.CAPSTONE PROJECT TOPIC Relationship between gastric cancer and Helicobacter pylori: A systematic...

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.CAPSTONE PROJECT TOPIC Relationship between gastric cancer and Helicobacter pylori: A systematic review. Summary 	One of the leading causes of cancer-related death worldwide is gastric cancer (Van Cutsem et al., 2016). Infection with Helicobacter pylori (H. pylori) is prevalent in humans, affecting 50 percent of the global population. Gastritis is caused by H. pylori invasion of the stomach, and infection is primarily asymptomatic in most infected people (Khatoon, 2016). Research Questions 1. What effect does H. pylori have on the formation of cancer cells in the stomach among adult U.S. migrants? 2. Does an active lifestyle promote fewer symptoms of gastric cancer causes? Study Design 	A systematic literature review will be used. Instrumentation 	Data sources for peer review articles will come from notable search engines listed; National University Library, Google Scholar, Science.gov, PubMed, and National Library of Medicine. References Khatoon, J. (2016). Role of helicobacter pylori in gastric cancer: Updates. World Journal of Gastrointestinal Oncology, 8(2), 147. https://doi.org/10.4251/wjgo.v8.i2.147  Van Cutsem, E., Sagaert, X., Topal, B., Haustermans, K., & Prenen, H. (2016). Gastric cancer. The Lancet, 388(10060), 2654–2664. https://doi.org/10.1016/s0140-6736(16)30354-3   Refer to Capella’s Dissertation Format Guidelines throughout the writing process CAPSTONE PROJECT TITLE, ALL CAPS, BOLDED, CENTERED,  DOUBLE-SPACED; TOP LINE ABOUT 3 INCHES FROM TOP OF PAGE by First Name MI. Last Name INSTRUCTOR NAME (ALL CAPS), PhD, Instructor A Public Health Capstone Project Presented in Partial Fulfillment of the Requirements for the Degree Add Degree Type Here (e.g., Master of Public Health) National University Add Month Year (of final Public Health Capstone Project approval) Abstract Note to writer: An abstract is required. Guidelines for development of the abstract (also referred to as an executive summary) can be found in section 2.04 of the APA Publication Manual, 6th edition. The target length of the executive summary is 350 words or less. Format the executive summary as one double-spaced paragraph without an indented first line; do not justify the right margin. The Abstract page is not numbered, and “Abstract” does not appear in the Table of Contents. Note: Delete this text, but do not remove the section break that follows—if you can’t see it, click on the ¶Show/Hide button on the formatting toolbar. Dedication The dedication, if desired, is a numbered page, but “Dedication” does not appear in the Table of Contents. If no Dedication is provided, then omit this page. The dedication should not be longer than two pages. Note that if the Abstract is two pages long, the page number of the Dedication must be changed to iv. Acknowledgments Note to writer: The “Acknowledgments” entry does appear in the Table of Contents. This section should be limited to two pages or less. Table of Contents Acknowledgments iv List of Tables (if tables are used) # List of Figures (if figures are used) # NOTE TO WRITER: These entries are not connected to the text via the “Index and Tables” feature of Microsoft Word. Below each chapter title in the Table of Contents, include only the main (level 1) headings from the chapters. Add page numbers for every entry. Remove this text prior to final submission. CHAPTER 1. INTRODUCTION 1 Introduction to the Problem 1 Background of the Problem # Statement of the Problem # Purpose of the Study # Hypotheses or Research Questions # Significance of the Study # Assumptions # Limitations # Summary # CHAPTER 2. LITERATURE REVIEW # Add subheadings as needed here # CHAPTER 3. METHODOLOGY # Introduction # Hypotheses or Research Questions # Descriptions of the Participants # Instrumentation # Ethical Considerations # CHAPTER 4. DATA COLLECTION, ANALYSIS AND RESULTS # Introduction # Data Collection Procedures # Data Analysis and Results # CHAPTER 5. CONCLUSIONS AND RECOMMENDATIONS # Introduction # Conclusions # Recommendations for Further Study # REFERENCES # APPENDIX A. ADD TITLE IN ALL CAPS (data collection instruments such as # surveys and interview protocols)  APPENDIX B. ADD TITLE IN ALL CAPS (additional data, charts, tables) # List of Tables Table 1. Add title (single-space table title; double-space between entries) # List of Figures Figure 1. Add title (single-space figure title; double-space between entries) # NOTE TO WRITER: Do not remove the section break that follows this paragraph. CHAPTER 1. INTRODUCTION Introduction to the Problem The introduction section begins with a brief discussion of the area of interest and then presents the following sub-sections: Background of the Problem Description of the background of the problem (brief historical