Helicobacter pylori infection and the development of gastric cancer — Second report — Long term endoscopic follow up study

Helicobacter pylori infection and the development of gastric cancer — Second report — Long... A726 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4 3945 IMPORTANCE OF WATER SOURCE IN CHILDHOOD IN THE EPIDEMILOGOGY OF H. PYLORI IN THE NEW CENTRAL ASIAN REBUBLIC OF KAZAKHSTAN. Zhannat Z. Nurgalieva, Hoda M. Malaty, Rousa K. Almuchambetova, Aigul K. Machmudova, Dina A. Kapsultanova, Michael S. Osato, F. Blaine Hollinger, David Y. Graham, Abai Zhangabyylov, VAMC and Baylor CoU of Medicine, Houston, TX; Kazakh State Med Univ, Almaty, Kazakhstan; Kazakh State Med Univ, Almaty, KZ; Baylor CoU of Medicine, Houston, TX. Background: Kazakhstan is a large country with a dry and harsh climate. Peptic ulcer and gastric cancer are very common there yet factors related to H. pylori prevalence and transmission are unknown. Aim: To investigate the epidemiology of H. pylori in Kazakhstan. The population of Kazakhstan is approximately 40% Kazakh and 40% Russian. Methods: A seroepidemiology study was done in unrelated individuals (30 per decade; ages 10 to 60) in each of the two major ethnic groups: Kazakh and Russian. Entry criteria included: ethnic Russian or Kazakh, males or females, born in Kazakhstan, with minimal or no UGI symptoms, no current clinical evidence or history of peptic ulcer or gastric cancer. Demographic details were obtained using a questionnaire administered by a physician. H. pylori status was determined by ELISA (e.g.· HM-CAP IgG ELISA). Results: The overall prevalence of Hp was high (e.g., prevalence in the age group 20-29 was 79% increasing to 100% by age 60). H. pylori prevalence was similar in Kazakhs (84%) and Russians (82%) without differences in sex. Water source in childhood was the most important variable. The prevalence of H. pylori was highest in those who carried water from a river (100%) followed by water from community bore wells (94%), and least in those with municipal water (74%). The differences were independent of sex or ethnic group. Water-associated diseases can be either waterborne or waterwashed. To address the role of sanitation (water-washed) we compared the prevalence of hepatitis A and H. pylori in relation to water source. The prevalences of H. pylori and HepA were essentially identical with relation to water source for the entire group and for a group of 56 children. Conclusions: The prevalence of H. pylori in Kazakhstan is related to water source. The high concordance between H. pylori and HepA suggest that H. pylori transmission in Kazakhstan is primarily fecal oral. H. pylori in Kazakhstan is most likely a water-washed disease related primarily to lack of adequate water for hygienic purposes. 3946 HIGHER INCIDENCE OF H. PYLORI REINFECTION IN PATIENTS AFFECTED BY INSULIN-DEPENDENT DIABETES MELLITUS. Veronica Ojetti, Antonio Gasbarrini, Dario Pitocco, Filippo Cremonini, Maria Assunta Zocco, Giovanni Ghirlanda, Giovanni Gasbarrini, Internal Medicine, Rome, Italy. Background:Reinfection by H. pylori(HP) after a successful treatment is extremely uncommon in the general population. Patients (pts) affected by insulin dependent diabetes mellitus (IDDM) are frequently infected by HP and showed an eradication rate lower to that observed in the general population, Aims: to assess the incidence of HP reinfection in IDDM pts and in a control group of dyspeptic pts matched for sex and age. Methods: 30 (12 females and 18 males) IDDM pts and 40 (17 females and 23 males) dyspeptic pts previously treated by HP infection and successfully eradicated ( l3C-urea breath test and hystolo£y) were re-eva1uated after 12 months. HP infection was assessed by 1 C-urea breath test. Results: the incidence of HP reinfection was significantly higher in IDDM pts compared to controls: II out of 30 (37%) and 2 out of 40 (5%), respectively (p<0.005). Among IDDM pts, mean age, daily insulin requirement and glicate haemoglobin (expression of metabolic disease control) were significantly higher in reinfected when compared to not infected subjects: mean age 49±4 vs 39±3, p<O.05; insulin requirement 46.8±4 vs 34±8, p<0.05; glicate haemoglobin 7.3±0,5 vs 6,5±O.3, p<O.05 respectively. Interestingly, IDDM duration was similar between reinfected and uninfected pts (21.2± 12 vs 20± 