Helicobacter pylori genotypes, host factors, and gastric mucosal histopathology in peptic ulcer disease

From 183 patients undergoing upper gastrointestinal endoscopy, we used antral and corpus gastric biopsies for bacterial culture and histopathologic examination, blood samples to detect immunoglobulin G antibodies against Helicobacter pylori, and H pylori genomic DNA to analyze cytotoxin-associated gene A (cagA) and vacuolating cytotoxin (vacA) genotypes. As expected, among H pylori biopsy-positive patients, those with duodenal ulcer (DU) (n = 34) had significantly more severe chronic and acute inflammation (P <.001) and epithelial degeneration (P =.004) in the gastric antrum than in the gastric corpus. Each of those 3 parameters and H pylori density were significantly higher in the antrum of patients with DU than in patients with gastric ulcer (GU) or no ulcer. Colonization with vacA s1/cagA-positive strains of H pylori was associated with inflammation and epithelial degeneration in gastric mucosa and increased risk for peptic ulcer disease (PUD), whereas colonization with vacA s2m2/cagA-negative strains was associated with mild gastric histopathology and was not associated with any significant risk for PUD. The predominant H pylori strains in African Americans were vacA s1bm1/cagA-positive, whereas all genotypes were well represented in non-Hispanic-Caucasians. By multivariate analysis, H pylori colonization was significantly associated with DU (Adjusted odds ratio [AdjOR] = 3.2 [1.4-7.2]) and nonsteroidal anti-inflammatory drugs (NSAID) use was inversely associated (AdjOR = 0.3 [0.2-0.7]). NSAID use (AdjOR = 4.3 [1.02-18.5]) and African-American ethnicity (AdjOR = 10.9 [2.6-50]) were significantly associated with GU. Smoking and age were not significantly associated with either DU or GU. These data indicate that DU is associated with an antral-dominant gastritis, and H pylori genotype and NSAID use independently contribute to the pathogenesis of PUD. HUM PATHOL 32:264-273. This is a US Government work. There are no restrictions on its use.     

Helicobacter colonization and histopathological profile of chronic gastritis in patients with or without dyspepsia,mucosal erosion and peptic ulcer: A morphological approach to the study of ulcerogenesis in man

Summary Helicobacter pylori colonization and the incidence, severity, activity and topography of gastritis were investigated systematically in antrum and corpus mucosal biopsies of 1177 subjects undergoing endoscopy in the absence of gastric complaints (asymptomatic, 49) or for non-ulcer dyspepsia (NUD; 631 patients, 72 of whom had gastric and/or duodenal erosions), active gastric ulcer (GU, 76 patients), active duodenal ulcer (DU, 138 patients), and healed gastric (HGU, 39 cases) or duodenal ulcer (HDU, 230 cases). In the antrum,H. pylori colonization and the incidence, severity and activity of gastritis increased progressively in the sequence asymptomatic, erosion-free NUD, erosive NUD, healed ulcer and active ulcer. The same trend was observed in the corpus as regardsH. pylori and gastritis incidence, whereas the severity and activity of gastritis were lower in active DU and erosive NUD and higher in active, proximal GU than in the remaining patients. Active DU and erosive NUD showed the highest incidence of nonatrophic gastritis and lowest type-A or AB atrophic gastritis, while active GU had lowest normal mucosa or type-A gastritis and highest type-B atrophic gastritis. In conclusion,H. pylori colonization and gastritis incidence, severity and, especially, activity of the antrum might all contribute to mucosal erosion and ulceration, whereas the same factors, at least in part and with the exception of proximal GU, seem to have a preventive role when affecting corpus mucosa.     

Upper gastrointestinal diseases in patients for endoscopy in South-Western Uganda

BackgroundThere is a paucity of published data regarding upper gastrointestinal diseases in Ugandans with upper gastrointestinal symptoms referred for endoscopy.ObjectivesTo study the presenting complaints, pathology and Helicobacter pylori prevalence among patients with upper gastrointestinal symptoms in South-Western Uganda.MethodsPatients presenting with upper gastrointestinal symptoms underwent upper endoscopy and a urease test for Helicobacter Pylori, all suspicious lesions were biopsied for histopathology review as appropriate.ResultsThe most common presenting complaints were epigastric pain (51.6%), dysphagia (13.6%) and odynophagia (7.1%). The most common endoscopy finding was gastritis (40.2%), followed by normal examination (15.2%), oesophageal cancer (13.6%), gastric ulcer (7.6%) and gastric cancer (7.1%). Patients older than 40 years (n=110) had significant findings including gastritis (50.9%), oesophageal cancer (22.7%) and gastric cancer (11.8%). However in younger patients, with the age range of 18–40 years (n=74), most examinations were normal (92.9%). Of the 176 patients able to undergo Helicobacter pylori testing 75.6% were positive. Helicobacter pylori infection was associated with statistically significant increase in gastritis, oesophageal cancer, gastric ulcer, gastric cancer, and duodenal ulcers (p-values< 0.05).ConclusionGastritis, ulcerative disease, and upper gastrointestinal malignancies are common in South-Western Ugandans and are associated with a high prevalence of Helicobacter pylori.     

