Histological assessment of the Sydney classification of endoscopic gastritis

Diagnostic value of neutrophil to lymphocyte ratio in identifying gastritis in children with chronic abdominal pain in northern Iran

BACKGROUND

This study aimed to assess the diagnostic value of the Neutrophil to Lymphocyte Ratio (NLR) specifically for children with suspected gastritis.

METHODS

This cross-sectional study included children with chronic abdominal pain referred to Amirkola Children's Hospital, Babol, Iran, in 2021. Gastritis was diagnosed using upper gastrointestinal endoscopy and biopsy, Giemsa staining performed for Helicobacter pylori. Blood samples were analyzed to determine the NLR. Analysis was employed to establish the optimal NLR cut-off for diagnosing gastritis, with sensitivity, specificity, and predictive values calculated.

RESULTS

126 patients with an average age of 10.03 ± 2.46 were included in this study. 53.2% of children were boys The overall sensitivity and specificity of the mean NLR in diagnosing gastritis in children with abdominal pain based on endoscopy were 11.76% and 97.56%, respectively and for pathology 78.57% and 11.90%, respectively (Area under curve = 0.524 for endoscopy and 0.509 for pathology).

CONCLUSION

This study indicate that the NLR lacks sufficient diagnostic accuracy to serve as a reliable alternative to conventional methods, such as endoscopy and pathology, for diagnosing gastritis or H. Pylori in children with chronic abdominal pain. Standard diagnostic techniques are needed for accurate evaluation and management of Helicobacter pylori-associated gastritis.

Effects of Granule Dendrobii on chronic atrophic gastritis induced by N-methyl-N'-nitro-N-nitrosoguanidine in rats

BACKGROUND

Dendrobium officinale is an herb of Traditional Chinese Medicine (TCM) commonly used for treating stomach diseases. One formula of Granule Dendrobii (GD) consists of Dendrobium officinale and American Ginseng (Radix Panacis quinquefolii), and is a potent TCM product in China. Whether treatment with GD can promote gastric acid secretion and alleviate gastric gland atrophy in chronic atrophic gastritis (CAG) requires verification.

AIM

To determine the effect of GD treatment on CAG and its potential cellular mechanism.

METHODS

A CAG model was induced by feeding rats N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) for 12 wk. After oral administration of low, moderate, and high doses of GD in CAG rats for 8 wk, its effects on body weight, gastric mucosa histology, mucosal atrophy, intestinal metaplasia, immunohistochemical staining of proliferating cell nuclear antigen (PCNA) and B-cell lymphoma-2, and hemoglobin and red blood cells were examined.

RESULTS

The body weights of MNNG-induced CAG model rats before treatment (143.5 ± 14.26 g) were significantly lower than that of healthy rats (220.2 ± 31.20 g, P < 0.01). At the 8^th week of treatment, the body weights of rats in the low-, moderate-, and high-dose groups of GD (220.1 ± 36.62 g) were significantly higher than those in the untreated group (173.3 ± 28.09 g, all P < 0.01). The level of inflammation in gastric tissue of the high-dose group (1.68 ± 0.54) was significantly reduced (P < 0.01) compared with that of the untreated group (3.00 ± 0.00, P < 0.05). The number and thickness of gastric glands in the high-dose group (31.50 ± 6.07/mm, 306.4 ± 49.32 µm) were significantly higher than those in the untreated group (26.86 ± 6.41/mm, 244.3 ± 51.82 µm, respectively, P < 0.01 and P < 0.05), indicating improved atrophy of gastric mucosa. The areas of intestinal metaplasia were significantly lower in the high-dose group (1.74% ± 1.13%), medium-dose group (1.81% ± 0.66%) and low-dose group (2.36% ± 1.08%) than in the untreated group (3.91% ± 0.96%, all P < 0.01). The expression of PCNA in high-dose group was significantly reduced compared with that in untreated group (P < 0.01). Hemoglobin level in the high-dose group (145.3 ± 5.90 g/L), medium-dose group (139.3 ± 5.71 g/L) and low-dose group (137.5 ± 7.56 g/L) was markedly increased compared with the untreated group (132.1 ± 7.76 g/L; P < 0.01 or P < 0.05).

CONCLUSION

Treatment with GD for 8 wk demonstrate that GD is effective in the treatment of CAG in the MNNG model by improving the histopathology of gastric mucosa, reversing gastric atrophy and intestinal metaplasia, and alleviating gastric inflammation.

The indications for biopsy in routine upper gastrointestinal endoscopy

This review describes the indications and contraindications for endoscopic biopsy, in routine practice, of the upper gastrointestinal (GI) tract. We accept that this review provides grounds for controversy, as our stance in certain situations is counter to some national guidelines. Nevertheless, we provide evidence to support our viewpoints, especially on efficiency and economic grounds. We describe the particular controversies concerning the biopsy assessment of Barrett's oesophagus, chronic gastritis and the duodenum in the investigation of coeliac disease. We accept that there are indications for more extensive upper GI biopsy protocols in children than in adults; the latter constitute our main focus in this article. We would encourage detailed discussion between pathologists and their endoscopy colleagues about the indications, or lack of them, for routine upper GI endoscopic biopsy, as studies have shown that adherence to agreed guidelines has resulted in a very considerable diminution in the biopsy workload without compromising patient management. Furthermore, where biopsy is indicated, we emphasise the importance of accompanying clinical information provided to the pathologist, in particular regarding biopsy site(s), and regular feedback to endoscopists to improve and maintain the quality of such information. Finally, local dialogue is also advised, when necessary, to indicate to endoscopists the need to appropriately segregate biopsies into separate, individually labelled specimens, to maximise the information that can be derived by pathological evaluation and thereby improve the quality of the final pathology report.

Evaluation of Better Staining Method among Hematoxylin and Eosin, Giemsa and Periodic Acid Schiff-Alcian Blue for the Detection of Helicobacter pylori in Gastric Biopsies

Background

This study was undertaken to evaluate the preferred method (Giemsa or periodic acid Schiff-Alcian blue [PAS-AB] stains) of detecting Helicobacter pylori (H. pylori) in gastric mucosal biopsies in terms of sensitivity, specificity and applicability. To the best of my knowledge, this is the first report comparing Giemsa and PAS-AB staining for the detection of H. pylori in such biopsies.

Methods

The formalin-fixed paraffin-embedded blocks of 49 gastric biopsies from different patients were collected from the archive of anatomical pathology at King Abdulaziz Medical City, National Guard, Riyadh, Saudi Arabia. From each block, three slides were prepared and analysed using the hematoxylin and eosin (H&E), Giemsa and PAS-AB stains to detect the presence/absence of H. pylori, and the results were compared in terms of sensitivity, specificity and applicability.

