Prevention of Gastric Cancer: When is Treatment of Helicobacter Pylori Warranted?
Prevention of Gastric Cancer: When is Treatment of Helicobacter Pylori Warranted?
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DOI：
10.1177/1756283x08093567
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发表时间：
2008-07
影响因子：
4.2
通讯作者：
Peek RM
中科院分区：
文献类型：
--
作者：
Peek RM
幽门螺杆菌（H.幽门螺杆菌）是胃远端腺癌最强的已知危险因素，但细菌根除对癌发生的影响仍不清楚。H.幽门螺杆菌分离株具有相当大的基因型多样性，这产生了影响临床结果的不同宿主炎症反应。H.具有CAG致病岛并分泌功能性细胞毒素的幽门螺杆菌菌株诱导更严重的胃损伤并进一步增加发展远端胃癌的风险。致癌作用还受到宿主遗传多样性的影响，特别是涉及免疫应答基因，如白细胞介素-1 β和肿瘤坏死因子-α。人体试验和动物研究表明，根除H。在萎缩性胃炎发生之前检查幽门螺杆菌，为预防胃癌提供了最好的机会。然而，尽管干预的时机影响癌前病变和肿瘤病变的抑制程度，但即使在长期感染中，细菌根除对宿主也有明显的益处。因此，深入了解H.研究幽门螺杆菌诱导的胃炎和腺癌不仅是为了开发更有效的胃癌治疗方法，而且还因为它可能作为慢性炎症在胃肠道内出现的其他恶性肿瘤发生中的作用的范例。
Chronic gastritis induced by Helicobacter pylori (H. pylori) is the strongest known risk factor for adenocarcinoma of the distal stomach, yet the effects of bacterial eradication on carcinogenesis remain unclear. H. pylori isolates possess substantial genotypic diversity, which engenders differential host inflammatory responses that influence clinical outcome. H. pylori strains that possess the cag pathogenicity island and secrete a functional cytotoxin induce more severe gastric injury and further augment the risk for developing distal gastric cancer. Carcinogenesis is also influenced by host genetic diversity, particularly involving immune response genes such as interleukin-1β and tumor necrosis factor-α. Human trials and animal studies have indicated that eradication of H. pylori prior to the development of atrophic gastritis offers the best chance for prevention of gastric cancer. However, although the timing of intervention influences the magnitude of suppression of premalignant and neoplastic lesions, bacterial eradication, even in longstanding infections, is of clear benefit to the host. It is important to gain insight into the pathogenesis of H. pylori-induced gastritis and adenocarcinoma not only to develop more effective treatments for gastric cancer, but also because it might serve as a paradigm for the role of chronic inflammation in the genesis of other malignancies that arise within the gastrointestinal tract.