ObjectiveTo determine the expressions of Lgr5 protein and Ki-67 protein in gastric cancer tissues, and to analyze the possible function in the carcinogenesis and development of gastric cancer.MethodsThe SABC immunohistochemical method was adopted to examine the expressions of Lgr5 protein and Ki-67 protein in the 69 paraffin slices of gastric cancer from the patients, with the adjacent normal gastric tissue as the control group. The statistical relationship between the expressions of these two kinds of proteins and clinicopathologic features of gastric cancer was examined respectively.ResultsIn the gastric cancer tissue group, the expressions of Lgr5 protein and Ki-67 protein upregulated in comparison to the adjacent normal gastric tissue group [Lgr5 protein: 87.0% (60/69) versus 16.7% (5/30), χ2=45.81, P<0.001; Ki-67 protein: 79.7% (55/69) versus 36.7% (11/30), χ2=17.43, P<0.001]. The expressions of Lgr5 protein and Ki-67 protein all upregulated in the N1–N3 stage groups, lowly differentiated+undifferentiated groups and positive Helicobacter pylori (HP) groups. The expression of Lgr5 protein upregulated in the T3+T4 stage groups in comparison to T1+T2 stage groups, while, no significant relationship was found in the expression of Ki-67 protein and tumor T staging. No significant relationship was found between the gender or metastasis and the expression of these two proteins. There was a positive correlation between the Lgr5 protein expression and the Ki-67 protein expression in the gastric cancer (rs=0.340, P=0.004).ConclusionsIn the development progress of gastric cancer, the Lgr5 protein might get involved in the mechanism of tumor invasion, lymph nodal metastasis, and low differentiation. Ki-67 protein might get involved in the mechanism of lymph nodal metastasis and low differentiation. The two proteins, together with the HP infection, might play a synergistic role in tumorigenesis and development.
ObjectiveTo summary the study results of the Sichuan Gastric Cancer Early Detection and Screening Research Program (SIGES). MethodsIn the past 10 years, SIGES program conducted a series of clinical and clinical epidemiological studies on the current situation and strategies of gastric cancer prevention and control in China, which provided evidence for supply-side structural reform to improve the gastric cancer prevention and control. We collected related studies and made a review. ResultsSIGES program systematically and specifically studied carcinogenic pathogens, risk factors, screening strategies, as well as critical technique and system construction of tertiary prevention for gastric cancer. The main results supported that Helicobacter pylori was highly correlated with precancerous atrophic gastritis and gastric cancer. Oncoviruses, such as Epstein-Barr virus, hepatitis B virus, human cytomegalovirus, human papillomavirus, John Cunningham virus were correlated with the risk of gastric cancer, and should be paid further attention in the prevention and screening strategy of gastric cancer. Ethnicity, domicile, and family history of gastric cancer were also correlated with gastric cancer and gastric cancer-related risk factors, so it was suggested to include in the personalized evaluation criteria system of high-risk groups for gastric cancer. ConclusionsAt present, the prevention and control of gastric cancer in China has achieved substantial achievements, but the burden of gastric cancer keeps heavy. It is still necessary to conduct further scientific research on critical technique or issues in designing prevention and control strategies.
ObjectiveTo discuss the etiological factors and risk factors for peptic ulcer hemorrhage with negative Helicobacter pylori (HP). MethodsA total of 182 patients with peptic ulcer treated in our hospital from January 2010 to December 2012 were chosen in our study. There were 85 cases of hemorrhage among them, with 50 HP positive and 35 HP negative ones. The other 97 patients were without hemorrhage. Etiological factors and correlated risk factors for peptic ulcer hemorrhage with HP negative were analyzed. ResultsHP negative rate of the hemorrhage group was 41.2%, while that rate of the non-hemorrhage group was 14.4%, and the difference was significant (P<0.05). The patients with peptic ulcer hemorrhage with negative HP had correlations with age, sex, wine drinking, taking non-steroidal anti-inflammatory medicine and so on. ConclusionPeptic hemorrhage is easily complicated with peptic ulcer with negative HP, and it is intimately correlated with patients' age, sex, wine drinking history, and taking non-steroidal anti-inflammatory medicine, etc.
