RESUMO
La gastritis es una enfermedad con una alta morbilidad a nivel mundial, el principal factor de riesgo es la infección por Helicobacter pylori. Objetivo: Describir las características clínicas, histopatológica y endoscópicas en una población con gastritis crónica. Material y métodos: Se realizó un estudio observacional de tipo descriptivo, retrospectivo, se incluyeron 49 pacientes que acudieron a la consulta externa del área de gastroenterología, de 18 a 65 años, a quienes se realizó el estudio histopatológico y endoscópico en el Servicio de Gastroenterología en el Hospital General Quevedo, de Los Ríos-Ecuador, durante septiembre 2017 septiembre 2018. Resultados: Se observó predominio del género masculino (65%); en mayores de 40 años (55%), la epigastralgía y la sensación de acidez estomacal, 39% y 35% respectivamente, fueron los síntomas más frecuentes, La positividad para Helicobacter pylori, alcanzó el 86%, y la lesión no erosiva un 73%, existió mayor presencia de la forma no atrófica (84%) sobre la atrófica. Conclusiones: La gastritis crónica predominó en el grupo etario mayor a 40 años y de género masculino, siendo los factores de riesgo de mayor prevalencia la infección por Helicobacter pylori y los asociados al consumo de antiinflamatorios no esteroideos, mala alimentación, alcohol y tabaco, los síntomas como epigastralgía y la sensación de acidez estomacal fueron los más frecuentes. El hallazgo endoscópico fue mayor para las formas no erosivas, y de acuerdo a la histopatología la gastritis no atrófica antral moderada fue la más frecuente(AU)
Gastritis is a disease with high morbidity worldwide, the main risk factor is Helicobacter pylori infection. Objective: To describe the clinical, histopathological and endoscopic characteristics in a population with chronic gastritis. Material and methods: An observational, descriptive, retrospective study was carried out, including 49 patients who attended the outpatient consultation of the gastroenterology area, aged 18 to 65 years, who underwent a histopathological and endoscopic study in the Gastroenterology Service at the Quevedo General Hospital, Los Ríos-Ecuador, during September 2017 - September 2018. Results: A predominance of the male gender was observed (65%); In people over 40 years of age (55%), epigastralgia and the sensation of heartburn, 39% and 35% spectively, were the most frequent symptoms, the positivity for Helicobacter pylori, reached 86%, and the non-erosive lesion 73 %, there was a greater presence of the non-atrophic form (84%) over the atrophic one. Conclusions: Chronic gastritis predominated in the age group over 40 years of age and male, the most prevalent risk factors being Helicobacter pylori infection and those associated with the consumption of non-steroidal anti-inflammatory drugs, poor diet, alcohol and tobacco. symptoms such as epigastric pain and the sensation of heartburn were the most frequent. The endoscopic finding was greater for non-erosive forms, and according to histopathology, moderate antral non-atrophic gastritis was the most frequent(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Anti-Inflamatórios não Esteroides , Helicobacter pylori/efeitos dos fármacos , Dispepsia/etiologia , Mucosa Gástrica/patologia , Gastrite/fisiopatologia , Úlcera Péptica , Sinais e Sintomas , Biópsia , Preparações Farmacêuticas , Endoscopia Gastrointestinal , Acidez , GastroenterologiaRESUMO
BACKGROUND AND AIMS: Patients with autoimmune atrophic gastritis (AAG) often complain of acid reflux symptoms, despite the evidence of hypo-achlorhydria. Rome IV criteria are used to define functional esophageal disorders. Our aim was to characterize gastroesophageal reflux disease (GERD) phenotypes in patients with AAG. METHODS: Between 2017-2018, 172 AAG patients were evaluated at Gastro-Oncology outpatient clinic of University of Padua. Of them, 38 patients with reflux symptoms underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring (MII-pH). Seventy-six AAG consecutive patients asymptomatic for gastroesophageal reflux were selected as age and gender matched controls. Serum biomarkers (pepsinogens, gastrin-17 and Helicobacter pylori antibodies), upper endoscopy, histology and clinical data were compared. RESULTS: Out of 38/172 (22%) AAG patients with reflux symptoms, 2/38 had a GERD diagnosis based on abnormal esophageal acid exposure and 6/38 had a major motility disorder (i.e. outflow obstruction). Among the 30/38 patients with normal endoscopic findings, 9/30 had reflux hypersensitivity, 19 functional heartburn, 1 functional globus, 1 functional chest pain according to the Rome IV criteria. Antral atrophy, advanced corpus atrophy and OLGA stage were more frequent in controls than in reflux patients (p=0.01, p=0.031, p=0.01, respectively). No differences were found for serum biomarkers and symptom presentation. Most of the patients received proton pump inhibitors (PPIs) treatment (87%), with a minority (34%) reporting clinical benefit. CONCLUSIONS: Reflux symptoms are relatively common in AAG patients, but a firm diagnosis of GERD is rare (5%), whereas most of the patients have a functional disorder. PPI treatment is mostly clinical ineffective and should not be largely indicated.
