Does an undiagnosed atrophic gastritis (acid-free stomach) increase the risk of coronavirus infection, its complications and mortality particularly among elderly people?
Coronavirus (COVID-19)-induced respiratory infection, first reported in Wuhan City (China) December 31, 2019, has spread during the winter and spring 2020 as a global pandemic. This disease is made terrifying, mortal and panic-rising by the fact that there is not yet any vaccine against the virus and any curative therapy, leaving the only option to support the body functions by intense care thus aiming to facilitate the eventual recovery. In Finland, the first elderly patient died of coronavirus already on March 21, 2020. At this writing, the number of coronavirus-induced deaths totals 64 patients, of whom the majority are above 50 years of age. Mortality is increasing sharply along with the increasing age (37 died patients has the median age of 81 years). The increased numbers of infections and consequent deaths together with the ever deteriorating economic situation and mass unemployment are prone to increase the global recession and panic, which could be markedly alleviated by any actions aiming to reduce the coronavirus-related mortality.
Kari Syrjänen, MD, PhD, Professor, Chairman of the Biohit Scientific Advisory Board: ”Advanced age as such is not the only risk factor, but also the patient’s comorbidity increases the risk of coronavirus infection. One such potential risk group consists of elderly people who have atrophic gastritis (atrophy of stomach mucosa). There are two causative factors for atrophic gastritis; helicobacter infection and autoimmune disease. Atrophic gastritis leads to acid-free stomach. Under normal circumstances, acidic gastric fluid destroys the bacteria and other micro-organisms reaching the stomach with ingested food. Particularly among the elderly people with acid-free stomach, in parallel with the declining body defence mechanisms, there is an increased risk of developing severe and even fatal infections in the gastrointestinal tract (eg. Clostridium difficile, E. coli EHEC and salmonella) as well as pneumonia (1,2).
Accordingly, it sounds rational that the atrophic gastritis-related (or PPI-induced) acid-free stomach with all associated risks and complications might predispose these people more easily also to coronavirus infections and aggravate its clinical course. During the ongoing corona pandemic, it might be useful to examine, along with the coronavirus testing, the coexistence of atrophic gastritis both among symptomatic and virus-infected patients. Most probably, such an information would help preparing for the eventual need of basic medical care and intense care of these patients, thus reducing the mortality.”
Semi Korpela, CEO, Biohit Oyj: ”About half of the world population, most prevalent in Asia and developing countries, are estimated to have helicobacter infection, which if left untreated can progress to atrophic gastritis. In addition, particularly in the Nordic countries, another more rare form of atrophic gastritis exists; the autoimmune-type AG. In addition to atrophic gastritis, acid-free stomach with an increased risk of gastric and esophageal cancer, is induced by the proton pump inhibitor (PPI) medication, which is used occasionally or regularly by around 10% of the European population. On the global scale, approximately 500 million people suffer from atrophic gastritis and altogether, one billion people might have an acid-free stomach. The risks and diseases associated with an acid-free stomach are well known, and in this light, it seems possible that these subjects also have an increased risk to contract coronavirus infection and develop a fatal disease outcome.
Screening of the increased risks associated with acid-free stomach is possible by using the unique GastroPanel blood test developed by Biohit Oyj, that detects, in addition to helicobacter infection, also atrophic gastritis (acid-free stomach) and the state of gastric acid output (1, www.gastropanel.com , www.biohithealthcare.com/additional-information ). In addition to its diagnostic use, it is also recommended to use GastroPanel in the screening of the gastric and esophageal cancer risks, which according to the modelling developed by Nordic Healthcare Groupin (NHG), could help saving up to €800 of the life-time health care costs of 10 age groups (65-74 year olds) in Finland (https://www.gastropanel.com/decision-makers/screening-model).”
Osmo Suovaniemi, MD, PhD, Professor, Chairman of Biohit Board of Directors: ”On the basis of published scientific evidence, as well as due to ethical reasons, we recommend a nationwide implementation of GastroPanel innovation that promotes patient safety and contributes to prevention of diseases, in the primary diagnosis of dyspeptic complaints and reflux symptoms to detect helicobacter infection and atrophic gastritis in the primary- and in occupational health care (1-8).
