Changes in Gastric Pathology after H. pylori Treatment in Community-Driven Research Aimed at Gastric Cancer Prevention
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Participating Communities
2.2. Summary of Research Sought by Communities
2.3. Study Population and Design
2.4. Diagnostic Methods
2.5. Statistical Analysis
3. Results
3.1. Participant Characteristics
3.2. Follow-Up Time Period
3.3. Hp Prevalence and Antimicrobial Resistance at Baseline and Follow-Up
3.4. Prevalence of Abnormal Gastric Pathology at Baseline and Follow-Up
3.5. Within-Individual Change in Abnormal Gastric Pathology Severity from Baseline to Follow-Up
3.6. Probability of Changes in Gastric Pathology Severity by Participant Characteristics
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Baseline | Hp (+) | Hp (−) | ||||
---|---|---|---|---|---|---|
Follow-Up | Hp (+) n = 3 | Hp (−) n = 2 | Hp (+) n = 1 | Hp (−) n = 16 | ||
Chronic gastritis | ||||||
None at both times | 0 | 0 | 0 | 11 | ||
Lower | 0 | 2 | 0 | 1 | ||
Unchanged | 2 | 0 | 0 | 1 | ||
Higher | 1 | 0 | 1 | 3 | ||
Active gastritis | ||||||
None at both times | 0 | 0 | 0 | 16 | ||
Lower | 0 | 2 | 0 | 0 | ||
Unchanged | 2 | 0 | 0 | 0 | ||
Higher | 1 | 0 | 1 | 0 | ||
Atrophic gastritis | ||||||
None at both times | 1 | 2 | 0 | 14 | ||
Lower | 0 | 0 | 0 | 0 | ||
Unchanged | 0 | 0 | 0 | 0 | ||
Higher | 2 | 0 | 1 | 2 | ||
Intestinal metaplasia | ||||||
None at both times | 2 | 2 | 0 | 14 | ||
Lower | 0 | 0 | 0 | 0 | ||
Unchanged | 0 | 0 | 0 | 0 | ||
Higher | 1 | 0 | 1 | 2 |
Hp Status at Follow-Up | |||||||
---|---|---|---|---|---|---|---|
Hp+ | Hp− | ||||||
% | 95% CI * | % | 95% CI * | ||||
Chronic gastritis | |||||||
Negative UBT ≥ 8 weeks after treatment | n = 7 | n = 27 | |||||
None at both times | 0 | 0, 41 | 0 | 0, 13 | |||
Lower | 43 | 10, 82 | 100 | 87, 100 | |||
Unchanged | 57 | 18, 90 | 0 | 0, 13 | |||
Higher | 0 | 0, 35 | 0 | 0, 13 | |||
Positive or unknown UBT ≥ 8 weeks after treatment | n = 7 | n = 6 | |||||
None at both times | 0 | 0, 41 | 0 | 0, 46 | |||
Lower | 57 | 18, 90 | 100 | 54, 100 | |||
Unchanged | 28 | 4, 71 | 0 | 0, 46 | |||
Higher | 14 | 0.4, 58 | 0 | 0, 46 | |||
Active gastritis | |||||||
Negative UBT ≥ 8 weeks after treatment | n = 7 | n = 27 | |||||
None at both times | 0 | 0, 41 | 7 | 0.9, 24 | |||
Lower | 43 | 10, 82 | 92 | 83, 100 | |||
Unchanged | 43 | 10, 82 | 0 | 0, 13 | |||
Higher | 14 | 0.4, 58 | 0 | 0, 13 | |||
Positive or unknown UBT ≥ 8 weeks after treatment | n = 7 | n = 6 | |||||
None at both times | 0 | 0, 41 | 0 | 0, 46 | |||
Lower | 28 | 4, 71 | 100 | 54, 100 | |||
Unchanged | 57 | 18, 90 | 0 | 0, 46 | |||
Higher | 14 | 0.4, 58 | 0 | 0, 46 | |||
Atrophic gastritis | |||||||
Negative UBT ≥ 8 weeks after treatment | n = 7 | n = 27 | |||||