perspective and explanation of why the problem remains unsolved at this time). Statement of the Problem The problem is presented in statement form, e.g., “The problem is …” Purpose of the Study This section explains why the study is being conducted. It may be (but not be limited to) one of the following: (1) to effect a change; (2) to solve a real business problem for an existing business; (3) to predict future situations; (4) to compare and contrast (strategies, technologies); (5) to develop a specific marketing program; (6) to determine the feasibility of a marketing option; (7) to conduct a marketing audit and diagnosis of the client organization; or (8) to conduct a marketing analysis of a given project, product, new market or other change in the existing marketing program. Hypotheses or Research Questions Hypotheses are only used in quantitative (statistical) research studies. A hypothesis statement predicts a relationship between two variables. Writing a hypothesis should always precede any actual experiments and is an important part of the scientific method.  Remember … a good hypothesis statement makes clear the relationship between the variables and is always testable. Research Questions, on the other hand, are used for either quantitative or qualitative studies. The Statement of the Problem should lend itself to translation into a research question that asks precisely what this study must answer in order to (1) solve the research problem, and (2) achieve its purpose. The research question is a conceptual question, indicating the exact scope of the study. Significance of the Study This section provides information concerning the importance of the study. A study may be significant because it adds to the body of knowledge of business in general or is critical to the business under study. Assumptions The purpose of this section is to present some of the factors the researcher is asking the reader to accept as conditions of the study. Some examples are (1) the sample is representative of the population, (2) the appropriate variables have been selected for examination, and (3) the measurement tools are valid and reliable. Also, identify your hypothesis statement here. Limitations These are those factors or conditions that may affect the data and are out of the researcher's control. For instance, validity and reliable issues from any surveys completed. Summary The purpose of this section is to summarize Chapter 1 and introduce the remaining chapters, including applicable subsections within each chapter. CHAPTER 2. LITERATURE REVIEW Add headings as necessary This section begins with a general description of how the review of literature will be organized and presented. The review should include: (1) the general history of the topic (presented chronologically); (2) the current state; and (3) discussion of related research by others as appropriate.  It is important to develop the literature review in a logical sequence, starting with a broad focus of the general topic and narrowing down to the existing state of research on the specific topic of your study. CHAPTER 3. METHODOLOGY Introduction This section describes the design of the research used to answer the postposed hypotheses or address the research problem and then presents the following sub-sections: Hypotheses or Research Questions State the proposed hypotheses (for a quantitative study) or research questions (for a quantitative or qualitative study) from Chapter 1 in the proper form and style. Description of the Participants Who are they, how they were selected for participation, and why were they chosen. Instrumentation Description and history regarding any survey instruments or sources (e.g., websites, vital statistics from local and state health departments, etc.) used to obtain data (include any reliability measures associated with the instrument). Ethical Considerations State how the study will adhere to established ethical norms. This includes how the study promotes the aims of research, promotes the values that are essential to collaborative work, how the researcher is held accountable to the public, how it builds public support for the research, and how it promotes a variety of other important moral and social values. CHAPTER 4. DATA COLLECTION, ANALYSIS AND RESULTS Introduction This section describes all methods and procedures for collecting and analyzing the data and then presents the following sub-sections: Data Collection Procedures Describe the methods and procedures for collecting the data including, if necessary, informed consent protocols for human participants and field tests preliminary to conducting the study.  