- Email: [email protected]
Mo1578 Gastric Premalignant Gastric Conditions - Changing Trends Over a Period of 15 Years in Germany
gastric mucosal condition. Results: Nineteen randomized controlled trials were included, with a total of 5.087 patients (range 20 to 1.630 patients per study). These trials compared H. pylori eradication therapy (n=2.604) with placebo or no treatment (n=1.764), or acid suppressive therapy (n=719). The effect of H. pylori eradication on gastric mucosal changes was evaluated after 8 weeks to 12 years follow-up (2 studies with follow-up ≤ 3 months; 7 studies ≤ 12 months; 5 studies ≤ 2 years; 5 studies 3 to 9 years). In 17 studies details on the effect of H. pylori eradication on atrophic gastritis were reported, of these 10 studies demonstrated less progression or even regression of atrophic gastritis (total n= 2.237; followup range 1 to 9 years), whereas 7 studies reported no beneficial effect (total n= 904; followup range 8 weeks to 1 year). Fourteen studies reported on the effect on intestinal metaplasia, of these four studies showed significant less progression (total n= 1.119; follow-up range 1 to 6 years), however, this finding was not confirmed by the reports of ten studies (total n= 1.822; follow-up range 1 to 9 years). The effect on the progression of dysplasia was only reported in three trials, one study showed a significant reduction of the progression of dysplasia after 9 years follow-up in a study population of 567 patients, whereas two studies showed no significant effect after 5 and 6 years of follow-up in a total of 824 patients. Since outcome measures varied between studies using non-interchangeable parameters, quantification of outcomes was not performed. Conclusion: Clinical evidence for the prevention of carcinogenic progression in patients with atrophic gastritis is highly suggestive, whereas the evidence in patients with intestinal metaplasia and dysplasia is conflicting. Therefore, H. pylori eradication may be insufficient to halt gastric carcinogenesis in patients with intestinal metaplasia and dysplasia.
Different Protein Expression and Genes Patterns of Helicobater Pylori in Pathological Disorders of the Gastric Mucosa Valli De Re, Ombretta Repetto, Stefania Zanussi, Marica Garziera, Mariangela Zorzi, Mariateresa Casarotto, Sendy Giacomini, Giancarlo Basaglia, Stefania Maiero, Giuseppe Toffoli, Vincenzo Canzonieri, Paolo De Paoli, Renato Cannizzaro Background and aim: One goal of Helicobacter pylori (HP) research is the individuation of bacterial markers of gastric cancer (GC). We accomplished a proteomic and genotypic pilot approach to discover bacterial biomarkers by comparing HP isolated from GC and precancerous lesions (duodenal ulcers, DU, and autoimmune atrophic gastritis, AAG). Material and methods: A total of 35 HP strains isolated from antrum and/or corpus of patients with HP-diseases (14 GC; 4 AAG; 8 DU) were investigated. Protein of HP colonies grown from cultured gastric biopsies were extracted and submitted to comparative ‘two-dimensional difference in gel electrophoresis, 2D-DIGE' followed by Decyder statistics analysis and protein identification by MALDI-Tof/Ms spectrometry. DNA was extracted from a total of 10 single colonies/patient and tested for virulence factors coding genes (CagA, CagE, VirB11) of Cag Pathogenicity Island (CagPAI) by PCR. For both proteomics and genetics, HP strains were categorized based on their tissue disease localization (corpo versus antro) and gastric mucosa pathologies. Results: Little genetic heterogeneity was shown in DU- and GC-derived HP strains, with only CagE deletions found in 6/19 GC. AAG-HP showed a substantial deletion of all the 3 genes. Protein maps specifically clusterized for gastric diseases but not for tissue localization, the GC group being discriminated from the others by the principal component analysis (ANOVA p<0.0001). A total of 29 protein spots were found to be differentially expressed. In particular, a subset of proteins (i.g. catalases, alkyhydroxyperoxide reductase, isocitrate dehydrogenase and S-adenosylmethionine synthase) was identified as specifically up-regulated in DU. Conclusions: Although, HP strains are difficult to be isolated from AAG (4/20 pts), in the only AAG genetic analyses evidenced a deletion of CagPAI, thus suggesting a decrease in HP growth with a prevalence of less virulent strains. Therefore, the progressive model of AAG to GC seems independent of HP virulence in our series. By converse, some important proteins were specifically found associated with GC. Previously, the same proteins were reported in different papers as single potential biomarkers for GC and DU. Our data strongly suggest their overall involvement in HP-related gastric disorders.
