Proliferating cell nuclear antigen (PCNA) immunostaining in Helicobacter pylori infection: Impact of eradication

Despite the fact that the association of Helicobacter pylori (H. pylori) with an increased risk of gastric cancer has been well documented, the exact mechanisms of this association have not been fully elucidated. The aim of the present prospective study was to contribute to the exploration of these mechanisms by studying the relationship between H. pylori infection and proliferating cell nuclear antigen (PCNA) immunostaining in endoscopic biopsies in gastric antrum. Furthermore, we examined the impact of H. pylori eradication on this relationship. We studied 28 H. pylori positive patients and the results were compared with 22 endoscopically and histologically normal H. pylori negative patients (control group) who were comparable to the H. pylori positive group for age and sex. In addition all H. pylori positive patients were examined before and after treatment aiming to eradicate H. pylori . In the H. pylori (+) patients the median PCNA index was 35 (range 8-58) and this was significantly higher than the respective number in the control group [5.5 (2-14), p<0.001]. In patients studied before and after successful eradication of H. pylori (n=10) the corresponding numbers were 35 (8-56) and 7 (4-13) (p<0.01) the latter not being significantly different from the control group of H. pylori (-) patients. On the contrary, in patients without successful H. pylori eradication (n=18) the PCNA indices before and after treatment were similar [35.5 (21-58) vs 31.5 (20-56)]. It is concluded that H. pylori infection alters the replication cycle of the gastric mucosa inducing hyperproliferation, which return towards normal after successful H. pylori eradication.