GASTRIC CANCER DETECTED AFTER HELICOBACTER PYLORI ERADICATION

Background: Helicobacter pylori is associated with progression to gastric cancer. However, it is still unclear whether eradication therapy can prevent the development of gastric cancer. Methods: Subjects were 242 patients in whom success in eradication of Helicobacter pylori had been continuous for more than 3 years. Clinical, endoscopic and histological findings were compared retrospectively between those who developed gastric cancer (cancer group) and those who did not (non‐cancer group). Clinical features of each cancer case were also evaluated. Results: Gastric cancer was found in six of the 242 subjects (2.5%) during a mean follow‐up period of 4.6 years (range: 3.0–7.0). The mean age of the cancer group tended to be higher than that of the non‐cancer group. Endoscopy revealed a more severe grade of gastric corpus atrophy in the cancer group, and histological findings showed that the degree of intestinal metaplasia in the upper corpus was higher in the cancer group. Four of the six cancers were located in the gastric antrum. All were early cancers and five were of 0‐IIc type endoscopically. All were intestinal type histologically. Conclusions: Gastric cancer was discovered at a rate of 2.5% during the mean follow‐up period of 4.6 years after H. pylori eradication. Careful endoscopic follow up is necessary even after successful eradication, especially in cases characterized by an endoscopically high grade of gastric atrophy and pathologically severe intestinal metaplasia at the upper corpus.     

Helicobacter pylori Infection,Pattern of Gastritis,and Symptoms in Erosive and Nonerosive Gastroesophageal Reflux Disease

Background: The aim of this study was to evaluate the prevalence of Helicobacter pylori infection and the characteristics of gastritis and symptoms of patients with erosive and nonerosive gastroesophageal reflux disease (GERD). Methods: We studied 202 consecutive patients with a diagnosis of GERD (symptoms score and endoscopy): group A (n = 110), erosive GERD; group B (n = 92), nonerosive GERD; 200 patients with upper abdominal complaints without abnormalities at endoscopy (functional dyspepsia, group C); and 200 asymptomatic controls tested for H. pylori serum antibody (group D). Antral and body biopsy specimens were taken for histology and the rapid urease test in groups A, B, and C. Results: The prevalence of H. pylori infection was higher in groups B and C (62% and 55%, respectively) than in A and D (36% and 40%) (P < 0.05). In positive patients H. pylori colonization and gastritis grade scores in the gastric body were higher in nonerosive than in erosive GERD and functional dyspepsia (P < 0.05). No differences in H. pylori colonization or gastritis grades were found in the antrum. Fifty-nine patients with nonerosive GERD (64%) and 42 with erosive GERD (38%) showed other dyspeptic symptoms associated with reflux symptoms (P < 0.05). Conclusions: H. pylori prevalence is higher in patients with nonerosive GERD than in normal subjects and in patients with erosive GERD and similar to that of patients with dyspepsia. Patients with nonerosive GERD often show dyspeptic symptoms and higher H. pylori colonization and inflammation grades in the proximal stomach. Our data support the hypothesis that in GERD H. pylori gastritis may, on the one hand, protect against the development of esophageal erosions and, on the other, contribute to the esophageal hypersensitivity to acid which is a feature of GERD.     

Helicobacter pylori infection and gastritis: the Systematic Investigation of gastrointestinaL diseases in China (SILC)

Background and Aim: Helicobacter pylori infection remains common in East Asia, though its prevalence is decreasing in Western countries. H. pylori‐related atrophic gastritis (AG) may reduce the likelihood of gastroesophageal reflux disease (GERD). We investigated the prevalence of H. pylori infection and AG and their association with endoscopic findings and symptom‐defined GERD in Shanghai. Methods: A representative random sample of 3600 Shanghai residents aged 18–80 years was invited to complete a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire, to provide blood samples for H. pylori serology and pepsinogen (PG) I/II assay (to detect AG, defined as PGI < 70 µg/L and/or PGI/PGII < 7), and to undergo endoscopy. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multivariate logistic regression. Results: A total of 1022 Shanghai residents underwent endoscopy and were valid for inclusion in the study. Of these, 71.7% tested positive for H. pylori, 63.8% had AG and 30.5% had moderate/severe AG (PGI < 50 µg/L and/or PGI/PGII < 5). Helicobacter pylori infection was equally common in all age groups. Severity of AG increased with age in women. Reflux esophagitis was inversely associated with AG (OR, 0.23 [CI, 0.09–0.55] for moderate/severe AG compared with no H. pylori or gastritis). However, symptom‐defined GERD showed no clear association with AG. Conclusions: Helicobacter pylori infection and AG are very common in Shanghai, and the infection is acquired early in life. Atrophic gastritis is inversely associated with reflux esophagitis but is not significantly associated with symptom‐defined GERD.     