Mo1580 Age, Smoking, Male Gender and Regular Aspirin use Predict Premalignant Conditions of the Stomach in a Low Gastric Cancer Prevalence Cohort Anthony O'Connor, Alaa Alakkari, Barbara M. Ryan, Niall Breslin, Deirdre McNamara, Humphrey J. O'Connor, Colm A. O'Morain INTRODUCTION: Adenocarcinoma of the stomach is the second leading cause of cancer related death in the world. It causes approximately 750,000 deaths on an annual basis worldwide. Prevalence of gastric cancer is lower in western European countries but still carries a significant disease burden. Gastric Intestinal metaplasia (GIM) is a recognised premalignant condition of the stomach which results from gastric stem cells that are diverted from proliferation into cells specific to the stomach towards those of the small intestine. It is usually caused by chronic inflammation of the stomach, often induced by H. pylori. AIMS & METHODS: We aimed to assess the prevalence of premalignant lesions of the stomach in our western european population at a university teaching hospital and identify factors which may be associated with the conditions. Biopsies were taken from the cardia, fundus, corpus, incisura and antrum of 160 consecutive patients presenting for gastroscopy. Clinical information was obtained at clinical examination and direct interview. P-values were calculated using fisher's exact test. RESULTS: 52.5% of patients undergoing biopsy were female (N=84). GIM was found in 22.5% (N=36) of patients. The median age of patients with GIM was 68.5 years compared to 53 years in those without IM. 31.6% (N=24) of males had GIM compared to 14.3% (N=13) of females (p=0.01). There was no difference in BMI between the two groups. 11.1% (N=6) of those who never smoked had GIM compared to 29.2% (N=31) of past or current habitual smokers (p=0.01). Regarding drug use, 13.9% (N=5) of patients with IM were NSAID users compared to 21% (N=26) of those without (p=0.4735). 44.4% (N=16) of patients with IM were Aspirin users compared to 14.5% (N=18) of those without (p=0.0003). 44.4% (N=16) of patients with IM were PPI users compared to 58.8% (N=73) of those without (p=0.1328). Rates of GIM in Aspirin users under the age of 65 were not statistically different from those over 65% (42.9% vs 47.4%)(p=1.000). H. pylori was observed in 27% (N=10) of patients with GIM compared to 17.7% (N=22) of patients without (p=0.2357). 61.5% (N=8) of male smokers taking aspirin were observed to have GIM. CONCLUSION: Premalignant lesions of the stomach are common and may be clinically significant. Older males are at greatest risk. Smoking is an important modifiable risk factor. The association with Aspirin use may be confounded by age. Awareness of risk factors such as age, gender, smoking history and medication history may identify patients at greatest risk who may benefit from more extensive biopsy sampling and surveillance if necessary.
