PRIMARY GASTRIC PLASMACYTOMA REFRACTORY TO HELICOBACTER PYLORI ERADICATION THERAPY

A 49‐year‐old woman underwent upper gastrointestinal endoscopic examination for epigastric discomfort, revealing giant folds on the greater curvature of the stomach. Histological examinations of biopsy specimens taken from the giant folds showed signs of chronic inflammation, and Helicobacter pylori was also identified. She underwent first‐step H. pylori eradication. On follow‐up endoscopy, H. pylori was not identified. However, endoscopic findings were unchanged and repeated biopsies showed dense infiltration of atypical plasma cells. No proliferation of centrocyte‐like cells was seen. Immunohistochemically, plasma cells were positive for λ‐chain. Primary gastric plasmacytoma was diagnosed. Total gastrectomy was carried out with splenectomy and regional lymph node dissection. The patient remains disease free as of 6 years postoperatively.     

中国人幽门螺杆菌根除后重感染的研究

幽门螺杆菌(Helicobacter pylori, HP)根除后重感染率在发达国家与发展中国家的报道差异很大。我们对85例HP根除后患者进行1～2年随访,定期于停药后3,6,12,18和24个月进行~(14)C-尿素呼吸试验检查。在停药后12、24个月或当呼吸试验呈阳性结果时分别行胃镜检查.胃镜下取胃窦及胃体粘膜行尿素酶、组织学及培养等检测HP,并观察溃疡复发情况。结果:①发现HP阳转在停药3个月有6例(7.1％)、6个月有1例(1.2％)及6个月以后无1例;②经随机引物DNA多态指模技术鉴定,停药3个月感染之HP菌株分别与该患者治疗前HP菌株具有相同的电泳图谱,表明停药早期检出的HP感染实为复发而非再感染;③本组病人中有20例患者在治疗前有1～7次的溃疡出血史,根除治疗后在随访1～2年中无1例再发出血。结论:中国人HP根除后年重感染率低于2％,与发达国家报道相仿。     

DEVELOPMENT OF SPORADIC GASTRIC FUNDIC GLAND POLYP AFTER ERADICATION OF HELICOBACTER PYLORI

The pathogenesis of sporadic gastric fundic gland polyps (FGP) without familial adenomatous polyposis remains unclear. However, development of FGP is associated with normal gastric mucosa without Helicobacter pylori infection. We report two cases of FGP newly developed after successful eradication therapy of H. pylori infection. H. pylori‐associated gastric ulcers occurred in the two patients; H. pylori eradication was performed in the patients and was successful. The patients have not received medication of long‐term proton pump inhibitors. Follow‐up gastrointestinal endoscopy demonstrated a FGP in the fundus of the stomach of each patient after eradication therapy. Regression of sporadic FGP can be observed to coincide with the acquisition of H. pylori infection. Conversely, the present cases demonstrated that the curing of H. pylori infection could lead to the development of FGP.     

ISOLATED GRANULOMATOUS GASTRITIS SHOWING DISCOLORATION OF LESIONS AFTER HELICOBACTER PYLORI ERADICATION

We report a case of isolated granulomatous gastritis (IGG) with a submucosal tumor and multiple ulcer scars which showed discoloration after Helicobacter pylori (Hp) eradication. Furthermore, other discolored areas were newly observed after Hp eradication in the present case. Although IGG is extremely rare, the relation between IGG and Hp infection has attracted recent attention, and some case reports of IGG with Hp eradication have appeared in the literature. Discoloration after Hp eradication, however, has never been noted in any case reports and, therefore, this feature made the present case clinically interesting.     

NODULAR GASTRITIS WITH HELICOBACTER PYLORI INFECTION IS STRONGLY ASSOCIATED WITH DIFFUSE‐TYPE GASTRIC CANCER IN YOUNG PATIENTS

Background: Nodular gastritis (NG), a particular type of gastritis, is now defined as antral nodularity. Recent studies have shown that NG is strongly associated with Helicobacter pylori infection, and we recently showed that it may be associated with diffuse‐type gastric cancer of the corpus. We retrospectively investigated the relation between NG and gastric cancer in patients aged 29 years or less. Patients and Methods: The study group comprised 150 patients (48 males, 102 females; mean age, 27.7 years) who were endoscopically diagnosed with NG and were less than 29 years of age; 3939 sex‐ and age‐matched patients without NG who were H. pylori‐positive served as the control group (1184 males, 2755 females; mean age, 27.5 years). We estimated the risk of gastric cancer development in patients with NG relative to that of patients without NG. Results: The prevalence of gastric cancer was significantly higher in patients with NG than in the control patients (7/150; 4.7% vs 3/3939; 0.08%, P < 0.001). The odds ratio for the risk of gastric cancer in patients with NG was found to be 64.2 (95% confidence interval; 16.4–250.9). The seven cases of gastric cancer with NG showed the same characteristics: all were diagnosed histologically as the diffuse type and were located in the corpus with H. pylori infection. Conclusion: NG with H. pylori infection is strongly associated with diffuse‐type gastric cancer of the corpus in young patients.     