Gastric myoelectrical activity in patients with recurrent gastric or duodenal ulcers.

The aim of this study was to characterize gastric myoelectrical activity in patients with recurrent gastric ulcer (GU) or duodenal ulcer (DU), and to compare gastric motility between these two groups of patients. Studies were performed in 59 patients with recurrent active peptic-ulcer disease as diagnosed by gastrointestinal endoscopy: 31 patients had a GU and 28 patients had a DU. Gastric myoelectrical activity was evaluated by cutaneous electro-gastrography (EGG). The following EGG parameters were assessed: the percentage of normogastria (regular 2.4-3.6 cpm slow waves); the EGG power ratio; and the occurrence of a postprandial dip (PD), which is the transient decrease in EGG frequency after a meal. In the GU group, no significant change occurred in the percentage of normogastria or in the EGG power ratio observed after treatment with a proton-pump inhibitor. During the healed stage, the occurrence of PD remained unchanged. In contrast, in the DU group, the percentage of normogastria and the EGG power ratio were significantly increased after treatment. Moreover, during the healed stage, the occurrence of PD significantly increased compared with that during the active stage. These findings suggest that abnormal gastric myoelectrical activity plays an important role in the pathophysiology of recurrent GU rather than DU.     

溃疡病胃壁内肥大细胞的观察

选取胃溃疡２１例，十二脂肠溃疡２３例，作ＨＥ和ＣＡＢＥ液染色，研究ＧＵ和ＤＵ胃壁内肥大细胞数量、分布和脱颗粒率与溃病发生的关系。结果表明；两组肥大细胞计数差异无显著性，两组肥大细胞脱颗粒率差异有显著性意义。ＧＵ组溃疡底部与边缘委员长我细胞脱颗粒度的差异也有其它显著性，并且由溃疡向外呈递减趋势。     

胃十二指肠溃疡患者血中生长抑素和胃泌素水平及其在不同状态下的变化

本文对55例胃十二指肠溃疡患者空腹血浆中SS、Gas水平作了测定,并就其在溃疡出血、幽门螺旋菌感染、H_2RA治疗后等多种状态下的进一步改变作了观察。结果表明溃疡病患者SS水平显著高于正常,并发出血、幽门螺旋菌感染、H_2RA治疗后,血中SS和Gas水平未受显著影响。     

Factors associated with gastro-duodenal disease in patients undergoing upper GI endoscopy at the Korle-Bu Teaching Hospital,Accra, Ghana

BackgroundThere is a high prevalence of gastro-duodenal disease in sub-Saharan Africa. Peptic ulcer disease in dyspeptic patients, 24.5%, was comparable to prevalence of gastro-duodenal disease among symptomatic individuals in developed countries (12 — 25%). Limited data exists regarding its associated risk factors despite accumulating evidence indicating that gastroduodenal disease is common in Ghana.ObjectivesThis study investigates risk factors associated with gastro-duodenal disease at the Korle-Bu Teaching Hospital, Accra, Ghana.MethodsThis study utilized a cross-sectional design to consecutively recruit patients referred with upper gastro-intestinal symptoms for endoscopy. The study questionnaire was administered to study participants. Helicobacter pylori infection was confirmed by rapid-urease examination at endoscopy.ResultsOf 242 patients sampled; 64 had duodenal ulcer, 66 gastric ulcer, 27gastric cancer and 64 non-ulcer dyspepsia. Nineteen (19) had duodenal and gastric ulcer while 2 had gastric ulcer and cancer. A third (32.6%) of patients had history of NSAID-use. H. pyloriwas associated with gastric ulcer (p=0.033) and duodenal ulcer (p=0.001). There was an increased prevalence of duodenal ulcer in H. pylori-infected patients taking NSAIDs, P=0.003.ConclusionH. pylori was a major risk factor for peptic ulcer disease. However, NSAID-related gastro-duodenal injury has been shown to be common in H. pylori infected patients. It highlights the need for awareness of the adverse gastro-intestinal effects in a H. pylori endemic area.     

