Is Helicobacter pylori infection a necessary condition for noncardia gastric cancer?

Although the association between Helicobacter pylori infection and gastric cancer is well established, this association might have been underestimated in epidemiologic studies because of possible clearance of the infection in the course of disease development. The authors addressed this hypothesis in a case-control study from Saarland, Germany (68 cases first diagnosed between 1996 and 1998 and 360 controls), with serologic assessment of H. pylori infection in which various exclusion criteria were used to minimize potential bias from this source. Joint application of three such exclusion criteria (blood sample taken more than 90 days after gastrectomy, advanced (T4) gastric cancer, and CagA positivity in Western blot analysis despite a negative result in anti-H. pylori immunoglobulin G enzyme-linked immunosorbent assay) increased the odds ratio of noncardia gastric cancer from 3.7 (95% confidence interval (CI): 1.7, 7.9) to 18.3 (95% CI: 2.4, 136.7) for any H. pylori infection and from 5.7 (95% CI: 2.6, 12.8) to 28.4 (95% CI: 3.7, 217.1) for CagA-positive H. pylori infections. Furthermore, there was no single H. pylori-negative patient out of 32 patients with noncardia gastric cancer left after additional exclusion of subjects with borderline levels in immunoglobulin G enzyme-linked immunosorbent assay. The H. pylori-gastric cancer relation may be much stronger than previously thought, and H. pylori infection may even be a (close to) necessary condition for development of noncardia gastric cancer.     

Helicobacter pylori and overweight status in the United States: data from the Third National Health and Nutrition Examination Survey

Obesity is an important public health problem in the United States. Because of its potential effects on gastric leptin homeostasis, Helicobacter pylori may play a role in regulating body weight. The authors' aim in this study was to examine the association between H. pylori colonization and overweight status. Nonpregnant participants in the Third National Health and Nutrition Examination Survey (1988-1994) aged > or = 20 years who had had H. pylori testing performed and body mass index (weight (kg)/height (m2)) measured were studied. Overweight was defined as a body mass index greater than or equal to 25. On the basis of serologic results, the participants were categorized into three H. pylori status groups: H. pylori-positive and cytotoxin-associated gene A (cagA)-positive (H. pylori+ cagA+), H. pylori-positive and cagA-negative (H. pylori+ cagA-), and H. pylori-negative (H. pylori-). Of the 7,003 subjects with complete body mass index and H. pylori data, 2,634 (weighted percentage, 22.9%) were H. pylori+ cagA+, 1,385 (15.1%) were H. pylori+ cagA-, and 2,984 (62.0%) were H. pylori-. The adjusted odds of being overweight were 1.17 (95% confidence interval: 0.98, 1.39; p = 0.075) for the H. pylori+ cagA+ group and 0.99 (95% confidence interval: 0.80, 1.22; p = 0.92) for the H. pylori+ cagA- group in comparison with H. pylori- subjects. Serum leptin levels did not differ significantly between the three H. pylori groups. In this US population-based study, there was no significant association between H. pylori colonization, cagA+ strains of H. pylori, and being overweight.     

Helicobacter pylori infection and subsequent peptic duodenal disease among young adults

BACKGROUND:Evidence for a causal relationship between presence of Helicobacter pylori (H. pylori) in gastric mucosa and development of peptic disease is based largely on intervention studies in which eradication of H. pylori led to healing of the lesion. The aim of this study was to assess the importance of H. pylori seropositivity for subsequent development of peptic disease in a prospective study design in young Israelis. METHODS:A nested case-control serum bank study based on a systematic sample of male and female inductees to the Israel Defense Force. Twenty-nine cases of duodenal ulcer or duodenitis of moderate or higher severity, diagnosed between 1986 and 1995, were individually matched for age, sex, ethnicity, education and year of induction, with five healthy controls each. Presence of anti-H. pylori antibodies in the frozen stored sera was determined by ELISA. RESULTS:The geometric mean titre of anti-H. pylori antibodies at baseline was significantly higher in cases (18. 3 U/ml) than controls (6.9 U/ml; P = 0.009). The matched odds ratio for peptic ulcer disease by seropositivity was 3.8 (95% CI : 1.4-10. 2). A stronger association was evident for subjects diagnosed > or =2 years after induction than those diagnosed earlier. The population attributable fraction was 56.6% (95% CI : 15.7-81.1). CONCLUSIONS:Pre-existing infection with H. pylori, as determined by seropositivity, is an important determinant of development of duodenal ulcer or duodenitis in young Israelis, supporting the generalizability of an apparent causal association to diverse populations.     