Assuntos
Doenças Autoimunes/fisiopatologia , Gastrite/imunologia , Gastrite/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Idoso , Anticorpos Antibacterianos/sangue , Biomarcadores/sangue , Endoscopia do Sistema Digestório , Gastrinas/sangue , Gastrite/patologia , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/patologia , Helicobacter pylori/imunologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pepsinogênios/sangue , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
INTRODUCTION: To describe the clinical and laboratory profile, natural course, treatment outcome, and risk factors of posttransplant esophageal and nonesophageal eosinophilic gastrointestinal disorders (EGIDs). METHODS: All children (aged <18 years) who underwent liver transplantation, between 2011 and 2019, in a single transplant center with a follow-up period of 1 year or more posttransplant and with a history of posttransplant endoscopic evaluation were included in this study. RESULTS: During the study period, 89 children met the inclusion criteria. Patients were followed for a median of 8.0 years. A total of 39 (44%) patients were diagnosed with EGID after transplantation. Of these, 29 (33%) had eosinophilic esophagitis (EoE), and 10 (11%) had eosinophilic gastritis, gastroenteritis or enterocolitis. In comparison with the non-EGID group, patients with EGID were younger at transplant (P ≤ 0.0001), transplanted more frequently due to biliary atresia (P ≤ 0.0001), and had higher rates of pretransplant allergy (P = 0.019). In the posttransplant period, they had higher rates of mammalian Target of Rapamycin inhibitor use (P = 0.006), Epstein-Barr virus viremia (P = 0.03), post-transplant lymphoproliferative disease (P = 0.005), and allergen sensitization (P ≤ 0.0001). In regression analysis, young age at transplant, age at diagnosis, pretransplant atopic dermatitis, and post-transplant lymphoproliferative disease were associated with an increased risk of EGID or EoE. Laboratory abnormalities such as anemia (P = 0.007), thrombocytosis (P = 0.012), and hypoalbuminemia (P = 0.031) were more commonly observed in the eosinophilic gastritis, gastroenteritis or enterocolitis group than in the EoE group. Following treatment, most patients had symptomatic resolution at 3 months and histologic resolution at 6 months postdiagnosis. Among the patients who had 5 years of follow-up, none recurred. DISCUSSION: EGID is a common posttransplant diagnosis, which seems to affect patients who are transplanted earlier and who have pretransplant atopy. Posttransplant EGID is responsive to treatment, but as histologic remission occurs after symptomatic resolution, the decision to perform control endoscopy should be delayed.
Assuntos
Enterite/epidemiologia , Enterocolite/epidemiologia , Eosinofilia/epidemiologia , Esofagite Eosinofílica/epidemiologia , Gastrite/epidemiologia , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Antialérgicos/uso terapêutico , Atresia Biliar/cirurgia , Budesonida/uso terapêutico , Criança , Pré-Escolar , Colestase Intra-Hepática/cirurgia , Dermatite Atópica/epidemiologia , Progressão da Doença , Redução da Medicação , Enterite/tratamento farmacológico , Enterite/fisiopatologia , Enterocolite/tratamento farmacológico , Enterocolite/fisiopatologia , Eosinofilia/tratamento farmacológico , Eosinofilia/fisiopatologia , Esofagite Eosinofílica/tratamento farmacológico , Esofagite Eosinofílica/fisiopatologia , Infecções por Vírus Epstein-Barr/epidemiologia , Feminino , Seguimentos , Gastrite/tratamento farmacológico , Gastrite/fisiopatologia , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Humanos , Hipersensibilidade/epidemiologia , Imunossupressores/uso terapêutico , Lactente , Cetotifeno/uso terapêutico , Falência Hepática Aguda/cirurgia , Transtornos Linfoproliferativos/epidemiologia , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/fisiopatologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Serina-Treonina Quinases TOR/antagonistas & inibidores , Tacrolimo/uso terapêutico , Resultado do Tratamento , Viremia/epidemiologiaRESUMO
Malignant melanoma is cancer of the skin which commonly metastasises to the stomach. There have been no reported cases of emphysematous gastritis secondary to metastasis of malignant melanomas, to date. However, a 61-year-old woman with metastatic malignant melanoma of the left great toe presented to us with symptoms of severe left hypochondrium pain associated with high-grade fever, gross abdominal distension and recurrent vomiting. Two months earlier, metastasis was observed to have spread to the stomach and inguinal lymph nodes. At this stage, the patient opted for traditional medication instead of definitive surgery and chemotherapy. Radiological imaging revealed an emphysematous change to the stomach which was radiologically consistent with gastric malignant melanoma. Unfortunately, the patient succumbed to this rare condition.
