Predicting the development of gastric cancer from combining Helicobacter pylori antibodies and serum pepsinogen status : prospective endoscopic cohort.

Slides:



Advertisements
Similar presentations
GastroPanel Innovation
Advertisements

Update on Screening of Gastrointestinal Diseases Niraj Jani, M.D. Greater Baltimore Medical Center 1/30/15.
Comparative evaluation of conventional methods and Elisa based IgG antibodies detection for diagnosis of helicobacter pylori infection in cases of dyspepsia.
ESA Style Question. Mrs Cole, a 56 year old woman presents to her GP with a burning epigastric pain, for the previous two weeks. The pain is worse at.
Management of Gastric Cancer Aviram Nissan, M.D. Department of Surgery Hadassah University Hospital Mount Scopus.
Peptic Ulcer Disease. Peptic ulcer  refers to erosion of the mucosa lining any portion of the G.I. tract.  It is defined as : A circumscribed ulceration.
Intestinal Metaplasia of the Stomach
Gastric Cancer Matt White AM Report April 19, 2010.
GASTRIC LYMPHOMAS Aswad H. Al.Obeidy FICMS, FICMS GE&Hep Kirkuk General Hospital.
Se cond Cancers and Residual Disease in Patients Treated for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma by Helicobacter pylori Eradication and.
Histology of the upper Git
Coordinator: Dr. Anca Negovan Author: Andreea Bianca Stoica Co-authors: Drd. Monica Pantea Adrian Stoica Roxana Spac Gavriela Radoiu.
The ulcer of gastric stump: a case-control study Coordinators: Author: Roxana Spac Dr.Anca Negovan Drd. Monica Pantea Co-author: Dr Nina Sincu Andreea.
NEOPLASMS OF THE STOMACH
Gastric carcinoma.
INCREASED EXPRESSION OF PROTEIN KINASE CK2  SUBUNIT IN HUMAN GASTRIC CARCINOMA Kai-Yuan Lin 1 and Yih-Huei Uen 1,2,3 1 Department of Medical Research,
Case-control study Chihaya Koriyama August 17 (Lecture 1)
The role of Endoscopy in Gastric Cancer Fergal Donnellan Gastroenterologist VGH.
By Dr. Gehan Mohamed Dr. Abdelaty Shawky
Do all colorectal polyps require pathological examination? Aim To assess whether it is possible to omit the pathological examination of some polyps without.
Hee-Won Kwak, Il Ju Choi, Soo-Jeong Cho, Jong Yeul Lee, Chan Gyoo Kim, Myeong-Cherl Kook, Keun Won Ryu and Young-Woo Kim Journal of Gastroenterology and.
R3 정명화 /Prof. 장재영 Gastrointest. Endosc. 2012; 75:39-46.
소화기내과 R1. 임형석 / Pf. 김정욱. BACKGROUND Recent data showed that H. pylori infection is less common in patients with IBD The prevalence of IBD has been increasing.
Gastric cancer. Is the third most common cause of cancer- related death in the world.
Effect of Helicobacter pylori Eradication on Metachronous Recurrence After Endoscopic Resection of Gastric Neoplasm Am J Gastroenterol 2014; 109:60–67.
1 Motohiko Kato, Tsutomu Nishida, Katsumi Yamamoto, Shiro Hayashi, Shinji Kitamura, Takamasa,Yabuta, Toshiyuki Yoshio, Takeshi Nakamura, Masato Komori,6.
Hyperglycemia Increases Risk of Gastric Cancer Posed by Helicobacter pylori Infection : A Population-Based Cohort Study FUMIE IKEDA,* YASUFUMI DOI,‡ KOJI.
GUT 2012;61:1533–1537. R3 Kim Dong Hyun / Prof. Chang Young-Woon Serum ghrelin is inversely associated with risk of subsequent oesophageal squamous cell.
Peptic Ulcer Bleeding Risk. The Role of Helicobacter Pylori Infection in NSAID/Low-Dose Aspirin Users C. Sostres, MD, P. Carrera-Lasfuentes, PhD, R. Benito,
The American Journal of Gastroenterology, October 2014, Volume 109:1595–1602 Prof. 장재영 /R3 김다래.