Data Analysis and Results For qualitative studies (which will have no hypotheses), discuss: (1) the type(s) of data obtained; (2) how the data will be prepared for analysis; (3) how the data will be coded; and (4) how the data will be initially analyzed (e.g., methodological approach [case study, grounded theory, etc.]). For quantitative studies (which contain hypotheses): (1) Decide on the type of data involved in each statistic and correlation; (2) Determine the descriptive statistics required or desired, including both descriptive statistics and summaries (diagrams, histograms, etc.); (3) Determine the sequence of methods for the desired analysis; and (4) Describe how each step will be carried out.  CHAPTER 5. CONCLUSIONS AND RECOMMENDATIONS Introduction As with the previous chapters, this introduction forms the transition for Chapter 5, not an introduction to the study itself. State the purpose of the chapter and then present the following sub-sections: Conclusions What are the implications for the proposed hypotheses (for quantitative studies) or research questions (for qualitative or quantitative studies), the previous literature and the wider communities of interest?  Recommendations for Further Study Researchers can discuss as many as four categories of recommendations for further studies. Each category reflects back on one of the previous sub-sections of the Chapter. The three most common categories of recommendations include those: (1) developed directly from the data; (2) derived from methodological, research design or other limitations of the study; (3) to investigate issues not supported by the data but relevant to the problem being studied. REFERENCES References should be double-spaced, with a double-space between entries. Use the ruler to create a hanging indent. APPENDIX A. ADD TITLE Attach your appendix item here. If no appendices are needed, then omit this page. If more than one appendix is needed, continue to the following page, place APPENDIX B (in all caps) centered at the top of the page, the title of the appendix (in all caps), then attach the applicable item (e.g., table, figure, graph, illustration, etc.). Continue the same process as necessary for all subsequent appendices. PAGE

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WRITTEN ASSIGNMENT		4
WRITTEN ASSIGNMENT
Abstract
	Worldwide, gastric cancer is the most common cancer-related mortality, and Helicobacter pylori (H. pylori) infection is common in people. This comprehensive review of the literature attempts to shed light on the link between H. pylori and gastric cancer, with an emphasis on how the infection affects adult immigrants to the United States who develop stomach cancer as well as any possible preventive benefits of leading an active lifestyle. The National University Library, Google Scholar, Science.gov, Pub Med, and the National Library of Medicine will serve as the data sources for peer-reviewed papers. The findings of this analysis will provide light on possible causes and treatment options for stomach cancer.
Acknowledgements
	The authors would like to express their gratitude to the National University Library, Google Scholar, Science.gov, Pub Med, and the National Library of Medicine for providing valuable resources for this systematic literature review. We would also like to thank our colleagues and peers for their support and valuable feedback throughout the research process. Our research team would also like to give thanks to the funding agency that supported this research. This study would not have been possible without their support. Finally, we would like to acknowledge the contributions of all the authors whose work has been included in this review.
Table of contents
Abstract	2
Acknowledgements	3
CHAPTER 1 – INTRODUCTION	6
Introduction to the Problem	6
Background of the Problem	6
Statement of the Problem	6
Purpose of the Study	6
Hypotheses or Research Question	7
Significance of the Study	7
Assumptions	7
Limitations	7
Summary	7
CHAPTER 2 – LITERATURE REVIEW	9
Description of gastric cancer	9
Statistics	13
Global Occurrence	14
Causes of Gastric Cancer	14
Symptoms of gastric cancer	16
Active Lifestyle and Cancer Prevention	17
H. pylori Infection and Gastric Cancer in Immigrants	19
CHAPTER 3 – METHODOLOGY	20
Introduction	20
Hypotheses or Research Questions	21
Descriptions of the Participants	21
Instrumentation	22
Ethical Considerations	22
CHAPTER 4 – DATA COLLECTION, ANALYSIS AND RESULTS	24
Introduction	24
Data Collection Procedures	24
Data Analysis and Results	25
CHAPTER 5 – CONCLUSIONS AND RECOMMENDATIONS	32
Introduction	32
Conclusions	32
Recommendations for Further Study	33
REFERENCES	36
CHAPTER 1 – INTRODUCTION
Introduction to the Problem
	Gastric cancer, one of the leading causes of cancer-related death worldwide, is a known risk factor for acquiring Helicobacter pylori (H. pylori). Half of the world's population is afflicted with the common pathogen H. pylori. Although most infected people have little symptoms, the infection has the ability to lead to gastritis, which in turn has the potential to develop into stomach cancer.
