Quantification of Helicobacter pylori infection in gastritis and ulcer disease using a simple and rapid carbon-14-urea breath test.

Gastric urease was studied isotopically in 230 patients with biopsy-proven normal mucosa or chronic gastritis, including 59 patients with ulcer disease. Carbon-14-urea was given in 25 ml of water without substrate carrier or nutrient-dense meal, and breath samples were collected over a 60-min period. The amount of 14CO2 excreted at 10 min was independent of the rate of gastric emptying and was not quantitatively influenced by the buccal urease activity. The 10-min 14CO2 values discriminated well between Helicobacter pylori positive and negative patients (94% sensitivity, 89% specificity) and correlated with the number of organisms assessed by histology. The test was a good predictor of chronic gastritis (95% sensitivity and 96% specificity), and a quantitative relationship was observed between 14CO2 values and the severity and activity of the gastritis. In H. pylori positive patients, breath 14CO2 was found to be similar in patients with and without ulcer disease, suggesting that the number of bacteria is not a determining factor for the onset of ulceration.

Assessment of the new immunological test Hemoblot for detecting occult blood in faeces.

Hemoblot, a new immunological faecal occult blood test, produced by Gamma, Angleur, Belgium, was characterized and compared with another immunological test (HemeSelect, SmithKline Diagnostics, USA) and with a guaiac test (Hemoccult II, SmithKline Diagnostics). The analytical sensitivity of Hemoblot is 0.15 mg haemoglobin/g faeces and the test is specific for human haemoglobin. In addition, 135 symptomatic patients who had to undergo a colonoscopy were tested using the three tests. Two criteria were considered for the analysis: (1) the blood criterion: any pathology likely to cause colorectal or other bleeding; and (2) the precancerous-cancerous criterion: the pathology being either a colorectal polyp > 0.5 cm or a colorectal cancer. Considering both criteria, the sensitivity of Hemoblot was significantly higher than the sensitivity of Hemoccult: 38% and 23%, respectively, for the blood criterion; and 54% and 29% for the precancerous-cancerous criterion. Sensitivity and specificity did not differ statistically between Hemoblot and HemeSelect but Hemoblot was faster and simpler to perform. It could be widely used in mass screening.

Gastric ulcers and Helicobacter heilmannii.

OBJECTIVE: To compare 14 patients with gastric ulcer and Helicobacter heilmannii with other patients with gastric ulcer: age and sex matched patients, patients colonized by Helicobacter pylori and patients on nonsteroidal anti-inflammatory drugs (NSAIDs). SETTING: The endoscopy unit of a university-affiliated hospital. PATIENTS AND METHODS: All patients underwent endoscopy with two antral biopsies and smears from biopsies (touch cytology) in addition to biopsies of ulcers. Most patients had fundic biopsies (n = 10), antral biopsies for culture (n = 7) and/or a urease test (n = 9). Serologic determination of antibodies against H. pylori was obtained in nine patients. RESULTS: Patients with H. heilmannii diagnosed on smears from biopsies (touch cytology) had multiple and antral ulcers in 11 samples, and nodular or irregular lesions in five samples. No patient had a history of peptic ulcer disease. Biopsy revealed mild chronic gastritis in all patients, with features of reactive gastritis in nine. No patient had coexistent infection with H. pylori. Only two of ten patients with follow-up endoscopies had persistent H. heilmannii infection on smear or biopsy. No patient had symptomatic recurrence. Patients with H. pylori infection were older and often had recurrent ulceration. The majority of ulcers associated with NSAIDs occurred in elderly women. CONCLUSIONS: Newly diagnosed gastric ulcers are associated with H. heilmannii infection. Healing is associated with the disappearance of H. heilmannii and the regression of reactive gastritis. Ulcers differ from those associated with H. pylori infection or with the use of NSAIDs, suggesting that H. heilmannii is a possible cause of gastric ulcers.

Touch cytology. A quick, simple, sensitive screening test in the diagnosis of infections of the gastrointestinal mucosa.

