Confocal endomicroscopy for phenotypic diagnosis of gastric cancer

Background and Aim: Relationships between mucin phenotype and malignant potential in gastric cancers have attracted attention. We attempted to assess the possibility of obtaining phenotypic diagnoses by confocal endomicroscopy. Methods: Confocal images of target lesions were obtained in 29 of 40 patients with gastric cancer. Appearances of the brush border, goblet cells, and gastric foveolar epithelium were investigated with immunohistochemical staining using CD10, MUC2, and human gastric mucin to evaluate phenotypic expression in gastric carcinomas. Confocal images were compared with immunohistochemical findings for goblet cells and brush borders. Results: Both the endoscopists and the pathologist obtained high accuracy rates for differential diagnosis. Sensitivity and specificity for goblet cells were 85.7% and 92.3% (Endoscopist A), and 85.7% and 88.5% (Endoscopist B). The κ‐value for correspondence between two endoscopists for the diagnosis of goblet cells in confocal images was 0.73. Sensitivity and specificity for the brush border were 93.8% and 91.7% (Endoscopist A), and 81.3% and 91.7% (Endoscopist B). The κ‐value for correspondence between two endoscopists for diagnosis of the brush border in confocal images was 0.79. Intestinal phenotypic gastric cancers show a brush border, goblet cells, or both. Sensitivity and specificity for the intestinal phenotype in confocal endomicroscopy were 90.9% and 77.8% (Endoscopist A), and 86.4% and 83.3% (Endoscopist B). Conclusion: The confocal endomicroscopic diagnosis of the mucin phenotype in gastric cancers was limited to intestinal and mixed phenotypes, but may be useful for the diagnosis of mucin phenotype and differential diagnosis.     

共聚焦激光显微内镜诊断幽门螺杆菌感染患者的价值

目的 探讨荧光素染色下共聚焦激光显微内镜(confocal laser endomicroscopy,CLE)对幽门螺杆菌(Hp)感染患者的诊断价值.方法 2009年6月至2009年11月,选择伴有上消化道症状(上腹部不适、腹胀、早饱、反酸、嗳气)及为行胃癌筛查而行胃镜检查的患者纳入研究.通过回顾分析行CLE检查且已确诊为Hp感染的患者20例和10例Hp阴性对照者的胃黏膜CLE图像,并与相应靶向活检的组织学图像相比较,制定出CLE下Hp感染诊断标准.在前瞻性研究中将CLE诊断结果 与Hp最终检测结果 进行比较,分析CLE诊断标准的观察者之间一致性,并将CLE图像与相应组织病理学结果 进行对比分析.结果 72例患者纳入前瞻性研究,Hp阳性34例,CLE正确诊断31例,CLE诊断总准确率、敏感性和特异性分别为88.9%、91.2%和86.8%.荧光素渗出伴细胞脱落诊断特异性最高(97.4%),荧光素渗出+胃小凹水肿扭曲敏感性最高(88.2%).CLE诊断标准具有较高的观察者之间一致性(Kappa值分别=0.72和0.87).CLE下Hp感染图像与活动性炎症高度相关(P＜0.001).结论 CLE可在细胞水平准确辨别正常胃黏膜和Hp感染的胃黏膜,对Hp感染有可靠的诊断价值.     

Confocal laser endomicroscopy for detection of neoplasia in Barrett's esophagus: a meta‐analysis

Barrett's esophagus (BE) is associated with an increased risk of esophageal adenocarcinoma, and the recommended guideline for detection of neoplasia is surveillance endoscopy with random four‐quadrant biopsies. Recently, a novel technique, confocal laser endomicroscopy (CLE), has emerged and enabled the endoscopist to perform a real‐time histologic assessment of the gastrointestinal tract. We aimed to assess the accuracy of CLE in diagnosing BE‐associated neoplasia by pooling data of existing trials. Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index and momentous meeting abstracts were searched and evaluated by two reviewers independently. Meta‐analysis was performed. Pooling data were conducted in a fixed effect model or a random effects model. Eight studies involving 709 patients and 4008 specimens were analyzed. In a per‐patient analysis, the pooled sensitivity of CLE for detection of neoplasia was 89% (95% confidence interval [CI], 0.80–0.95), and the specificity was 75% (95% CI, 0.69–0.81). The area under the curve under the summary receiver operating characteristic was 0.9472. In a per‐location analysis, the pooled sensitivity of CLE for detection of neoplasia was 70% (95% CI, 0.65–0.74), and the specificity was 91% (95% CI, 0.90–0.92). The area under the curve under the summary receiver operating characteristic was 0.9509. CLE is a reasonable, promising modality for management of patients with BE; more prospective trials need doing to determine whether it is superior to traditional method in diagnosing BE‐associated neoplasia.     

