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OBJECTIVE: Colonic diverticulosis might be caused by low-fiber dietary habits, gastrointestinal motility disorders, and colonic wall resistance changes, which might also affect the upper gastrointestinal system mucosa. Therefore, the present study aims to answer whether the gastric histopathological findings of the cases with diverge from those without. METHODS: This retrospective cross-sectional study included 184 cases who underwent both upper and lower gastrointestinal endoscopy procedures between January 2020 and December 2022. Notably, 84 cases were colonic diverticulosis, while the rest of the study group was control. Their demographic, laboratory, and histopathological findings were compared meticulously. RESULTS: The median ages for the colonic diverticulosis and control were 67.07±8.14 and 66.29±15.83 years, respectively, and no statistical difference concerning the age and gender distribution between them was recognized. The median levels of white blood cells, neutrophils, glucose, creatinine, and aspartate aminotransferase in colonic diverticulosis were significantly increased compared to control. As for pathological comparison, colonic diverticulosis had a higher prevalence of Helicobacter pylori (45.2 vs. 38%), while atrophy and intestinal metaplasia prevalence were nearly the same in the groups, without significance regarding Helicobacter pylori. CONCLUSION: Consequently, colonic diverticulosis should not be overlooked, particularly when the abovementioned laboratory parameters are augmented in a dyspeptic patient. A correlation might be raised between Helicobacter pylori and colonic diverticulosis. Eradication therapy might help attenuate the risk of colonic diverticulosis when Helicobacter pylori has emerged in a patient.
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Diverticulosis del Colon , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Femenino , Masculino , Estudios Transversales , Estudios Retrospectivos , Helicobacter pylori/aislamiento & purificación , Infecciones por Helicobacter/patología , Infecciones por Helicobacter/complicaciones , Diverticulosis del Colon/patología , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Estudios de Casos y ControlesRESUMEN
BACKGROUND: Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and host genetic polymorphism of innate and pro-inflammatory cascade, nucleotide-binding oligomerization domain 1 (NOD-1), and interleukin-1 beta (IL-1ß) in HpD was not explored. AIM: To evaluate the association of NOD1-796G>A and IL-1B-511C>T gene variants and low-grade duodenal eosinophilia in HpD. METHODS: A multicenter cross-sectional study was conducted. A total of 253 patients who met Rome-IV criteria were selected before upper endoscopy and 98 patients were included after unremarkable upper endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori cagA and duodenal histology, were evaluated. RESULTS: Sixty-four (65%) patients had epigastric pain syndrome (EPS), 24 (25%) postprandial distress syndrome (PDS), and 10 (10%) EPS/PDS overlap. FD subtypes were not associated with NOD1-796G>A and IL-1B-511C>T gene variants. Low-grade duodenal eosinophilia was significantly increased in NOD1-796 GG versus single A-allele, but not in IL-1B-511 single T-allele or CC-allele. This association is dependent of cagA infection, since harboring cagA strain was significantly associated with low-grade duodenal eosinophilia with isolated variants NOD1-796 GG and IL-1B-511 single T-allele, but not without cagA. When we performed combined polymorphism analysis with NOD1-796 GG/IL-1B-511 single T-allele, a synergistic effect on low-grade duodenal eosinophilia was found between these two loci irrespective of cagA strain status in HpD. CONCLUSION: Our findings suggest that low-grade duodenal eosinophilia is significantly associated with NOD1-796 GG allele specially in cagA strain and with allelic combination NOD1-796 GG/IL-1B-511 single T-allele independent of cagA strain infection in HpD patients.
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Dispepsia , Eosinofilia , Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Antígenos Bacterianos/genética , Antígenos Bacterianos/metabolismo , Proteínas Bacterianas/genética , Estudios Transversales , Dispepsia/genética , Dispepsia/complicaciones , Eosinofilia/complicaciones , Gastritis/complicaciones , Infecciones por Helicobacter/patología , Helicobacter pylori/genética , Helicobacter pylori/metabolismo , Proteína Adaptadora de Señalización NOD1/genética , Polimorfismo GenéticoRESUMEN
BACKGROUND: Recent data on the prevalence of H. pylori infection in Jamaica are lacking. It is postulated that there has been a decline in the prevalence of H. pylori infection and its associated complications. We determined sociodemographic characteristics, prevalence of H. pylori infection and clinical outcomes among adults undergoing esophagogastroduodenoscopy (EGD) and histology at the University Hospital of the West Indies (UHWI) between May 2018 and December 2020. MATERIALS AND METHODS: A cross-sectional study of patients (≥18 years old), who underwent EGD and histological evaluation for H. pylori infection, was conducted. Associations of H. pylori positivity and gastric cancer with sociodemographic/clinical variables and endoscopic findings were determined by stepwise logistic regression using backward selection. Unadjusted and adjusted odds ratios with related 95% confidence intervals (Cis) were calculated for H. pylori positivity and gastric cancer status. RESULTS: There were 323 participants (mean age 58.6 ± 17.8 years, 54.2% females). H. pylori prevalence was 22.2% (n = 70 of 315), 5.6% had gastric neoplasia (GN), 15.5% gastric atrophy, 11.4% intestinal metaplasia and 3.7% dysplasia on histology. Mucositis (64.5%), gastric ulcer (14.9%), and duodenal ulcer (13.9%) were the most common endoscopic findings. Participants with peptic ulcer disease (PUD) (unOR = 4.0; p = .017), gastric cancer (unOR = 9.5; p = .003), gastric atrophy (unOR = 12.8; p < .001), and intestinal metaplasia (unOR = 5.0; p < .001) had a significantly higher odds of being H. pylori positive, but after multivariable analyses only gastric atrophy remained significant (aOR = 27.3; p < .001). Participants with mucositis had a significantly lower odds of gastric cancer (unOR 0.1; p = .035) while participants with dysplasia had significantly higher odds (unOR 8.0; p = .042), but these were no longer significant after multivariable analyses (aOR = 0.2; p = .156 and aOR = 18.9; p = .070, respectively). CONCLUSIONS: Histology based prevalence of H. pylori infection is lower than previously reported in Jamaica. Gastric atrophy is a significant predictor of H. pylori positivity.