Mo1578 Gastric Premalignant Gastric Conditions - Changing Trends Over a Period of 15 Years in Germany Mariya Varbanova, Thomas Wex, Thomas Guenther, Peter Malfertheiner Background. Atrophy (AT) and intestinal metaplasia (IM), frequently induced by Helicobacter infection, are considered premalignant conditions in the stomach. Their presence is reported to predict gastric cancer risk. Aim. To investigate possible changes of the prevalence of AT and IM and also their distribution within the stomach, cases from two periods of time in 1995 and 2011 have been focused on and compared. Methods. The histopathology database at the Otto-von-Guericke University has been searched for gastric biopsy cases with AT and/ or IM in a 6-months period in 1995, when the Sydney System was introduced in the department, and in 2011. Inclusion criteria were the presence of either AT or IM in antrum or corpus. In total, 160 cases (58% male, age range 26-88, median 61) have been recruited from the 1995 period and 159 cases (50% male, age range 32-94, median 70) from 2011. Histopathology results were reported following the Sydney system with statements on the degree of AT, IM, activity and chronicity. The combined frequencies of moderate (score = 2) and severe (score 3) AT and IM were analyzed. Results. The overall frequency of AT and IM was higher in tendency in 2011 (49.4%) compared to 1995 (39.4%, p=0.06). Subanalysis revealed significantly reduced antral atrophy (7 vs. 16%, p=0.014) and increased corpus atrophy (34 vs. 16%, p<0.0001) in 2011 compared to 1995. Notably, the frequency of IM was stable in the antrum as well as in the corpus in the two time periods (table 1). The direct histological detection of H. pylori infection dropped from 54% to 17% (p<0.0001) for 1995 and 2011, respectively. Clinical data on use of medication were not available. Conclusions. Within the last 15 years, the presence and topographic pattern of premalignant conditions have changed significantly. The decrease of H. pylori prevalence may be either trend dependent, or could be due to the effect of acid suppressive and other drugs. Table 1. Combined frequencies of moderate to severe premalignant gastric conditions. *p= 0.014, **p<0.0001
Mo1581 Natural History of Gastric Intestinal Metaplasia in an Urban Patient Population Naveen Anand, Cynthia Victor, Alexander Zaslavsky, Pierre Hindy, Samy McFarlane, Adam J. Goodman, Sherif A. Andrawes, Vlado Simko, Frank G. Gress Purpose: To determine the prevalence of gastric intestinal metaplasia (GIM) in GI subspecialty patients receiving upper endoscopy (EGD) in an urban patient population, and identify the risk of gastric cancer (GC) distal to the cardia. Methods: We retrospectively reviewed all EGDs (n=5,157) done over a five-year period at Kings County Hospital Center, in Brooklyn, NY. From this group we identified all EGDs performed with biopsy (n=2,799) and identified all patients found to have gastric pre-malignant and malignant lesions. The latter group makes up our study subset. Clinical and demographic data, including age, ethnicity, gender, H. pylori status, and endoscopic findings were recorded. Patients under the age of 18, and those in whom biopsy samples could not be obtained were excluded from the study. Results: A total of 294 patients were found to have GIM (10.5% of those biopsied), of these 54 (18.4%) had at least one repeat EGD. Of all African-American (AA) patients who had EGD with biopsy, 14.2% had GIM, 6.3% of Asians had GIM, 25.0% of Caucasians had GIM, 10.7% of Hispanics had GIM, and 19.0% of Middle Eastern patients had GIM. The mean age of patients with GIM was 63.2 +/- 0.73 (+/- SEM), whereas in patients without GIM it was 54.7 +/- 0.29 (p<0.01). The mean age of the entire cohort was 56.07 +/- 0.21. 53% of the GIM patients were male compared to 36.2% in the non-GIM group (p<0.01). 46.9% of the GIM patients had H. pylori, while only 27.1% of patients without GIM had it (p<0.01). Of the 294 patients with GIM, 2.7% (n=8) were found to have gastric cancer. Using a logistic regression model with a step-wise approach we assessed the risk of gastric cancer in patients with GIM; the odds ratio (OR) was 2.47 (1.08-5.7) (95% CI) after adjusting for age, sex, and endoscopic findings such as gastropathy, erosions, nodules, ulcers, etc. In our model,
