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AGA Abstracts II ratio in H. pylori-negative subjects. Conclusions: The urinary sodium to creatinine ratio was associated with the serum PG I/II ratio in H. pylori-positive subjects. High salt intake may be a risk factor of the progression of atrophic gastritis. Tu1072 Relationship Between the Helicobacter pylori Icea Gene and Clinical Outcomes in Western Countries: Meta-Analysis Seiji Shiota, Ayaka Takahashi, Miyuki Matsuda, Osamu Matsunari, Masahide Watada, Rumiko Suzuki, Katsuhiro Hanada, Yoshio Yamaoka Background: Although the iceA (induced by contact with epithelium) allelic types of Helicob- acter pylori (H. pylori) have been reported to be associated with peptic ulcer, the importance of the iceA gene on clinical outcomes is conflicting in subsequent studies. The aim of this study was to estimate the magnitude of the risk for clinical outcomes associated with iceA gene in Western countries (Europe, North and South America). Methods: A literature search was performed using the PubMed and EMBASE databases for articles published through November 2010, using the following text words: 1) iceA, iceA1 or iceA2, and 2) pylori or Helicobacter. We did not include abstract alone or unpublished articles. The following criteria were applied to select fully published case-control studies examining the relationship between the iceA gene and clinical outcomes (gastritis, peptic ulcer including gastric ulcer and duodenal ulcer, and gastric cancer) in adult population; the presence of the iceA gene was examined by polymerase chain reaction (PCR); original articles published in English. Studies were excluded if raw data were not presented. Subgroup analysis was performed by geo- graphic area. Results: Nineteen studies with a total of 2,218 patients were identified in the search. Infection with the iceA1-positive H. pylori increased the risk for peptic ulcer by 1.27- fold (95% confidence interval [CI], 1.01-1.59) overall. However, the test of heterogeneity was significant among these studies. Sensitivity analysis showed that the presence of the iceA1 gene was significantly associated with peptic ulcer (odds ratio [OR] = 1.28, 95% CI = 1.02-1.61) overall. Those of the iceA2 gene was inversely associated with peptic ulcer especially in Europe (OR = 0.55, 95% CI = 0.40-0.76). This trend was the same as in case of duodenal ulcer. There was no association between the presence of the iceA gene and gastric ulcer and gastric cancer. Seven studied examined the correlation with cagA gene, and only two showed the positive correlation. Publication bias did not exist. Conclusion: Our meta-analysis confirmed the importance of the presence of the iceA gene for duodenal ulcer in Western countries, especially in Europe although the significance was small. It is possible that the iceA gene is discriminating factor for peptic ulcer independent on cagA gene. Tu1073 Correlation Between the Prevalence of Gallstone and Helicobacter pylori Infection Jae G. Kim, Beom Jin Kim, Hyoung-Chul Oh, Jeong Wook Kim Background/Aim Several studies have been reported that the presence of Helicobacter DNA in human bile sample, although its pathological role is not clear. Moreover, little is known about the association between Helicobacter pylori (H. pylori) infection and gallstone. The aim of this study was to determine whether H. pylori infection is associated with an increased risk of gallstone in asymptomatic population. Methods We examined 2,782 subjects (1,635 men and 1,147 women) who underwent both upper endoscopy with CLO test and abdominal ultrasound at the Health Examination Center at Chung-Ang University Yong-san Hospital in Korea from January 2007 to December 2009. We compared the prevalence of gallstone on ultrasound and endoscopic findings such as reflux esophagitis, gastric diseases in the H. pylori infected subjects with that of the H. pylori uninfected subjects. Results The overall prevalence of H. pylori infection in our study was 45.6% (1,271/2,782). When the subjects were divided into two groups according to the H. pylori infection status, there was no significant differences of the baseline characteristics between the two groups. The prevalence of gallstone in the H. pylori infected subjects was higher than that of the H. pylori uninfected subjects (5.4% vs 3.2%, P=0.032). The prevalence of peptic ulcer in the H. pylori