Background of the Problem
Bacteria known as H. pylori have the ability to inflame the stomach after infection. Over time, this inflammation may pave the way for the emergence of stomach cancer. H. pylori and stomach cancer have a complicated and poorly understood association. However, evidence indicates that H. pylori may contribute to the occurrence of stomach cancer in some people.
Statement of the Problem
	The aim of this study is to investigate the relationship between adult H. pylori infections and stomach cancer among U.S. immigrants. The study's objective is to learn more about how H. pylori affect the growth of stomach cancer cells and how leading an active lifestyle affects gastric cancer symptoms.
Purpose of the Study
	This study's objective is to conduct a thorough literature review to investigate the relationship between adult U.S. immigrants' H. pylori infections and stomach cancer. The study's objective is to determine how H. pylori impacts the growth of stomach cancer cells and how an active lifestyle affects gastric cancer symptoms.
Hypotheses or Research Question
· What effect do H. pylori have on the formation of cancer cells in the stomach among adult U.S. migrants?
· Does an active lifestyle promote fewer symptoms of gastric cancer causes?
Significance of the Study
	The findings of this study may help to clarify the connection between H. pylori and stomach cancer, particularly among adult immigrants to the United States. Using this knowledge, methods for preventing and treating stomach cancer in this group might be developed.
Assumptions
	It is anticipated that the study's participants will be typical adult U.S. immigrants, and that the information gathered will appropriately depict the association between stomach cancer and H. pylori in this community.
Limitations
	The volume of currently available information restricts the conclusions that may be drawn from this study, which is limited to a systematic literature review. The study also only included adult U.S. immigrants, so it might not be generalizable to other groups.
Summary
	This study uses a thorough literature analysis to examine the connection between adult U.S. immigrants' H. pylori infection and stomach cancer. The study will look at how H. pylori affect the development of stomach cancer cells and how an active lifestyle affects symptoms of gastric cancer. The findings of this study may help to improve knowledge of the association between gastric cancer and H. pylori in this group and may be applied to the development of preventative and therapeutic methods for gastric cancer.
CHAPTER 2 – LITERATURE REVIEW
Description of gastric cancer
	Within the gastrointestinal plot, the stomach is an unusual organ. Its part in food digestion depends on the function of the muscles and enzymes that guide the processes, as well as the tubular form of the organ. The stomach comprises several layers of tissue, including the muscular propria, serosa, and submucosa. Similarly to that, it is partitioned into four compartments: the cardia, pylorus, fundus, and body. Endocrine cells in the gastric antrum of the mucosa produce more than half of the gastrin in the human stomach (Sugano, 2019) A diverse network of blood arteries and lymph nodes, as well as specific undifferentiated cells with a limit with respect to recovery, is present in the compartment. Understanding the formation of stomach tumors and the progression of gastric malignancies depends on this regenerative process. The expression "gastric cancer" describes cancer in the stomach's lining. Its rise is an intricate process, showing that a number of variables affect both its occurrence and prevalence. However, the bacterium Helicobacter pylori are closely linked to the onset of stomach cancer. Tumors including squamous cell carcinomas and adenosquamous carcinomas can form in the stomach (Ford, Yuan & Moayyedi, 2020). These tumors are uncommon, nevertheless. The adenocarcinoma, which originates in the mucosal layer of the stomach and continues advancement through the lymphatic vessels to surrounding nodes, is the most widely recognized tumor discovered there.
Figure 1 – The stomach's layers (The mucosa is the deepest layer, including the endocrine cells entrusted with secretion of gastrin. The serosa is the top layer).
Source – (Jiang et al., 2019)
Figure 2 – Pathogenesis of gastric cancer. When H. pylori interacts with stomach components, the pathogenesis process begins, and either atrophic or non-atrophic gastritis results. A duodenal ulcer might occur if the etiology does not progress to full-blown malignancy.
