Helicobacter pylori: Helicobacter pylori gastritis--a novel distinct disease entity.

A global consensus report on Helicobacter pylori gastritis has been developed. Topics discussed include whether dyspepsia caused by H. pylori infection is separate from functional dyspepsia or not, the evaluation method for H. pylori-induced gastritis, eradication therapy for H. pylori gastritis to prevent gastric carcinogenesis and management after H. pylori eradication.

Kyoto global consensus report on Helicobacter pylori gastritis.

OBJECTIVE: To present results of the Kyoto Global Consensus Meeting, which was convened to develop global consensus on (1) classification of chronic gastritis and duodenitis, (2) clinical distinction of dyspepsia caused by Helicobacter pylori from functional dyspepsia, (3) appropriate diagnostic assessment of gastritis and (4) when, whom and how to treat H. pylori gastritis. DESIGN: Twenty-three clinical questions addressing the above-mentioned four domains were drafted for which expert panels were asked to formulate relevant statements. A Delphi method using an anonymous electronic system was adopted to develop the consensus, the level of which was predefined as ≥80%. Final modifications of clinical questions and consensus were achieved at the face-to-face meeting in Kyoto. RESULTS: All 24 statements for 22 clinical questions after extensive modifications and omission of one clinical question were achieved with a consensus level of >80%. To better organise classification of gastritis and duodenitis based on aetiology, a new classification of gastritis and duodenitis is recommended for the 11th international classification. A new category of H. pylori-associated dyspepsia together with a diagnostic algorithm was proposed. The adoption of grading systems for gastric cancer risk stratification, and modern image-enhancing endoscopy for the diagnosis of gastritis, were recommended. Treatment to eradicate H. pylori infection before preneoplastic changes develop, if feasible, was recommended to minimise the risk of more serious complications of the infection. CONCLUSIONS: A global consensus for gastritis was developed for the first time, which will be the basis for an international classification system and for further research on the subject.

[Acute erosive gastropathies].

There is a rise in the rates of acute erosive gastropathies in patients with cardiovascular and other somatic diseases. The role of acute erosive gastropathy-induced hemorrhages in the tanatogenesis of these diseases is underestimated; the problems of their prevention, diagnosis, and treatment remained unsolved. Many factors, mainly acute or chronic ischemia of the gastroduodenal mucosa, as well as its age-related involution, Helicobacter pylori infection, reflux gastritis, multiple organ dysfunction, drug-induced damage, etc., which are implicated in the pathogenesis of acute erosive gastropathies in patients with cardiovascular and other somatic diseases, are summarized.

[Principles of current classification of duodenitis]. / Printsipy sovremennoi klassifikatsii duodenitov.

The paper considers the principles of classification of chronic duodenitis. The current classification of chronic duodenitis may be divided into three parts: endoscopic, histological, and etiological. The characterizing terms of the endoscopic part are as follows: erythema, hemorrhages, atrophy, erosions, follicles. The endoscopic localization of duodenitis is as follows: proximal and distal portions (panduodenitis, including bulbitis in the proximal portion and postbulbitis in the distal portion, palpilitis). The nonspecific terms of the histological part are as follows: activity, inflammation, and atrophy. Its specific terms are: ventricular metaplasia, ventricular heterotopia, Helicobacter pylori, granulomas, lymphatic follicles, eosinophilic infiltration, lymphocytic infiltration. The following morphological categories of duodenitis are: nonatrophic, nodular, granulomatous, eosinophilic, and lymphocytic. The morphological localization of duodenitis is as follows: proximal and distal portions (panduodenitis, including bulbitis in the proximal portion and postbulbitis in the distal portion). The following degrees of its severity are: none changes, mild, moderate, and sever. The types (etiological factors) of duodenitis are as follows: acid-associated, drug-dependent, toxic (eliminating), and isolated nonspecific (idiopathic). Its special forms are: H. pylori-induced, granulomatous (Crohn's disease, sarcoidosis), nodal (Crohn's disease, sarcoidosis, acid-associated diseases), eosinophilic (unspecified allergens), lymphocytic (gluten-induced).

