Associação de alterações anatomopatológicas com o Helicobacter spp. por meio de análise imuno-histoquímica em estômagos de leitões

O objetivo deste trabalho foi relacionar os achados anatomopatológicos das lesões gástricas subclínicas de ocorrência natural em leitões com a presença, ou não, de Helicobacter spp. por meio da imuno-histoquímica. Foram utilizados 48 leitões de linhagem genética comercial. Os animais foram adquiridos em uma granja comercial, com peso médio de 34 Kg e idade média de 79 dias; após o abate, seus estômagos foram coletados e avaliados. Avaliações histopatológicas e imuno-histoquímicas foram realizadas em amostras das regiões anatômicas aglandular e glandular. Macroscopicamente, 34 (70,83%) leitões apresentaram lesões na região aglandular, enquanto que em 14 animais (29,17%) não foram encontradas alterações nesta região. Dos estômagos com lesão, 14 foram classificados como grau 1, seis como grau 2 e 14 como grau 3. Microscopicamente, 44 amostras (91,66%) apresentaram paraqueratose. Deste total, 22 apresentaram a forma discreta, 20 a moderada e dois a acentuada. Na avaliação macroscópica da porção glandular, 41 (85,4%) animais apresentaram alteração em pelo menos uma das três regiões, e em somente sete (14,6%) não foram encontradas lesões em nenhuma delas. Em 14 deles, houve aumento da atividade mucípara, em dois, houve erosão e, em cinco, hiperemia.  As lesões na região glandular do estômago foram mais extensas no antro e no cárdia, seguidas do fundo. Em relação à análise imuno

The aim of this study was to relate the anatomopathological findings of naturally occurring subclinical gastric lesions in piglets, with or without Helicobacter spp. through immunohistochemistry. Forty-eight piglets of commercial genetic lineage were used. The animals were acquired in a commercial farm, with an average weight of 34 kg and an average age of 79 days, and after slaughter, their stomachs were collected and evaluated. Samples from the glandular and aglandular anatomical regions were evaluated. Macroscopically, 34 (70.83%) samples had lesions on aglandular region, while 14 (29.17%) nothing had. Of the injured stomachs, 14 were classified as grade 1, six as grade 2 and 14 as grade 3. Microscopically, 44 samples (91.66%) showed parakeratosis. Of these, 22 showed a discreet manner, 20 moderate and two severe. In the glandular region, in 41 (85.4%) samples there was a change in at least one of the three regions, and only seven animals (14.6%) showed no change in any of the three. Fourteen samples showed increased muciparous activity, two showed erosion and five hyperemia. The lesions were higher in antral regions and cardic, followed the fundus. In relation to immunohistochemistry, 21(43.8%) samples were negative in all areas, 24 (50%) were positive in at least one, and none were positive in all. The anatomopathological findings showed a statistical relationship with the bacteria, and its immunostaining, not associated with gastric lesions in certain regions, demonstrates its saprophytic and opportunistic character.

Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis / Úlcera gástrica penetrante como manifestación de tuberculosis multisistémica

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

Se presenta un caso de una mujer de 30 años de edad con historia de dolor abdominal, fiebre, poca tolerancia oral y pérdida de peso por 6 meses. Un CT scan abdominal muestra dilatación marcada gástrica debido a una compresión extrínseca por adenopatías alrededor de la segunda porción del duodeno. Una endoscopía alta revela la presencia de una úlcera gástrica penetrante en la curvatura mayor. Las biopsias mostraron histiocitos con granulomatosis y bacilos acid fast positivos y en los cultivos crecieron micobacterium tuberculosis sensibles a isoniacidad y rifampicina. Subsecuentemente se inició el régimen anti TBC lográndose una mejoría clínica y endoscópica evidente.