11) Conclusions: A significantly higher incidence of reinfection was observed in IDDM pts when compared to dyspeptic controls. Among IDDM pts, mean age, daily dosage of insulin and a poor metabolic control of the disease appear to be risk factors for reinfection occurrence. The alterations of immunological response of IDDM pts could be one of the mechanism underlying this phenomenon. The data suggest that vaccine development seems to be the only effective long run treatment for this subset of pts. 3947 HELICOBACTER PYLORI INFECTION AND THE DEVELOPMENT OF GASTRIC CANCER· SECOND REPORT - LONG TERM ENDOSCOPIC FOLLOW UP STUDY". Naomi Uemura, Shiro Okamoto, Soichiro Yamamoto, Hiroshi Masuda, Shuji Yamaguchi, Hiroto Mashiba, Kiyomi Taniyama, Naomi Sasaki, Koji Sumii, Ken Haruma, Masaharu Yoshihara, Goro Kajiyama, Kure Kyosai Hosp, Kure-City, Japan; Hiroshima Univ, Hiroshima, Japan. BACKGROUND: In previous AGA, we reported that the development of gastric cancer was caused by H.pylori-associated gastritis, based on a long-term clinical and endoscopic prospective follow-up study. We report new follow-up data at this time. SUBJECTS and METHODS: Subjects of this study comprised 1166 patients who, with informed consent, underwent endoscopy and were assessed as to the presence of H. pylori infection by histology, rapid urease test and serologic test between April 1990 and March 1993. AU were followed up by endoscopy at least once every three years. Of the total, 246 (male:110, female:136; mean age:54y) were H. pylori-negative, and 920(male:51O. female:41O; 54y) were positive. H. pylori-positive patients included 382 with chronic gastritis (CG) (male: 180, female:202; 55y), 186 with active gastric ulcer (GU) (male:141, female:45; 54y), 180 with active duodenal ulcer (DU) (male:129, female: 51; 49y) and 172 with gastric polyp (GP) (male:60, female:112; 57y). No patients received eradication therapy; the foUow-up period was 6-9.5 years (average:8y). RESULTS: (1) FoUow-up endoscopy detected no gastric cancer in H.pylori-negative patients (n=246). On the other hand, after 8 years follow-up, gastric cancers were endoscopicaUy discovered in 31 (3.4%) of the 920 H. pylori-positive patients. This ratio is significantly higher compared with that of H. Pylori-negative patients. (2) These 31 gastric cancer patients comprised 17 (4.5%) with CG, 9 (4.8%) with GU and 5 (2.9%) with GP. No gastric cancer was detected in DU patients. The ratio of gastric cancer development in CG, GU and GP patients is significantly higher than in H. pylori-negative cases and DU patients. (3) Background gastric mucosa at entry time in these 3 Igastric cancer patients was characterized by severe gastric atrophy and corpus predominant gastritis. CONCLUSION: The above results show that the development of both types of gastric cancer is caused by H. pylori-associated gastritis. H. pylori-positive corpus predominant gastritis may be at particularly high risk for gastric cancer in Japan. 3948 SERUM FERRITIN INCREASES AFTER LOSS OF IGG ANTIBODIES TO H. PYLORI; A PROSPECTIVE POPULATION-BASED COHORT STUDY COMPRISING 1,947 DANISH ADULTS. Steffen J. Rosenstock, Nils Milman, Torben Joergensen, Leif P. Andersen, Olaf Bonnevie, Dept of Surg A, Hilleroed, Denmark; Dept of Medicine, Naestved, Denmark; Ctr of Preventive Med, Glostrup, Denmark; Dept of Clin Microbiology, Copenhagen, Denmark; Dept of Medicine I, Bispebjerg, Denmark. Background: Recent cross-sectional studies have suggested that H. pylori infection affects iron status in otherwise healthy individuals. Aim: to examine changes in serum ferritin levels in Danish adults who lost or acquired IgG antibodies to H. pylori within an II-year time period. Material and methods: 1,947 Danish adults were examined in 1982 and 1994. Anti-H. pylori IgG were measured with an ELISA and serum ferritin levels were assessed with an immunoradiometric assay at study entry(Phadebas PRIST)and at foUow-up(RIA Amersham). People who were IgG negative at study entry and IgG positive at foUow-up were assumed to have acquired H. pylori infection (sere-converters). Sero-reverters had four-fold decreases in seropositive base-line IgG levels between study entry and follow-up and were assumed to have lost the infection. Results: Twelve people sero-converted and 42 people sero-reverted within the observation period. There were no