Results

The majority of the biopsies in this study showed antrum-type gastric mucosa. Only 15 biopsies showed active gastritis, whereas the rest showed chronic gastritis. Three biopsies showed intestinal metaplasia. All were detected by PAS-AB stain, but only two-thirds were detected by H&E stain. Fifteen gastric biopsies showed H. pylori infection in general and in 13 of them, active gastritis cases were discovered. Fourteen out of these 15 H. pylori infection cases were detected by Giemsa stain, whereas only 13 cases were detected by H&E stain. PAS-AB stain showed the worst results since it demonstrated only 40% sensitivity and 67.65% specificity in H. pylori detection.

Conclusion

Giemsa stain has better sensitivity and specificity in gastric H. pylori infection detection than PAS-AB. Therefore, using PAS-AB stain to detect H. pylori infection is not recommended.

A modified Sydney system for the diagnosis of chronic gastritis in dogs

Background

The Sydney system for assessing inflammatory lesions in the gastric mucosa is based on endoscopic and histological examinations. This study aimed to apply the Sydney system to diagnose gastritis in dogs. The study also compared the results of endoscopic and histological examinations conducted on gastric mucosal biopsy specimens. A total of 56 dogs with chronic vomiting were analyzed in the study. The physical appearance of the gastric mucosa was assessed through endoscopic examination, while the severity of the gastric inflammation, inflammation activity, glandular atrophy, and intestinal metaplasia were assessed by histopathological examination.

Results

The endoscopic examination confirmed the presence of inflammatory lesions affecting the gastric corpus and pylorus in all the dogs, although the severity of these lesions differed between the individuals. Reflux gastritis was the most commonly observed gastric inflammation. In the histopathological examination of the gastric mucosal samples, inflammatory lesions were found in the gastric corpus of 53 dogs, while 55 dogs had lesions in the pylorus. This corresponds to a 96.4% agreement between the methods.

Conclusions

The Sydney system is a useful tool for macroscopic and microscopic assessment of changes in the gastric mucosa as it enables the determination of inflammation type and severity, which helps the canine gastroenterologists to reliably compare the results of the tests performed in different facilities. Besides, the use of the Sydney system in diagnosing lesions facilitates the selection and effective monitoring of treatment. However, despite a high rate of agreement between the results of endoscopic and histopathological examinations, it is recommended to use both these methods for the assessment of the gastric mucosa in dogs.

Linked color imaging confers benefits in profiling H. pylori infection in the stomach

Background and study aims There is a high prevalence of Helicobacter pylori infection. White light endoscopy (WLE) can be used for evaluating the mucosal lesions, but it does not have high diagnostic efficiency. Linked color imaging (LCI) is a newly developed endoscopic imaging technique. The aim of this study was to compare LCI with WLE in detecting and staging H. pylori infection in the stomach in a randomized controlled clinical trial.

Patients and methods A total of 253 patients who had indications for gastroduodenoscopy were enrolled and randomized into Group A (n = 127), who underwent WLE followed by LCI, and Group B (n = 126), who underwent LCI followed by WLE. Clinical data were collected and the diagnostic accuracy of WLE and LCI was calculated and compared.

Results The overall diagnostic accuracy of WLE and LCI for H. pylori infection was 31.5 % (n = 40) and 50.4 % (n = 64) in Group A (P = 0.001), and 36.5 % (n = 46) and 49.2 % (n = 62) in Group B (P = 0.029). In both groups, LCI had higher sensitivity, specificity, and Youden index scores than WLE. Four stages were defined in the course of H. pylori infection in the stomach. LCI staging results were more highly consistent with pathological staging than were WLE staging results (kappa value 0.772 vs. 0.516). The LCI observations were closely correlated with the pathology.

Conclusion LCI had a higher diagnostic efficacy for H. pylori infection in the stomach. Endoscopic color features under LCI can help to stage and profile H. pylori-associated gastritis.

Diagnostic Performance of Magnifying Endoscopy for Helicobacter pylori Infection: A Meta-Analysis

Background

Diagnosis of Helicobacter pylori (H. pylori) infection using magnifying endoscopy offers advantages over conventional invasive and noninvasive tests.

Objective

This meta-analysis aimed to assess the diagnostic performance of magnifying endoscopy in the prediction of H. pylori infection.

Methods

A literature search of the PubMed, Medline, EMBASE, Science Direct and the Cochrane Library databases was performed. A random-effects model was used to calculate the diagnostic efficiency of magnifying endoscopy for H. pylori infection. A summary receiver operator characteristic curve was plotted, and the area under the curve (AUC) was calculated.

Results

A total of 18 studies involving 1897 patients were included. The pooled sensitivity and specificity of magnifying endoscopy to predict H. pylori infection were 0.89 [95% confidence interval (CI) 0.87–0.91] and 0.82 (95%CI 0.79–0.85), respectively, with an AUC of 0.9461. When targeting the gastric antrum, the pooled sensitivity and specificity were 0.82 (95%CI 0.78–0.86) and 0.72 (95%CI 0.66–0.78), respectively. When targeting the gastric corpus, the pooled sensitivity and specificity were 0.92 (95%CI 0.90–0.94) and 0.86 (95%CI 0.82–0.88), respectively. The pooled sensitivity and specificity using magnifying white light endoscopy were 0.90 (95%CI 0.87–0.91) and 0.81 (95%CI 0.77–0.84), respectively. The pooled sensitivity and specificity using magnifying chromoendoscopy were 0.87 (95%CI 0.83–0.91) and 0.85 (95%CI 0.80–0.88), respectively. The “pit plus vascular pattern” classification in the gastric corpus observed by magnifying endoscopy was able to accurately predict the status of H. pylori infection, as indicated by a pooled sensitivity and specificity of 0.96 (95%CI 0.94–0.97) and 0.91 (95%CI 0.87–0.93), respectively, with an AUC of 0.9872.

Conclusions

Magnifying endoscopy was able to accurately predict the status of H. pylori infection, either in magnifying white light endoscopy or magnifying chromoendoscopy mode. The “pit plus vascular pattern” classification in the gastric corpus is an optimum diagnostic criterion.

Macroscopy predicts tumor progression in gastric cancer: A retrospective patho-historical analysis based on Napoleon Bonaparte's autopsy report

BACKGROUND

The cause of Napoleon Bonaparte's death remains controversial. Originally suggested to be gastric cancer, whether this was truly neoplastic or a benign lesion has been recently debated.

AIMS

To interpret findings of original autopsy reports in light of the current knowledge of gastric cancer and to highlight the significance of accurate macroscopy in modern-day medicine.

METHODS

Using original autopsy documents, endoscopic images and data from current literature, Napoleon's gastric situation was reconstructed. In a multicenter collection of 2071 gastric cancer specimens, the relationship between tumor size and features of tumor progression was assessed.

