin, and amoxicillin (MEA) therapy; or 7- or 14-day esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapy were administered based on the agar dilution-determined MIC. Eradication, treatment compliance, and adverse events were examined. RESULTS In total, 74 patients were enrolled, and 69 patients completed the protocols. The overall resistance rates to amoxicillin, clarithromycin, metronidazole, and moxifloxacin were 6.7%, 31.0%, 41.8%, and 39.2%, respectively. The patients were allocated to the PPI triple (n = 50), MEA (n = 8) or quadruple (n = 16) therapy. The eradication rate in the intention-to-treat analysis was 93.1% (69 of 74 patients). The eradication rates in the per-protocol analysis were 100.0% (69 of 69 patients). Epigastric pain, nausea, and vomiting were less common than those of other empirical therapies. CONCLUSIONS Culture-based, susceptibility-guided therapy is effective first-line eradication therapy, especially in regions with high levels of antimicrobial resistance.
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Affiliation(s)
- Jung W Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Ryoung H Nam
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun M Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong H Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - So D Sohn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung M Kim
- Department of Microbiology, Hanyang University School of Medicine, Seoul, South Korea
| | - Dong H Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun C Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Miftahussurur M, Waskito LA, Syam AF, Nusi IA, Siregar G, Richardo M, Bakry AF, Rezkitha YAA, Wibawa IDN, Yamaoka Y. Alternative eradication regimens for Helicobacter pylori infection in Indonesian regions with high metronidazole and levofloxacin resistance. Infect Drug Resist 2019; 12:345-358. [PMID: 30774400 PMCID: PMC6362932 DOI: 10.2147/idr.s187063] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background The prevalence of Helicobacter pylori resistance to metronidazole and clarithromycin is high in Indonesia. Moreover, the increasing levofloxacin resistance rates in the absence of bismuth treatment in Indonesia has led to the use of other antibiotics as alternative regimens. Methods We determined the minimum inhibitory concentrations (MICs) of five alternative antibiotics for H. pylori (rifaximin, rifabutin, furazolidone, garenoxacin, and sitafloxacin) using the agar dilution method and assessed mutations associated with antibiotic resistance using next-generation sequencing. Result Analysis of 106 strains isolated from 1039 adult dyspeptic patients revealed that none of the strains were furazolidone-resistant. All strains were also sensitive to rifabutin and sitafloxacin. In contrast, the rates of resistance to rifaximin and garenoxacin were high (38.9% and 6.7%, respectively). The strains isolated from patients on Java Island had the highest resistance rates to garenoxacin and rifaximin. In addition, the resistance was distributed evenly among the ethnic groups, ranging between 25.0% and 69.2%. Except for rifaximin, for which the resistance rate was 38.9%, the other four antibiotics could be successfully employed to eradicate levofloxacin- and metronidazole-resistant H. pylori infections in vitro. Interestingly, garenoxacin-sensitive strains were found in regions with high clarithromycin resistance rates such as Bali and Papua Islands. In contrast, rifaximin might not be considered as an alternative antibiotic in regions with high clarithromycin resistance. There was an inconsistent association between gyrA and gyrB mutations and garenoxacin resistance. We confirmed that the I837V (replacement of isoleucine at position 837 with valine), A2414T/V, Q2079K and K2068R were the predominant rpoB point mutations. There was an association between vacA genotypes of H. pylori and rifaximin resistance (P = 0.048). Conclusion furazolidone-, rifabutin-, and sitafloxacin-based therapies might be considered as alternative regimens to eradicate H. pylori in Indonesia, including regions with high metronidazole and clarithromycin resistance rates. Moreover, sitafloxacin but not garenoxacin should be considered for eradication of levofloxacin-resistant strains.
