Helicobacter pylori infection progresses proximally associated with pyloric metaplasia in age-dependent tendency: a cross-sectional study

Abstract

BackgroundThe elderly population presents higher morbidity of H. pylori associated diseases in proximal stomach. The specific pathogenesis and mechanism have not been clearly addressed. The gastric environment for H. pylori colonization is dynamic with increasing age. The aim of present study is to investigate the correlation among the distribution of H. pylori, mucosal inflammation, gastric microenvironment and age.MethodsA total of 180 patients with dyspepsia symptoms were divided into young, middle-aged and elderly groups. Biopsies were obtained from each patient in five locations: great curvature (mid-corpus, mid-antrum), lesser curvature (mid-corpus, mid-antrum) and incisura angularis (IA), analyzed for H. pylori density, mucosal inflammation and histopathology.ResultsThe infection rate of H. pylori increased linearly with age (p < 0.001) in corpus, but not in antrum and IA. The H. pylori density was significantly aggravated in IA (p = 0.002) and corpus (p < 0.001) in elderly patient, but not in antrum. The mucosa inflammation scores were consistent with the severity of H. pylori colonization among three age groups. In elderly patients, the pyloric glands present more frequently in corpus, comparing with young and middle-aged group. A significant positive correlation among aggravating severity of H. pylori infection, mucosal inflammation and pyloric metaplasia in corpus with increasing age (p < 0.001) was occurred.ConclusionsWith increasing age, both topographic distribution of H. pylori and the expansion of pyloric glands increased in a distal-to-proximal gastric direction. Pyloric metaplasia in corpus was correlated with the risk of aggravated H. pylori colonization and associated inflammation in elderly population.

Consistency between the endoscopic Kyoto classification and pathological updated Sydney system for gastritis: A cross‐sectional study

“…5,29 After the continuation of acute inflammation induced by H. pylori infection, atrophy and intestinal metaplasia appear, and active inflammation and H. pylori density decrease. 30 The present study showed that enlarged folds, nodularity, and diffuse redness were inversely associated with pathological atrophy and intestinal metaplasia in the antrum, which is supported by this evidence. Nakashima et al reported that patients with endoscopic nodularity had little pathological atrophy and intestinal metaplasia, but severe neutrophil activity and chronic inflammation, 31 which is consistent with our results.…”

“…5 , 29 After the continuation of acute inflammation induced by H. pylori infection, atrophy and intestinal metaplasia appear, and active inflammation and H. pylori density decrease. 30 The present study showed that enlarged folds, nodularity, and diffuse redness were inversely associated with pathological atrophy and intestinal metaplasia in the antrum, which is supported by this evidence. Nakashima et al .…”

Endoscopic tissue sampling – Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…During such procedures, biopsies should be performed in the antrum and corpus. The need to assess both compartments is drawn from indirect evidence of the patchy distribution in the corpus in surgical specimens and that, with age and expansion of pyloric glands, a distal to proximal gastric spread of H. pylori occurs [43][44][45]. Moreover, according to the management of precancerous conditions and lesions in the stomach (MAPS) guidelines, biopsies should be taken with the purpose of staging atrophy/intestinal metaplasia as this will affect the allocation to different surveillance strategies [46].…”

Frequency of H. pylori in liver cirrhosis patients with overt Hepatic encephalopathy at tertiary care hospital, Karachi.

“…Regarding age, both liver cirrhosis and H. pylori infection occurs more commonly in older people 27,28 . Elucidating a relationship between the age of the cirrhotic patient and H. pylori infection, our study showed a statistically significant association between the two (p=0.00).…”