幽门螺杆菌密度和细胞毒素相关基因A在胃部疾病中的检测

目的探讨H.pylori的定植密度及cagA分布与慢性胃疾病病理类型的相互关系。方法胃镜直视下,取胃黏膜组织,经分离培养、快速尿素酶试验和W-S银染对H.pylori感染进行定性、定量诊断,用PCR检测H.pylori的cagA基因,以SPSS软件分析数据。结果①H.pylori在慢性胃部疾病的阳性率为84.6%。cagA阳性率为62.5%,在慢性胃炎,不典型增生,胃癌中的分布分别为:58.0%,70.6%,72.2%,3组间差异无统计学意义(χ2(2,104)=1.804,P=0.406);②H.pylori定植密度在胃黏膜中的分布分别为:1级16(13.0%),2级44(35.8%),3级44(35.8%)。其中慢性胃炎组的分布分别为:1级13(15.9%),2级24(29.3%),3级32(39.0%);不典型增生组的分布分别为:1级1(5.0%),2级8(40.0%),3级8(40.0%);胃癌组中的分布分别为:1级2(9.5%),2级12(57.1%),3级4(19.0%)。密度级别在慢性胃炎、不典型增生、胃癌组的分布差异无统计学意义(χ2(2,123)=7.724,P=0.259)。结论①太原地区慢性胃部疾病患者中H.pylori呈高感染率,且cagA阳性率较高,后者随着疾病的严重程度有增高趋势,但差异无统计学意义,提示ca-gA可能不是影响胃部疾病病理类型的独立因素;②胃部疾病患者中,H.pylori定植密度级别与胃部疾病病理类型无一定的规律。     

Helicobacter pylori infection, garlic intake and precancerous lesions in a Chinese population at low risk of gastric cancer

BACKGROUND: Cangshan County of Shandong Province has one of the lowest rates of gastric cancer (GC) in China. While intestinal metaplasia (IM) and dysplasia (DYS) are less common in Cangshan than in areas of Shandong at high risk of GC, these precursor lesions nevertheless affect about 20% of adults age > or = 55. SUBJECTS AND SETTING: In order to evaluate determinants of IM and DYS in Cangshan County, a low risk area of GC a survey was conducted among 214 adults who participated in a gastroscopic screening survey in Cangshan County in 1994. METHOD: A dietary interview and measurement of serum Helicobacter pylori antibodies were performed. RESULTS: The prevalence of H. pylori was lowest (19%) among those with normal gastric mucosa, rising steadily to 35% for superficial gastritis (SG), 56% for chronic atrophic gastritis (CAG), 80% for IM, and 100% for DYS. The prevalence odds of precancerous lesions were compared with the odds of normal histology or SG. The odds ratio (OR) or CAG associated with H. pylori positivity was 4.2 (95% confidence interval [CI] : 1.7-10.0), while the OR of IM/DYS associated with H. pylori positivity was 31.5 (95% CI: 5.2-187). After adjusting for H. pylori infection, drinking alcohol was a risk factor for CAG (OR = 3.2, 95% CI: 1.1-9.2) and IM/DYS (OR = 7.8, 95% CI: 1.3-47.7). On the other hand, consumption of garlic showed non-significant protective effects and an inverse association with H. pylori infection. CONCLUSIONS: The findings of this study suggest that infection with H. pylori is a risk factor and garlic may be protective, in the development and progression of advanced precancerous gastric lesions in an area of China at relatively low risk of GC.     

