ABSTRACT
Helicobacter pylori is apparently the etiologic agent of 90% of duodenal ulcers (DUs), 80% of gastric ulcers (GUs) not induced by nonsteroidal anti-inflammatory drugs, and gastric carcinoma (GC). Our community-based investigations and retrospective reviews, however, have been unable to substantiate these associations. A retrospective review of 30 patients with GC revealed only 2 (6.6%) patients with H. pylori infection. A retrospective review of all patients with the diagnosis of DU (332) was undertaken. One hundred sixty-six had gastroscopy-confirmed DUs, and 112 had three antral biopsies. Only 36 (32%) of 112 were H. pylori-positive. Of bleeding ulcers, 25% were H. pylori-positive. These findings differ from the literature, and it provoked us to study prospectively all patients undergoing endoscopy. Biopsy specimens were obtained from the cardia and antrum and were stained for H. pylori. Of 272 patients' biopsy specimens, 65 (24%) of 272 were H. pylori-positive. Sixteen DUs were diagnosed, and five (31%) were H. pylori-positive. There were 36 GUs, and 11 (30%) were H. pylori-positive. The prevalence of H. pylori in consecutive patients undergoing endoscopy is 24% in Orlando, Florida. This is not significantly different from the prevalence of H. pylori in patients with DUs and GUs. Further community-based studies are needed to determine the widespread applicability of these data in the United States.
Subject(s)
Helicobacter Infections/complications , Helicobacter pylori , Peptic Ulcer/complications , Peptic Ulcer/microbiology , Stomach Neoplasms/epidemiology , Stomach Neoplasms/microbiology , Aged , Female , Helicobacter Infections/microbiology , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Retrospective Studies , Rural Health , Southeastern United States/epidemiologyABSTRACT
A review of 107 patients with Barrett's esophagus revealed three patients who concomitantly had scleroderma. Two of the three patients had pathological evidence of high-grade dysplasia of the columnar-lined epithelium, and the third patient had nondysplastic columnar-lined epithelium in the distal esophagus. Patients with scleroderma often have an incompetent lower esophageal sphincter, poor or absent distal esophageal peristalsis, and reflux esophagitis, all of which are believed to predispose to Barrett's esophagus. The importance of Barrett's esophagus is its potential for malignant transformation. Identification of such patients permits aggressive medical treatment and endoscopic and pathological surveillance.
Subject(s)
Barrett Esophagus/etiology , Esophageal Diseases/etiology , Scleroderma, Systemic/complications , Barrett Esophagus/pathology , Cell Transformation, Neoplastic/physiopathology , Epithelium/pathology , Esophagoscopy , Esophagus/pathology , Female , Humans , Male , Middle AgedABSTRACT
Barrett's esophagus has been reported in patients with achalasia who have undergone esophagomyotomy. The condition was thought to be acquired from gastroesophageal reflux secondary to the iatrogenically produced incompetent sphincter. We present the case of a patient with Barrett's esophagus and achalasia without any previous surgical intervention.