Serum screening for detection of high-risk group for early-stage diffuse type gastric cancer in Japanese

Background and Aim: Serum screening systems are beneficial for gastric cancer mass surveys; however, the marker for diffuse type gastric cancer (DGC) is not defined. We attempted to define the high‐risk group for DGC by using serum markers of anti‐Helicobacter pylori antibody and pepsinogens (PG). Methods: Forty‐two patients in the early stage of DGC and 511 controls were enrolled. Fasting serum samples were collected, and anti‐H. pylori antibody and PG were evaluated. The risk for DGC was calculated. Results: The prevalence of DGC was higher in H. pylori‐positive patients (odds ratio [OR] = 4.3 in men, 9.6 in women). DGC prevalence was significantly higher in the PG1+ group in women (OR = 10.7); however, it was lower in the PG3+ group in both men and women. Patients with PG II ≥ 30 revealed a significantly higher risk for DGC. By combining factors, higher OR (OR = 12.5 in men, 42.7 in women) were obtained when we defined the risk group as H. pylori‐positive, PG‐negative, and having PG II ≥ 30. Conclusion: The risk group for DGC can be defined by evaluating ordinary serum gastritis markers.     

Relationship of sliding hiatus hernia to gastroesophageal reflux disease: a possible role for Helicobacter pylori infection?

Sliding hiatal hernia is a common endoscopic finding with a prevalence that increases with the age of patients. Although nearly all patients with GERD have HH, only a minority of patients with hernia reports reflux symptoms. Our hypothesis is that H. pylori infection may be responsible for the high number of asymptomatic hernias. After exclusion of patients with peptic ulcer, 507 patients with an endoscopic diagnosis of hernia were considered. Patients were divided into three groups: A, 45 years, 141 patients; B, 46–60 years, 144 patients; and C, 61 years, 222 patients. Presence of reflux symptoms (questionnaire) and esophagitis, H. pylori status, and gastric histology were recorded. The prevalence of hernia in the total series was 11% in group A, 23% in B, and 38% in C. Aging was associated with a significant increase in H. pylori prevalence and corpus gastritis scores, and a parallel decrease of GERD symptom prevalence, which was 66.6% in group A, 52.1% in B, and 46.8% in C (P < 0.01). Taking the three groups together, prevalence of H. pylori infection was higher in patients without GERD than with GERD (66.4 vs 57.3%, P < 0.05), and higher in patients with nonerosive GERD than erosive GERD (62.8 vs 48.6%, P = 0.02); corpus gastritis scores were significantly higher in patients without GERD than those with GERD and in those with nonerosive than erosive GERD. In conclusion, H. pylori infection protects against development of GERD in subjects with hiatus hernia. This effect is significantly more evident in the elderly where, in spite of the high prevalence of hernia, only a small number of individuals develop GERD. The development of a corpus-predominant gastritis is probably responsible for this effect.     

Gastroesophageal reflux disease: An Asian perspective

The prevalence of gastroesophageal reflux disease (GERD) ranges from 2.5% to 7.1% in most population‐based studies in Asia. There is evidence that GERD and its complications are rising, coinciding with a decline in Helicobacter pylori (H. pylori) infection. Asian GERD patients share similar risk factors and pathophysiological mechanisms with their Western counterparts. Possible causes for the lower prevalence of GERD include less obesity and hiatus hernia, a lesser degree of esophageal dysmotility, a high prevalence of virulent strains of H. pylori, and low awareness. Owing to the lack of precise translation for ‘heartburn’ in most Asian languages, reflux symptoms are often overlooked or misinterpreted as dyspepsia or chest pain. Furthermore, a symptom‐based diagnosis with a therapeutic trial of the proton pump inhibitor (PPI) may be hampered by the high prevalence of H. pylori‐related disease. The risk stratification for prompt endoscopy, use of a locally‐validated, diagnostic symptom questionnaire, and response to H. pylori‘test and treat’ help improve the accuracy of the PPI test for diagnoses. PPI remain the gold standard treatment, and ‘on‐demand’ PPI have been shown to be a cost‐effective, long‐term treatment. The clinical course of GERD is benign in most patients in Asia. The risk of progression from non‐erosive reflux disease to erosive esophagitis is low, and treatment response to a conventional dose of PPI is generally higher. Although H. pylori eradication may lead to more resilient GERD in a subset of patients, the benefits of H. pylori eradication outweigh the risks, especially in Asian populations with a high incidence of gastric cancer.     