Copyright © 2008 Delmar. All rights reserved. Chapter 4 Epidemiology and Public Health Nursing.
Eradication of Helicobacter pylori After Endoscopic Resection of Gastric Tumors Does Not Reduce Incidence of Metachronous Gastric Carcinoma Clinical Gastroenterology.
Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification R1 김진숙 / Prof. 장재영.
ELIAS Ca stomach Risk factors. Gastric cancers show two morphologic types Intestinal; Arise from gastric mucous cells that have undergone intestinal metaplasia.
Should Elderly Patients Undergo Additional Surgery After Non-Curative Endoscopic Resection for Early Gastric Cancer? Long-Term Comparative Outcomes R3.
Long-term outcomes of combination of endoscopic submucosal dissection and laparoscopic lymph node dissection without gastrectomy for early gastric cancer.
Normal stomach. Fundic mucosa with parietal & chief cells Antral mucosa with mucin secreting glands Stomach - Histology.
KShotaro Nakamura,1 Toshiro Sugiyama,2 Takayuki Matsumoto,1 Katsunori Iijima,3 Shouko Ono,4 Masahiro Tajika,5 Akira Tari,6 Yasuhiko Kitadai,7 Hiroshi Matsumoto,8.
R3 김재민 / Prof. 장영운 Journal conference 1.
Patterns of chronic H pylori infection with respect to acid production and pathology. Left: Acid hyposecretion. H pylori infection of the stomach body.
GI For Rehabilitation.
Helicobacter pylori eradication prior bariatric/metabolic surgery
Frequency of Helicobacter Pylori Infection among Type II Diabetic and Non-Diabetics Patients with Functional Dyspepsia Hanan Mahmoud Fayed1 , Mohamed A.
Seroprevalence, prevalence, type and factors associated with HPV infection at multiple sites in young HIV-positive MSM On behalf of the HPV MAPS Research.
The Prevalence of and Risk Factors for Barrett Esophagus in a Korean Population - A Nationwide Multicenter Prospective Study - J Clin Gastroenterol 2009.
Gastritis.
Gastric carcinoma.
Patterns of chronic H pylori infection with respect to acid production and pathology. Left: Acid hyposecretion. H pylori infection of the stomach body.
DR.IHSAN Edan. A. ALSAIMARY (Ph.D , assist professor)
By Dr. Abdelaty Shawky Assistant professor of pathology
Emilia H. Koumans, Fujie Xu, Maya Sternberg, Lauri E. Markowitz
Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma
EMT inducing transcription factor SIP1: a predictive biomarker of colorectal cancer survival and recurrence? A Patel, R Sreekumar, R Bhome, KA Moutasim,
Screening for H. Pylori – finding out if it prevents stomach cancer
Effect of Eradication of Helicobacter pylori on the Histology and Cellular Phenotype of Gastric Intestinal Metaplasia  Jiro Watari, Koushik K. Das, Peter.
Volume 148, Issue 4, Pages e3 (April 2015)
Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma
Helicobacter pylori Infection Is Strongly Associated With Gastric and Duodenal Ulcers in a Large Prospective Study  Ben Schöttker, Mariam A. Adamu, Melanie.
THE MANAGEMENT OF PATIENTS WITH GASTRIC DYSPLASIA
Volume 137, Issue 5, Pages e2 (November 2009)
Volume 141, Issue 3, Pages e7 (September 2011)
GASTRITIS By : BILAL HUSSEIN.
Volume 148, Issue 4, Pages e3 (April 2015)
Helicobacter pylori Eradication and Metachronous Gastric Cancer
Care of Patients with Stomach Disorders
CNA Certification Exam Preparation
Duodenal ulcer promoting gene of Helicobacter pylori
Finding Sex Partners On-Line: What’s the Risk for STI
Surgical resection of metachronous liver metastases
Presentation transcript:

