Introduction

Portugal is an intermediate-high risk country for gastric cancer and Helicobacter pylori (Hp) infection is an important risk factor for such condition. All of infected patients should be treated; however, the increasing frequency of antibiotic resistance reduces its eradication rate.

Aims & Methods

Aims: To analyze the prevalence of Hp infection in Portugal and its antimicrobial resistance profile. To evaluate the prevalence of premalignant gastric conditions.
Methods: A multicentric cross-sectional study involving 9 endoscopy units from Portugal, distributed across the country (north, central and south regions). We included patients aged ≥40 who underwent upper endoscopy in these units between February and March 2024. Hp detection was performed using immunohistochemistry (IHC). In positive IHC samples, clarithromycin, fluoroquinolones and metronidazole resistances were assessed in biopsy samples using real-time polymerase chain reaction.

Results

Four hundred twenty-one patients were included (58% women, mean age 60), 172 of which were Hp-positive (41%). Excluding patients with prior eradication therapy, the prevalence of Hp infection was 47.4%. Infection was more prevalent in the north region of the country (north 46.8%; central 36%; south 36.5%). The antimicrobial resistance rates were: clarithromycin 26%; fluoroquinolones 16%; metronidazole 2%; clarithromycin/fluoroquinolones 4%. Intestinal metaplasia (IM) was identified in 138 patients (32.8%), 24 of which (6%) had extensive IM (both antrum and corpus) and 31 (7%) had an endoscopic grading of gastric IM (EGGIM) ≥5.

Conclusion

Hp infection in Portugal is frequent, showing a north-south gradient, albeit smaller than expected. More than half of the strains showed no antibiotic resistance and only 4% exhibited dual resistance to clarithromycin/fluoroquinolones. We demonstrate the feasibility of studying resistance profile in endoscopic biopsies, suggesting that such tests may lead to reduce antibiotic consumption and associated side effects, as well as lower therapeutic costs. The presence of IM in approximately one-third of patients, in a predominantly young population, reinforces the relevance of endoscopic screening in Portugal.

References

1. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71:1724-62.
2. Hooi JKY, Lai WY, Ng WK, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153:420-9.
3. Howden CW, Graham DY. Recent Developments Pertaining to H. pylori Infection. Am J Gastroenterol. 2021;116:1-3.
4. Savoldi A, Carrara E, Graham DY, et al. Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions. Gastroenterology. 2018;155:1372-82.
5. Lopo I, Libânio D, Pita I, et al. Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta-analysis. Helicobacter. 2018;23:e12493.
6. Kovacheva-Slavova M, Valkov H, Angelov T, et al. Screening for Helicobacter pylori infection and Clarithromycin resistance using Real-Time Polymerase Chain Reaction. Eur Rev Med Pharmacol Sci. 2021;25:5042-46.
7. Egli K, Wagner K, Keller PM, et al. Comparison of the Diagnostic Performance of qPCR, Sanger Sequencing, and Whole-Genome Sequencing in Determining Clarithromycin and Levofloxacin Resistance in Helicobacter pylori. Front Cell Infect Microbiol. 2020;10:596371.
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Introduction

Aims & Methods

Results

Conclusion

Introduction

Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Indeed, several risk stratification scores have been developed to anticipate early detection in order to better codify their management, including the Toronto Hepatocellular Carcinoma Risk Index (THRI). It is a simple and validated tool that has been developed to predict the risk of HCC in patients with cirrhosis and is mainly based on the following parameters: etiology, age, sex and platelet count.
The objective of this study was to evaluate the reliability of the THRI score in predicting the occurrence of hepatocellular carcinoma.

Aims & Methods

We conducted a monocentric retrospective study collecting all cirrhotic patients over an 8-year period [2008-2015]. Clinico-biological data, disease severity, and long-term outcomes were collected.
THRI was calculated for all patients, and were classified according to HCC risk into three levels : low HCC risk (<120), intermediate HCC risk (between 120 and 240), and those with high HCC risk (>240).
A statistical study using the SPSS tool was carried out. The performance of this score was evaluated with the area under the receiver operating characteristics curve (AUROC).

Results

We included 120 cirrhotic patients with an M/F sex ratio equal to 0.5. The mean age was 57 years [14-85]. The most frequent aetiology of cirrhosis were viral C (49%) and viral B (31%). The mean overall survival was approximately 6 years after diagnosis.
Twenty-five patients developed HCC during follow-up (20.8%). Patients who developed HCC had a higher THRI score than those who did not develop HCC : 264.8 ± 48.6 versus 232.3 ± 64.8, respectively with p-value = 0.008
Patients with a low risk of HCC were 5 (4.2%), none of whom had developed HCC. Fifty-eight patients (48.3%) were at intermediate risk, 12% of them (N=7) had developed HCC. The remaining 57 patients (47.5%) were at a high risk and 31.6% of them (N=18) developed HCC during their follow-up.
The AUROC for the THRI to predict HCC was 0.649 ([95% CI 0.533–0.765]. The cutoff THRI value in predicting the occurrence of HCC was 235.5 with a sensitivity of 72% and a specificity of 50%.

Conclusion

According to our study, the THRI score appears to be an effective tool for predicting the occurrence of HCC in cirrhotic patients. Its good sensitivity allows to identify the high-risk HCC population for early screening.