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Gastritis Atrófica , Infecciones por Helicobacter , Helicobacter pylori , Mucositis , Neoplasias Gástricas , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Adolescente , Masculino , Estudios Transversales , Jamaica/epidemiología , Neoplasias Gástricas/patología , Mucositis/complicaciones , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/patología , Endoscopía Gastrointestinal , Gastritis Atrófica/complicaciones , Atrofia , Hospitales de Enseñanza , Metaplasia/complicaciones , PrevalenciaRESUMEN
INTRODUCTION: The regular arrangement of collecting venules has high value to predict the absence of gastric infection by Helicobacter Pylori, the studies that have validated this finding were carried out with magnification images and digital chromoendoscopy, it is common to perform endoscopies with conventional white light equipment without magnification. OBJECTIVE: This study aims to validate this finding as a predictor of the absence of H. Pylori infection using endoscopy equipment with conventional white light without magnification. MATERIAL AND METHODS: An observational study was carried out identifying the presence of RAC with a conventional endoscope, the determination of Helicobacter pylori was established by histopathology. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated in relation to the presence of RAC and the H. pylori infection status. RESULTS: 241 patients were included, finding a sensitivity of 5%, with a specificity of 89%. The prevalence of H. Pylori decreased with age. CONCLUSION: This study reports a low sensitivity with a high specificity of the regular distribution of collecting venules to establish the state of infection by H. Pylori. The diagnostic performance was lower than that reported in studies carried out with chromium endoscopy with magnification.
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Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/patología , Gastritis/diagnóstico , Vénulas/patología , América Latina , Mucosa Gástrica/patología , EndoscopiosRESUMEN
Emerging deep learning-based applications in precision medicine include computational histopathological analysis. However, there is a lack of the required training image datasets to generate classification and detection models. This phenomenon occurs mainly due to human factors that make it difficult to obtain well-annotated data. The present study provides a curated public collection of histopathological images (DeepHP) and a convolutional neural network model for diagnosing gastritis. Images from gastric biopsy histopathological exams were used to investigate the performance of the proposed model in detecting gastric mucosa with Helicobacter pylori infection. The DeepHP database comprises 394,926 histopathological images, of which 111 K were labeled as Helicobacter pylori positive and 283 K were Helicobacter pylori negative. We investigated the classification performance of three Convolutional Neural Network architectures. The models were tested and validated with two distinct image sets of 15% (59K patches) chosen randomly. The VGG16 architecture showed the best results with an Area Under the Curve of 0.998%. The results showed that CNN could be used to classify histopathological images from gastric mucosa with marked precision. Our model evidenced high potential and application in the computational pathology field.
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Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/patología , Mucosa Gástrica/patología , Gastritis/diagnóstico , Gastritis/patología , Gastroscopía/métodosRESUMEN
Background: Genetic variability of Helicobacter pylori is associated with various gastrointestinal diseases; however, little is known about interaction with sociodemographic in the development of premalignant lesions in Colombian patients. Methods: An analytical study was conducted including cases (patients with gastric atrophy, intestinal metaplasia, and gastric dysplasia) and controls (patients with nonatrophic gastritis). Sociodemographic information was obtained using a questionnaire. Histopathological diagnosis was performed according to the Sydney System. The cagA and vacA genotypes were established using polymerase chain reaction in paraffin blocks. The effect of each variable on the study outcome (premalignant lesion) is presented as odds ratio (OR) and 95% CI. A p value of <0.05 was considered as statistically significant. Results: The vacA/s1m1 genotype increases the risk of developing premalignant lesions of the stomach (OR: 3.05, 95% IC: 1.57-5.91, p=0.001). Age and educational level showed a positive interaction with the s1m1 genotype (adjusted OR: 3.68, 95% CI: 1.73-7.82, p=0.001). The cagA genotype was not correlated to the development of premalignant lesions of the stomach (OR: 1.32, 95% CI: 0.90-1.94, p=0.151). Conclusions: The vacA genotype, age, and educational level are indicators of the risk of developing premalignant lesions of the stomach in the study population. Significance Statement. Genetic variability of H. pylori and sociodemographic information could be used to predict the risk of premalignant lesions in stomach in Colombian population.