significant differences in median serum ferritin levels between 1982 and 1994 in IgG sero-converters (88.5 /Lgll VS. 115.4 /LgIl, P = O. 08). Serum ferritin levels increased significantly in people who sero-reverted in IgG antibodies (table). This trend was seen in men and in postmenopausal women. Conclusion: Loss of antibodies to H. pylori leads to an increase in serum ferritin levels. This temporal relationship supports a link between H. pylori infection and iron metabolism. People with unexplained iron-deficiency anemia should be tested for H. pylori infection and may benefit from eradication therapy if infected. Median serum ferritin levels (llgn) in1982 and in 1994"inanti·Hp IgG sero-reverters Year Men (n-16) Women (n=26) premenopausal postmenopausal (0=19) (0=7) All (n=42) 1982 1994 p.value' 79 118 0,05 99 139 0,01 'Wilcoxons matched pairs teslfor differences in ferritin levels in1982 and 1994, "A parabolic regression equation was used tocontroi forvariation between ferritin kits HEUCOBACTER PYLORI INFECTION DOES NOT AFFECT OVERALL MORTALITY IN DENMARK. A POPULATIONBASED PROSPECTIVE COHORT STUDY COMPRISING 3,590 DANISH ADULTS. Steffen 1. Rosenstock, Torben Joergensen, Olaf Bonnevie, Leif P. Andersen, Dept of Surg A, Hilleroed, Denmark; Ctr of Preventive Med, Glostrup, Denmark; Dept of Medicine I, Bispebjerg, Denmark; Dept of Clin Microbiology, Copenhagen, Denmark. Background: H. pylori infection is a life-long condition which causes chronic gastritis, peptic ulcer disease, and may be involved in the etiology of gastric cancer. H. pylori infection has been linked to a number of non-gastrointestinal diseases such as ischemic heart disease, but data on this issue remains equivocal. If H. pylori infection increases the likelihood of ischemic heart disease, overall mortality is likely to be increased in H. pylori infected individuals. Aim: to examine, if seropositivity for IgG antibodies to H. pylori relates to the overall mortality in Danish adults. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Gastroenterology Elsevier

Helicobacter pylori infection and the development of gastric cancer — Second report — Long term endoscopic follow up study

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Elsevier
Copyright
Copyright © 2000 American Gastroenterological Association
ISSN
0016-5085
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1528-0012
D.O.I.
10.1016/S0016-5085(00)85035-0
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Abstract

A726 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4 3945 IMPORTANCE OF WATER SOURCE IN CHILDHOOD IN THE EPIDEMILOGOGY OF H. PYLORI IN THE NEW CENTRAL ASIAN REBUBLIC OF KAZAKHSTAN. Zhannat Z. Nurgalieva, Hoda M. Malaty, Rousa K. Almuchambetova, Aigul K. Machmudova, Dina A. Kapsultanova, Michael S. Osato, F. Blaine Hollinger, David Y. Graham, Abai Zhangabyylov, VAMC and Baylor CoU of Medicine, Houston, TX; Kazakh State Med Univ, Almaty, Kazakhstan; Kazakh State Med Univ, Almaty, KZ; Baylor CoU of Medicine, Houston, TX. Background: Kazakhstan is a large country with a dry and harsh climate. Peptic ulcer and gastric cancer are very common there yet factors related to H. pylori prevalence and transmission are unknown. Aim: To investigate the epidemiology of H. pylori in Kazakhstan. The population of Kazakhstan is approximately 40% Kazakh and 40% Russian. Methods: A seroepidemiology study was done in unrelated individuals (30 per decade; ages 10 to 60) in each of the two major ethnic groups: Kazakh and Russian. Entry criteria included: ethnic Russian or Kazakh, males or females, born in Kazakhstan, with minimal or no UGI symptoms, no current clinical evidence or history of peptic ulcer or gastric cancer. Demographic details were obtained using a questionnaire administered by a physician. H. pylori status was determined by ELISA (e.g.