Relationship of Sliding Hiatus Hernia to Gastroesophageal Reflux Disease: A Possible Role for Helicobacter pylori Infection?

Sliding hiatal hernia is a common endoscopic finding with a prevalence that increases with the age of patients. Although nearly all patients with GERD have HH, only a minority of patients with hernia reports reflux symptoms. Our hypothesis is that H. pylori infection may be responsible for the high number of asymptomatic hernias. After exclusion of patients with peptic ulcer, 507 patients with an endoscopic diagnosis of hernia were considered. Patients were divided into three groups: A, 45 years, 141 patients; B, 46–60 years, 144 patients; and C, 61 years, 222 patients. Presence of reflux symptoms (questionnaire) and esophagitis, H. pylori status, and gastric histology were recorded. The prevalence of hernia in the total series was 11% in group A, 23% in B, and 38% in C. Aging was associated with a significant increase in H. pylori prevalence and corpus gastritis scores, and a parallel decrease of GERD symptom prevalence, which was 66.6% in group A, 52.1% in B, and 46.8% in C (P < 0.01). Taking the three groups together, prevalence of H. pylori infection was higher in patients without GERD than with GERD (66.4 vs 57.3%, P < 0.05), and higher in patients with nonerosive GERD than erosive GERD (62.8 vs 48.6%, P = 0.02); corpus gastritis scores were significantly higher in patients without GERD than those with GERD and in those with nonerosive than erosive GERD. In conclusion, H. pylori infection protects against development of GERD in subjects with hiatus hernia. This effect is significantly more evident in the elderly where, in spite of the high prevalence of hernia, only a small number of individuals develop GERD. The development of a corpus-predominant gastritis is probably responsible for this effect.     

Five‐year follow‐up study after Helicobacter pylori eradication: Reinfection and peptic ulcer status

OBJECTIVE: To investigate the prevalence of peptic ulcers and Helicobactor pylori reinfection 5 years after H. pylori eradication. METHODS: One thousand and six adults were randomly sampled from the general population in a high‐incidence region of gastric cancer. Of these, 552 subjects were confirmed to be H. pylori‐positive by using both the rapid urease test and the Warthin?Starry stain. All H. pylori‐positive subjects were randomly divided into two groups: (i) the eradication group, who received 1 week of omeprazole‐based triple therapy; and (ii) the control group, who received placebo tablets. Four weeks after the cessation of treatment, ¹³C‐urea breath tests demonstrated that H. pylori had been successfully eradicated in 88.9% of patients in the eradication group, whereas 96.4% of patients remained H. pylori positive in the control group. Subjects in both groups were followed up using endoscopy at the end of the first and fifth year after treatment. The H. pylori infection status was determined by using the rapid urease test and Warthin?Starry staining. RESULTS: The response rates to endoscopy at the end of the first and fifth year were 89.3 and 83.11%, respectively. The prevalence of peptic ulcers in the eradication group and control group were 9.87 and 7.61% before treatment, 3.70 and 12.58% 1 year after treatment (P < 0.05), and 5.86 and 14.93% 5 years after treatment (P < 0.05), respectively. The recurrence rates of peptic ulcers in the eradication group and the control group were 3.70 and 38.10% 1 year after treatment, and 14.81 and 42.86% 5 years after treatment, respectively. The rates of H. pylori infection 1 and 5 years after treatment in the eradication group were 13.58, and 19.82%, respectively. In the control group, the rates of H. pylori infection were 91.97 and 83.26% 1 and 5 years after treatment, respectively. CONCLUSIONS: The prevalence of peptic ulcers decreased significantly after the eradication of H. pylori. The reinfection rate after H. pylori eradication was 4?5% per year. Helicobacter pylori infection status remained constant in almost 85% of cases.     

