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World J Gastrointest Oncol. Aug 15, 2021; 13(8): 835-844
Published online Aug 15, 2021. doi: 10.4251/wjgo.v13.i8.835
Helicobacter pylori infection and other bacteria in pancreatic cancer and autoimmune pancreatitis
Lumir Kunovsky, Petr Dite, Petr Jabandziev, Jiri Dolina, Jitka Vaculova, Martin Blaho, Martina Bojkova, Jana Dvorackova, Magdalena Uvirova, Zdenek Kala, Jan Trna
Lumir Kunovsky, Zdenek Kala, Department of Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
Lumir Kunovsky, Petr Dite, Jiri Dolina, Jitka Vaculova, Jan Trna, Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 62500, Czech Republic
Petr Dite, Martin Blaho, Martina Bojkova, Department of Gastroenterology and Internal Medicine, University Hospital Ostrava, Ostrava 70800, Czech Republic
Petr Dite, Martin Blaho, Martina Bojkova, Jana Dvorackova, Faculty of Medicine, University of Ostrava, Ostrava 70300, Czech Republic
Petr Jabandziev, Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno 61300, Czech Republic
Petr Jabandziev, Central European Institute of Technology, Masaryk University, Brno 62500, Czech Republic
Jana Dvorackova, Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University Hospital Ostrava, Ostrava 70800, Czech Republic
Magdalena Uvirova, CGB Laboratory a.s. Ostrava, Ostrava 70300, Czech Republic
Jan Trna, Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno 65653, Czech Republic
Jan Trna, Department of Internal Medicine, Hospital Boskovice, Boskovice 68001, Czech Republic
Author contributions: Kunovsky L and Dite P performed the manuscript concept, writing of the manuscript and literature search; Jabandziev P and Vaculova J performed the contribution in reviewing and editing of the manuscript and literature search; Dolina J, Blaho M and Kala Z performed the consultation and critical review of the manuscript; Bojkova M, Dvorackova J and Uvirova M conducted a critical review of the manuscript; Trna J contributed to reviewing and editing the manuscript; all authors made scientific contributions to the study design and discussion and have read and approved the final version of the manuscript.
Supported by Ministry of Health of the Czech Republic, No. NU20-03-00126; and Ministry of Health of the Czech Republic–conceptual development of research organization, No. FNBr, 65269705, SUp 3/21.
Conflict-of-interest statement: All of the authors declare having nothing to disclose.
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: Jan Trna, MD, PhD, Associate Professor, Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Žlutý kopec 7, Brno 65653, Czech Republic. jan.trna@mou.cz
Received: January 13, 2021
Peer-review started: January 13, 2021
First decision: February 24, 2021
Revised: March 24, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: August 15, 2021
Processing time: 212 Days and 13.6 Hours
Abstract

Helicobacter pylori (H. pylori) is an infectious agent influencing as much as 50% of the world’s population. It is the causative agent for several diseases, most especially gastric and duodenal peptic ulcer, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the stomach. A number of other, extragastric manifestations also are associated with H. pylori infection. These include neurological disorders, such as Alzheimer’s disease, demyelinating multiple sclerosis and Parkinson’s disease. There is also evidence for a relationship between H. pylori infection and such dermatological diseases as psoriasis and rosacea as well as a connection with infection and open-angle glaucoma. Generally little is known about the relationship between H. pylori infection and diseases of the pancreas. Most evidence about H. pylori and its potential role in the development of pancreatic diseases concerns pancreatic adenocarcinoma and autoimmune forms of chronic pancreatitis. There is data (albeit not fully consistent) indicating modestly increased pancreatic cancer risk in H. pylori-positive patients. The pathogenetic mechanism of this increase is not yet fully elucidated, but several theories have been proposed. Reduction of antral D-cells in H. pylori-positive patients causes a suppression of somatostatin secretion that, in turn, stimulates increased secretin secretion. That stimulates pancreatic growth and thus increases the risk of carcinogenesis. Alternatively, H. pylori, as a part of microbiome dysbiosis and the so-called oncobiome, is proven to be associated with pancreatic adenocarcinoma development via the promotion of cellular proliferation. The role of H. pylori in the inflammation characteristic of autoimmune pancreatitis seems to be explained by a mechanism of molecular mimicry among several proteins (mostly enzymes) of H. pylori and pancreatic tissue. Patients with autoimmune pancreatitis often show positivity for antibodies against H. pylori proteins. H. pylori, as a part of microbiome dysbiosis, also is viewed as a potential trigger of autoimmune inflammation of the pancreas. It is precisely these relationships (and associated equivocal conclusions) that constitute a center of attention among pancreatologists, immunologists and pathologists. In order to obtain clear and valid results, more studies on sufficiently large cohorts of patients are needed. The topic is itself sufficiently significant to draw the interest of clinicians and inspire further systematic research. Next-generation sequencing could play an important role in investigating the microbiome as a potential diagnostic and prognostic biomarker for pancreatic cancer.

Keywords: Helicobacter pylori; Pancreatic cancer; Autoimmune pancreatitis; Carcinogenesis; Microbiome; Molecular mimicry

Core Tip: Helicobacter pylori is the causative agent for several gastrointestinal diseases and a number of extragastric manifestations. The role of Helicobacter pylori in the inflammation characteristic of autoimmune pancreatitis seems to be explained by a mechanism of molecular mimicry between several proteins (mostly enzymes) of Helicobacter pylori and pancreatic tissue. The topic is itself sufficiently significant to draw the interest of clinicians and inspire further systematic research. Next-generation sequencing could play an important role in investigating the microbiome as a potential diagnostic and prognostic biomarker for pancreatic cancer.