To assess the role of touch cytology (imprint from endoscopic biopsy specimens) in the diagnosis of mucosal infections of the gastrointestinal tract, we reviewed all records and specimens of patients seen during a 30-month period. Touch cytology was performed by rolling biopsy specimens on glass slides. After air fixation, a rapid staining method similar to May-Grünwald-Giemsa was used. The following infections and pathogens were diagnosed (in decreasing order of frequency): Helicobacter pylori gastritis (n = 53), Candida albicans esophagitis (n = 40), Giardia lamblia (n = 13), Gastrospirillum hominis (n = 11), and Blastocystis hominis (n = 8). The smear was positive in 45 patients with H pylori, in 35 patients with C albicans, in nine patients with G lamblia, in 11 patients with G hominis, and in eight patients with B hominis. Cytology was the only positive test in eight, nine, four, seven, and eight patients, respectively, and increased thus the diagnostic yield obtained by histologic examination.

Cytologic patterns of reparative processes, true dysplasia and carcinoma of the gastric mucosa.

The cytologic features of dysplasia and carcinoma of the stomach are still poorly defined. In a series of 90 cases, a precise correlation could be made between smears and histologic data. Cytology was sensitive enough to allow characterization of: (1) active repair/regeneration, associated, in a number of cases, with intestinal metaplasia (slight dysplasia); the cellular atypia is minimal; (2) true dysplasia (formerly moderate and severe); this preneoplastic state is characterized by cellular atypia within clusters; and (3) true carcinomas (intestinal or diffuse type); classic criteria for malignancy are present, with a prominent lack of cell cohesiveness, though distinction from dysplasia may be very difficult. The advantages of cytology are the survey of large mucosal areas, investigation of the cardial region, not always accessible to endoscopic biopsy, and exploration of large ulcers. With the adjunct of cytology, the specificity and sensitivity of endoscopy plus histology clearly increase.

[Validation and clinical and epidemiological use of a serologic test recommended in the diagnosis of Helicobacter pylori infection]. / Validation et usage clinique et épidémiologique d'un test sérologique commercialsié dans le diagnostic de l'infection à Helicobacter pylori.

A commercial serologic test using purified antigens of Helicobacter pylori has been evaluated in the diagnosis of this infection. In a series of 250 patients undergoing endoscopy with antral biopsies for cytology, histology and culture, serology was positive in 68 of 71 patients with a positive culture (sensitivity: 96%) and negative in 67 of 69 patients with a normal mucosa and no microorganisms on biopsy (specificity: 97%). In the entire series, serology was positive in 33 patients with no infection on biopsies (13%). In a group of 205 blood donors, we confirmed an increasing prevalence with age, ranging from 13% in subjects less than 30 years old to 38% in subjects more than 60 years old.

[An original method of bacteriological sampling for studying Campylobacter pylori in duodenal ulcer]. / Une méthode originale de prélèvement bactériologique pour l'étude de "Campylobacter pylori" dans l'ulcère duodénal.

The presence of Campylobacter pylori in duodenal ulcer was investigated in 26 patients. The method used was a sterile endoscopic sampling technique which forcasted and checked for contamination of the samples. A sterile catheter was introduced through the endoscope and then an infusion of saline was instituted. Once the catheter was in the intestinal lumen, the infused solution was aspirated for control of sterility. Semi-quantitative cultures of gastric and duodenal juices and of biopsies of the duodenal ulcer, the bulbar mucosa close to the ulcer and prepyloric antral mucosa were compared. Only two contaminations were detected with this method. C. pylori was isolated in one gastric and one duodenal sample only. It was isolated in 14 of 26 duodenal ulcers, 12 of 26 bulbar mucosa and 20 of 26 mucosal specimens. Our study established that the presence of C. pylori was very uncommon in gastric and duodenal juices even when the bacterium was present in the mucosal membrane in large quantities.

[Evaluation of per-endoscopic cytology in the identification of Campylobacter pylori on gastric mucosa]. / Evaluation de la valeur de la cytologie perendoscopique dans l'identification du "Campylobacter pylori" sur la muqueuse gastrique.

The presence of Campylobacter pylori on gastric mucosa was evaluated by touch cytology of gastric biopsies in a series of 100 patients. Results were compared to biopsy cultures. Of 43 culture-positive patients, cytology was positive in 37 (86 p. 100). Cytology was positive in 16 of 57 culture-negative patients, who had peptic ulcer and/or gastritis on biopsy, conditions widely associated with the presence of Campylobacter pylori. Cytologic examination, yielding quick results, is thus a sensitive diagnostic method for Campylobacter pylori. In addition, retrospective studies of previous specimens are possible: among 11 patients with a follow up of more than one year, three of the four Campylobacter pylori carriers subsequently developed an ulcer.