幽门螺旋杆菌诱导基质金属蛋白酶-9表达的研究

目的 通过研究幽门螺旋杆茼对基质金属蛋白酶表达水平的影响，探讨幽门螺旋杆茼致病的分子机理。方法 ATCC49503(CagA^ )、HP30929(CagA^-)幽门螺旋杆茼分别与BGC-823共同培养后提取总RNA，用RT-PCR方法分析BGC-823细胞中MMP-9的表达水平；通过胃镜活检选取9例HP阳性胃溃疡、9例HP阴性胃溃疡患者的标本采用RT-PCR分析MMP-9的表达水平；取17例HP阳性和14例HP阴性的胃溃疡标本经切片后石蜡包埋，用免疫组化染色检测MMP-9表达并图象定量分析测量MMP-9染色阳性的面积。结果 HP能诱导MMP-9在BGC-823细胞中表达，CagA^ HP株明显强于CagA^-株；在HP阳性胃溃疡的胃黏膜上皮细胞中，MMP-9表达水平明显高于HP阴性胃溃疡。结论 HP诱导MMP-9的表达在胃溃疡、胃癌的病理过程中可能起到重要的作用。     

IL-1B基因多态性在十二指肠溃疡发病中的作用

目的探讨幽门螺杆菌(Hp)感染与IL-1B-511位点单核苷酸多态性(SNP)在十二指肠溃疡(DU)发病中的作用。方法用病例-对照研究方法,调查某院54例DU患者及94例同院同期非DU患者(对照),用ELISA方法检测其血清Hp IgG抗体,PCR扩增IL-1B-511,限制片段长度多态性分析(RFLP)检测其SNP。结果DU组Hp阳性率为90.74%(49/54),而对照组则为54.26%(51/94),病例组高于对照组,OR为8.26(95%CI为3.02~22.59)。DU组IL-1B-511基因T/T、C/T和C/C基因型频率分别为31.48%,35.19%,33.33%;而在对照组则分别为38.30%,46.81%,14.89%,IL-1B-511 C/C型能增加DU的患病危险,OR为3.05(95%CI为1.23~7.57),但按有无Hp感染进行分层后,则IL-1B-511 C/C只在有Hp感染时才有作用,OR为4.60(95%CI为1.40~15.12)。结论Hp感染时IL-1B-511 C/C能增加十二指肠溃疡病的患病风险,机体的遗传基因与Hp共同影响Hp感染者的临床结局。     

Relation of serum ascorbic acid to Helicobacter pylori serology in US adults: the Third National Health and Nutrition Examination Survey

PURPOSE: To examine the relation between serum ascorbic acid and Helicobacter pylori serology from a probability sample of US adults. Subjects and Methods: Data from 6,746 adults (ages 20 to 90 years) enrolled in the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 were analyzed. Multiple logistic regression models were examined taking into account sample weights and the complex survey design of NHANES III, and controlling for the effects of potential confounders. Because race appeared to modify the association between serum ascorbic acid and seropositivity to H. pylori, we conducted the analyses stratified by race. RESULTS: A total of 2,189 adults (32%) had a positive serology for H. pylori, and, of these, 1,175 (54%) were positive for the CagA antigen. Among whites, a 0.50 mg/dL increase in serum ascorbic acid level was associated with decreased seroprevalence of H. pylori (Odds Ratio (OR) = 0.89, 95% confidence interval (CI) CI 0.82-0.96, p < 0.01). In analyses that controlled for seroprevalence of H. pylori, a 0.50 mg/dL increase in serum ascorbic acid level among whites was independently associated with a decreased seroprevalence of the pathogenic cagA-positive strain of H. pylori (OR = 0.31, 95% CI 0.12-0.79, p < 0.05). Serum ascorbic acid levels were not significantly associated with H. pylori serology among non-whites (all p > 0.05). CONCLUSIONS: Higher serum levels of ascorbic acid were associated with a decreased seroprevalence of H. pylori and of the pathogenic cagA-positive strain of H. pylori among whites. If these associations are related causally and are not the result of residual confounding by factors such as socioeconomic status, ascorbic acid may affect the risk of H. pylori infection and in turn, the risk for peptic ulcer disease and gastric cancer among white Americans.     