Objective We aimed to evaluate the prevalence of H.pylori infection and the prevalence of cagA+ strains in patients with and without Barrett’s esophagus. Methods A full literature search to February 2008 was conducted in PubMed, MEDLINE and EMbase databases to identify case-control studies or cohort studies evaluating the prevalence of H.pylori in patients with or without Barrett’s esophagus. Summary odds ratios (OR) and 95% confidence interval (CI) were calculated by RevMan 4.2.8. Results Nineteen studies were identified (16 case-controlled studies and 3 cohort studies). In case controlled studies, the prevalence of H.pylori infection significantly decreased in patients with Barrett’s esophagus as compared subjects with normal endoscopic appearance, with a overall OR of 0.56 (95%CI 0.40 to 0.79). The prevalence of H.pylori infection was no statistically significant difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease, with a overall OR of 0.86 (95% CI 0.74 to 1.00). In cohort studies, the prevalence of H. pylori was no statistically significant difference in patients with Barrett’s esophagus as compared to patients with normal endoscopic appearance or patients with gastroesophageal reflux disease, with a overall OR of 1.12 (95%CI 0.77 to 1.61) and 1.10 (95%CI 0.32 to 3.83). When the analysis was stratified by the status of cagA, the prevalence of cagA positive strains significantly decreased in patients with Barrett’s esophagus as compared both to subjects with normal endoscopic appearance with OR 0.30 and 95% CI 0.12 to 0.74, and to those with gastroesophageal reflux disease (OR 0.55; 95%CI 0.33 to 0.94). Irrespective of the presence of intestinal metaplasia, similar magnitude for the reduction of H.pylori infection was observed for patients with Barrett’s esophagus and those with normal endoscopic appearance. While accompared with the presence of intestinal metaplasia, Barrett’s esophagus was associated with a significantly reduction as compared to the patients with gastroesophageal reflux disease (OR 0.81, 95%CI 0.68 to 0.98). When stratified analyses were performed, a significant reduction of H.pylori infection was observed only in patients with long-segment Barrett’s esophagus (OR 0.54; 95%CI 0.35 to 0.82), but not in those with short-segment Barrett’s esophagus (OR 0.72; 95%CI 0.43 to 1.20). Conclusion This meta-analysis indicated that the prevalence of H.pylori infection, especially the prevalence of cagA positive strains was significantly lower in patients with Barrett’s esophagus than in subjects with normal endoscopic appearance. However, the prevalence of H. pylori infection was no statistical difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease. Colonization with cagA positive strains may be protective against the formation of Barrett’s esophagus.
Objective To analyze the relationship between helicobacter pylori (HP) and gastric cancer. Methods We searched CNKI (Jan.1995-Dec.2005) and Wangfandatabase (Jan.1995-Dec.2005). Case-control studies on relationship of helicobacter pylori infection and gastric cancer were collected. Meta-analysis method was used to sum up the odds ratio (OR) and 95%CI of these studies.Results We identified 14 case-control studies with 11 studies of healthy adults versus gastric cancer patients and 4 studies of gastritis versus gastric cancer patients. The results of subgroup analyses based on patients resource showed: statistical difference was founded between healthy adults and gastric cancer patients with pooled OR 2.00 and 95%CI 1.25 to 3.20; no statistical difference was founded between gastritis patients and gastric cancer patients with pooled OR 1.54 and 95%CI 0.68 to 3.50. The results of subgroup analyses based on locations of gastric cancer showed: statistical difference was founded between the non-cardiac gastric cancer patients and the control with pooled OR 3.60 and 95%CI 1.25 to 10.36; no statistical difference was found between cardiac gastric cancer patients and control with pooled OR 0.88 and 95%CI 0.56 to 1.39.Conclusion HP infection can be associated with gastric cancer, and the different conclusions of the 14 reports may be attributed to the locations of gastric cancer and the selection of controls.