NODULAR GASTRITIS AND GASTRIC CANCER

Nodular gastritis is defined as antral gastritis usually characterized endoscopically by a miliary pattern resembling gooseflesh and pathologically by prominent lymphoid follicles and infiltration of mononuclear cells. This physiological phenomenon was once considered particular to young women. Recent studies have shown that nodular gastritis is strongly associated with Helicobacter pylori infection and may be associated with gastric cancer. Reported cases of gastric cancer with nodular gastritis showed some features in common: all gastric cancers were diagnosed histologically as the diffuse‐type, and all were located in the corpus with Helicobacter pylori infection. Because nodular gastritis may be a risk factor for diffuse‐type gastric cancer, Helicobacter pylori may need to be eradicated to prevent gastric cancer in patients with nodular gastritis.     

幽门螺杆菌相关性胃炎中的非典型增生

本文分析６１５例幽门螺杆菌相关性胃炎及３８５例幽门螺杆菌非相关性胃炎。结果表明两者在非典型增生、肠上皮化生以及相关病变之间具有显著性差异（Ｐ＜０．０１）。据此结果，作者认为幽门螺杆菌的感染是胃粘膜非典型增生及肠上皮化生的危险因素之一。     

幽门螺杆菌相关性胃炎内镜随访研究

为了解Ｈｐ长期感染是否促进胃粘膜萎缩、肠上皮化生和异型增生的形成与发展，对首次胃镜检查诊断为慢性胃炎而不伴有肠化生和异型增生的１２０例Ｈｐ阳性患者和８７例Ｈｐ阴性患者进行内镜随访。随访时间３～８年，平均４．８年，随访次数２－１０次，活检组织进行Ｈｐ检查、病理学检查和ＡｇＮＯＲｓ，银染及ＰＣＮＡ免疫组化染色。结果Ｈｐ阳性患者其慢性萎缩性胃炎、肠化生、Ⅲ型肠化生和异型增生的发生率显著高于Ｈｐ阴性患者，Ｈｐ阳性胃粘膜ＰＣＨＡ标记指教和ＡｇＮＯＲｓ数也显著高于Ｈｐ阴性胃粘膜。表明Ｈｐ感染可能通过刺激胃粘膜细胞的过度增殖、更新加快，促进萎缩性胃炎和肠化生的形成与发展，从而增加患胃癌的危险性。     

幽门螺杆菌相关性胃炎内镜随访研究

为了解Ｈｐ长期感染是否促进胃粘膜萎缩、肠上皮化生和异型增生的形成与发展，对首次胃镜检查诊断为慢性胃炎而不伴有肠化生和异型增生的１２０例Ｈｐ阳性患者和８７例Ｈｐ阴性患者进行内镜随访。随访时间３～８年，平均４．８年，随访次数２～１０次，活检组织进行Ｈｐ检查、病理学检查和ＡｇＮＯＲｓ，银染及ＰＣＮＡ免疫组化染色。结果Ｈｐ阳性患者其慢性萎缩性胃炎、肠化生、Ⅲ型肠化生和异型增生的发生率显著高于Ｈｐ阴性患者，Ｈｐ阳性胃粘膜ＰＣＮＡ标记指数和ＡｇＮＯＲｓ数也显著高于Ｈｐ阴性胃粘膜。表明Ｈｐ感染可能通过刺激胃粘膜细胞的过度增殖、更新加快，促进萎缩性胃炎和肠化生的形成与发展，从而增加患胃癌的危险性。     

聚合酶链反应快速检测胃粘膜幽门螺杆菌

本研究的目的是了解简单的PCR方法诊断幽门螺杆菌感染的价值。选用互补于幽门螺杆菌尿素酶A基因片段的一对引物,建立PCR方法扩增幽门螺杆菌DNA,扩增产物经琼脂糖电泳显示一条411bp区带。用PCR扩增41株HP分离菌均阳性,而空肠弯曲菌等8种肠道细菌均阴性,显示100％特异,系列稀释试验显示PCR能检测0.1pg的HP DNA;126例胃粘膜标本用PCR、尿素酶试验、培养和涂片检查,HP检出率分别为70.6％、56.3％、32.5％和56.3％,这些结果提示简单快速的PCR方法是检测HP的有价值的方法。     

Five‐year follow‐up study on histological and endoscopic alterations in the gastric mucosa after Helicobacter pylori eradication