None at both times | 28 | 4, 71 | 60 | 41, 78 | |||
Lower | 43 | 10, 82 | 37 | 19, 55 | |||
Unchanged | 14 | 0.4, 58 | 0 | 0, 13 | |||
Higher | 14 | 0.4, 58 | 4 | 0, 19 | |||
Positive or unknown UBT ≥ 8 weeks after treatment | n = 7 | n = 6 | |||||
None at both times | 57 | 18, 90 | 50 | 12, 88 | |||
Lower | 43 | 10, 82 | 50 | 12, 88 | |||
Unchanged | 0 | 0, 41 | 0 | 0, 46 | |||
Higher | 0 | 0, 41 | 0 | 0, 46 | |||
Intestinal Metaplasia | |||||||
Negative UBT ≥ 8 weeks after treatment | n = 7 | n = 27 | |||||
None at both times | 57 | 18, 90 | 93 | 83, 100 | |||
Lower | 0 | 0, 41 | 4 | 0.1, 19 | |||
Unchanged | 14 | 0.4, 58 | 0 | 0, 13 | |||
Higher | 28 | 0.4, 71 | 4 | 0.1, 19 | |||
Positive or unknown UBT ≥ 8 weeks after treatment | n = 7 | n = 6 | |||||
None at both times | 43 | 10, 82 | 67 | 23, 96 | |||
Lower | 14 | 0.4, 58 | 0 | 0, 46 | |||
Unchanged | 28 | 4, 71 | 17 | 0.4, 64 | |||
Higher | 14 | 0.4, 58 | 17 | 0.4, 64 |
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Baseline | Follow-Up | ||||
---|---|---|---|---|---|
n | % | n | % | ||
Total | 310 | 100 | 69 | 100 | |
Sex | |||||
Male | 139 | 45 | 25 | 36 | |
Female | 171 | 55 | 44 | 64 | |
Ethnicity | |||||
Non-Indigenous | 22 | 7 | 3 | 4 | |
Inuvialuit | 117 | 40 | 26 | 39 | |
Gwich’in | 139 | 47 | 36 | 54 | |
Other | 16 | 5 | 2 | 3 | |
Missing * | 16 | 2 | |||
Age at endoscopy (years) | |||||
<30 | 76 | 24 | 3 | 4 | |
30–59 | 172 | 56 | 41 | 59 | |
60+ | 62 | 20 | 25 | 36 |
Baseline (n = 310) | Follow-Up (n = 69) | ||||||
---|---|---|---|---|---|---|---|
n | % | 95% CI * | n | % | 95% CI * | ||
H. pylori infection | 223 | 72 | 66, 77 | 18 | 26 | 16, 36 | |
Active gastritis | |||||||
None | 93 | 30 | 25, 35 | 51 | 74 | 64, 84 | |
Any | 215 | 70 | 65, 75 | 18 | 26 | 16, 36 | |
Mild | 101 | 33 | 27, 38 | 12 | 17 | 8, 28 | |
Moderate | 81 | 26 | 21, 31 | 6 | 9 | 3, 18 | |
Severe | 33 | 11 | 7, 14 | 0 | 0 | 0, 5 | |
Missing ** | 2 | 0 | |||||
Chronic gastritis | |||||||
None | 76 | 25 | 19, 29 | 43 | 62 | 51, 74 | |
Any | 234 | 75 | 71, 80 | 26 | 38 | 26, 49 | |
Mild | 28 | 9 | 6, 12 | 12 | 17 | 8, 26 | |
Moderate | 99 | 32 | 27, 37 | 11 | 16 | 7, 25 | |
Severe | 107 | 34 | 29, 40 | 3 | 4 | 1, 12 | |
Atrophic gastritis | |||||||
None | 214 | 69 | 64, 74 | 59 | 86 | 77, 94 | |
Any | 96 | 31 | 26, 36 | 10 | 14 | 6, 23 | |
Mild | 67 | 22 | 17, 26 | 8 | 12 | 5, 22 | |
Moderate | 24 | 7 | 5, 11 | 2 | 3 | 0, 10 | |
Severe | 5 | 2 | 0.5, 4 | 0 | 0 | 0, 5 | |
Intestinal metaplasia | |||||||
None | 268 | 86 | 83, 90 | 56 | 81 | 72, 90 | |
Any | 42 | 14 | 10, 17 | 13 | 19 | 10, 28 | |
Mild | 27 | 9 | 6, 12 | 9 | 13 | 6, 23 | |
Moderate | 12 | 4 | 2, 6 | 4 | 6 | 2, 14 | |
Severe | 3 | 1 | 0.2, 3 | 0 | 0 | 0, 5 |
Hp− at Follow-Up | Hp+ at Follow-Up † | ||||||
---|---|---|---|---|---|---|---|
