1210Understanding the effect of Helicobacter pylori infection on gastroesophageal reflux disease and Barrett’s oesophagus

Background Helicobacter pylori (H.pylori) infection causes atrophic gastritis and gastric cancer. Ironically, decreased gastric acid production in those with atrophic gastritis might reduce harmful gastroesophageal refluxate, thereby reducing gastroesophageal reflux disease (GERD) and Barrett’s oesophagus (BE) risk. Methods In two nested case-control studies with 425 GERD and 169 BE cases, we compared sex-specific GERD and BE risk in H.pylori seronegative participants with seropositive participants. Where seronegativity was associated with increased BE risk, we quantified the effect mediated by GERD using a Monte Carlo simulation-based g-computation approach to estimate interventional effects. Moreover, we classified participants into gastritis types using serum pepsinogen-I and gastrin-17 data. Results For men, H.pylori seronegativity was associated with 1.69-fold (CI:1.03-2.75) and 2.14-fold (CI:1.18-3.88) higher odds for GERD and BE respectively. Five (33%) out of the 15 per 1000 excess BE risk from being seronegative was mediated by GERD. No association was observed for women. Among those seropositive, the proportion with atrophic antral gastritis was higher for men than for women (68% vs 56%; p = 0.015). Conclusions H.pylori seronegativity was associated with increased GERD and BE risk for men but not women, which could be partly explained by the higher proportion of H.pylori-associated atrophic antral gastritis in men. Evidence of GERD mediating seronegativity’s effect on BE supports this explanation. Key messages Whilst H.pylori infection might reduce GERD and BE risk, this is potentially a by-product of atrophic gastritis, a risk factor for gastric cancer. Treating GERD could partly reduce the excess BE risk for seronegative individuals.

Chronic gastrite: modern state of the problem

Aim. Тo evaluate the modern view on the problem of chronic gastritis and the effectiveness of the drug ursodexic acid (UHC) Grinterol in the treatment of patients with chronic antral reflux-gastritis (biliar). Materials and methods. The work provides modern ideas about chronic gastritis, the issues of etiology and pathogenesis are considered. Contemporary classifications and the attitude of the authors of the work to them are presented. Clinical studies were conducted in 50 patients with chronic antral reflux-gastritis biliary (32 women and 18 men) between the ages of 20 and 80 years (average age 50.3 to 8.0 years). The treatment uses the drug Grinterol in a daily dose of 12.5 mg/kg of body weight for 4 weeks. Results. Among patients with chronic antral gastritis isolated patients with reflux-gastritis biliary, the pathogenetic factor of which is the damaging property of aggressive bile acids. The main treatment for such patients are drugs UHC (in this study (this study uses Grinterol at a daily dose of 12.5 mg/kg of body weight); the duration of treatment is 4 years. The overall efficiency (according to endomorphological data) was 76%, according to clinical data 100%. Discussion. Critical consideration of the classifications used and proposed for consideration indicates that the time has come for the adoption of a new classification with the allocation of reflux-gastritis biliary. Treatment of this form of antral gastritis is effective with UDHC drugs. Conclusion. the selection of a form of antral reflux-gastritis biliar in a separate classification group is scientifically justified. The results suggest that for the treatment of patients with chronic biliary refluxdrugs of choice are drugs UDHC.

Verrucous antral gastritis in relation to Helicobacter pylori infection, nutrition, and gastric atrophy

