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Clinical Parameters Including Serum Pepsinogen Level and Management Strategy in Patients with Gastric Low-Grade Dysplasia.

Jun Hyung CHO ; Young Woon CHANG ; Young HWANGBO ; Jaejun SHIM ; Jae Young JANG ; Hyo Jong KIM ; Byung Ho KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):52-58. doi:10.7704/kjhugr.2011.11.1.52

BACKGROUND/AIMS: There are no proper guidelines for the management of gastric low-grade dysplasia (LGD). We evaluated clinical parameters, histological results and follow-up endoscopies to find a management strategy of LGD. MATERIALS AND METHODS: A total of 590 patients with LGD, high-grade dysplasia (HGD), functional dyspepsia (FD), early or advanced gastric cancer (early gastric cancer [EGC] or advanced gastric cancer [AGC]) were consecutively enrolled. We examined the association of clinical parameters including low serum pepsinogen (PG) I/II ratio < or =3.0 with the disease phenotypes. Histological results between initial forceps-biopsy and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) specimens were compared. RESULTS: The PG I/II ratio in FD was 4.2+/-1.7, but was significantly low in LGD (2.8+/-1.6, P<0.0001). The ratio was not further decreased in the HGD, EGC, and AGC groups. In FD patients with the ratio of < or =3.0, smoking habits and high salt intake were independent risk factors for gastric dysplasia or gastric cancer. In about 11% (n=8/70) of LGD lesions, the pathologic diagnoses were upgraded to HGD or EGC after endoscopic resection. Neither serious complications nor recurrence at the primary site were found. CONCLUSIONS: It is proposed that endoscopic resection followed by endoscopic surveillance might be a beneficial strategy for patients with LGD having a PG I/II ratio of < or =3.0.
Dyspepsia ; Follow-Up Studies ; Humans ; Pepsinogen A ; Phenotype ; Recurrence ; Risk Factors ; Smoke ; Smoking ; Stomach Neoplasms

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Effect of Helicobacter pylori Infection on p16, p53, CEA, EGFR Expression in Gastric Neoplasia.

Chan Sik WON ; Mee Yon CHO ; Hyun Soo KIM ; Ki Tae SUK ; Jae Woo KIM ; Hong Jun PARK ; Hyo Keun JEON ; Soon Koo BAIK ; Sang Ok KWON

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):45-51. doi:10.7704/kjhugr.2011.11.1.45

BACKGROUND/AIMS: Gastric cancer is one of the most widespread cancers and the second leading cause of cancer-related death worldwide. Although Helicobacter pylori (H. pylori) has been classified as a type I carcinogen for gastric cancer, the exact pathway has remained indistinct. In this study, we investigated the effects of H. pylori on oncogenic proteins (epidermal growth factor receptor [EGFR], CEA), tumor suppressor (p53) and cell-cycle regulator (p16) expression, using immunohistochemical stains, in gastric neoplasias. MATERIALS AND METHODS: From April 2007 until July 2009, 166 patients with consecutive gastric neoplasias resected were retrospectively enrolled; 35 gastric dysplasias, 70 early gastric cancers and 60 advanced gastric cancers. We examined the relationship of clinicopathologic features of gastric neoplasias such as age, sex, p16, p53, EGFR, tissue CEA, TNM stage, Lauren classification, location, histologic type of neoplasia to H. pylori infection status. RESULTS: H. pylori infection detected in the samples of gastric dysplasia, early gastric cancer (EGC) and advanced gastric cancer (AGC) were 15 (41.7%), 38 (54.3%) and 33 (55.0%) samples. p53, CEA and EGFR stains expression were associated with cancer stage (P<0.05). There was no relation between the immunohistochemical stains (p16, p53, CEA, EGFR) and H. pylori infection. CONCLUSIONS: This study failed to show any relation of immunohistochemical markers of p16, p53, EGFR, CEA expressions to H. pylori infection in gastric dysplasia as well as gastric cancer. Further study is necessary to investigate the effect of H. pylori infection on p16, p53, CEA, EGFR expressions in precancerous lesions such as atrophic gastritis and intestinal metaplasia.
Coloring Agents ; Cyclin-Dependent Kinase Inhibitor p16 ; Gastritis, Atrophic ; Helicobacter ; Helicobacter pylori ; Humans ; Metaplasia ; Proteins ; Retrospective Studies ; Stomach Neoplasms

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The Simple Predictive Factors of Emergency Endoscopy for Non-variceal Acute Upper Gastrointestinal Bleeding.