· HM-CAP IgG ELISA). Results: The overall prevalence of Hp was high (e.g., prevalence in the age group 20-29 was 79% increasing to 100% by age 60). H. pylori prevalence was similar in Kazakhs (84%) and Russians (82%) without differences in sex. Water source in childhood was the most important variable. The prevalence of H. pylori was highest in those who carried water from a river (100%) followed by water from community bore wells (94%), and least in those with municipal water (74%). The differences were independent of sex or ethnic group. Water-associated diseases can be either waterborne or waterwashed. To address the role of sanitation (water-washed) we compared the prevalence of hepatitis A and H. pylori in relation to water source. The prevalences of H. pylori and HepA were essentially identical with relation to water source for the entire group and for a group of 56 children. Conclusions: The prevalence of H. pylori in Kazakhstan is related to water source. The high concordance between H. pylori and HepA suggest that H. pylori transmission in Kazakhstan is primarily fecal oral. H. pylori in Kazakhstan is most likely a water-washed disease related primarily to lack of adequate water for hygienic purposes. 3946 HIGHER INCIDENCE OF H. PYLORI REINFECTION IN PATIENTS AFFECTED BY INSULIN-DEPENDENT DIABETES MELLITUS. Veronica Ojetti, Antonio Gasbarrini, Dario Pitocco, Filippo Cremonini, Maria Assunta Zocco, Giovanni Ghirlanda, Giovanni Gasbarrini, Internal Medicine, Rome, Italy. Background:Reinfection by H. pylori(HP) after a successful treatment is extremely uncommon in the general population. Patients (pts) affected by insulin dependent diabetes mellitus (IDDM) are frequently infected by HP and showed an eradication rate lower to that observed in the general population, Aims: to assess the incidence of HP reinfection in IDDM pts and in a control group of dyspeptic pts matched for sex and age. Methods: 30 (12 females and 18 males) IDDM pts and 40 (17 females and 23 males) dyspeptic pts previously treated by HP infection and successfully eradicated ( l3C-urea breath test and hystolo£y) were re-eva1uated after 12 months. HP infection was assessed by 1 C-urea breath test. Results: the incidence of HP reinfection was significantly higher in IDDM pts compared to controls: II out of 30 (37%) and 2 out of 40 (5%), respectively (p<0.005). Among IDDM pts, mean age, daily insulin requirement and glicate haemoglobin (expression of metabolic disease control) were significantly higher in reinfected when compared to not infected subjects: mean age 49±4 vs 39±3, p<O.05; insulin requirement 46.8±4 vs 34±8, p<0.05; glicate haemoglobin 7.3±0,5 vs 6,5±O.3, p<O.05 respectively. Interestingly, IDDM duration was similar between reinfected and uninfected pts (21.2± 12 vs 20± 11) Conclusions: A significantly higher incidence of reinfection was observed in IDDM pts when compared to dyspeptic controls. Among IDDM pts, mean age, daily dosage of insulin and a poor metabolic control of the disease appear to be risk factors for reinfection occurrence. The alterations of immunological response of IDDM pts could be one of the mechanism underlying this phenomenon. The data suggest that vaccine development seems to be the only effective long run treatment for this subset of pts. 3947 HELICOBACTER PYLORI INFECTION AND THE DEVELOPMENT OF GASTRIC CANCER· SECOND REPORT - LONG TERM ENDOSCOPIC FOLLOW UP STUDY". Naomi Uemura, Shiro Okamoto, Soichiro Yamamoto, Hiroshi Masuda, Shuji Yamaguchi, Hiroto Mashiba, Kiyomi Taniyama, Naomi Sasaki, Koji Sumii, Ken Haruma, Masaharu Yoshihara, Goro Kajiyama, Kure Kyosai Hosp, Kure-City, Japan; Hiroshima Univ, Hiroshima, Japan. BACKGROUND: In previous AGA, we reported that the development of gastric cancer was caused by H.pylori-associated gastritis, based on a long-term clinical and endoscopic prospective follow-up study. We report new follow-up data at this time. SUBJECTS and METHODS: Subjects of this study comprised 1166 patients who, with informed consent, underwent endoscopy and were assessed as to the presence of H. pylori infection by histology, rapid urease test and serologic test between April 1990 and March 1993. AU were followed up by endoscopy at least once every three years. Of the total, 246 (male:110, female:136; mean age:54y) were H. pylori-negative, and 920(male:51O. female:41O; 54y) were positive. H. pylori-positive patients included 382 with chronic gastritis (CG) (male: 180, female:202; 55y), 186 with active gastric ulcer (GU) (male:141, female:45; 54y), 180 with active duodenal ulcer (DU) (male:129, female: 51; 49y) and 172 with gastric polyp (GP) (male:60, female:112; 57y). No patients received eradication therapy; the foUow-up period was 6-9.5 years (average:8y). RESULTS: (1) FoUow-up endoscopy detected no gastric cancer in H.pylori-negative patients (n=246). On the other hand, after 8 years