Hp− at Baseline n = 17 | Hp+ at Baseline ‡ n = 34 | n = 18 | |||||
% | 95% CI * | % | 95% CI * | % | 95% CI * | ||
Chronic gastritis | |||||||
None at both times | 65 | 42, 87 | 0 | 0, 10 | 0 | 0, 19 | |
Lower | 12 | 1, 36 | 100 | 90, 100 | 39 | 17, 64 | |
Unchanged | 6 | 0.1, 29 | 0 | 0, 10 | 44 | 22, 69 | |
Higher | 18 | 4, 43 | 0 | 0, 10 | 17 | 4, 41 | |
Active gastritis | |||||||
None at both times | 100 | 80, 100 | 3 | 0.1, 15 | 0 | 0, 19 | |
Lower | 0 | 0, 20 | 97 | 91, 100 | 28 | 10, 53 | |
Unchanged | 0 | 0, 20 | 0 | 0, 10 | 50 | 26, 74 | |
Higher | 0 | 0, 20 | 0 | 0, 10 | 22 | 6, 48 | |
Atrophic gastritis | |||||||
None at both times | 88 | 73, 100 | 59 | 42, 75 | 39 | 17, 64 | |
Lower | 0 | 0, 20 | 38 | 22, 56 | 33 | 13, 59 | |
Unchanged | 0 | 0, 20 | 0 | 0, 10 | 6 | 0.1, 27 | |
Higher | 12 | 1, 36 | 3 | 0.1, 15 | 22 | 6, 48 | |
Intestinal Metaplasia | |||||||
None at both times | 88 | 73, 100 | 88 | 77, 99 | 50 | 26, 74 | |
Lower | 0 | 0, 20 | 3 | 0.1, 15 | 6 | 0.1, 27 | |
Unchanged | 0 | 0, 20 | 3 | 0.1, 15 | 17 | 4, 41 | |
Higher | 12 | 1, 36 | 6 | 1, 20 | 28 | 10, 53 |
n | Risk | 95% CI * | ||
---|---|---|---|---|
Chronic gastritis improved among 54 participants with chronic gastritis at baseline | ||||
Total | 43/54 | 0.80 | 0.66, 0.89 | |
Sex | ||||
Male | 16/21 | 0.76 | 0.53, 0.92 | |
Female | 27/33 | 0.82 | 0.65, 0.93 | |
Age (years) | ||||
27–49 | 14/19 | 0.74 | 0.49, 0.91 | |
50–59 | 14/15 | 0.93 | 0.68, 1.0 | |
60–78 | 15/20 | 0.75 | 0.51, 0.91 | |
Ethnicity | ||||
Gwich’in | 26/30 | 0.87 | 0.69, 0.96 | |
Inuvialuit | 14/19 | 0.74 | 0.49, 0.91 | |
Community | ||||
Aklavik NT | 21/27 | 0.78 | 0.58, 0.91 | |
Old Crow YT | 8/9 | 0.89 | 0.52, 1.00 | |
Fort McPherson NT | 14/18 | 0.78 | 0.52, 0.94 | |
Baseline Hp density | ||||
No bacteria observed | 2/3 | 0.67 | 0.09, 0.99 | |
Mild | 12/17 | 0.71 | 0.44, 0.90 | |
Moderate | 18/21 | 0.85 | 0.64, 0.97 | |
Marked | 11/13 | 0.85 | 0.55, 0.98 | |
Baseline Hp resistance | ||||
To metronidazole | 13/17 | 0.76 | 0.49, 0.92 | |
To clarithrymycin | 7/7 | 1 | 0.53, 1 | |
To 1+ antibiotics | 15/19 | 0.79 | 0.53, 0.92 | |
To 2+ antibiotics | 5/6 | 0.83 | 0.23, 0.99 | |
Baseline chronic gastritis severity | ||||
Mild | 4/8 | 0.50 | 0.16, 0.84 | |
Moderate | 18/23 | 0.78 | 0.56, 0.93 | |
Severe | 21/23 | 0.91 | 0.72, 0.99 | |
Treated to eliminate Hp before follow-up | ||||
No | 3/6 | 0.50 | 0.12, 0.88 | |
Yes | 40/48 | 0.83 | 0.70, 0.93 | |
Hp-negative breath test before follow-up | ||||
No | 12/18 | 0.67 | 0.41, 0.87 | |
Yes | 31/36 | 0.86 | 0.71, 0.95 | |
Hp density improved at follow-up | ||||
No | 4/13 | 0.20 | 0.03, 0.56 | |
Yes | 39/41 | 0.95 | 0.84, 0.99 | |
Hp density at follow-up | ||||
No bacteria observed | 36/37 | 0.97 | 0.86, 1.0 | |
Mild | 2/5 | 0.40 | 0.05, 0.85 | |
Moderate | 4/9 | 0.44 | 0.14, 0.79 | |