Comparison of endoscopic findings with symptom assessment systems (FSSG and QUEST) for gastroesophageal reflux disease in Japanese centres

Background and Aim: We compared endoscopic findings of the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), a written questionnaire developed in Japan, to that for the questionnaire for the diagnosis of reflux esophagitis (QUEST) for the diagnosis of reflux esophagitis. Methods: We registered 475 patients with untreated symptoms of upper abdominal pain (male/female: 252/223, average age 52.4 ± 17.8 years). Subjects were assessed first with the FSSG and QUEST questionnaires, then by endoscopy, before allocation to a gastric ulcer (GU), duodenal ulcer (DU), gastroesophageal reflux disease (GERD) or functional dyspepsia (FD) group. Results: On the basis of the endoscopic findings the diagnoses for the 475 subjects were as follows: FD 52.2%, DU 7.6%, GU 7.8%, and GERD 32.4% (Grade M 10.1%, Grade A + B 20.2%, Grade C + D 2.3%). There was no difference between the FSSG and QUEST in sensitivity, specificity or accuracy for any condition. The FSSG score rose with increasing endoscopic severity of GERD, but there was no correlation between the QUEST score and endoscopic severity. The FSSG total score was inferior to QUEST in terms of distinguishing GERD from other conditions, but when only the questions relating to reflux symptoms were used, the FSSG was able to distinguish GERD from other conditions as well as QUEST. Conclusions: The FSSG score reflects the severity of the endoscopic findings of GERD.     

ACCURACY OF ENDOSCOPIC DIAGNOSIS OF HELICOBACTER PYLORI IN PATIENTS WITH HEMORRHAGIC PEPTIC ULCERS

Background: Recent progress in Helicobacter pylori eradication has resulted in dramatic improvements in the incidence of peptic ulcers and decreased rates of ulcer relapse. Because bleeding is an important complication of ulcer diseases, accurate diagnosis of H. pylori infection is necessary. Methods: We studied the efficacy of diagnostic methods to detect H. pylori in hemorrhagic peptic ulcer patients. A total of 59 patients who had received emergency endoscopy because of symptoms such as hematemesis, melena or tarry stool, were examined. Endoscopic methods of H. pylori diagnosis (culture, histological assessment and rapid urease test) and serum anti‐H. pylori assays were used in the hemorrhagic peptic ulcer group and the control group. Results: The percentage of endoscopically determined H. pylori‐negative patients was significantly higher in the hemorrhagic ulcer group than the control group (P < 0.05). Out of the endoscopically determined H. pylori‐negative patients in the hemorrhagic ulcer group, 78.9% were serologically H. pylori‐positive. Conclusion: Endoscopic methods are not sufficient for the diagnosis of H. pylori infection in hemorrhagic ulcer patients. Therefore, serum anti‐H. pylori assessment should also be performed for such patients.     

糖尿病与胃食管反流病临床流行病学研究

目的通过对2型糖尿病患者进行胃食管反流病(GERD)的流行病学调查,探讨其与胃食管反流病发病率的相关性。方法对500例2型糖尿病患者进行反流性疾病问卷调查,其中相关临床指标包括性别、年龄、吸烟、饮酒、BMI、糖尿病病程、空腹血糖、糖尿病并发症等,探讨其与胃食管反流病的相关性。结果糖尿病组GERD发生率(14.2%)较非糖尿病组(7.0%)明显增高(P0.05);糖尿病组中年龄65岁组GERD患病率最高(16.9%),而45岁以下年龄组患病率最低(7.4%);女性人群在糖尿病组中的GERD阳性率(14.8%)明显高于非糖尿病组(5.6%,P0.05);糖尿病病程、糖尿病并发症与糖尿病并发GERD相关(P0.05),吸烟、饮酒、BMI、空腹血糖与GERD无明显相关性(P0.05)。结论糖尿病并发GERD的患病率较高;糖尿病患者中年龄65岁组GERD发病率高于其他年龄组;女性人群在高血糖时发生GERD相关症状的危险性增大;糖尿病病程、糖尿病并发症与糖尿病合并GERD相关。     

Clinically distinct characteristics in patients younger than 40 years old with non-cardiac chest pain