Gastric sarcoidosis

A 58-year-old Jamaican male presented with acute-onset, right-sided facial droop and slurred speech. He had an episode of upper gastrointestinal (GI) bleed on the second day of admission and endoscopy with biopsy of antral ulcer revealed gastric sarcoidosis. This case demonstrates the rare entity of gastric sarcoidosis presenting acutely with an upper GI bleed.     

Helicobacter pylori in gastroduodenal diseases

OBJECTIVE: To determine the prevalence and disease association of Helicobacter pylori (H. pylori) in dyspeptic patients in southwest Nigeria. Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-lfe, Nigeria. METHODS: Consecutive dyspeptic patients for upper gastrointestinal endoscopy from January 1996 to March 1997 were investigated for H. pylori in gastric biopsy by histopathology and culture. Patients without gastroduodenal ulcerations or neoplastic lesions constituted the nonulcer dyspeptic (NUD) group. RESULTS: 138 (92 males, 46 females) patients aged 4.5-85 years [mean (7) = 45+/-SD 17.8 years] who had upper gastrointestinal endoscopy were analyzed for presence of H. pylori. Eighty-three had histopathology alone, while 55 others had both histology and culture. Endoscopic diagnosis included duodenal ulcer (DU) (n=35, 23%); gastric ulcer (n=4, 3%); gastric cancer (n=14, 9%); NUD, including gastritis (n=49, 32%); duodenitis (n=47, 31%); and normal (n=16, 11%). Overall, H. pylori was positive in 107 of 138 (77.5%) patients. There was a significant association of H. pylori with DU and NUD (p<0.000). Three-quarters of cases of normal endoscopy harbored H. pylori. The finding of 80% and 85% H. pylori in gastritis and duodenitis, respectively, was of interest. CONCLUSIONS: These findings suggest that DU and NUD were the main clinical expressions of H. pylori infection in southwest Nigerian dyspeptic patients similar to what is found in developed nations. Of note is the high incidence of H. pylori in endoscopically normal patients.     

Helicobacter pylori in patho- and morphogenesis of chronic gastritis and peptic ulcer

Review of the literature on the role of Helicobacter pylori (HP) in the patho- and morphogenesis of chronic gastritis (CG) type B, gastric ulcer (GU) and duodenal ulcer (DU) is presented. Various hypotheses of pathogenetic effect of HP, histologic and ultrastructural characteristics of changes in the gastric and duodenal mucosa in HP infection are presented. The majority of authors consider HP as a possible pathogenic factor in CG type B, GU and DU. However, there are works in which HP is regarded as a saprophyte or a secondary infection. This indicates a necessity of further studies.     

Helicobacter pylori-related gastritis and gastric ulcer. A continuum of progressive epithelial degeneration.

One hundred forty-five consecutive gastric biopsy specimens showing colonization by Helicobacter pylori (HP) were studied. Biopsy specimens were obtained from patients with the following conditions: gastric ulcer (GU; 76), active chronic gastritis (ACG; 52), GU with duodenal ulcer (DU; 10), and ACG with DU (7). The mean age of the patients in the ACG group was 8.6 years less than the patients in the GU group. Helicobacter pylori colonization and HP-induced epithelial degeneration (ED) were quantified by a grading system (grades 0 to 6) comprising both focal and global scores for bacterial density (HP grade) and severity of ED (ED grade). The ED grade was directly proportional to the HP grade in all biopsy specimens. Gastric ulcer biopsy specimens were associated with higher HP grades: HP grade more than 5 in 25 cases (32.9%) and ED grade more than 5 in 18 cases (23.6%) of GU compared with similar respective scores in 9 cases (17.9%) and 2 cases (3.8%) of ACG. The difference was due primarily to a higher global score of bacterial density and higher focal score of ED in the GU biopsy specimens. These results support the hypothesis that HP-positive ACG and HP-positive GU are lesions within a single disease spectrum. Heavy HP colonization and severe HP-induced epithelial damage are predisposing factors in ulcerogenesis. Because HP-positive ACG is probably a preulcerative state, eradication of the bacteria in HP-positive ACG might prevent subsequent GU.     