In addition to carefully conducted gastroscopy and biopsies, GastroPanel test is the only examination that detects helicobacter infection and atrophic gastritis with all their associated risks (1-8, www.gastropanel.com). Furthermore, GastroPanel accurately detects the disturbances in the gastric acid output that remain undetected in gastroscopy. Constant high acid output predisposes the subject to esophageal reflux disease, which can progress to ulcerative esophagitis, Barrett’s esophagus and lower esophageal cancer. Atrophic gastritis that contributes to the development of calcium-, magnesium-, zinc- and iron deficiency, is also the major cause of vitamin B12 deficiency. Among elderly people, B12 vitamin- and iron-deficiency have become a major public health burden, further reducing the otherwise deteriorating general body resistance (www.biohithealthcare.com/additional-information, www.biohithealthcare.com /Links: State of the art GastroPanel and Acetium innovations for the unmet need ).
In the public health care, helicobacter-induced or autoimmune-type atrophic gastritis with multiple risks still receive little attention, and consequently, e.g. the risk of gastric and esophageal cancer remains undetected on time. Because of this, the treatment is being instituted only when alarming symptoms appear, when the disease outlook is poor. In our country, almost 1000 patients develop gastric and esophageal cancer each year, and 700 patients die of these cancers, a part most likely because of the fact that helicobacter infection and atrophic gastritis remain undiagnosed on time (1-9).
The primary diagnosis of dyspepsia and reflux symptoms suffers from the practice followed for several years, according to which, obsolete and outdated helicobacter tests are being continuously recommended by the national guidelines. Consequently, atrophic gastritis with all potentially serious consequences have remained undiagnosed (1,9). Atrophic gastritis developing slowly during several years and associated with the risk of eg. gastric cancer, is not considered as a significant disease, among other reasons, because it is mostly asymptomatic and remains unrecognised. It is a proper time to speed up the solution of the severe communication problem concerning the correct information about atrophic gastritis with its multiple severe risks, by correcting the Management Guidelines: Dyspepsia and Reflux symptoms, that still contains the limitations and errors hidden in it since he early 2000’s (1,2,9, www.google.com/ Search with ”Hyvä Kollega 2006”).
Due to the above detailed problem, our view is that particularly the symptomatic and coronavirus-positive individuals who present with an undiagnosed atrophic gastritis and acid-free stomach, might be at a significantly increased risk of severe complications (and even death). In the context of a recently initiated research project: ”IHW (THL) starts exploring the vulnerability of the people to contract with a severe coronavirus infection” (https://www.is.fi/kotimaa/art-2000006465454.html?cs=email ), we have proposed an additional study arm, where all the enrolled subjects would be tested for eventual atrophic gastritis. As compared with an expensive and tedious gastroscopy, atrophic gastritis and its associated risks can be confirmed under the current circumstances, more safely, considerably less expensively and more cost-effectively, from a blood sample by using a GastroPanel examination.
Semi Korpela: ”Biohit Oyj has delivered the following message to all its international business partners:
Let’s help together people in your country as well as all other people worldwide to avoid too often deadly coronavirus infection.
Consequently, we suggest the following study: Because low acid or acid free stomach, due to atrophic gastritis (AG) diagnosed by GastroPanel & GastroSoft and/or due to for example a long term use of proton pump inhibitors (PPIs), predisposes particularly elderly or otherwise debilitated people to several (often fatal) infections in the gastrointestinal and respiratory tracts, it is feasible to assume that AG/acid-free stomach also increase the likelihood of contracting coronavirus-infections in such subjects, at the same time increasing the risk of developing more severe disease and fatal outcome of the infection. In the event that AG/acid-free stomach increases the risk of severe disease and fatal complications, the treatment policies of these high-risk patients should be adjusted accordingly, e.g., by timely preparing for the increased demand of the facilities for intense care units in the country. For patients diagnosed with COVID-19, the unavailability of any treatments proven to be efficacious in relieving symptoms and treating the underlying disease means that supportive care by intense care is the only therapeutic option.
Furthermore, the undiagnosed atrophic gastritis (by traditional tests: 13C-urea breath-, stool antigen- or H. pylori antibody-test), and its associated acid-free stomach, can predispose (elderly people in particular) to severe, even fatal, infections of the gastrointestinal and respiratory tract.
In the meantime, before the results of the suggested study, please do all your best efforts by offering GastroPanel & GastroSoft to find the AG patients at high risk for coronavirus infection.”