Background There have been few studies in the English literature regarding verrucous gastritis (VG). The present study investigated the clinical and endoscopic features of verrucous antral gastritis, especially focusing on Helicobacter pylori infection, nutrition, and gastric atrophy. Methods We performed a retrospective study of patients who underwent routine endoscopy with indigo carmine chromoendoscopy and a comparative study was conducted between VG-positive and VG-negative groups. VG was subdivided into classical and numerous types based on the number and distribution of verrucous lesions. Demographic, clinical, and endoscopic data including body mass index (BMI), serum albumin and cholesterol, gastric atrophy, reflux oesophagitis, Barrett’s oesophagus, and H. pylori status were collected. Univariate and multivariable analyses were performed to identify factors associated with VG. Results We analysed the data of 621 patients undergoing routine endoscopy and found that VG (n = 352) was significantly associated with increased BMI (1.12 [1.05–1.18], P < 0.01), reflux esophagitis (1.96 [1.10–3.28], P < 0.01), and H. pylori negativity with or without a history of eradication (9.94 [6.00–16.47] and 6.12 [3.51–10.68], P < 0.001, respectively). Numerous-type (n = 163) VG was associated with both closed- and open-type gastric atrophy (9.9 [4.04–21.37] and 8.10 [3.41–19.24], P < 0.001, respectively). There were no statistical differences between groups regarding age, sex, total cholesterol, albumin, and bile-colored gastric juice. Conclusions Verrucous antral gastritis was related to increased BMI, reflux esophagitis, and H. pylori negativity. Numerous-type verrucous lesions were associated with gastric atrophy. These indicate that VG may be a physiological phenomenon due to high gastric acidity, mechanical overload, and vulnerability of background mucosa.

THE MORPHOLOGY OF THE INFLAMMATION OF THE GASTRIC AND DUODENUM MUCOSA WITH HELICOBACTER PYLORI CONTAMINATION

The aim of the study was to study the morphological features of the inflammatory processes of the mucous membrane of various parts of the stomach and duodenum in patients with chronic gastritis and duodenitis. 24 patients (18 men and 6 women) were observed with chronic gastritis and duodenitis associated with Helicobacter pylori. The average age of the patients was 47 years. 120 biopsy samples of the mucosa of different parts of the stomach and duodenum were studied using histological, histochemical, morphometric and microbiological methods. Histological and microbiological examination of biopsy specimens revealed chronic antral gastritis, chronic fundal gastritis and chronic diffuse pangastritis. Superficial chronic duodenitis was rare and was erosive only in 11.4%. Helicobacter pylori in biopsy of stomach samples were detected more often in associations of various forms. Chronic antral gastritis of the type B was characterized by a predominantly high activity of the pathological process, moderate atrophy of the pyloric glands and a high incidence of small bowel metaplasia. Violations of the microvasculature, hemorrhages in the interfoveolaris part, plethora of blood vessels, and sludge in the capillaries were revealed in the lamina propria of the mucosa of the antrum of the stomach; lymph nodes with pronounced germinal centers were observed in half the cases. In the interfoveolaris part of the lamina propria of the mucous membrane, a high density of inflammatory cell infiltrate was observed, in which plasmocytes, lymphocytes, fibroblasts, fibrocytes, eosinophilic and neutrophilic granulocytes, macrophages were detected. Chronic fundal gastritis of the type B was characterized mainly with moderate and minimal activity of the pathological process. Helicobacter pylori were detected on the surface of the entire epithelium. Focal small intestinal metaplasia and atrophy of the main glands were rarely detected. Atrophy of the main glands was predominantly and minimal and was often combined with hyperplasia of parietal cells. The density of the inflammatory cellular infiltrate remained high; plasmocytes, lymphocytes, fibroblasts, eosinophilic and neutrophilic granulocytes, macrophages were found in it (in decreasing order). The study of biopsy samples of the mucosa of different parts of the stomach and duodenum against the background of contamination with a pyloric helicobacter revealed the presence of chronic antral, fundal gastritis and chronic duodenitis of the II-III degree with the development of small bowel metaplasia and dysplasia.

THE PREVALENCE OF CAGA HELICOBACTER PYLORI AND CHARACTERISTICS OF AN ASSOCIATED GASTRITIS IN SCHOOLCHILDREN IN THE REPUBLIC OF TYVA