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Infecciones por Helicobacter , Helicobacter pylori , Lesiones Precancerosas , Neoplasias Gástricas , Antígenos Bacterianos/genética , Proteínas Bacterianas/genética , Colombia/epidemiología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patología , Helicobacter pylori/genética , Humanos , Parafina , Lesiones Precancerosas/complicaciones , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/genética , Estómago , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/genética , Virulencia/genéticaRESUMEN
BACKGROUND: Helicobacter pylori infection has been reported to lead to post-operative complications after bariatric surgery (BS), especially marginal ulcers. The optimal method for pre-operative screening is yet to be determined. OBJECTIVE: To analyze the diagnostic accuracy of the endoscopic urease test for the detection of H. pylori in individuals undergoing BS and the main endoscopic and histological changes within this population. METHODS: A cross-sectional study was carried out based on a database from medical records of 232 individuals who underwent BS between 2016 and 2019 at a tertiary university hospital. Clinical, anthropometric, and endoscopic data were analyzed. The gold-standard method considered to calculate diagnostic accuracy variables was histopathological examination through hematoxylin-eosin/Giemsa stains. RESULTS: 87.5% of the participants were female; mean age was 38.5±9.5 years and average body mass index was 37.6±3.8 kg/m2. The commonest endoscopic finding was gastritis (50.9%) with a predominance of the mild erosive form (25%). Upon histological examination, 59.1% of the participants had confirmed H. pylori infection. H. pylori infection was associated with higher frequencies of endoscopic duodenitis (23.4% vs 12.6%; P=0.04), histological chronic gastritis (100% vs 56.8%; P<0.0001) and histological acute gastritis (58.4% vs 2.1%; P<0.0001). The urease test had a sensitivity of 79.6% and a specificity of 97.9%, leading to an overall accuracy of 87.1%. CONCLUSION: The endoscopic urease test is highly accurate for pre-operative screening of H. pylori infection in individuals who undergo BS. H. pylori infection was significantly associated with endoscopic (duodenitis) and histopathological (chronic and active gastritis) changes.
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Bariatria , Duodenitis , Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Adulto , Estudios Transversales , Femenino , Gastritis/diagnóstico , Infecciones por Helicobacter/patología , Humanos , Masculino , Persona de Mediana Edad , Ureasa/análisisRESUMEN
Helicobacter pylori (H. pylori) infection involves multiple factors internal and external to the host. Among the internal factors, the immune response plays a fundamental role in the process of antigen presentation, lymphocytic response and cytokine-mediated regulatory response that are directly as sociated with disease progression and prognosis. OBJECTIVE: To compare the immune response in gas tric mucosa of H. pylori infected patients in two regions comparing the risk of developing gastric can cer. PATIENTS AND METHOD: 71 participants with symptoms of dyspepsia were included. The samples for biopsies were collected from different regions of the gastric mucosa; the identification of H. pylori was carried out by culture and polymerase chain reaction (PCR) of the ureA gene. For the characteri zation of the histopathological alterations and the immunophenotyping of lymphocytes, anti-human mouse monoclonal antibodies specific for each antigen were used: T lymphocytes: CD3 and CD8; B lymphocytes: CD20; Natural Killer Cells: CD56; Macrophages: CD68. RESULTS: The prevalence of H. pylori was 83.1%, the predominant types of gastritis were chronic gastritis and multifocal atrophic gastritis with intestinal metaplasia (63.4% and 22.5%, respectively). The cellular response was charac terized mainly by polymorphonuclear lymphocytes and positive anti-CD8 reactivity both in stroma and epithelium. CONCLUSIONS: Multifocal atrophic gastritis was more prevalent in the high-risk region for gastric cancer (GC) while non-atrophic gastritis and the expression of CD3 and CD8 antigens in the foveolar epithelium was higher in the low-risk region.
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Gastritis Atrófica , Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Neoplasias Gástricas , Animales , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Gastritis/metabolismo , Gastritis/patología , Gastritis Atrófica/metabolismo , Gastritis Atrófica/patología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/metabolismo , Infecciones por Helicobacter/patología , Humanos , Inmunofenotipificación , Ratones , Neoplasias Gástricas/etiología , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patología , Linfocitos T/metabolismo , Linfocitos T/patologíaRESUMEN
PURPOSE: To evaluate the radial peripapillary capillary density using optical coherence tomography angiography in patients with and without Helicobacter pylori infection. METHODS: This prospective, cross-sectional study comprised 52 patients (52 eyes: Group 1) and 38 patients (38 eyes: Group 2) with and without H. pylori infections, respectively. The radial peripapillary capillary density and retinal nerve fiber layer thickness in 4 equal quadrants and 2 equal hemispheres in the peripapillary region were calculated using optical coherence tomography angiography. The optic nerve head parameters of the patients were also assessed. RESULTS: The groups were similar in terms of age, gender, and the optic nerve head parameters. The radial peripapillary capillary densities in the superior hemisphere and quadrant were significantly lower in Group 1 than in Group 2 (p=0.039 and p=0.028, respectively) and were positively correlated with the superior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). Similarly, the radial peripapillary capillary densities in the inferior hemisphere and quadrant were also significantly lower in Group 1 compared to Group 2 (p=0.03 and p=0.017, respectively) and were positively correlated with the inferior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). The retinal nerve fiber layer thickness in the nasal and temporal quadrants were significantly decreased in Group 1 when compared to Group 2 (p=0.013 and p=0.022) and were positively correlated with the corresponding radial peripapillary capillary densities of the 2 quadrants (p=0.002 and p=0.022). CONCLUSION: The decreased radial peripapillary capillary density in the H. pylori-positive patients suggests that H. pylori may play a role in the etiopathogenesis of glaucoma.