Background: To investigate long‐term changes in the gastric mucosa after Helicobacter pylori eradication, we examined histological and endoscopic ?ndings of the gastric mucosa before and 5 years after eradication. Methods: The subjects comprised 59 H. pylori‐positive patients with peptic ulcer who had been periodically followed for 5 years after H. pylori eradication. Acid‐suppressive drugs were not given after eradication, and endoscopic examination and tests for H. pylori infection (urea breath test (UBT), culture and histology) were performed before and 1 to 2 months, 1 year, and 5 years after eradication. Biopsy samples were taken from the greater curvature of the gastric antrum and upper corpus, and were scored histologically according to the Updated Sydney System. The atrophic border was evaluated endoscopically based on Kimura and Takemoto's classi?cation. Antral erosion and spotty redness in the corpus were also scored. Results: (1) Neutrophil in?ltration was signi?cantly reduced 1 to 2 months after eradication and remained around the reduced level over the next 5 years. Mononuclear cell in?ltration began to decrease 1 to 2 months after eradication and continued to subside 1 year and 5 years later. (2) Histological atrophy of the gastric glands was signi?cantly improved 1 year and 5 years after eradication. However, endoscopy revealed no consistent alteration in the atrophic border. (3) There was no signi?cant change in the degree of intestinal metaplasia for 5 years. (4) In some cases, antral erosion became more conspicuous after 5 years. Spotty redness in the corpus was observed in 15% of cases (9/59) before and 10% (6/59) 1 year after eradication, but had disappeared in all cases 5 years later. Conclusions: Neutrophil in?ltration improved rapidly after H. pylori eradication in contrast with mononuclear cell in?ltration, which decreased gradually over 5 years. Glandular atrophy improved in the long term, whereas intestinal metaplasia had not altered 5 years after eradication. Spotty redness in the gastric corpus disappeared in all cases after eradication, suggesting that it is an endoscopic ?nding related to H. pylori infection.     

儿童幽门螺杆菌感染与上胃肠道疾病

我们对153例因胃肠道症状接受胃镜检查的连续患儿进行前瞻性活检组织学、尿素酶试验及血清学检查,探讨幽门螺杆菌(HP)感染和上胃肠道疾病关系,并和成人及健康儿童对照。结果显示,消化性溃疡患儿HP感染率15/22(68％),明显高于功能性消化不良29/130(22％),而后者和健康儿童62/181(34％)无显著差异,提示HP和消化性溃疡相关,但与症状无关。儿童HP相关性胃炎内镜无特异性征象,组织学多集中在胃窦部,炎症细胞浸润和活动较明显。     

Role of intestinal metaplasia subtyping in the risk of gastric cancer in Korea

Background and Aim:  Gastric cancer is believed to develop by a multistage process. Intestinal metaplasia (IM) is regarded as a premalignant condition; it is classified into subtypes I, II and III. The aim of this study was to evaluate whether the subtypes of IM were associated with progression to gastric cancer.
Methods:  The study cohort consisted of 861 subjects, categorized as controls, gastric ulcers, dysplasia and cancer. The IM was scored histologically using the Sydney classification for the antrum and the body of the stomach. The biopsies were stained with high iron diamine and alcian blue (pH 2.5) (HID-AB2.5), and the IM was subtyped as I, II or III.
Results:  The proportion of IM subtypes I, II and III were 14.5%, 47.2% and 38.3% in the antrum, and 28.1%, 57.8% and 14.1% in the body of the stomach, respectively. These distributions did not show significant differences depending on disease or Helicobacter pylori positivity. In cases that were H. pylori -positive, the prevalence of IM subtype II in the cancer and dysplasia groups was higher than in the control group in the body of the stomach ( P  < 0.05). The proportion of IM subtype III in the antrum increased in proportion with age ( P  = 0.036).
Conclusions:  IM subtyping was not found to play a major role in the prediction of gastric cancer development in Korea. IM subtype III was associated with aging, and IM subtype II appeared to be related to gastric carcinogenesis in the presence of H. pylori infection.     

原发性胃恶性淋巴瘤与幽门螺杆菌感染的相关性初探

为了探讨原发性胃恶性淋巴瘤（ＰＧＭＬ）与幽门螺杆菌（Ｈｐ）感染的相关性，收集３９例ＰＧＭＬ与２２例淋巴性胃炎、３２例Ｈｐ无关疾病的胃粘膜作病例对照研究；Ｈｐ感染的确定采用改良的Ｇｉｅｍｓａ染色；ＰＧＭＬ的分类结合组织学和免疫组化染色。结果：ＰＧＭＬ组Ｈｐ检出率为８７．１８％，显著高于对照的６３．６４％及５３．１３％（Ｐ＜０．００５）。粘膜相关淋巴样组织（ＭＡＬＴ）来源的淋巴瘤占９２．３１％，Ｈｐ检出率达８６．１１％，瘤周慢性活动性胃炎及淋巴滤泡检出率分别为８４．６２％及５６．４１％。组织学检测的初步结论为：胃Ｂ细胞ＭＡＬＴ淋巴瘤与Ｈｐ感染相关。