Study of the cytoxin-associated gene A [CagA Gene] in helicobacter pylori using gastric biopsies of Iraqi patients

The Helicobacter pylori CagA gene is a major virulence factor that plays an important role in gastric pathologies. The size variation of CagA gene, which is dependent on the 3' repeat region, contains one or more Glu-Pro-Ile-Tyr-Ala [EPIYA] motifs and CagA multimerization [CM] motifs. Four segments flanking the EPIYA motifs, EPIYA A, B, C, or D, were reported to play a crucial role in the pathogenesis of H. pylori infection. The aim was to determine the roles of EPIYA segments and CM motifs in gastroduodenal pathogenesis in an Iraqi population. Gastric biopsies were collected from 210 patients with gastritis, duodenal ulcer [DU], gastric ulcer [GU], and gastric cancer [GC]. The EPIYA motif genotyping was determined by polymerase chain reaction and sequencing. The differences in age, gender, and CagA EPIYA motifs of H. pylori between GC, DU, GU and gastritis patients were analyzed using a 2-test. A total of 22 [45.8%] strains had three copies of EPIYA [ABC type], 2 [4.16%] had four copies [ABCC type], 6 [12.7%] had five copies [ABCCC type], 13 [27.08%] had two copies [AB type], 3 [6.25%] had the BC, and 2 [4.17%] had AC motif. The alignment of the deduced protein sequences confirmed that there were no East Asian type EPIYA-D sequences in Iraqi strains. A significant association was found between increase in number of EPIYA-C motifs and GU [P 0.01] compared with gastritis. The structure of the 3' region of the CagA gene in Iraqi strains was Western type with a variable number of EPIYA-C and CM motifs. A significant association was found between increase in number of EPIYA-C motifs and GU compared with gastritis indicating predictive association with the severity of the disease. The GenBank accession numbers for the partial CagA nucleotide sequences determined in this study are JX164093-JX164112

Detección histológica y molecular de Helicobacter pylori y genotipificación con base en los genes de virulencia babA2 e iceA en pacientes con patología gástrica benigna / Molecular and histological detection of Helicobacter pylori and genotyping based on babA2 and iceA in patients with benign gastric pathologies

Objective: To investigate the presence of Helicobacter pylori in a Colombian population. Material and Methods: Gastric biopsies from 60 patients with benign gastric pathologies were submitted to histopathological examination and genotyped by PCR through amplification of babA2 and iceA genes. Results: The presence of H. pylori was demonstrated in 78.3 percent, 63.3 percent and 66.7 percent of the samples after Giemsa staining, andH. pylori 16S DNAr and iceA gene amplification, respectively. In addition, H. pylori babA2 positive was found infecting 7 patients. Among the iceA positive samples, 35 percent were identified as iceAl, 47.5 percent as iceA2 and 17.5 percent contained iceAl and iceA2 or different iceA2 types. This work allowed detection and genotyping of H. pylori, demonstrating a low proportion of patients carrying strains babA2 positive and an iceA genotype distribution according to previous reports. No association was found between the presence of babA2 and iceA genes and ulcer disease.

Objetivo: El presente estudio investiga la presencia de Helicobacter pylori en pacientes de una población colombiana con enfermedad gastro-duodenal benigna y realiza su genotipificación usando como blanco los genes babA2 e iceA. Pacientes y Métodos: Se analizaron biopsias gástricas de 60 pacientes usando histopatologíay RPC. Resultados: La presencia de H. pylori se demostró en 78,3 por ciento, 63,3 por ciento y 66,7 por ciento de los pacientes, mediante tinción de Giemsa, amplificación del gen 16S ADNr y del locus iceA, respectivamente. Helicobacter pylori babA2 positivo se encontró infectando 7 pacientes y de las 40 muestras positivas para la presencia del locus iceA, 35 por ciento eran iceAl, 47.5 por ciento iceA2 y en 17,5 por ciento se evidenció infección múltiple. Se aportan datos sobre la prevalencia de H. pylori encontrando una baja proporción de casos babA2 positivos y una distribución de los genotipos iceA acorde con datos reportados previamente. La presencia de los genes babA2 e iceA no se encontró asociada con la presentación de úlcera.