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Infecciones por Helicobacter , Helicobacter pylori , Estudios Transversales , Angiografía con Fluoresceína/métodos , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patología , Humanos , Fibras Nerviosas/patología , Estudios Prospectivos , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodosRESUMEN
BACKGROUND: Recent experimental studies have suggested a potential link between cathepsin S (CTTS) and gastric adenocarcinoma progression. Herein, we aimed to evaluate the expression of CTTS in gastric adenocarcinoma in patients who underwent curative-intent surgical resection. METHODS: This was a cross-sectional study that included two groups: gastric adenocarcinoma (n = 42) and gastritis (n = 50). The gastritis group was then subdivided into H. pylori-positive (n = 25) and H. pylori-negative (n = 25) groups. Gastric tissue samples were analysed to determine CTTS expression through immunohistochemistry. Samples were obtained by oesophagogastroduodenoscopy or surgical specimens. RESULTS: In patients with gastritis, the age ranged from 18 to 78 years. Among them, 34% were male, and 66% were female. In patients with gastric adenocarcinoma, the age ranged from 37 to 85 years. Among them, 50% were male. When comparing the expression of CTTS between the two groups, only 16% of the gastritis samples had an expression higher than 25%. Alternatively, among patients with gastric adenocarcinoma, 19% had expression between 25-50%, 14.3% between 51-75%, and 26.2% had expression higher than 75% (p < 0.001). In the gastritis group, CTTS expression was significantly higher in patients with a positive test for H. pylori than negative test for H. pylori: 87.5% and 38.5%, respectively (p<0.001). There was no statistically significant association between CTTS positivity and clinicopathological variables, including tumour staging, histological type, angiolymphatic invasion, recurrence, current status and death. CONCLUSION: CTTS expression is higher in gastric adenocarcinoma samples. Patients with gastritis due to H. pylori also show a higher expression of CTTS than patients with negative results for this bacterium.
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Adenocarcinoma , Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Neoplasias Gástricas , Adenocarcinoma/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Catepsinas , Estudios Transversales , Femenino , Mucosa Gástrica/patología , Gastritis/patología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Gástricas/patología , Adulto JovenRESUMEN
INTRODUCTION AND AIMS: Colombia has high incidence levels of gastric cancer that can be explained by the genetic variability of Helicobacter pylori (H. pylori). Our aim was to establish the relation of the H. pylori CagA and VacA genotypes to dysplasia and gastric cancer, in a high-risk population. MATERIAL AND METHODS: A case-control study was conducted on 202 patients from a high-risk cancer zone. Patients with dysplasia and gastric cancer (cases) and patients with nonatrophic gastritis (controls) were included. Endoscopic sampling and histologic classification were carried out according to the Sydney system and the Lauren classification. Genetic information was obtained through polymerase chain reaction on paraffin blocks. The measures of association of the variables of interest were evaluated in bivariate and multivariate models. A P<0.05 was considered statistically significant and the SPSS version 25 program was employed. RESULTS: Age above 50 years (OR: 23.76; CI: 8.40-67.17; P=0.000) and the VacA s1m1 genotype (OR: 6.18; CI: 1.25-30.51; P=0.025) were associated with higher risk for developing dysplasia and gastric cancer. The CagA+ genotype was not found to be a risk factor for developing those pathologies (OR: 1.02; CI: 0.39-2.62; P=0.965). CONCLUSIONS: The H. pylori VacA genotypes are markers for the development of gastric cancer. That information could be used to create a risk index in a predictive model to optimize the healthcare of higher-risk patients.
