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Homocysteine Levels in Chronic Gastritis and Other Conditions: Relations to Incident Cardiovascular Disease and Dementia
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Ryhov Hospital.
Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
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2010 (English)In: DIGESTIVE DISEASES AND SCIENCES, ISSN 0163-2116, Vol. 55, no 2, 351-358 p.Article in journal (Refereed) Published
Abstract [en]

Background Homocysteine levels in circulation are determined by several factors and hyperhomocysteinemia is reportedly associated with cardiovascular diseases and dementia. The aim of this study is to determine the relation of chronic gastritis and other conditions to homocysteine levels and their relation to incident cardiovascular diseases and dementia. Methods An adult population-based cohort (N = 488) was screened for H. pylori infection, gastro-duodenitis ( endoscopic biopsies), disease history, and lifestyle factors. Blood samples were analyzed for pepsinogen I and II ( gastric function), vitamin B12, folate, homocysteine, and cystatin C ( renal function). The methylenetetrahydrofolate reductase C677T polymorphism reportedly associated with hyperhomocysteinemia was analyzed by pyrosequencing. Incident cardiovascular diseases and dementia were monitored during a median follow-up interval of 10 years. Results At baseline, there was a positive relation of S-homocysteine to male gender, age, S-cystatin C, methylenetetrahydrofolate reductase 677TT genotype and atrophic gastritis. During follow-up, cardiovascular diseases occurred in 101/438 and dementia in 25/488 participants, respectively. Logistic regression analysis ( adjusting for gender, age at baseline, follow-up interval, BMI, smoking, alcohol consumption, NSAID use, P-cholesterol, and P-triglycerides) showed an association of S-homocysteine higher than 14.5 mu mol/l to cardiovascular diseases (OR 2.05 [95% c.i. 1.14-3.70]), but not to dementia overall. Conclusions Gender, age, vitamin B12, folate, renal function, atrophic gastritis and the methylenetetrahydrofolate 677TT genotype were significant determinants of homocysteine levels, which were positively related to incident cardiovascular diseases.

Place, publisher, year, edition, pages
2010. Vol. 55, no 2, 351-358 p.
Keyword [en]
Atrophic gastritis, Cardiovascular disease, Cohort, Cystatin C, Dementia, Folate, Gastritis, Homocysteine, H. pylori, Pepsinogen, Vitamin B12
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-53694DOI: 10.1007/s10620-009-0761-0OAI: oai:DiVA.org:liu-53694DiVA: diva2:291257
Available from: 2010-02-01 Created: 2010-02-01 Last updated: 2010-05-25
In thesis
1. Chronic Gastritis: Diagnosis, natural history and consequences
Open this publication in new window or tab >>Chronic Gastritis: Diagnosis, natural history and consequences
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background & alms: The main cause of chronic gastritis is Helicobacter pylori (H. pylori). Clinical manifestations of chronic gastritis are ulcer disease, gastric cancer and mucosa-associated lymphoma tissue (MALT) lymphoma in the stomach. It is uncertain whether gastritis can be diagnosed macroscopically at endoscopy. H. pylori infection may be diagnosed by several different methods, the accuracy of which needs to be explored. Some individuals with H. pylori related chronic gastritis will develop atrophy of the gastric mucosa. This condition is the main risk factor for cancer development and may also be associated with vitamin B12 deficiency leading to hyperhomocysteinaemia. The natural history of chronic gastritis in terms of development of atrophy and ulcer disease in the adult general population is largely unknown.

Material & methods: A sample of 50 I volunteers from the general population in the municipality of Linköping was examined with esophago-gastro-duodenoscopy (EGD) with biopsy. Blood samples were collected in the fasting state and the subjects answered a questionnaire about lifestyle factors, medications and disease history. In-hospital diagnoses and causes of death during follow-up of the population were extracted from local and national patient files. Re-examination was done in 314 subjects after a median follow-up interval of 8.4 years. Five diagnostic tests (serology UBT, RUT, culture and microscopic examination) for H. pylori infection were used at re-examination.

Results: The best values of sensitivity and specificity were for visible vessels in relation to microscopic presence of severe atrophy in the gastric corpus mucosa (80% and 87%, respectively). There was a positive relation of S-homocysteine to male gender, age, S-cystatin C (renal function), methylenetetrahydrofolate reductase 677TT genotype and atrophic gastritis. Logistic regression analysis showed an association of S-homocysteine higher than 14.5 Ilmol/L to cardiovascular diseases (OR 2.05), but not to dementia overall.

The incidence ofulcer was 0.45 per 100 person years and was associated with weekly NSAID use, weekly alcohol consumption (OR 19.4) and smoking (OR 31.0), but not with H. pylori status. Among subjects with chronic gastritis, the incidence of atrophy of the corpus mucosa was 1.4 per 100 person years. Considering diagnostic test for H. pylori infection the accuracy was 0.86 for serology, 0.94 for UBT, 0.94 for RUT, 0.93 for culture, and 0.93 for histological examination. There was a strong correlation between the results of UBT and the histological scores of H. pylori colonisation as well as between the results of UBT and scores of RUT.

Conclusions: The occurrence of chronic gastritis or H. pylori infection is not evaluable macroscopically at gastroscopy, except for the absence of rugae or visible vessels in the gastric corpus mucosa. Serum Hcy concentrations are dependent on gender, age, the levels of vitamin B12 and folate, renal function, the occurrence of atrophic gastritis and the MTHFR 677 TT genotype. Elevated S-Hcy is a risk factor for cardiovascular disease. The incidence of atrophy of the corpus mucosa is 1.4 per 100 person years for chronic gastritis overall. Chronic gastritis with or without H. pylori infection is a variable process in which milder degrees of atrophy of the corpus mucosa may appear or disappear. In contrast, moderate-to-severe atrophy of the corpus mucosa rarely regresses. Age and the degree of chronic inflammation in the gastric corpus mucosa are major risk factors for the development of atrophy. The incidence of ulcer was 0.45 per 100 person years. There are only minor differences in accuracy between the three invasive tests for H. pylori infection. The UBT is recommended for situations where endoscopy is not required. RUT may be recommended as the first non-invasive method of choice in the diagnosis of H. pylori infection.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 72 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1174
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-56575 (URN)978-91-7393-426-8 (ISBN)
Public defence
2010-06-11, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
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Available from: 2010-05-25 Created: 2010-05-25 Last updated: 2012-05-09Bibliographically approved

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Redéen, StefanRyberg, AnnaEriksson, OlleNägga, KatarinaBorch, Kurt

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Surgery Faculty of Health SciencesDepartment of Surgery in ÖstergötlandDepartment of Clinical and Experimental MedicineStatisticsFaculty of Arts and SciencesGeriatricsDepartment of Geriatric Medicine
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