Assuntos
Enfisema , Melanoma/patologia , Neoplasias Cutâneas/patologia , Neoplasias Gástricas , Estômago/patologia , Diagnóstico Diferencial , Enfisema/diagnóstico , Enfisema/etiologia , Evolução Fatal , Feminino , Gastrite/diagnóstico , Gastrite/etiologia , Gastrite/fisiopatologia , Humanos , Metástase Linfática/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Administração dos Cuidados ao Paciente/métodos , Neoplasias Gástricas/complicações , Neoplasias Gástricas/fisiopatologia , Neoplasias Gástricas/secundário , Tomografia Computadorizada por Raios X/métodosRESUMO
Currently, there are inconsistencies in the recommendations of when to obtain an esophagogastroduodenoscopy (EGD) in children with feeding difficulties. The aim of our study was to identify EGD findings in patients presenting to a large, outpatient feeding program. Additionally, we investigated the presence of any relationship between abnormal pathology seen on biopsies (inflammation) and symptoms of feeding intolerance such as vomiting, gagging, retching, or abdominal pain. Retrospective analysis of electronic medical records (EMRs) was conducted for all new patients aged 0-17 years presenting to the Multidisciplinary Feeding Clinic. Three hundred and thirty patients (50.2%) had an EGD with complete biopsies. Of these 330 patients, biopsies revealed esophagitis in 40%, gastritis in 33.6%, and duodenitis in 15.2%. Overall, 61.21% had an abnormal pathology in at least one site. We found that children with feeding disorders commonly have esophagitis, gastritis, and/or duodenitis and that symptoms are poor predictors of pathology. This study underscores the importance of gastrointestinal evaluation as part of a multidisciplinary evaluation in patients with feeding difficulties.
Assuntos
Duodenite/diagnóstico , Endoscopia do Sistema Digestório/métodos , Esofagite/diagnóstico , Gastrite/diagnóstico , Dor Abdominal/etiologia , Adolescente , Criança , Pré-Escolar , Duodenite/complicações , Duodenite/fisiopatologia , Esofagite/complicações , Esofagite/fisiopatologia , Feminino , Gastrite/complicações , Gastrite/fisiopatologia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Vômito/etiologiaRESUMO
Helicobacter pylori (H. pylori) infection leads to the massive apoptosis of the gastric epithelial cells, causing gastric ulcers, gastritis, and gastric adenocarcinoma. Autophagy is a cellular recycling process that plays important roles in cell death decisions and can protect cells by preventing apoptosis. Upon the induction of autophagy, the level of the autophagy substrate p62 is reduced and the autophagy-related ratio of microtubule-associated proteins 1A/1B light chain 3B (LC3B)-II/LC3B-I is heightened. AMP-activated protein kinase (AMPK) and mammalian target of rapamycin (mTOR) are involved in the regulation of autophagy. Astaxanthin (AST) is a potent anti-oxidant that plays anti-inflammatory and anti-cancer roles in various cells. In the present study, we examined whether AST inhibits H. pylori-induced apoptosis through AMPK-mediated autophagy in the human gastric epithelial cell line AGS (adenocarcinoma gastric) in vitro. In this study, H. pylori induced apoptosis. Compound C, an AMPK inhibitor, enhanced the H. pylori-induced apoptosis of AGS cells. In contrast, metformin, an AMPK activator, suppressed H. pylori-induced apoptosis, showing that AMPK activation inhibits H. pylori-induced apoptosis. AST inhibited H. pylori-induced apoptosis by increasing the phosphorylation of AMPK and decreasing the phosphorylation of RAC-alpha serine/threonine-protein kinase (Akt) and mTOR in H. pylori-stimulated cells. The number of LC3B puncta in H. pylori-stimulated cells increased with AST. These results suggest that AST suppresses the H. pylori-induced apoptosis of AGS cells by inducing autophagy through the activation of AMPK and the downregulation of its downstream target, mTOR. In conclusion, AST may inhibit gastric diseases associated with H. pylori infection by increasing autophagy through the activation of the AMPK pathway.