Iron-induced mucosal pathology of the upper gastrointestinal tract: a common finding in patients on oral iron therapy

Aims:  Upper gastrointestinal injury from iron tablets at therapeutic dose is not widely recognized. The aim was to document cases of iron-related upper gastrointestinal (GI) pathology and to determine frequency of occurrence.
Methods and results:  We prospectively studied patients with iron deficiency anaemia undergoing upper GI endoscopy from November 2005 to July 2006. Cases of upper GI iron deposition from these and other cases extracted retrospectively between 1999 and 2006 were examined histopathologically and patient notes were reviewed. In the prospective study, 15/160 patients investigated for iron deficiency anaemia [16.1% (15/93) of those taking oral iron tablets] had iron deposition noted on routine haematoxylin and eosin staining. In this plus the retrospective series, 59 patients were identified with 64 episodes of iron deposition. Eighty-six percent (6/7) with oesophageal iron deposition had associated erosion. Sixty-three percent (29/46) with gastric iron deposition had erosion and 80% (37/46) had reactive gastritis. Duodenal deposition was usually (91%, 10/11) within macrophages in villous tips with no erosion. Ninety-eight percent (58/59) of iron deposition cases had documented oral iron intake.
Conclusions:  Iron deposition in the upper GI tract is common in patients taking iron tablets. It is frequently associated with mucosal disruption in the oesophagus and stomach.     

Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital,northern Uganda

Background

Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions.

Objective

To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda.

Methods

The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed.

Results

A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB

Conclusions

Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.     

溃疡病患者胃肠运动功能障碍及表皮生长因子的变化

用连续灌注导管测压，并测定胃液和血清的表皮生长因子（ＥＧＦ）的含量，为了解十二指肠球溃疡（ＤＵ）患者消化间期移行性复合运动（ＭＭＣ）的规律，及其胃液和血清中的表皮生长因子含量的变化。结果显示：１、６０％ＤＵ患者缺乏ＭＭＣⅢ期，与正常人比Ｐ＜０．０５。２、ＤＵ患者ＭＭＣⅢ期持续时间（２．９±１．９ｍｉｎ）比正常人（４．３±１．１ｍｉｎ）缩短，（Ｐ＜０．０５）。３、ＤＵ患者ＭＭＣⅢ用十二指肠近端及远端的运动波幅较正常人减低（Ｐ＜０．０１）。４、ＤＵ患者的胃液和血清的表皮生长因子含量显著降低，分别为１９９．２７±１４７．８１ｐｇ／ｍＬ和１４８．６７±１２４．３１ｐｇ／ｍＬ，（Ｐ＜０．０１）。说明消化间期移行性复合运动和表皮生长因子在十二指肠球溃疡发病机理上起一定作用。     

Heterotopic gastric mucosa in the duodenum.

Thirteen patients are described who, on routine endoscopy of the upper gastrointestinal (GI) tract, were found to show a characteristic appearance in the proximal duodenum. This consisted of multiple small mucosal nodules, predominantly in the anterior wall. All cases were biopsied, and showed identical histological appearances of heterotopic gastric mucosa of body type. The incidence of this condition is probably much higher than reported previously, and may be present in up to 2% of the population. In all our patients a diagnosis was reached, other than heterotopic gastric mucosa, to explain the GI tract symptoms. In none was a healed or active duodenal ulcer evident and in none was there a history of a pre-existing ulcer. In our opinion these nodules are probably of little or no clinical significance.     

Molecular Identification and Detection of Virulent Factors in Helicobacter pylori from Gastric Biopsy Samples of Patients Attended at Assam Medical College and Hospital,Dibrugarh, Assam,India

The present study aimed to detect the major virulence determinants of Helicobacter pylori, the gastric bacteria by polymerase chain reaction from genomic DNA of 314 gastric biopsies from dyspeptic patients in 2015-2016 through upper gastrointestinal endoscopy. In 153 cases out of 314, the high prevalence of oipA gene followed by cagA-vacA s1 m1 combined genotypes was found in mostly gastritis/duodenitis patients followed by the peptic ulcer and normal patients. Therefore, the clinical significance of the virulence markers of H. pylori associated with the severe forms of gastroduodenal diseases is still a matter of controversy since the endoscopically normal patients were found to harbour the virulent genes.     

Häufigkeit pathologischer Veränderungen des oberen Gastrointestinaltraktes bei Patienten vor Herzoperationen

Resümee Schwerwiegende gastroduodenale Erkrankungen sind bei fast der Hälfte aller Patienten, die sich einer Operation am offenen Herzen unterziehen müssen, auch bei Fehlen von Symptomen nachweisbar. Das erhebliche Überwiegen von Magenläsionen spricht dafür, daß die arteriosklerotisch bedingte Perfusionsminderung der Schleimhaut die entscheidende Ursache hierfür ist. Routinemäßige präoperative Ösophago-Gastro-Duodenoskopien können die nicht unerhebliche durch gastrointestinale Komplikationen bedingte postoperative Mortalität senken helfen.

