Prekanseröz lezyonların Helicobacter pylori eradikasyonuna olan etkisi

Yıl 2018, Cilt: 17 Sayı: 3, 117 - 122, 29.12.2018

Evrim Kahramanoğlu Aksoy , Muhammet Yener Akpınar , Ferdane Pirinççi Sapmaz , Zeynep Göktaş Gülçin Güler Şimşek Metin Uzman , Yaşar Nazlıgül

https://doi.org/10.17941/agd.502358

Öz

Giriş
ve Amaç: Mide mukozasındaki Helicobacter pylori yoğunluğu, inflamasyonun aktivite derecesi,
gastrit şiddeti ile eradikayon başarısı arasındaki ilişkiyi gösteren çalışma
sayısı sınırlıdır. Biz çalışmamamızda; Helicobacter
pylori eradikasyon başarısı üzerine gastrit şiddetinin ve Sidney
klasifikasyon parametrelerinin etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya; Temmuz 2017
ve Aralık 2017 tarihleri arasında Keçiören Eğitim ve Araştırma Hastanesi’nde Helicobacter pylori enfeksiyonu patoloji
olarak konmuş, eradikasyon için bizmut içeren standart dörtlü tedaviyi
tamamlayan hastalar dahil edildi. Bulgular:
Çalışmaya toplam 634 hasta dahil edildi. Antrumda atrofi varlığında Helicobacter pylori eradikasyon başarısı
düşükken, intestinal metaplazi varlığında eradikasyon başarısı etkilenmemiştir
(sırasıyla p=0,025 ve p >0,05); benzer şekilde korpustaki atrofi ve
intestinal metaplazi olan grupta da eradikasyon başarısı daha azdı (sırasıyla
p=0,016 ve p=0,01). Şiddetli gastrit gruplarında eradikasyon başarısızlığı daha
fazlaydı (OLGA III-IV için p=0.015, OLGIM III-IV için p=0.032). Multiple lineer
regresyon analizinde değerlendirildiğinde korpus intestinal metaplazi ve
lenfoid agregasyon şiddeti bağımsız risk faktörü olarak değerlendirilmiştir (sırasıyla
p=0.002 ve p=0.042). Sonuç: Gastrit
ciddiyeti, intestinal metaplazi ve gastrik atrofi Helicobacter pylori eradikasyon tedavisi başarısı üzerinde negatif
etki göstermektedir. Bu yüzden, patolojilerinde bu özelliklere sahip olan
hastalarda tedavi protokolü ve tedavi süresi yeniden gözden geçirilmelidir. 

Anahtar Kelimeler

Atrofi, Helicobacter pylori, intestinal metaplazi

Precancerous lesions effects on the eradication of Helicobacter pylori

Öz

Background
and Aims: There is limited data regarding the effect of
gastritis severity, the existence of atrophy, and intestinal metaplasia on the Helicobacter
pylori eradication. Herein we aimed to investigate the relationship between
Helicobacter
pylori eradication and histopathological parameters like gastritis
severity, intestinal metaplasia and/or atrophy, and the Sydney classification. Material and Methods:  Patients diagnosed with Helicobacter pylori gastritis
were enrolled in the study between July 2017 and December 2017. All patients
received standard quadruple therapy with bismuth salt. Results: In total, 634 patients were enrolled. The success of Helicobacter pylori eradication in the presence of
atrophy in the gastric antrum was low, while the eradication success
was not affected in the presence of intestinal metaplasia (p=0.025 and p >0.05,
respectively). Eradication success was lower in the group with
atrophy and intestinal metaplasia in the antrum (p=0.016 and p=0.01,
respectively). Eradication failure was higher in the group with severe
gastritis (p=0.015 for OLGA III-IV, p=0.032 for OLGIM III-IV). Intestinal
metaplasia in the corpus and severity of the lymphoid aggregation were
independent risk factors for treatment failure (p=0.002 and p=0.042,
respectively). Conclusion: Severity of gastritis,
intestinal metaplasia, and gastric atrophy had a negative effect on Helicobacter pylori eradication success. Treatment protocols and
duration should be carefully planned in patients with these features.