Assuntos
Antineoplásicos , Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Células Epiteliais/microbiologia , Células Epiteliais/fisiologia , Gastrite/microbiologia , Gastrite/fisiopatologia , Infecções por Helicobacter , Helicobacter pylori , Proteínas Quinases Ativadas por AMP/genética , Proteínas Quinases Ativadas por AMP/metabolismo , Anti-Inflamatórios , Antioxidantes , Apoptose/genética , Autofagia/genética , Linhagem Celular Tumoral , Mucosa Gástrica/citologia , Humanos , Proteínas Associadas aos Microtúbulos/genética , Proteínas Associadas aos Microtúbulos/metabolismo , Fosforilação/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Serina-Treonina Quinases TOR/genética , Serina-Treonina Quinases TOR/metabolismo , Xantofilas/farmacologiaRESUMO
BACKGROUND: It is well known that Crohn's disease can involve the stomach. However, most often this upper gastrointestinal tract involvement is asymptomatic. Typically, there is involvement of the small intestine with the typical associated symptoms of Crohn's disease: abdominal cramps, diarrhoea and weight loss. METHODS: We report a case of a young woman with complaints of dyspepsia since 2 months. RESULTS: Gastroscopy revealed severe aphthous pangastritis with biopsies showing a focal active and chronic gastritis with presence of granulomas. We therefore performed a coloscopy showing an aphthous terminal ileum. The pathologic report indicated granulomatous reaction concordant with a slightly active, mildly chronic terminal ileitis typical for Crohn's disease. CONCLUSION: The incidence of upper gastrointestinal tract involvement of Crohn's disease is still underestimated, partially due to the asymptomatic nature in two thirds of patients. IBD gastritis should always be included in the differential diagnosis of gastritis, considering the increased risk of a more severe disease course and complications.
Assuntos
Dor Abdominal/fisiopatologia , Doença de Crohn/diagnóstico , Dispepsia/fisiopatologia , Gastrite/fisiopatologia , Adulto , Colonoscopia , Doença de Crohn/patologia , Doença de Crohn/fisiopatologia , Endoscopia do Sistema Digestório , Esofagite Péptica/patologia , Feminino , Gastrite/patologia , Humanos , Ileíte/patologiaRESUMO
Primary eosinophilic gastrointestinal diseases (EGIDs) represent a heterogeneous group of disorders characterized by eosinophilic inflammation in the absence of known causes for eosinophilia, selectively affecting different segments of the gastrointestinal tract. While pediatric eosinophilic esophagitis (EoE) is a well-defined disease with established guidelines, Eosinophilic Gastritis (EoG), Eosinophilic Gastroenteritis (EoGE) and Eosinophilic Colitis (EoC) remain a clinical enigma with evidence based on limited anecdotal case reports. Large cross-sectional studies in the US defined a prevalence of EoG and EoGE ranging from 1,5 to 6,4/100.000 and from 2,7 to 8,3/100.000 subjects respectively, while the prevalence of EoC ranges from 1,7 to 3,5/100.000 subjects. Regarding the pathogenesis, it is hypothesized that EGIDs result from the interplay between genetic predisposition, intestinal dysbiosis and environmental triggers. Clinically, EGIDs might present with different and nonspecific gastrointestinal symptoms depending on the involved intestinal tract and the extension of eosinophilic inflammatory infiltrate. The diagnosis of EGIDs requires: 1. recurrent gastrointestinal symptoms, 2. increased eosinophils for high power field in biopsy specimens, 3. absence of secondary causes of gastrointestinal eosinophilia. No validated guidelines are available on the clinical management of patients with EGIDs. Evidence from case reports and small uncontrolled case series suggests the use of dietary and corticosteroids as the first-line treatments. Considering the clinical follow-up of EGIDs, three different patterns of disease course are identified: single flare, recurring course-disease and chronic course-disease. This review will focus on pediatric EGIDs distal to esophagus, including Eosinophilic Gastritis (EoG), Eosinophilic Gastroenteritis (EoGE) and Eosinophilic Colitis (EoC).
