BACKGROUND/AIMS: The aims of this study were to investigate whether a broccoli sprout extract containing sulforaphane (BSES) inhibited the Helicobacter pylori infection density and exerted an antioxidative effect on gastric mucosal damage. METHODS: The enrolled subjects were randomized in a double-blinded manner into three groups. Finally, 33 H. pylori (+) BSES treatment subjects (group A), 28 H. pylori (+) placebo subjects (group B), and 28 H. pylori (-) BSES treatment subjects (group C) were studied. H. pylori infection density was indirectly quantified by a 13C-urea breath test (UBT), and the ammonia concentration in gastric juice aspirates was measured through gastroscopic examination. Malondialdehyde (MDA), an oxidative damage biomarker, and reduced glutathione (GSH), an antioxidant biomarker, were measured in the gastric mucosa by an enzyme-linked immunosorbent assay. RESULTS: BSES treatment did not significantly affect the UBT values or ammonia concentration in group A (p=0.634 and p=0.505, respectively). BSES treatment did significantly reduce mucosal MDA concentrations in group A (p<0.05) and group C (p<0.001), whereas the gastric mucosal GSH concentrations did not differ before and after treatment in any of the groups. CONCLUSIONS: BSES did not inhibit the H. pylori infection density. However, BSES prevented lipid peroxidation in the gastric mucosa and may play a cytoprotective role in H. pylori-induced gastritis.
Adult ; Ammonia/metabolism ; Antioxidants/*pharmacology ; Biomarkers/analysis ; Brassica/*chemistry ; Breath Tests ; Double-Blind Method ; Enzyme-Linked Immunosorbent Assay ; Female ; Gastric Juice/enzymology ; Gastric Mucosa/*drug effects/metabolism ; Glutathione/analysis ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Isothiocyanates/*pharmacology ; Lipid Peroxidation/*drug effects ; Male ; Malondialdehyde/analysis ; Middle Aged ; Plant Extracts/chemistry/*pharmacology ; Urea

As a commensal or a pathogen, Helicobacter pylori can change the balance of a complex interaction that exists among gastric epithelial cells, microbes, and their environment. Therefore, unraveling this complex relationship of these mixtures can be expected to help prevent cancer as well as troublesome unmet medical needs of H. pylori infection. Though gastric carcinogenesis is a multi-step process, precancerous lesion can be reversible in the early phase of mucosal damage before reaching the stage of no return. However, biomarkers to predict rejuvenation of precancerous atrophic gastritis have not been identified yet and gastric cancer prevention is still regarded as an impregnable fortress. However, when we take the journey from H. pylori-associated gastritis to gastric cancer, it provides us with the clue for prevention since there are two main preventive strategies: eradication and anti-inflammation. The evidence supporting the former strategy is now ongoing in Japan through a nation-wide effort to eradicate H. pylori in patients with chronic gastritis, but suboptimal apprehension to increasing H. pylori resistance to antibiotics and patient non-compliance still exists. The latter strategy has been continued in the author's research center under siTRP (short-term intervention to revert premalignant lesion) strategy. By focusing on the role of inflammation in the development of H. pylori-associated gastric carcinogenesis, this review is intended to explain the connection between inflammation and gastric cancer. Strategies on H. pylori eradication, removal of inflammation, and reverting preneoplastic lesion will also be introduced. In the end, we expect to be able to prevent gastric cancer by take a detour from the unpleasant journey, i.e. from H. pylori-associated gastritis to gastric cancer.
Animals ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Biomarkers/metabolism ; Disease Models, Animal ; Gastritis/*etiology ; Helicobacter Infections/*complications/drug therapy ; Helicobacter pylori/drug effects/metabolism/physiology ; Humans ; Stomach Neoplasms/etiology/*prevention & control ; Virulence Factors/metabolism

The prevalence of Helicobacter pylori infection in Korea shows a decreasing trend and has changed to that of developed country, especially for those below 30 years old. However, the primary antibiotic resistance rates are higher than those of developed countries. The reason for the decrease in the efficacy of standard triple therapy is mainly due to the increase in the resistance against clarithromycin. Sequential therapy seems to be more effective than the standard triple therapy, but the intention-to-treat eradication rate of sequential therapy in Korea, which is mostly under 80.0%, is still not satisfactory. Therefore, a promising regimen is needed. Recently, the Japanese health insurance system admitted 'H. pylori-infected gastritis' as an indication of eradication. Furthermore, the Kyoto Consensus Meeting on H. pylori Gastritis held from January 30th to February 1st, 2014, proposed that 'all H. pylori positive patients should be offered to receive H. pylori eradication'. This suggests that the concept of eradication has been changed from 'treatment' to 'prevention'. Various individualized tailored therapy based on the polymorphism, age and other demographic factors and antibiotic resistance has been attempted to maximize H. pylori eradication therapy. The aim of this article is to review the current epidemiology, H. pylori resistance state, treatment guideline, and to assess the possible future strategy and treatment for H. pylori infection in Korea.
Anti-Bacterial Agents/pharmacology/*therapeutic use ; Aryl Hydrocarbon Hydroxylases/genetics/metabolism ; Clarithromycin/pharmacology/therapeutic use ; Disease Eradication/trends ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Guidelines as Topic ; Helicobacter Infections/*drug therapy/epidemiology ; *Helicobacter pylori/drug effects ; Humans ; Quinolones/pharmacology/therapeutic use ; Republic of Korea ; Treatment Failure