[Solitary lesions of the rectum caused by suppositories combining acetylsalicylic acid and paracetamol]. / Lésions solitaires du rectum dues à des suppositoires associant acide acétylsalicylique et paracétamol.

The reports of 8 female patients who, because of recurrent headache, were using analgesic suppositories containing acetylsalicylic acid and paracetamol (Perdolan) for more than two years are analyzed. Symptoms were nonspecific: anal pain, rectal tenesmus or bleeding. The lesions were located within 8 cm from the anal verge and consisted of superficial ulcerations, fibrotic scar tissue and rectal stenosis. Biopsies showed non-specific inflammation, limited to the rectum. Rectal prolapse or intussusception was not associated. By discontinuing the use of suppositories, symptoms usually resolved; rectal stenoses required anorectal dilatations and in 2 cases surgical resection. When solitary rectal lesions are observed in the absence of rectal prolapse, chemical aggression of the rectal mucosa by use of suppositories containing acetylsalicylic acid should be considered.

[Stomach ulcers and Helicobacter pylori. Clinical, endoscopic and histological characteristics]. / Ulcères gastriques et Helicobacter pylori. Caractéristiques cliniques, endoscopiques et histologiques.

OBJECTIVES: The aim of the study was to determine in a large group of patients with a gastric ulcer the differences between patients, ulcers and gastric mucosa as related to the presence or absence of Helicobacter pylori (H. pylori). METHODS: This prospective study evaluated 150 patients with a benign gastric ulcer. A patient was considered as H. pylori positive on the basis of a positive culture or the presence of gastritis and another positive diagnostic test for H. pylori (urease test, cytology, histology, serology). RESULTS: One hundred and five patients were positive for H. pylori (70%) whereas 45 patients were not infected (30%). There were significant differences regarding the clinical characteristics of patients, the ulcer and the mucosa. H. pylori positive patients differed in terms of past history of ulcer (63 vs 12%), age (57 vs 50 years), sex (48% males vs 24%) and consumption of non steroidal antiinflammatory drugs (39 vs 75%). H. pylori positive ulcers were more often single (79 vs 53%) and located on the small curvature (76 vs 33%). Chronic gastritis was always present in positive patients, with associated intestinal metaplasia (35 vs 2%) and atrophy (45 vs 9%). Negative patients often had a normal gastric mucosa (53%) or reactive gastritis (27%). CONCLUSION: Seventy percent of gastric ulcer are associated with H. pylori infection, corresponding to the classical ulcer. The majority of H. pylori negative ulcers appears to be associated to non steroidal antiinflammatory drugs.

[Carney's syndrome: 2 new cases]. / Syndrome de Carney: deux nouveaux cas.

The association of gastric leiomyoblastomas, pulmonary chondromas and extra-adrenal paragangliomas has been called "Carney's Triad" since 1977. It is incomplete when only two of these lesions are present. 42 cases has been published. We report observations of two young women with gastric leiomyoblastomas and pulmonary chondromas; one of them also had an adrenocortical adenoma.

[Endoscopic exploration of the small intestine]. / L'exploration endoscopique de l'intestin grêle.

The development of Japanese enteroscopes, mot of which are still prototypes, has made it possible to explore the entire small bowel. These instruments are either introduced into the jejunum like an ordinary endoscope, or pushed along a guidewire, or weighted with mercury, like a Miller-Abbott probe. A simplified study of the adult malabsorption syndrome can be performed by proximal jejunoscopy, usually carried out in Europe with a paediatric colonoscope. Perendoscopic forceps biopsy of the jejunum can replace probe sampling and is well suited to measurements of disaccharidase activity. In cases with "blind loop syndrome", bacteriological examination of the intestinal juice, endoscopically collected in sterile conditions, usefully supplements the visual and bioptic information. Since several investigations can be performed during one single enteroscopic examination, this method will be increasingly used in the study of small bowel diseases.

[Currents aspects of H2 receptor antagonists in the treatment of ulcers]. / Actualité des antagonistes des récepteurs H2 dans le traitement de l'ulcère.