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Affiliation(s)
- Muhammad Miftahussurur
- Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60131, Indonesia, .,Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia,
| | - Langgeng Agung Waskito
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia, .,Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan,
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Iswan Abbas Nusi
- Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60131, Indonesia,
| | - Gontar Siregar
- Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, University of Sumatera Utara, Medan 20136, Indonesia
| | - Marselino Richardo
- Department of Internal Medicine, Merauke City General Hospital, Merauke 99656, Indonesia
| | - Achmad Fuad Bakry
- Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, Sriwijaya University, Palembang 30126, Indonesia
| | - Yudith Annisa Ayu Rezkitha
- Institute of Tropical Disease, Universitas Airlangga, Surabaya 60115, Indonesia, .,Department of Internal Medicine, Muhammadiyah University of Surabaya, Surabaya 60113, Indonesia
| | - I Dewa Nyoman Wibawa
- Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, University of Udayana, Denpasar 80232, Indonesia
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu 879-5593, Japan, .,Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX 77030, USA, .,Global Oita Medical Advanced Research Center for Health, Yufu 879-5593, Japan,
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Kim SE, Roh JH, Park MI, Park SJ, Moon W, Kim JH, Jung K, Heo JJ. Effect of 7-day Bismuth Quadruple Therapy versus 14-day Moxifloxacin Triple Therapy for Second-line Helicobacter pylori Eradication Therapy. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2019; 73:26-34. [PMID: 30690955 DOI: 10.4166/kjg.2019.73.1.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/05/2018] [Accepted: 12/19/2019] [Indexed: 04/14/2025]
Abstract
BACKGROUND/AIMS Both bismuth-containing quadruple therapy and moxifloxacin-containing triple therapy have been suggested as second-line eradication therapy for Helicobacter pylori (H. pylori) infection. We aimed to evaluate the efficacy of 14-day moxifloxacin-containing triple therapy (14-EAM) in second-line H. pylori eradication in comparison to 7-day bismuth-containing quadruple therapy (7-RBMT). METHODS From January 2011 to December 2015, a total of 569 patients who failed to respond to first-line triple therapy and who subsequently received second-line 7-RBMT or 14-EAM were retrospectively enrolled. The eradication rates were identified using per-protocol (PP) analysis. H. pylori eradication was confirmed by a ¹³C-urea breath test (UBiT-IR300®; Otsuka Electronics, Co., Ltd., Osaka, Japan) or a rapid urease test (CLOtest® Delta West, Bentley, Australia) at least 4 weeks after completion of eradication therapy. RESULTS A total of 487 and 82 patients received 7-RBMT and 14-EAM, respectively. PP eradication rates were 93.6% (366/391; 95% CI, 91.0-95.9%) with 7-RBMT and 73.8% (48/65; 95% CI, 63.1-84.6%) with14-EAM (p<0.001). Therefore, the eradication rates with 7-RBMT were significantly higher than with 14-EAM according to the PP analysis. The adverse event rate was 17.1% (67/391) with 7-RBMT and 7.7% (5/65) with 14-EAM (p=0.065). In terms of risk factors, multivariate analysis revealed that 14-EAM (OR, 5.47; 95% CI, 2.74-10.93) was related to H. pylori eradication failure. CONCLUSIONS 7-RBMT may be an effective second-line therapy in patients who failed to respond to first-line triple therapy in Korea, where there is a high prevalence of H. pylori infection.
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Affiliation(s)
- Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ji Hun Roh
- Department of Internal Medicine, Dong-eui Medical Center, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Joon Heo
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Helicobacter pylori Infection in Children and Adolescents. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1149:107-120. [PMID: 31037557 DOI: 10.1007/5584_2019_361] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
About one-third of all children worldwide is infected with H. pylori and its prevalence is low in developed and high in developing countries. H. pylori is mainly acquired during childhood and transmission of the bacterium commonly proceeds from person to person, especially among family members. The most frequent transmission route is from the mother to children. Various gastrointestinal and extra-gastrointestinal diseases are reported to be associated with H. pylori in children and adolescents, but the strongest recommendation for testing and treating is introduced only with children and adolescents having peptic ulcer disease. Iron deficiency anemia and chronic immune thrombocytopenic purpura are also considered for testing and treating, but the effectiveness is somewhat controversial. Invasive diagnosis is recommended, whereas none of the available diagnostic tests have 100% accuracy for reliable diagnosis, and therefore at least two or more tests should be performed. Urea breath test is the most reliable among the non-invasive tests. Because the number of antibiotics-resistant H. pylori strains is increasing, it is desirable to conduct a drug susceptibility test before treatment and to select the corresponding regime. H. pylori has been proven to be a major cause of gastric cancer and 'screen-and-treat' strategies are recommended in communities at high risk of gastric cancer. However, the application to children and adolescents is controversial. An effective vaccine is desirable, but not yet available. Screen-and-treat for adolescents has started in a few areas in Japan, where conditions are well established. New prevention strategies for gastric cancer are awaited worldwide.