infected subjects was higher than that of the H. pylori uninfected subjects (8.2% vs 3.4%, P<0.001). The prevalence of reflux esophagitis in the H. pylori infected subjects was lower than that of the H. pylori uninfected subjects (6.2% vs 14.0%, P=0.012). Conclusion These findings suggest that H. pylori infection is associated with an increased risk of gallstone in asymptom- atic population. Tu1074 Comparative Study of Gastric Mucosa Between High Frequent and Low Frequent Country of Gastric Cancer: Japan and Bangladesh Takeshi Matsuhisa, Nobutaka Yamada, Hafeza Aftab [Aim] Japanese has high incidence of gastric cancer (47 cases per 100,000 populations in male). In spite of very high prevalence of Helicobacter pylori (H. pylori) infection in Bangladesh, the incidence of gastric cancer is very low (Asian paradox). Characteristics of gastric mucosa in both countries were compared. [Materials and methods] 2,420 Japanese (Tokyo) and 283 Bangladeshi (Dhaka) were used in this study. Among them, 283 pairs, 566 cases were obtained by matching of age, gender, and endoscopic diagnosis. H. pylori positive 167 pairs, 334 cases were also obtained by matching of age, gender, and endoscopic diagnosis. Biopsy specimen for the diagnosis of chronic inflammation, neutrophile activity, glandular atrophy, intestinal metaplasia, and H. pylori score was sampled from the greater curvature of the lower antrum (A), the greater curvature of the upper body (B), and the lesser curvature of the lower body (C). Histological diagnosis was performed by the same pathologist according to the Updated Sydney system. Neutrophile activity score sampled from A and C were used for the diagnosis of gastritis. All participants gave written informed consent. [Results] Duodenal ulcer (DU) was predominant than gastric ulcer (GU) in Bahgladesh (GU/DU ratio: 0.30). The prevalence of H. pylori infection was higher in Bangladesh than Japan (65.0%, 50.5%, respectively, p=0.0006). Mean of chronic inflammation, neutrophile activity, glandu- lar atrophy and intestinal metaplasia scores in H. pylori positive cases were all significantly S-734 AGA Abstracts higher in Japanese than in Bangladeshi. Ratio of corpus gastritis to antrum gastritis (C/A ratio) in H. pylori positive Japanese showed antrum predominant gastritis in young group (C/A ratio<1.00) and it changed to corpus predominant gastritis (C/A ratio>1.00) over 50 year-old groups. On the other hand, Bangladeshi C/A ratio showed antrum predominant in every age group. [Conclusion] In spite of high prevalence of H. pylori infection in Bangladesh, chronic inflammation, neutrophile activity, glandular atrophy and intestinal metaplasia scores in H. pylori positive cases were all lower than Japanese. Type of gastritis was also different. These may be one of the cause of the different incidence of gastric cancer between Japan and Bangladeshi. Tu1075 Helicobacter pylori Eradication and Change in Body Weight: A Systematic Review Dunja Sumanac, Yuhong Yuan, Richard H. Hunt Background: Some data suggest that eradication of H. pylori infection may have an effect on body weight and that this may occur due to the influence of H. pylori infection on levels of hormones responsible for regulating food intake and satiety. Conflicting results about the effect of H. pylori eradication on weight change have been reported. Taking into consideration that treatments for the eradication of H. pylori have become widely used, we aimed to explore the evidence for an association between eradication of H. pylori infection and change in body weight by systematic review. Methods: A comprehensive literature search was conducted using Medline, Embase, and relevant reference lists between January 2000 and June 2009 for fully published studies (cohort or open clinical trials) in English reporting body mass index (BMI, kg/m 2 ) data prior to and following H. pylori eradication therapy. StatsDirect ® 2.7.7 was used to calculate the pooled mean difference in BMI following successful, as well as failed, H. pylori eradication treatment in comparison to pre-treatment BMI. The pooled mean difference in post-treatment BMI in patients with successful eradication was also compared to those with failed eradication. A fixed effects model was applied for statistical analyses. Results: The literature search yielded 34 abstracts, of which 12 were relevant studies and 4 were subsequently