Objective To make an individualized treatment plan for one first-visit gastro-esophageal reflux disease patient via evidence-based medicine methods. Methods The condition of the patient was evaluated comprehensively, then clinical problems were put forward according to PICO principle, and high-quality evidence was collected from The Cochrane Library (1990 to 2010), PubMed (1990 to 2010), and EMbase (1990 to 2010). The treatment plan was designed based on the evaluation of evidence, doctor’s experience, and patient’s preferences. Results A total of 17 RCTs and 10 meta-analyses/ systematic reviews were included. The evidence showed that the therapeutic effect of PPI was better than that of H2RA, and meanwhile prokinetic drugs should be used. When PPI needed to be use for a long time, HP eradication operation was required for the combination of HP inflammation. Laparoscopic fundoplication surgery was a better choice if the operation was required. Based on the above evidence combined with the patient’s preferences, the combination of general treatment, esomeprazole and cisaPride were adopted to treat. Meanwhile, anti-HP medicine was used to control the HP inflammation caused by the long-term maintenance therapy. The gastro-esophageal reflux symptoms were remarkably relieved six months after the treatment. Conclusion PPI plus prokinetic drugs, combined with HP eradication of gastroesophageal reflux surgery, can improve the clinical outcomes and patient’s quality of life. However, long-term prognostic benefits need to be confirmed by further follow-up.
Serum tumor markers CEA, CA19-9, CA72-4 and Helicobacter pylori (H.pylori) antibodies were measured in 162 patients with gastric cancer. CEA, CA19-9 and CA72-4 had sensitivities of 24.0%, 35.5% and 21.9% respectively. CA72-4 provided 100% specifity, compared to 77% and 93% for CA19-9 and CEA. The positive predictive value (PV) in CEA, CA19-9 and CA72-4 was higher than negative PV. Serum CA19-9 and CA72-4 levels rose in tumor of ＞5.0cm in diameter. The CA19-9 increased remarkably when the deeper stomach wall was invased. The significantly elevated CEA, CA72-4 and CA19-9 levels were found in patients who had nodal involvement in more than 50% and distant metastasis. However, the increase of CEA, CA19-9 and CA72-4 were found in undifferentiated tumor. Antibodies to H.pylori were detected in 54% of patients but in only 22% control subjects. A significant association was found between H.pylori infection and gastric cancer (odds ratio=3.75; 95% confidence interval=2.11-5.41, Ｐ＜0.01). Conclusions: CEA, CA19-9 and CA72-4 have higher specifity but lower sensitivity in diagnosis of the gastric cancer. The levels of CEA, CA19-9 and CA72-4 are significantly associated with the diameter, the depth of invasion, nodal involvement, distant metastasis and cell differention. Infection with H.pylori may be an important cause of gastric cancer.
Objective To study the earlier and later clinic results of 64 chronic duodenal ulcer patients treated with high selective vagotomy and mucosal antrectomy (HSV+MA). Methods The clinic results of the patients and the changes of gastrin, motilin and somatostatin in the blood were prospectively investigated. Results Fifty nine (92.2%) patients after 3-6 months of follow-up and 26 (92.9%) patients after 5-8 years of follow-up achieved Visick grates Ⅰ-Ⅱ. No patients died. Gastric acid secretion and infection rate of helicobacter pylori in antral mucosa were significantly reduced after operation. No significant difference was showed in bile acids and total bacterial counts of gastric juice before and after operation. No ulcer recurrence was found by barium meal and endoscopy. There was no significant difference in serum gastrin and plasma motilin before and after operation. The level of somatostatin in the blood of patients after 5-8 years of follow-up was decreased. Conclusion HSV+MA is the better operative treatment for duodenal ulcer, since it can not only effectively and lastingly decrease acid secretion and rates of ulcer recurrence, but also preserve the function of the antrum and pylorus and keep the gastric milieu interne relatively stable.
