The reinfection rate after eradication of H. pylori is low in Japan despite the country's high prevalence of H. pylori infection.

Infection with Helicobacter pylori induces humoral immune responses against various antigens of the bacterium. Heat shock proteins (hsps) are immunodominant antigens in various diseases including H. pylori infection. In the present study, we measured the anti-hsp antibody titers in 42 patients with H. pylori-infected peptic ulcers during a bacterial eradication study. The patients were treated with a proton pump inhibitor and antimicrobial agents to eradicate the organism. Their sera were obtained at pretreatment and at 1 month and 6 months after the eradication therapy. The titers of immunoglobulin G antibodies to the H. pylori hsp, wholecell lysate, and urease (30-kDa subunit) antigens in serum were measured by a capture enzyme-linked immunosorbent assay. The levels of H. pylori hsp60 antibodies in sera collected 1 month after treatment had declined significantly, even when changes in the titers of antibodies to whole-cell and urease antigens were not apparent. These results suggest that measurement of antibodies to H. pylori hsp60 in serum is useful for the early monitoring of the effectiveness of eradication therapy.Helicobacter pylori is associated with gastritis and peptic ulcer disease in humans. H. pylori infection induces the host's constitutional immune response against various antigens of this bacterium. The detection of immunoglobulin G (IgG) antibodies to H. pylori is useful for the diagnosis of infection. Some investigators reported that the titers of these antibodies declined during therapy for H. pylori eradication (1,12,14,15,17,18). Kosunen (13) reported that a consistent decrease in the IgG antibody titer within 6 months of antimicrobial therapy reliably indicated the eradication of H. pylori (13). However, a serological test that can be used to judge the success of treatment earlier in the follow-up period has not yet been established. In this study we measured the titers of IgG antibodies to the heat shock protein (hsp) hsp60, urease, and whole-cell lysates of H. pylori in sera from patients with peptic ulcer during antimicrobial treatment of H. pylori and then assessed its usefulness for the monitoring of eradication therapy. MATERIALS AND METHODSPatients studied. We investigated 20 subjects with gastric ulcer (GU) (17 men and 3 women; age range, 35 to 74 years; mean age, 52 years) and 17 subjects with duodenal ulcer (DU) (13 men and 4 women; age range, 22 to 51 years; mean age, 36.6 years). All patients underwent gastroduodenoscopy because of gastrointestinal symptoms. Examinations were performed in the First Department of Internal Medicine, Okayama University School of Medicine, and its affiliated hospitals. At the initial diagnostic endoscopy, all patients were diagnosed as having a peptic ulcer.Status of H. pylori infection. H. pylori infection status was evaluated by bacterial culture, measurement of urease activity, and histologic analysis. A patient was judged to be H. pylori positive if culture and/or histologic analysis of specimens retrieved endoscopically was positive for the org...

BackgroundWe aimed to clarify the factors associated with the presentation of erosive esophagitis (EE) symptoms in subjects undergoing health checkups.MethodsWe utilized baseline data from 7,552 subjects who underwent upper endoscopy for health screening in a prospective, multicenter cohort study. The subjects were asked to complete a questionnaire detailing their upper abdominal symptoms and lifestyle. Based on the heartburn and/or acid regurgitation frequency, the EE subjects were stratified into the following three groups: (1) at least one day a week (symptomatic EE [sEE]), (2) less than one day a week (mild symptomatic EE [msEE]), and (3) never (asymptomatic EE [aEE]). Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were defined according to the Rome III criteria.ResultsOf the 1,262 (16.7%) subjects (male 83.8%, mean age 52.6 years) with EE, the proportions of sEE, msEE and aEE were 15.0%, 37.2% and 47.9%, respectively. The sEE group showed significant associations with overlapping EPS (OR: 58.4, 95% CI: 25.2–160.0), overlapping PDS (OR: 9.96, 95% CI: 3.91–26.8), severe hiatal hernia (OR: 2.43, 95% CI: 1.43–4.05), experiencing high levels of stress (OR: 2.20, 95% CI: 1.43–3.40), atrophic gastritis (OR: 1.57, 95% CI: 1.03–2.36) and Los Angeles (LA) grade B or worse (OR: 1.72, 95% CI: 1.12–2.60) in the multivariate analysis.ConclusionsApproximately one-sixth of EE subjects were symptomatic. A multifactorial etiology, including factors unrelated to gastric acid secretion, was associated with the symptom presentation of EE subjects.

Apolipoprotein A2-ATQ/AT (apoA2-ATQ/AT) has been identified as a minimally invasive biomarker for detecting pancreatic cancer (PC) and high-risk (HR) individuals for PC. To establish an efficient enrichment strategy for HR, we carried out a plasma apoA2-ATQ/AT level-based prospective screening study among the general population. The subjects for the screening study were recruited at six medical check-up facilities in Japan between October 2015 and January 2017. We evaluated the positive predictive value (PPV) of the plasma apoA2-ATQ/AT level of ≤35 μg/mL for detecting PC and HR. Furthermore, we prospectively confirmed its diagnostic accuracy with another post-diagnosis population in a cross-sectional study. We enrolled 5120 subjects in experimental screening, with 84 subjects (1.3%) showing positive results for apoA2-ATQ/AT. Pancreatic abnormalities were recognized in 26 of the 84 subjects from imaging examinations. Pancreatic abnormalities detected included 1 PC and 15 HR abnormalities, such as cystic lesions including intraductal papillary mucinous neoplasm. The PPV of apoA2-ATQ/AT for detecting PC and HR was 33.3%. Moreover, a combination study with another cross-sectional study revealed that the area under the curve for apoA2-ATQ/AT to distinguish PC from healthy controls was 0.903. ApoA2-ATQ/AT has the potential to enrich PC and HR by increasing the diagnostic probability before imaging examinations.

BackgroundThe association of alcohol intake with the incidence of Barrett’s esophagus (BE) has been inconsistent. Although hiatal hernia and male sex are well-known risk factors of BE, its effect on the association of alcohol intake with the incidence of BE remains unknown.AimTo investigate whether the influence of alcohol intake on the occurrence of BE might differ depending on male sex and presence of hiatal hernia.MethodsWe utilized a database of 8031 patients that underwent upper endoscopy for health screening in a prospective, multicenter, cohort study (the Upper Gastro Intestinal Disease study). The incidence of endoscopic columnar-lined esophagus (eCLE; endoscopically diagnosed BE) was the outcome variable. Multivariable logistic regression analysis was conducted to assess the association between alcohol intake and eCLE stratified by male sex and hiatal hernia, adjusting for clinical features and other potential confounders.ResultsAlcohol intake (≥20 g/day) showed a marginally significant association with the incidence of eCLE in participants without hiatal hernia (0 vs. ≥20 g/day; odds ratio [OR], 1.62; 95% confidence interval [CI], 0.92–2.85, P = 0.09) but not in participants with hiatal hernia (0 vs. ≥20/day; OR, 0.99; 95% CI, 0.59–1.65; P = 0.95). Furthermore, alcohol intake (≥20 g/day) was significantly associated with the incidence of eCLE in male participants without hiatal hernia (0 vs. ≥20 g/day; OR, 1.98; 95% CI, 1.04–4.03; P = 0.04) but not in female participants without hiatal hernia (0 vs. ≥20 g/day; OR, 0.47; 95% CI, 0.03–2.37; P = 0.42).ConclusionsThe effect of alcohol intake on the incidence of eCLE might be associated with hiatal hernia status and male sex.