Mo1579 Cochrane Review: Helicobacter pylori Eradication for Pre-Malignant Lesions of the Gastric Mucosa Annemarie C. de Vries, Ingrid L. Holster, Ernst J. Kuipers Background: Helicobacter pylori infection is a major risk factor for gastric cancer development. However, the effect of eradication for prevention of gastric cancer is still controversial, in particular in patients with pre-malignant gastric lesions. This systematic literature Cochrane review was performed to assess the effect of H. pylori eradication therapy on different stages of pre-malignant lesions of the gastric mucosa, i.e. atrophic gastritis, intestinal metaplasia and dysplasia. Methods: Randomized controlled trials comparing H. pylori eradication therapy with placebo or symptomatic treatment in patients with pre-malignant gastric lesions were included. The trials were identified through electronic searches of the Cochrane Library, MEDLINE and EMBASE databases, using appropriate subject headings and keywords. Data were collected on histological changes of the gastric mucosa and functional parameters of
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AGA Abstracts
AGA Abstracts
Mo1577
Different Protein Expression and Genes Patterns of Helicobater Pylori in Pathological Disorders of the Gastric Mucosa Valli De Re, Ombretta Repetto, Stefania Zanussi, Marica Garziera, Mariangela Zorzi, Mariateresa Casarotto, Sendy Giacomini, Giancarlo Basaglia, Stefania Maiero, Giuseppe Toffoli, Vincenzo Canzonieri, Paolo De Paoli, Renato Cannizzaro Background and aim: One goal of Helicobacter pylori (HP) research is the individuation of bacterial markers of gastric cancer (GC). We accomplished a proteomic and genotypic pilot approach to discover bacterial biomarkers by comparing HP isolated from GC and precancerous lesions (duodenal ulcers, DU, and autoimmune atrophic gastritis, AAG). Material and methods: A total of 35 HP strains isolated from antrum and/or corpus of patients with HP-diseases (14 GC; 4 AAG; 8 DU) were investigated. Protein of HP colonies grown from cultured gastric biopsies were extracted and submitted to comparative ‘two-dimensional difference in gel electrophoresis, 2D-DIGE' followed by Decyder statistics analysis and protein identification by MALDI-Tof/Ms spectrometry. DNA was extracted from a total of 10 single colonies/patient and tested for virulence factors coding genes (CagA, CagE, VirB11) of Cag Pathogenicity Island (CagPAI) by PCR. For both proteomics and genetics, HP strains were categorized based on their tissue disease localization (corpo versus antro) and gastric mucosa pathologies. Results: Little genetic heterogeneity was shown in DU- and GC-derived HP strains, with only CagE deletions found in 6/19 GC. AAG-HP showed a substantial deletion of all the 3 genes. Protein maps specifically clusterized for gastric diseases but not for tissue localization, the GC group being discriminated from the others by the principal component analysis (ANOVA p<0.0001). A total of 29 protein spots were found to be differentially expressed. In particular, a subset of proteins (i.g. catalases, alkyhydroxyperoxide reductase, isocitrate dehydrogenase and S-adenosylmethionine synthase) was identified as specifically up-regulated in DU. Conclusions: Although, HP strains are difficult to be isolated from AAG (4/20 pts), in the only AAG genetic analyses evidenced a deletion of CagPAI, thus suggesting a decrease in HP growth with a prevalence of less virulent strains. Therefore, the progressive model of AAG to GC seems independent of HP virulence in our series. By converse, some important proteins were specifically found associated with GC. Previously, the same proteins were reported in different papers as single potential biomarkers for GC and DU. Our data strongly suggest their overall involvement in HP-related gastric disorders.