Predicting the development of gastric cancer from combining Helicobacter pylori antibodies and serum pepsinogen status : prospective endoscopic cohort study H Watabe, T Mitsushima, Y Yamaji, M Okamoto, R Wada, T Kokubo, H Doi, H Yoshida, T Kawabe, M Omata Gut 2005;54:764–768

Background Pathogenic role of Helicobacter pylori for gastric cancer Pathogenic role of Helicobacter pylori for gastric cancer in a large number of epidemiological studies and basic researches in a large number of epidemiological studies and basic researches In earlier epidemiological studies In earlier epidemiological studies using H pylori antibody as a marker of infection using H pylori antibody as a marker of infection various risk ratios of H pylori infection for gastric cancer (0~≥10) various risk ratios of H pylori infection for gastric cancer (0~≥10) Recently, a follow up study by Uemura et al Recently, a follow up study by Uemura et al gastric cancer developed only in patients infected with H pylori gastric cancer developed only in patients infected with H pylori subjects with severe gastric atrophy, corpus predominant gastritis, or intestinal metaplasia were at increased risk for gastric cancer subjects with severe gastric atrophy, corpus predominant gastritis, or intestinal metaplasia were at increased risk for gastric cancer In our previous cross sectional study In our previous cross sectional study gastric atrophy status was essential for cancer development gastric atrophy status was essential for cancer development gastric atrophy was estimated by serum pepsinogen level gastric atrophy was estimated by serum pepsinogen level

Background Pepsinogen I and II Pepsinogen I and II two main precursors of pepsin two main precursors of pepsin produced by chief cells and mucous neck cells of the stomach produced by chief cells and mucous neck cells of the stomach Pepsinogen II Pepsinogen II also produced by pyloric gland cells also produced by pyloric gland cells Chief cells are replaced by pyloric glands Chief cells are replaced by pyloric glands decrease in pepsinogen I as gastric atrophy develops decrease in pepsinogen I as gastric atrophy develops decrease in pepsinogen II is minimal decrease in pepsinogen II is minimal Therefore, both low serum pepsinogen I and a low pepsinogen I/II ratio Therefore, both low serum pepsinogen I and a low pepsinogen I/II ratio recognized as serological markers of gastric atrophy recognized as serological markers of gastric atrophy

Background Combination of serum pepsinogen and H pylori antibody Combination of serum pepsinogen and H pylori antibody useful marker for the prevalence of gastric cancer in a cross sectional setting useful marker for the prevalence of gastric cancer in a cross sectional setting much simpler and less invasive than those using endoscopy much simpler and less invasive than those using endoscopy therefore suitable for a large general population therefore suitable for a large general population We aimed to evaluate We aimed to evaluate natural history of gastric cancer development according to H pylori infection and gastric atrophy status natural history of gastric cancer development according to H pylori infection and gastric atrophy status

Method ~ ~ Health examination programmes Health examination programmes by Kameda General Hospital and Makuhari Clinic by Kameda General Hospital and Makuhari Clinic Excluding Excluding gastric cancer, peptic ulcer, past history of surgical resection of the stomach gastric cancer, peptic ulcer, past history of surgical resection of the stomach Candidates Candidates 9293 participants 9293 participants None had undergone None had undergone PPI or H2 blockers within last one month PPI or H2 blockers within last one month eradication therapy for H pylori eradication therapy for H pylori Endoscopic examination annually Endoscopic examination annually to check for the gastric cancer to check for the gastric cancer During the observation period During the observation period 6983 revisited the programme for follow up endoscopy 6983 revisited the programme for follow up endoscopy