Anahtar Kelimeler

Atrophy, Helicobacter pylori, intestinal metaplasia

Kaynakça

• 1- Go MF. Review article: natural history and epidemiology of Helicobacter pylori infection. Aliment Pharmacol Ther 2002;16(Suppl 1):3-15.
• 2- Sugano K, Tack J, Kuipers EJ, et al; faculty members of Kyoto Global Consensus Conference. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015;64:1353-67.
• 3- Schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994. IARC Monogr Eval Carcinog Risks Hum 1994;61:1-241.
• 4- Rugge M, Capelle LG, Cappellesso R, et al. Precancerous lesions in the stomach: from biology to clinical patient management.Best Pract Res Clin Gastroenterol 2013;27:205-23.
• 5- de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology 2008;134:945-52.
• 6- Chen HN, Wang Zi Li X, Zhou ZG. Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplesia: evidence from a meta-analysis. Gastric Cancer 2016;19:166-75.
• 7- Lee YC, Chen TH, Chiu HM, et al. The benefit of mass eradication of Helicobacter pylori infection:a community based study of gastric cancer prevention. Gut 2013;62:676-82.
• 8- Hwang YJ, Kim N, Lee HS, et al. Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication - a prospective study for up to 10 years. Aliment Pharmacol Ther 2018;47:380-90.
• 9- Dinis-Ribeiro M, Areia M, de Vries AC, et al; European Society of Gastrointestinal Endoscopy; European Helicobacter Study Group; European Society of Pathology; Sociedade Portuguesa de Endoscopia Digestiva. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 2012;44:74-94.
• 10- Malfertheiner P, Megraud F, O'Morain CA, et al; European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017;66:6-30.
• 11- Furuta T, Sugimoto M, Shirai N, et al. Effect of MDR1 C3435T polymorphism on cure rates of Helicobacter pylori infec¬tion by triple therapy with lansoprazole, amoxicillin and clarithromycin in relation to CYP 2C19 genotypes and 23S rRNA genotypes of H. pylori. Aliment Pharmacol Ther 2007;26:693-703.
• 12- Abdullahi M, Annibale B, Capoccia D, et al. The eradication of Helicobacter pylori is affected by body mass index (BMI). Obes Surg 2008;18:1450-4.
• 13- Suzuki T, Matsuo K, Ito H, et al. Smoking increases the treatment failure for Helicobacter pylori eradication. Am J Med 2006;119:217-24.
• 14- Moshkowitz M, Konikoff FM, Peled Y, et al. High Helicobacter pylori numbers are associated with low eradication rate after triple therapy. Gut 1995;36:845-7.
• 15- Sheu BS, Yang HB, Su IJ, et al. Bac¬terial density of Helicobacter pylori predicts the success of triple therapy in bleeding duodenal ulcer. Gastrointest Endosc 1996;44:683-8.
• 16- Ghasemi Basir HR, Ghobakhlou M, Akbari P, et al. Correlation between the intensity of Helicobacter colonization and severity of gastritis. Gastroenterol Res Pract 2017;2017:8320496.
• 17- Ardakani AS, Mohammadizadeh F. The study of relationship between Helicobacter density in gastric mucosa. J Res Med Sci 2006;11:282.
• 18- Onal IK, Sokmensuer C, Onal ED, et al. Clinical and pathological features of nodu¬lar gastritis in adults. Turk J Med Sci 2009;39:719-23.
• 19- Gumurdulu Y, Serin E, Ozer B, et al. Low eradication rate of Helicobacter pylori with triple 7-14 days and quadriple therapy in Turkey. World J Gastroenterol 2004;10:668-71.
• 20- Shah DK, Jain SS, Mohite A, et al. Effect of H. pylori density by histopathology on its complications and eradication therapy. Trop Gastroenterol 2015;36:101-6.
• 21- Unler GK, Ozgur GT, Gokturk HS, et al. Does the urea breath test predict eradication of Helicobacter pylori infection?Acta Gastroenterol Belg 2016;79:3-7.
• 22- Kalkan IH, Sapmaz F, Güliter S, Atasoy P. Severe gastritis decreases success rate of Helicobacter pylori eradication. Wien Klin Wochenschr 2016;128:329-34.
• 23- Liu KS, Wong IO, Leung WK. Helicobacter pylori associated gastric intestinal metaplasia: Treatment and surveillance. World J Gastroenterol 2016;22:1311-20.
• 24- Kamada T, Hata J, Sugiu K, et al. Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan. Aliment Pharmacol Ther 2005;21:1121-6.
• 25- Kara N, Urganci N, Kalyoncu D, Yılmaz B. The association between Helicobacter pylori gastritis and lymphoid aggregates, lymphoid follicles and intestinal metaplasia in gastric mucosa of children. J Paediatr Child Health 2014;50:605-9.
• 26- Öner Rİ, Özdaş S. Histopathological findings in morbid obese patients undergoing laporoscopic sleeve gastrectomy: Does H. pylori infection effective on pathological changes? Obes Surg 2018 Apr 16 [Epub ahead of print].
• 27- Yang HB, Sheu BS, Su IJ, et al. Clinical application of gastric histology to monitor treatment of dual therapy in H. pylori eradication. Dig Dis Sci 1997;42:1835-40.
• 28- Georgopoulos SD, Ladas SD, Karatapanis S, et al. Factors that may affect treatment outcome of triple Helicobacter pylori eradication therapy with omeprazole, amoxicillin, and clarithromycin. Dig Dis Sci 2000;45:63-7.