Helicobacter pylori infection and cancer of the stomach

Although the incidence of gastric cancer has declined in the past few decades in developed countries, it has remained one of the most frequent malignomas with high mortality. Epidemiological, clinical and basic research studies confirm the role of Helicobacter pylori in the pathogenesis of the tumors of the distal stomach and low-grade MALT lymphomas. On the contrary more and more data suggest a possible protective role of the infection in the gastro-oesophageal reflux disease, tumors of the cardia and adenocarcinoma of the distal oesophagus. The intensive research being done in the past few years prove our previous concept, that the pathogenesis of gastric cancer is a multifactorial process, which is affected by Helicobacter pylori ("a major environmental factor") together with distinct environmental, social and genetic factors. The interaction of these factors and the importance of them urge further investigations, which may differ in different populations.     

Implications of Helicobacter pylori infection for stomach cancer prevention

Accumulating evidence has implicated Helicobacter pylori, an established cause of chronic gastritis and peptic ulcer, in the etiology of gastric cancer. Control of this infection would reduce the occurrence of chronic gastritis and peptic ulcer and might substantially lower the risk of stomach cancer as well. The public health impact of this infectious agent warrants efforts to identify preventive measures. This paper reviews the evidence linking H. pylori infection to gastric cancer and evaluates the potential for control in high-risk populations. Current obstacles to H. pylori control are discussed, including the link to poor socioeconomic conditions, difficulty in identifying incident cases, lack of natural immunity to reinfection, limited effectiveness of antibiotic therapy in high-prevalence populations, and incomplete knowledge regarding the reservoir of infection, mode of transmission, host susceptibility factors, and the potential for developing an effective vaccine. Worthwhile avenues of research include studies designed to identify modifiable risk factors for acquisition of the infection, modifiable host factors that may increase resistance to chronic infection, more effective antibiotic therapies, and effective vaccines.     

幽门螺杆菌与胃癌

1　概述业已证实幽门螺杆菌 (Ｈｐ)是胃腺癌与胃淋巴瘤的诱发因素之一 ,1994年国际癌症研究中心(ＩＡＲＣ)将Ｈｐ列为Ⅰ类致癌因子。Ｈｐ的感染率极高 ,在发达国家 30 %～ 5 0 %的成年人有Ｈｐ感染 ,而发展中国家的Ｈｐ感染率则高达 80 %。 1998年日本学者Ｗａｔａｎａｂｅ等首次报道了单独用Ｈｐ长期感染蒙古沙土鼠能成功地诱发出胃腺癌。目前国内也已开展Ｈｐ与胃癌关系的动物实验及分子生物学研究 ,试图阐明Ｈｐ感染与胃癌发生的可能机制。2　胃癌流行病学新进展Ｈｐ感染与胃癌的发生有着一定的联系 ,如两者都与人群的经济状况、社会地位…     

Helicobacter pylori allergy]

A case of a 44 year old woman with antrum gastritis and H. pylori infection was reported. After unsuccessful treatment of the disorder with bismuth and tinidazole, an auto-vaccine was prepared from the bacterium in order to eliminate the infection. After the first injection of the vaccine a generalised urticaria was observed. In the development of the skin eruptions a type I, and a type IV allergic reaction could be demonstrated using the H. pylori specific RAST-test and leukocyte migration inhibition respectively. After eradication of the bacterium by amoxycillin treatment, the clinical signs of both the gastrointestinal and allergic diseases disappeared.     

Pathophysiology of Helicobacter pylori infection]

The (re)discovery of the gastric pathogen Helicobacter pylori almost one and a half decade ago completely changed our conception on gastroduodenal ulcer disease and gastric cancer. The most important issue is that Helicobacter pylori induces a mild, antrum dominant chronic pangastritis without increased risk of severe diseases in most of the cases. A smaller part of the infected develops antrum dominant gastritis with increased risk of duodenal ulcer. In a few cases the corpus is also affected, pangastritis occurs with increased risk to develop gastric ulcer and gastric cancer. Until now it is not quite obvious why some of the infected patients get ill while others not, and why different diseases develop in different patients. 1. From the bacterial point of view it is ascertained that toxin-producing strains (VacA, CagA positive) are more likely to induce ulcer formation and gastric carcinoma. 2. Genetic phenotype of the infected patients (blood-group and HLA antigens) may also be of importance. 3. Environmental factors may affect (promote or inhibit) disease development. All of these factors determine the complex immunological, functional and morphological changes characteristic for the developing disease.     

Helicobacter pylori infection in diabetic patients]

The purpose of our research was to prove the occurrence of Helicobacter pylori infection in diabetic patients. Out of the 100 patients who were treated at the diabetological clinic, the antibody of Helicobacter pylori could be shown in 57 patients. Through histological tests carried out in the course of upper panendoscopia of the patients having positive results of serological test, Helicobacter pylori infection could be actually proved in 39 cases. On the basis of the evaluated material of diabetic patients, the occurrence of Helicobacter pylori infection was not higher than that in of the average population. No connection has been found between the frequency of the infection, and type of diabetes or its duration. The eradicational treatment was successful with 85% of the patients.     