Assuntos
Enterite , Eosinofilia , Gastrite , Criança , Progressão da Doença , Enterite/diagnóstico , Enterite/imunologia , Enterite/fisiopatologia , Enterite/terapia , Eosinofilia/diagnóstico , Eosinofilia/imunologia , Eosinofilia/fisiopatologia , Eosinofilia/terapia , Gastrite/diagnóstico , Gastrite/imunologia , Gastrite/fisiopatologia , Gastrite/terapia , HumanosRESUMO
BACKGROUND AND AIM: Helicobacter pylori (H. pylori) is closely associated with pre-neoplastic lesions such as atrophic gastritis (AG) and gastric intestinal metaplasia (GIM). The relationshionship between inflammation, hyperhomocysteinemia and arterial stiffness is of pathophysiological relevance for the development of cardiovascular disease. This study aimed to investigate the relationship between vitamin B12, folic acid, homocysteine (Hcy) and pulse wave velocity (PWV) levels in patients with GIM, AG and non-atrophic non-metaplastic chronic gastritis. PATIENTS AND METHODS: ninety-seven patients with GIM, 67 patients with AG and 69 patients with chronic gastritis were included in the study. Glucose, creatinine, total cholesterol, triglyceride, low-density lipoprotein, cholesterol, high-density lipoprotein cholesterol, vitamin B12, folic acid and Hcy levels were measured by biochemical methods. PWV and other vascular parameters were measured using the Phsyio-port AS device. MAIN RESULTS: PWV was higher in patients with GIM and AG than in controls (p < 0.05 and p < 0.05, respectively). Vitamin B12 levels were significantly lower in patients with GIM and AG than in controls (p < 0.01 and p < 0.01, respectively). Folic acid levels were significantly lower in patients with GIM than in controls (p < 0.05). Hcy levels were significantly higher in patients with GIM and AG than in controls (p < 0.001 and p < 0.05, respectively). A logistic regression analysis showed that GIM, AG and vitamin B12 deficiency were predictors for arterial stiffness. CONCLUSIONS: PWV values increased in patients with GIM and AG compared to non-atrophic non-metaplastic chronic gastritis, without different conventional cardiovascular risk factors.
Assuntos
Ácido Fólico/sangue , Gastrite Atrófica/sangue , Gastrite Atrófica/fisiopatologia , Homocisteína/sangue , Intestinos/patologia , Análise de Onda de Pulso , Estômago/patologia , Rigidez Vascular , Vitamina B 12/sangue , Adulto , Idoso , Doença Crônica , Feminino , Gastrite/sangue , Gastrite/complicações , Gastrite/fisiopatologia , Gastrite Atrófica/complicações , Humanos , Masculino , Metaplasia/complicações , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The prevalence of Helicobacter pylori varies geographically by age, race, and socioeconomic status (SES). However, the impact of ethnicity on endoscopic outcomes in infected individuals is not well known. OBJECTIVES: To assess the impact of ethnicity among Israelis with biopsy-proven H. pylori infection. METHODS: A retrospective study, including patients who underwent gastroscopy and were diagnosed histologically with H. pylori infection, was conducted. Information on demographics, SES, medications, and co-morbidities were extracted from medical records. Univariate (Student's t-test, chi-square test) and multivariate (multinomial and logistic) regression analysis were conducted to examine the predictors of the clinical outcome. RESULTS: The study included 100 Israeli Jews and 100 Israeli Arabs diagnosed with biopsy-proven H. pylori infection. At univariate analysis, the number of households was higher among Arabs (P < 0.001), whose family income and parental education were lower than among Jews (P < 0.001 for both variables). The response to amoxicillin and clarithromycin differed between the two groups, being higher among Jews (P < 0.001).In clinical outcomes (gastritis severity, gastric and duodenal ulcer, intestinal metaplasia, atrophic gastritis, and MALT), no statistically significant differences could be detected between Jews and Arabs. Concerning intestinal metaplasia, lack of consumption of nonsteroidal anti-inflammatory drugs resulted a statistically significant protective factor (odds ratio 0.128, 95% confidence interval 0.024-0.685, P = 0.016). CONCLUSIONS: Although in the literature ethnicity seems to be a risk factor for H. pylori colonization, no statistical significance was detected in various endoscopic and histological findings related to H. Pylori infection between Israeli Arabs and Jews.
Assuntos
Amoxicilina/uso terapêutico , Claritromicina/uso terapêutico , Mucosa Gástrica , Gastrite , Gastroscopia , Infecções por Helicobacter , Helicobacter pylori/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Árabes/estatística & dados numéricos , Biópsia/métodos , Biópsia/estatística & dados numéricos , Demografia , Feminino , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastrite/etnologia , Gastrite/patologia , Gastrite/fisiopatologia , Gastroscopia/métodos , Gastroscopia/estatística & dados numéricos , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/etnologia , Infecções por Helicobacter/patologia , Infecções por Helicobacter/fisiopatologia , Humanos , Israel/epidemiologia , Judeus/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores SocioeconômicosRESUMO
No specific endoscopic features for eosinophilic gastroenteritis (EGE) have been reported previously. This study therefore evaluated the endoscopic findings of six patients with EGE. The diagnosis was confirmed based on gastrointestinal symptoms, pathological findings on biopsy, and the absence of other diseases. The site of the lesion was identified based on eosinophilic infiltration with ≥20 cells per high-power field during a pathological specimen analysis. Flattening of the small intestinal villi was observed in four patients; we speculate that this may be a specific feature in the diagnosis of EGE.