Association between Helicobacter pylori infection and the risk of gastric cancer in the Korean population: prospective case-controlled study

Background. Gastric cancer is still the most common malignant tumor in Koreans. Although many reports have supported the association of Helicobacter pylori infection and the development of gastric cancer, few studies have been adjusted by variable factors such as age, sex, education, and economic status. Furthermore, most results from areas with a high incidence of gastric cancer, such as China and Korea, have failed to document any relationship between H. pylori infection and gastric cancer. We conducted a prospective case-controlled study, with controls matched for and adjusted by age, sex, education, and economic status, to evaluate the causal relationship between H. pylori infection and gastric cancer in Korean people. Methods. From March 1997 to October 1998, 136 consecutive patients with gastric cancer, diagnosed by endoscopic histology, and 136 age- and sex-matched control subjects, confirmed to be free of gastric cancer by endoscopy during the same period, were enrolled in the study. The presence of H. pylori infection was determined by enzyme immunoassay (EIA) serology test. Results. Seventy-two of the 136 gastric cancer patients (53%) were positive for H. pylori infection and 54 of the 136 control subjects (40%) were positive for H. pylori infection. The odds ratio (OR), adjusted by variable risk factors, such as age, sex, education, and economic status, for gastric cancer in H. pylori-infected patients was 1.82 (95% confidence internal [CI], 1.10–3.00; P = 0.019). The age- and sex-matched OR by conditional logistic regression was 1.6 (95% CI, 1.01–2.53; P = 0.043). Conclusions. H. pylori infection may be one of the important risk factors for the development of gastric cancer in Korea, an area of high prevalence of H. pylori infection and a high incidence of gastric cancer. Received: September 27, 2000 / Accepted: May 25, 2001     

老年患者幽门螺杆菌感染与胃炎活动性相关性分析

目的探讨老年患者幽门螺杆菌(Hp)感染与胃炎活动性的相关性。方法回顾性地分析2014年1月至2014年6月于北京老年医院接受胃镜及~(13)C呼气试验检查的良性上消化道疾病患者278例,依据年龄分为年龄≥60岁(老年组)111例和年龄60岁(非老年组)167例,分别观察两组患者Hp感染情况及胃黏膜组织中性粒细胞浸润与Hp感染的关系。结果老年组与非老年组比较,Hp感染率分别为27.0%(30/1 11)和36.5%(61/167),差异无统计学意义(P0.05);中性粒细胞浸润率分别为18.9%(21/111)和29.3%(49/118),差异无统计学意义(P0.05);Hp阳性和Hp阴性患者中性粒细胞浸润分别为70.3%(64/91)和3.2%(6/187),差异有统计学意义(P0.05);Hp阳性患者老年组和非老年组中性粒细胞浸润分别为63.3%(19/30)和73.8%(45/61),中性粒细胞浸分级(轻、中、重)分别为26.3%vs 17.8%,57.9%vs 71.1%,15.8%vs11.1%,差异均无统计学意义(P0.05)。结论胃黏膜急性炎症与Hp感染相关,急性炎症分级与感染年龄无关。     

幽门螺杆菌感染对胃粘膜超微结构的影响

目的研究幽门螺杆菌（Ｈｐ）感染及其根除前后胃粘膜超微结构的变化．方法Ｈｐ感染患者１０例经三联疗法２８ｄ．Ｈｐ阴转７例于停药１月后及治疗前内镜下取胃窦粘膜，经切片染色后分别行透射电镜及扫描电镜观察．结果透射电镜显示，Ｈｐ聚集处上皮细胞微绒毛变短、减少或消失，细胞呈毛刺状或外突形成分枝状，细胞膜内侧粘液颗粒聚集，细胞破裂，释放粘液颗粒．扫描电镜下Ｈｐ横卧于微绒毛表面或垂直镶嵌在微绒毛里．应用三联疗法（德诺１２０ｍｇ＋四环素０２５ｇ＋呋喃唑酮１０ｍｇ，４次／ｄ）治疗２８ｄ，停药１月后７例Ｈｐ根除．电镜显示Ｈｐ消失，粘膜细胞变性逆转，上皮细胞及微绒毛结构恢复正常．结论Ｈｐ引起的胃粘膜超微结构损害在根除Ｈｐ后有改善及恢复     