Source – (Pormohammad et al., 2019)
	Adenocarcinomas effectively assault the stomach walls, first puncturing the muscular propria and later the mucosa (Xiao et al., 2019). H pylori cause the advancement of non-atrophic gastritis and further infection results in atrophic gastritis. Also, the stomach lining is supplanted with cells that resemble the intestinal lining when gastric cancer progresses to intestinal metaplasia. Dysplasia, the stage before the advancement of adenocarcinoma, is the following one in the dangerous progression route. The antral-pyloric district is the most common area for the improvement of stomach cancer, with mass tumors and body carcinomas occurring in the space of the more noteworthy or lesser curvature, according to (Keikha & Karbalaei, 2021). Although they are uncommon, cardia cancers have been on the rise during the past several years. Cancers of the cardia can be difficult to distinguish from those approaching from the oesophageal junction due to their unique case and close closeness to the esophagus. However, there are very much separated and undifferentiated kinds of adenocarcinoma from a histological standpoint. In diffuse gastritis without atrophy, the diffuse kinds (poorly separated) exist. Also hereditary, diffuse gastric cancer is less frequent than intestinal cancer. It is characterized by the presence of cells with signet forms, which are sometimes challenging to recognize during an upper endoscopy. The intestinal assortment of gastric cancer, which is more prevalent, has a specific example of stepwise improvement from gastritis to metaplasia (Holmes et al., 2021). This form of cancer's tumor cells cling to each other and take on tubular shapes similar to those of other parts of the digestive system.
Figure 3 – The Inner Stomach. The stomach's inside lining is where cancer cells progress before reaching the serosa.
Source – (Holmes et al., 2019)
Figure 4 – Differentiated (a–c) and undifferentiated (d–f) gastric cancer phenotypes.
Source – (Khan et al., 2019)
Statistics
	The occurrence of stomach cancer has been steadily reducing in the USA, which has resulted in a decrease in the number of fatalities from this sort of cancer (Zhao et al., 2020). Except for white males matured 29 to 39, the occurrence of non-cardia stomach cancer considerably decreased in the USA somewhere in the range between 1977 and 2006 for all categories. This characteristic suggested significant environmental impacts, as well as the contribution of lifestyle choices to the rise in risk factors for this sort of cancer. The improvement of the refrigerator is correlated with a fall in stomach cancer cases in the USA, showing that the accessibility of more fresh foods contributed to the decay. This decrease resulted from both the rise in vegetable admission and the surrender of salting food as a method of food preservation. Salt was presently not a risk factor because of these lifestyle changes, which also saw the introduction of fruit and vegetables as healthful meals. As anticipated, stomach cancer affected roughly 21,600 persons in 201 — 13,230 males and 8,370 ladies (Fan et al., 2020). Annually, there were 24,000 new cases and 14,000 fatalities in the United States. Somewhere in the range of 2009 and 2012, there were 5.3 men and 2.7 ladies diagnosed with stomach cancer per 100,000 predictions adjusted for studies. The figures were gotten from before research and analysis of changes in the rate of stomach cancer. This number suggests that it is feasible to decide the level of risk of creating stomach cancer in the future, even though the amount is still too small to be in any way represented as a part of the general population. Despite the way that the USA was the first country to record dropping rate, these figures might seem striking on a worldwide level, but the frequency is still significant. Poland has the highest pace of cancer nearby, with male cases outnumbering those in any remaining European nations (France, Germany, Italy, and Spain), while the UK has the lowest rates (Keikha & Karbalaei, 2021). Stomach cancer rates range significantly by more than threefold between the highest rates in Poland and the lowest rates in the UK, according to Get al (2019) research. The pace of stomach cancer frequency has decreased during the past forty years, as it has in the majority of nations worldwide. However, the prevalence in Eastern Europe is still significant, with both sexes encountering a pace of 139.6 per 100,000 in 2012. Within this area are nations like Albania and the Russian League, where stomach cancer positioned second for male cancer fatalities and third for female cancer fatalities in 2012.