淮南地区学生幽门螺杆菌vacA和cagA基因分布特征

目的研究淮南地区学生幽门螺杆菌(Helicobacter pylori,H.pylori)cagA和vacA基因分布特征,为防治工作提供理论依据。方法对74例有消化道症状,年龄在7~24岁的在校学生进行胃镜检查,并在胃窦部取活检粘膜作H.pylori的分离培养,利用聚合酶链反应技术(PCR)测定分离培养出的H.pylori菌株的cagA和vacA基因并进行分型。结果74例学生中,分离培养出H.pylori菌株24例,基因测定结果显示,24株H.pylori临床分离株中,94.7%(23/24)含vacA基因,70.8%(17/24)含cagA基因;其中慢性胃炎vacA和cagA基因检出率分别为94.7%(18/19),70.6%(12/17);2例胃溃疡及3例十二指肠球部溃疡均全部为vacA和cagA阳性;进一步分型发现89.5%(17/19)的慢性胃炎为vacA 和cagA ,而5例溃疡患者均为vacA 和cagA 。结论淮南地区学生H.pylori感染多为vacA 和cagA 菌株,应充分重视H.pylori毒力因子的监测。     

Effects of cytotoxin-associated gene a (CagA) antibodies with Helicobacter pylori infection and lifestyle on chronic atrophic gastritis

OBJECTIVE: We conducted a population-based study to examine differences in risk of developing chronic atrophic gastritis in association with Helicobacter pylori (H. pylori) infection, with and without the presence of cytotoxin-associated gene A (CagA) antibodies, as well as to determine associations with the lifestyle factors. METHOD: Seventy hundred and thirty eight residents (295 men and 443 women) aged 30-64 living in a village in the southern part of Fukuoka Prefecture had an annual health checkup, and all participated in our study. We obtained information on their lifestyle with informed consent and measured the levels of serum pepsinogen I (PGI) and pepsinogen II (PGII), H. pylori and CagA antibodies. Chronic atrophic gastritis was defined as both PGI < 70 micrograms/l and PGI/PGII < 3.0. RESULTS: The odds ratios for development of chronic atrophic gastritis were 4.26 (95% CI, 2.22-8.17) for CagA-positive H. pylori infection and 3.87 (95% CI, 1.95-7.68) for CagA-negative H. pylori infection in males, and 4.92 (95% CI, 3.06-7.92) and 3.02 (95% CI, 1.69-5.41) respectively for females, as compared with H. pylori-negative subjects. Regarding the relationship between chronic atrophic gastritis and lifestyle factors, high consumption of green tea was found to be negatively associated with risk, particularly with CagA-positive H. pylori infection. CONCLUSIONS: Our results suggest that a CagA-positive H. pylori infection is associated with an elevated risk for developing chronic atrophic gastritis as compared with Cag-negative H. pylori infection.     

Helicobacter pylori infection and colorectal cancer risk: evidence from a large population-based case-control study in Germany

Evidence concerning the role of Helicobacter pylori infection in the development of colorectal cancer remains controversial. The authors assessed the association of H. pylori seroprevalence with risk of colorectal cancer in a large population-based case-control study from Germany in 2003-2007. Serum antibodies to H. pylori in general and the cytotoxin-associated gene A protein (CagA) were measured in 1,712 incident colorectal cancer cases and 1,669 controls. The association between H. pylori seroprevalence and colorectal cancer risk was estimated by logistic regression, with adjustment for potential confounders and stratification by age group, sex, anatomic subsites, and cancer stage. Overall, H. pylori seroprevalence was higher in cases (46.1%) than in controls (40.1%), resulting in an age- and sex-adjusted odds ratio of 1.30 (95% confidence interval (CI): 1.14, 1.50). Adjustment for established colorectal cancer risk factors decreased the odds ratio to 1.26 (95% CI: 1.09, 1.47), with a further reduction to 1.18 (95% CI: 1.01, 1.38) after additional adjustment for previous colorectal endoscopy. Stratified analyses showed risk elevation to be essentially confined to left-sided colorectal cancer, with an odds ratio of 1.22 (95% CI: 1.02, 1.45), suggesting that H. pylori infection may be associated with a small yet relevant risk increase in the left colorectum.     