Mo1580 Age, Smoking, Male Gender and Regular Aspirin use Predict Premalignant Conditions of the Stomach in a Low Gastric Cancer Prevalence Cohort Anthony O'Connor, Alaa Alakkari, Barbara M. Ryan, Niall Breslin, Deirdre McNamara, Humphrey J. O'Connor, Colm A. O'Morain INTRODUCTION: Adenocarcinoma of the stomach is the second leading cause of cancer related death in the world. It causes approximately 750,000 deaths on an annual basis worldwide. Prevalence of gastric cancer is lower in western European countries but still carries a significant disease burden. Gastric Intestinal metaplasia (GIM) is a recognised premalignant condition of the stomach which results from gastric stem cells that are diverted from proliferation into cells specific to the stomach towards those of the small intestine. It is usually caused by chronic inflammation of the stomach, often induced by H. pylori. AIMS & METHODS: We aimed to assess the prevalence of premalignant lesions of the stomach in our western european population at a university teaching hospital and identify factors which may be associated with the conditions. Biopsies were taken from the cardia, fundus, corpus, incisura and antrum of 160 consecutive patients presenting for gastroscopy. Clinical information was obtained at clinical examination and direct interview. P-values were calculated using fisher's exact test. RESULTS: 52.5% of patients undergoing biopsy were female (N=84). GIM was found in 22.5% (N=36) of patients. The median age of patients with GIM was 68.5 years compared to 53 years in those without IM. 31.6% (N=24) of males had GIM compared to 14.3% (N=13) of females (p=0.01). There was no difference in BMI between the two groups. 11.1% (N=6) of those who never smoked had GIM compared to 29.2% (N=31) of past or current habitual smokers (p=0.01). Regarding drug use, 13.9% (N=5) of patients with IM were NSAID users compared to 21% (N=26) of those without (p=0.4735). 44.4% (N=16) of patients with IM were Aspirin users compared to 14.5% (N=18) of those without (p=0.0003). 44.4% (N=16) of patients with IM were PPI users compared to 58.8% (N=73) of those without (p=0.1328). Rates of GIM in Aspirin users under the age of 65 were not statistically different from those over 65% (42.9% vs 47.4%)(p=1.000). H. pylori was observed in 27% (N=10) of patients with GIM compared to 17.7% (N=22) of patients without (p=0.2357). 61.5% (N=8) of male smokers taking aspirin were observed to have GIM. CONCLUSION: Premalignant lesions of the stomach are common and may be clinically significant. Older males are at greatest risk. Smoking is an important modifiable risk factor. The association with Aspirin use may be confounded by age. Awareness of risk factors such as age, gender, smoking history and medication history may identify patients at greatest risk who may benefit from more extensive biopsy sampling and surveillance if necessary.
Mo1578 Gastric Premalignant Gastric Conditions - Changing Trends Over a Period of 15 Years in Germany Mariya Varbanova, Thomas Wex, Thomas Guenther, Peter Malfertheiner Background. Atrophy (AT) and intestinal metaplasia (IM), frequently induced by Helicobacter infection, are considered premalignant conditions in the stomach. Their presence is reported to predict gastric cancer risk. Aim. To investigate possible changes of the prevalence of AT and IM and also their distribution within the stomach, cases from two periods of time in 1995 and 2011 have been focused on and compared. Methods. The histopathology database at the Otto-von-Guericke University has been searched for gastric biopsy cases with AT and/ or IM in a 6-months period in 1995, when the Sydney System was introduced in the department, and in 2011. Inclusion criteria were the presence of either AT or IM in antrum or corpus. In total, 160 cases (58% male, age range 26-88, median 61) have been recruited from the 1995 period and 159 cases (50% male, age range 32-94, median 70) from 2011. Histopathology results were reported following the Sydney system with statements on the degree of AT, IM, activity and chronicity. The combined frequencies of moderate (score = 2) and severe (score 3) AT and IM were analyzed. Results. The