Objective To explore the interference of recent use of antibiotics in the sensitivities of different methods for the detection of Helicobacter pylori (Hp) in children. Methods From June 2015 to December 2017, children who were highly suspected of Hp infection and required gastroscopy were divided into the antibiotic group and the control group according to the recent use of antibiotics, with 200 cases in each group. The use of antibiotics of children in the antibiotic group was analyzed. The children in the two groups completed five methods of Hp detection, including rapid urease test (RUT), 13C-urea breath test (13C-UBT), pathological Warthin-Starry staining, colloidal gold method for measuring Hp immunoglobulin M (IgM) antibody, and enzyme linked immunosorbent assay method for measuring Hp stool antigen (HpSA). Comparative analyses of data were done. Results The positive rate of RUT was 36.5% in the antibiotic group and 75.0% in the control group (P<0.05). The positive rate and value of13C-UBT were 59.0% and 13.6±4.7 in the antibiotic group, and 78.0% and 41.7±6.6 in the control group (P<0.05). The positive rate of pathological biopsy was 48.0% in the antibiotic group and 68.0% in the control group (P<0.05), and L-forms were found in 80.9% of the Hp-positive specimens in the antibiotic group. The positive rate of IgM antibody was 54.5% in the antibiotic group and 65.5% in the control group (P<0.05). The positive rate of HpSA was 38.0% in the antibiotic group and 69.0% in the control group (P<0.05). In the antibiotic group, only 12.5% of the children used antibiotics for eradication of Hp and 87.5% for non Hp eradication. Conclusions Under the interference of antibiotics use, the sensitivity of 13C-UBT is the highest among the five methods for Hp detection, and the sensitivities of RUT and HpSA are very low. For children who could not cooperate with 13C-UBT, the sensitivity of IgM detection is relatively high. For children who need gastroscopy, prolonged chromogenic time for RUT and multi-point pathological biopsy can reduce misdiagnosis.
ObjectiveTo determine the level of CDH1 gene promoter hypermethylation in human gastric carcinoma by establishing MS-PCR method, and analyze retrospectively the possible statistical relationship between CDH1 gene promoter hypermethylation in human gastric carcinoma and HP infection, tumor differentiation, invasion, lymph nodal and distant metastasis, respectively. MethodsThe bisulfite conversion MS-PCR method was adopted to examine the level of CDH1 gene promoter hypermethylation in 40 cases of human gastric carcinoma tissue collected between January 2008 and December 2009. The statistical relationship between CDH1 gene promoter hypermethylation in human gastric carcinoma and HP infection, tumor differentiation, invasion, lymph nodal and distant metastasis were examined respectively with SPSS statistical tools. ResultsThe positive rate of CDH1 gene promoter hypermethylation in gastric carcinomas (67.5%) was higher than that in paired normal gastric mucosae (12.5%), and the difference was significant (P<0.05). In gastric carcinomas, the positive rate of CDH1 gene promoter hypermethylation in well differentiated or moderately differentiated groups (22.2%) was lower than that in poorly differentiated groups (80.6%), and the difference was significant (P<0.05). The positive rate of CDH1 gene promoter hypermethylation in HP positive groups (78.1%) was higher than that in HP negative groups (25.0%), and the difference was significant (P<0.05). ConclusionCDH1 gene promoter hypermethylation may play an important role in the process of tumor carcinogenesis in gastric carcinomas. Meanwhile, the CDH1 gene promoter hypermethylation may lead to poor differentiation in gastric carcinomas. CDH1 gene promoter hypermethylation is related to HP infection in the original gastric carcinomas, which shows that HP may get involved in the process of tumor suppressor gene methylation/inactivation and tumor development process.