Gastric microbes associated with gastric inflammation, atrophy and intestinal metaplasia 1 year after Helicobacter pylori eradication

• Published in: Gut Vol. 69; no. 9; pp. 1572 - 1581
• Main Authors: Sung, Joseph J Y, Coker, Olabisi Oluwabukola, Chu, Eagle, Szeto, Chun Ho, Luk, Simson Tsz Yat, Lau, Harry Cheuk Hay, Yu, Jun
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Society of Gastroenterology 01.09.2020; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Algorithms; Amino acids; Antibiotics; Atrophy; Bacteria; Bacteria - classification; Bacteria - genetics; Bacteria - isolation & purification; Bacteria - pathogenicity; Biopsy; Biopsy - methods; Biopsy - statistics & numerical data; Carcinogenesis; Deoxyribonucleic acid; Discriminant analysis; Disease Eradication - methods; Disease Eradication - statistics & numerical data; Disease Progression; DNA; Endoscopy; eradication; Female; Folic acid; Gastric cancer; gastric inflammation; gastric microbes; Gastritis, Atrophic - microbiology; Gastritis, Atrophic - pathology; Genes; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori; Helicobacter pylori - drug effects; Helicobacter pylori - isolation & purification; Humans; Infections; Inflammation; Inositol phosphate; intestinal metaplasia; Intestine; Male; Metabolism; Metaplasia; Metaplasia - microbiology; Metaplasia - pathology; Microbial Interactions - drug effects; Microbiota; Microorganisms; Middle Aged; Principal components analysis; Probiotics; rRNA 16S; Sequence Analysis, RNA - methods; Signal transduction; Stomach; Stomach - microbiology; Stomach - pathology; Hong Kong China; China; atrophy; H. pylorieradication; gastric microbes; intestinal metaplasia; gastric inflammation
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2019-319826

Objective Helicobacter pylori is associated with gastric inflammation, precancerous gastric atrophy (GA) and intestinal metaplasia (IM). We aimed to identify microbes that are associated with progressive inflammation, GA and IM 1 year after H. pylori eradication.DesignA total of 587 H. pylori–positive patients were randomised to receive H. pylori eradication therapy (295 patients) or placebo (292 patients). Bacterial taxonomy was analysed on 404 gastric biopsy samples comprising 102 pairs before and after 1 year H. pylori eradication and 100 pairs before and after 1 year placebo by 16S rRNA sequencing.ResultsAnalysis of microbial sequences confirmed the eradication of H. pylori in treated group after 1 year. Principal component analysis revealed distinct microbial clusters reflected by increase in bacterial diversity (p<0.00001) after H. pylori eradication. While microbial interactions remained largely unchanged after placebo treatment, microbial co-occurrence was less in treated group. Acinetobacter lwoffii, Streptococcus anginosus and Ralstonia were enriched while Roseburia and Sphingomonas were depleted in patients with persistent inflammation 1 year after H. pylori eradication. A distinct cluster of oral bacteria comprising Peptostreptococcus, Streptococcus, Parvimonas, Prevotella, Rothia and Granulicatella were associated with emergence and persistence of GA and IM. Probiotic Faecalibacterium praustznii was depleted in subjects who developed GA following H. pylori eradication. Functional pathways including amino acid metabolism and inositol phosphate metabolism were enriched while folate biosynthesis and NOD-like receptor signalling decreased in atrophy/IM-associated gastric microbiota.ConclusionThis study identified that gastric microbes contribute to the progression of gastric carcinogenesis after H. pylori eradication.