BACKGROUNDHelicobacter pylori (H. pylori) infection could lead to most gastroduodenal diseases and is even identified as a carcinogen of gastric cancer. Total alkaloids of sophora alopecuroides (TASA) is widely used in herbal remedies to treat various infectious diseases, including stomach-associated diseases. This study is aimed at evaluating the antimicrobial activity of TASA on H. pylori-infected BALB/c mice mouse gastritis.

METHODSTotally 120 BALB/c mice were orally inoculated with H. pylori Bacterial liquid to construct BALB/c mice H. pylori infection gastritis animal model, after the model was successfully created. We randomly assigned 100 infected mice into 10 treatment groups, the first group (normal saline); the second group (bismuth pectin); the third group (omeprazole); the fourth group (TASA 2 mg/d); the fifth group (TASA 4 mg/d); the sixth group (TASA 5 mg/d); the seventh group (TASA + bismuth pectin); the eighth group (TASA + omeprazole); the ninth group (bismuth pectin + clarithromycin + metronidazole); the tenth group (omeprazole + clarithromycin + metronidazole), 5 other non-infected mice as negative control. Mice were orally inoculated twice a day and 7 days continuously. Then the mice were killed 4 weeks after treatment, we used realtime PCR to detect 16sDNA of H. pylori to test both the colonization and the clearance mice of bacteria of each treatment. We applied hematoxylin and eosin (HE) staining and immunostaining of mice gastric mucosa to observe the general inflammation and related factors interleukin 8 (IL-8), cyclooxygenase 2 (COX-2), and nuclear factor-kappa B (NF-κB) expression change after treatments.

RESULTSFirstly, we ensured that after 6-week intragastric administration, the bacteria colonization reached an exceed peak which is far higher than positive threshold (P < 0.001); secondly, after treatments, it is revealed that TASA combined with omeprazole or bismuth pectin showed promising antimicrobial activity against H. pylori as well as conventional triple therapy (P < 0.001); thirdly, HE staining showed that the inflammation on mice gastric mucosal membrane were also relieved obviously in TASA combined treatments and conventional triple therapy compared with normal saline treated mice, moreover, from immunohistochemistry results, H. pylori-induced IL-8, COX-2, and NF-κB were consistently suppressed in seventh, eighth, ninth, and tenth group to a certain extent.

CONCLUSIONThese results open the possibility of taking TASA as an anti-inflammatory agent for H. pylori gastritis.

Alkaloids ; pharmacology ; therapeutic use ; Animals ; Anti-Inflammatory Agents ; pharmacology ; therapeutic use ; Cyclooxygenase 2 ; metabolism ; Female ; Helicobacter Infections ; drug therapy ; Helicobacter pylori ; drug effects ; metabolism ; Immunohistochemistry ; Interleukin-8 ; metabolism ; Mice ; Mice, Inbred BALB C ; NF-kappa B ; metabolism ; Omeprazole ; therapeutic use ; Real-Time Polymerase Chain Reaction ; Sophora ; chemistry

Previous studies suggested that polymorphisms of proinflammatory cytokine genes are important host genetic factors in Helicobacter pylori infection. The present study evaluated whether IL-8-251 polymorphism affected H. pylori eradication rate and to investigate the effect of H. pylori eradication on angiogenesis and the inflammatory process according to the IL-8-251 polymorphism. A total of 250 H. pylori-positive patients treated by endoscopic resection of the gastric neoplasm were classified into 3 groups (134 H. pylori-eradicated group, 19 H. pylori-eradication failure group, and 97 H. pylori-infected group). H. pylori status, histology, and angiogenic factor levels were evaluated at baseline, 6 months, and 18 months. H. pylori eradication rate was 92.9% in AA genotype, 85.7% in AT genotype and 88.4% in TT genotype (P value = 0.731). Elevated IL-8 and matrix metalloproteinase-9 concentrations in H. pylori-infected gastric mucosa were reversible by successful eradication of H. pylori, independent of the IL-8-251 polymorphism. It is suggested that elevated IL-8 and MMP-9 concentrations in H. pylori-infected gastric mucosa are altered significantly after successful eradication and these conditions continue for 18 months. However, IL-8-251 polymorphism does not affect H. pylori eradication rate and the sequential changes of related angiogenic factors after H. pylori eradication in Koreans.
Aged ; Alleles ; Angiopoietin-1/analysis ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Asian Continental Ancestry Group/*genetics ; Female ; Gastric Mucosa/metabolism/pathology ; Genotype ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Interleukin-8/analysis/*genetics ; Male ; Matrix Metalloproteinase 9/analysis ; Middle Aged ; *Polymorphism, Single Nucleotide ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Retrospective Studies ; Stomach Neoplasms/pathology/surgery ; Time Factors ; Vascular Endothelial Growth Factor A/analysis