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Infecciones por Helicobacter , Helicobacter pylori , Neoplasias Gástricas , Antígenos Bacterianos/genética , Proteínas Bacterianas/genética , Estudios de Casos y Controles , Colombia/epidemiología , Genotipo , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/patología , Helicobacter pylori/genética , Humanos , Persona de Mediana Edad , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/epidemiologíaRESUMEN
Extracellular vesicles (EVs) are cell-derived vesicles important in intercellular communication that play an essential role in host-pathogen interactions, spreading pathogen-derived as well as host-derived molecules during infection. Pathogens can induce changes in the composition of EVs derived from the infected cells and use them to manipulate their microenvironment and, for instance, modulate innate and adaptive inflammatory immune responses, both in a stimulatory or suppressive manner. Gastric cancer is one of the leading causes of cancer-related deaths worldwide and infection with Helicobacter pylori (H. pylori) is considered the main risk factor for developing this disease, which is characterized by a strong inflammatory component. EVs released by host cells infected with H. pylori contribute significantly to inflammation, and in doing so promote the development of disease. Additionally, H. pylori liberates vesicles, called outer membrane vesicles (H. pylori-OMVs), which contribute to atrophia and cell transformation in the gastric epithelium. In this review, the participation of both EVs from cells infected with H. pylori and H. pylori-OMVs associated with the development of gastric cancer will be discussed. By deciphering which functions of these external vesicles during H. pylori infection benefit the host or the pathogen, novel treatment strategies may become available to prevent disease.
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Vesículas Extracelulares/metabolismo , Infecciones por Helicobacter/metabolismo , Helicobacter pylori/metabolismo , Gastropatías/metabolismo , Membrana Externa Bacteriana/metabolismo , Progresión de la Enfermedad , Vesículas Extracelulares/genética , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/patogenicidad , Humanos , Gastropatías/microbiología , Gastropatías/patologíaRESUMEN
PURPOSE: Analyze the expression of caspase-9, Smac/DIABLO, XIAP, let-7a, and let-7b in patients with normal gastric tissue, chronic gastritis, and gastric adenocarcinoma. METHODS: The expression of caspase-9, Smac/DIABLO, XIAP, let-7a, and let-7b by qRT-PCR was analyzed in 158 samples from 53 patients with normal gastric mucosa, 86 with chronic gastritis, and 19 with gastric cancer. RESULTS: The comparison between the gastric cancer and the control group revealed a decreased expression of caspase-9 in gastric cancer tissues; considering the Helicobacter pylor presence, comparable results were revealed. Smac/DIABLO was increased in gastric cancer cells, while XIAP demonstrated no significant difference in the gene expression. The microRNA analysis revealed a decreased expression of let-7a and let-7b in samples positive to H. pylori infection and in gastric cancer group, regardless of the presence of the bacterium. CONCLUSION: Our study provided some evidence of low activity of the intrinsic apoptosis pathway, as well as the influence of H. pylori on let-7a and let-7b expression.
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Adenocarcinoma/genética , Apoptosis/genética , Biomarcadores de Tumor/genética , Carcinogénesis/genética , Neoplasias Gástricas/genética , Adenocarcinoma/patología , Adulto , Anciano , Proteínas Reguladoras de la Apoptosis/genética , Biopsia , Caspasa 9/genética , Femenino , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Gastritis/genética , Gastritis/microbiología , Gastritis/patología , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Infecciones por Helicobacter/genética , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , MicroARNs/genética , Persona de Mediana Edad , Proteínas Mitocondriales/genética , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patología , Proteína Inhibidora de la Apoptosis Ligada a X/genéticaRESUMEN
PURPOSE: The aim of this study was to evaluate the expression of miR-125a-5p in patients with dyspeptic symptoms and gastric cancer, correlating them with the development of this cancer and H. pylori. METHODS: Patients were divided in groups according to histopathological analysis (control, gastritis, and cancer groups). Polymerase chain reaction was performed to detect H. pylori and real-time quantitative PCR to determine miR-125a-5p expression. RESULTS: H. pylori was detected in 44% of the patients, with prevalence in the gastritis and cancer groups. A statistically significant decrease of miR-125a-5p expression was found in the control positive (p = 0.0183*), gastritis positive (p = 0.0380*), and cancer positive (p = 0.0288*) groups when compared with the control negative group. CONCLUSION: We suggest that decreased expression of the miRNA-125a-5p associated with the presence of the H. pylori is an important mechanism in gastric diseases and could be a possible marker for early diagnosis of gastric cancer.