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Park JY, Kim JG. [New Helicobacter pylori Eradication Therapies]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:237-244. [PMID: 30642139 DOI: 10.4166/kjg.2018.72.5.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/20/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
While the prevalence of Helicobacter pylori (H. pylori) infection is decreasing in Korea, the incidence of gastric cancer remains high, emphasizing the importance of H. pylori eradication. A new treatment strategy is needed as the eradication rate with standard triple therapy, which is currently the standard first-line regimen for H. pylori infection, has decreased below the optimum level. The major cause of eradication failure is increased antibiotic resistance. Sequential, concurrent, and hybrid therapies that include clarithromycin produce higher eradication rates than conventional standard triple therapy. However, the effectiveness of these treatments is limited in regions where the resistance rate to various antibiotics is high. Bismuth quadruple therapy is another alternative therapy, but again the eradication rate is not sufficiently high. Tailored therapy based on individual characteristics, including antibiotic susceptibility, may be ideal, but there are several limitations for clinical application and further research is needed. New potassium-competitive acid blocker-based therapies could emerge as effective alternatives in the near future. A consensus is needed to establish a strategy for applying new eradication therapies in Korea.
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Affiliation(s)
- Jae Yong Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Gyu Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Ozaki H, Harada S, Takeuchi T, Kawaguchi S, Takahashi Y, Kojima Y, Ota K, Hongo Y, Ashida K, Sakaguchi M, Tokioka S, Sakamoto H, Furuta T, Tominaga K, Higuchi K. Vonoprazan, a Novel Potassium-Competitive Acid Blocker, Should Be Used for the Helicobacter pylori Eradication Therapy as First Choice: A Large Sample Study of Vonoprazan in Real World Compared with Our Randomized Control Trial Using Second-Generation Proton Pump Inhibitors for Helicobacter pylori Eradication Therapy. Digestion 2018; 97:212-218. [PMID: 29393194 DOI: 10.1159/000485097] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/07/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Phase III study demonstrated that vonoprazan-based Helicobacter pylori eradication therapy achieved higher eradication rate compared with lansoprazole. However, there is no study that evaluated the efficacy of vonoprazan in a large sample in real world. We investigated the eradication rate and safety of vonoprazan-based eradication therapy compared with our randomized control trial using second-generation proton pump inhibitor (PPIs). METHODS (First study) A total of 147 patients who have H. pylori infection were randomly assigned to receive either, esomeprazole (EPZ) group and rabeprazole (RPZ) group. (Second study) 1,688 patients who have H. pylori infection underwent primary eradication with triple therapy involving vonoprazan. In both studies, triple therapy with amoxicillin, clarithromycin, and PPI or vonoprazan was performed, and eradication effect was assessed by an urea breath test. RESULTS (First study) Eradication rate was 77.5% in the EPZ group and 68.4% in the RPZ group; no significant difference was observed between the 2 groups. (Second study) The successful primary eradication rate was 90.8%. There was no severe adverse effect. CONCLUSIONS The eradication rate of vonoprazan-based triple therapy was remarkably higher compared with second-generation PPIs-based triple therapy in real world. Vonoprazan is very likely to become the first option for future eradication therapy.
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Affiliation(s)
- Haruhiko Ozaki
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Satoshi Harada
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Toshihisa Takeuchi
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Shinpei Kawaguchi
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshiaki Takahashi
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yuichi Kojima
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Kazuhiro Ota
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Yasushi Hongo
- Gastroenterology, Hirakata City Hospital, Hirakata, Japan
| | | | | | - Satoshi Tokioka
- Gastroenterology, Daiichi Towakai Hospital, Takatsuki, Japan
| | | | - Takahisa Furuta
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunari Tominaga
- Osaka Medical Collage, Premier Developmental Research of Medicine, Osaka, Japan
| | - Kazuhide Higuchi
- The Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Talebi Bezmin Abadi A, Yamaoka Y. Helicobacter pylori therapy and clinical perspective. J Glob Antimicrob Resist 2018; 14:111-117. [PMID: 29581076 DOI: 10.1016/j.jgar.2018.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/06/2018] [Accepted: 03/16/2018] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori induces chronic gastritis and duodenal ulcer in a small fraction of the colonised population. Three decades after the discovery of H. pylori and disclosure of an urgent need for eliminating the bacterium in patients, it seems that we are still in the first steps of dealing with this mysterious organism. Treatment of H. pylori is a complex dilemma for clinicians, a repeating sentence by many scientists who spend years on this research topic. Apart from many modifications in initial first-line treatment of H. pylori, gastroenterologists are unable to overcome the problem of therapeutic failure. Choosing the best regimen in any region depends on many factors, which have been the focus of many randomised clinical trials. A potential increase in efficacy of future therapies may be influenced by adding the novel potassium-competitive acid blocker vonoprazan. Undeniably, in-depth analysis is necessary to propose more effective therapeutic regimens. Meanwhile, we recommend the performance of antimicrobial susceptibility testing before any antimicrobial prescription.