Agglutination of Helicobacter pylori coccoids by lectins

AIM To study the agglutination pattern of Helicobacter pylori coccoid and spiral forms.METHODS Assays of agglutination and agglutination inhibition were applied using fifteen commercial lectins. RESULTS Strong agglutination was observed with mannose-specific Concanavalin A (Con A ),fucose-specific Tetragonolobus purpureas ( Lotus A ) and N-acetyl glucosamine-specific Triticum vulgaris (WGA) lectins. Mannose and fucose specific lectins were reactive with all strains of H. pylori coccoids as compared to the spirals. Specific carbohydrates, glycoproteins and mucin were shown to inhibit H. pylori lectin-agglutination reactions. Pre-treatment of the bacterial cells with formalin and sulphuric acid did not alter the agglutination patterns with lectins. However, sodium periodate treatment of bacterial cells were shown to inhibit agglutination reaction with Con A, Lotus A and WGA lectins. On the contrary, enzymatic treatment of coccoids and spirals did not show marked inhibition of H. pylori-lectin agglutination. Interestingly, heating of H.pylori cells at 60℃ for 1 hour was shown to augment the agglutination with all of the lectins tested. CONCLUSION The considerable differences in lectin agglutination patterns seen among the two differentiated forms of H. pylori might be attributable to the structural changes during theevents of morphological transformation,resulting in exposing or masking some of the sugar residues on the cell surface. Possibility of various sugar residues on the cell wall of the coccoids may allow them to bind to different carbohydrate receptors on gastric mucus and epithelial cells. The coccoids with adherence characteristics like the spirals could aid in the pathogenic process of Helicobacter infection.This may probably lead to different clinical outcome of H. pylori associated gastroduodenal disease.     

幽门螺杆菌感染内镜下的诊疗方法

目的探讨活检部位与Ｈｐ的检出率，观察内镜下喷洒美蓝治疗Ｈｐ的效果．方法选择内镜下诊断的慢性萎缩性胃炎或其它胃病伴有萎缩改变及肠上皮化生改变者２６８例．对其萎缩面的形态、肠上皮化生的特点进行分型．结果闭合型萎缩性胃炎以窦部Ｈｐ检出率高，而开放型以体部检出率高（Ｐ＜００１），肠上皮化生广泛的部位，Ｈｐ检出率低（Ｐ＜００１）．美蓝喷洒法与口服法比较具有相同治疗效果．结论内镜下取活检的部位及肠上皮化生的程度可影响Ｈｐ检出率．喷洒美蓝治疗Ｈｐ法，经济、效果好、副作用少．     

Mechanism for gastric cancer development by Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection plays a crucial role in the development of gastric cancer. There are two major pathways for the development of gastric cancer by H. pylori infection: the indirect action of H. pylori on gastric epithelial cells through inflammation, and the direct action of the bacteria on epithelial cells through the induction of protein modulation and gene mutation. Both pathways work together to promote gastric carcinogenesis.     

Effects of Helicobacter pylori infection on mucin expression in gastric carcinoma and pericancerous tissues

BACKGROUND: Helicobacter pylori infection is one of the major causes of human gastric carcinoma and can disturb the gastric mucosa barrier. Mucins have not only lubricating and protecting functions, but are also related to signal transduction, turnover of gastric epithelium and carcinogenesis of gastric mucosa. The aim of this study was to investigate the relationship between H. pylori infection and aberrant mucin expression in patients with gastric carcinoma. METHODS: H. pylori infection was diagnosed by the Warthin-Starry staining method. Different kinds of mucins were detected using an immunohistochemical method. RESULTS: Of 46 patients with gastric carcinoma, there were 26 patients who had H. pylori infection (56.5%). Of 21 pericancerous mucosas from the H. pylori-positive patients, 14 had MUC2 expression (66.7%), seven had strong MUC1 expression (+ + +) (33.7%), seven had strong MUC6 expression (+ + +) (33.3%), and five had strong MUC5AC expression (+ + +) (23.8%). In contrast, only six of 18 H. pylori-negative pericancerous mucosas had MUC2 expression (33.3%) (P < 0.05 compared with H. pylori-positive pericancerous mucosas), 12 had strong MUC1 expression (+ + +) in 16 H. pylori-negative pericancerous mucosas (75%) (P < 0.05), 11 had strong MUC6 expression (+ + +) in 16 H. pylori-negative pericancerous mucosas (68.8%) (P < 0.05), and 10 had strong MUC5AC expression (+ + +) in 14 H. pylori-negative pericancerous mucosas (71.4%) (P < 0.01). Of the H. pylori-positive cancerous tissues, 50% (13/26) had MUC1 expression and 38.5% (10/26) had MUC6 expression. In comparison, of the H. pylori-negative cancerous tissues, 80% (16/20) had MUC1 expression (P < 0.05) and 80% (16/20) had MUC6 expression (P < 0.01). CONCLUSIONS: The results indicate that H. pylori infection can alter the expression of some mucin genes in pericancerous mucosa and cancerous tissues of gastric carcinoma, then destroy the gastric mucosa barrier.