helicobacter pylori infection is associated with advanced colorectal neoplasia
TRANSCRIPT
Scandinavian Journal of Gastroenterology. 2014; 49: 516–517
LETTER TO THE EDITOR
Helicobacter pylori infection is associated with advanced colorectalneoplasia
HAIM SHMUELY, EHUD MELZER, MICHAL BRAVERMAN, NOAM DOMNITZ &JACOB YAHAV
Kaplan Medical Center, Rehovoth, Israel
To the Editor,Kountouras et al. [1] in their letter commenting on
our study [2] stated that only current Helicobacterpylori infection (Hp-I) reduces humoral and cellularimmune responses inducing or perpetuating chronicinflammatory processes in the gastrointestinal tractwith potential oncogenic sequelae. Most malignan-cies, including colorectal carcinoma (CRC), occur atthe chronic inflammation sites and infection.In our study [2], we used two serology tests.
ELISA, validated in our laboratory, involving patientswho had undergone an endoscopy at our hospital,yielded a sensitivity of 94% and specificity of 90%.Positive and negative predictive values of 100% and90%, respectively, were observed. We also tested forIgG antibodies against CagA protein with immuno-blot staining using a Western blot kit (Helicoblot 2.0;Genelabs Diagnostic, Singapore).CRC is a slow-growing cancer and it takes up to
18 years for a dysplastic cell to transform tocancer [3], and Hp-I initiates the process. The lowrates of natural acquisition and elimination of Hp inadults [4] suggest that there is almost no self-elimination of the bacteria that persists throughoutlife; thus, serology may remain positive even aftercuring the infection [5]. In patients treated withantisecretory drugs, H. pylori antibodies persist. Pos-itive antibody levels were found in 86% of patientswith chronic atrophic gastritis; however, positivehistology was only apparent in 33% of the subjectsand in patients after gastrectomy [6].
Regarding Kountouras’ letter [1], the authorsbase their results on only 50 CRC patients and25 patients with colorectal adenomas (CRAs) andonly 10 controls. The number of controls is unusu-ally low and do not represent a comparable group.The authors neither specify gender and age ofpatients and controls nor their socioeconomicstatus. As to the small number of cases, the presenceof Hp-I in the CRA (68%) and CRC (84%) groupshas no statistical significance in univariate analysis,especially without multivariate analysis for confoun-ders. Only 8 out of 50 CRC and 8 out of 25 patientswith CRAs were Hp negative, rendering it very dif-ficult to reach any conclusions, especially regardingHp eradication.The results presented by Kountouras et al. [1]
indicate that Hp-I impacts colorectal oncogenesis,thus supporting our results and conclusion.
Declaration of interest: The authors report noconflicts of interest. The authors alone are responsiblefor the content and writing of the paper.
References
[1] Kountouras J, Kapetanakis N, Zavos C, Polyzos SA,Kouklakis G, Venizelos I, et al. Active Helicobacter pyloriinfection is associated with colorectal mucosa - adenomatouspolyp - early and advanced adenocarcinoma sequence. Scand JGastroenterol 2013;Epub ahead of print.
[2] Shmuely H, Melzer E, Braverman M, Domniz N, Yahav J.Helicobacter pylori infection is associated with advanced
Correspondence: Haim Shmuely MD, Kaplan Medical Center, Rehovoth, Israel. E-mail: [email protected]
(Received 22 December 2013; accepted 24 December 2013)
ISSN 0036-5521 print/ISSN 1502-7708 online � 2014 Informa HealthcareDOI: 10.3109/00365521.2013.879336
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colorectal neoplasia. Scand J Gastroenterol 2014;49:35–42.
[3] Kozuka S, Nogaki M, Ozeki T, et al. Premalignancy ofthe mucosal polyp in the large intestine: II. Estimationof the periods required for malignant transformation ofmucosal polyps. Dis Colon Rectum 1975;18:494–500.
[4] Xia HH, Talley NJ. Natural acquisition and spontaneouselimination of Helicobacter pylori infection: clinicalimplications. Am J Gastroenterol 1997;92:1780–7.
[5] Morris AJ, Ali MR, Nicolson GI, Perez-Perez GI,Blaser MJ. Long-term follow-up of voluntary ingestionof Helicobacter pylori. Ann Intern Med 1991;114:662–3.
[6] Karnes WE, Samloff IM, Siurala M, Kekki M, Sipponen P,Kim SW, et al. Positive serum antibody and negative tissuestaining for Helicobacter pylori in subjects with chronicatrophic body gastritis. Gastroenterology 1991;101:167–74.
Letter to the Editor 517
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