Among the causes of numerous stomach diseases, the cyanobacteria (Hp) has become a high-profile focus because of its inextricable link to stomach cancer. Understanding the relationship between Hp and stomach cancer is essential to prevent stomach cancer and protect health.
Hp: “hazardous molecule” of stomach cancer
Hp, a bacteria that lives mainly in the human stomach and the 12-finger intestines, is relatively contagious, with about half of the world ‘ s population infected with Hp, and 46.7 per cent in China. As early as 1994, the World Health Organization/International Agency for Research on Cancer (WHO/IARC) identified Hp as an I-type biological carcinogen for stomach cancer, which means that Hp is one of the most important risk factors for stomach cancer. Studies have shown that Hp infections increase the risk of stomach cancer by 5.9 times, and that among stomach cancer patients the proportion of combined Hp infections is as high as 61.14 per cent, and about 90 per cent of non-narrow stomach cancer is associated with Hp infections. As a country with a high incidence of stomach cancer, our country ranks third in terms of both the incidence and mortality of stomach cancer, which has increased from 30.5 per 100,000 to 43.1 per 100,000 between 2000 and 2019. These data reveal the significant impact of Hp infections on stomach cancer, and we must be vigilant.
Hp “modus operandi” for stomach cancer
The Hp infection does not lead directly to stomach cancer, but rather to the gradual introduction of normal stomach mucous membranes into the abyss of cancer through a complex pathological process. Hp Long-term infection activates the original cancer gene, inhibits the cancer gene, triggers a reaction to stomach inflammation, leads to a large amount of oxygen free radicals, damages the upper skin stem cells of the gastric mucous membranes DNA, activates a large number of original cancer genes and inhibits their function, and ultimately contributes to the malformation of the stomach mucous cells. Specifically, Hp can directly induce chromosomal damage, causing chromosomal instability, leading to a mutation accumulation; toxic factors in the genus cause pathological changes in the gastric mucous membranes; and prolonged infections stimulate inflammation of the gastric mucous membranes, which in turn triggers a series of ripple reactions, setting a pent for stomach cancer.
Stopping the process of stomach cancer: the eradication of Hp is key
Positive impact of Hp eradication at different stages
Pre-cancer pathologies: The eradication of Hp before gastric mucous membrane atrophy and/or intestinal cystosis can no longer occur and/or intestinal membrane can almost completely eliminate the risk of gastrointestinal cancer. For example, a forward-looking, random, placebo comparison study has shown that no stomach cancer occurs in patients without pre-cancer disease and actively eradicated Hp, which can significantly reduce the incidence of stomach cancer compared to the placebo.
Pre-cancer pathologies have occurred: for patients with pre-cancer pathologies such as atrophy, intestinal or hemogenic growth, the eradication of Hp can slow down stomach atrophy, intestinal development, lower histopathological scores of stomach tissues, slow the process of disease and reduce the risk of stomach cancer to varying degrees. As several studies have shown, after the eradication of Hp, there has been a significant improvement in the baseline for atrophy of gastroenteritis and intestinal biochemicals, and the incidence of stomach cancer is significantly lower than the control group for the eradication of Hp.
Early stomach cancers: Surgery and the eradication of Hp can significantly reduce the risk of re-emergence of stomach cancer and the risk of transient stomach cancer. The relevant Meta analysis shows that the elimination of Hp treatment reduces the risk of relapse by 51 per cent and the risk of heterosexual stomach cancer by 58 per cent after surgery by early stomach cancer patients.
