Helicobacter pylori infection and gastric MALTomas: an up-to-date and therapy highlight

During the last 20 years Helicobacter pylori (Hp) has been, undoubtly, the star of gastroenterology and microbiology, so much to deserve the "Nobel prize 2005" for biology and medicine to its discoverers. More recently, an increased interest arised on Hp and its linkages with other medical fi elds such as immunology, surgery and dentistry. The outcome of the pathologies due to such bacterium is dependent on many factors, including bacterial genotype, host physiology and genetics, and environmental factors such as diet. In spite of its clear involvement in some pathologies like acute and chronic gastritis, peptic ulcer and gastric cancer, very little is known about another pathology recently proved to be closely associated to the infection by Hp: the gastric MALToma, which account for 7% of all newly diagnosed non-Hodgkin's lymphoma. The chronic infection of the gastric mucosa from Helicobacter pylori primes a complex pathogenic process which could determine the onset of the gastric cancer through some intermediary steps. On these bases, in 1994, the International Agency for Cancer Research (IARC) defined this bacterium a "class I carcinogenic agent" for gastric cancer. The MALT lymphomas are the most frequent lymphoid neoplasms of the digestive tract; we can also observe other and more rare lymphomatous tumours with specific clinical patterns, like the T-lymphoma associated with lymphomatous polyposis and enteropathy. The development of gastric lymphomas is usually preceded by the acquisition of lymphatic tissue, after inflammatory stimuli and particularly after the infection from Hp, which organizes itself with the characteristics of the MALT. Recently, a number of papers have highlighted the remarkable efficacy of Hp eradicating therapy in patients with low-grade MALT lymphoma of the stomach without other modalities, e.g. surgery and systemic chemotherapy. The aim of this study is to be helpful for a comprehensive understanding the possible connections between Hp and gastric MALT lymphoma, evaluating the best therapy strategies, surgical and non surgical, actually available for its treatment.

Our experience in Helicobacter pylori infection and gastric MALToma

OBJECTIVE

A number of recent studies have expanded our understanding of Helicobacter pylori (Hp) infection and of the pathogenesis of MALT lymphoma. The purpose of this paper is to perform a retrospective analysis of the clinical characteristics of gastric MALT lymphoma and its relationship with H. pylori infection in authors' experience.

MATERIALS AND METHODS

We report nineteen patients observed during 10 years, presenting with gastric MALTomas at any stage. The staging classification and the presence of H. pylori infection have been assessed, and the chosen therapy also.

RESULTS

The most part of our patients underwent surgery, still now resulting the most effective therapy. None of the patients had eradicating therapy due to their poor compliance and because the most part of cases were observed before the time of clinical validation of such treatment.

CONCLUSIONS

In our series, surgery was effective for treatment of gastric MALT lymphomas. Surgery and chemotherapy remain, in accord with literature data, the best treatment for gastric MALTomas. Hence, because Hp may play a role in the development of such pathology in certain patients, antibiotic treatment for Hp eradication should not be discouraged in these patients, especially in them with low grade gastric MALT lymphomas. In fact, the failure of this therapy will not modify either survival or later recourse to surgical and/or radio- and chemotherapy.

Gastroesophageal reflux disease and dental erosion. A case report and review of the literature

The term gastroesophageal reflux refers to the regurgitation of gastric material into the oesophagus. When the reflux is accompanied by inflammation of the oesophageal mucosa and extra-oesophageal symptoms the complaint is classified as a pathological condition called gastroesophageal reflux disease (GERD). GERD is caused by backward expulsion of the gastric content into the oesophagus. It is characterized by a complex clinical picture that may include lesions of the oesophageal mucosa and lesions of a different nature and severity of the respiratory and stomatognathic apparatus. GERD is considered to be a proteiform complaint induced by many different pathogenetic mechanisms resulting in a wide spectrum of clinical and morphological manifestations secondary to the reflux. Among extra-oesophageal manifestations, those affecting the dental structures are particularly important, owing to their aesthetic and functional implications on the stomatognathic apparatus. The Authors present a recently observed and treated case of GERD with associated severe aesthetic lesions of the frontal teeth. The currently available treatment options for the primary disease are examined, as well as the possible forms of conservative treatment of the affected teeth.