Detection of Helicobacter spp. in gastric, fecal and saliva samples from swine affected by gastric ulceration

The aim of this study was to evaluate the presence of Helicobacter (H.) spp. in swine affected by gastric ulceration. Stomachs from 400 regularly slaughtered swine were subjected to gross pathological examination to evaluate the presence of gastric ulcers. Sixty-five samples collected from ulcerated pars esophagea and 15 samples from non-ulcerated pyloric portions were submitted to histopathological and molecular analyses, to detect Helicobacter spp., H. suis and H. pylori by PCR. Feces and saliva swabs were also collected from 25 animals in order to detect in vivo the presence of Helicobacter spp.. Gastric ulcers were detected in 373 cases (93%). The presence of ulcers in association with inflammatory processes was further confirmed by histological examination. Forty-nine percent (32/65) of the ulcerated esophageal portions as well as 53% (8/15) of the non-ulcerated pyloric portions were positive for Helicobacter spp. by PCR. The Helicobacter spp. positive samples were also positive for H. suis, while H. pylori was not detected. These results were confirmed by restriction enzyme analysis. With regard to feces and saliva samples, 15/25 (60%) and 16/25 (64%) were positive for Helicobacter spp. PCR, respectively but all were negative in H. suis and H. pylori specific PCR.

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients / Estudo comparativo quanto à recidiva ulcerosa do tratamento cirúrgico de úlcera péptica perfurada entre pacientes H. Pylori positivos, após erradicação, e negativos

BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done.AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori.METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months.RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients.CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

RACIONAL: O tratamento cirúrgico da úlcera péptica perfurada é assunto discutível. Os cirurgiões, por muitos anos, fizeram suas opções entre procedimentos de redução ácida, somente fechamento da perfuração - porém com maior chance de recidiva ulcerosa. Desde a comprovada vinculação da úlcera péptica e suas complicações à infecção gastroduodenal causada pelo Helicobacter pylori, houve recomendação para mudança na atitude dos cirurgiões na volta à operação mais simples com erradicação da bactéria.OBJETIVO: Analisar a recidiva ulcerosa em pacientes com úlcera perfurada H. pylori positiva que foram submetidos à simples sutura da lesão e omentopexia com erradicação da bactéria e compará-la com H. pylori negativo submetido ao mesmo tratamento cirúrgico.MÉTODOS: Cento e quatorze pacientes com úlceras pré-pilóricas, pilóricas e duodenais perfuradas foram atendidos com fechamento simples. Trinta dias após a operação submeteram-se à endoscopia digestiva alta com biópsias para testes da urease e histopatológicos. Foram divididos em dois grupos de acordo com o resultado dos testes: positivo e negativo.Os positivos foram erradicados e, junto com o grupo negativo, foram seguidos com endoscopias semestrais e testes de detecção para H. pylori procurando por recidiva ulcerosa e reinfecção no grupo erradicado.RESULTADOS: O grupo positivo foi formado por 25 pacientes, dos quais dois foram considerados não erradicáveis segundo os critérios do protocolo. Os demais foram seguidos por período médio de 38,21 meses e detectadas recidivas em quatro pacientes (17,39%), metade deles (8,69%) foram reinfectados. O grupo negativo foi formado por 26 pacientes, seguido por período médio de 38,28 meses e oito (30,76%) apresentaram recidiva ulcerosa. Não foi evidenciada diferença estatisticamente significativa entre os grupos...

Frequency of Helicobacter pylori vacA genotypes in Iranian patients with gastric and duodenal ulcer

Helicobacter pylori infection is a risk factor for developing chronic peptic ulcers and gastric cancer. The purpose of this study was to investigate the frequency of Helicobacter pylori vacA genotypes in patients with gastric and duodenal ulcer. A total of 100 biopsy specimens of patients with gastric [n = 50] and duodenal [n = 50] ulcer were collected. The specimens were cultured on selective media and incubated in a microaerophilic atmosphere at 37°C for 5-10 days. The isolates were characterized to species level by conventional biochemical tests. The extracted DNA from isolates was used to perform a polymerase chain reaction based, simultaneous analysis of the cagA status, allelic variation of the signal regions [s1, s2] and the middle regions [m1, m2] of the vacA gene. H. pylori isolated from 50 specimens of patients and the vacA gene was detected in all isolates. Among vacA genotypes the s1/m1 was the most common in H. pylori isolates from patients with gastric ulcer [56%] and duodenal ulcer [68%]. This study demonstrated that vacA slml is common genotype of H. pylori in patients with peptic ulcer and the vacA allele s1 of this bacterium is associated with ulcer

Helicobacter pylori: su importancia práctica en la gastroenterología / Helicobacter pylori: its practical importance in gastroenterology