excluded due to insufficient data. Eradication therapy regimens and length of follow-up (range from 3 months to 5 years) for assessment of BMI post-treatment varied across studies. In comparison with baseline, the pooled mean difference in BMI was 0.12 (95% CI 0.05 to 0.20, P = 0.002) (8 studies, n=1264) following successful H. pylori eradication and -0.04 (-0.35 to 0.28, P = 0.83) (4 studies, n= 78) following failed eradication. The pooled mean of BMI in patients with successful eradication was not significantly different compared to those who failed eradication (pooled mean difference= -0.01, -0.25 to 0.24, P = 0.95) (4 studies, n success =402, n fail =78). The BMI value at baseline was non-significantly lower in the successful group (pooled mean difference = -0.12, -0.37 to 0.12, P = 0.33). No significant heterogeneity was detected in any of the analyses. Conclusions: There has been little investigation into the effect of H. pylori eradica- tion on change in body weight. The present evidence indicates that BMI following successful H. pylori eradication increased significantly in comparison to pre-treatment BMI, and patients who failed H. pylori eradication had a non-significant decrease in BMI compared to baseline. Eradication of H. pylori infection may play a role in body weight change, but the clinical significance of this change needs further research. Tu1076 Nationwide Survey Antibiotic Resistant Strains of Helicobacter pylori Infection in Thailand Varocha Mahachai, Thawee Ratanachu-Ek, Ratha-korn Vilaichone OBJECTIVE: The aim of this study was to national survey the antibiotic resistant pattern of H. pylori infection in different geographical locations in Thailand between January 2005 and December 2010 and to compare the antibiotic resistant strains among the patients with gastritis and peptic ulcer diseases. METHODS: A total of 3,012 dyspeptic patients who underwent upper endoscopy from different regions (North, Northeastern, Central and South- ern) of Thailand during January 2005- January 2010 were enrolled in this study. Two antral gastric biopsies were obtained for culture and susceptibility tests were performed using the E-test. RESULTS: 933 patients (31%) were infected with H. pylori identified by rapid urease test. E-test for all 4 antibitiotics was successfully in 250 isolations (106 male, 144 female, mean age 51 years). The endoscopic findings demonstrated 184 gastritis patients and 66peptic ulcer patients. The prevalence of antibiotic-resistant H. pylori was amoxycillin 7.2%, tetracyc- lin 3 %, clarithromycin 3.4%, metronidazole 38%, and multi-drugs 4%. In metronidazole resistant strains, Age> 40 years and gastritis patients were significantly higher than age<40 years and peptic ulcer patients(81% vs 19%; P-value <0.05 and 76% vs 24%:P-value<0.05 respectively). CONCLUSION: Prevalence of H. pylori infection has decreased in all regions of Thailand. The prevalence of metronidazole resistant strain was high and remains the most common antibiotic resistant strains in Thailand whereas clarithromycin resistance has markedly declined in recent years. The reason for such a decline is likely due to the wide use of other newer antibiotics in place of clarithromycin. Age >40 years and gastritis patients might be predictor for metronidazole resistant strain in Thailand. Tu1077 Significant Drop in the Serological Prevalence of Helicobacter pylori-Infection in Patients Born After 1980 in the Area of Magdeburg, Germany Marino Venerito, Thomas Wex, Juliane Kreutzer, Tobias Götze, Arne Kandulski, Peter Malfertheiner Background and aims: Epidemiological studies from different countries have shown a steady age-related increase in prevalence of Helicobacter pylori infection. We sought to investigate the seroprevalence of H. pylori infection in the area of Magdeburg, a city of the former East Germany, by analysing H. pylori antibodies among patients presenting in our emergency wards with a wide spectrum of different disorders. Methods: According to a new standard operating procedure, all 1941 patients who were seen in our emergency wards between
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sII ratio in H. pylori-negative subjects. Conclusions: The urinary sodium to creatinine ratiowas associated with the serum PG I/II ratio in H. pylori-positive subjects. High salt intakemay be a risk factor of the progression of atrophic gastritis.