2369例高校职工幽门螺杆菌感染检测结果分析

目的 观察高校教职工人群胃幽门螺杆菌(HP)感染情况,加强对其感染的防控工作。方法 空腹采集教职工体检人群静脉血,检测胃幽门螺杆菌抗体滴度,观察其感染情况。结果 人群HP总阳性率为43.31%。其中:男性阳性率为45.82%,女性阳性率为40.53%,差异有统计学意义(P<0.05)。按年龄段分组比较其感染情况,各年龄组阳性率男性普遍高于女性,但只有41～50岁组男性与女性比较差异有统计学意义(P<0.05)。41～50岁年龄组和51～60岁年龄组阳性率高于其他年龄组,差异有统计学意义(P<0.05)。结论 胃幽门螺杆菌感染率较高,且男性感染率高于女性。应加强对该疾病的预防保健工作,提高人群防病治病的健康意识。     

Occurrence of Helicobacter pylori in patients with gastroesophageal tumors]

Authors examined the occurrence of H. p. retrospectively in bioptic material for three years. Fifty-one oesophageal and gastric tumorous patients were examined and as a control fourty-seven non tumorous patients with chronic gastritis chosen at random. The demonstration of H. p. was performed by modified Giemsa stain. Different types of chronic gastritis, forms and localisation of the tumours as well as their relation with sex and age were investigated. The occurrence of H. p. was higher in chronic gastritis than in tumorous processes. Seventy-one % H. p. positivity was found in the control group against 17.6% in the tumorous patients.     

Clinical significance of serological markers of Helicobacter pylori]

Helicobacter pylori (H. pylori) is a Gram-negative, curved bacillus known since 1983. It is supposed to play role in the pathogenesis of certain gastroduodenic diseases, e.g. non-ulcer dyspepsia (NUD), chronic inflammation, ulcers, etc. Serum samples of 70 patients who were examined for stomach complaints with gastroscopy and those of 22 healthy persons were analysed. The purpose of the study was to evaluate anti-H. pylori IgG, IgM and IgA antibodies using ELISA method. Whether the antibodies can be detected or not, 8 possible variations exist, each of them denoting certain state of infection. These states are not always going parallel with the macroscopic pictures revealed by gastroscopy, but there are some obvious congruences. Results show that serologic examination cannot replace gastroscopy but on the other hand in follow-up tests and examinations as well as in understanding the aetiology of different gastroduodenal diseases it can play an important role.     

口腔与胃幽门螺杆菌的相关性研究

【目的】分析口腔与胃中幽门螺杆菌(Helicobacter pylori,Hp)的检测结果,证明口腔Hp可能是胃HP的一个重要储菌池。【方法】采用快速尿素酶试验和13C尿素呼气试验相结合的方法,对97例有上消化道症状患儿行口腔和胃黏膜幽门螺杆菌感染检测。【结果】97例患者中口腔幽门螺杆菌感染率(78.35%)明显高于胃内幽门螺杆菌感染率(58.76%);胃内有幽门螺杆菌感染者,其口腔亦同时有幽门螺杆菌感染;口腔无幽门螺杆菌感染者,则胃内亦同时无幽门螺杆菌感染。【结论】口腔Hp与胃Hp感染密切相关,它可能是胃Hp的一个重要储菌池。     

蛋白芯片技术检测幽门螺杆菌感染的临床价值

目的研究蛋白芯片技术检测幽门螺杆菌(Hp)感染的临床应用价值。方法用蛋白芯片技术检测300例患者血清中细胞毒素相关蛋白(CagA)、尿素酶(Ure)和空泡细胞毒素(VacA)3种抗体,其中170例患者同时取胃活检组织做快速尿素酶试验(RUT)、改良Giemsa染色检查和14C尿素呼气试验(14C-UBT),20例Hp感染者治疗后复查抗体滴度。结果蛋白芯片方法诊断Hp感染的敏感性为92.5%、特异性为41.3%、总符合率为73.5%、阳性预测值为72.8%、阴性预测值为76.5%;胃部疾病严重程度与CagA阳性率呈正相关;Hp感染者治疗后抗体滴度下降。结论蛋白芯片检测Hp感染便于对Hp分型,有助于临床明确诊断、判断预后和疗效跟踪。     

胃镜消毒后乙型肝炎病毒、幽门螺杆菌的检测分析

随着胃镜在临床诊断和治疗上的广泛应用，胃镜污染而引起的医源性感染已引起人们的重视。其中，乙型肝炎病毒(HBV)和幽门螺杆菌(Hp)是两种最常见的感染病原体。为此，笔者对我院常规消毒后的胃镜进行了HBV DNA，HBsAg和Hp DNA的检测，以了解消毒后胃镜HBV和Hp的污染情况。     