follow-up, gastric cancers were endoscopicaUy discovered in 31 (3.4%) of the 920 H. pylori-positive patients. This ratio is significantly higher compared with that of H. Pylori-negative patients. (2) These 31 gastric cancer patients comprised 17 (4.5%) with CG, 9 (4.8%) with GU and 5 (2.9%) with GP. No gastric cancer was detected in DU patients. The ratio of gastric cancer development in CG, GU and GP patients is significantly higher than in H. pylori-negative cases and DU patients. (3) Background gastric mucosa at entry time in these 3 Igastric cancer patients was characterized by severe gastric atrophy and corpus predominant gastritis. CONCLUSION: The above results show that the development of both types of gastric cancer is caused by H. pylori-associated gastritis. H. pylori-positive corpus predominant gastritis may be at particularly high risk for gastric cancer in Japan. 3948 SERUM FERRITIN INCREASES AFTER LOSS OF IGG ANTIBODIES TO H. PYLORI; A PROSPECTIVE POPULATION-BASED COHORT STUDY COMPRISING 1,947 DANISH ADULTS. Steffen J. Rosenstock, Nils Milman, Torben Joergensen, Leif P. Andersen, Olaf Bonnevie, Dept of Surg A, Hilleroed, Denmark; Dept of Medicine, Naestved, Denmark; Ctr of Preventive Med, Glostrup, Denmark; Dept of Clin Microbiology, Copenhagen, Denmark; Dept of Medicine I, Bispebjerg, Denmark. Background: Recent cross-sectional studies have suggested that H. pylori infection affects iron status in otherwise healthy individuals. Aim: to examine changes in serum ferritin levels in Danish adults who lost or acquired IgG antibodies to H. pylori within an II-year time period. Material and methods: 1,947 Danish adults were examined in 1982 and 1994. Anti-H. pylori IgG were measured with an ELISA and serum ferritin levels were assessed with an immunoradiometric assay at study entry(Phadebas PRIST)and at foUow-up(RIA Amersham). People who were IgG negative at study entry and IgG positive at foUow-up were assumed to have acquired H. pylori infection (sere-converters). Sero-reverters had four-fold decreases in seropositive base-line IgG levels between study entry and follow-up and were assumed to have lost the infection. Results: Twelve people sero-converted and 42 people sero-reverted within the observation period. There were no significant differences in median serum ferritin levels between 1982 and 1994 in IgG sero-converters (88.5 /Lgll VS. 115.4 /LgIl, P = O. 08). Serum ferritin levels increased significantly in people who sero-reverted in IgG antibodies (table). This trend was seen in men and in postmenopausal women. Conclusion: Loss of antibodies to H. pylori leads to an increase in serum ferritin levels. This temporal relationship supports a link between H. pylori infection and iron metabolism. People with unexplained iron-deficiency anemia should be tested for H. pylori infection and may benefit from eradication therapy if infected. Median serum ferritin levels (llgn) in1982 and in 1994"inanti·Hp IgG sero-reverters Year Men (n-16) Women (n=26) premenopausal postmenopausal (0=19) (0=7) All (n=42) 1982 1994 p.value' 79 118 0,05 99 139 0,01 'Wilcoxons matched pairs teslfor differences in ferritin levels in1982 and 1994, "A parabolic regression equation was used tocontroi forvariation between ferritin kits HEUCOBACTER PYLORI INFECTION DOES NOT AFFECT OVERALL MORTALITY IN DENMARK. A POPULATIONBASED PROSPECTIVE COHORT STUDY COMPRISING 3,590 DANISH ADULTS. Steffen 1. Rosenstock, Torben Joergensen, Olaf Bonnevie, Leif P. Andersen, Dept of Surg A, Hilleroed, Denmark; Ctr of Preventive Med, Glostrup, Denmark; Dept of Medicine I, Bispebjerg, Denmark; Dept of Clin Microbiology, Copenhagen, Denmark. Background: H. pylori infection is a life-long condition which causes chronic gastritis, peptic ulcer disease, and may be involved in the etiology of gastric cancer. H. pylori infection has been linked to a number of non-gastrointestinal diseases such as ischemic heart disease, but data on this issue remains equivocal. If H. pylori infection increases the likelihood of ischemic heart disease, overall mortality is likely to be increased in H. pylori infected individuals. Aim: to examine, if seropositivity for IgG antibodies to H. pylori relates to the overall mortality in Danish adults.

Journal

GastroenterologyElsevier

Published: Apr 1, 2000

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