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Affiliation(s)
- Amin Talebi Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Yoshio Yamaoka
- Department of Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA; Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan
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41
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Zare A, Ahadi A, Larki P, Omrani MD, Zali MR, Alamdari NM, Ghaedi H. The clinical significance of miR-335, miR-124, miR-218 and miR-484 downregulation in gastric cancer. Mol Biol Rep 2018; 45:1587-1595. [PMID: 30171475 DOI: 10.1007/s11033-018-4278-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/22/2018] [Indexed: 12/15/2022]
Abstract
Gastric cancer (GC) is one of the leading types of malignancy worldwide, particularly in Asian populations. Although the exact molecular mechanism of GC development remains unknown, microRNA (miRNA) has recently been shown to be involved. The current study aims to investigate the expression levels of bioinformatically ranked miRNAs in gastric tissues. Using bioinformatics tools, we prioritized miRNAs thought to be implicated in GC. Furthermore, polyA-qPCR was used to validate bioinformatics findings in 40 GC, 31 normal gastric tissue (NG) and 45 gastric dysplasia (GD) samples. As identified by bioinformatics analysis, miR-335 was shown to be the top-ranked miRNA implicated in GC. Moreover, a significant downregulation of miR-335, miR-124, miR-218 and miR-484 was found in GC and GD compared to NG samples. We found bioinformatics to be an efficient approach to finding candidate miRNAs relevant to GC development. Finally, the findings show that downregulation of miRNAs such as miR-124 and miR-218 in gastric tissue can be a significant indicator for neoplastic transformation.
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Affiliation(s)
- Ali Zare
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
| | - Alireza Ahadi
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
| | - Pegah Larki
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
| | - Mir Davood Omrani
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran.,Urogenital Stem Cell Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Malekpour Alamdari
- Department of General Surgery, Clinical Research and Development Unit at Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ghaedi
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran.
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Okamura T, Iwaya Y, Kitahara K, Suga T, Tanaka E. Accuracy of Endoscopic Diagnosis for Mild Atrophic Gastritis Infected with Helicobacter pylori. Clin Endosc 2018; 51:362-367. [PMID: 29695148 PMCID: PMC6078923 DOI: 10.5946/ce.2017.177] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background/Aims This study examined the accuracy of endoscopic evaluation for determining the Helicobacter pylori infection status in patients with mild atrophy who might not exhibit characteristic endoscopic findings.
Methods Forty endoscopists determined the H. pylori infection status of 50 randomly presented H. pylori-positive and H. pylori-negative cases on the basis of a list of established findings.
Results The median clinical endoscopy experience was 7 years (range, 1–35 years), including 22 board-certified endoscopists (55%) of the Japan Gastroenterological Endoscopy Society. The mean accuracy rate of endoscopic diagnosis was 67% and was unrelated to experience status (experienced vs. trainee: 69% vs. 65%, p=0.089) and total years of experience (R2 =0.022). The most frequently selected endoscopic findings were regular arrangement of collecting venules (59%), atrophy (45%), and red streak (22%), which had fair accuracy rates of 67%, 65%, and 73%, respectively. By contrast, the accuracy rates of nodularity (89%) and mucosal swelling (77%) were highest. The 20 endoscopists who more frequently identified these findings diagnosed H. pylori infection significantly more accurately than did the other endoscopists (71% vs. 64%, p=0.008).
Conclusions Careful attention to nodularity and mucosal swelling in patients with mild atrophy may enhance diagnosis, enable prompt treatment, and avoid possible long-term carcinogenesis.
