Male non-insulin users with type 2 diabetes mellitus are predisposed to gastric corpus-predominant inflammation after H. pylori infection

Yao-Jong Yang, Chung-Tai Wu, Horng-Yih Ou, Chin-Han Lin, Hsiu-Chi Cheng, Wei-Lun Chang, Wei-Ying Chen, Hsiao-Bai Yang, Cheng-Chan Lu, Bor-Shyang Sheu, Yao-Jong Yang, Chung-Tai Wu, Horng-Yih Ou, Chin-Han Lin, Hsiu-Chi Cheng, Wei-Lun Chang, Wei-Ying Chen, Hsiao-Bai Yang, Cheng-Chan Lu, Bor-Shyang Sheu

Abstract

Background: Both H. pylori infection and diabetes increase the risk of gastric cancer. This study investigated whether patients with type 2 diabetes mellitus (T2DM) and H. pylori infection had more severe corpus gastric inflammation and higher prevalence of precancerous lesions than non-diabetic controls.

Methods: A total of 797 patients with type 2 diabetes mellitus were screened for H. pylori, of whom 264 had H. pylori infection. Of these patients, 129 received esophagogastroduodenoscopy to obtain topographic gastric specimens for gastric histology according to the modified Updated Sydney System, corpus-predominant gastritis index (CGI), Operative Link on Gastritis Assessment, and Operative Link on Gastric Intestinal Metaplasia Assessment. Non-diabetic dyspeptic patients who had H. pylori infection confirmed by esophagogastroduodenoscopy were enrolled as controls.

Results: The male as well as total T2DM patients had higher acute/chronic inflammatory and lymphoid follicle scores in the corpus than non-diabetic controls (p < 0.05). In contrast, the female T2DM patients had higher chronic inflammatory scores in the antrum than the controls (p < 0.05). In T2DM patients, the males had significantly higher rates of CGI than the females (p < 0.05). Multivariate logistic regression analysis showed that male patients (odds ratio: 2.28, 95% confidence interval: 1.11-4.69, p = 0.025) and non-insulin users (odds ratio: 0.33, 95% confidence interval: 0.15-0.74, p = 0.007) were independent factors for the presence of CGI in the H. pylori-infected patients with type 2 diabetes mellitus.

Conclusions: Patients with type 2 diabetes mellitus and H. pylori infection had more severe corpus gastric inflammation than non-diabetic controls. Moreover, male gender and non-insulin users of T2DM patients were predisposed to have corpus-predominant gastritis after H. pylori infection.

Trial registration: ClinicalTrial: NCT02466919 , retrospectively registered may 17, 2015.

Keywords: Gastric cancer; Gender; H. Pylori; Insulin; Type 2 diabetes mellitus.

Conflict of interest statement

Ethics approval and consent to participate

The study design was reviewed and approved by the Ethical Committee of National Cheng Kung University Hospital (A-BR-103-021). All participates have read and signed the consents to participate this study.

Consent for publication

All authors have read and approved the content and declared there is no conflict of the decision to submit the paper for publication.

Competing interests

No conflicts of interest relevant to this article were reported.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The schematic flow chart of the study protocol and case numbers
Fig. 2
Fig. 2
The ratio of precancerous lesions (CGI, OLGIM≥ II, OLGA≥ II) in 73 male and 56 female diabetic patients who did and did not use insulin. The trend of the risk of precancerous lesions was analyzed by linear-to-linear regression (CGI, P < 0.001; OLGIM≥ II, P = 0.64; OLGA≥ II, P = 0.51)

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