Background and Aim: Little is known about non‐cardiac chest pain (NCCP) in young patients. We aimed to examine the proportion of gastroesophageal reflux disease (GERD) in young patients with NCCP compared to the average‐aged NCCP patients and to evaluate their symptomatic characteristics and the clinical efficacy of a 2‐week proton pump inhibitor (PPI) trial. Methods: Ninety‐six patients with NCCP ≥ 1/week were classified into the young‐aged (≤ 40 years, n = 38) and the average‐aged groups (> 40 years, n = 58). Typical reflux symptoms were assessed. The patients were defined into a GERD group and non‐GERD group according to reflux esophagitis on esophagogastroduodenoscopy and/or pathologic acid exposure on 24‐h esophageal pH monitoring. Then the patients were treated with 30 mg of lansoprazole bid for 14 days. Results: Nine patients (23%) in the young‐aged group and 22 patients (38%) in average‐aged group were diagnosed with GERD‐related NCCP (P = 0.144). The proportion of typical reflux symptoms was higher in the GERD group compared with the non‐GERD group in both age groups. A PPI test improved symptoms in the GERD group irrespective of age, but this improvement was not observed in non‐GERD group. Conclusions: In young NCCP patients, the prevalence of GERD was relatively low compared to average‐aged NCCP, but the difference was insignificant. The PPI test was very effective in diagnosing GERD in the NCCP patients in both age groups. Therefore, in young NCCP patients, if there is a negative response to a 2‐week PPI trial, the possibility of extra‐esophageal disease origin needs to be considered.     

Correlation of serum pepsinogens and gastrin-17 with atrophic gastritis in gastroesophageal reflux patients: a matched-pairs study

Background and Aim: An algorithm (GastroPanel) for the non‐invasive diagnosis of atrophic gastritis has been previously proposed, based on serum pepsinogen‐I, gastrin‐17, and Helicobacter pylori (H. pylori) antibodies. The aim of the present study was to evaluate whether serum markers correlate with and predict gastric atrophy in gastroesophageal reflux disease (GERD) patients. Methods: The baseline data of the prospective ProGERD study, a study on the long‐term course of GERD (n = 6215 patients), served to select patients with atrophic gastritis diagnosed in biopsies from gastric antrum and corpus, and control cases without atrophy. A total of 208 pairs were matched for age, sex, GERD status (erosive vs non‐erosive), presence of Barrett's esophagus, and histological H. pylori status were retrieved. Serum pepsinogen‐I, gastrin‐17, and H. pylori antibodies were determined using specific enzyme immunoassays. Results: A significant negative correlation was found between the degree of corpus atrophy and the level of serum pepsinogen‐I. A previously‐reported negative correlation between the degree of antral atrophy and serum gastrin‐17 could not be confirmed. The low sensitivity (0.32) and specificity (0.70) of the GastroPanel algorithm were mainly due to over diagnosis and under diagnosis of advanced atrophy in the antrum. Conclusion: The diagnostic validity of the GastroPanel algorithm to diagnose gastric atrophy non‐invasively is not sufficient for general use in GERD patients.     

Correlation between serum pepsinogen levels and gastric mucosal histological findings before and after Helicobacter pylori eradication therapy

Background: Helicobacter pylori causes chronic gastritis and is also associated with many other gastrointestinal diseases. The incidence of gastric cancer is thought to vary according to the degree and topography of chronic gastritis. Histological findings of specimens obtained at endoscopy are therefore important. In the present study, we investigated the correlation between these histological findings and serum pepsinogen (PG) levels. Methods: Helicobacter pylori eradication therapy was conducted in 100 H. pylori‐positive patients. Endoscopies were performed prior to, and 2 months after, eradication therapy; gastric mucosal biopsies were taken from the antrum and corpus. Helicobacter pylori infection was diagnosed using the rapid urease test, culture and histology. Using the Updated Sydney System, histological findings of inflammation, activity, atrophy and intestinal metaplasia were each graded. Blood was taken on the same two occasions for determination of serum levels of PG I and II. Results: Levels of PG I were highest in association with antrum‐predominant gastritis (APG), followed in order by pangastritis (PAN) and corpus‐predominant gastritis (CPG), with a significant difference between APG and CPG. No correlations were seen between PG II levels and gastritis topography. Examination of the relationship between PG levels and histological findings revealed significant correlations between PG I levels after eradication atrophy and intestinal metaplasia in the gastric corpus. No significant correlations were seen between PG II levels and before or after eradication histological findings. Conclusion: Our results indicate that serum PG levels may be a useful indicator of before‐eradication gastritis topography and after‐eradication gastric atrophy in the gastric corpus.     

Will symptomatic gastroesophageal reflux disease develop into reflux esophagitis?