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Pathological changes in the upper gastrointestinal tract in patients awaiting open heart surgery

Summary While waiting for open heart surgery, in 153 patients (104 male, 49 female, 22–76 years of age) without gastrointestinal symptoms and/or history esophago-gastro-duodenoscopy was performed. 124 patients suffered from coronary heart disease, 29 from valvular defect, aneurysm of the sinus of Valsalva or tumor of the heart.In 47.1% endoscopy revealed serious abnormal findings: in 16.3% gastric ulcer, in 20.9% erosive gastritis, duodenal ulcer and erosive duodenitis in 5.2%, respectively, 1 case of gastric carcinoma, 2 of large polyps and 3 of reflux esophagitis of higher degree (totally 3.9%).In patients with coronary artery disease, the relation of erosive and ulcerous gastric lesions as compared with those of duodenal origin was 41, in patients with other cardiac diseases it was 21, respectively (p<0,001).Compared with a normal population, the incidence of pathological gastric findings was 54-fold higher in our patients, and 1.7-fold concerning duodenal lesions, respectively (p<0.001).51 patients on acethylsalicylic acid (160 mg/ die) showed pathologic findings in 41.2%, and 96 patients without ulcer-inducing therapy in 51%. Thus, low-dose Aspirin does not seem to have serious gastric side effects.The results of the study stress the necessity of routinely performed endoscopy of the upper gastrointestinal tract in patients awaiting open heart surgery. This will lead to a lower incidence of serious gastrointestinal complications postoperatively, which are known to have a high mortality.

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Abkürzungen ASS Azetylsalizylsäure - J. Jahre - GI-Trakt Gastrointestinaltrakt     

Effect of glucocorticoids on indomethacin-induced gastric ulcer in the adult male albino rat – histological,morphometric and electron microscopy study

Introduction

Indomethacin is a non steroidal anti-inflammatory drug (NSAID) which is capable of producing injury to gastric mucosa. To prevent of NSAID-induced gastropathy, it is important to evaluate the risk factors. One of them is steroid. The aim is to study time dependent effects of glucocorticoids (GC) on indomethacin induced gastric ulcer.

Material and methods

Forty-nine albino rats were used. They were divided into control and experimental groups. The experimental group was subgroup I (rats were given indomethacin and were sacrificed 1 day after drug intake), subgroup II (rats were given indomethacin + dexamethasone and were sacrificed 1 day after drug intake), subgroup III (rats were given indomethacin + dexamethasone and were sacrificed 3 days after drug intake) and subgroup IV (rats were given indomethacin + dexamethasone and were sacrificed 7 days day after drug intake). Histological, scanning electron microscopy and morphometric studies were used.

Results

Indomethacin induced gastric ulceration with shredding of the superficial epithelial cells. The fundic glands were dilated in the subgroups II, III, IV. The surface epithelial cells were shredded and the ulcer sizes were big in subgroup IV. All subgroups exhibited abnormal surface epithelial cells within the gastric ulcer area.

Conclusions

Indomethacin is capable of producing injury to gastrointestinal mucosa. With prolonged use of GC the surface epithelial cells became more affected and the ulcer sizes became bigger. Concomitant use of both medications will delay the healing of the indomethacin induced gastric ulcer and induce more gastric complication.     

Gastric histologic findings in patients with nonsteroidal anti-inflammatory drug-associated gastric ulcer.

The purpose of this study was to characterize gastric histologic findings in patients with nonsteroidal anti-inflammatory drug (NSAID)-associated gastric ulcer (GU). Gastric biopsy specimens from 136 patients with NSAID-related GU were compared with those from a control population of 185 patients with Helicobacter pylori-related gastritis. Foveolar hyperplasia, edema, muscular stranding, vascular ectasia, and active and chronic inflammation were semiquantitatively graded. Lymphoid aggregates, intestinal metaplasia, atrophy, and cystic gland changes were noted. No single parameter reliably distinguished between the two populations, although moderate/severe foveolar hyperplasia, edema, and vascular ectasia were significantly more common in the NSAID group. With use of the Dixon scoring system for reflux/reactive gastropathy, with a threshold score of 11 or more, 39 (29%) patients in the NSAID group were correctly diagnosed as having reactive gastropathy (sensitivity, 29%; specificity, 100%; positive predictive value, 100%). When the Dixon scoring threshold score was decreased to 8 or more, 114 (84%) patients were classified as having reactive gastropathy (sensitivity, 84%; specificity, > 99%; positive predictive value, > 99%). We conclude that a decreased threshold enhances the usefulness of the reactive gastropathy score in the NSAID-related GU population. Additional studies, however, must be performed to evaluate the effect of a lowered threshold relative to a normal population and those with other causes of reactive gastropathy.