Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Incidence of Infection among Subjects with Helicobacter pylori Seroconversion

  • Young Jung Kim (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Sun-Young Lee (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Jeong Hwan Kim (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • In-Kyung Sung (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Hyung Seok Park (Department of Internal Medicine, Konkuk University School of Medicine)
  • Received : 2020.11.16
  • Accepted : 2021.03.03
  • Published : 2022.01.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Helicobacter pylori (H. pylori) seroconversion may occur during screening for gastric cancer. Our study aimed to assess the number of seroconverted subjects with H. pylori and their results in follow-up tests. Methods: Data were consecutively collected on subjects who were H. pylori-seronegative and presented for gastric cancer screening. Subjects who were followed up using the same serology test and pepsinogen (PG) assays on the day of endoscopy were included in the study. Results: During the follow-up of 57.7±21.4 months, 61 (15.0%) of 407 seronegative subjects showed seroconversion. H. pylori infection was detected in six (9.8%) of 61 seroconverted subjects. A diffuse red fundal appearance, with a significant increase in the Kyoto classification scores for gastritis, was observed in the infected subjects (p<0.001). Compared to the false-seropositive subjects, infected subjects showed higher serology titers (p<0.001) and PG II levels (p<0.001) and lower PG I/II ratios (p=0.002), in the follow-up tests. Conclusions: Seroconversion occurred in 3.3% of seronegative subjects per year; however, only 9.8% had H. pylori infection. The majority (90.2%) of the seroconverted subjects showed false seropositivity without significant changes in the follow-up test results. The diffuse red fundal appearance could be an indicator of H. pylori infection.

Keywords

Acknowledgement

This study was supported by the National Research Foundation (NRF) of Korea, funded by the Ministry of Education (NRF2016R1D1A1B02008937).