Tu1072
Relationship Between the Helicobacter pylori Icea Gene and Clinical Outcomesin Western Countries: Meta-AnalysisSeiji Shiota, Ayaka Takahashi, Miyuki Matsuda, Osamu Matsunari, Masahide Watada,Rumiko Suzuki, Katsuhiro Hanada, Yoshio Yamaoka
Background: Although the iceA (induced by contact with epithelium) allelic types of Helicob-acter pylori (H. pylori) have been reported to be associated with peptic ulcer, the importanceof the iceA gene on clinical outcomes is conflicting in subsequent studies. The aim of thisstudy was to estimate the magnitude of the risk for clinical outcomes associated with iceAgene in Western countries (Europe, North and South America). Methods: A literature searchwas performed using the PubMed and EMBASE databases for articles published throughNovember 2010, using the following text words: 1) iceA, iceA1 or iceA2, and 2) pylori orHelicobacter. We did not include abstract alone or unpublished articles. The following criteriawere applied to select fully published case-control studies examining the relationship betweenthe iceA gene and clinical outcomes (gastritis, peptic ulcer including gastric ulcer andduodenal ulcer, and gastric cancer) in adult population; the presence of the iceA gene wasexamined by polymerase chain reaction (PCR); original articles published in English. Studieswere excluded if raw data were not presented. Subgroup analysis was performed by geo-graphic area. Results: Nineteen studies with a total of 2,218 patients were identified in thesearch. Infection with the iceA1-positive H. pylori increased the risk for peptic ulcer by 1.27-fold (95% confidence interval [CI], 1.01-1.59) overall. However, the test of heterogeneitywas significant among these studies. Sensitivity analysis showed that the presence of theiceA1 gene was significantly associated with peptic ulcer (odds ratio [OR] = 1.28, 95% CI =1.02-1.61) overall. Those of the iceA2 gene was inversely associated with peptic ulcerespecially in Europe (OR = 0.55, 95% CI = 0.40-0.76). This trend was the same as in caseof duodenal ulcer. There was no association between the presence of the iceA gene andgastric ulcer and gastric cancer. Seven studied examined the correlation with cagA gene,and only two showed the positive correlation. Publication bias did not exist. Conclusion:Our meta-analysis confirmed the importance of the presence of the iceA gene for duodenalulcer in Western countries, especially in Europe although the significance was small. It ispossible that the iceA gene is discriminating factor for peptic ulcer independent on cagA gene.
Tu1073
Correlation Between the Prevalence of Gallstone and Helicobacter pyloriInfectionJae G. Kim, Beom Jin Kim, Hyoung-Chul Oh, Jeong Wook Kim
Background/Aim Several studies have been reported that the presence of Helicobacter DNAin human bile sample, although its pathological role is not clear. Moreover, little is knownabout the association between Helicobacter pylori (H. pylori) infection and gallstone. The aimof this study was to determine whether H. pylori infection is associated with an increasedrisk of gallstone in asymptomatic population. Methods We examined 2,782 subjects (1,635men and 1,147 women) who underwent both upper endoscopy with CLO test and abdominalultrasound at the Health Examination Center at Chung-Ang University Yong-san Hospitalin Korea from January 2007 to December 2009. We compared the prevalence of gallstoneon ultrasound and endoscopic findings such as reflux esophagitis, gastric diseases in the H.pylori infected subjects with that of the H. pylori uninfected subjects. Results The overallprevalence of H. pylori infection in our study was 45.6% (1,271/2,782). When the subjectswere divided into two groups according to the H. pylori infection status, there was nosignificant differences of the baseline characteristics between the two groups. The prevalenceof gallstone in the H. pylori infected subjects was higher than that of the H. pylori uninfectedsubjects (5.4% vs 3.2%, P=0.032). The prevalence of peptic ulcer in the H. pylori infectedsubjects was higher than that of the H. pylori uninfected subjects (8.2% vs 3.4%, P<0.001).The prevalence of reflux esophagitis in the H. pylori infected subjects was lower than thatof the H. pylori uninfected subjects (6.2% vs 14.0%, P=0.012). Conclusion These findingssuggest that H. pylori infection is associated with an increased risk of gallstone in asymptom-atic population.