El Helicobacter pylori es una bacteria que ha revolucionado la Gastroenterología en los últimos 25 años. Hasta mediados de los 80 la úlcera péptica era considerada una enfermedad sicosomática asociada a una hiperacidez gástrica en el caso de la úlcera duodenal (UD), o a una alteración de la barrera mucosa en el caso de la úlcera gástrica. Al descubrirse su relación con esta bacteria la enfermedad ulcero-péptica pasó a ser una enfermedad infecciosa con un muy alto índice de curación, y una muy baja tasa de recurrencia, lo que era la regla hasta ese entonces. No en vano este notable descubrimiento les valió a dos científicos australianos obtener el Premio Nóbel de Medicina en 2005. Revisaremos aspectos generales de este germen, su asociación con diversas patologías gastro-duodenales, los métodos de estudio clínico y su tratamiento de erradicación.

The Gastroenteroly has been dramatically impacted in last 25 years by a bacterium named helicobacter pylori. Until the eighties, peptic ulcer was considered as a psychosomatic disease related to high gastric acidity in duodenal ulcer (DU) or an impaired gastric mucosa in gastric ulcer. The helicobacter pylori-peptic ulcer relationship has changed the way we consider this disease, now it is an infectious disease with very high rate of clinical resolution and no more recurrences one of its more characteristic features. This outstanding medical discovery has deserved in 2005 the Nobel Prize to the Australian scientific investigators who made possible this medical breakthrough. This is a review on this bacterium, the diseases associated to it, the diagnostic clinical tests and its treatment.

Genotipo cag A+ en cepas de Helicobacter pylori asociadas a úlcera péptica, gastritis crónica y cáncer gástrico / Cag A+ genotype in Helicobacter pylori strains associated with peptic ulcer, chronic gastritis and gastric cancer

Se estudiaron 171 pacientes con úlcera duodenal, úlcera gástrica, gastritis crónica y cáncer gástrico; los 3 últimos confirmados histológicamente. Se analizaron 56 casos con úlcera duodenal, 48 con úlcera gástrica, 47 con gastritis crónica y 20 con cáncer gástrico. Se detectó la presencia de Helicobacter pylori mediante PCR en el 98,2 por ciento de las úlceras duodenales; en el 95,8 por ciento de las úlceras gástricas; en el 95,0 por ciento de los cánceres gástricos y en el 93,6 por ciento de las gastritis crónicas, para una prevalencia total del 95,9 por ciento. El genotipaje cag A de las cepas detectadas reportó positividad en el 80,0 por ciento de las úlceras duodenales; en el 72,7 por ciento de las gastritis crónicas; en el 69,6 por ciento de las úlceras gástricas y en el 42,1 por ciento de los cáncer gástricos, para una prevalencia total del 70,7 por ciento. Tanto las úlceras en su conjunto, como la gastritis crónica presentaron una prevalencia de cepas Helicobacter pylori cag A+ significativamente superior al cáncer gástrico (p = 0,19).

171 patients with duodenal ulcer, gastric ulcer, chronic gastritis and gastric cancer were studied. The last 3 were histologically confirmed. 56 cases with duodenal ulcer, 48 with gastric ulcer, 47 with chronic gastritis and 20 with gastric cancer were analyzed. The presence of Helicobacter pylori was detected by PCR in 98.2 percent of the duodenal ulcers; in 95.8 percent of the gastric ulcers; in 95.0 percent of the gastric cancers; and in 93.6 percent of the chronic gastritis. The cag A genotyping of the strains found proved to be positive in 80.0 percent of the duodenal ulcers; in 72.7 percent of the chronic gastritis; in 69.6 percent of the gastric ulcers; and in 42.1 percent of the gastric cancers, for a total prevalence of 70.7 percent. Both, the ulcers as a whole and the chronic gastritis showed a prevalence of cag A+ strains of Helicobacter pylori significantly higher than gastric cancer (p = 0,19).

Relationship between Pepsinogen I/II Ratio and Age or Upper Gastrointestinal Diseases in Helicobacter pylori-positive and -negative Subjects / 대한소화기학회지

BACKGROUND/AIMS: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. METHODS: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. RESULTS: H. pylori infected patients showed markedly increased serum PG II levels (24.0+/-14.7 ng/mL vs. 13.8+/-16.6 ng/mL, p<0.001) and low PG I/II ratio (3.9+/-2.0 vs. 6.0+/-2.5, p<0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p<0.001, ANOVA, Turkey's multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0+/-1.4 vs. 3.8+/-1.7, p<0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R(2)=0.9, p=0.005, linear regression analysis). CONCLUSION: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age.

