Year 2019 / Volume 111 / Number 7
Original
Is there a possible relationship between gastric intestinal metaplasia and systemic arterial stiffness?

500-506

DOI: 10.17235/reed.2019.5945/2018

Ufuk Kutluana, Ayse Guldem Kilciler,

Abstract
Background and aim: Helicobacter pylori (H. pylori) is closely associated with pre-neoplastic lesions such as atrophic gastritis (AG) and gastric intestinal metaplasia (GIM). The relationshionship between inflammation, hyperhomocysteinemia and arterial stiffness is of pathophysiological relevance for the development of cardiovascular disease. This study aimed to investigate the relationship between vitamin B12, folic acid, homocysteine (Hcy) and pulse wave velocity (PWV) levels in patients with GIM, AG and non-atrophic non-metaplastic chronic gastritis. Patients and methods: ninety-seven patients with GIM, 67 patients with AG and 69 patients with chronic gastritis were included in the study. Glucose, creatinine, total cholesterol, triglyceride, low-density lipoprotein, cholesterol, high-density lipoprotein cholesterol, vitamin B12, folic acid and Hcy levels were measured by biochemical methods. PWV and other vascular parameters were measured using the Phsyio-port AS device. Main results: PWV was higher in patients with GIM and AG than in controls (p < 0.05 and p < 0.05, respectively). Vitamin B12 levels were significantly lower in patients with GIM and AG than in controls (p < 0.01 and p < 0.01, respectively). Folic acid levels were significantly lower in patients with GIM than in controls (p < 0.05). Hcy levels were significantly higher in patients with GIM and AG than in controls (p < 0.001 and p < 0.05, respectively). A logistic regression analysis showed that GIM, AG and vitamin B12 deficiency were predictors for arterial stiffness. Conclusions: PWV values increased in patients with GIM and AG compared to non-atrophic non-metaplastic chronic gastritis, without different conventional cardiovascular risk factors.
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References
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1. Graham DY. History of Helicobacter pylori , duodenal ulcer, gastric ulcer and gastric cancer. World J Gastroenterol 2014:14;20(18):5191-5204
2. Zhang Q, Lian Z, Wang L, et al. Analysis of alarming signals for the progression of atrophic gastritis to dysplasia. Rev Esp Enferm Dig 2012;104 (8): 399-404.
3. Ribeiro MD, Areia M, Vries AC, et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) Endoscopy:2012;44(1):74–94.
4. Sánchez-Cuén JA, Irineo-Cabrales AB, Bernal-Magaña G, et al. Regression of gastric intestinal metaplasia after the eradication of Helicobacter pylori infection in a hospital in Mexico. Rev Esp Enferm Dig 2016;108(12):770-775
5. Fox JG, Beck P, Dangler CA, et al. Concurrent enteric helminth infection modulates inflammation and gastric immune responses and reduces helicobacter induced gastric atrophy. Nat Med 2000;6:536–542.
6. Devi S, Ansari SA, Vadivelu J, et al. Helicobacter pylori Antigen HP0986 (TieA) Interacts with Cultured Gastric Epithelial Cells and Induces IL8 Secretion via NF-B Mediated Pathway. Helicobacter 2013:19;26–36
7. Rau TT, Rogler A, Frischauf M, et al. Methylation-Dependent Activation of CDX1 through NF-B A Link from Inflammation to Intestinal Metaplasia in the Human Stomach The American Journal of Pathology, 2012;181:487-498.
8. Maeda S, Akanuma M, Mitsuno Y, et al. Distinct mechanism of Helicobacter pylori-mediated NF–B activation between gastric cancer cells and monocytic cells. J. Biol. Chem. 2001:276:44856–44864.
9. McEniery C, Wilkinson CM. Large artery stiffness and inflammation. J Hum Hypertens 2005;19:507–509.
10. Flamant M, Placier S, Dubroca C, et al. Role of matrix metalloproteinases in early hypertensive vascular remodeling. Hypertension. 2007;50:212–218.
11. Wu J, Saleh MA, Kirabo A, et al. Immune activation caused by vascular oxidation promotes fibrosis and hypertension. J Clin Invest 2016;126:50–67.
