Long term follow up of patients treated for Helicobacter pylori infection

Abstract

Background: Helicobacter pylori infection induces progressive inflammatory changes in the gastric mucosa that may lead to gastric cancer. Understanding long term effects resulting from the cure of this infection is needed to design cancer prevention strategies. Methods: A cohort of 795 adults with preneoplastic gastric lesions was randomised to receive anti-H pylori treatment and/or antioxidants. At the end of six years of intervention, those who did not receive anti-H pylori treatment were offered it. Gastric biopsies were obtained at baseline, and at 3, 6, and 12 years. A histopathology score was utilised to document changes in gastric lesions. Non-linear mixed models were used to estimate the cumulative effect of H pylori clearance on histopathology scores adjusted for follow up time, interventions, and confounders. Results: Ninety seven per cent of subjects were H pylori positive at baseline, and 53% were positive at 12 years. Subjects accumulated 1703 person years free of infection. A multivariate model showed a significant regression in histopathology score as a function of the square of H pylori negative time. Subjects who were H pylori negative had 14.8% more regression and 13.7% less progression than patients who were positive at 12 years (p = 0.001). The rate of healing of gastric lesions occurred more rapidly as years free of infection accumulated, and was more pronounced in less advanced lesions. Conclusions: Preneoplastic gastric lesions regress at a rate equal to the square of time in patients rendered free of H pylori infection. Our findings suggest that patients with preneoplastic gastric lesions should be treated and cured of their H pylori infection.

Helicobacter pylori Induces ERK-dependent Formation of a Phospho-c-Fos·c-Jun Activator Protein-1 Complex That Causes Apoptosis in Macrophages

“…The formation of this dimer was dependent on ERK phosphorylation and resulted in c-Myc and ODC expression and apoptosis. These findings are important because failure of the immune response to H. pylori contributes to its strong ability to colonize, as evidenced by prevalence rates approaching 100% in underdeveloped regions (45). Our work provides new insight into the molecular mechanism underlying the polyamine-mediated macrophage apoptosis that contributes to the immunopathogenesis of H. pylori infection.…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…China have demonstrated a beneficial effect of eradicating the bacteria even in patients with precancerous conditions (34,120,139) . Even though the further advanced the existing preneoplastic condition is, the less likely it is that H pylori eradication will stop gastric cancer development (37,59) , a randomized study of patients undergoing H pylori eradication following early gastric cancer resection was able to demonstrate a reduction in the appearance of metachronous gastric cancer (66) .…”

“…Intervention studies conducted in Latin America and Asia and meta-analysis have shown that H pylori eradication is an effective step in preventing gastric cancer, particularly if treatment is performed on patients prior to development of precancerous conditions (atrophic gastritis and intestinal metaplasia) (65,139,193,206,210) . Studies using animal models have also confirmed that gastric cancer development can be prevented by early eradication of the microorganism (14,151) .…”

Clinical Factors Related with Helicobacter Pylori Infection - Is there an Association with Gastric Cancer History in First-Degree Family Members?

“…As H pylori infection plays an important role in gastric cancer pathogenesis, the elimination of H pylori has great importance. Evidences point out a significant reduction in the risk of gastric cancer development following H pylori eradication (Mera et al, 2005;Take et al, 2005;Fuccio et al, 2009). More accentuated in wealthy societies, a steady decrease in the prevalence of H pylori infection and the incidence of gastric cancer has been observed in most populations in recent decades (Correa et al, 2008).…”