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Biomarcadores de Tumor/metabolismo , Gastritis/genética , Infecciones por Helicobacter/genética , MicroARNs/metabolismo , Neoplasias Gástricas/genética , Adulto , Anciano , Biomarcadores de Tumor/análisis , Brasil/epidemiología , Línea Celular Tumoral , Proliferación Celular , Detección Precoz del Cáncer/métodos , Femenino , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Gastritis/microbiología , Gastritis/patología , Perfilación de la Expresión Génica , Predisposición Genética a la Enfermedad , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , MicroARNs/análisis , Persona de Mediana Edad , Prevalencia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patologíaRESUMEN
BACKGROUND & AIMS: Helicobacter pylori eradication and endoscopic surveillance of gastric precancerous lesions are strategies to reduce gastric cancer (GC) risk. To our knowledge, this study is the longest prospective cohort of an H pylori eradication trial in a Hispanic population. METHODS: A total of 800 adults with precancerous lesions were randomized to anti-H pylori treatment or placebo. Gastric biopsy samples taken at baseline and 3, 6, 12, 16, and 20 years were assessed by our Correa histopathology score. A generalized linear mixed model with a participant-level random intercept was used to estimate the effect of H pylori status on the score over time. Logistic regression models were used to estimate progression by baseline diagnosis and to estimate GC risk by intestinal metaplasia (IM) subtype and anatomic location. RESULTS: Overall, 356 individuals completed 20 years of follow-up. Anti-H pylori therapy (intention-to-treat) reduced progression of the Correa score (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.38-0.93). H pylori-negative status had a beneficial effect on the score over time (P = .036). Among individuals with IM (including indefinite for dysplasia) at baseline, incidence rates per 100 person-years were 1.09 (95% CI, 0.85-1.33) for low-grade/high-grade dysplasia and 0.14 (95% CI, 0.06-0.22) for GC. Incomplete-type (vs complete-type) IM at baseline presented higher GC risk (OR, 13.4; 95% CI, 1.8-103.8). Individuals with corpus (vs antrum-restricted) IM showed an OR of 2.1 (95% CI, 0.7-6.6) for GC. CONCLUSIONS: In a high-GC-risk Hispanic population, anti-H pylori therapy had a long-term beneficial effect against histologic progression. Incomplete IM is a strong predictor of GC risk.
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Antibacterianos/uso terapéutico , Mucosa Gástrica/patología , Infecciones por Helicobacter/tratamiento farmacológico , Lesiones Precancerosas/epidemiología , Neoplasias Gástricas/prevención & control , Adulto , Anciano , Biopsia , Colombia/epidemiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/microbiología , Gastroscopía/estadística & datos numéricos , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Humanos , Incidencia , Masculino , Metaplasia/diagnóstico , Metaplasia/epidemiología , Metaplasia/microbiología , Metaplasia/patología , Persona de Mediana Edad , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/microbiología , Lesiones Precancerosas/patología , Estudios Prospectivos , Factores de Riesgo , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patología , Resultado del TratamientoRESUMEN
Resumen: Introducción: Las últimas guías clínicas conjuntas de NASPGHAN y ESPGHAN en relación a la infección por H. pylori publicadas el año 2016, contienen 20 afirmaciones que han sido cuestionadas en la práctica respecto a su aplicabilidad en Latinoamérica (LA); en particular en relación a la preven ción del cáncer gástrico. Métodos: Se realizó un análisis crítico de la literatura, con especial énfasis en datos de LA y se estableció el nivel de evidencia y nivel de recomendación de las afirmaciones mas controversiales de las Guías Conjuntas. Se realizaron 2 rondas de votación de acuerdo a la técnica Delfi de consenso y se utilizó escala de Likert (de 0 a 4) para establecer el "grado de acuerdo" entre un grupo de expertos de SLAGHNP. Resultados: Existen pocos estudios en relación a diagnóstico, efectividad de tratamiento y susceptibilidad a antibióticos de H. pylori en pacientes pediátricos de LA. En base a estos estudios, extrapolaciones de estudios de adultos y la experiencia clínica del panel de expertos participantes, se realizan las siguientes recomendaciones. Recomendamos la toma de biopsias para test rápido de ureasa e histología (y muestras para cultivo o técnicas moleculares, cuando estén disponibles) durante la endoscopia digestiva alta sólo si en caso de confirmar la infección por H. pylori, se indicará tratamiento de erradicación. Recomendamos que centros regionales seleccio nados realicen estudios de sensibilidad/resistencia antimicrobiana para H. pylori y así actúen como centros de referencia para toda LA. En caso de falla de erradicación de H. pylori con tratamiento de primera línea, recomendamos tratamiento empírico con terapia cuádruple con inhibidor de bomba de protones, amoxicilina, metronidazol y bismuto por 14 días. En caso de falla de erradicación con el esquema de segunda línea, se recomienda indicar un tratamiento individualizado considerando la edad del paciente, el esquema indicado previamente y la sensibilidad antibiótica de la cepa, lo que implica realizar una nueva endoscopía con extracción de muestra para cultivo y antibiograma o es tudio molecular de resistencia. En niños sintomáticos referidos a endoscopía que tengan antecedente de familiar de primer o segundo grado con cáncer gástrico, se recomienda considerar la búsqueda de H. pylori mediante técnica directa durante la endoscopia (y erradicarlo cuando es detectado). Con clusiones: La evidencia apoya mayoritariamente los conceptos generales de las Guías NASPGHAN/ ESPGHAN 2016, pero es necesario adaptarlas a la realidad de LA, con énfasis en el desarrollo de centros regionales para el estudio de sensibilidad a antibióticos y mejorar la correcta selección del tratamiento de erradicación. En niños sintomáticos con antecedente familiar de primer o segundo grado de cáncer gástrico, se debe considerar la búsqueda y erradicación de H. pylori.