National and international consensus on guidelines: a strong recommendation for the eradication of Hp: Given the close relationship between Hp infection and stomach cancer, many national and international guidelines and consensus have made it clear that the eradication of Hp should be the first level of prevention of stomach cancer. For example, Japan ‘ s Guidelines for the Management of Spectrum Spectrum Infection (revision 2016) strongly recommend the eradication of Hp as promising for the prevention of stomach cancer; the consensus of experts on the eradication of cholesterol and stomach cancer control in China also emphasizes that the eradication of Hp can reduce the risk of stomach cancer in our country; and the Taipei Global Consensus statement on the eradication of Hp can reduce the risk of stomach cancer among infected people. In addition, the United States ACG Clinical Guidelines and the Consensus of Experts on the Prevention and Management of Sphinx Infections in Chinese Homes recommend that the diagnosis of Hp infections should be eliminated.
IV. Hp Situation of infection and eradication:
The challenge and the response to the “three-thirty-thirty” dilemma: the Hp infection and eradication situation in my country is characterized by a “three-thirty-thirty-thirty-thy-low”, namely, high infection rates, high morbidity, high drug resistance and low eradication rates. Despite the fact that our country has developed a five-year consensus on treatment and has continuously adapted its treatment programmes over the years, the overall decline in the rate of eradication of treatment for primary patients has not been effectively curbed. This is mainly due to the reduction in the rate of elimination of empirical treatment as Hp antibiotic resistance increases with the spread of Hp eradication treatment.
The importance and challenges of the first eradication: Hp ‘ s failure to eradicate for the first time has many negative consequences, such as causing bacterial drug resistance, reducing the range of drug choices and making it more difficult to treat again; repeated use of drugs can exacerbate the adverse effects of drugs, affect the quality of life of patients and cause physical and psychological harm to patients; it can also increase the financial burden on patients and waste medical resources. Therefore, it is essential to increase the first eradication rate.
Improved Hp Eradication Rate: Multipronged
Standard americant IV: In response to drug resistance, the Standard americant IV (acid + americant + 2 antibiotics) programme is recommended as a first-line treatment programme in domestic and international guidelines, usually for 10 – 14 days. Rational choice of a combination of antibiotics is essential to increase the eradication rate and should be based on the patient ‘ s individual circumstances and local drug resistance, avoiding the use of antibiotics that have produced resistance.
The key role of strong acidism: the success of Hp eradication is closely related to the level of acidism, and the PH value in the stomach is positive for Hp eradication. Increasing the PH value in the stomach can affect Hp and antibiotics in many ways, thus increasing the eradication rate. For example, it can increase antibiotic antibacterial activity and stability, keep Hp active, increase gastric resistance to Hp-IgA, inhibit urea enzyme activity and influence Hp planting. Clinical studies show that 24-hour medium pH6 is important for Hp eradication success. In the choice of acids, consideration should be given to PPI acidism, which is influenced by factors such as CYP2C19 ‘ s genetic polymorphism, the choice of less affected acids, or, depending on the patient ‘ s circumstances, for example, for PPI Quick Metabolism, an increase in PPI dosage or the replacement of PPAB (e.g. Vonora) with PPI to achieve a more effective acidic effect.
VI. Prevention of Hp Infection: from the point of life
Attention to dietary hygiene: Hp can be transmitted through food and water sources and should therefore avoid eating raw, cold foods, such as raw fish chips, raw water, etc., ensuring food hygiene and preventing Hp from entering the human body via mouth.
Maintaining good personal hygiene practices: Hp can spread by hand, wash hands, especially after meals, and can effectively reduce Hp infections.
(c) Promotion of the utensils and the use of utensils: the introduction of utensils or the use of utensils to avoid cross-contamination of food sets and reduce the risk of Hp spreading among the population.
Summary
There is a clear causal link between Hp and stomach cancer, which is the most important and manageable risk factor. We should be fully aware of the seriousness of the Hp infection and take proactive measures to reduce the risk of infection. For those infected with Hp, medical advice should be followed, timely and regular treatment should be provided, and the first eradication rate should be increased in order to disrupt the development of stomach cancer. Increased public health awareness through increased understanding of the relationship between Hp and stomach cancer, starting with all aspects of life, to prevent Hp infections, reduce the incidence of stomach cancer and protect our stomach health and life.