Determination of cagA, vacA genotypes of Helicobacter pylori with real-time PCR-method

Presence of cagA gene of Helicobacter pylori (H. pylori) increases proliferation of stomach mucosa and it is an index of raised virulence of the bacteria. The vacA gene of H. pylori induces a serious inflammation of stomach. The purpose of this study was to determine cagA and vacA genotypes of H. pylori using real-time polymerase chain reaction (PCR) method with the double strain DNA-(dsDNA) binding SYBR Green I. dye. Results were compared with those of two immunohistochemical methods. 43 patients' paraffin embedded biopsy tissue samples were examined by histology, epidermal growth factor receptor (EGFR), proliferating cell nuclear antigen (PCNA) immunohistochemistry and melting curve analysis of real-time PCR using LightCycler instrument. Results of histology and real-time PCR from gastric biopsies correlated in 57% of cag acases and in 58% of vac cases. Significant difference was detected between normal and gastritis cases in the presence of cagA gene (p = 0.003) and between normal epithelial and intestinal metaplasia cases in the presence of vacA gene (p = 0.045) by investigation of association of histology and genotype of bacterium. Statistically significant difference (p = 0.02) was found between increased cell proliferation and the presence of gastritis. Significant correlation was found between the presence of cagA gene and EGFR expression in intestinal metaplasia cases (p = 0.0418). Results underlie the statistics that infection with cagA positive H. pylori strain increases the cell proliferation on the stomach mucosa and raises the chance of development of intestinal metaplasia. Infection with vacA positive H. pylori inhibits the signal-transduction pathway of EGFR, which influences mechanisms of mucosa repair. The role of EGFR and H. pylori infection is yet unclear in intestinal metaplasia and cancer. The authors' method seem to be suitable for determination of genotypes of H. pylori.     

Effect modification by vitamin C on the relation between gastric cancer and <Emphasis Type="Italic">Helicobacter pylori</Emphasis>

A hospital-based case–control study of 295 cases with histologically confirmed gastric cancer and age and sex-matched controls was conducted to evaluate the effect of dietary vitamin C intake upon the relation between Helicobacter pylori infection and gastric cancer in Korea in 1997–1998. Anti-H. pylori IgG was detected by ELISA. A food frequency questionnaire, and a questionnaire on demographic factors, including past medical history, smoking, alcohol consumption, and life style was also administered. The prevalences of H. pylori IgG in cases and controls were 80.7% and 71.2%, respectively, and the odds ratio (OR) of H. pylori for gastric cancer was 1.68 (95% confidence interval (CI): 1.14, 2.44), after adjusting for age, sex, educational level, and a past medical history of gastritis or gastric ulcer. In a stratified analysis, H. pylori seropositivity was found to be a significant risk factor for gastric cancer in the low vitamin C intake group (OR=4.68; 95% CI: 1.97, 11.1), but not in the high vitamin C intake group (OR=0.72; 95% CI: 0.32, 1.65). Vitamin C intake was found to modify the relation between H. pylori and gastric cancer.     

Helicobacter pylori prevalences and risk factors among school beginners in a German urban center and its rural county.

In 1998, the Helicobacter pylori [(13)C]urea breath test was offered to all school beginners (birth cohort 1991/1992) in the city of Leipzig and in Leipzig County, Germany, to determine the colonization prevalence and potential transmission pathways of the bacterium. A total of 3,347 school beginners participated in the test, and 2,888 parents completed the detailed, self-administered questionnaire. The H. pylori prevalence was 6.5% [95% confidence interval (CI), 5.3-7.6] in the city and 5.7% (CI, 4.2-7.0) in the county. Using cluster analysis (WARD's method, Euclidean distances), we identified different sets of variables (confirmed by multivariate logistic regression analyses [odds ratios (ORs)] that are signficantly associated with H. pylori positivity. Among city children, the risk is significantly increased with contact to a pet hamster (OR = 2.4; 95% CI, 1.2-4.7; p < 0.015) and travels to Asian countries (OR = 3.7; 95% CI, 1.6-8.7; p < 0.002). Among county children, H. pylori positivity increased significantly with drinking of water from nonmunicipal sources (OR = 16.4; 95% CI, 3.1-88.5; p < 0.001), more than 3 children living in a household (OR = 4.2; 95% CI, 1.2-14.6; p < 0.02), and contact with pet hamsters (OR = 2.4; 95% CI, 1.0-5.7; p < 0.04). These data suggest that, in a general population sample, indirect fecal-oral transmission and living conditions are important risk factors in the spread of H. pylori infection. However, clinical symptoms do not necessarily indicate H. pylori positivity.     