RESULTS

Greater tumor size was associated with advanced pT, nodal metastases and Borrmann types 3-4 (p<0.001). The best cut-off for predicting pT3-4 tumors was 6.5cm (AUC 0.8; OR 1.397, 95% CI 1.35-1.446), and 6cm for lymph node metastases (AUC 0.775; OR 1.389, 95% CI 1.338-1.442). The 6cm cut-off of had a positive predictive value of 0.820 for nodal metastases and a negative predictive value of 0.880 for distant metastases.

CONCLUSION

This analysis combines Napoleon's autopsy with present-day knowledge to support gastric cancer as his terminal illness and emphasizes the role of macroscopy, which may provide valuable information on gastric cancer progression and aid patient management.

Endoscopic and histological findings and Helicobacter pylori status in patients with reflux and/or dyspeptic symptoms: a recent Greek cohort study

The associations between symptoms and endoscopic findings have not been clearly defined. We aimed to assess the associations of reflux dyspepsia and/or symptoms with specific endoscopic findings, histological findings, as well as the presence of Helicobacter pylori infection and its CagA subtype. A total of 160 patients with dyspeptic and/or reflux symptoms underwent upper gastrointestinal endoscopy. Type and severity of symptoms during the last week were evaluated according to a questionnaire. Biopsy specimens were obtained from the esophagus and stomach. Presence of H. pylori was tested in tissue specimens and its CagA subtype in serum samples. Of the 160 patients, 70% reported reflux, 73.7% dyspeptic symptoms, while 43.7% of patients reported both. The major endoscopic findings were chronic gastritis (n = 134), hiatal hernia (n = 98), and erosive esophagitis (n = 55). There was no significant difference in the endoscopic findings of patients with and without dyspepsia except for the subgroup of ulcer-like dyspeptic patients with significantly more frequently erosive peptic lesions (25% vs. 8.7%, p = .01). Patients with reflux symptoms had more frequently erosive esophagitis (42.9% vs. 14.6%, p = .001). Types of histological lesions, presence of H. pylori infection, and its cagA subtype had no statistical difference with presence or not of any symptoms. Patients with compared with those without reflux or ulcer-like dyspeptic symptoms had endoscopically more frequently erosive esophagitis and erosive peptic lesions, respectively. On the contrary, there is no statistical difference regarding the histological lesions, the presence of H. pylori, and its cagA subtype in all subgroups of patients.

Evolution of the Hypothalamic-Pituitary-Gonadal Axis Regulation in Vertebrates Revealed by Knockout Medaka

Reproduction is essential for life, but its regulatory mechanism is diverse. The analysis of this diversity should lead us to understand the evolutionary process of the regulation of reproduction. In mammals, the hypothalamic-pituitary-gonadal axis plays an essential role in such regulation, and each component, hypothalamic GnRH, and pituitary gonadotropins, LH, and FSH, is indispensable. However, the common principle of the hypothalamic-pituitary-gonadal axis regulation among vertebrates remains unclear. Here, we used a teleost medaka, which is phylogenetically distant from mammals, and analyzed phenotypes of gene knockouts (KOs) for GnRH, LH, and FSH. We showed that LH release, which we previously showed to be directly triggered by GnRH, is essential for ovulation in females, because KO medaka of GnRH and LH were anovulatory in spite of the full follicular growth and normal gonadosomatic index, and spawning could be induced by a medaka LH receptor agonist. On the other hand, we showed that FSH is necessary for the folliculogenesis, because the follicular growth of FSH KO medaka was halted at the previtellogenic stage, but FSH release does not necessarily require GnRH. By comparing these results with the previous studies in mammals that both GnRH and LH are necessary for folliculogenesis, we propose a hypothesis as follows. During evolution, LH was originally specialized for ovulation, and regulation of folliculogenesis by GnRH-LH (pulsatile release) was newly acquired in mammals, which enabled fine tuning of reproduction through hypothalamus.

Comparison of endoscopic based diagnosis with Helicobacter urease test for Helicobacter pylori infection

Background

Helicobacter pylori is an important risk factor for gastritis, peptic ulcers and gastric cancer. The prevalence in developed countries is lower than 40 % but higher than 80 % in some developing countries. It is 75 % in Ghana. The Helicobacter urease test (HUT) is performed at endoscopy and gives an accurate diagnosis. The HUT is not routinely done at our facility and presumption of H. pylori is made based on endoscopic findings and H. pylori eradication prescribed, as the incidence in the general population is presumed high. Is this endoscopic diagnosis sufficient for diagnosing and treating H. pylori? We aimed to assess the feasibility of an endoscopic based H. pylori diagnosis and its accuracy using a HUT as the gold standard in consecutive patients.

Methods

Seventy-six consecutive adult patients with dyspepsia were assessed by upper gastrointestinal endoscopy. A clinical diagnosis of H. pylori or not was made. Biopsy samples were collected for HUT. H. pylori was diagnosed if HUT was positive. The results were then compared.

Results

Median age of patients was 45.0 years. H. pylori prevalence detected by HUT was 51.3 % (95 % CI 40.0–63.0). Sensitivity of endoscopic diagnosis of H. pylori was 71.8 % (95 % CI 55.1–85.0) and specificity was 37.8 % (95 % CI 22.5–55.2). There was no association between clinical findings (73.7 %) and HUT (26.3 %) (OR = 0.80; [95 % CI 0.24–2.64], p = 0.682). There was also no association between endoscopic diagnosis (71.8 %) and HUT (28.2 %), (OR = 1.55; 95 % CI 0.59–4.06, p = 0.373).

Conclusion

Helicobacter pylori infection was not as high as that published in earlier reports. The endoscopic diagnosis alone is not sufficient to make a diagnosis of H. pylori.

Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection

BACKGROUND AND STUDY AIMS

Linked color imaging (LCI) is a new image-enhanced endoscopy technique using a laser light source to enhance slight differences in mucosal color. The aim of this study was to compare the usefulness of LCI and conventional white light imaging (WLI) endoscopy for diagnosing Helicobacter pylori (H. pylori).

PATIENTS AND METHODS

We retrospectively analyzed images from 60 patients examined with WLI and LCI endoscopy between October 2013 and May 2014. Thirty patients had H. pylori infections, and other thirty patients tested negative for H. pylori after eradication therapy. Four endoscopists evaluated the 2 types of images to determine which was better at facilitating a diagnosis of H. pylori infection.

RESULTS

H. pylori infection was identified with LCI by enhancing the red appearance of the fundic gland mucosa. The accuracy, sensitivity, and specificity for diagnosing H. pylori infection using WLI were 74.2 %, 81.7 %, and 66.7 %, respectively, while those for LCI were 85.8 %, 93.3 %, and 78.3 %, respectively. Thus, the accuracy and sensitivity for LCI were significantly higher than those for WLI (P = 0.002 and P = 0.011, respectively). The kappa values for the inter- and intraobserver variability among the 4 endoscopists were higher for LCI than for WLI.

