Nonsteroidal antiinflammatory drug associated gastroduodenal lesions and its relation to Helicobacter pylori infection. Endoscopic and histopathological study

Objective To investigate the histomorphological characteristics of the gastric mucosa and the prognosis in patients with Helicobacter pylori infection. Methods Progressive damage to the gastric mucosa was examined by immunohistochemistry in 2294 patients with H. pylori infection and follow-up information was analyzed. Results H. pylori initially colonized the mucus layer covered by the gastric mucosa epithelium, then selectively adhered to and destroyed the surface mucus cells causing intra-gastric and extra-gastric lesions. Gastric mucosal damage induced by H. pylori was divided into five stages according to the depth of H. pylori invasion and degree of lesion deterioration: mucilaginous, surface mucocellular, lamina propria lesion, mucosal atrophy, and intraepithelial neoplasia stages. Morphological follow-up analysis revealed no significant difference in 6-month curative effects between stage I and stage II, but significant differences were found between stages II and III, stages III and IV, and between stages IV and stage V, respectively. Conclusions This novel staging strategy may be a valuable tool for diagnosing and predicting the results of gastric mucosal damage induced by H. pylori infection.

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Helicobacter pylori and Nonsteroidal Antiinflammatory Drug Peptic Ulcers

10.2310/gastro.5438 ◽

2016 ◽

Author(s):

Edward A Lew

Keyword(s):

Helicobacter Pylori ◽

Diagnostic Tests ◽

Antiinflammatory Drug ◽

Nonsteroidal Antiinflammatory Drug ◽

Small Intestinal Mucosa ◽

Peptic Ulcers ◽

Treatment Regimens ◽

Chronic Active Gastritis ◽

Hematoxylin And Eosin ◽

H Pylori

Peptic ulcers are defects or breaks in the gastric or small intestinal mucosa that have depth and extend through the muscularis mucosae. The pathogenesis of peptic ulcers is multifactorial and arises from an imbalance of protective and aggressive factors such as when gastrointestinal mucosal defence mechanisms are impaired in the presence of gastric acid and pepsin. Infection with Helicobacter pylori and the use of nonsteroidal anti-inflammatory drugs and acetylsalicylic acid are major risk factors associated with peptic ulcers. In general, these factors disrupt normal mucosal defenses and repair, making the mucosa more susceptible to acid. This review covers the epidemiology of peptic ulcers, diagnostic tests for H. pylori, and treatment of peptic ulcers and H. pylori. The figure shows gastric biopsy samples stained with hematoxylin and eosin demonstrating chronic active gastritis both with and without the presence of H. pylori organisms. The tables list diagnostic tests for H pylori, and common treatment regimens for H. pylori. Key words: Helicobacter pylori, H. pylori, NSAID-related peptic ulcer, diagnosis of helicobacter pylori, H. pylori treatment, urea breath test, ASA after bleeding ulcer This review contains 1 highly rendered figure, 2 tables, and 54 references

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