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Affiliation(s)
- Takuma Okamura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Japan
| | - Yugo Iwaya
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Japan
| | - Kei Kitahara
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Japan
| | - Tomoaki Suga
- Endoscopic Examination Center, Shinshu University Hospital, Matsumoto, Japan
| | - Eiji Tanaka
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Japan
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Kotachi T, Ito M, Yoshihara M, Boda T, Kiso M, Masuda K, Matsuo T, Tanaka S, Chayama K. Serological Evaluation of Gastric Cancer Risk Based on Pepsinogen and Helicobacter pylori Antibody: Relationship to Endoscopic Findings. Digestion 2018; 95:314-318. [PMID: 28571035 DOI: 10.1159/000477239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUNDS AND AIMS The serological risk-prediction system combined the pepsinogen (PG) test, and anti-Helicobacter pylori antibody is available for evaluation of gastric cancer risk. In this system, chronic atrophic gastritis (CAG) or H. pylori infection is diagnosed. Subjects with H. pylori negative and PG test negative (group A) are supposed to be those who have never been infected with H. pylori and are at extremely low risk for gastric cancer. However, a certain proportion of patients with CAG has been identified as the extremely low-risk group (group A). Here we examined endoscopic atrophy and investigated its relationship with the ABC classification system. METHODS We examined 540 patients. All patients underwent an endoscopic examination for evaluating corpus atrophy. Fasting sera were collected and serum PGs and anti-H. pylori antibody (Hp-Ab) titer (E-plate Eiken) were evaluated. RESULTS Of the 540 patients, 306 were classified into group A. However, 136 of them showed signs of endoscopic atrophy (group A with CAG). Group A with CAG frequently comprised the elderly. A new titer cut-off (<3 U/mL) of the Hp-Ab improved the discrimination of group A with CAG by 8%. CONCLUSION The prevalence of group A with CAG patients is a critical problem, especially in elderly subjects.
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Affiliation(s)
- Takahiro Kotachi
- Department of Medicine and Molecular Science, Hiroshima University, Hiroshima, Japan
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Hwang YJ, Kim N, Yun CY, Kwon MG, Baek SM, Kwon YJ, Lee HS, Lee JB, Choi YJ, Yoon H, Shin CM, Park YS, Lee DH. Predictive Factors for Improvement of Atrophic Gastritis and Intestinal Metaplasia: A Long-term Prospective Clinical Study. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.3.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Young-Jae Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Institute of Liver Research, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Yong Yun
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Gu Kwon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Min Baek
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeong Jae Kwon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Bong Lee
- Division of Statistics in Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Institute of Liver Research, Seoul National University College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW The paper aims to discuss the global trends in gastric cancer incidence in relation to important factors involved in the pathogenesis of gastric cancer. RECENT FINDINGS Despite a significant worldwide decline, gastric cancer remains a common cause of cancer death. The decline has been multifactorial and preceded the fall in Helicobacter pylori prevalence. The initial decline was associated with changes in food preservation and availability, especially of fresh fruits and vegetables, followed by a decline in the primary etiologic factor, H. pylori. Gastric cancer incidence remains high in East Asia, intermediate in Latin America, and low in developed countries. Significant racial/ethnic variability exists. The rapid decline in incidence in East Asia will continue as primary and secondary prevention strategies are implemented. The incidence in Latin America is unlikely to decline significantly over the next few decades given high H. pylori prevalence in the young. Ultimately, global H. pylori eradication will be needed to largely eliminate gastric cancer.
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Affiliation(s)
- Maya Balakrishnan
- Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Rollin George
- Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Ashish Sharma
- Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - David Y Graham
- Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA.