CONCLUSIONS

H. pylori infection can be identified by enhancing endoscopic images of the diffuse redness of the fundic gland using LCI. LCI is a novel image-enhanced endoscopy and is more useful for diagnosing H. pylori infection than is WLI.

Helicobacter pylori chronic gastritis updated Sydney grading in relation to endoscopic findings and H. pylori IgG antibody: diagnostic methods

Helicobacter pylori (Hp) inhabits the stomach of > 50% of humans and has been established as a major etiological factor in the pathogenesis of chronic gastritis, gastric atrophy, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. The aim of this study was to provide unequivocal information about Hp-associated gastritis grading according to the Sydney grading system and to compare the histopathological features with the endoscopic findings and anti-Hp immunoglobulin (Ig)G serological status. This analytical study was conducted on 157 patients with dyspeptic gastritis. All patients underwent esophagogastroduodenoscopy, and antrum and corpus biopsies were taken. Blood samples were obtained from all participants. Different stains were performed on formalin-fixed, paraffin-embedded tissue blocks that included hematoxylin and eosin and Giemsa stain for histopathological interpretation. The endoscopic findings of gastritis were observed in 120 patients and most of them showed hyperemia (80 patients), whereas seven patients had normal appearing gastric mucosa. Histologically variable numbers of mononuclear inflammatory cellular infiltrates were seen in 150 cases (95.5%). Most of them showed Grade 1 gastritis (80 patients), whereas Grades 2 and 3 were found in 43 and 27 biopsies, respectively. Hp colonization was observed in most of the examined biopsies (93.7%). Hp-IgG seropositivity was found in 80.9% of cases and 19.1% were seronegative. The relationship between endoscopic and histological findings was significant (p < 0.001).

Measuring Quality in Pediatric Endoscopy

Measuring quality in endoscopy includes the assessment of appropriateness of a procedure and the skill with which it is performed. High-quality pediatric endoscopy is safe and efficient, used effectively to make proper diagnoses, is useful for excluding other diagnoses, minimizes adverse events, and is accompanied by appropriate documentation from beginning through end of the procedure. There are no standard quality metrics for pediatric endoscopy, but proposed candidates are both process and outcomes oriented. Both are likely to be used in the near future to increase transparency about patient outcomes, as well as to influence payments for the procedure.

The effective use of gastrointestinal histopathology: guidance for endoscopic biopsy in the gastrointestinal tract

This is the first of three articles, published in Frontline Gastroenterology, that provides practical guidance of what to, and what not to, biopsy in the gastrointestinal (GI) tract. This initiative was established by the Endoscopy and Pathology Sections of the British Society of Gastroenterology, and the guidance is published with an initial general review (this manuscript), followed by practical guidance on upper GI and lower GI endoscopic biopsy practice. The three articles are written by experienced operatives, each one by a pathologist and an endoscopist, working in the same hospital/group of hospitals.

Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study

BACKGROUND

Endoscopic features corresponding to pathological findings in the Sydney System have not been identified, and endoscopic diagnosis of chronic gastritis has not yet been established. To establish the diagnosis of Helicobacter pylori (H. pylori) infection in gastric mucosa by endoscopic features, a prospective multicenter study was carried out.

PATIENTS AND METHODS

Two hundred and ninety-seven registered patients from 24 facilities between March 2008 and February 2009 were enrolled. Association between endoscopic findings (conventional findings and indigocarmine contrast (IC) method findings) and diagnosis of H. pylori infection made by microscopic observation of biopsy specimens was investigated in the corpus and antrum and their diagnostic accuracies were investigated.

RESULTS

Two hundred and seventy-five patients were analyzed. The area under the receiver operating characteristic (ROC) curve for H. pylori infection of conventional endoscopy was 0.811 in thecorpus and 0.707 in the antrum (P = 0.006). Evaluation of diffuse redness, spotty redness and mucosal swelling by conventional endoscopy and swelling of areae gastricae by the indigocarmine contrast (IC) method were useful for diagnosing H. pylori infection. Regular arrangement of collecting venules (RAC) in the angle, fundic gland polyposis, hemorrhagic erosion and bleeding spot in the corpus and red streaks, and erosions (flat, raised, hemorrhagic and bleeding spot) in the antrum may be used as diagnostic features suggesting negative H. pylori infection.

CONCLUSION

It is suggested that endoscopic diagnosis of H. pylori infection in gastric mucosa by conventional endoscopy and the IC method is mostly possible.

Accuracy of endoscopic diagnosis of Helicobacter pylori infection according to level of endoscopic experience and the effect of training

BACKGROUND

Accurate prediction of Helicobacter pylori infection status on endoscopic images can contribute to early detection of gastric cancer, especially in Asia. We identified the diagnostic yield of endoscopy for H. pylori infection at various endoscopist career levels and the effect of two years of training on diagnostic yield.

METHODS

A total of 77 consecutive patients who underwent endoscopy were analyzed. H. pylori infection status was determined by histology, serology, and the urea breast test and categorized as H. pylori-uninfected, -infected, or -eradicated. Distinctive endoscopic findings were judged by six physicians at different career levels: beginner (<500 endoscopies), intermediate (1500-5000), and advanced (>5000). Diagnostic yield and inter- and intra-observer agreement on H. pylori infection status were evaluated. Values were compared between the two beginners after two years of training. The kappa (K) statistic was used to calculate agreement.

RESULTS

For all physicians, the diagnostic yield was 88.9% for H. pylori-uninfected, 62.1% for H. pylori-infected, and 55.8% for H. pylori-eradicated. Intra-observer agreement for H. pylori infection status was good (K > 0.6) for all physicians, while inter-observer agreement was lower (K = 0.46) for beginners than for intermediate and advanced (K > 0.6). For all physicians, good inter-observer agreement in endoscopic findings was seen for atrophic change (K = 0.69), regular arrangement of collecting venules (K = 0.63), and hemorrhage (K = 0.62). For beginners, the diagnostic yield of H. pylori-infected/eradicated status and inter-observer agreement of endoscopic findings were improved after two years of training.

CONCLUSIONS

The diagnostic yield of endoscopic diagnosis was high for H. pylori-uninfected cases, but was low for H. pylori-eradicated cases. In beginners, daily training on endoscopic findings improved the low diagnostic yield.