BACKGROUND/AIMS: DNA double strand breaks (DSB) is one of the critical types of DNA damage. If unrepaired, DSB is accumulated in the nucleus of cells, the cells become apoptotic or transform to tumor by way of genomic instability. Some of malignant cancers and its premalignant lesions were proven to have DSB in their nuclei. There was no report that Helicobacter pylori (H. pylori), the gastric carcinogen, induce DNA DSB in gastric epithelium in vivo. The aim of this study was to investigate whether H. pylori induce DSB in the gastric epithelial cells of chronic gastritis. METHODS: Immunohistochemical stains were performed for the DSB markers, phospho-53BP1 and gammaH2AX, in the gastric epithelium derived from 44 peptic ulcer disease patients before and after H. pylori eradication. DNA fragmentation assay was performed in the cell line to investigate the DNA damage by H. pylori infection. RESULTS: The mean expression score of gammaH2AX was significantly higher in the H. pylori infected gastric epithelium as compared to the H. pylori eradicated gastric epithelium (8.8+/-5.5 vs. 6.2+/-5.3 respectively; p=0.008). The expression score of phospho-53BP1 between before and after eradication of H. pylori was not statistically different, but tended to be higher in H. pylori infection. DNA fragmentation was developed significantly more in the cell lines after infection with H. pylori. CONCLUSIONS: DSB of DNA damage was typical feature of H. pylori infection in the gastric epithelium.
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cell Line, Tumor ; DNA/metabolism ; *DNA Breaks, Double-Stranded ; Female ; Gastric Mucosa/*metabolism ; Helicobacter Infections/drug therapy/*metabolism ; Helicobacter pylori/*drug effects/pathogenicity ; Histones/genetics/metabolism ; Humans ; Immunohistochemistry ; Intracellular Signaling Peptides and Proteins/genetics/metabolism ; Male ; Middle Aged ; Peptic Ulcer/genetics/pathology

It has been suggested that Helicobacter pylori eradication may influence production of some peptides in the stomach, which can affect appetite. This hypothesis is controversial. To verify the hypothesis, we conducted this randomized controlled trial using H. pylori infected subjects without any gastrointestinal symptoms. The treatment group received triple H. pylori eradication therapy for 7 days and the control group received no medication. We measured ghrelin, obestatin and the tumor necrosis factor-alpha (TNF-alpha) mRNA levels in endoscopic biopsy specimens and the changes from baseline to follow-up. The plasma active n-octanoyl ghrelin and obestatin levels were measured in both groups. The ghrelin/obestatin ratios in plasma and gastric mRNA expression were calculated at baseline and follow-up. Ghrelin mRNA expression in the fundic mucosa after H. pylori eradication increased significantly compared to the control group (4.47+/-2.14 vs. 1.79+/-0.96, P=0.009), independent of inflammatory changes. However, obestatin mRNA expression decreased in the antral mucosa (-0.57+/-1.06 vs. 0.41+/-0.72, P=0.028). The treatment group showed a marginal increase (P=0.060) in plasma ghrelin/obestatin ratio. The TNF-alpha mRNA expression also decreased significantly with treatment. This randomized controlled trial demonstrates that H. pylori eradication increases ghrelin mRNA expression, independent of inflammatory cell changes.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Female ; Gastric Mucosa/*metabolism/microbiology ; Gastroscopy ; Ghrelin/blood/genetics/*metabolism ; Helicobacter Infections/drug therapy/genetics/*metabolism ; *Helicobacter pylori ; Humans ; Male ; RNA, Messenger/metabolism ; Tumor Necrosis Factor-alpha/genetics/metabolism