Additional information:
CEO Semi Korpela, Biohit Oyj
tel. +358 9 773 861
investor.relations@biohit.fi
www.biohithealthcare.com
As a result of Biohit Oyj’s community responsible (sustainable) significant investments as well as the company’s aggressive innovation and patenting strategy (www.biohithealthcare.com/Company/History ), the company has a wide spectrum of products based on several domestic innovations. Those products for unmet major global need include the following patient safety-enhancing and disease-preventing GastroPanel, ColonView-FIT and Acetium. GastroPanel is a blood test for the first-line diagnosis of upper abdominal complaints (dyspepsia) and reflux symptoms (www.gastropanel.com). ColonView-FIT is a screening test for colorectal cancer that detects cancer precurs lesions and helps in timely referring for further examinations and treatment (www.colonview.com ). Acetium-capsules bind carcinogenic acetaldehyde synthesized in acid-free stomach which is an important risk factor of gastric and esophageal cancer. Acetium-capsules might also prevent the headache atacks of certain type of migraine (www.biohithealthcare.com/Investors/ Stock Exchange Releases: 2019-08-09T12:30:00Z – Two clinical trials with Acetium® capsule for prevention of migraine-type headache have been concluded). Acetium lozenge helps quit smoking and possibly also relieve alcohol abuse, and these promote oral health by binding cigarette smoke- and alcohol-derived acetaldehyde (this innovation has been granted a patent in over 50 countries) (www.acetium.com) (www.biohithealthcare.com/additional-information ).
The recently launched recommendation of Russian Federation states that before endoscopic examination of the stomach (gastroscopy) in patients with a low risk of stomach cancer, the state of their gastric mucosa needs to be examined by the four-biomarker panel (pepsinogen I, pepsinogen II, gastrin-17 and Helicobacter pylori antibody test) (www.biohithealthcare.com / Stock Exchange Releases: 2019-10-14T13:15:00Z – TREATMENT RECOMMENDATION IN RUSSIA: GastroPanel® biomarkers should be used for detection of gastrointestinal diseases).
A recent population-based screening study in Russia confirmed that using these GastroPanel biomarkers would practically eliminate the risk of gastric cancer during a long-term follow-up. In that study, two cohorts of 2.220 subjects were followed-up prospectively for 7 years (www.biohithealthcare.com/Investors/ Stock Exchange Releases: 2020-03-12T08:00:00Z – Population-based screening by Biohit GastroPanel[®] biomarkers practically eliminates the risk of gastric cancer during a long-term follow-up ).
REFERENCES
1. www.biohithealthcare.com / Links: GastroPanel Innovation
2. Syrjänen K, Eskelinen M, Peetsalu A, Sillakivi T, Sipponen P, Härkönen M, Paloheimo L, Mäki M, Tiusanen T, Suovaniemi O, DiMario F, Fan ZP. GastroPanel® Biomarker Panel: The most comprehensive test for Helicobacter pylori infection and its clinical sequelae. A critical review. Anticancer Res. 2019; 39:1091-1104.
3. Agréus L, Kuipers EJ, Kupcinskas L, Malfertheiner P, Di Mario F, Leja M, Mahachai V, Yaron N, van Oijen M, Perez Perez G, Rugge M, Ronkainen J, Salaspuro M, Sipponen P, Sugano K and Sung J: Rationale in diagnosis and screening of atrophic gastritis with stomach-specific plasma biomarkers. Scand J Gastroenterol 47(12): 136-147, 2012
4. Sipponen P, Graham DY. Importance of 12. atrophic gastritis in diagnostics and prevention of gastric cancer: application of plasma biomarkers. Scand J Gastroenterol 2007; 42: 2–10.
5. Storskrubb T, Aro P, Ronkainen J, Sipponen 11. P, Nyhlin H, Talley NJ, Engstrand L, Stolte M, Vieth M, Walker M and Agréus L. Serum biomarkers provide an accurate method for diagnosis of atrophic gastritis in a general population: The Kalixanda study. Scand J Gastroenterol, 2008; 43:1448–55.
6. HUSLAB laboratory test directory includes the following indications for GastroPanel test: The tests are used for the diagnostic workup of the symptoms in dyspeptic patients, in diagnosis of Helicobacter pylori infection, as well as for early detection of atrophic gastritis. http://www.huslab.fi/Tutkimusohjekirja search with helikobakteeri: 20609 fP-Mabi-La fP-Mahalaukun biomerkkiainetutkimus, laaja
7. www.biohithealthcare.com/test-request-form
8. www.biohithealthcare.com / Links: State of the art diagnosis of Helicobater pylori
9. Critisism about current care recommendations: www.biohithealthcare.com/Critisism-about-current-care-recommendations
Biohit in brief
Biohit Oyj is a globally operating Finnish biotechnology company. Biohit’s mission is “Innovating for Health” – we produce innovative products and services to promote research and early diagnosis. Biohit is headquartered in Helsinki, Finland, and has subsidiaries in Italy and the UK. Biohit's Series B share (BIOBV) is quoted on Nasdaq Helsinki in the Small cap/Healthcare group.
www.biohithealthcare.com