Irregular arrangement of collecting venules (IRAC) provides a critical endoscopic insight in Helicobacter pylori-induced gastritis: A secondary publication

The aim of this study was to evaluate the significance of an endoscopic atrophic border and irregular arrangement of collecting venules (IRAC) in the diagnosis of Helicobacter pylori (H. pylori)-induced gastritis. Upper gastrointestinal tract endoscopy was performed on 723 patients, who were screened them for H. pylori infection. Any patients who had undergone H. pylori eradication therapy were excluded from the study. The endoscopic atrophic border and IRAC in each patient were assessed. The H. pylori status was determined in the patients by combination of a serological test and/or histopathological examination. The H. pylori infection rates were 95.4% (455/477) in the group with an endoscopic atrophic border and 22.3% (55/246) in the group without an endoscopic atrophic border. In the diagnostic validity check, presence of an endoscopic atrophic border had a sensitivity of 89.2% and a specificity of 89.7%. Furthermore, the H. pylori infection rates were 95.5% (506/530) in the IRAC group and 2.1% (4/193) in the regular arrangement of collecting venules (RAC) group. In the diagnostic validity check, IRAC had a sensitivity of 99.2% and a specificity of 88.7%. In conclusion, the presence of an endoscopic atrophic border and IRAC are highly indicative of an H. pylori-infected gastric mucosa.

An examination of the relationship between the endoscopic appearance of duodenitis and the histological findings in patients with epigastric pain

The endoscopic appearance of duodenitis is a common finding in patients undergoing endoscopy because of epigastric pain however, the relationship of the visual findings to histology is poorly defined. We set out to ascertain if there was a correlation between the endoscopic and histological appearances of the duodenal mucosa. Consecutive patients with epigastric pain referred for diagnostic gastroduodenoscopy were studied. The visual appearances of 'duodenitis' (erythema, erosions and sub-epithelial haemorrhage) were reported independently by two endoscopists. Duodenal biopsies were taken and assessed for: neutrophil infiltrate, mononuclear infiltrate, gastric metaplasia, villous atrophy and a breach in the mucosa. H pylori status was determined. Of the 93 patients with endoscopic features of duodenitis an increase in histological markers of inflammation was found in 75 (81%). However, histological inflammation was absent or minimal in 68 (73%). Conversely, biopsies from normal-looking mucosa revealed histological evidence of inflammation in 26 (27%). For patients with the endoscopic features of duodenitis the positive & negative predictive value for neutrophilic infiltrate was 39% and 98% respectively. Biopsies from erosions confirmed a breach in the mucosa in only 2 of 40 patients. Neutrophilic infiltrate occurred with NSAI ingestion and infection with H pylori. The endoscopic appearance of the duodenal mucosa is unreliable in determining the presence of histological inflammation. The endoscopic appearance of 'erosions' is not usually associated with a mucosal breach.

Downregulation of gastrokine-1 in gastric cancer tissues and restoration of its expression induced gastric cancer cells to apoptosis

Background

Gastrokine-1 (GKN1), a secreted protein, is specifically expressed in gastric mucosa to protect and maintain the integrity of gastric epithelium. The present study investigated differential expression of GKN1 in normal, precancerous, and cancerous gastric tissues, and explored the biological functions of GKN1 protein in gastric cancer cells.

Methods

RT-PCR, Western blot, and immunohistochemistry were performed to detect GKN1 expression in normal, precancerous, cancerous gastric tissues and seven gastric cancer cell lines. Gene transfection was used to restore GKN1 expression in gastric cancer AGS cells. Phenotypic changes (i.e., cell viability, apoptosis, cell cycle modulation, and sensitivity of gastric cancer cells to fluorouracil (5-FU)) were assayed in the transfected cells. DNA microarrays were used to analyze expression changes of apoptosis-related genes.

Results

Significant downregulation or absence of GKN1 expression in seven gastric cancer cell lines were detected and progressive decrease of GKN1 expression from normal mucosa, precancerous tissue, to cancer tissues was observed. Moreover, restoration of GKN1 expression suppressed gastric cancer cell viability and induced the cells to undergo apoptosis. GKN1 expression also enhanced tumor cell sensitivity to 5-FU treatment. Moreover, it was found that GKN1 expression in AGS cells modulated expression of 19 apoptosis-related genes.

Conclusions

Expression of GKN1 is progressively lost from normal mucosa, precancerous to cancerous gastric tissues, while restoration of GKN1 expression induces gastric cancer cells to undergo apoptosis, and enhances sensitivity of gastric cancer cells to 5-FU-induced apoptosis.

[The Usefulness of the Regular Arrangement of Collecting Venules Pattern for the Determination of Helicobacter pylori Infection]

BACKGROUND/AIMS

In the Helicobacter pylori (H. Pylori)-negative normal stomach, collecting venules are visible over all the gastric body as numerous minute points evaluated with standard endoscopy. This finding was termed regular arrangement of collecting venules (RAC), and its absence suggests H. pylori gastritis. The aim of this study was to evaluate the correlation between the RAC and rapid urease test.

METHODS

Two hundred sixty three consecutive adults undergoing upper digestive endoscopy and rapid urease test were included. The lesser curvature of the lower corpus was evaluated for the RAC pattern using a standard endoscope and different hemoglobin index. Two biopsies from the lesser curvature of the antrum and the greater curvature of the body were collected for rapid urease test.

RESULTS

H. pylori were detected in 51.3% (135/263) patients. Of the 57 patients with H. pylori-negative normal stomachs 53 patients (93%) had RAC. As a determinant of the normal stomach without H. pylori infection, the presence of RAC had 41.4% sensitivity, 97.0% specificity, 93.0% positive predictive value and 63.6% negative predictive value.

CONCLUSIONS

RAC-positive finding by standard endoscopy showed high positive predictive value and specificity of H. pylori-negative normal stomach. RAC-positive finding by standard endoscopy could be an useful finding to predict H. pylori negativity.

Pancreatoduodenectomy with subtotal stomach-preserving and uncut Roux reconstruction

BACKGROUND/PURPOSE

Pylorus-preserving pancreatoduodenectomy (PD) has become the therapy of choice for resectable tumors located in the head of the pancreas and periampullary region. In addition, a distal gastrectomy may still be required for tumors located in the dorsal part of the pancreatic head or when there is evidence of proximal duodenal invasion. This may lead to postoperative complications, including gastric dumping, marginal ulceration, and bile reflux gastritis. This study reports on the postoperative course following subtotal stomach-preserving PD with the uncut Roux reconstruction diverting biliary and pancreatic secretions from the gastric remnant.

METHODS

A technique combining subtotal stomach-preserving PD with the uncut Roux reconstruction was applied in 10 patients. The postoperative clinical follow-up data are reviewed, and clinical criteria of biliary gastric reflux and gastritis were evaluated.

RESULTS

The postoperative course was uneventful in 4 patients and complicated in 6 patients. Delayed gastric emptying occurred in 3 patients. No deaths occurred in the postoperative period. One patient suffered from occasional nausea with abdominal discomfort for which endoscopy and cholescintigraphy were performed. Endoscopy confirmed complete occlusion of the afferent jejunal limb and showed marginal ulceration within the gastrojejunal anastomosis. Cholescintigraphy showed signs of enterogastric reflux. The check-up endoscopy following typical antisecretory therapy revealed complete ulcer healing. Four patients died of tumor recurrence 6, 7, 8, and 12 months following surgery.