Assuntos
Duodeno/fisiopatologia , Endoscopia/métodos , Enterite/diagnóstico , Enterite/fisiopatologia , Eosinofilia/diagnóstico , Eosinofilia/fisiopatologia , Gastrite/diagnóstico , Gastrite/fisiopatologia , Mucosa Intestinal/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas e Procedimentos Diagnósticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Helicobacter pylori (H. pylori) eradication therapy may improve gastric atrophy and intestinal metaplasia, but the results of previous studies have not always been consistent. The aim of this study was to compare the histological changes of intestinal metaplasia and gastric atrophy among the use of acid-suppressing drugs after H. pylori eradication. METHODS: A cohort of 242 patients who underwent successful eradication therapy for H. pylori gastritis and surveillance endoscopy examination from 1996 to 2015 was analyzed. Changes in the histological scores of intestinal metaplasia and atrophy according to drug use (proton-pump inhibitors (PPIs), H2 receptor antagonists (H2RAs), and non-acid suppressant use) were evaluated in biopsies of the antrum and corpus using a generalized linear mixed model in all patients. RESULTS: The mean follow-up period and number of biopsies were 5.48 ± 4.69 years and 2.62 ± 1.67 times, respectively. Improvement in the atrophy scores of both the antrum (p = 0.042) and corpus (p = 0.020) were significantly superior in patients with non-acid suppressant drug use compared with those of PPI and H2RA use. Metaplasia scores in both the antrum and corpus did not improve in all groups, and no significant differences were observed among groups in the antrum (p = 0.271) and corpus (p = 0.077). CONCLUSIONS: Prolonged acid suppression by PPIs or H2RAs may limit the recovery of gastric atrophy following H. pylori eradication.
Assuntos
Atrofia/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Atrofia/microbiologia , Atrofia/fisiopatologia , Atrofia/prevenção & controle , Endoscopia , Feminino , Ácido Gástrico/metabolismo , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/microbiologia , Mucosa Gástrica/fisiopatologia , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Gastrite/fisiopatologia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/fisiopatologia , Helicobacter pylori/metabolismo , Helicobacter pylori/patogenicidade , Humanos , Intestinos/efeitos dos fármacos , Intestinos/microbiologia , Intestinos/fisiopatologia , Masculino , Metaplasia/tratamento farmacológico , Metaplasia/microbiologia , Metaplasia/fisiopatologia , Pessoa de Meia-IdadeRESUMO
Helicobacter pylori (H. pylori) is a common problem and a significant cause of chronic gastric inflammation. H. pylori, ongoing gastric inflammation and its severity are the most critical component of precursors of gastric cancer. Hypothetically, every chronic tissue injury activates platelets, and the mean platelet volume (MPV) reflects this action well. The potential relationship between H. pylori and platelet count has been shown before. However, there are few and conflicting papers about the relationship between MPV and H. pylori related chronic gastric inflammation and its severity. The study aimed to assess any potential relationship between MPV and presence of H. pylori, as well as the severity of chronic gastric inflammation. A total of 6890 endoscopic reports were initially evaluated, and a total of 218 dyspeptic patients having undergone upper endoscopy were included. Of these, 118 (54.2%) were H. pylori positive and 100 (45.8%) were H. pylori negative. At least four gastric biopsies were obtained and evaluated according to Sydney classification. Age, gender, hemoglobin, mean corpuscular volume, ferritin, serum iron and C-reactive protein, as well as endoscopic findings were also recorded. A p<0.05 was accepted as significant. The MPV and platelet count did not differ between H. pylori positive and H. pylori negative groups of patients (p>0.05). There were no differences and correlation between MPV and gastric inflammation severity according to Sydney classification (p>0.05). When stratifying MPV as <9.15 fL and >9.15 fL, there was no difference between H. pylori positive and H. pylori negative groups either (p>0.05). In this study, we found no relationship between MPV and presence of H. pylori or severity of gastric inflammation. Although there are still conflicting publications on this issue, in our opinion and according to the results of this study, MPV is not a suitable marker for evaluation of gastric inflammation severity, being H. pylori either positive or negative.
Assuntos
Biomarcadores/sangue , Plaquetas/patologia , Gastrite/sangue , Gastrite/fisiopatologia , Infecções por Helicobacter/sangue , Infecções por Helicobacter/fisiopatologia , Volume Plaquetário Médio , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagenous band with an inflammatory infiltrate in the mucosa. We report the first Tunisian case revealed by severe anemia. Lesions were limited to the stomach and remained unchanged on 3 series biopsies during a 24 month follow up despite treatment with corticosteroids. The cause of the disease remains unknown; our findings suggest that lesions of collagenous gastritis may result from a local immune process.