Enfermedad ácido péptica asociada a helicobacter pylori en niños

Ciento diecinueve niños de uno a 14 años que consultaron por síntomas sugestivos de enfermedad ácido péptica (EAP) fueron estudiados con endoscopia y biopsia. Presentaron gastritis antral 73.1 por ciento, duodenitis 10.08 por ciento, úlcera duodenal 4.2 por ciento, úlcera gástrica 1.6 por ciento y esofagitis 0.8 por ciento. Cincuenta y un pacientes fueron positivos para H.pylori. Tanto el grupo positivo como el negativo tuvieron sintomatología similar, pero la úlcera duodenal se asoció significativamente a H.pylori. Veintinueve (87.8 por ciento) de 33 niños positivos mejoraron clínicamente con diferentes combinaciones de amoxacilina, metronidazol, bismuto y antiácidos y antagonistas H2. Veinticinco (95 por ciento) de 26 negativos mejoraron con antiácidos y antagonistas H2

Duodenitis--distinguishing features in a retrospective endoscopic and histological study.

Routine films of 596 upper GI endoscopies with the diagnosis of duodenitis were reviewed and a classification was made into granular (G), multi-polypoid (MP), reddened (R) and erosive (E) types. Two hundred and thirty-four histological specimens from 117 of the patients, as well as 100 specimens from 50 controls, were analyzed for villous obliteration, Brunner's gland dilatation and mucus depletion, erosion, mucosal hemorrhage and edema, atypia of the surface epithelium and gastric surface epithelial metaplasia. Inflammatory cell counts for polymorphonuclear and mononuclear cells in the epithelium, in the lamina propria together with a histological score was also made. On the basis of this study and a review of classifications of duodenitis in the literature, it is concluded that some endoscopical features like erosions and redness may represent more acute phases of duodenitis, mucosal elevations representing more hyperplastic changes and that the endoscopic classification into G, MP, R and E types seem relevant to use in clinical practice.

Clinical and histologic study of endoscopic duodenitis.

Duodenitis was investigated by endoscopy in 93 cases from among 1242 subjects. Endoscopic duodenitis was classified into three types endoscopically--reddening type, erosive type and nodular type. There was a relatively high correlation between the endoscopic and the histological diagnosis of duodenitis. Severely inflamed cases were found histologically more frequently in erosive- or nodular-type duodenitis than in reddening-type duodenitis. During the follow-up period, changes in endoscopic findings were observed more frequently, from the erosive type to the reddening type, and from the reddening type to normal. There were no cases which subsequently developed duodenal ulcers. We found a significantly high incidence of "endoscopic duodenitis" in uremic patients who had been given regular dialysis, and not in hepatic cirrhosis patients.

[Erosive duodenitis. Clinical study of 287 cases]. / La bulbite érosive. Etude clinique de 287 observations.

We relate here the results of a retrospective (1984-1987) investigation on 1043 protocols of gastroscopy, where the diagnosis of erosive duodenitis (ED) has been made 372 times in 287 patients. The presence of Campylobacter pylori was not investigated. ED endoscopic incidence was 5.6%. Patients were divided into three groups: 1. ED alone: 15.7%. 2. ED associated with duodenal ulcer (DU): 48.4%. 3. E.D. associated with various diseases: 35.9%. There was a higher male/female ratio in the three groups, and mean ages were similar (50 years). In the group ED alone, the first symptom was nonspecific epigastric pain in 61%; no risk factor appeared, and it did not recur. When associated with DU, ED preceded DU in 8.8% of the cases, followed DU in 18.9%, had the same course in 37.1%, appeared transiently in 2.5%, or during DU healing in 3.7%. The two diseases were unrelated in 28.3% of the cases. Only tobacco seemed to promote the association of DU with ED.

The diagnosis and classification of gastritis and duodenitis.

There are specific and nonspecific categories of gastritis and duodenitis. In each category, the mucosal pattern may be erosive or nonerosive. Specific refers to distinctive patterns of inflammation associated with defined clinical syndromes. These are rare in the stomach and include granulomatous disorders and hypertrophic gastropathies. In the duodenal bulb they include Crohn's disease and any other disorder that may affect the proximal small bowel. Endoscopy diagnoses nonspecific erosive disease of the stomach and duodenal bulb. Histology diagnoses nonspecific, nonerosive gastritis (NNG) and duodenitis (NND). The major interest in NNG and NND is in their potential as pathogenic risk factors for other disorders. Although NNG and NND may theoretically cause symptoms, provocative tests need to be devised to prove this. Confusion in the classifications of NNG and NND often arises because clinicians, radiologists, endoscopists, and pathologists use similar terms to mean different things.