CONCLUSION

This pilot study suggests that the uncut Roux reconstruction may represent a good alternative to gastrointestinal reconstruction following PD. Further studies including the determination of intragastric bile acid concentration and radionuclide isotope scanning in a larger number of patients are warranted.

The regular arrangement of collecting venules pattern evaluated by standard endoscope and the absence of antrum nodularity are highly indicative of Helicobacter pylori uninfected gastric mucosa

AIM

To evaluate the accuracy of antrum nodularity and the regular arrangement of collecting venules for diagnosing Helicobacter pylori gastritis.

METHODS

Ninety-nine consecutive children and adolescents (1.07 years-17.69 years, mean+/-S.D.=9.71+/-3.80 F:M 54:45) undergoing upper digestive endoscopy were assessed for the presence of antrum nodularity and regular arrangement of collecting venules pattern to determine the status of H. pylori infection. Antrum nodularity was observed by a tangential view of the greater curvature of the gastric antrum. Regular arrangement of collecting venules was visualized as being the regular pattern of red points evaluated with a standard endoscope. Two biopsies from the antrum were collected for histology and rapid urease test. The accuracy of diagnosis based on antrum nodularity and regular arrangement of collecting venules was evaluated considering the sensitivity, specificity and likelihood ratio.

RESULTS

H. pylori was detected in 32/99 patients (32.3%). Antrum nodularity provided 59.4% sensitivity (95% confidence interval 50.7-68.1), 98.5% specificity (95% confidence interval: 97-100), likelihood ratio+ 39.78, and likelihood ratio- 0.41. A regular arrangement of collecting venules pattern provided 96.9% sensitivity (95% confidence interval: 93.8-100), 88.1% specificity (95% confidence interval: 84.1-92), likelihood ratio+ 8.11, and likelihood ratio- 0.04.

CONCLUSION

Antrum nodularity is a specific finding, although its sensitivity is low. A regular arrangement of collecting venules pattern and the absence of antrum nodularity are highly indicative of normal gastric mucosa that is negative for Helicobacter pylori.

Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia

BACKGROUND

The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia may lead to early diagnosis of gastric cancer. However, to-date no cost-effective model has been proposed. Improved endoscopic examination using magnification chromoendoscopy together with non-invasive functional assessment with pepsinogen serum levels are accurate in the diagnosis of intestinal metaplasia (extension) and minute dysplastic lesions. The aim of this study was to assess the feasibility and cost-effectiveness of a follow-up model for patients with atrophic chronic gastritis and intestinal metaplasia based on gastric mucosal status using magnification chromoendoscopy and pepsinogen.

METHODS

A cohort of patients with lesions as severe as atrophic chronic gastritis were followed-up according to a standardized protocol using magnification chromoendoscopy with methylene blue and measurement of serum pepsinogen I and II levels. A single node decision tree and Markov chain modeling were used to define cost-effectiveness of this follow-up model versus its absence. Transition rates were considered time-independent and calculated using primary data following cohort data analysis. Costs, quality of life and survival were estimated based on published data and extensive sensitivity analysis was performed.

RESULTS

A total of 100 patients were successfully followed-up over 3 years. Seven cases of dysplasia were diagnosed during follow-up, all among patients with incomplete intestinal metaplasia at baseline, six of whom had extensive (pepsinogen I to II ratio <3) incomplete intestinal metaplasia. For those individuals with atrophic chronic gastritis or complete intestinal metaplasia, a yearly measurement of pepsinogen levels or an endoscopic examination on a 3-yearly basis would cost 455 euros per quality-adjusted life year (QALY) gain. Endoscopic examination and pepsinogen serum level measurement on a yearly basis would cost 1868 euros per QALY for patients with extensive intestinal metaplasia.

CONCLUSIONS

The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia is both feasible and cost-effective if improved accurate endoscopic examination of gastric mucosa together with non-invasive assessment of gastric mucosal status are used to identify individuals at high-risk for development of gastric cancer.

Extensive intestinal metaplasia in gastric carcinoma and in other lesions requiring surgery: a study of 3,421 gastrectomy specimens from dwellers of the Atlantic and Pacific basins

BACKGROUND

Extensive intestinal metaplasia (EIM) has been reported in gastrectomies from patients dwelling in the Pacific and Atlantic basins.

AIMS

To compare all the results in an attempt to explain the findings.

METHOD

All sections from 3,421 gastrectomies were reviewed at various hospitals: 1946 in the Atlantic and 1475 in the Pacific basin. Sections with EIM showed IM encompassing one or more entire low power field (>or=5 mm in length/section) in one or more section.

RESULTS

In the Atlantic basin, EIM was present in 18.8% (153 of 814) of specimens with intestinal carcinoma (IC) and in 10.3% (65 of 630) of those with diffuse carcinoma (DC). In the Pacific basin, EIM was found in 62.9% (412 of 655) of gastrectomies with IC and in 33.3% (160 of 481) of those with DC. The numbers of specimens with EIM were significantly higher in the Pacific than in the Atlantic basin for both carcinoma phenotypes, particularly among elderly patients (>or=60 years).

CONCLUSIONS

The proportion of gastrectomies with EIM was higher among populations at a higher gastric cancer risk than in those with a lower cancer risk. EIM was mostly associated with IC rather than DC or with miscellaneous gastric diseases (841 control gastrectomies) in both basins. The proportion of gastrectomies with EIM was significantly higher in Vancouver than in New York and in Santiago de Chile than in Buenos Aires, even though these populations reside at approximately the same geographical latitude, but in different basins. Environmental factors seem to accelerate the evolution of EIM.

Diagnosis and grading of gastritis by non-invasive optical analysis

OBJECTIVES

The precise identification of many diseases of the gastrointestinal tract requires the histological analysis of multiple biopsies of the lining mucosae, thus preventing an immediate diagnosis and the safe screening of the entire organ. To address these limitations, we developed a novel spectroscopic procedure for a real-time, non-invasive optical analysis of mucosae.

METHODS

We have used a fibre-optic probe that monitors light propagation through small tissue volumes to evaluate the antral and fundic mucosa of 51 patients that underwent gastroscopy for symptoms of dyspepsia. Several optical coefficients were computed from the recorded light reflectance, and confronted to the diagnosis made by an expert gastroscopist at the time of the clinical examination. Both evaluations were then validated by comparison with the histological diagnosis of a pathologist who screened biopsies taken at the sites of the optical measurements.

RESULTS

We report that the optical procedure discriminated normal and pathological gastric mucosae with a higher sensitivity and specificity than endoscopic diagnosis. We also show that the changes in light-scattering coefficient, which permitted the optical diagnosis of gastritis alterations, were indirectly correlated with the extent of inflammatory infiltration of the mucosa and detected mucosal alterations mild enough to escape endoscopic detection.

