Krooniline gastriit

Hoolimata kroonilise gastriidi levimuse vähenemisest viimastel aastakümnetel on krooniline gastriit endiselt sage raske pandeemiline nakkushaigus, mille tagajärjel tekkivad peptiline haavand ja maovähk võivad olla tüsistuste tõttu fataalsed. Rohkem kui pool rahvastikust maailmas põeb tõenäoliselt kroonilist gastriiti. Kroonilise gastriidi peamiseks põhjuseks on Helicobacter pylori (H. pylori) nakkus lapseeas. Mao limaskesta elukestva põletiku tagajärjel areneb aastate jooksul atroofiline gastriit. See omakorda põhjustab mao limaskesta funktsiooni häireid ja atroofilise gastriidi lõppstaadiumis kujuneb välja püsiv anatsiidsus. Atroofiline gastriit ja sellest tulenev maohappe kadumine on maovähi tekke kõige olulisemad sõltumatud riskitegurid. Lisaks põhjustavad mao limaskesta atroofia ning anatsiidsus B12-vitamiini, mikroelementide (raud, kaltsium, tsink, magneesium), toitainete ja ravimite imendumise häireid. Kroonilise gastriidi ja selle staadiumite diagnoosimiseks kasutatakse lisaks mao limaskesta patohistoloogilisele uuringule mitmeid H. pylori kolonisatsiooni ning mao funktsiooni peegeldavaid biomarkereid, näiteks H. pylori antikehad, pepsinogeen I ja II ning gastriin-17 vereseerumis.Eesti Arst 2016; 95(10):637–64

When will Helicobacter pylori gastritis disappear in history in Finland?

Objectives To predict how the10-year birth cohort specific prevalence rates of chronic non-atrophic (CG) and atrophic gastritis (AG), related to Helicobacter pylori (Hp) infection, will decline during the 21(st) century among the native adult Finns. Materials and methods The predictions are based as continuums of our earlier observations of gradual and significant declines in birth cohort specific prevalence rates of CG and AG in endoscopic biopsies from gastric antrum and corpus of 2298 adult dyspeptic outpatients or asymptomatic volunteers born 1890-1977 that were endoscopied in 1972-1997 in Finland. Results and discussion We could predict that the Hp related CG and AG will gradually disappear in history among the native Finns during the 21(st) century. From the 2020s onward, the CG and AG would decrease with time in prevalence rate, cohort-by-cohort, and would be more and more highlighted in the middle aged or elderly age groups only. Finally, since all birth cohorts (generations) infected with Hp have passed away by 2080, the Hp related gastrites would not appear anymore in notable counts among the native Finns. Correspondingly, gastric cancers and peptic ulcers (both duodenal and gastric), which are etiopathogenetically linked with Hp gastrites, would similarly become gradually more and more infrequent and rare disorders among native Finns during the 21(st) century.Peer reviewe

Challenges in evaluation of screening for gastric cancer among men based on nonrandomized design

Background: Objective was to quantify biases in screening for gastric cancer when comparing attenders to nonattenders using serum pepsinogen I (SPGI) level as primary test.Methods: In mid 1990s, all men aged 51-65 years from two Finnish cities were invited to SPGI screening. Mortality and premature mortality in attenders were compared to nonattenders. Efficacy of screening was studied by 15 years' follow-up of standardized mortality ratio (SMR) and potential years of life lost (PYLL) due to gastric cancer. Bias due to selective attendance was quantified using corrective coefficients based on total cancer incidence and mortality, and gastric cancer-specific incidence and mortality for total population and nonattenders.Results: In 1994-1996, men aged 51-65 years (16,872) were invited to SPGI assay and 12,175 men (72%) attended. SPGI was 25 microg/l or less in 610 (5%) men, indicating severe atrophic gastritis (AG). Post-screening gastroscopy was performed to 435 men with low SPGI. Of these, 168 men were referred for treatment due to abnormal focal lesions. Attributable proportions in reductions of SMR and PYLL from gastric cancer due to screening were 59% and 67%. After correcting for selective participation, attributable proportions were reduced to 23% and 39%.Conclusions: Biomarker screening by low SPGI among middle-aged men followed by upper gastrointestinal endoscopy decreased long-term and premature mortality due to gastric cancer. However, in spite of methodological corrections done, the results do not justify any firm conclusions or recommend general screening programs. Randomized trials are warranted for this purpose.Peer reviewe

Oesophageal cancer incidence in 20-year follow-up in a population-based sample of 12 000 middle-age men with or without Helicobacter pylori infection in Finland

Non peer reviewe

Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection

Peer reviewe

Risk of gastric carcinoma will be low in generations born at turn of the 20(th) and 21(st) centuries in Finland. Modelling NORDCAN data of the age group specific incidence rates of gastric cancer with PLS-regression and with attention to age ('age effect') and year of the birth ('cohort effect')

Background and methodsWe examined in NORDCAN database how the annual age group-specific incidence rates (IR) of gastric cancer (GCA), and correspondingly the GCA risk, have declined in Finland during the twentieth century, and whether this decline corresponds to a decrease in the cohort-specific prevalence rate of Helicobacter pylori (Hp) gastritis that is considered an important precancerous risk condition for GCA.ResultsIn modelling with partial least squares regression (PLSR), the logarithmically transformed IRs (ln(IR) of GCA were well explained with age and birth cohort as explanatory model variables. By considering the observed (actual) and the PLSR-modelled IRs, the IR of GCA (and the risk of GCA) has decreased gradually in Finland from 1900 onward, cohort by cohort. By prediction of the future with PLSR, the IRs of GCA will be markedly lower in all cohorts during the twenty-first century than in the twentieth century. By PLSR modelling, less than 10 GCA cases per 100,000 people are predicted to appear annually in cohorts (generations) born at the turn of the 20th and 21st centuries, even when these people will be 60-80 years old in the years 2060-2070.ConclusionsThe IR of GCA and GCA risk progressively declined by cohort in Finland during the whole twentieth century. This decline corresponds in extent and time window to earlier observations in the decline of the prevalence rate of Hp gastritis in the same birth cohorts and supports the hypothesis of the role of Hp gastritis as an important risk condition of GCA.Peer reviewe

Helicobacter pylori, the cardia and gastroesophageal reflux disease

SCOPUS: ar.jinfo:eu-repo/semantics/publishe