12. Loehr LR, Meyer ML, Poon AL. “Prediabetes and diabetes are associated with arterial stiffness in older adults: the ARIC study,” American Journal of Hypertension. 2016; 29(9):1038–1045.
13. Kutluana U, Simsek I, Akarsu M, et al. Is there a possible relation between atrophic gastritis and premature atherosclerosis? Helicobacter. 2005;6:623-629.
14. Torisu T, Takata Y, Ansai T, et al. Possible association of atrophic gastritis and arterial stiffness in healthy middle-aged Japanese. J Atheroscler Thromb. 2009;16(5):691-697.
15. Dixon MF, Genta RM, Yardley JH, et al. Classification and grading of gastritis. The updated Sydney system. International Workshop on the Histopathology of Gastritis. Am J Surg Pathol 1996;20:1161–1181.
16. Friedewald WT, Levy RI, Fredericson DS. Estimation of the concentration of low-density lipoprotein in plasma without use of the preparative ultracentrifuge. Clin Chem 1972;8:499–502
17. Wassertheurer S, Kropf J, Weber T, et al. A new oscillometric method for pulse wave analysis: comparison with a common tonometric method. J Hum Hypertens 2010; 24:498–504.
18. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31(7):1281–1357.
19. Sugano K,Tack J,Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015;64:1353–1367.
20. Mentis A, Lehours L, Megraud F. Epidemiology and Diagnosis of Helicobacter pylori infection. Helicobacter 2015;20(1):1–7
21. Correa P, Piazuelo MB, Camargo MC. Etiopathogenesis of gastric cancer. Scand J Surg 2006;95:218-24.
22. Schroecksnadel K, Frick B, Winkler C, et al. Crucial role of interferon gamma
and stimulated macrophages in cardiovascular disease. Curr Vasc Pharmacol. 2006;4:205–213.
23. Korkmaz H, Sozen M, Kebapcilar L. Increased arterial stiffness and its relationship with inflammation, insulin, and insulin resistance in celiac disease. Eur J Gastroenterol Hepatol 2015;27:1193–1199
24. Lentz SR. Mechanisms of homocysteine-induced atherothrombosis J Thromb Haemost 2005; 3: 1646–54.
25. Santarelli L, Gabrielli M, Cremonini F, et al. Atrophic gastritis as a cause of hyperhomocysteinaemia. Aliment Pharmacol Ther 2004;19:107–11.
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31. Santoro L, Matteis GD, Fuorlo M et al. Atherosclerosis and cardiovascular involvement in celiac disease: the role of autoimmunity and inflammation. Eur Rev Med Pharmacol Sci 2017; 21: 5437-5444.
32. Park S, Lakatta EG. Role of inflammation in the pathogenesis of arterial stiffness. Yonsei Med J 2012; 53:258–261.
33. Roman MJ, Devereux RB, Schwartz JE, et al. Arterial stiffness in chronic inflammatory diseases. Hypertension 2005; 46:194–199.
34 Mendall MA, Goggin PM, Molineaux N, et al. Relation of Helicobacter pylori infection and coronary heart disease. Br Heart J 1994;71:437-439
35. Osawa H, Kawakami M, Fujii M, et al. Helicobacter pylori infection and coronary heart disease in Japanese patients. Cardiology, 2001;95:14-19
36. Patel P, Mendall MA, Carrington D, et al. Association of Helicobacter pylori and Chlamydia pneumoniae infections with
coronary heart disease and cardiovascular risk factors. BMJ 1995;311:711-714
37. Torisu T, Takata Y, Ansai T, et al. Possible association of Atrophic Gastritis and Arterial Stiffness in Healthy Middle-Aged Japanese. J Atheroscler Thromb, 2009;16:691-697.
38. Danesh J, Peto R: Risk factors for coronary heart disease and infection with Helicobacter pylori: meta-analysis of 18 studies. BMJ. 1998; 316: 1130-1132
39. Folsom AR, Nieto FJ, Sorlie P, et al. Helicobacter pylori seropositivity and coronary heart disease incidence. Atherosclerosis Risk In Communities (ARIC) Study Investigators. Circulation. 1998;98:845- 850.
40. Bjorkegren K, Svaerdsudd K. Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes a population-based study. Journal of Internal Medicine 2001;249: 423-432.
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Publication history

Received: 29/09/2018

Accepted: 12/01/2019

Online First: 13/05/2019

Published: 04/07/2019

Article revision time: 103 days

Article Online First time: 226 days

Article editing time: 278 days


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