Relationship between Pepsinogen I/II Ratio and Age or Upper Gastrointestinal Diseases in Helicobacter pylori-positive and -negative Subjects / 대한소화기학회지

BACKGROUND/AIMS: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. METHODS: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. RESULTS: H. pylori infected patients showed markedly increased serum PG II levels (24.0+/-14.7 ng/mL vs. 13.8+/-16.6 ng/mL, p<0.001) and low PG I/II ratio (3.9+/-2.0 vs. 6.0+/-2.5, p<0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p<0.001, ANOVA, Turkey's multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0+/-1.4 vs. 3.8+/-1.7, p<0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R(2)=0.9, p=0.005, linear regression analysis). CONCLUSION: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age.

Helicobacter pylori and cagA gene detected by polymerase chain reaction in gastric biopsies: correlation with histological findings, proliferation and apoptosis

CONTEXTO E OBJETIVO: A virulência de Helicobacter pylori em doenças gastroduodenais está relacionada à presença de ilha de patogenicidade (cagPAI) que ocorre em algumas cepas. A infecção pelo cagPAI induz a secreção de IL-8, aumenta a proliferação epitelial, podendo ter um papel importante na carcinogênese. Nosso objetivo foi detectar HP e o gene cagA (marcador de cagPAI) pela técnica de PCR (polymerase chain reaction), correlacionando com os achados histológicos, de proliferação e apoptose. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, no Laboratório de Patologia Cirúrgica e Molecular do Hospital Sírio Libanês. MÉTODOS: DNA isolado de 164 biópsias gástricas foi submetido a PCR para detecção de HP. Os casos positivos foram submetidos a nova reação para identificação do gene cagA. Pela técnica de imunohistoquímica foi analisada a proliferação celular e, pela TUNEL, a apoptose. RESULTADOS: HP foi detectado em 67,7% dos pacientes. Houve correlação entre a presença do HP e o diagnóstico de gastrite moderada ou grave, úlcera e linfoma do tipo MALT. Houve correlação entre cagPAI+ e a doença gástrica grave, incluindo o câncer. O risco de úlcera, adenocarcinoma ou linfoma MALT para os portadores de cagA+ foi de 8,8. Infecção pelo cagPAI correlacionou-se com aumento na taxa de proliferação. O índice proliferação/apoptose foi significantemente maior para os pacientes cagPAI+. CONCLUSÕES: Uma desregulação do crescimento celular nos pacientes cagPAI+ foi demonstrada pela diferença do índice de proliferação, que acreditamos pode explicar o papel carcinogênico da bactéria.

Prevalencia de la infección por Helicobacter pylori en pacientes dispépticos / Histologic alterations of the gastric mucous and prevalence of Helicobacter pylori in dyspeptic patients

Un estudio en pacientes dispépticos puede permitirnos arrojar alguna claridad sobre aspectos epidemiológicos importantes relacionados con la infección por Helicobacter pylori en nuentro medio. Se realizó un estudio descriptivo, prospectivo, donde el universo estuvo constituido por pacientes con síntomas dispépticos, a los que se les indicó una endoscopia superior, durante el período comprendido entre marzo del 2000 y marzo del 2002. La muestra quedó constituida por 200 pacientes, 108 de sexo femenino y 92 de sexo masculino con promedio de edad de 52 años. Se tomaron muestras de biopsia gástrica para histología y para test de ureasa. En pacientes con úlcera duodenal se encontró una prevalencia de la infección por Helicobacter pylori de 99.0. En 22 pacientes con úlcera gástrica se encontró una prevalencia de 91.0. La prevalencia de la infección encontrada en los pacientes con gastritis crónica fue 94.0. En pacientes con histología normal la infección tuvo una prevalencia de 68.0

Low dose, one-week triple therapy (lanzoprazole, amoxycillin, clarithromycin) for eradication of Helicobacter pylori infection.