References

  1. Shin CM, Kim N, Lee HS, et al. Validation of diagnostic tests for Helicobacter pylori with regard to grade of atrophic gastritis and/or intestinal metaplasia. Helicobacter 2009;14:512-519.  https://doi.org/10.1111/j.1523-5378.2009.00726.x
  2. Kim JH, Lee SY, Lee SP, et al. The histologic detection of Helicobacter pylori in seropositive subjects is affected by pathology and secretory ability of the stomach. Helicobacter 2018;23:e12480. 
  3. Tu H, Sun L, Dong X, et al. Serum anti-Helicobacter pylori immunoglobulin G titer correlates with grade of histological gastritis, mucosal bacterial density, and levels of serum biomarkers. Scand J Gastroenterol 2014;49:259-266.  https://doi.org/10.3109/00365521.2013.869352
  4. Bosch DE, Krumm N, Wener MH, et al. Serology is more sensitive than urea breath test or stool antigen for the initial diagnosis of Helicobacter pylori gastritis when compared with histopathology. Am J Clin Pathol 2020;154:255-265.  https://doi.org/10.1093/ajcp/aqaa043
  5. Lee SP, Lee SY, Kim JH, Sung IK, Park HS, Shim CS. Link between serum pepsinogen concentrations and upper gastrointestinal endoscopic findings. J Korean Med Sci 2017;32:796-802.  https://doi.org/10.3346/jkms.2017.32.5.796
  6. Kwon H, Lee SY, Kim JH, et al. ABC classification is less useful for older Koreans born before 1960. Gut Liver 2019;13:522-530.  https://doi.org/10.5009/gnl18399
  7. Kishino T, Oyama T, Tomori A, Takahashi A, Shinohara T. Usefulness and limitations of a serum screening system to predict the risk of gastric cancer. Intern Med 2020;59:1473-1480.  https://doi.org/10.2169/internalmedicine.3521-19
  8. Yoshii S, Mabe K, Watano K, et al. Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis. Dig Endosc 2020;32:74-83.  https://doi.org/10.1111/den.13486
  9. Jung JH, Choi KD, Han S, et al. Seroconversion rates of Helicobacter pylori infection in Korean adults. Helicobacter 2013;18:299-308.  https://doi.org/10.1111/hel.12043
  10. Choi HS, Lee SY, Kim JH, et al. Combining the serum pepsinogen level and Helicobacter pylori antibody test for predicting the histology of gastric neoplasm. J Dig Dis 2014;15:293-298.  https://doi.org/10.1111/1751-2980.12144
  11. Kim GH. Endoscopic findings of Kyoto classification of gastritis. Korean J Helicobacter Up Gastrointest Res 2019;19:88-93.  https://doi.org/10.7704/kjhugr.2019.19.2.88
  12. Han HS, Lee SY, Oh SY, Moon HW, Cho H, Kim JH. Correlations of the gastric and duodenal microbiota with histological, endoscopic, and symptomatic gastritis. J Clin Med 2019;8:312. 
  13. Sugimoto M, Ban H, Ichikawa H, et al. Efficacy of the Kyoto classification of gastritis in identifying subjects at high risk for gastric cancer. Intern Med 2017;56:579-586.  https://doi.org/10.2169/internalmedicine.56.7775
  14. Lee SY, Moon HW, Hur M, Yun YM. Validation of western Helicobacter pylori IgG antibody assays in Korean adults. J Med Microbiol 2015;64:513-518.  https://doi.org/10.1099/jmm.0.000050
  15. Seo TH, Lee SY, Uchida T, et al. The origin of non-Helicobacter pylori-related positive Giemsa stain in human gastric biopsy specimens. Dig Liver Dis 2011;43:23-27.  https://doi.org/10.1016/j.dld.2010.04.006
  16. Inoue M, Sawada N, Goto A, et al.; JPHC Study Group. High-negative anti-Helicobacter pylori IgG antibody titers and long-term risk of gastric cancer: Results from a large-scale population-based cohort study in Japan. Cancer Epidemiol Biomarkers Prev 2020;29:420-426.  https://doi.org/10.1158/1055-9965.EPI-19-0993
  17. Lee JH, Kim N, Chung JI, et al. Long-term follow up of Helicobacter pylori IgG serology after eradication and reinfection rate of H. pylori in South Korea. Helicobacter 2008;13:288-294.  https://doi.org/10.1111/j.1523-5378.2008.00616.x
  18. Massarrat S, Haj-Sheykholeslami A, Mohamadkhani A, et al. Pepsinogen II can be a potential surrogate marker of morphological changes in corpus before and after H. pylori eradication. Biomed Res Int 2014;2014:481607. 
  19. Shan J, Lei H, Shi W, Sun X, Tang Y, Ren C. High serum pepsinogen I and beta Helicobacter pylori infection are risk factors for aspirin-induced gastroduodenal injury. Dig Dis 2018;36:66-71.  https://doi.org/10.1159/000477203
  20. Noh G, Kim N, Choi Y, et al. Long-term follow up of serum pepsinogens in subjects with gastric cancer or dysplasia after Helicobacter pylori eradication. J Gastroenterol Hepatol 2020;35:1540-1548.  https://doi.org/10.1111/jgh.15017
  21. Iijima K, Koike T, Ara N, et al. Identification of a high-risk group for low-dose aspirin-induced gastropathy by measuring serum pepsinogen in H. pylori-infected subjects. J Gastroenterol 2015;50:305-312.  https://doi.org/10.1007/s00535-014-0976-5
  22. Song HJ, Jang SJ, Yun SC, et al. Low levels of pepsinogen I and pepsinogen I/II ratio are valuable serologic markers for predicting extensive gastric corpus atrophy in patients undergoing endoscopic mucosectomy. Gut Liver 2010;4:475-480.  https://doi.org/10.5009/gnl.2010.4.4.475
  23. Lee SY. Helicobacter pylori-negative gastric cancer. Korean J Helicobacter Up Gastrointest Res 2020;21:10-21.  https://doi.org/10.7704/kjhugr.2020.0036
  24. Kato M, Terao S, Adachi K, et al.; Study Group for Establishing Endoscopic Diagnosis of Chronic Gastritis. Changes in endoscopic findings of gastritis after cure of H.pylori infection: multicenter prospective trial. Dig Endosc 2013;25:264-273.  https://doi.org/10.1111/j.1443-1661.2012.01385.x
  25. Kato T, Yagi N, Kamada T, Shimbo T, Watanabe H, Ida K; Study Group for Establishing Endoscopic Diagnosis of Chronic Gastritis. Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study. Dig Endosc 2013;25:508-518.  https://doi.org/10.1111/den.12031
  26. Toyoshima O, Nishizawa T, Arita M, et al. Helicobacter pylori infection in subjects negative for high titer serum antibody. World J Gastroenterol 2018;24:1419-1428.  https://doi.org/10.3748/wjg.v24.i13.1419
  27. Otani K, Watanabe T, Kosaka S, et al. Utility of Kyoto classification of gastritis in subjects with a high-negative titer of anti-Helicobacter pylori antibody during a medical check-up. J Clin Biochem Nutr 2020;67:317-322.  https://doi.org/10.3164/jcbn.20-21
  28. Toyoshima O, Nishizawa T, Yoshida S, et al. Endoscopy-based Kyoto classification score of gastritis related to pathological topography of neutrophil activity. World J Gastroenterol 2020;26:5146-5155.  https://doi.org/10.3748/wjg.v26.i34.5146
  29. Nishizawa T, Sakitani K, Suzuki H, et al. A combination of serum anti-Helicobacter pylori antibody titer and Kyoto classification score could provide a more accurate diagnosis of H. pylori. United European Gastroenterol J 2019;7:343-348.  https://doi.org/10.1177/2050640619825947
  30. Osawa H, Miura Y, Takezawa T, et al. Linked color imaging and blue laser imaging for upper gastrointestinal screening. Clin Endosc 2018;51:513-526. https://doi.org/10.5946/ce.2018.132