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Dynamics of Helicobacter pylori infection as a determinant of progression of gastric precancerous lesions: 16-year follow-up of an eradication trial
Gut ( IF 24.5 ) Pub Date : 2017-06-24 , DOI: 10.1136/gutjnl-2016-311685
Robertino M Mera , Luis E Bravo , M Constanza Camargo , Juan C Bravo , Alberto G Delgado , Judith Romero-Gallo , Maria C Yepez , José L Realpe , Barbara G Schneider , Douglas R Morgan , Richard M Peek , Pelayo Correa , Keith T Wilson , M Blanca Piazuelo

Objective To evaluate the long-term effect of cumulative time exposed to Helicobacter pylori infection on the progression of gastric lesions. Design 795 adults with precancerous gastric lesions were randomised to receive anti-H. pylori treatment at baseline. Gastric biopsies were obtained at baseline and at 3, 6, 12 and 16 years. A total of 456 individuals attended the 16-year visit. Cumulative time of H. pylori exposure was calculated as the number of years infected during follow-up. Multivariable logistic regression models were used to estimate the risk of progression to a more advanced diagnosis (versus no change/regression) as well as gastric cancer risk by intestinal metaplasia (IM) subtype. For a more detailed analysis of progression, we also used a histopathology score assessing both severity and extension of the gastric lesions (range 1–6). The score difference between baseline and 16 years was modelled by generalised linear models. Results Individuals who were continuously infected with H. pylori for 16 years had a higher probability of progression to a more advanced diagnosis than those who cleared the infection and remained negative after baseline (p=0.001). Incomplete-type IM was associated with higher risk of progression to cancer than complete-type (OR, 11.3; 95% CI 1.4 to 91.4). The average histopathology score increased by 0.20 units/year (95% CI 0.12 to 0.28) among individuals continuously infected with H. pylori. The effect of cumulative time of infection on progression in the histopathology score was significantly higher for individuals with atrophy (without IM) than for individuals with IM (p<0.001). Conclusions Long-term exposure to H. pylori infection was associated with progression of precancerous lesions. Individuals infected with H. pylori with these lesions may benefit from eradication, particularly those with atrophic gastritis without IM. Incomplete-type IM may be a useful marker for the identification of individuals at higher risk for cancer.

中文翻译:

幽门螺杆菌感染的动态作为胃癌前病变进展的决定因素:根除试验的 16 年随访

目的评价幽门螺杆菌感染累积时间对胃病变进展的长期影响。设计 795 名患有癌前病变的成人随机接受抗 H. 基线时的幽门螺杆菌治疗。在基线和 3、6、12 和 16 岁时进行胃活检。共有456人参加了为期16年的访问。幽门螺杆菌暴露的累积时间计算为随访期间感染的年数。多变量逻辑回归模型用于估计进展为更高级诊断的风险(与无变化/回归相比)以及肠上皮化生 (IM) 亚型的胃癌风险。为了对进展进行更详细的分析,我们还使用了组织病理学评分来评估胃病变的严重程度和范围(范围 1-6)。基线和 16 年之间的得分差异通过广义线性模型建模。结果 持续感染幽门螺杆菌达 16 年的个体比清除感染并在基线后保持阴性的个体进展为更高级诊断的可能性更高(p = 0.001)。与完全型相比,不完全型 IM 与更高的癌症风险相关(OR,11.3;95% CI 1.4 至 91.4)。在持续感染幽门螺杆菌的个体中,平均组织病理学评分增加了 0.20 个单位/年(95% CI 0.12 至 0.28)。感染的累积时间对组织病理学评分进展的影响对于萎缩(无 IM)的个体显着高于具有 IM 的个体(p<0.001)。结论 长期暴露于 H. pylori 感染与癌前病变的进展有关。感染幽门螺杆菌且具有这些病变的个体可能受益于根除,尤其是那些没有 IM 的萎缩性胃炎。不完全型 IM 可能是识别癌症风险较高个体的有用标志物。
更新日期:2017-06-24
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