Marked | 0/2 | 0 | 0, 0.85 † | |
Active gastritis improved among 50 participants with active gastritis at baseline | ||||
Total | 36/50 | 0.72 | 0.56, 0.84 | |
Sex | ||||
Male | 14/20 | 0.70 | 0.46, 0.88 | |
Female | 22/30 | 0.73 | 0.54, 0.88 | |
Age (years) | ||||
27–49 | 10/19 | 0.53 | 0.29, 0.76 | |
50–59 | 13/14 | 0.93 | 0.66, 1.00 | |
60–78 | 13/17 | 0.76 | 0.50, 0.93 | |
Ethnicity | ||||
Gwichin | 21/27 | 0.78 | 0.58, 0.91 | |
Inuvialuit | 14/18 | 0.78 | 0.52, 0.94 | |
Community | ||||
Aklavik NT | 18/26 | 0.69 | 0.48, 0.86 | |
Old Crow YT | 6/9 | 0.67 | 0.30, 0.93 | |
Fort McPherson NT | 12/15 | 0.80 | 0.52, 0.96 | |
Baseline Hp density | ||||
Mild | 12/16 | 0.75 | 0.48, 0.93 | |
Moderate | 16/21 | 0.76 | 0.53, 0.92 | |
Marked | 8/13 | 0.62 | 0.32, 0.86 | |
Baseline Hp resistance | ||||
To metronidazole | 11/17 | 0.65 | 0.38, 0.84 | |
To clarithrymycin | 7/7 | 1 | 0.53, 1 | |
To 1+ antibiotics | 13/19 | 0.68 | 0.43, 0.86 | |
To 2+ antibiotics | 6/6 | 1 | 0.48, 1 | |
Baseline active gastritis severity | ||||
Mild | 20/27 | 0.74 | 0.54, 0.89 | |
Moderate | 12/18 | 0.67 | 0.41, 0.87 | |
Marked | 4/5 | 0.80 | 0.28, 0.99 | |
Treated to eliminate Hp before follow-up | ||||
No | 3/4 | 0.75 | 0.19, 0.99 | |
Yes | 33/46 | 0.72 | 0.57, 0.84 | |
Hp-negative breath test before follow-up | ||||
No | 10/18 | 0.56 | 0.31, 0.78 | |
Yes | 26/32 | 0.81 | 0.64, 0.93 | |
Hp density improved at follow-up | ||||
No | 3/10 | 0.30 | 0.07, 0.65 | |
Yes | 33/40 | 0.83 | 0.67, 0.93 | |
Hp density at follow-up | ||||
No bacteria observed | 33/33 | 1 | 0.89, 1 † | |
Mild | 0/5 | 0 | 0, 0.52 † | |
Moderate | 7/9 | 0.22 | 0.03, 0.60 | |
Marked | 2/4 | 0.50 | 0.01, 0,99 | |
Atrophic gastritis improved among 20 participants with atrophic gastritis at baseline | ||||
Total | 19/20 | 0.95 | 0.75, 1 † | |
Treated to eliminate Hp before follow-up | ||||
No | 0/20 | -- | -- | |
Yes | 20/20 | 0.95 | 0.75, 1 † | |
Hp-negative breath test before follow-up | ||||
No | 6/6 | 1 | 0.54, 1 † | |
Yes | 13/14 | 0.93 | 0.66, 1.00 | |
Hp density improved at follow-up | ||||
No | 3/3 | 1 | 0.29, 1 † | |
Yes | 16/17 | 0.94 | 0.71, 1.00 | |
Atrophic gastritis and/or intestinal metaplasia progressed (including new onsets and six co-occurring cases) among 69 participants assessed at baseline | ||||
Total | 10/69 | 0.14 | 0.07, 0.25 | |
Sex | ||||
Male | 3/25 | 0.12 | 0.03, 0.31 | |
Female | 7/44 | 0.16 | 0.07, 0.30 | |
Age (years) | ||||
27–49 | 5/21 | 0.24 | 0.08, 0.47 | |
50–59 | 1/23 | 0.04 | 0.00, 0.22 | |
60–78 | 4/25 | 0.16 | 0.05, 0.36 | |
Community | ||||
Aklavik NT | 9/39 | 0.23 | 0.11, 0.39 | |
Old Crow YT | 0/9 | 0 | 0, 0.34 † | |
Fort McPherson NT | 1/21 | 0.05 | 0.00, 0.24 | |
Baseline Hp density | ||||
No bacteria observed | 3/18 | 0.17 | 0.04, 0.41 | |