OBJECTIVE: To evaluate the efficacy and safety of low dose one week triple therapy with lansoprazole, amoxycillin and clarithromycin for the eradication of Helicobacter pylori (H. pylori). METHOD: A total of 103 patients with H. pylori infection who had gastritis, duodenal ulcer (DU) or gastric ulcer (GU) received 1 week's triple therapy of lansoprazole 30 g once daily (OD), amoxycillin 250 mg qid and clarithromycin 250 mg tid. The status of H. pylori infection was determined using the CLO test and histology (gram stain) of biopsy specimens during endoscopic examination. RESULT: After treatment with triple therapy H. pylori infection was eradicated in 98 of 103 patients (95.15%), dyspeptic symptoms and upper gastrointestinal hemorrhage improved in 99 of 103 patients (96.1%). No adverse effect was observed in all the patients was received treatment. CONCLUSION: Low dose one-week triple therapy with lansoprazole, amoxycillin and clarithromycin is effective for eradication of H. pylori infection.

Soroprevalência de anticorpos contra o antígeno CagA do Helicobacter pylori em pacientes com úlcera gástrica na regiÒo Norte do Brasil / Seroprevalence of antibodies against Helicobacter pylori CagA antigen in patients with gastric ulcer in the North region of Brazil

Helicobacter pylori is a pathogenic agent with a worldwide distribution and is involved in the development of many gastrointestinal diseases. Nowadays infection with the virulent strain CagA+ of H. pylori is considered one of the main etiological factors in the development of gastric ulcer. Based on this information, we investigated the seroprevalence of virulent strains among patients with gastric ulcer from one region, using serologic tests to detect antibodies against H. pylori and CagA protein. Infection by the virulent strain was found in 82 (40/55) of the patients, and among these, 89 (40/45) presented an increased degree of inflammation in the gastric mucosa, with a dense infiltration of leukocytes in the tissue, which probably favored the formation of gastric ulcer. We concluded that the presence of the virulent strain is related to the development of an increased inflammation in the gastric mucosa.

Inhibitory effect of Lactobacillus acidophilus on Helicobacter pylori in peptic ulcer patients: in vitro study.

Lactobacillus acidophilus (L. acidophilus) have been introduced into many fermented dairy products. The presence of L. acidophilus appears to decrease Helicobacter pylori (H. pylori) density in the human stomach and could enhance antibiotic therapy for H. pylori eradication. This study was designed to determine the optimal density of L. acidophilus that has a maximum inhibitory effect on H. pylori in peptic ulcer patients. To determine whether L. acidophilus has an inhibitory effect on H. pylori isolated from peptic ulcer patients and to determine whether the optimal density of L. acidophilus has a maximum inhibitory effect on H. pylori isolated from peptic ulcer patients. H. pylori was isolated from gastric biopsy specimens of peptic ulcer patients. The suspension of pure H. pylori colonies were inoculated into the broth and adjusted to match the density of No.3 MacFarland standard (approximately 9x10(8) cells/ml). Forty microliters of the suspension were equally spread onto each quadrant of the plate and left to dry. L. acidophilus was prepared from LC-1 (Nestle Research Center, Switzerland). They were grown on blood agar and incubated overnight at 37 degrees C. The suspension of L. acidophilus was inoculated into the broth and adjusted to match the density of No.1, No.2, No.3 and No.4 MacFarland standard (approximately 3x10(8), 6x10(8), 9x10(8) and 12x10(8) cells/ml respectively). Ten microliters of each density of L. acidophilus was dropped onto each quadrant of a previously inoculated H. pylori plate and then the plate was kept under microaerophilic conditions for 72 hours. Inhibition clear halo zone of H. pylori around the colonies of L. acidophilus was interpreted as the inhibitory effect. H. pylori were isolated from gastric biopsy specimens of fifteen peptic ulcer patients (eleven patients with gastric ulcer and four patients with duodenal ulcer). A total of sixty tests of inhibitory effect of L. acidophilus on H. pylori were evaluated in the present study. L. acidophilus had inhibitory effect on H. pylori in 13/15 patients (86.67%) and L. acidophilus in the density of No.3 MacFarland standard had a significantly higher inhibitory effect on H. pylori in the density of No.3 MacFarland than that of No.1 (60% vs 20%; p<0.05), No.2 (60% vs 20%; p<0.05) and No.4 (60% vs 20%; p<0.05) MacFarland standard. In conclusion, L. acidophilus has an inhibitory effect on H. pylori isolated from peptic ulcer patients. Approximately an equal density of L. acidophilus on H. pylori has the most favorable effect. This optimal density of L. acidophilus should have maximum effect on H. pylori clearance and could enhance antibiotic therapy for H. pylori eradication in humans.

