Gastric mucin expression in Helicobacter pylori-related, nonsteroidal anti-inflammatory drug-related and idiopathic ulcers

doi:10.3748/wjg.v18.i33.4597

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Sep 7, 2012 (publication date) through Feb 15, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Sep 7, 2012; 18(33): 4597-4603
Published online Sep 7, 2012. doi: 10.3748/wjg.v18.i33.4597

Table 1 Patient characteristics

	H. pylori+/NSAID-	H. pylori-/NSAID+	H. pylori+/NSAID+	H. pylori-/NSAID-	Total
	n = 30 (32.6%)	n = 18 (19.6%)	n = 24 (26.1%)	n = 20 (21.7%)	n = 92
Age, yr [mean (SD, range)]	58.6 (18.58, 18-88)	72.17 (10.44, 56-89)	69.46 (13.08, 24-83)	70.3 (12.64, 42-95)	66.6 (15.5, 18-95)
Gender (male) n (%)	10 (33)	9 (50)	13 (54.2)	12 (60)	44 (47.8)
Ethnicity n (%)
Israeli (Jewish)	11 (36.7)	9 (50)	12 (50)	6 (30)	38 (41.3)
Israeli (Arab)	3 (10)	0 (0)	2 (8.3)	1 (5)	6 (6.5)
Western Europe/United States	7 (23.3)	0 (0)	1 (4.2)	2 (10)	10 (10.9)
Eastern Europe/FSU	2 (6.7)	6 (33.3)	6 (25)	6 (30)	20 (21.7)
Middle east/Africa	7 (23.3)	2 (11.1)	3 (12.5)	4 (20)	16 (17.4)
South America	0 (0)	1 (5.6)	0 (0)	1 (5)	2 (2.2)
Inpatient n (%)	11 (36.7)	12 (60)	10 (41.7)	16 (80)	49 (53.3)
Comorbid disease n (%)
ASCVD	3 (10)	12 (66.7)	11 (45.8)	6 (30)	32 (34.8)
COPD	2 (6.7)	4 (22.2)	2 (8.3)	7 (35)	15 (16.3)
Diabetes	4 (13.3)	4 (22.2)	12 (50)	6 (30)	26 (28.3)
Current malignancy	1 (3.3)	2 (11.1)	2 (8.3)	2 (10)	7 (7.6)
Alcohol abuse	0 (0)	0 (0)	0 (0)	3 (15)	3 (3.3)
Other significant systemic disease	1 (3.3)³	1 (5.6)⁴	1 (4.2)⁴	5 (25)⁵	8 (8.7)
Total¹	7 (23.3)	15 (83.3)	19 (79.2)	14 (70)	55 (59.8)
Primary indication for endoscopy n (%)
Iron deficiency anemia	9 (30)	5 (27.8)	6 (25)	1 (5)	21 (22.8)
Epigastric pain/GERD	8 (26.7)	6 (33.3)	4 (16.5)	4 (20)	22 (23.9)
Upper GI bleeding	7 (23.3)	6 (33.3)	6 (25)	9 (45)	28 (30.4)
Fecal occult blood	2 (6.7)	0 (0)	1 (4.2)	1 (5)	4 (4.3)
Weight loss	2 (6.7)	1 (5.6)	5 (20.8)	0 (0)	8 (8.7)
Screening for gastric cancer	2 (6.7)	0 (0)	0 (0)	0 (0)	2 (2.2)
Esophageal varices	0 (0)	0 (0)	0 (0)	2 (10)	2 (2.2)
Vomiting	0 (0)	0 (0)	0 (0)	1 (5)	1 (1.1)
Other²	0 (0)	0 (0)	2 (8.3)	2 (10)	4 (4.3)
Hemoglobin, g/dL [mean (SD, range)]	11.0 (3.22, 3.4-16.7)	10.6 (2.77, 5.5-15.5)	11.0 (2.84, 5.7-14.7)	11.1 (2.70, 6.2-15.3)	10.9 (2.98, 3.4-16.7)
Died within 12 mo of endoscopy	3 (10)	2 (11.1)	2 (8.3)	5 (25)	12 (13.0)

