Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Helicobacter pylori-induced inflammation masks the underlying presence of low-grade dysplasia on gastric lesions
Alba Panarese, Giovanni Galatola, Raffaele Armentano, Pedro Pimentel-Nunes, Enzo Ierardi, Maria Lucia Caruso, Francesco Pesce, Marco Vincenzo Lenti, Valeria Palmitessa, Sergio Coletta, Endrit Shahini
Alba Panarese, Endrit Shahini, Department of Gastroenterology and Digestive Endoscopy, National Institute of Gastroenterology "S De Bellis", Research Hospital, Castellana Grotte 70013, Italy
Raffaele Armentano, Maria Lucia Caruso, Sergio Coletta Department of Clinical Pathology, National Institute of Gastroenterology "S De Bellis", Research Hospital, Castellana Grotte 70013, Italy
Pedro Pimentel-Nunes, Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto 4200072, Portugal
Pedro Pimentel-Nunes, Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto 4200072, Portugal
Enzo Ierardi, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Francesco Pesce, Nephrology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Marco Vincenzo Lenti, First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Italy
Valeria Palmitessa, Laboratory of Microbiology and Virology, National Institute of Gastroenterology "S De Bellis", Research Hospital, Castellana Grotte 70013, Italy
Endrit Shahini, Giovanni Galatola Gastroenterology Unit, Institute for Cancer Research and Treatment, Turin 10121, Italy
Author contributions: Panarese A and Shahini E were the guarantor and designed the study; Panarese A, Palmitessa V, Coletta S, and Shahini E participated in the acquisition, analysis, and interpretation of the data; Panarese A and Shahini E drafted the initial manuscript; all authors revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Committees on Ethics of Italy State National Institute of Gastroenterology “S De Bellis”.
Informed consent statement: Patients details have been removed from these case descriptions to ensure anonymity.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Alba Panarese, MD, Chief Doctor, Research Scientist, Department of Gastroenterology and Digestive Endoscopy, National Institute of Gastroenterology "S De Bellis", Research Hospital, Via Turi n. 27, Castellana Grotte 70013, Italy. alba.panarese@irccsdebellis.it
Received: March 18, 2020
Peer-review started: March 18, 2020
First decision: May 21, 2020
Revised: June 20, 2020
Accepted: June 30, 2020
Article in press: June 30, 2020
Published online: July 14, 2020
ARTICLE HIGHLIGHTS
Research background
Helicobacter pylori (H. pylori) infection is frequently responsible for precancerous gastric conditions (PGC) and the long-term risk of PGC may even progress after H. pylori eradication.
Research motivation
Heterogeneous long-term endoscopic follow-up studies (2-16 years) have shown conflicting results on the efficacy of H. pylori eradication in reducing the prevalence and histological progression of advanced PGC. Moreover, High-Resolution White-Light Endoscopy (HR-WLE) in combination with narrow-band imaging (NBI) is effective in detecting PGC and determines the timing and mode of endoscopic surveillance.
Research objectives
To assess the efficacy of HR-WLE with NBI in detecting PGC, before and after H. pylori eradication at a short-term interval.
Research methods
We evaluated 85 consecutive patients with H. pylori-related gastritis with/without PGC at baseline and 6 mo after proven H. pylori eradication. The Operative-Link on Gastritis-Assessment and Operative-Link on Gastric-Intestinal Metaplasia have been used as gold standards for histological definition of gastritis, atrophy and intestinal metaplasia. Serum anti-parietal cell antibody and anti-intrinsic factor were measured when autoimmune atrophic gastritis was suspected.
Research results
HR-WLE in combination with NBI allows for a more accurate diagnosis of gastric low-grade dysplasia (LGD) when performed soon after H. pylori eradication, due to regression of H. pylori-induced signs of inflammation. Furthermore, we observed an unexpected high prevalence of autoimmune disorders, suggesting an interaction between the genetics of immune response and H. pylori chronic infection, especially in relation to the risk of LGD development.
Research conclusions
HR-WLE with NBI allows an accurate diagnosis of gastric LGD on visible lesions after regression of H. pylori-induced signs of active infection, especially in high-risk subjects. Patients with overlap between autoimmune and H. pylori-induced chronic gastritis may require more extensive gastric mapping.
Research perspectives
Our findings will appeal to both clinical gastroenterologists and endoscopists, and stimulate the development of more accurate and cost-effective strategies for identifying patients with H. pylori infection who are at risk of gastric cancer. Subjects with an overlap between autoimmune and H. pylori-induced chronic gastritis should be considered to be at a higher risk of more severe gastric injury.