CONCLUSIONS

The results show that, in a normal clinical setting, the optical in vivo analysis provided by our system detects alterations typical of gastritis, and allow for their graded scoring with a specificity and sensitivity that compare well with those of standard histology, while avoiding the invasiveness of the latter procedure. The method is adaptable to the screening of other types of lesions and mucosae and, hence, should prove useful in improving available diagnostic approaches.

Correlations of hemoglobin index (IHb) of gastric mucosa with Helicobacter pylori (H. pylori) infection and inflammation of gastric mucosa

BACKGROUND

Helicobacter pylori (H. pylori) infection causes various gastric diseases, among them H. pylori-associated gastritis characterized by diffuse redness of the gastric mucosa. The haemoglobin index (IHb) of the fundic mucosa is an objective parameter of the extent of mucosal redness, but it is unclear whether or not IHb can be used as a diagnostic marker for H. pylori infection. The purpose of this investigation was to evaluate the correlations between IHb of the fundic mucosa and H. pylori infection, inflammatory cell infiltration, and inflammatory mediator production.

METHODS

IHb of the fundic mucosa was measured in 108 patients with various gastric diseases (group 1), and values were compared between H. pylori-positive and H. pylori-negative patients. Fifteen patients with H. pylori infection from group 1 underwent H. pylori eradication therapy and IHb was measured before and after treatment. Both IHb and inflammatory cell infiltration were assessed in 61 patients (group 2). In 31 patients from group 2, the expression of interleukin (IL)-8 and inducible nitric oxide synthase (iNOS) messenger RNA (mRNA) was assayed in gastric biopsy specimens by the reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

IHb levels were significantly higher in H. pylori-positive patients than in H. pylori-negative patients (P < 0.001). IHb was decreased at one month after the eradication of H. pylori (P < 0.001). IHb was higher in patients with infiltration by both mononuclear cells and neutrophils (P < 0.001). There was a significant correlation between the IHb level and the expression of IL-8 mRNA (P < 0.001), as well as between IHb and iNOS mRNA expression (P < 0.05).

CONCLUSIONS

There were significant correlations between IHb of the gastric mucosa and H. pylori infection, inflammatory cell infiltration, and IL-8/iNOS mRNA expression, suggesting that IHb is a reliable marker of H. pylori infection for use during follow-up endoscopy after H. pylori eradication therapy.

Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia

BACKGROUND

The aim of this study was to define the reproducibility and accuracy of magnification chromoendoscopy for the diagnosis of lesions associated with gastric cancer (intestinal metaplasia and dysplasia).

METHODS

A total of 136 patients with previously diagnosed lesions and 5 gastrectomy specimens were studied. Endoscopic examination was performed with a magnification endoscope after methylene blue (1%) spraying. According to differences in color and mucosal pattern, groups and subgroups of endoscopic images were defined, and biopsies taken (n = 462). Five endoscopists were asked to classify individually 2 endoscopic images per subgroup on 2 separate occasions.

RESULTS

Three groups of endoscopic images were defined: nonmetaplastic, nondysplastic mucosa (I); metaplastic mucosa (II); and dysplastic mucosa (III). Ten subgroups were defined according to pit pattern: round small (IA), round and tubular small (IB), coarse round (IC), and course round pits with a straight pit (ID); blue irregular marks (IIA), blue round and tubular pits (IIB), blue villi (IIC), and blue small pits (IID); and loss of clear pattern, with depression (IIIA) or with slight elevation (IIIB). The kappa statistic for intraobserver agreement on the classification of endoscopic images in groups was 0.86; for interobserver agreement, it was 0.74. For classification into subgroups, kappa values ranged from 0.48 to 0.78. For 85% of the areas classified endoscopically as Group I (n = 146), no mucosal lesions or gastritis was described at histologic examination; for 83% of those in Group II (n = 198), intestinal metaplasia was found. Subgroups IIA and IIB were more often associated with complete intestinal metaplasia (62%), and IIC and IID with incomplete metaplasia (67%); in Group III (n = 118), dysplasia was diagnosed histopathologically in 33%. For the diagnosis of dysplasia, specificity was 81% (95% CI [77%, 85%]) and negative predictive value 99% (95% CI [99%, 100%]).

CONCLUSIONS

Gastric endoscopic patterns with chromoendoscopy and magnification seem reproducible and valid for the diagnosis of lesions associated with gastric cancer. This procedure may improve the follow-up of individuals at high-risk of gastric cancer, at least for the exclusion of severe lesions.

Gastritis and carditis

Dyspepsia is a common clinical problem. Its causes include peptic ulcer disease, gastroesophageal reflux, and functional (nonulcer) dyspepsia. A detailed clinical description of pain does not reliably differentiate the cause. Approximately 80% of gastroscopies are performed for the investigation of dyspepsia. "Gastritis" is diagnosed endoscopically in 59% of all stomachs, although in only 3% are the changes severe. Pathologic examination of unselected gastric biopsy specimens reveals that abnormalities are present in 62-73%, but there is only a weak correlation between endoscopic and histologic findings. For these reasons, it is recommended that endoscopic examination should always be accompanied by biopsy. Ideally, biopsies should be taken in a systematic fashion to include sampling of antrum and corpus. Recent evidence suggests that gastric infection by Helicobacter pylori initially presents as a superficial gastritis. Later it may become atrophic with development of intestinal metaplasia. The onset of atrophic changes may be related to the duration of infection, the strain of the infecting organism, associated dietary factors, or as-yet undefined host factors related to immunity. Persistent superficial gastritis predisposes to duodenal ulcer and gastric mucosa-associated lymphoid tissue lymphoma. Atrophic gastritis predisposes to gastric ulcer and adenocarcinoma. Evidence is accumulating that in some patients, pernicious anemia may be an end result of H. pylori-induced atrophic gastritis. Reactive gastropathy is a relatively common finding in gastric biopsies; in most instances it is associated with either reflux of duodenal contents or therapy with nonsteroidal anti-inflammatory drugs. Lymphocytic gastritis, eosinophilic gastritis, and the gastritis associated with Crohn's disease are distinct morphologic entities. Lymphocytic gastritis and eosinophilic gastritis have a variety of clinical associations. Carditis is a controversial topic: currently opinions are divided as to whether it is the result of gastroesophageal reflux or a proximal extension of H. pylori infection from the remainder of the stomach.

Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection

BACKGROUND AND AIMS

The aim of this study was to clarify the endoscopic features of the Helicobacter pylori (H. pylori)-free stomach by examining the arrangement of minute points visible on the corpus. Since these points were clarified by magnifying endoscopy as collecting venules, this finding was termed 'regular arrangement of collecting venules (RAC)'. The findings from more endoscopic studies are presented and the differences between magnified views of the normal and H. pylori-infected corpus and antrum are described in particular.