¹Number of patients with comorbidities as listed;

²Fever unknown origin, gastric outlet obstruction, and surveillance following resection of gastric and esophageal carcinoma (1 case for each indication);

³Inflammatory bowel disease;

⁴Hemodialysis;

⁵Inflammatory bowel disease, sepsis, cirrhosis (2 cases), tetraplegia following trauma. H. pylori: Helicobacter pylori; NSAID: Non-steroidal anti-inflammatory drugs; ASCVD: Atherosclerotic cardiovascular disease; COPD: Chronic obstructive pulmonary disease; GERD: Gastro esophageal reflux disease; GI: Gastrointestinal. +: Positive; -: Negative.

Table 2 Endoscopic findings

	H. pylori+/NSAID-	H. pylori-/NSAID+	H. pylori+/NSAID+	H. pylori-/NSAID-	Total
	n = 30 (32.6%)	n = 18 (19.6%)	n = 24 (26.1%)	n = 20 (21.7%)	n = 92
Ulcer number (per procedure) n (%)
1	21 (70)	10 (55.6)	13 (54.2)	14 (70)	58 (63.0)
2	4 (13.3)	3 (16.7)	5 (20.8)	3 (15)	15 (16.3)
≥ 3	5 (16.7)	5 (27.8)	6 (25)	3 (15)	19 (20.7)
Ulcer size (n)¹
≤ 5 mm	18	14	27	14	73
6-10 mm	7	8	10	11	36
11-20 mm	5	3	4	4	16
> 20 mm	4	0	0	2	6
Not specified	2	2	2	0	6
Ulcer location n (%)
Antrum	19 (63.3)	10 (55.6)	18 (75)	16 (80)	63 (68.5)
Body	9 (30)	6 (33.3)	6 (25)	4 (20)	25 (27.2)
Cardia	2 (6.7)	2 (11.1)	0 (0)	0	4 (4.3)
Ulcer H. pylori positive n (%)	28 (93.3)²	0 (0)	20 (83.3)	0 (0)	48 (52.2)
Ulcer IM n (%)	5 (16.7)	4 (22.2)	3 (16.7)	4 (20)	16 (17.4)

¹In 10 instances the endoscopist reported “ulcer number” as “multiple”. Therefore the total number of ulcers is unknown and percentages cannot be calculated;

²Cases where H. pylori was absent from ulcer margin, but had either positive rapid urease test, positive C13-urea breath test or positive histology in biopsy not taken from ulcer margin. NSAID: Non-steroidal anti-inflammatory drugs; H. pylori: Helicobacter pylori; IM: Intestinal metaplasia. +: Positive; -: Negative.

Table 3 Staining positivity for mucin 5AC and mucin 6 n (%)

		Mucin 5AC			Mucin 6
		Surface cell positivity	Neck cell positivity	Gland cell positivity	Surface cell positivity	Neck cell positivity	Gland cell positivity
H. pylori+/NSAID-	a	29 (96.7)	29 (96.7)	2 (6.7)	0 (0)	4 (13.3)	29 (96.7)
(n = 30)	b	29 (96.6)	27 (90)	0 (0)	0 (0)	1 (3.3)	25 (83.3)
H. pylori-/NSAID+	a	18 (100)	18 (100)	2 (11.1)	0 (0)	4 (22.2)	17 (94.4)
(n = 18)	b	16 (88.9)	15 (83.3)	0 (0)	0 (0)	2 (11.1)	14 (77.8)
H. pylori+/NSAID+	a	24 (100)	24 (100)	2 (8.3)	0 (0)	5 (20.8)	24 (100)
(n = 24)	b	24 (100)	23 (95.8)	2 (8.3)	0 (0)	2 (8.3)	22 (91.7)
H. pylori-/NSAID-	a	20 (100)	20 (100)	0 (0)	0 (0)	5 (25)	20 (100)
(n = 20)	b	19 (95)	16 (80)	0 (0)	0 (0)	1 (5)	19 (95)
Total	a	91 (98.9)	91 (98.9)	6 (6.5)	0 (0)	18 (19.6)	90 (97.8)
(n = 92)	b	88 (95.7)	81 (88.0)	2 (2.2)	0 (0)	6 (6.5)	80 (97.0)

a: Positive stain defined as a stain extent and intensity score product ≥ 2; b: Strongly positive stain, defined as a stain extent and intensity score product equalling 6 or 9. H. pylori: Helicobacter pylori; NSAID: Non-steroidal anti-inflammatory drugs. +: Positive; -: Negative.

