Frequency of Helicobacter pylori and gastritis in healthy subjects without gastrointestinal symptoms

[Endoscopy of the upper gastrointestinal tract]

Esophagogastroduodenoscopy (EGD) has replaced X-ray diagnosis as the standard method for assessment of the upper gastrointestinal tract. It also offers an array of minimally invasive treatment options. This contribution presents the requisite medical, technical, and human resources needed for EGD. The indication for this invasive procedure should always be carefully reviewed and contraindications excluded. EGD should be performed according to standardized procedures and well documented by noting distinctive features of peristalsis and describing alterations of mucosal size and surface texture. The endoscopic techniques of biopsy, chromoendoscopy, and percutaneous endoscopic gastrostomy should always be available in routine endoscopy.

Involvement of the corporal mucosa and related changes in gastric acid secretion characterize patients with iron deficiency anaemia associated with Helicobacter pylori infection

BACKGROUND

Recent studies have reported an association between iron deficiency anaemia and Helicobacter pylori. Helicobacter pylori could cause iron deficiency anaemia by altering iron absorption. We observed that most patients with Helicobacter pylori infection and iron deficiency anaemia present a chronic superficial pangastritis.

AIM

To investigate whether Helicobacter pylori-positive patients with iron deficiency anaemia have peculiar histological and functional features when compared with non-anaemic Helicobacter pylori-positive subjects.

PATIENTS

Fifty-one patients with iron deficiency anaemia, in whom chronic superficial Helicobacter pylori gastritis was the only gastrointestinal finding, and 103 non-anaemic Helicobacter pylori-positive controls were included in the study. Thirty-seven patients were randomly matched with 37 controls of the same sex and age.

METHODS

Gastroscopy, with antral (n=3) and body (n=3) biopsies, was performed. Gastrin and pepsinogen I levels and antiparietal cell antibodies were evaluated. Intragastric pH was also measured.

RESULTS

Gastritis involved the corporal mucosa in 90% of patients compared to 42.7% of controls (P < 0.0001). The mean inflammatory score in the gastric body was significantly higher among patients than in controls (2.2 vs. 0.6; P=0.012). Gastrin was significantly higher in patients than in controls (mean 60.2 vs. 29 pg/mL; P=0.0069). Intragastric pH was higher in patients than in controls (median 5.7 vs. 2; P=0.0026).

CONCLUSIONS

These data suggest that patients with iron deficiency anaemia and Helicobacter pylori infection have a peculiar pattern of gastritis with corporal involvement and related changes in intragastric pH.

Upper gastrointestinal endoscopic and histologic findings before and after vertical banded gastroplasty

BACKGROUND

A total of 30 consecutive morbidly obese patients, six males and 24 females, who underwent vertical banded gastroplasty (VBG) between January 1992 and December 1994 and were followed up by endoscopy and biopsy were included in this study with the aim to determine the short- and mid-term complications and to investigate alterations in esophageal, gastric, and duodenal mucosa after surgery.

METHODS

All patients underwent endoscopy before operation. Postoperatively, 28 patients were reendoscoped at 6 months, 26 at 12 months, and 22 at 18 months. Biopsies were taken from the lower part of esophagus, just below the esophagogastric junction (vertical part of the partitioned stomach), corpus, antrum, and duodenal bulb.

RESULTS

Before operation 5 patients (16.6%) had a hiatus hernia and four of them (13.3%) had esophagitis. Endoscopic gastritis was diagnosed in nine patients (30%) and endoscopic duodenitis in two (6. 6%). Histologically, in 15 patients (50%) esophagitis was recognized; in 24 patients (80%) corpus gastritis; in 27 patients (90%) antral gastritis; and in 23 (76.6%) duodenitis. Helicobacter pylori was found in 20 (66.6%) patients. Postoperatively, three patients developed a mild stoma stenosis and were treated only by passing the endoscope 6 months after operation; one patient, with a severe stoma stenosis, was treated by Eder-Puestow dilatations and surgery. Gastric ulcer was found in two patients 6 and 12 months after surgery. One patient developed an endostomach channel because of staple line dehiscence 18 months after VBG. An increasing incidence of esophagitis and gastritis of the vertical part of the stomach was found at 6 and 12 months. Endoscopic and histologic gastritis of the corpus and antrum, as well as endoscopic and histologic duodenitis decreased gradually after surgery.

CONCLUSIONS

Our findings suggest that postoperative complications of VBG can be diagnosed by endoscopy, and some of them can easily be managed. Vertical banded gastroplasty causes not only no harm to the esophageal, gastric, and duodenal mucosa but also influences them favorably.