Assuntos
Anemia/etiologia , Doenças do Colágeno/diagnóstico , Gastrite/diagnóstico , Biópsia , Colágeno/metabolismo , Doenças do Colágeno/tratamento farmacológico , Doenças do Colágeno/fisiopatologia , Seguimentos , Gastrite/tratamento farmacológico , Gastrite/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Tunísia , Adulto JovemRESUMO
Hepatic iron accumulation is generally increased in the chronic hepatitis C (CHC) liver; however, the precise mechanism of such accumulation remains unclear. We evaluated iron absorption from the gastrointestinal tract of patients with CHC and control participants. We measured the expression of a panel of molecules associated with duodenal iron absorption and serum hepcidin levels to determine the mechanism of iron accumulation in the CHC liver. We enrolled 24 patients with CHC and 9 patients with chronic gastritis without Helicobacter pylori infection or an iron metabolism disorder as control participants. An oral iron absorption test (OIAT) was administered which involved a dosage of 100 mg of sodium ferrous citrate. Serum level of hepcidin-25 was measured by liquid chromatography-tandem mass spectrometry. Ferroportin 1 (FPN) mRNA was measured by RT-PCR and FPN protein was analyzed by western blot. Samples were obtained from duodenum biopsy tissue from each CHC patient and control participant. Caco-2/TC7 cells were incubated in Costar transwells (0.4 µm pores). The OIAT showed significantly greater iron absorption in CHC patients than control participants. Serum hepcidin-25 in the CHC group was significantly lower than in the control group. Compared with control participants, duodenal FPN mRNA expression in CHC patients was significantly upregulated. The FPN mRNA levels and protein levels increased significantly in Caco-2/TC7 cell monolayers cultured in transwells with hepcidin. Lower serum hepcidin-25 levels might upregulate not only FPN protein expression but also mRNA expression in the duodenum and cause iron accumulation in patients with CHC.
Assuntos
Proteínas de Transporte de Cátions/metabolismo , Hepatite C Crônica/fisiopatologia , Hepcidinas/sangue , Absorção Intestinal , Sobrecarga de Ferro/fisiopatologia , Ferro/metabolismo , Adulto , Idoso , Células CACO-2 , Proteínas de Transporte de Cátions/genética , Doença Crônica , Duodeno/metabolismo , Duodeno/fisiopatologia , Feminino , Gastrite/fisiopatologia , Expressão Gênica/efeitos dos fármacos , Hepatite C Crônica/sangue , Hepatite C Crônica/complicações , Hepcidinas/deficiência , Hepcidinas/farmacologia , Humanos , Sobrecarga de Ferro/sangue , Sobrecarga de Ferro/virologia , Masculino , Pessoa de Meia-Idade , RNA Mensageiro/metabolismo , Regulação para Cima/efeitos dos fármacos , Adulto JovemRESUMO
BACKGROUND: Infection with Helicobacter pylori (H. pylori) is a major pathogenic factor for gastroduodenal ulcer disease and gastric carcinoma, as well as for other types of gastric and extragastric disease. As a result of changing epidemiologic conditions (e.g., immigration), changing resistance patterns with therapeutic implications, and new knowledge relating to the indications for pathogen eradication, the medical management of H. pylori is a dynamic process in need of periodic reassessment. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed and the Cochrane Database, with particular attention to three international consensus reports and the updated German S2k guideline. RESULTS: H. pylori is now dealt with as an infection, whether or not the infected individual has symptoms or suffers from and H.-pylori-induced illness. H.-pylori-associated dyspepsia and functional dyspepsia are distinct entities that can only be diagnosed when competing elements in the differential diagnosis have been ruled out. H. pylori can be detected with noninvasive methods (13C-urea breathing test, stool antigen detection) and with invasive methods (histology, culture, rapid urease test). An important consideration for treatment is that primary clarithromycin resistance is common in many groups of patients; in Germany, its prevalence is now 10.9%. Primary treatment can be with either standard triple therapy (clarithromycin and amoxicillin or metronidazole) or bismuth-containing quadruple therapy. Treatment for 10 to 14 days is more likely to eradicate the pathogen than treatment for 7 days. When H. pylori infection is initially diagnosed in a patient over age 50, gastritis risk stratification should be performed by means of endoscopic biopsy and histologic examination. CONCLUSION: The new, clinically relevant developments that are presented and commented upon in this review now enable evidence-based management of H. pylori infection.