Gastric juice urease test and brushing urease test for Helicobacter pylori detection.

The aim of the study was to demonstrate the sensitivity, specificity and accuracy of gastric juice urease test and brushing-urease test compared to the biopsy-urease test for Helicobacter pylori (H. pylori) detection. For each patient, two milliliters of gastric juice was collected and one milliliter in the supernatant was tested for rapid urease reactions. One gastric mucus brushing and two biopsies were taken from the body and the antrum. The brushing specimens were tested for rapid urease reaction by shaking the brush into the urea broth. The gold standards for diagnosing of H. pylori are positive H. pylori upon specimen culture or positive identification of H. pylori from polymerase chain reaction (PCR) assay using primer for vac A gene. Forty patients were enrolled in the study including ten patients with gastric ulcer, six patients with duodenal ulcer and twenty four patients with non-ulcer dyspepsia. Brushing-urease test and biopsy-urease test were not different sensitivity (87.50% vs 93.20%), specificity (100% vs 100%) and accuracy (90.25% vs 95.50%). The gastric juice urease test had a sensitivity of 65.25 per cent, specificity of 100 per cent and accuracy of 75 per cent for detecting of H. pylori infection. In conclusion, gastric juice urease test had low sensitivity in the diagnosis of H. pylori infection. Brushing-urease test is as accurate as biopsy-urease test in detecting H. pylori infection. However, the brushing method had lower gastric tissue injury than the biopsy and so should be used for detecting H. pylori infection in patients with coagulopathy.

Evaluation of inhouse rapid urease test for detection of Helicobacter pylori from gastric biopsy specimens.

Inhouse rapid urease test for detecting Helicobacter pylori was evaluated. Biopsy specimens were taken for inhouse urease test, commercial rapid urease CLO test, culture, gram stain and histology from the antrium or duodenum of patients who had peptic ulcer. The culture and/or histologic examination and CLO test were used as the gold standard. One hundred and twelve specimens were evaluated. The sensitivity and specificity of the inhouse urease test was 100 per cent and 90 per cent respectively. The inhouse urease test was suitable for detecting Helicobacter pylori from gastric antral biopsy specimens. The medium can be kept in a refrigerator for up to 6 months.

Helicobacter pylori y gastritis crónica: relación entre infección y actividad inflamatoria en población de alto riesgo de cáncer gástrico / Helicobacter pylori and chronic gastritis: relationship between infection and inflammatory activity in a high risk population for gastric cancer

Background: Helicobacter pylori has been involved in gastric epithelial cell damage and gastric gland loss or atrophy. Aims: to evaluate role of Helicobacter pylori infection in acute and chronic changes of chronic gastritis in a high gastric cancer-risk population. Material and methods: 200 patients with chronic gastritis were selected from pathological files of Temuco Hospital. A complete histopathological protocol was fulfilled considering the presence of infection by Helicobacter pylori-like-organism (HLO), acute and chronic inflammatory infiltrate, epithelial cell damage and epithelial cell regeneration. Results: 82 percent of patients showed infection by HLO. Moreover, this infection reached a frequency of 92.7 percent in gastric ulcer patients and 94.4 percent in duodenal ulcer patients. A statistically significant positive correlation was found between HLO infection and polymorphonuclear infiltrate, Iymphocytic infiltrate, mucus depletion and epithelial regenerative activity. There was not a statistical correlation between HLO infection and atrophy. Finally, 90 percent of patients with multifocal atrophic gastritis and 100 percent of patients with diffuse antral gastritis had HLO infection. Conclusions: HLO gastric infection frequently caused acute inflammatory changes in gastric mucosa with chronic gastritis. Sometimes these changes were severe, with marked polymorphonuclear migration throughout epithelium and severe epithelial cell damage. Recovery of these changes could be considered as a goal in Helicobacter pylori eradication therapy decision