Moreover, Hp seropositive subjects are associated with a modest increase in the risk for colorectal adenoma, and since Hp-I can increase

the risk especially of advanced adenomas, the medical community should take into account that a preventive strategy is needed, and, furthermore, elucidating the pathophysiological role of Hp in the development of CRC is highly warranted (6). However, as mentioned by the authors (5,6), the serologic measurement of infection status is less than perfect, thereby representing a specific limitation of their studies. Indeed, the serological test does not discriminate between current and past infections and, apart Inhibitors,research,lifescience,medical from past infection that may even be more

relevant for oncogenesis, such a distinction is essential because only current Hp-I induces Inhibitors,research,lifescience,medical humoral and cellular immune responses that produce or perpetuate chronic inflammatory processes in gastrointestinal tract with potential oncogenic sequelae; many neoplasms including colorectal STAT inhibitor adenomas and cancers arise at the sites of chronic inflammation and infection (7-10). Based on histology, the practical gold standard for Hp-I diagnosis, our own preliminary studies indicated Hp presence in malignant tissue in 34 of 41 (82.9%) patients with CRC (23 men, mean age 73.6±7.9 years) (11). Extending Inhibitors,research,lifescience,medical these preliminary data we currently included 50 patients (28 men, mean age 71.3±9.7

Inhibitors,research,lifescience,medical years) with CRC and 25 patients (13 men, mean age 72.8±10.1 years) with colonic polyps with the following results: Hp presence in malignant and polyp tissues of patients were observed in 84% and 64%, respectively, confirming our preliminary data (12). It is important to note that, apart from Cresyl fast violet staining mainly used to detect Hp, its presence was also documented by immunohistochemical method (using polyclonal Inhibitors,research,lifescience,medical rabbit anti-Hp antibody (dilution 1:50, DAKO, Athens, Greece) in adenoma and malignant colonic tissues. Specifically, in accordance with Hong et al. (6), Hp progressive increased presence was observed in our patients with adenomas associated with mild (50%) and moderate/high-grade (80%) dysplasia; PDK4 the latter lesions are frequently described as advanced adenomas. However, contrary to the authors’ considerations (6), our series showed an increased Hp presence in left-sided (79%) than in the proximal colon (21%) adenomas; left-sided cancers were also observed in 70.7% of our patients, a finding also noticed by Zhang et al. (5), thereby suggesting that Hp-I might be associated with a rather relevant risk increase in the left CRC. The multistep model of gastric cancer postulates that there is initially an inflammation, caused mainly by Hp-I, which can lead to the development of chronic active gastritis.