幽门螺杆菌阿莫西林耐药株缺乏青霉素结合蛋白基因外突变特征

目的 研究实验室诱导的耐阿莫西林(AMO)幽门螺杆菌(H.pylori)的青霉素结合蛋白基因(pbp)突变情况,探讨pbp基因突变与耐药性形成的关系,比较AMO耐药菌株和敏感菌株的蛋白表达谱,为筛选与H.pylori耐药相关的蛋白提供线索.方法 体外诱导敏感菌株H.pylori 26695产生AMO耐药,测定耐药菌株5个PBP的全基因的点突变情况;同时运用蛋白质组学技术,比较AMO耐药菌株和敏感菌株的蛋白表达谱.结果 (1)体外诱导获得MIC为8 μg/ml的耐药菌1株(AMOr),其耐药表型经-80℃冻存或在不含AMO的培养基上多次传代后会丧失;(2)AMOr全部待测序列和出发菌株26695相应的靶序列完全相同,未检出基因点突变等结构变异;(3)对26695和AMOr的蛋白表达图谱进行比较发现:11个蛋白斑点在表达量上有显著变化.结论 H.pylori AMO耐药性的形成主要是一种不稳定的表型变化,可能不是由pbp基因结构变异所致.实验中耐药株和敏感株差异表达的蛋白在H.pylori的耐药形成过程中发挥着怎样的作用还有待进一步研究.     

Tooth loss,pancreatic cancer,and Helicobacter pylori

BACKGROUND: Poor dental health has been associated with increased risks of oral, esophageal, and gastric cancer and may also be associated with pancreatic cancer. In addition, Helicobacter pylori has been found in dental plaque and has been associated with periodontal disease and pancreatic cancer. OBJECTIVE: The objective was to investigate prospectively the relation between dentition history and pancreatic cancer in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort in Finland and the association between dentition history and H. pylori seropositivity in a cross-sectional sample of subjects without cancer (n = 475) from the same cohort. DESIGN: Of the 29,104 male smokers aged 50-69 y in the cohort for whom there were complete data, 174 developed pancreatic cancer from 1985 to 1997. Cox proportional hazard models were used to estimate age-, smoking-, education-, urban living-, and height-adjusted hazard ratios and 95% CIs for pancreatic cancer, and logistic regression models were used to estimate age- and education-adjusted odds ratios for H. pylori carriage. RESULTS: Tooth loss was positively associated with pancreatic cancer (edentulous compared with missing 0-10 teeth: hazard ratio = 1.63; 95% CI: 1.09, 2.46; P for trend = 0.02) but was not significantly associated with H. pylori seropositivity (edentulous compared with missing 0-10 teeth: odds ratio = 1.30; 95% CI: 0.73, 2.32; P for trend = 0.37). CONCLUSION: Additional studies are needed to evaluate the association between tooth loss and pancreatic cancer, as well as cancers at other gastrointestinal sites, particularly with respect to possible biological mechanisms.     

幽门螺杆菌与慢性胃病幽门螺杆菌毒力和致病力

幽门螺杆菌（Helicobacter pylori,HP）是最常见的慢性感染之一，人群感染率估计在50%左右。Hp感染相关胃疾病包括慢性胃炎、消化性溃疡、胃腺癌和胃黏膜伴有淋巴样组织淋巴瘤。     

幽门螺杆菌感染对结直肠癌发生的相关因素分析

目的 探讨幽门螺杆菌(Hp)感染对结直肠癌发生的相关因素,为预防结直肠癌发生提供依据.方法 将选取的60只清洁级雄性Wistar幼年大鼠随机分为4组,第1组为单纯Hp组,用Hp菌灌胃法定植Hp;第2组单纯N-甲基亚硝基脲(MNU)组用Hp菌液等量布氏肉汤灌喂,10周后用MNU灌肠诱发结直肠癌形成;第3组采用Hp+ MNU联合处理定植Hp基础上,10周后用MNU灌肠诱发结直肠癌形成;第4组用与Hp菌液等量布氏肉汤灌喂基础上用MNU等量去离子水经肛门灌肠,定期处死大鼠后提取标本,检测Hp,同时做病理切片标本,观察有无肠壁增厚、肠黏膜充血、水肿、糜烂、溃疡及结节发生.结果 Hp组及Hp+ MNU组大鼠较MNU组、第4组胃黏膜明显偏薄,以胃窦部较为明显,且可见肠上皮化生;Hp组及Hp+ MNU组共定植28只小鼠,尿素酶染色阳性21只,培养阳性17只,Giemsa染色阳性达23只,两项阳性大鼠共有25只,占总定指数89.3％.结论 长期的Hp感染可能会增加大鼠结直肠癌对致癌剂的敏感性,促进结直肠癌病变形成,而血胃泌素在结直肠癌的发生过程中是诱导机制之一.