Abstract: Introduction: The latest joint H. pylori NASPGHAN and ESPGHAN clinical guidelines published in 2016, contain 20 statements that have been questioned in practice regarding their applicability in Latin America (LA); in particular in relation to gastric cancer prevention. Methods: We conduc ted a critical analysis of the literature, with special emphasis on LA data and established the level of evidence and level of recommendation of the most controversial claims in the Joint Guidelines. Two rounds of voting were conducted according to the Delphi consensus technique and a Likert scale (from 0 to 4) was used to establish the "degree of agreement" among a panel of SLAGHNP ex perts. Results: There are few studies regarding diagnosis, treatment effectiveness and susceptibility to antibiotics of H. pylori in pediatric patients of LA. Based on these studies, extrapolations from adult studies, and the clinical experience of the participating expert panel, the following recom mendations are made. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, when available) during upper endoscopy only if in case of confirmed H. pylori infection, eradication treatment will be indicated. We recommend that selected regional centers conduct antimicrobial sensitivity/resistance studies for H. pylori and thus act as reference centers for all LA. In case of failure to eradicate H. pylori with first-line treatment, we recommend empirical treatment with quadruple therapy with proton pump inhibitor, amoxi cillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second line scheme, it is recommended to indicate an individualized treatment considering the age of the pa tient, the previously indicated scheme and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with sample extraction for culture and antibiogram or molecular resistance study. In symptomatic children referred to endoscopy who have a history of first or se cond degree family members with gastric cancer, it is recommended to consider the search for H. pylori by direct technique during endoscopy (and eradicate it when detected). Conclusions: The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivity and to improve the correct selection of the eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H. pylori should be considered.
Asunto(s)
Humanos , Preescolar , Niño , Adolescente , Endoscopía del Sistema Digestivo/normas , Helicobacter pylori/aislamiento & purificación , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/patología , Infecciones por Helicobacter/prevención & control , Infecciones por Helicobacter/tratamiento farmacológico , Inhibidores de la Bomba de Protones/uso terapéutico , Antibacterianos/uso terapéutico , Pediatría/métodos , Pediatría/normas , Estómago/patología , Estómago/diagnóstico por imagen , Biopsia , Pruebas de Sensibilidad Microbiana/normas , Endoscopía del Sistema Digestivo/métodos , Técnica Delphi , Resultado del Tratamiento , Quimioterapia Combinada , América LatinaRESUMEN
OBJECTIVES: The study was designed to determine the presence of Helicobacter genus and three species of H. pylori, H. bilis, and H. canis, in the duodenum, ileum, colon, and liver of stray cats. Moreover, the histopathological and immunohistochemical analyses have been performed. METHODS: Samples were taken from the duodenum, ileum, colon, and liver of 30 cats for molecular and histopathological evaluations. Polymerase chain reaction was carried out for the detection of the Helicobacter genus in the mentioned samples. Then, species-specific primers were used in Helicobacter-positive samples. RESULTS: Helicobacter genus prevalence rates in the duodenum, ileum, colon, and liver samples were 50%, 60%, 50%, and 43.3%, respectively. Helicobacter pylori, H. canis, and H. bilis were isolated from at least one tissue of 18 (60%), 13 (43.3%), and 8 (26.7%) of the cats, respectively. Immunohistochemical findings confirmed the presence of bacteria in the intestinal crypt or the mucosal layer of duodenum, ileum, colon, and hepatic sinusoids. CONCLUSION: In the present study, the concurrent infection of duodenum and liver was noticeable. Furthermore, the high prevalence of H. pylori in cats, as a well-known human pathogen, should be considered. High incidence of Helicobacter in gut and liver of Ahvaz stray cats is noticeable. According to the zoonotic importance of Helicobacter, more studies in the field of treatment and prevention are highly recommended.
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Animales Salvajes/microbiología , Infecciones por Helicobacter/veterinaria , Helicobacter/clasificación , Intestinos/microbiología , Hígado/microbiología , Animales , Gatos/microbiología , ADN Bacteriano/genética , Helicobacter/aislamiento & purificación , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/patología , Inmunohistoquímica , Irán/epidemiología , Prevalencia , ARN Ribosómico 16S/genéticaRESUMEN
BACKGROUND: Regional variations in gastric cancer incidence are not explained by prevalence of Helicobacter pylori, the main cause of the disease, with several areas presenting high H. pylori prevalence but low gastric cancer incidence. The IARC worldwide H. pylori prevalence surveys (ENIGMA) aim at systematically describing age and sex-specific prevalence of H. pylori infection around the world and generating hypotheses to explain regional variations in gastric cancer risk. METHODS: We selected age- and sex-stratified population samples in two areas with different gastric cancer incidence and mortality in Chile: Antofagasta (lower rate) and Valdivia (higher rate). Participants were 1-69 years old and provided interviews and blood for anti-H. pylori antibodies (IgG, VacA, CagA, others) and atrophy biomarkers (pepsinogens). RESULTS: H. pylori seroprevalence (Age-standardized to world population) and antibodies against CagA and VacA were similar in both sites. H. pylori seroprevalence was 20% among children <10 years old, 40% among 10-19 year olds, 60% in the 20-29 year olds and close to or above 80% in those 30+ years. The comparison of the prevalence of known and potential H. pylori cofactors in gastric carcinogenesis between the high and the low risk area showed that consumption of chili products was significantly higher in Valdivia and daily non-green vegetable consumption was more common in Antofagasta. Pepsinogen levels suggestive of gastric atrophy were significantly more common and occurred at earlier ages in Valdivia, the higher risk area. In a multivariate model combining both study sites, age, chili consumption and CagA were the main risk factors for gastric atrophy. CONCLUSIONS: The prevalence of H. pylori infection and its virulence factors was similar in the high and the low risk area, but atrophy was more common and occurred at younger ages in the higher risk area. Dietary factors could partly explain higher rates of atrophy and gastric cancer in Valdivia. IMPACT: The ENIGMA study in Chile contributes to better understanding regional variations in gastric cancer incidence and provides essential information for public health interventions.