Tu1074
Comparative Study of Gastric Mucosa Between High Frequent and LowFrequent Country of Gastric Cancer: Japan and BangladeshTakeshi Matsuhisa, Nobutaka Yamada, Hafeza Aftab
[Aim] Japanese has high incidence of gastric cancer (47 cases per 100,000 populations inmale). In spite of very high prevalence ofHelicobacter pylori (H. pylori) infection in Bangladesh,the incidence of gastric cancer is very low (Asian paradox). Characteristics of gastric mucosain both countries were compared. [Materials and methods] 2,420 Japanese (Tokyo) and 283Bangladeshi (Dhaka) were used in this study. Among them, 283 pairs, 566 cases wereobtained by matching of age, gender, and endoscopic diagnosis. H. pylori positive 167 pairs,334 cases were also obtained by matching of age, gender, and endoscopic diagnosis. Biopsyspecimen for the diagnosis of chronic inflammation, neutrophile activity, glandular atrophy,intestinal metaplasia, and H. pylori score was sampled from the greater curvature of thelower antrum (A), the greater curvature of the upper body (B), and the lesser curvature ofthe lower body (C). Histological diagnosis was performed by the same pathologist accordingto the Updated Sydney system. Neutrophile activity score sampled from A and C wereused for the diagnosis of gastritis. All participants gave written informed consent. [Results]Duodenal ulcer (DU) was predominant than gastric ulcer (GU) in Bahgladesh (GU/DU ratio:0.30). The prevalence of H. pylori infection was higher in Bangladesh than Japan (65.0%,50.5%, respectively, p=0.0006). Mean of chronic inflammation, neutrophile activity, glandu-lar atrophy and intestinal metaplasia scores in H. pylori positive cases were all significantly
S-734AGA Abstracts
higher in Japanese than in Bangladeshi. Ratio of corpus gastritis to antrum gastritis (C/Aratio) in H. pylori positive Japanese showed antrum predominant gastritis in young group(C/A ratio<1.00) and it changed to corpus predominant gastritis (C/A ratio>1.00) over 50year-old groups. On the other hand, Bangladeshi C/A ratio showed antrum predominant inevery age group. [Conclusion] In spite of high prevalence of H. pylori infection in Bangladesh,chronic inflammation, neutrophile activity, glandular atrophy and intestinal metaplasia scoresin H. pylori positive cases were all lower than Japanese. Type of gastritis was also different.These may be one of the cause of the different incidence of gastric cancer between Japanand Bangladeshi.
