03805255

October 24, 2021, 21:18

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This article is very interesting and intriguing because it tries to evaluate the association of different forms of Helicobacter pylori with gastric cancer characteristics and outcome. The chronically inflamed and atrophic gastric mucosa has not been considered an ideal environment for H.pylori infection, and a decreased level of colonisation of the gastric mucosa has been reported in patients with gastric atrophy, which is associated with the development of gastric cancer1.In this study, a high percent of rapid urease tests has been reported (84.5%) in spite of a significant percent of coccoid forms of H.pylori which belong to the dormant phase of H.pylori's life2. H.pylori is known to colonize multiple sites in the body3, but colonization of the peritoneum, peritoneal lymph nodes, and addipose tissue was documented in this study.AB treatment which did not eradicate the bacterium should be considered carefully and not without consideration of other important prognostic factors for gastric cancer survival and applied treatment. 1. Satoh K, Yoshida Y, Taniguchi Y, Kimura K. [Relationship between Helicobacter pylori colonization in the gastric mucosa and the severity of atrophic gastritis]. Nihon Rinsho. 1993 Dec;51(12):3227-30. Japanese. PMID: 8283638 2. Ierardi, E.; Losurdo, G.; Mileti, A.; Paolillo, R.; Giorgio, F.; Principi, M.; Di Leo, A. The Puzzle of Coccoid Forms of Helicobacter pylori: Beyond Basic Science. Antibiotics 2020, 9, 293. https://doi.org/10.3390/antibiotics9060293 3. Testerman TL, Morris J. Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol 2014; 20(36): 12781-12808 [PMID: 25278678 DOI: 10.3748/wjg.v20.i36.12781]

Thank you very much for your comments.

Replied on October 31, 2021, 14:41

We thank the Reader (Reader's ID: 03805255) for his interest in our publication. We are confident that the problem of the role of H.pylori in the progression of gastric cancer is still far from being solved. Many questions remain that are not only of theoretical interest, but also of practical importance. 1. It can be assumed that the role of H.pylori urease is not only in reducing the acidity of gastric juice to provide more comfortable conditions for the persistence of bacteria in the body, but also in providing nitrogen necessary for protein synthesis during bacterial replication. This can explain the presence of urease activity in coccal forms of bacteria, which was confirmed in a number of studies. This hypothesis has been repeatedly voiced by researchers (Levitt DG, 2018). 2. It can be assumed that the role of Helicobacter pylori in the progression of gastric cancer is due to the activation of the main transcriptional pathways associated with the progression of malignant neoplasms, such as NF-κB, AP-1, HIF-1α, MAPK, MEK1 / 2-ERK1 / 2, PI3K-AKT-mTOR and others, as evidenced by numerous scientific publications. 3. We believe that the effect of preoperative antibiotic therapy in gastric cancer is associated not with the elimination of bacteria, but with a decrease in inflammation and the processes of the above transcriptional pathways. There are currently quite a few studies showing the antitumor effect of a number of antibacterial drugs (azithromycin, clarithromycin, doxycycline). We have no doubt that further research is needed on the role of H. pylori in the progression of gastric cancer. The authors also thank the Reader for the recommended interesting references. We were already familiar with some of them, but we were happy to familiarize ourselves with these, having received useful information. Best regards, Marina Senchukova