Effect ofHelicobacter pyloriInfection on Ghrelin Expression in Human Gastric Mucosa

Tatsuguchi, Atsushi; Miyake, Kazumasa; Gudis, Katya; Futagami, Seiji; Tsukui, Taku; Wada, Ken; Kishida, Teruyuki; Fukuda, Yuh; Sugisaki, Yuichi; Sakamoto, Choitsu
November 2004
American Journal of Gastroenterology;Nov2004, Vol. 99 Issue 11, p2121
Academic Journal
Background: Several studies showed that colonic flat neoplasia, most often defined as having an endoscopic flat aspect, are as frequent in Western countries as in Japan. Aims: To evaluate prospectively the frequency of histologically defined colonic flat neoplasia >3 mm in consecutive patients undergoing colonoscopy and assess concordance between endoscopic aspect and histological diagnosis. Methods: Standard video endoscopy without dye-spraying was used. Lesions endoscopically classified as pedunculated, sessile or flat were removed and spread on cardboard before fixation. Flat adenomas were histologically defined by a thickness <2 times that of the normal colonic mucosa. Results: Among 562 polyps resected from 196 patients, 240> 3 mm were studied. Endoscopically, 168 polyps were sessile, 47 pedunculated and 25 flat. Histologically, 174 (of 230 analyzed) were neoplastic: 65 (3 7%) flat adenomas (8 with high grade dysplasia and 4 with invasive adenocarcinoma), 107 (61%) polypoid adenomas (18 with high grade dysplasia and 9 with invasive adenocarcinoma), 1 unclassified adenoma and 1 de novo flat adenocarcinoma. The median size of flat and polypoid adenomas was similar. Four of the 6 depressed lesions were high grade dysplasia or adenocarcinomas. The concordance between endoscopic aspect and histological diagnosis was poor (K = 0.22), except for polyps >10 mm (K = 0.60). Conclusion: The frequency of colonic flat neoplasia defined according to histological criteria was similar to that found in series using an endoscopic definition, but we found no concordance between these approaches for our cases except for lesions >10 mm. Flat and polypoid adenomas, except when depressed, had similar adenocarcinoma rates. OBJECTIVES: One of the counter-effects of Helicobacter pylon eradication therapy is subsequent obesity. Ghrelin is a recently discovered growth hormone releasing peptide. This endogenous secretagogue increases appetite and facilitates fat storage. The majority of circulating ghrelin is produced in the gastric mucosa. Therefore, we aimed at investigating changes in ghrelin immunoreactivity in gastric mucosa tissues of patients infected with H. pylori. METHODS: Sixty-one patients with H. pylori infection (25 cases each of duodenal and gastric ulcer, and 11 cases of gastritis) and 22 healthy controls without H. pylori infection were included in the study. H. pylori-infected patients received standard proton pump-based triple therapy followed by histological examination and 13C-urea breath test to confirm H. pylori eradication. H. pylori was eradicated in 50 out of 61 patients. Biopsy specimens were obtained from antrum and corpus before and 3 months following eradication. Ghrelin expression was evaluated immunohistochemically with an anti-ghrelin antibody, and the number of ghrelin-positive cells determined per 1 mm² of the lamina propria mucosa. RESULTS: There was no relationship between ghrelin immunoreactivity and body weight or body mass index for healthy controls. The number of ghrelin-positive cells was significantly lower for H. pylori-infected patients than for healthy controls. However, the ghrelin-positive cell number increased significantly following H. pylori eradication without significant change in severity of atrophy. CONCLUSIONS: These data indicated that H. pylori infection affected ghrelin expression. After H. pylori eradication, gastric tissue ghrelin concentration increased significantly. This could lead to the increased appetite and weight gain seen following H. pylori eradication.


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