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Infecciones por Helicobacter/complicaciones , Helicobacter pylori/aislamiento & purificación , Neoplasias Gástricas/etiología , Estómago/patología , Adolescente , Adulto , Anciano , Atrofia/etiología , Atrofia/microbiología , Atrofia/patología , Niño , Preescolar , Chile/epidemiología , Femenino , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/patología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Estómago/microbiología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/patología , Adulto JovenRESUMEN
INTRODUCTION: Inflammation associated with Helicobacter pylori (H. pylori) infection is linked to the development of a gastric precancerous lesion. Helminth infections could influence the pro-inflam matory response to such infection from LTCD4+ Th1 to a less harmful LTCD4+ Th2 response. Ob jective: To characterize the polarization of the LTCD4+ Th2 immune response in co-infected pa tients with H. pylori and helminths from low-risk areas for developing gastric cancer. PATIENTS AND METHOD: We analyzed 63 patients infected by H. pylori (40 adults and 23 children). Through the Multiplex Analysis technology (xMAP), we determined the serum profiles of the interleukins asso ciated with the polarization of the immune response of LTCD4+ Th1 (IL-1Β, INF-γ, TNF-α) as well as the LTCD4+ Th2 (IL-4, IL-10, and IL-13). The ratio between helminths co-infection status in H. pylori-infected patients and the polarization of the immune response mediated by LTCD4+ Th1 and LTCD4+ Th2 was assessed using a Mixed Effects Logistic Regression Model. RESULTS: The frequency of helminths was similar between adults (15%) and children (17%). The polarization of the immu ne response was more prevalent in LTCD4+ Th1. Serum values of interleukins associated with the immune response polarization of LTCD4+ Th1 (IL-1Β, INF-γ, and TNF-α) and LTCD4+ Th2 (IL-4, IL-10, and IL-13) were independent of helminths infection status. CONCLUSION: The prevalence of in testinal parasitic infection was high and the immune response polarization was mainly LTCD4 + Th1.
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Linfocitos T CD4-Positivos/inmunología , Coinfección/inmunología , Infecciones por Helicobacter/inmunología , Helicobacter pylori/inmunología , Helmintiasis/inmunología , Balance Th1 - Th2 , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Linfocitos T CD4-Positivos/metabolismo , Niño , Preescolar , Coinfección/sangre , Coinfección/diagnóstico , Coinfección/patología , Femenino , Infecciones por Helicobacter/sangre , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/patología , Helmintiasis/sangre , Helmintiasis/diagnóstico , Helmintiasis/patología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana EdadRESUMEN
AIMS: Silibinin is the major component of flavonolignans complex mixture (Silymarin), which is obtained from Silybum marianum (L.) Gaertn. Despite several reports about silibinin, little is known about its effects on gastric diseases. Then, the present study aims to evaluate the silibinin effect against Helicobacter pylori infection, gastric tumor cells and immunomodulation. MAIN METHODS: The anti-H. pylori effect was performed on 43504 and 43629 strains by minimum inhibitory concentration (MIC) determination, observing morphological alterations by scanning electron microscopy and in silico evaluation by molecular docking. Immunomodulatory activity (Interleukins-6 and 10, TNF-α and NO inhibition) was determined in H. pylori-stimulated macrophages and the cytotoxic activity on gastric adenocarcinoma cells prior and after metabolization by S9 fraction. KEY FINDINGS: Silibinin showed anti-H. pylori activity with MIC of 256 µg/mL, promoted important morphological changes in the bacterial cell wall, as blebs and clusters, suggesting interaction with Penicillin Binding Protein (PBP) subunits. Immunomodulatory potential was observed at 50 µg/mL with the inhibition of produced cytokines and NO by H. pylori-stimulated macrophages of 100% for TNF-É, 56.83% for IL-6, and 70.29% for IL-10 and 73.33% for NO. Moreover, silibinin demonstrated significant cytotoxic activity on adenocarcinoma cells (CI50: 60.17 ± 0.95 µg/mL) with a higher selectivity index (SI: 1.52) compared to cisplatin. After metabolization silibinin showed an increase of cytotoxicity with a CI50 six-fold decrease (10.46 ± 0.25). SIGNIFICANCE: The use of silibinin may become an important alternative tool in the prevention and treatment of H. pylori infection and, consequently, in gastric cancer.