Regression of MALT lymphomas coexisting in the duodenal bulb and the stomach by eradication of Helicobacter pylori

Helicobacter pylori eradication. During an endoscopic examination, multiple polyps in the duodenal bulb were observed in a 62-year-old woman. The pathology of the duodenal polyps was low-grade B-cell MALT lymphoma. Gastric MALT lymphoma was also detected in biopsies of rough mucosa from the gastric corpus. Southern blot analysis showed rearranged bands of DNA immunoglobulin heavy chain J portion (IgH-J) in both lesions, but the positions of these bands were different in the two lesions. H. pylori was recognized in the gastric mucosa by positive serum H. pylori antibody and urease tests, while bacterial bodies were not found in the duodenal bulb. With 1 year after the successful eradication of H. pylori, both the lesions, that in the duodenal bulb and that in the gastric corpus, had disappeared. Furthermore, positive rearrangement of IgH-J was not found at either of the lesion sites. In May 2000, 3 years after the treatment, endoscopic surveillance failed to find any recurrence of these malignant lymphomas. Received: October 6, 2000 / Accepted: March 2, 2001     

Endoscopy and biopsy of the esophagus]

Since glass fibre instruments are used, the number of oesophagoscopies very much increased. The complication rate is small. The oesophagus can be inspected without any gaps in all sections. Our knowledge on pathogenesis and distribution of certain diseases of the oesophagus has considerably been enlarged by modern biopsy and endoscopy. In the urgent clarification of acute causes of haemorrhage in the upper alimentary tract endoscopy stands in the first place compared with all other diagnostic methods. The interpretation of the findings in the oesophagus demands an experienced and critical examinator, as the bioptic particles frequently are very small.     

The pitted duodenal bulb

The radiologic, endoscopic, and histologic findings in two patients with flaskshaped or collar-button collections of barium in the duodenum are presented. These abnormal mucosal depressions, which may be related to inflammation, were seen endoscopically and identified radiographically and have not been reported previously.     

Endosonography of the esophagus and stomach

Endosonography is considered to be the most exact method for the staging of carcionomas of the oesophagus and stomach. It enables a differentiation of the T stages of carcinomas of the oesophagus and stomach with an accuracy of between 65 and 90 %. Endosonography with a mini-probe, however, does not appear to be superior to the macroscopic evaluation by an experienced endoscopist. A further decisive criterion for therapy is the lymph node status. Here, endosonography exhibits a high sensitivity albeit with an unsatisfactory specificity. The specificity can be increased by the cytological evaluation of biopsy samples from the fine needle puncture of suspicious lymph nodes, a method with a very low complication rate. But new methods such as contrast medium-enhanced endosonography or elastography also appear to be useful for the differentiation of suspicious lymph nodes.     

Relationship of heartburn with histopathological changes in esophagus and stomach in patients with duodenal ulcer

Histopathological changes in the esophagus and gastric antrum were studied in 47 patients with duodenal ulcer. Twenty three (49%) patients complained of heartburn. Esophagitis was present in 87% of the patients with heartburn and in 71% of the patients with no heartburn. In the majority, esophagitis was of mild to moderate severity. Gastritis was present in 83% (atrophic type in 22%) of patients with heartburn compared to 96% (25% atrophic type) of patients without heartburn. There was no statistical difference in the incidence of esophagitis and gastritis between the heartburn and no heartburn groups. This study suggests that histologic esophagitis and gastritis occur frequently in patients with duodenal ulcer and the presence of heartburn is not related to these histologic changes.