Seung Min LEE ; Sang Ho LEE ; Sung Jun KIM ; Hye Won PARK ; Hyoung Su KIM ; Kyoung Ho KIM ; Myoung Kuk JANG ; Jin Heon LEE ; Hak Yang KIM ; Woon Geon SHIN

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):37-44. doi:10.7704/kjhugr.2011.11.1.37

BACKGROUND/AIMS: Although endoscopy is an important diagnostic method for acute upper gastrointestinal bleeding (AUGIB), the guideline of emergency endoscopy for AUGIB is not yet established. This study was performed to assess the predictive factors of emergency endoscopy for non-variceal AUGIB. MATERIALS AND METHODS: From June 2006 to December 2008, the medical records of 283 patients with non-variceal AUGIB treated in Kangdong Sacred Heart Hospital were retrospectively analyzed. Patients were divided into two groups: emergency endoscopic procedure group or non-procedure group. We compared the factors for predicting the necessity of emergency endoscopic hemostasis. RESULTS: Among 283 patients, 194 were in the emergency endoscopic procedure group and 89 were in the non-procedure group. No significant differences in age, co-morbidities, drug history, and chief complaints were observed. After adjustment of several factors including syncope, systolic blood pressure, nasogastric (NG) tube irrigation and digital rectal examination findings, hemoglobin decline of more than 2 g/dL after 6 hours, prothrombin time, BUN and BUN/creatinine ratio that showed significant differences between the two groups, bloody NG aspiration was the only significant predictive factor (hazard ratio 13.69: P<0.001). CONCLUSIONS: Bloody NG aspiration was a simple factor for predicting emergent endoscopic procedure in non-variceal AUGIB patients.
Blood Pressure ; Digital Rectal Examination ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Heart ; Hemoglobins ; Hemorrhage ; Humans ; Intubation, Gastrointestinal ; Medical Records ; Prothrombin Time ; Retrospective Studies ; Syncope

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The Effect of Probiotics for Helicobacter pylori.

Sun Hee ROH ; Ki Nam SHIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):26-36. doi:10.7704/kjhugr.2011.11.1.26

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection is a major cause of chronic gastritis and peptic ulcer and a risk factor of gastric malignancy. Antibiotics based H. pylori eradication treatment is 90% effective, however, it is expensive and causes side effects and antibiotics resistance. Probiotics could present a low-cost, alternative solution to prevent or decrease H. pylori colonization. MATERIALS AND METHODS: Eligible articles were indentified by researches of electronic databases. RESULTS: In vitro studies demonstrated an inhibitory activity of probiotics on H. pylori growth and that this effect is extremely strain specific. The probiotics seem to be efficacious for the prevention of antibiotics associated side effects and might be of help for the prevention of H. pylori complications by decreasing H. pylori density and gastritis, and for the prevention of H. pylori colonization or re-infection by inhibiting adhesion to gastric epithelial cells. There was no significant evidence that probiotics may increase the H. pylori eradication rate. CONCLUSION: Probiotics could be an accessory treatment for H. pylori related gastric diseases, but more researches will be needed.
Anti-Bacterial Agents ; Colon ; Electronics ; Electrons ; Epithelial Cells ; Gastritis ; Helicobacter ; Helicobacter pylori ; Peptic Ulcer ; Probiotics ; Risk Factors ; Sprains and Strains ; Stomach Diseases

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Treatment of Helicobacter pylori.

Kyoung Oh KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):21-25. doi:10.7704/kjhugr.2011.11.1.21

The seroprevalence of Helicobacter pylori (H. pylori) in Korea was found to be decreased. However eradication rate of 1st line therapy has become lower and antimicrobial resistance has increased, recently. Therefore we must also be prepared to face treatment failure and in designing a treatment strategy we should not focus on the results of 1st line therapy alone, but also on the rescue therapy. Some studies have demonstrated that levofloxacine-based triple regimen shows favourable results in 2nd or 3rd line therapy. However, it has shown that resistance to quinolones is easily acquired, and in Korea with a high consumption of these drugs, the resistance rate is increasing and is already relatively high. Therefore it should be reserved for final rescue treatment. Another potential regimen for final rescue therapy is rifabutin-based regimen which is known to be effective for H. pylori strains resistant to clarithromycin or metronidazole. Several concerns still remain, however, regarding rifabutin treatment. Firstly it is very expensive. Secondly myelotoxicity such as leukopenia and thrombocytopenia have been reported in some patients treated with rifabutin. Finally because of multiresistant strains of Mycobacterium tuberculosis increasing in numbers, indications for these drugs should be chosen very carefully to avoid further acceleration of development of resistance. Therefore refabutin should be considered only as the last option. It is difficult to choose proper treatment in Korea after failure of 2nd line treatment, because only a few study about 3rd line rescue therapy have been reported. Therefore we need more well designed randomized controlled studies.
Acceleration ; Clarithromycin ; Helicobacter ; Helicobacter pylori ; Humans ; Korea ; Leukopenia ; Metronidazole ; Mycobacterium tuberculosis ; Quinolones ; Rifabutin ; Seroepidemiologic Studies ; Thrombocytopenia ; Treatment Failure

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Antibiotic Resistance in Helicobacter pylori Infection.