- Michael E. DeBakey Veterans Affairs Medical Center, RM 3A-318B (111D), 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
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Tsuda M, Asaka M, Kato M, Matsushima R, Fujimori K, Akino K, Kikuchi S, Lin Y, Sakamoto N. Effect on Helicobacter pylori eradication therapy against gastric cancer in Japan. Helicobacter 2017; 22:e12415. [PMID: 28771894 PMCID: PMC5655764 DOI: 10.1111/hel.12415] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Japan, there have been approximately 50 000 deaths from gastric cancer annually for over 40 years with little variation. It has been reported that most gastric cancers in Japan are caused by Helicobacter pylori infection. H. pylori eradication therapy was approved for patients with chronic gastritis by the Japanese national health insurance scheme in February 2013 for patients with an endoscopic diagnosis of chronic gastritis is positive for H. pylori. We examined the effect on gastric cancer death rate 4 years after expansion of health insurance coverage. AIM We conducted an epidemiological study and analyzed trends in prescription for H. pylori eradication therapy. We used the electronic medical claims database from Hokkaido, Japan to evaluate the impact of expansion of national health insurance coverage for H. pylori eradication therapy on deaths from gastric cancer. METHODS Data on deaths from gastric cancer were obtained from the Japanese Ministry of Health, Labour and Welfare and the Cancer Statistics in Japan (2015). Analysis of electronic claims records was performed using the National Database, mainly focusing on Hokkaido. Prescriptions for H. pylori eradication therapy and the number of patients treated for gastric cancer were also extracted from the Hokkaido database. RESULTS Approximately 1.5 million prescriptions for H. pylori eradication therapy were written annually. Gastric cancer deaths fell each year: 48 427 in 2013, 47 903 in 2014, 46 659 in 2015, and 45 509 in 2016, showing a significant decrease after expansion of insurance coverage for H. pylori eradication therapy (P<.0001). CONCLUSIONS Prescriptions for H. pylori eradication therapy increased markedly after approval of the gastritis indication by the national health insurance scheme and was associated with a significant decrease in gastric cancer deaths.
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Affiliation(s)
- Momoko Tsuda
- Department of GastroenterologyHokkaido University Graduate School of MedicineSapporoJapan
| | | | - Mototsugu Kato
- National Hospital Organization Hakodate HospitalHakodateJapan
| | - Rumiko Matsushima
- Department of GastroenterologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Kenji Fujimori
- Health Administration and PolicyTohoku University School of MedicineSendaiJapan
| | - Kozo Akino
- Health Sciences University of HokkaidoTobetsu‐choJapan
| | - Shogo Kikuchi
- Department of Public HealthAichi Medical University School of MedicineAichiJapan
| | - Yingsong Lin
- Department of Public HealthAichi Medical University School of MedicineAichiJapan
| | - Naoya Sakamoto
- Department of GastroenterologyHokkaido University Graduate School of MedicineSapporoJapan
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Huang CC, Tsai KW, Tsai TJ, Hsu PI. Update on the first-line treatment for Helicobacter pylori infection - a continuing challenge from an old enemy. Biomark Res 2017; 5:23. [PMID: 28702193 PMCID: PMC5505131 DOI: 10.1186/s40364-017-0103-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023] Open
Abstract
Because the prevalence of antibiotic resistance markedly increases with time worldwide, anti-H. pylori treatment is continuing to be a great challenge forsphysicians in clinical practice. The Real-world Practice & Expectation of Asia-Pacific Physicians and Patients in Helicobacter Pylori Eradication (REAP-HP) Survey demonstrated that the accepted minimal eradication rate of anti-H. pylori regimen in H. pylori-infected patients was 91%. The Kyoto Consensus Report on Helicobacter Pylori Gastritis also recommended that, within any region, only regimens which reliably produce eradication rates of ≥90% in that population should be used for empirical treatment. This article is aimed to review current first-line eradication regimens with a per-protocol eradication rate exceeding 90% in most geographic areas. In regions with low (≦15%) clarithromycin resistance, 14-day hybrid (or reverse hybrid), 10 ~ 14-day sequential, 7 ~ 14-day concomitant, 10 ~ 14-day bismuth quadruple or 14-day triple therapy can achieve a high eradication rate in the first-line treatment of H. pylori infection. However, in areas with high (>15%) clarithromycin resistance, standard triple therapy should be abandoned because of low eradication efficacy, and 14-day hybrid (or reverse hybrid), 10 ~ 14-day concomitant or 10 ~ 14-day bismuth quadruple therapy are the recommended regimens. If no recent data of local antibiotic resistances of H. pylori strains are available, universal high efficacy regimens such as 14-day hybrid (or reverse hybrid), concomitant or bismuth quadruple therapy can be adopted to meet the recommendation of consensus report and patients' expectation.