中国香港地区幽门螺杆菌毒力基因型与十二指肠溃疡关系的研究

目的：研究幽门螺杆菌（Hp）的重要毒力因子vacA，cagA，iceA及插入序列IS在中国香港地区分离菌株中的分布特征及其与十二指肠溃疡的关系。方法：采用聚合酶链反应（PCR）和Southern blot方法，对72例证实为Hp感染的胃十二指肠疾病患者的胃黏膜标本直接进行检测。结果：72例患者中，69例（95.8％）感染的Hp菌株为vacA sIc型，3例（4.2％）为sIa型；23例（31.9％）为vacAm1b型，46例（63.9％）为vacAm2型；6例（8.3％）为混合型。63.9％（46/72）的患者感染菌株为iceA1型，29.2％（21/72）为iceA2型。CagA的阳性率为88.9％（64/72）。结论：Hp毒力因子vacA，cagA和iceA在香港菌株中的分布有自己的特点；未发现特定cagA，vacA和iceA基因型别与DU相关。     

ABO blood group, secretor status and detection of Helicobacter pylori among patients with gastric or duodenal ulcers

Patients (454) referred for gastroscopy to the General Hospital of Athens were examined to determine (1) if non-secretors were over-represented among patients with ulcers and (2) if there was an association with ABO blood group or secretor status and carriage of Helicobacter pylori. Compared with the local population, among patients with either gastric ulcer (51) or duodenal ulcer (96) there was a significant increase in the proportion of those who were blood group O (P less than 0.025); however, there were no significant differences in the proportions of non-secretors. H. pylori was identified in 62% of the 454 patients: 59.5% of those without evidence of ulcers; 62.5% of those with gastric ulcer; 88% of those with duodenal ulcer (P less than 0.0005). These bacteria were cultured more often and in higher numbers from patients with duodenal ulcer (P less than 0.025). There was no association between ABO blood group and prevalence of H. pylori. The prevalence of H. pylori among non-secretors with gastric ulcer (12.5%) was significantly lower than that for non-secretors with duodenal ulcer (100%) (P less than 0.0005). This was not observed for secretors.     

A preliminary study on the genetic profile of cag pathogenicity-island and other virulent gene loci of Helicobacter pylori strains from Turkey.

Helicobacter pylori genetic diversity affects the function and antigenicity of virulence factors associated with the disease outcome. Gene profile was done to identify the distribution of gene loci within and outside the cag pathogenicity-island (PAI). H. pylori strains from 35 patients [21 gastritis, 14 peptic ulcer diseases (PUD)] were analyzed using PCR. The profile of the cag PAI was evaluated using primers spanning the 3' end, cagA, promoter region of the cagA, cagE, cagT, 5' end (LEC), extreme right end, plasticity region open reading frames (ORFs), oipA (Hp0638) and vacA alleles. We found few intact cag PAI in the strains examined. Deletions were found in LEC1 (9.5% versus 14.3%), LEC2 (4.8% versus 14.3%), cagT (33.3% versus 28.6%), cagE (28.6% versus 28.6%) and the promoter region of the cagA (19.0% versus 42.9%) of gastritis and PUD strains, respectively. The cagA gene was detectable in 57.1% of gastritis and 92.9% of PUD-associated strains. The cagRJ region also showed deletions for many of its genes. The oipA (Hp0638) gene was detected in 80.9% of gastritis and in 92.9% of PUD strains. The plasticity region ORFs JHP912 and JHP931 were predominant in PUD strains. The vacA-s1a-m1a genotype was predominant in PUD, while s2m2 in gastritis strains. This comprehensive analysis showed deletions in several genes within and outside the cag PAI. However, cagA, oipA, JHP912, JHP931 and vacA-s1a-m1a were more predominant in PUD strains than gastritis-associated strains, suggesting the importance of genetic diversity on the disease progression and clinical outcome.     