METHODS

The study group consisted of 557 patients who were subjected to endoscopy and checked for H. pylori. The RAC in each patient was assessed. Magnifying endoscopy in 301 patients was used to examine the corpus and in 94 patients to examine the antrum.

RESULTS

One hundred and fifty-eight patients had normal stomachs without H. pylori. We diagnosed 389 patients with H. pylori gastritis. In 10 patients H. pylori was not detected, but inflammation was present. Of the 158 patients with H. pylori-negative normal stomachs, 151 had RAC. As a determinant of the normal stomach without H. pylori infection, the presence of RAC had 93.8% sensitivity and 96.2% specificity. All 30 patients with H. pylori-negative normal stomachs had a well-defined ridge pattern (wDRP) on the antrum as observed under magnifying endoscopy. As a determinant of the normal stomach without H. pylori infection, wDRP had a specificity of 100%, but a sensitivity of only 54.5%.

CONCLUSIONS

The presence of RAC is characteristic of a normal stomach without H. pylori. Magnified views of the normal antrum were different from that of the normal corpus.

Fundal gastritis as a potential cause of reflux oesophagitis

The transient lower oesophageal sphincter relaxations which allow reflux may be due to altered afferent pathways from the fundus. We aimed to determine whether fundal inflammation is the underlying cause. Two endoscopic biopsies were taken from each of the gastric antrum and fundus in 25 asymptomatic controls with a normal endoscopy (median age 54 range 13-83 years), and 33 patients with erosive oesophagitis (median age 52, 11-78 years). No patient had taken acid suppression therapy or antibiotics for at least 1 month. Sections were stained with haematoxylin and eosin and Giemsa stain and examined in a blinded fashion by one pathologist for the presence of gastritis (Sydney classification) and Helicobacter pylori. Chronic gastritis was common in both groups, but was usually mild. In Helicobacter pylori-negative subjects, there was significantly less chronic gastritis in the antrum and the fundus in oesophagitis patients than in controls (p < 0.05). When present, gastric atrophy was usually antral and mild in severity. There was no difference in the incidence of gastric atrophy in patients with oesophagitis compared with controls (24% compared with 40%; p > 0.05). Chronic gastritis is not more common in patients with oesophagitis, and is unlikely to play a part in the pathogenesis of this disease.

Endoscopic and histological comparison of nonulcer dyspepsia with and without Helicobacter pylori infection evaluated by the modified Sydney system

OBJECTIVE

Our aim was to identify endoscopic features associated with Helicobacter pylori (H. pylori) infection in patients with nonulcer dyspepsia.

METHODS

A total of 50 infected patients with nonulcer dyspepsia who underwent endoscopy with antral and corporal biopsies and 50 patients matched for age and sex but with nonulcer dyspepsia without H. pylori were reviewed retrospectively by three endoscopists blinded to the H. pylori status and the patient's history. The endoscopic findings of gastritis, classified by a modification of the Sydney system as present or absent, were evaluated, and the histological severity was graded by the updated Sydney system.

RESULTS

For endoscopic features, the odds ratio was 53.1 (95% confidence interval, 6.8-414.9) for edema, 18.8 (5.8-60.5) for erythema with reddish streaks excluded, 0.0275 (0.0002-0.477) for reddish streaks, 17.4 (0.97-313.7) for friability, 14.2 (5.1-40.0) for exudate, 17.2 (2.2-137.6) for flat erosions, 2.54 (0.81-7.94) for raised erosions, 40.1 (2.3-694.5) for rugal hypertrophy, 19.1 (2.4-151.6) for rugal atrophy, 96.2 (23.4-395.9) for a vascular pattern, 0.125 (0.010-1.06) for bleeding spots, and 21.0 (2.6-166.5) for nodularity. The histological severity of inflammation, neutrophil activity, and atrophy in the antrum and corpus and of metaplasia in the antrum was greater in the infected patients than in the noninfected patients.

CONCLUSIONS

Endoscopic features associated with H. pylori were a vascular pattern, edema, rugal hypertrophy, nodularity, rugal atrophy, erythema with reddish streaks excluded, flat erosions, and exudate. These endoscopic features were associated with the histological findings of inflammation, neutrophil activity, atrophy, and metaplasia.

The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis

BACKGROUND

This study examines endoscopic findings in the diagnosis of Helicobacter pylori (H. pylori) in the Japanese population.

MATERIALS AND METHODS

The endoscopic findings (including gastric fold findings and degree of atrophy by the Kimura-Takemoto classification system), histologic severity of inflammation, and glandular atrophy were assessed according to the Sydney system in 642 patients (419 men; 223 women; mean age 43.5 years, range 13-86). H. pylori infection was evaluated by Giemsa staining and serum IgG antibodies.

RESULTS

391 of 642 patients (60.9%) were diagnosed as having endoscopic gastritis. Of the 391 patients with endoscopic gastritis, 318 (82.6%) had histologic gastritis and 310 (79.3%) had H. pylori infection. Of the 251 patients with endoscopically normal stomachs, 43 (17.1%) had histologic gastritis and 32 (12.7%) had H. pylori infection. Atrophic gastritis was the most prevalent finding (56.3%) among those with endoscopic gastritis. The prevalence of H. pylori infection in patients with atrophic gastritis (92.7%) and rugal hyperplastic gastritis (92.3%) was significantly higher than in those with other types of gastritis or with a normal stomach (12. 7%). A markedly high prevalence of H. pylori infection was found in subjects with tortuosity, hyperrugosity, and/or hyporugosity of the gastric folds.

CONCLUSIONS

The accurate endoscopic assessment of gastritis according to the Sydney system along with gastric fold findings and the endoscopically identified extent of gastric atrophy are valuable indicators for determining H. pylori infection and histologic gastritis in the Japanese population.

Presence of Helicobacter pylori in the oral cavity, oesophagus, stomach and faeces of patients with gastritis

The presence of Helicobacter pylori in the oral cavity (6 sites), oesophagus, stomach and bowel of 20 dyspeptic patients was investigated. Samples were cultured on three selective media and analyzed by 16S rDNA polymerase chain reaction (PCR) and southern hybridization. Helicobacter pylori DNA was detected by PCR from oral-cavity samples of three (20%) and from faeces samples of only one (7%) of the patients whose stomach biopsies were positive for Helicobacter pylori. When culture was used, the microorganism's rate of recovery from the oral cavity and faeces was 13% and 7%, respectively. One patient had a Helicobacter pylori-like organism in samples collected from the tongue and palate. Both strains were urease, catalase and oxidase positive and grew microaerophilically but were negative on PCR analysis. This demonstrates the possibility of false identification of Helicobacter pylori by use of routine enzyme reactions. Interestingly, specimens collected from the cheeks of three patients were positive for Helicobacter pylori by PCR analysis. This is the first instance of detection of this microorganism in the cheek.