Tu1075
Helicobacter pylori Eradication and Change in Body Weight: A SystematicReviewDunja Sumanac, Yuhong Yuan, Richard H. Hunt
Background: Some data suggest that eradication of H. pylori infection may have an effecton body weight and that this may occur due to the influence of H. pylori infection on levelsof hormones responsible for regulating food intake and satiety. Conflicting results about theeffect of H. pylori eradication on weight change have been reported. Taking into considerationthat treatments for the eradication of H. pylori have become widely used, we aimed toexplore the evidence for an association between eradication of H. pylori infection and changein body weight by systematic review. Methods: A comprehensive literature search wasconducted using Medline, Embase, and relevant reference lists between January 2000 andJune 2009 for fully published studies (cohort or open clinical trials) in English reportingbody mass index (BMI, kg/m2) data prior to and following H. pylori eradication therapy.StatsDirect® 2.7.7 was used to calculate the pooled mean difference in BMI followingsuccessful, as well as failed, H. pylori eradication treatment in comparison to pre-treatmentBMI. The pooledmean difference in post-treatment BMI in patients with successful eradicationwas also compared to those with failed eradication. A fixed effects model was applied forstatistical analyses. Results: The literature search yielded 34 abstracts, of which 12 wererelevant studies and 4 were subsequently excluded due to insufficient data. Eradicationtherapy regimens and length of follow-up (range from 3 months to 5 years) for assessmentof BMI post-treatment varied across studies. In comparison with baseline, the pooled meandifference in BMI was 0.12 (95% CI 0.05 to 0.20, P = 0.002) (8 studies, n=1264) followingsuccessful H. pylori eradication and -0.04 (-0.35 to 0.28, P = 0.83) (4 studies, n= 78)following failed eradication. The pooled mean of BMI in patients with successful eradicationwas not significantly different compared to those who failed eradication (pooled meandifference= -0.01, -0.25 to 0.24, P = 0.95) (4 studies, nsuccess=402, nfail=78). The BMI valueat baseline was non-significantly lower in the successful group (pooled mean difference =-0.12, -0.37 to 0.12, P = 0.33). No significant heterogeneity was detected in any of theanalyses. Conclusions: There has been little investigation into the effect of H. pylori eradica-tion on change in body weight. The present evidence indicates that BMI following successfulH. pylori eradication increased significantly in comparison to pre-treatment BMI, and patientswho failed H. pylori eradication had a non-significant decrease in BMI compared to baseline.Eradication of H. pylori infection may play a role in body weight change, but the clinicalsignificance of this change needs further research.
Tu1076
Nationwide Survey Antibiotic Resistant Strains of Helicobacter pylori Infectionin ThailandVarocha Mahachai, Thawee Ratanachu-Ek, Ratha-korn Vilaichone
OBJECTIVE: The aim of this study was to national survey the antibiotic resistant pattern ofH. pylori infection in different geographical locations in Thailand between January 2005 andDecember 2010 and to compare the antibiotic resistant strains among the patients withgastritis and peptic ulcer diseases. METHODS: A total of 3,012 dyspeptic patients whounderwent upper endoscopy from different regions (North, Northeastern, Central and South-ern) of Thailand during January 2005- January 2010 were enrolled in this study. Two antralgastric biopsies were obtained for culture and susceptibility tests were performed using theE-test. RESULTS: 933 patients (31%) were infected with H. pylori identified by rapid ureasetest. E-test for all 4 antibitiotics was successfully in 250 isolations (106 male, 144 female,mean age 51 years). The endoscopic findings demonstrated 184 gastritis patients and 66pepticulcer patients. The prevalence of antibiotic-resistant H. pylori was amoxycillin 7.2%, tetracyc-lin 3 %, clarithromycin 3.4%, metronidazole 38%, and multi-drugs 4%. In metronidazoleresistant strains, Age> 40 years and gastritis patients were significantly higher than age<40years and peptic ulcer patients(81% vs 19%; P-value <0.05 and 76% vs 24%:P-value<0.05respectively). CONCLUSION: Prevalence of H. pylori infection has decreased in all regionsof Thailand. The prevalence of metronidazole resistant strain was high and remains themost common antibiotic resistant strains in Thailand whereas clarithromycin resistance hasmarkedly declined in recent years. The reason for such a decline is likely due to the wideuse of other newer antibiotics in place of clarithromycin. Age >40 years and gastritis patientsmight be predictor for metronidazole resistant strain in Thailand.
Tu1077
Significant Drop in the Serological Prevalence of Helicobacter pylori-Infectionin Patients Born After 1980 in the Area of Magdeburg, GermanyMarino Venerito, Thomas Wex, Juliane Kreutzer, Tobias Götze, Arne Kandulski, PeterMalfertheiner
Background and aims: Epidemiological studies from different countries have shown a steadyage-related increase in prevalence of Helicobacter pylori infection. We sought to investigatethe seroprevalence of H. pylori infection in the area of Magdeburg, a city of the former EastGermany, by analysing H. pylori antibodies among patients presenting in our emergencywards with a wide spectrum of different disorders. Methods: According to a new standardoperating procedure, all 1941 patients who were seen in our emergency wards between
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