Mild | 2/17 | 0.12 | 0.01, 0.36 | |
Moderate | 4/21 | 0.19 | 0.05, 0.42 | |
Marked | 1/13 | 0.08 | 0.00, 0.36 † | |
Treated to eliminate Hp before follow-up | ||||
No | 5/21 | 0.24 | 0.08, 0.47 | |
Yes | 5/48 | 0.10 | 0.03, 0.23 | |
Hp-negative breath test before follow-up | ||||
No | 4/18 | 0.22 | 0.06, 0.48 | |
Yes | 6/51 | 0.12 | 0.04, 0.24 | |
Hp density at follow-up | ||||
No bacteria observed | 4/51 | 0.08 | 0.02, 0.19 | |
Mild | 0/6 | 0 | 0, 0.46 † | |
Moderate | 5/10 | 0.50 | 0.19, 0.81 | |
Marked | 1/2 | 0.50 | 0.01, 0.99 |
* Adjusted Risk Difference | 95% CI | ||||
---|---|---|---|---|---|
Probability of improved chronic gastritis among 54 participants with chronic gastritis at baseline | |||||
Treated to eliminate Hp at baseline | |||||
No | Referent | ||||
Yes | 0.29 | 0.04, 0.53 | |||
Hp density improved at follow-up | |||||
No | Referent | ||||
Yes | 0.74 | 0.50, 0.99 | |||
Probability of improved active gastritis among 50 participants with active gastritis at baseline | |||||
Baseline Hp density | |||||
Mild | Referent | ||||
Moderate | −0.15 | −0.31, −0.01 | |||
Marked | −0.35 | −0.58, −0.13 | |||
Hp density improved at follow-up | |||||
No | Referent | ||||
Yes | 0.63 | 0.39, 0.87 | |||
Progression in atrophic gastritis and/or intestinal metaplasia (including new onsets and six co-occurring cases) among 69 participants assessed at baseline | |||||
Hp observed on histology at baseline | |||||
No | Referent | ||||
Yes | 0.19 | 0.12, 0.27 | |||
Treated to eliminate Hp at baseline | |||||
No | Referent | ||||
Yes | −0.29 | −0.45, −0.13 | |||
Hp observed on histology at follow-up | |||||
No | Referent | ||||
Yes | 0.23 | 0.00, 0.45 |
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Wang, T.; Girgis, S.; Chang, H.-J.; Assi, A.; Fagan-Garcia, K.; Cromarty, T.; Munday, R.; Goodman, K.J.; Veldhuyzen van Zanten, S.; the CANHelp Working Group. Changes in Gastric Pathology after H. pylori Treatment in Community-Driven Research Aimed at Gastric Cancer Prevention. Cancers 2023, 15, 3950. https://doi.org/10.3390/cancers15153950
Wang T, Girgis S, Chang H-J, Assi A, Fagan-Garcia K, Cromarty T, Munday R, Goodman KJ, Veldhuyzen van Zanten S, the CANHelp Working Group. Changes in Gastric Pathology after H. pylori Treatment in Community-Driven Research Aimed at Gastric Cancer Prevention. Cancers. 2023; 15(15):3950. https://doi.org/10.3390/cancers15153950
Chicago/Turabian StyleWang, Ting, Safwat Girgis, Hsiu-Ju Chang, Ali Assi, Katharine Fagan-Garcia, Taylor Cromarty, Rachel Munday, Karen J. Goodman, Sander Veldhuyzen van Zanten, and the CANHelp Working Group. 2023. "Changes in Gastric Pathology after H. pylori Treatment in Community-Driven Research Aimed at Gastric Cancer Prevention" Cancers 15, no. 15: 3950. https://doi.org/10.3390/cancers15153950