overall frequency of AT and IM was higher in tendency in 2011 (49.4%) compared to 1995 (39.4%, p=0.06). Subanalysis revealed significantly reduced antral atrophy (7 vs. 16%, p=0.014) and increased corpus atrophy (34 vs. 16%, p<0.0001) in 2011 compared to 1995. Notably, the frequency of IM was stable in the antrum as well as in the corpus in the two time periods (table 1). The direct histological detection of H. pylori infection dropped from 54% to 17% (p<0.0001) for 1995 and 2011, respectively. Clinical data on use of medication were not available. Conclusions. Within the last 15 years, the presence and topographic pattern of premalignant conditions have changed significantly. The decrease of H. pylori prevalence may be either trend dependent, or could be due to the effect of acid suppressive and other drugs. Table 1. Combined frequencies of moderate to severe premalignant gastric conditions. *p= 0.014, **p<0.0001
Mo1581 Natural History of Gastric Intestinal Metaplasia in an Urban Patient Population Naveen Anand, Cynthia Victor, Alexander Zaslavsky, Pierre Hindy, Samy McFarlane, Adam J. Goodman, Sherif A. Andrawes, Vlado Simko, Frank G. Gress Purpose: To determine the prevalence of gastric intestinal metaplasia (GIM) in GI subspecialty patients receiving upper endoscopy (EGD) in an urban patient population, and identify the risk of gastric cancer (GC) distal to the cardia. Methods: We retrospectively reviewed all EGDs (n=5,157) done over a five-year period at Kings County Hospital Center, in Brooklyn, NY. From this group we identified all EGDs performed with biopsy (n=2,799) and identified all patients found to have gastric pre-malignant and malignant lesions. The latter group makes up our study subset. Clinical and demographic data, including age, ethnicity, gender, H. pylori status, and endoscopic findings were recorded. Patients under the age of 18, and those in whom biopsy samples could not be obtained were excluded from the study. Results: A total of 294 patients were found to have GIM (10.5% of those biopsied), of these 54 (18.4%) had at least one repeat EGD. Of all African-American (AA) patients who had EGD with biopsy, 14.2% had GIM, 6.3% of Asians had GIM, 25.0% of Caucasians had GIM, 10.7% of Hispanics had GIM, and 19.0% of Middle Eastern patients had GIM. The mean age of patients with GIM was 63.2 +/- 0.73 (+/- SEM), whereas in patients without GIM it was 54.7 +/- 0.29 (p<0.01). The mean age of the entire cohort was 56.07 +/- 0.21. 53% of the GIM patients were male compared to 36.2% in the non-GIM group (p<0.01). 46.9% of the GIM patients had H. pylori, while only 27.1% of patients without GIM had it (p<0.01). Of the 294 patients with GIM, 2.7% (n=8) were found to have gastric cancer. Using a logistic regression model with a step-wise approach we assessed the risk of gastric cancer in patients with GIM; the odds ratio (OR) was 2.47 (1.08-5.7) (95% CI) after adjusting for age, sex, and endoscopic findings such as gastropathy, erosions, nodules, ulcers, etc. In our model,
Mo1579 Cochrane Review: Helicobacter pylori Eradication for Pre-Malignant Lesions of the Gastric Mucosa Annemarie C. de Vries, Ingrid L. Holster, Ernst J. Kuipers Background: Helicobacter pylori infection is a major risk factor for gastric cancer development. However, the effect of eradication for prevention of gastric cancer is still controversial, in particular in patients with pre-malignant gastric lesions. This systematic literature Cochrane review was performed to assess the effect of H. pylori eradication therapy on different stages of pre-malignant lesions of the gastric mucosa, i.e. atrophic gastritis, intestinal metaplasia and dysplasia. Methods: Randomized controlled trials comparing H. pylori eradication therapy with placebo or symptomatic treatment in patients with pre-malignant gastric lesions were included. The trials were identified through electronic searches of the Cochrane Library, MEDLINE and EMBASE databases, using appropriate subject headings and keywords. Data were collected on histological changes of the gastric mucosa and functional parameters of
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AGA Abstracts
AGA Abstracts
Mo1577