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Noguchi H, Kumamoto K, Harada Y, Sato N, Nawata A, Tasaki T, Kimura S, Shimajiri S, Nakayama T. Prevalence of Helicobacter pylori infection rate in heterotopic gastric mucosa in histological analysis of duodenal specimens from patients with duodenal ulcer. Histol Histopathol 2019; 35:169-176. [PMID: 31264199 DOI: 10.14670/hh-18-142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Heterotopic gastric mucosa in the duodenal bulb is a rare congenital disorder with varied clinical presentations. The mechanism of formation of a duodenal ulcer is failure of balance of the attack factor and the defense factor, which is the same as the mechanism of formation of a gastric ulcer. However, the true etiology of the duodenal ulcer remains unknown. Gastric mucosa can secrete gastric juice which injures itself, but the duodenal mucosa does not contain cells secreting a digestive enzyme. We assume that duodenal ulcers are caused by the presence of heterotopic gastric mucosa that can secrete gastric acid. This study was designed to assess the prevalence and associations of heterotopic gastric mucosa in duodenal ulcers. The present study included 137 patients who underwent biopsy or resection of duodenal ulcer. We detected gastric foveolar metaplasia due to inflammation from a heterotopic gastric mucosa using immunohistochemical staining. Heterotopic gastric mucosa consists of foveolar epithelium (MUC5AC-positive) and fundic gland (H⁺K⁺ ATPase-positive parietal cells, pepsinogen I-positive chief cells and MUC6-positive mucous neck cells), whereas gastric metaplasia is composed of foveolar epithelium without fundic glands. These specimens were stained with toluidine blue for detection of Helicobacter pylori infection. Among the 137 patients with duodenal ulcer, 76 cases (55%) had heterotopic gastric mucosa in the obtained specimens, and Helicobacter pylori was found in 45 cases (59%,45/76) among those with heterotopic gastric mucosa. Our results suggest that heterotopic gastric mucosa was strongly associated with concurrent duodenal ulcer.
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Affiliation(s)
- Hirotsugu Noguchi
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Keiichiro Kumamoto
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshikazu Harada
- Department of Dentistry and Oral Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoko Sato
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Aya Nawata
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takashi Tasaki
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Kimura
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shohei Shimajiri
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Department of Surgical Pathology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiyuki Nakayama
- Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Duodenal bulb mucosa with hypertrophic gastric oxyntic heterotopia in patients with zollinger ellison syndrome. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2009; 2009:298381. [PMID: 19587828 PMCID: PMC2705831 DOI: 10.1155/2009/298381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 05/07/2009] [Indexed: 01/19/2023]
Abstract
Objectives.
Zollinger-Ellison Syndrome (ZES) results in
hypersecretion of gastric acid (via gastrinoma)
leading to peptic ulcers, diarrhea, and abdominal
pain. We describe the novel discovery of
hypertrophic, heterotopic gastric mucosa in the
proximal duodenal bulb in patients with ZES,
which we hypothesize results in an increased
incidence of postbulbar ulcers in patients with
ZES (a mechanism previously unreported). We
determined the incidence of the novel finding of
duodenal gastric oxyntic hypertrophic
heterotopia (GOH) in patients with ZES.
Methods. Seven patients with
ZES were enrolled. The diagnosis of ZES was
established by hypergastrinemia, gastric acid
hypersecretion, and a positive secretin test or
based on biopsy specimens (evaluated via tissue
staining). Basal acid output (BAO) and baseline
gastrin secretion were determined by established
methods. Endoscopic examinations with methylene
blue staining and biopsy of the gastric and
duodenal mucosa were conducted in all patients
every 3–6 months for an average of 5
years. Results. The duodenal
mucosa demonstrated hypertrophic GOH in 5 out of
7 patients with ZES and an intact stomach and
duodenum. Biopsies from the bowel mucosa
demonstrated patchy replacement of surface
epithelium by gastric-type epithelium with
hypertrophic oxyntic glands in the lamina
propria in 5 patients. Two of the patients had
no evidence of GOH in the duodenal bulb.
Patients with GOH had an average serum gastrin
level of 1245 pg/mL and BAO of
2.92 mEq/hr versus 724 pg/mL and
0.8 mEq/hr in patients without GOH.
Conclusions. This study
demonstrated the presence of duodenal mucosa
with GOH in 5 out of 7 patients with ZES and an
intact stomach and duodenum. The presence of
hypertrophic and heterotopic gastric mucosa is
proposed to result from increased gastrin levels
and may contribute to the increased incidence of
postbulbar ulcers in these
patients.
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Abstract
Heterotopic gastric tissue in the duodenal bulb is a rare congenital lesion. Its prevalence has been reported to be 0.5-2%. It must be differentiated from gastric metaplasia of the duodenal bulb because the two entities have different clinical implications. During one year, we found three cases of gastric heterotopia of the duodenal bulb. In one of the cases, active acid-secreting gastric mucosa was documented by performing the pentagastrin Congo red dye test. The differences between gastric heterotopia of the duodenal bulb and gastric metaplasia of the duodenal bulb have been discussed.
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Affiliation(s)
- N S Mann
- Division of Gastroenterology, Texas A & M University, College of Medicine, V.A. Medical Center, Temple, USA
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Noach LA, Rolf TM, Bosma NB, Schwartz MP, Oosting J, Rauws EA, Tytgat GN. Gastric metaplasia and Helicobacter pylori infection. Gut 1993; 34:1510-4. [PMID: 8244134 PMCID: PMC1374412 DOI: 10.1136/gut.34.11.1510] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Duodenal and antral mucosal biopsy specimens were obtained from 139 patients with dyspeptic complaints to study the prevalence and extent of gastric metaplasia in the duodenal bulb in relation to Helicobacter pylori (H pylori) infection and duodenal ulcer disease. On logistic regression, the presence and extent of gastric metaplasia was not significantly associated with H pylori infection. The prevalence of gastric metaplasia, however, was found to be higher in patients with current or past evidence of duodenal ulcer disease in comparison with subjects with functional dyspepsia (p = 0.01). A follow up study on 22 patients before and at least one year after eradication of H pylori showed that the mean extent of gastric metaplasia did not change significantly after eradication and did not differ when compared with 21 patients with persisting infection. It is concluded that the unchanged gastric acid output after eradication of H pylori is a more important factor in the development of gastric metaplasia than the H pylori related inflammatory process.
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Affiliation(s)
- L A Noach
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
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Abstract
Campylobacter pylori is now known to be the most common and important cause of gastritis, and C. pylori infections have been associated with duodenal ulcer, gastric ulcer, nonulcer dyspepsia, and gastric cancer. Although it has been only possible to culture C. pylori for about 5 yr, there are already sufficient data available to allow us to develop the basic framework that relates C. pylori gastritis to the causation of peptic ulcer disease. We review the data and propose mechanisms that implicate C. pylori as an important factor in the pathogenesis of peptic ulcer disease and consider the therapeutic implications. What we now know about C. pylori begins to unravel some of the mysteries surrounding peptic ulcer disease.
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Affiliation(s)
- D Y Graham
- Department of Medicine, Veterans Administration Medical Center, Houston, Texas
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