Background The objective of this study was to ascertain whether symptomatic gastroesophageal reflux disease (SGERD) without endoscopic evidence of inflammatory findings would develop into esophagitis. Methods Observation by endoscopic examination was conducted annually for 5 years, using as subjects 497 patients among those who underwent gastroesophageal endoscopy in their health examination, but patients with findings of esophagitis and those who had undergone Helicobacter pylori eradication therapy were excluded. Of the 497 subjects, 47 were found to belong to the SGERD group and the remaining 450 to the negative GERD group. Results Hiatus hernia was observed in 31.9% of the SGERD group and 10.9% of the negative GERD group, with the rate being significantly higher in the SGERD group. Esophagitis developed in 36.2% of the SGERD group and in 11.3% of the negative GERD group. The risk of esophagitis was significant in the presence of SGERD (P < 0.01), the absence of H. pylori infection (P < 0.01), the absence of gastric mucosa atrophy (P < 0.01), elevated triglycerides during the 5-year follow-up (P < 0.05), and an elevated body mass index (P < 0.05). Thus, even following adjustment for other factors, SGERD, with a demonstrated hazard ratio of 3.07, was a significant risk of reflux esophagitis. Conclusions The possibility is high that the presence of SGERD is a risk factor for esophagitis. In particular, individuals with hiatus hernia, those without H. pylori infection, and those who smoke and drink alcohol are prone to develop esophagitis.     

NODULAR GASTRITIS WITH HELICOBACTER PYLORI INFECTION IS STRONGLY ASSOCIATED WITH DIFFUSE‐TYPE GASTRIC CANCER IN YOUNG PATIENTS

Background: Nodular gastritis (NG), a particular type of gastritis, is now defined as antral nodularity. Recent studies have shown that NG is strongly associated with Helicobacter pylori infection, and we recently showed that it may be associated with diffuse‐type gastric cancer of the corpus. We retrospectively investigated the relation between NG and gastric cancer in patients aged 29 years or less. Patients and Methods: The study group comprised 150 patients (48 males, 102 females; mean age, 27.7 years) who were endoscopically diagnosed with NG and were less than 29 years of age; 3939 sex‐ and age‐matched patients without NG who were H. pylori‐positive served as the control group (1184 males, 2755 females; mean age, 27.5 years). We estimated the risk of gastric cancer development in patients with NG relative to that of patients without NG. Results: The prevalence of gastric cancer was significantly higher in patients with NG than in the control patients (7/150; 4.7% vs 3/3939; 0.08%, P < 0.001). The odds ratio for the risk of gastric cancer in patients with NG was found to be 64.2 (95% confidence interval; 16.4–250.9). The seven cases of gastric cancer with NG showed the same characteristics: all were diagnosed histologically as the diffuse type and were located in the corpus with H. pylori infection. Conclusion: NG with H. pylori infection is strongly associated with diffuse‐type gastric cancer of the corpus in young patients.     

Effects of Helicobacter pylori infection on Zollinger-Ellison syndrome

Both Zollinger-Ellison syndrome (ZES) and Helicobacter pylori infection are major etiologic factors for peptic ulcer. The aim of this study was to investigate the effect of H. pylori infection on ZES with special reference to acid secretion. Sixteen patients with ZES were selected (median age, 59 years; range, 39–66 years; M/F, 9/7), and H. pylori status, ulcer location, gastric acid secretion, serum pepsinogen (PG) I and II concentrations, and PG I/II ratio were determined. The seroprevalence of H. pylori infection was 50%, whereas active H. pylori infection was seen in only 25% of the patients. Thirteen patients had duodenal ulcer (DU), 1 had gastric ulcer (GU), and 2 had both GU and DU. DU was seen in both H. pylori-positive and H. pylori-negative patients, whereas GU was found only in H. pylori-positive patients. Both basal and maximal acid outputs were significantly lower in H. pylori-positive patients than in H. pylori-negative patients (P < 0.05). Moreover, both serum PG I and the PG I/II ratio were significantly lower in H. pylori-positive patients than in H. pylori-negative patients. These results indicate that ZES is an independent risk factor for DU, but H. pylori infection may play some role in the development of GU in ZES. In patients with ZES, H. pylori infection may reduce both hypersecretion from parietal cells and PG I secretion from chief cells, and hyperacidity of the stomach in ZES may have eradicated H. pylori in some patients. Received: March 30, 2000 / Accepted: May 26, 2000     

Clinical evaluation of hemorrhagic gastroduodenal ulcer in the elderly: Is Helicobacter pylori infection a risk factor for hemorrhage?