Table 4 Effect of Helicobacter pylori and non-steroidal anti-inflammatory drug status on mucin staining

	H. pylori+	H. pylori-	P value	NSAID+	NSAID-	P value
MUC5AC
Surface cell positivity	53/54 (98.1)	38/38 (100)	0.39	42/42 (100)	49/50 (98)	0.36
Neck cell positivity	53/54 (98.1)	38/38 (100)	0.39	42/42 (100)	49/50 (98)	0.36
Gland cell positivity	4/54 (7.4)	2/38 (5.3)	0.68	4/42 (9.5)	2/50 (4)	0.29
MUC6
Surface cell positivity	0/54 (0)	0/38 (0)	NA	0/42 (0)	0/50 (0)	NA
Neck cell positivity	9/54 (16.7)	9/38 (23.7)	0.40	9/42 (21.4)	9/50 (18)	0.68
Gland cell positivity	53/54 (98.1)	37/38 (97.4)	0.80	41/42 (97.6)	49/50 (98)	0.90

H. pylori: Helicobacter pylori; NSAID: Non-steroidal anti-inflammatory drugs; NA: Not available. +: Positive; -: Negative.

Table 5 Intraepithelial/mucosal T-cell populations (n = 20)

Group	CD4+/CD8+	CD8+/HPF	CD4+/HPF
H. pylori+/NSAID-	3.15	22.0 ± 4.4	69.6 ± 38.2^a
H. pylori-/NSAID+	0.55	14.0 ± 9.4	8.4 ± 12.5
H. pylori+/NSAID+	2.99	26.6 ± 20.9	50.0 ± 25.2
H. pylori-/NSAID-	1.15	29.0 ± 11.4	38.0 ± 27.7

^aP = 0.009 vs H. pylori-/NSAID+ group. H. pylori: Helicobacter pylori; NSAID: Non-steroidal anti-inflammatory drugs; HPF: High-power field.

Table 6 Inflammation score according to the Sydney system (n = 20)

Group	H. pylori	Atrophy	Intestinal metaplasia	Lymphocytes	PMN	Score
H. pylori+/NSAID-	2.20 ± 0.44	0.60 ± 0.54	0.40 ± 0.54	1.80 ± 0.83	1.20 ± 1.30	6.20 ± 2.48^a
H. pylori-/NSAID+	0.00 ± 0.00	0.40 ± 0.54	0.60 ± 1.34	1.40 ± 0.89	0.20 ± 0.44	2.60 ± 2.19
H. pylori+/NSAID+	1.80 ± 1.09	0.80 ± 0.83	0.40 ± 0.89	2.00 ± 0.70	1.40 ± 0.89	6.40 ± 3.13
H. pylori-/NSAID-	0.00 ± 0.00	0.20 ± 0.44	0.20 ± 0.44	1.40 ± 0.54	0.40 ± 0.54	2.20 ± 1.64

^aP = 0.017 vs H. pylori-/NSAID- group. PMN: Polymorphonuclear cells; H. pylori: Helicobacter pylori; NSAID: Non-steroidal anti-inflammatory drugs.

Citation: Boltin D, Halpern M, Levi Z, Vilkin A, Morgenstern S, Ho SB, Niv Y. Gastric mucin expression in Helicobacter pylori-related, nonsteroidal anti-inflammatory drug-related and idiopathic ulcers. World J Gastroenterol 2012; 18(33): 4597-4603
URL: https://www.wjgnet.com/1007-9327/full/v18/i33/4597.htm
DOI: https://dx.doi.org/10.3748/wjg.v18.i33.4597