Comparative case-control analysis of gastric and duodenal ulcers

A case-control analysis was conducted comparing gastric and duodenal ulcers involving 369 cases with gastric ulcer, 127 cases with duodenal ulcer an 3,104 control subjects based on a questionnaire survey of subjects who received gastroscopic examination at the Aichi Cancer Center Hospital from April, 1985 to March, 1989. Risk of gastric ulcer was positively associated with smoking (relative risk (RR) = 3.67, 95% confidence interval (CI): 2.63-5.13), irregular time of meals (RR = 1.39, 95% CI: 1.06-1.81) and milk intake (RR = 1.60, 95% CI: 1.25-2.04) and inversely associated with fruit intake (RR = 0.73, 95% CI: 0.57-0.95), while the risk of duodenal ulcer was positively associated with smoking (RR = 1.94, 95% CI: 1.16-3.26), a preference for foods that are not rich (RR = 1.55, 95% CI: 1.03-2.32), intake of pickled vegetables (RR = 1.76, 95% CI: 1.21-2.55) and presence of methods of diversion (RR = 1.77, 95% CI: 1.16-2.71). These results suggest that life style is involved in the etiology of both diseases and that there are some differences in the associations between both diseases.     

Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study

The authors' aim in this study was to explore the prevalence, symptomatology, and risk factors for peptic ulcer in a general adult population. Between December 1998 and June 2001, the authors surveyed a random sample (n=3,000) of the adult population (n=21,610) in two communities in northern Sweden using a validated questionnaire, the Abdominal Symptom Questionnaire (response rate=74%). A subsample (n=1,001) of the responders was randomly invited to undergo esophagogastroduodenoscopy and symptom assessment (response rate=73%). The prevalence of peptic ulcer was 4.1% (20 gastric ulcers and 21 duodenal ulcers). Nausea and gastroesophageal reflux were significant predictors of peptic ulcer disease, but epigastric pain/discomfort was not. Six persons with gastric ulcer and two persons with duodenal ulcer were asymptomatic. Eight subjects with duodenal ulcer (38%) lacked evidence of current Helicobacter pylori infection. Five (25%) of the gastric ulcers and four (19%) of the duodenal ulcers were idiopathic (no use of aspirin or nonsteroidal antiinflammatory drugs, no H. pylori infection). Smoking, aspirin use, and obesity were risk factors for gastric ulcer; smoking, low-dose (相似文献   

Detection of CagA protein in strains of Helicobacter pylori isolated from patients with gastritis and gastric ulcer disease

A total of 156 Helicobacter pylori strains isolated from adult patients (81 men, 75 women) with diagnosis of gastritis (43 strains GAS) and gastric ulcer (113 strains GU) were analyzed for the production of CagA protein by quantitative and qualitative immunoblot methods. 80% of gastric ulcer group strains (84% in men, 73% in women) produced CagA protein, while in the gastritis patients group only 63% of strains were CagA protein positive (59% in men, 65% in women). Quantitative production was estimated by CagA index (mean production of CagA protein in CagA positive strains) in both groups of strains GAS and GU in men and women. Strains of GU group were shown to be higher producers (index CagA 2.42) as compared to GAS group (2.09). Index CagA was higher in strains isolated from men (index CagA 2.54) than is strains from women (index CagA 2.13). CONCLUSION: CagA production has been proved in 75% of analysed Helicobacter pylori strains. CagA positive strains were more frequent in gastric ulcer disease patients, slightly higher in the male than in the female patients. Strains isolated from men, irrespective of diagnosis (GAS and GU), are higher producers of CagA protein.