Global Occurrence
	The global variance in the risk of stomach cancer shows a 10-crease propensity, with double the rates in males contrasted with ladies, according to (Askari et al., 2021). Despite the way that the global pace of stomach cancer continues to fall consistently, any further decay is unrealistic due to the maturing global population. Also, the drop has occurred at variable rates for various nations, with regions in Japan having lower rates than those in Europe and the USA (Youssefi et al., 2020). Furthermore, the drop started in other nations like the USA prior to the 20th century, with the 1930s getting a period of headway in the counteraction of stomach cancer. However, a global descending pattern started during the 1980s and has persisted from that point onward in the majority of countries throughout the world.
Causes of Gastric Cancer
	As a multifactorial illness, stomach cancer can develop as a result of a variety of environmental causes. There are several associated factors that might lead to stomach cancer:
· Helicobacter pylori infection  
· Atrophic gastritis
· Pernicious anaemia
· Stomach adenomas
	However, the bacterium Helicobacter pylori, which is commonly known to be the cause of stomach ulcers, has been recognized as an essential contributor to gastric cancer. According to research from 2001, infection with H. pylori, particularly the cagA positive form of infection, raises the risk of non-cardia adenocarcinoma by six times (Terasawa et al., 2019). Some H. pylori strains produce toxins that consider stronger bacterial adhesion and, over the long haul, advance stomach lining disturbance, which leads to this illness. Despite the way that not all varieties of H. pylori create toxins, these inflammations are the foundation of noncardiac stomach cancer.
Figure 5 – H. pylori-induced intestinal malignancy in the gerbil
Source – (Curado et al., 2019)
	H. pylori bacteria, especially on account of the non-cardia type of stomach cancer, are just the first cause of the disease. The presence of gastritis has shown a consistent connection to the eventual improvement of stomach cancer. Truth is told, Helicobacter pylori gastritis is a factor in 80% of stomach carcinomas (Wang et al., 21019). Due to their job as precursors to dysplasia and, eventually, adenocarcinoma, gastritis and gastric intestinal metaplasia (IM) convey a higher chance of forming into gastro cancer. According to Mao et al., (2019), the presence of H. pylori causes the normal stomach glandular epithelium to disappear and be supplanted with metaplastic glandular structures. As a result, those with severe atrophic gastritis have a more serious risk of getting stomach cancer than individuals without the infection or related irritation. Atrophic gastritis frequently causes severe frailty because of the continuous loss and absence of vitamin B12 (Farmanfarma et al., 2020). Pernicious weakness patients foster true adenomatous polyps of the stomach three times more frequently than everyone. Nevertheless, the majority of adenomatous polyps reported in investigations were hyperplastic or regenerative polyps rather than true adenomas. Therefore, H. pylori simply serve as the foundation for causes of stomach cancer. Later occurrences including the start of weakness and the progression of gastritis lead to the emergence of harmful growths inside the stomach. Gastric cancer is consequently more typical in populations with high levels of atrophic gastritis. Gastric cancer does not create at such a high rate in communities where H. pylori infections are not present.
Symptoms of gastric cancer
	The difficulty with stomach cancer is that it seldom exhibits symptoms in the beginning phases (Pabla et al., 2020). When symptoms do arise, they frequently mirror those of stomach ulcers, making it difficult to distinguish without doing a thorough endoscopy (Tavakoli et al., 2020). In the beginning phases, weariness is a typical symptom, even in the absence of any strenuous exercise. The majority of symptoms are frequently gentle, although individuals with gastric outlet blockage and visceral perforation are frequently seen in crisis settings. The patients also frequently have recurrent acute heartburn after using run-of-the-mill prescription medications. Periods of indigestion may also wait for quite a while and cause quite a severe discomfort, alongside this heartburn. Constant nausea and regurgitation are other beginning phase symptoms that are prevalent. Some patients' regurgitation might contain microscopic blood streaks that are just visible under careful inspection. Another normal sign of these periods is the presence of stomach aches. Furthermore,

CAPSTONE PROJECT TOPICRelationship between gastric cancer and Helicobacter pylori: A systematic review.SummaryOne of the leading causes of cancer-related death worldwide is gastric cancer (Van...

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