Method Serum H pylori antibody Serum H pylori antibody commercial ELISA kit (GAP-IgG kit; Biomerica Inc., California, USA) commercial ELISA kit (GAP-IgG kit; Biomerica Inc., California, USA) seropositivity for H pylori antibody seropositivity for H pylori antibody defined by optical density values according to the manufacturer’s protocol defined by optical density values according to the manufacturer’s protocol in Japan in Japan sensitivity of 95% and specificity of 83% for H pylori infection sensitivity of 95% and specificity of 83% for H pylori infection Serum pepsinogen level Serum pepsinogen level commercial RIA kit (pepsinogen I/II RIA bead kit; Dainabot Co., Tokyo, Japan) commercial RIA kit (pepsinogen I/II RIA bead kit; Dainabot Co., Tokyo, Japan) serum pepsinogen status serum pepsinogen status atrophic - serum pepsinogen I level ≤70 ng/ml and a pepsinogen I/II ratio (serum pepsinogen I (ng/ml)/serum pepsinogen II (ng/ml)) ≤3.0 atrophic - serum pepsinogen I level ≤70 ng/ml and a pepsinogen I/II ratio (serum pepsinogen I (ng/ml)/serum pepsinogen II (ng/ml)) ≤3.0 normal - all other cases normal - all other cases in Japan in Japan sensitivity of 70.5% and specificity of 97.0% for atrophic gastritis sensitivity of 70.5% and specificity of 97.0% for atrophic gastritis

Method Classification by anti-H pylori antibody and serum pepsinogen status Classification by anti-H pylori antibody and serum pepsinogen status Group A - ‘‘normal’’ pepsinogen and were negative for H pylori antibody Group A - ‘‘normal’’ pepsinogen and were negative for H pylori antibody Group B - ‘‘normal’’ pepsinogen and were positive for H pylori antibody Group B - ‘‘normal’’ pepsinogen and were positive for H pylori antibody Group C - ‘‘atrophic’’ pepsinogen and were positive for H pylori antibody Group C - ‘‘atrophic’’ pepsinogen and were positive for H pylori antibody Group D - ‘‘atrophic’’ pepsinogen and were negative for H pylori antibody Group D - ‘‘atrophic’’ pepsinogen and were negative for H pylori antibody Endoscopic and clinicopathological examinations Endoscopic and clinicopathological examinations electronic panendoscopes (type XQ200 or P230; Olympus, Tokyo, Japan) electronic panendoscopes (type XQ200 or P230; Olympus, Tokyo, Japan) experienced endoscopists performed each examination experienced endoscopists performed each examination without knowledge of the serological data of the study subjects without knowledge of the serological data of the study subjects histopathological assessment of gastric cancer histopathological assessment of gastric cancer using surgically resected or endoscopically biopsied samples using surgically resected or endoscopically biopsied samples categorised as intestinal-type or diffuse-type, according to Lauren’s classification categorised as intestinal-type or diffuse-type, according to Lauren’s classification classified as cardiac or non-cardiac in terms of location classified as cardiac or non-cardiac in terms of location

Result

Gastric cancer development Gastric cancer development 43 (37 men, 6 women) during the follow up period 43 (37 men, 6 women) during the follow up period Annual incidence rate Annual incidence rate calculated by the person-year method calculated by the person-year method 0.13% (95% CI; 0.10%–0.18%) 0.13% (95% CI; 0.10%–0.18%) Histopathological feature Histopathological feature 34 - intestinal, 9 - diffuse 34 - intestinal, 9 - diffuse 2 - Gastric cardia 2 - Gastric cardia All of the cancers All of the cancers were localized within the submucosa were localized within the submucosa except for one invading the muscularis propria (group B) except for one invading the muscularis propria (group B) Management Management endoscopic resection – 23 cases endoscopic resection – 23 cases surgical operation - 20 cases surgical operation - 20 cases All were alive in August 2004 All were alive in August 2004

Kaplan-Meier analysis of the proportion of gastric cancer development Kaplan-Meier analysis of the proportion of gastric cancer development

∮ no association between the groups and histopathological differentiation of cancer ∮

Conclusion We prospectively observed the natural course of gastric cancer development in the Japanese general population We prospectively observed the natural course of gastric cancer development in the Japanese general population Combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer Combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer