Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia.
It has been proposed that eradication of Helicobacter pylori infection is a sound strategy for gastric cancer prevention. Several factors including smoking have been associated to treatment failure rates. This study aimed to evaluate the smoking effect on the efficacy of H. pylori therapy, as well as on the histological parameters in the gastric mucosa from subjects from a high gastric cancer risk area. Two-hundred-sixty-four Colombian subjects with gastric precancerous lesions who participated in a chemoprevention trial, received anti-H. pylori treatment at baseline and had data recorded on cigarette use, were included in this study. A detailed histopathological assessment of the gastric mucosa was performed in biopsies taken before any intervention. H. pylori eradication was assessed in gastric biopsies at 36 months post-treatment. The overall eradication rate was 52.3%; rates of 41.3% and 57.1% were observed for active-smokers and non-smokers, respectively. Multivariate logistic regression analysis showed that smokers had a 2-fold higher probability of failure in Helicobacter pylori eradication than non-smokers (OR: 2.0; 95% CI: 1.01-3.95). At baseline, active-smokers had a higher score of intestinal metaplasia compared to non-smokers. In the corpus mucosa, active-smokers showed lower scores of H. pylori density, total inflammation, neutrophil infiltration, and mucus depletion than non-smokers. In the antrum, no significant differences were observed between active-smokers and non-smokers. In summary, in patients who smoked, H. pylori treatment was less effective. Smoking cessation may benefit H. pylori eradication rates.
Camargo
M Constanza
MC
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, TN 37232-0252, USA.
Piazuelo
M Blanca
MB
Mera
Robertino M
RM
Fontham
Elizabeth T H
ET
Delgado
Alberto G
AG
Yepez
M Clara
MC
Ceron
Cristina
C
Bravo
Luis E
LE
Bravo
Juan C
JC
Correa
Pelayo
P
D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D003105:Colombia; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000382:microbiology* / Q000473:pathology; D005757:Gastritis, Atrophic / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008679:Metaplasia; D008795:Metronidazole / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use; D011230:Precancerous Conditions / Q000188:drug therapy / Q000382:microbiology; D012044:Regression Analysis; D012459:Salicylates / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects*; D017211:Treatment Failure
D000890:Anti-Infective Agents; D009942:Organometallic Compounds; D012459:Salicylates; D008795:Metronidazole; C015715:bismuth subsalicylate; D000658:Amoxicillin; D001729:Bismuth