Aim of the research. To study the prevalence of H. pylori cytotoxin-associated gene A (CagA) strain and estimate the activity of associated gastritis in schoolchildren with dyspepsia syndrome in the Republic of Tyva. Materials and Methods. We studied the prevalence of H. pylоri CagA strain by performing the cross-sectional examination for picked up randomly 1064 schoolchildren aged of from 7 to 17 years, residing in the Republic of Tyva. We used the technique of determination of blood IgG to CagA antigen of H. pylori in 218 children, including 131 cases with dyspeptic complaints. We also executed esophagogastroduodenoscopy including biopsy sampling. Results. CagA-seropositive children accounted for 47.2%. We noted the increase in the activity of antral gastritis in H. pylori-infected schoolchildren with the maximum being related to CagA-seropositive schoolchildren. Gastritis activity in the body of stomach in H. pylori-infected children was higher as compared to non-infected children, but as a whole it was lower than in antral region of the stomach. Besides that we revealed specific features of gastritis activities in the body and in the antral region of stomach in children in ethnic populations. The peculiarities are referred to the presence of the differences between the mentioned parameters in alien schoolchildren and the absence of such differences in the Tyvan schoolchildren. Conclusion. Widely spread H. pylori, in particular CagA strain of the microorganism, plays the adverse role in the development and especially progressing of gastritis in schoolchildren residing in the Republic of Tyva. The importance of the adverse impact of the infection is associated with the ethnicity of children.

Application of PCR and Microscopy to Detect Helicobacter pylori in Gastric Biopsy Specimen among Acid Peptic Disorders at Tertiary Care Centre in Eastern Nepal

Background. Helicobacter pylori infection is most prevalent in developing countries. It is an etiological agent of peptic ulcer, gastric adenocarcinoma, and mucosal-associated lymphoid tissue (MALT) lymphoma. Despite the development of different assays to confirm H. pylori infection, the diagnosis of infection is challenged by precision of the applied assay. Hence, the aim of this study was to understand the diagnostic accuracy of PCR and microscopy to detect the H. pylori in the gastric antrum biopsy specimen from gastric disorder patients. Methods. A total of 52 patients with gastric disorders underwent upper gastrointestinal endoscopy with biopsy. The H. pylori infection in gastric biopsies was identified after examination by microscopy and 23S rRNA specific PCR. The agreement between two test results were analysed by McNemar’s test and Kappa coefficient. Result. H. pylori infection was confirmed in 9 (17.30%) patients by both assays, 6.25% in antral gastritis, 22.22% in gastric ulcer, 100% in gastric ulcer with duodenitis, 50% in gastric ulcer with duodenal ulcer, and 33.33% in severe erosive duodenitis with antral gastritis. Out of nine H. pylori infection confirmed patients, 3 patients were confirmed by microscopy and 8 patients by PCR. In case of two patients, both microscopy and PCR assay confirmed the H. pylori infection. The agreement between two test results was 86.54% and disagreed by 13.46% (p value > 0.05). Conclusion. We found that PCR assay to detect H. pylori is more sensitive than microscopy. However, we advocate for the combination of both assays to increase the strength of diagnostic accuracy due to the absence of the gold standard assay for H. pylori infection.

COMPARISON BETWEEN THE ENDOSCOPIC FINDINGS AND THE HISTOLOGICAL DIAGNOSIS OF ANTRAL GASTRITES

ABSTRACT BACKGROUND: Gastritis is a very common disorder that is widely distributed worldwide, representing one of the most prevalent pathological entities in Gastroenterology and Digestive Endoscopy. OBJECTIVE: This study aims to analyze the correlation between the endoscopic findings and the histological diagnosis of antral gastritis. METHODS: In this study, 92 reports of upper digestive endoscopy were performed between November 2014 and January 2015, including biopsy of the antral gastric mucosa, comparing the endoscopic and histological findings, which were classified according to the Sidney System. The 92 exams included 35 men and 57 women, ranging in age from 15 to 84 years. The most frequent indication was epigastric pain. RESULTS: Of the 92 examinations analyzed, the histological diagnosis of antral gastritis appeared in 75 exams, 59 endoscopic reports contained the diagnosis of antral gastritis, and 33 endoscopic findings were normal. The kappa coefficient was 0.212 (P<0.05), indicating that there was no significant agreement between the endoscopic findings and the histological diagnosis of antral gastritis. CONCLUSION: We conclude that histology represents the gold standard method for the diagnosis of antral gastritis and that in daily clinical practice, biopsies should always be performed, regardless of the endoscopic findings.