BACKGROUND/AIMS: The cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS), the proteins that have the role in the gastric carcinogenesis, are stimulated by H. pylori infection in the gastric mucosa. The aim of this study was to evaluate the expression of COX-2 and iNOS proteins one year after the eradication of H. pylori. METHODS: Gastric antral mucosa from fifty eight patients with chronic gastritis who were all infected with H. pylori was examined for the expression of COX-2 and iNOS proteins before and one year after the eradication of H. pylori by immunohistochemical stain. RESULTS: COX-2 and iNOS proteins were expressed in the epithelial cells and interstitial inflammatory cells of gastric mucosa. Percent expressions of COX-2 and iNOS were significantly decreased one year after the eradication in the patients with cured infection, but not in those having persistent H. pylori. COX-2 and iNOS expressions were well correlated with H. pylori density, acute and chronic inflammation of gastric mucosa. CONCLUSIONS: The eradication of H. pylori can decrease the expression of COX-2 and iNOS in the gastric mucosa in long-term period. This seems to be due to the removal of H. pylori itself and related regression of gastric inflammation.
Cyclooxygenase 2/immunology/*metabolism ; Drug Therapy, Combination ; Gastric Mucosa/*enzymology ; Helicobacter Infections/drug therapy ; *Helicobacter pylori ; Humans ; Nitric Oxide Synthase Type II/immunology/*metabolism ; Time Factors

OBJECTIVETo observe the effect of volatile oil of amomum (VOA) on the expressions of mastocarcinoma-related peptide (PS2) and platelet activating factor (PAF) in helicobacter pyloriassociated gastritis (HPG) and to analyze its potential mechanism.

METHODSEighty patients with HPG were randomly assigned to two groups, 42 patients in the treated group treated with 0.5 mL VOA, thrice per day; and the 38 patients in the control group receiving Western tertiary medicinal treatment. Gastroscopic picture and helicobacter pylori (HP) infection (by quick urease and Warthin-Starry stain) of the gastro-membrane, expressions of PS2 and PAF (by immunohistochemical assay and Western blotting) as well as the contents of aminohexose and phospholipid (by Neuhaus method) in the gastric membrane of all patients were detected before treatment and 4 weeks after treatment. The clinical efficacy in the two groups was compared.

RESULTSThe total effective rate in the treated group was 88.1%, which was significantly higher than that in the control group (78.9%, P<0.05). After treatment, in the treated group, gastric membranous contents of aminohexose and phospholipid was increased, expression of PS2 elevated but that of PAF lowered, all showing significant difference as compared with those in the control group (P<0.01). In the control group, the expressions of PS2 and PAF changed insignificantly. The radical eliminating rate of HP in the treated group and the control group was insignificantly different between them (76.1% vs. 65.8%, P>0.05).

CONCLUSIONThe mechanism of VOA for anti-gastritis might be related with its action in increasing the expression of PS2 and decreasing the expression of PAF, and thus regulating the hydrophobicity of the gastric membrane.

Adult ; Aged ; Amomum ; Blotting, Western ; Chronic Disease ; Female ; Gastric Mucosa ; chemistry ; Gastritis ; drug therapy ; metabolism ; Helicobacter Infections ; drug therapy ; metabolism ; Helicobacter pylori ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Oils, Volatile ; adverse effects ; therapeutic use ; Peptides ; analysis ; Phospholipids ; analysis ; Platelet Activating Factor ; analysis

OBJECTIVE: To observe the change in expressions of connexin 32 and connexin 43 after the eradication of Helicobacter pylori (H.pylori) in patients with gastric precancerous lesion. METHODS: The expressions of connexin 32 and connexin 43 in gastric mucosa specimens biopsy under endoscopy were detected by immunohistochemistry. The expressions of connexin 32 and connexin 43 were detected before and after the eradication of H.pylori in 88 patients with gastric precancerous lesion, and in 33 patients with chronic superficial gastritis (CSG). RESULTS: The positive expression rates and the expressional intensity of connexin 32 and connexin 43 in patients with gastric precancerous lesions (51.1% and 54.5%) were lower than those in patients with CSG (100% and 93.9%, P < 0.05).In patients with gastric precancerous lesions,the positive expression rates and the expressional intensity of connexin 32 and connexin 43 in H.pylori positive group (41.4% and 44.8%) were lower than those in H.pylori negative group (70% and 73.3%, P < 0.05). In gastric precancerous lesions group, the positive expression rates of connexin 32 and connexin 43 in H.pylori positive group before the eradication therapy (41.4% and 44.8%, respectively) was lower than those after the eradication of H.pylori (97.9% and 91.7%, P < 0.05); in the eradication failure group, the positive expression rates of connexin 32 and connexin 43 were 40% and 50%. The eradication failure group before the treatment and after the treatment had no statistical significance(P > 0.05). CONCLUSION The expressions of connexin 32 and connexin 43 in patients with gastric precancerous lesions are low, and the eradication of H.pylori can upregulate their expressions.
Adult ; Aged ; Connexin 43 ; biosynthesis ; Connexins ; biosynthesis ; Female ; Gastritis ; metabolism ; microbiology ; Helicobacter Infections ; drug therapy ; metabolism ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Precancerous Conditions ; metabolism ; microbiology ; Stomach Neoplasms ; metabolism ; microbiology