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Affiliation(s)
- Chih-Chieh Huang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan
| | - Kuo-Wang Tsai
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tzung-Jiun Tsai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan
- Taiwan Acid-related Disease (TARD) Study Group, Kaohsiung, Taiwan
| | - Ping-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan
- Taiwan Acid-related Disease (TARD) Study Group, Kaohsiung, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Kaoshiung Veterans General Hospital, 386 Ta Chung 1st Road, Kaohsiung, 813 Taiwan, ROC
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Chuah YY, Wu DC, Chuah SK, Yang JC, Lee TH, Yeh HZ, Chen CL, Liu YH, Hsu PI. Real-world practice and Expectation of Asia-Pacific physicians and patients in Helicobacter Pylori eradication (REAP-HP Survey). Helicobacter 2017; 22. [PMID: 28244264 DOI: 10.1111/hel.12380] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aims of the study were: 1, to survey the most popular anti-H. pylori regimens in Asia-Pacific region and the real-world effectiveness of these regimens; and 2, to investigate the expectation gaps of eradication rate between physicians and patients. DESIGN A questionnaire was distributed to Asia-Pacific physicians who attended the Asia-Pacific Digestive Week 2015 meeting. Reported eradication rates from the literatures were compared with real-world rates of surveyed popular regimens within the region. In addition, a questionnaire was distributed to H. pylori-infected patients in three regions of Taiwan. RESULTS A total of 691 physicians and 539 patients participated in the survey. The top five most commonly used regimens were 7-day clarithromycin-based standard triple therapy (50.4%), 14-day clarithromycin-based standard triple therapy (31.0%), 10-day sequential therapy (6.1%), 14-day bismuth quadruple therapy (3.9%), and 14-day hybrid therapy (3.6%). All countries except for China had a significant gap between the expectation of physicians on anti-H. pylori therapy and the real-world eradication rate of most commonly adopted regimens (all P value <.05). The expectation on minimal eradication rate among patients was higher than that of physicians (91.4% vs 86.5%, P<.001). CONCLUSIONS It is time for physicians in Asia-Pacific countries to adopt newer and more efficacious anti-H. pylori regimens to meet the Kyoto consensus recommendation and their patients' expectations.
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Affiliation(s)
- Yoen-Young Chuah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping-Tung Christian Hospital, Ping-Tung county, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Taiwan Acid-related Disease (TARD) Study Group
| | - Seng-Kee Chuah
- Taiwan Acid-related Disease (TARD) Study Group
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Jyh-Chin Yang
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzong-Hsi Lee
- Division of Gastroenterology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chan-Lin Chen
- Hualian Tzu-Chi Medical Center, Hualian county, Taiwan
| | - Yu-Hwa Liu
- Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ping-I Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan
- Taiwan Acid-related Disease (TARD) Study Group
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Lee JH, Park J, Park MR, Na YH, Cho SJ. A Comparative Study ofHelicobacter pyloriGrowth on Different Agar-based Media. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2017. [DOI: 10.7704/kjhugr.2017.17.4.208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Jung Hwan Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jiwan Park
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Mi Ri Park
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Yoon Hee Na
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Soo-Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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Abstract
Objective: Although Helicobacter pylori (H. pylori) is considered as the main etiological factor for gastric cancer, the strategy of screening and treating the oncogenic bacterium is still controversial. The objective was to evaluate the status and progress of the cognition about the relationship between H. pylori infection and gastric cancer from a clinical aspect. Data Sources: The data used in this review were mainly from the PubMed articles published in English from 1984 to 2015. Study Selection: Clinical research articles were selected mainly according to their level of relevance to this topic. Results: Gastric cancer is the fifth most common malignancy and the third leading cause of cancer deaths worldwide. The main etiological factor for gastric cancer is H. pylori infection. About 74.7–89.0% gastric cancer was related to H. pylori infection. Up to date, some regional gastric cancer prevention programs including the detection and treatment of H. pylori infection are under way. Current data obtained from the randomized controlled trials suggest that population-based H. pylori screening and treatment is feasible and cost-effective in preventing gastric cancer; however, a population-based H. pylori eradication campaign would potentially lead to bacterial resistance to the corresponding antibiotics, as well as a negative impact on the normal flora. Conclusions: The important questions of feasibility, program costs, appropriate target groups for intervention, and the potential harm of mass therapy with antibiotics must first be answered before implementing any large-scale program.
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Affiliation(s)
| | - Li-Ya Zhou
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
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