Aim: In this study, the aim was to determine the demographic characteristics of elderly patients with gastroduodenal ulcer who had undergone endoscopic hemostasis by comparing them with younger patients. Methods: A total of 353 patients with Forrest class I–IIa hemorrhagic gastroduodenal ulcer who underwent endoscopic hemostasis at our hospital between December 2004 and May 2010 were divided into two groups: one for those 75 years or older (old‐old group; n = 71; age ≥75 years) and one for those younger than 75 years (younger group; n = 282; age <75 years). Then, their demographic characteristics were compared. Results: There were significantly more female patients, patients with underlying chronic renal failure and patients using non‐steroidal anti‐inflammatory drugs in the old‐old group than in the younger group. In addition, the prevalence of open‐type atrophy in the background gastric mucosa was significantly higher in the old‐old group. Although more than half the patients in each group were infected with Helicobacter pylori, the prevalence was significantly higher in the younger group. Of the patients who underwent endoscopic hemostasis only once, those in the old‐old group constituted a significantly higher medical cost than those in the younger group. Comparison of deaths between the two groups revealed that the old‐old patients were more likely to develop severe complications associated with hematemesis, such as aspiration pneumonia. Conclusions: The observed lower prevalence of Helicobacter pylori infection among the elderly patients compared to the younger patients with hemorrhagic gastroduodenal ulcer suggests that other factors, such as non‐steroidal anti‐inflammatory drugs use and chronic renal failure, predispose the elderly to hemorrhagic ulcer.     

Analysis of factors associated with recovery of the serum pepsinogen ratio after Helicobacter pylori eradication: a long-term follow-up study in Korea

Abstract

Objective: Serum levels of pepsinogen (PG) are related to Helicobacter pylori-induced inflammation of the gastric mucosa. This study aimed to examine the influence of H. pylori eradication on serum PG, analyze its associated factors, and evaluate the long-term outcomes.

Methods: H. pylori-positive patients who underwent gastroscopy and serum PG measurement were enrolled in a single academic hospital. After H. pylori eradication, the measurement of serum PG level was performed. Recovery of serum PG I/II ratio was defined as a PG I/II ratio after eradication of >3.0 in patients with a PG I/II ratio ≤ 3.0 before eradication. Follow-up involved serum PG measurement and gastroscopy with a rapid urease test annually.

Results: In all, 327 patients were eligible for study inclusion. Compared to those before H. pylori eradication, serum PG I (74.9 vs. 44.3?ng/mL, p?<?.001) and PG II (25.4 vs. 9.1?ng/mL, p?<?.001) levels significantly decreased after successful eradication. In addition, there was a significant increase in serum PG I/II ratio after eradication (3.07 vs. 4.98, p?<?.001). In multivariate analyses, the following were independently associated with failed recovery of serum PG I/II ratio despite successful eradication: age ≥ 60?years (odds ratio [OR]?=?0.231, 95% confidence interval [CI]?=?0.084–0.629, p?=?.004) and severe gastric atrophy (OR = 0.156, 95% CI = 0.055–0.440, p?<?.001).

Conclusions: Recovery of serum PG I/II ratio after H. pylori eradication may be achieved in H. pylori-infected patients aged <60?years without severe gastric atrophy.     

Nonulcer dyspepsia

Opinion Statement Dyspepsia is a heterogeneous symptom complex with differing symptom presentations, underlying pathophysiology and available treatments. Patients older than 50 years and those who have “alarm” symptoms or signs (eg, weight loss, dysphagia, vomiting, anemia, or heme-positive stool) should undergo an initial endoscopic evaluation. Empiric treatment without diagnostic testing may be used in the initial approach to young patients without alarm symptoms. For patients presenting with uncomplicated dyspepsia, initial testing for H. pylori is appropriate. If present, H. pylori infection is generally treated and symptoms are followed. In patients who do not have H. pylori infection or do not respond to H. pylori treatment, initial treatment with an H2 blocker or promotility agent is appropriate empiric therapy. In some patients, gastroesophageal reflux disease (GERD) presents atypically with primarily dyspeptic symptoms. In these patients, a trial of gastric acid suppressant may help implicate GERD. For patients with nonulcer dyspepsia (ie, dyspeptic symptoms with negative endoscopy), prokinetic therapy may be the most effective empiric treatment.