Jae G KIM ; Beom Jin KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):13-20. doi:10.7704/kjhugr.2011.11.1.13

Helicobacter pylori (H. pylori) causes chronic gastritis, peptic ulcer disease, primary B-cell gastric lymphoma, and adenocarcinoma of the stomach. The eradication of H. pylori infection requires combination of antibiotics including proton pump inhibitors. However, development of antibiotic resistance is a major cause of treatment failure. To select an appropriate regimen, systemic information on the antibiotic resistance is mandatory. H. pylori acquires resistance essentially via point mutations, and this phenomenon is found with most antibacterials. The prevalence of primary antibiotic resistance in H. pylori strains isolated from Korean patients has been increasing along with the shift to high minimum inhibitory concentrations from 1987 to 2009. Moreover, MIC values of secondary isolates were higher than those of primary isolates. In addition, there is an increasing tendency for the emergence of strains with multi-drug resistance. Resistance rates of H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, levofloxacin, and moxifloxacin have been reported up to 18.5%, 38.5%, 66.2%, 34.6%, 34.6%, 29.5%, and 23.2%, respectively. Especially, antibiotic resistance to metronidazole or clarithromycin affects undermining the efficacy of eradication treatment. Further nation-wide surveillance regarding the effect of antibiotic resistance on the eradication rate is necessary to establish the appropriate treatment for H. pylori infection.
Adenocarcinoma ; Amoxicillin ; Anti-Bacterial Agents ; Aza Compounds ; B-Lymphocytes ; Ciprofloxacin ; Clarithromycin ; Drug Resistance, Microbial ; Drug Resistance, Multiple ; Gastritis ; Helicobacter ; Helicobacter pylori ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Metronidazole ; Microbial Sensitivity Tests ; Ofloxacin ; Peptic Ulcer ; Point Mutation ; Prevalence ; Proton Pump Inhibitors ; Quinolines ; Stomach ; Stomach Neoplasms ; Tetracycline ; Treatment Failure

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Helicobacter pylori Virulence Factors and Host Factors.

Bong Ku KANG ; Byung Wook KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):7-12. doi:10.7704/kjhugr.2011.11.1.7

Helicobacter pylori (H. pylori) is one of the most common human infection world-wide. However, only a limited proportion of the infected population developed gastrointestinal diseases such as peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. These various outcomes of H. pylori infection may result from bacterial virulence factors, host factors such as genetic diversities, and environmental influences. Bacterial factors such as cagA PAI, vacA, adhesin and outer membrane proteins, and peptidoglycans are known to be associated with specific gastrointestinal diseases such gastric adenocarcinoma. Various cytokines including interleukin (IL)-1beta, IL-10, and tumor necrosis factor-alpha, and host immune reaction to the bacteria are closely related to specific diseases such as gastric adenocarcinoma and duodenal ulcer. In this article, we reviewed each factors and their relevance to the disease outcome.
Adenocarcinoma ; Bacteria ; Cytokines ; Duodenal Ulcer ; Gastrointestinal Diseases ; Genetic Variation ; Helicobacter ; Helicobacter pylori ; Humans ; Interleukin-10 ; Interleukins ; Lymphoma, B-Cell, Marginal Zone ; Membrane Proteins ; Peptic Ulcer ; Peptidoglycan ; Stomach Diseases ; Tumor Necrosis Factor-alpha ; Virulence Factors

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Epidemiology of Helicobacter pylori Infection in Korea.

Yeon Soo KIM ; Gwang Ho BAIK

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2011;11(1):1-6. doi:10.7704/kjhugr.2011.11.1.1

Helicobacter pylori (H. pylori) is the most common chronic bacterial infection in humans and causes many upper abdominal diseases and symptoms. Infection is more frequent and acquired at an earlier age in developing countries compared to industrialized nations. In Korea, the nation-wide seroprevalence of H. pylori infection in 1998 was higher than that of the developed countries. At the year, the seroprevalence in children (neonate~15 years) and adult (16~79 years) were 17.2% and 66.9%, respectively. However, seroprevalence in 2005 (59.6%) significantly decreased compared with that of 1998 (66.9%), and the decrease was significant in subjects aged less than 70 years, living in Seoul and Gyeonggi province (which is close to Seoul). The major route of transmission remains poorly understood. However, according to multivariate analysis, sex, age, geographic area, crowding (number of person per room) in childhood, economic status in childhood, and types of housing in childhood were significantly and independently associated with H. pylori seroprevalence. As 13 years have already passed since the nation-wide study in 1998, well designed study including infants and children is warranted to elucidate the seroprevalence, epidemiological factors, and the route of transmission of H. pylori infection in Korea.
Adult ; Aged ; Bacterial Infections ; Child ; Crowding ; Developed Countries ; Developing Countries ; Helicobacter ; Helicobacter pylori ; Housing ; Humans ; Infant ; Korea ; Multivariate Analysis ; Seroepidemiologic Studies

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Learning from the 29th International Workshop on Helicobacter & Microbiota in Inflammation and Cancer in Conjunction with the EAGEN/EHMSG Postgraduate Course.

Tae Ho KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):240-241. doi:10.7704/kjhugr.2016.16.4.240

No abstract available.
Education* ; Helicobacter* ; Inflammation* ; Learning* ; Microbiota*

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Can Helicobacter pylori Eradication Prevent the Development of Gastric Cancer?.

Chang Seok BANG ; Gwang Ho BAIK

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):238-239. doi:10.7704/kjhugr.2016.16.4.238

No abstract available.
Helicobacter pylori* ; Helicobacter* ; Stomach Neoplasms*

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