Assuntos
Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Adulto , Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Anticorpos Monoclonais/análise , Bismuto/uso terapêutico , Feminino , Gastrite/etiologia , Gastrite/fisiopatologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/patogenicidade , Humanos , Masculino , Ureia/análiseAssuntos
Duodeno/patologia , Gastrite , Hepatite , Fígado/patologia , Neurossífilis , Penicilina G/administração & dosagem , Estômago/patologia , Treponema pallidum/isolamento & purificação , Antibacterianos/administração & dosagem , Biópsia/métodos , Diagnóstico Diferencial , Endoscopia do Sistema Digestório/métodos , Gastrite/diagnóstico , Gastrite/microbiologia , Gastrite/fisiopatologia , Gastrite/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hepatite/diagnóstico , Hepatite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Sífilis/sangue , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/fisiopatologia , Resultado do TratamentoRESUMO
Phlegmonous gastritis is a rare but often fatal acute pyogenic infection of the stomach. We herein report three cases of phlegmonous gastritis with different causes: the long-term placement of a nasogastric feeding tube, bacteremia associated with cellulitis in a diabetic patient, and an adverse reaction to paclitaxel/carboplatin chemotherapy for cancer of unknown primary cause, which were classified as primary, secondary, and idiopathic types, respectively. Coping with the increasing morbidity rate associated with the diverse background of such patients requires a thorough understanding of the clinical features and image findings associated with this entity.
Assuntos
Celulite (Flegmão)/diagnóstico por imagem , Celulite (Flegmão)/fisiopatologia , Gastrite/diagnóstico por imagem , Gastrite/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Bacteriemia/complicações , Celulite (Flegmão)/etiologia , Feminino , Gastrite/etiologia , Humanos , Intubação Gastrointestinal/efeitos adversos , MasculinoRESUMO
INTRODUCTION: Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands. Two phenotypes of the disease have been described: a pediatric-onset and an adult-onset type. The adult-onset form is associated with collagenous colitis and autoimmune disorders. No effective treatment has been identified to date. OBJECTIVE: We aim to describe the clinical features and outcomes of patients in our cohort and provide a summary of published pediatric cases with collagenous gastritis and colitis reported to date to gather information that will contribute to improved knowledge of this rare condition. METHODS: A retrospective chart review of all patients with collagenous gastritis and/or colitis who were treated at the Royal Children's Hospital, Melbourne, was performed. A literature review was also conducted. RESULTS: A total of 12 cases of collagenous gastritis were reviewed. Three of 12 (25%) patients had associated collagenous colitis. The most common clinical presentation was iron deficiency anemia. Nine (75%) patients were followed up, and repeat endoscopies were performed in 8 (67%). Iron deficiency anemia resolved in all patients on oral iron supplementation. Histologic improvement was only identified in one patient with the adult phenotype who had been treated with oral corticosteroids and azathioprine. CONCLUSIONS: Collagenous gastritis is a rare condition in children. A small proportion of children develop features of the "'adult" phenotype at a very young age. Patients with collagenous gastritis require long-term follow-up and monitoring of their disease. Further randomized clinical trials are needed to establish an effective therapeutic strategy.
Assuntos
Colite Colagenosa/diagnóstico , Colite Colagenosa/terapia , Gastrite/diagnóstico , Gastrite/terapia , Adolescente , Biópsia , Criança , Pré-Escolar , Colite Colagenosa/fisiopatologia , Colágeno , Dieta/métodos , Dieta Livre de Glúten , Endoscopia Gastrointestinal/métodos , Feminino , Seguimentos , Mucosa Gástrica/fisiopatologia , Gastrite/fisiopatologia , Humanos , Masculino , Inibidores da Bomba de Prótons/uso terapêutico , Estudos RetrospectivosRESUMO
Abstract Temporomandibular disorders (TMD) are a highly prevalent, painful musculoskeletal condition affecting the masticatory system, and are frequently associated with migraines (M) and other diseases. This study aimed to investigate the association between painful TMD and M with other painful conditions and systemic diseases, such as cervicalgia, body pain (BP), ear-nose-throat disorders, musculoskeletal disorders, diabetes, cardiopulmonary diseases and gastritis/peptic ulcer. Methods: This was a cross-sectional study conducted in a sample of 352 individuals. Participants were stratified into three groups according to the presence of painful TMD and M: controls [individuals free of TMD and any headache (HA)]; TMD only (presence of painful TMD, but free of any HA); and TMD+M (presence of painful TMD and M). TMD was classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) - Axis I. Nonspecific physical symptoms (NSPS) were assessed by RDC/TMD - Axis II. The International Classification of Headache Disorders - II criteria, second edition, were applied to identify and classify primary HA. Other painful conditions and systemic diseases were assessed by volunteers' self-report. The prevalence of all assessed conditions was higher in the TMD+M group. Multiple regression models showed that cervicalgia was associated with the TMD only group (p<0.05), whereas gender (p<0.05), cervicalgia (p<0.05), BP (p<0.05) and NSPS (p<0.05) were significantly associated with the TMD+M group. Our results suggest that individuals with a comorbidity (TMD associated with M) have a more severe condition than those presenting only painful TMD.