Brush cytology: a reliable method to detect Helicobacter pylori

This study was conducted to verify the reliability of brush cytology in detecting Helicobacter pylori in an unselected group of patients with duodenal ulcer (DU) and nonulcer dyspepsia (NUD). Endoscopy was performed on 416 consecutive patients: group A, 94 with active DU; group B, 176 patients with DU after omeprazole (n = 78), ranitidine (n = 43), or triple anti-H. pylori therapy (n = 55); and group C, 146 patients with NUD. During endoscopy, the gastric mucosa was brushed and two biopsy samples from the antrum and body were obtained for histology. In 65 patients, culture of the brush-collected materials also was performed as was that from of biopsy samples. The overall frequency of H. pylori presence detected by brush cytology was significantly higher compared with that of histology (p < 0.001), particularly in group A (p < 0.05), group C (p < 0.05), and in patients with DU after omeprazole treatment (p < 0.01), but not in patients with DU after ranitidine or anti-H. pylori treatment. The overall frequency of H. pylori-positive cultures from the brush-collected material was higher compared with cultures from the biopsy samples (38.5% vs. 24.6%), particularly in the NUD group (32.6% vs. 16.3%). Brush cytology is more sensitive than histology, besides being faster and cheaper, for the assessment of H. pylori infection, particularly when the density of the bacteria is low.

Helicobacter colonization of biopsy specimens cultured in vitro is dependent on both mucosal type and bacterial strain

BACKGROUND

Colonization by Helicobacter pylori is strictly tissue-specific. We have previously reported on an in vitro adhesion model for pig and human gastric mucosa, in which biopsy specimens were successfully infected and cultured for 72h. The aim of this study was to compare H. pylori colonization of different mucosae and by different Helicobacter strains.

METHODS

Specimens from pig, rabbit, and rat antrum, pig urinary bladder, and pig duodenum were inoculated with two H. pylori strains and one H. mustelae strain. Four additional strains, including one mutant lacking flagella, were compared on pig antral specimens.

RESULTS

The viability of all mucosae was comparable at 48h of culture. The percentage adhering bacteria increased with time in all mucosae, reaching 17%, 11%, and 2% in pig, rabbit and rat antral mucosa, 11% in pig bladder, and 3% in duodenum at 48h. The type of H. pylori strain was a strong determinant for adhesion in pig antrum. Strain SVA40 had the highest adhesion; the mutant lacking flagella colonized very poorly. H. mustelae adhered to all types of mucosae in a more unspecific manner.

CONCLUSIONS

On the basis of tissue viability, bacterial colonization, and adhesion, pig antral mucosa is clearly superior. H. pylori strains differ in their ability to adhere to and colonize cultured mucosa.

Helicobacter pylori infection, serum gastrin, and gastric acid secretion in teen-age subjects with duodenal ulcer, gastritis, or normal mucosa

BACKGROUND

Many studies have confirmed the close association of Helicobacter pylori with duodenal ulcer (DU) in adults. However, in the subtype of DU known as 'childhood' or 'early onset DU' genetic factors seem to play a prominent role in the pathogenesis. The aim of this study was to investigate the prevalence of H. pylori in teen-age subjects with DU, gastritis, and normal mucosa and to examine the relationship of H. pylori to serum gastrin levels and gastric acid secretion.

METHODS

Sixty-one teen-age subjects (24 with DU, 14 with gastritis, and 23 normal subjects) were investigated for the presence of H. pylori, antral histology, gastrin levels, basal acid output (BAO), and maximal acid output (MAO).

RESULTS

All 24 patients with DU and 8 of 14 with gastritis were infected with H. pylori; none of the normal subjects were infected. Mean gastritis scores and fasting serum gastrin levels were significantly higher in patients with DU or H. pylori-positive gastritis than in subjects with H. pylori-negative gastritis or normal mucosa (p < 0.05). The difference in serum gastrin levels was also significant when patients with DU were compared with those with H. pylori-positive gastritis (p < 0.05). BAO and MAO were significantly higher in patients with DU than in subjects with H. pylori-positive gastritis or normal mucosa (p < 0.05), but there was no difference between subjects with H. pylori-positive gastritis and those with normal mucosa.

CONCLUSION

H. pylori infection is associated closely with teen-age DU and gastritis and with hypergastrinemia but does not affect BAO and MAO in most infected teen-age subjects.