Inhibition of H2 receptors has been the first fully evaluated treatment of peptic ulcer and remains the most widely used mode of therapy. In this review, we summarize the current data on clinical pharmacology, therapeutic indications and results of the four currently used drugs: cimetidine - ranitidine - pepticidine - nizatidine. Their similarities are stressed. Recent data are underlined. The superiority or necessity of a single evening dose is questioned, as well as the clinical importance of tolerance and rebound. The effect on gastric alcohol dehydrogenase is mentioned pending further work on the clinical importance of this discovery. In the acute treatment, the antisecretory potency is of major importance in duodenal ulcer, the duration of treatment in gastric ulcer. Maintenance treatment prevents complication as well as recurrence. H2 receptor antagonists remain a primary treatment of peptic ulcer.

Gastric polyps.

Endoscopy allows a better diagnosis and treatment of gastric polyps. Current methodology includes a detailed examination of the stomach after good insufflation, necessary to diagnose small fundic polyps, biopsies of the polyp as well as of the surrounding mucosa (antrum and fundus). Endoscopy allows a preliminary diagnosis based on the number, location and size of the polyps. Resection is not performed at initial endoscopy as it is not necessary for all polyps and may be risky if vascular lesions are confused with polyps. Glandulocystic fundic polyps are the most frequent (50%), are always associated with a normal gastric mucosa and sometimes with omeprazole. Resection and follow-up are not indicated. Hyperplastic polyps represent 25% of gastric polyps, are located everywhere, with a mean size of 1 cm, and sometimes erosions or superficial necrosis. Gastritis is present, Helicobacter pylori is frequent and eradication may cause regression or disappearance of polyps. The small risk of cancer and the risk of bleeding increase with size. Polypectomy and follow-up are thus indicated in most cases. Adenomatous polyps, although similar in appearance to hyperplastic polyps concerning macroscopy and gastritis have a higher risk of cancer in the polyp or in the stomach. Polypectomy and follow-up are thus mandatory.

[Hypersensitivity interstitial pneumopathy and ulcero-hemorrhagic rectocolitis: role of methotrexate]. / Pneumopathie interstitielle d'hypersensibilité et rectocolite ulcéro-hémorragique: rôle du methotrexate.

The authors report the case of a 46-year-old man with refractory ulcerative colitis treated with methotrexate who was admitted in the hospital for asthenia, fever, cough and dyspnea. Owing to the development of adult respiratory distress syndrome despite broad spectrum antibiotherapy, the patient was transferred to the intensive care unit. A diagnosis of pneumonitis due to methotrexate was made. Patient's condition improved after discontinuation of the drug, mechanical ventilation, and corticosteroids. The increasing use of methotrexate in several gastroenterological diseases warrants further consideration of the potential devastating side effects of this drug, particularly on the lungs. A review of the literature on this topic is provided in the "discussion" section.

Gastrospirillum hominis ("Helicobacter heilmanii"): a cause of gastritis, sometimes transient, better diagnosed by touch cytology?

OBJECTIVE: Besides Helicobacter pylori, another spirillar microorganism, provisionally called Gastrospirillum hominis, has been described in the human stomach in association with gastritis. The aim of this study was to assess the role of cytology in the diagnosis, to assess the gastritis associated with this infection, and to approach its natural history. METHODS: Charts and endoscopic biopsies and smears (touch cytology) from 28 patients with G. hominis seen between 1986 and 1992 were reviewed and compared with biopsies and smears from 28 patients with H. pylori gastritis. RESULTS: G. hominis was seen on smears from all 28 patients but diagnosed in only 15 of the corresponding sets of biopsies. No patient had evidence of H. pylori colonization. All patients had chronic antral gastritis with lymphoplasmocytes, and neutrophils were present in 13 patients. In addition, reactive changes were frequent: foveolar hyperplasia (n = 25), vasodilation (n = 23), lamina propria edema (n = 23), and increased intracytoplasmic mucin (n = 19). In contrast, intestinal metaplasia (n = 3) and glandular atrophy (n = 2) were infrequent, and lymphoid nodules were not seen. In patients with H. pylori, reactive changes were mild, and the lymphoplasmocytic infiltration was more intense (p < 0.005). Eleven patients had at least two endoscopic examinations with biopsies, with persistent colonization in only four. Seven patients cleared the infection with a concomitant regression of gastritis. CONCLUSIONS: G. hominis is more often detected in smears than biopsies. It is seen in association with a peculiar form of gastritis-associating chronic and reactive changes. Colonization may be a transient phenomenon and is never associated with H. pylori.

Helicobacter pylori: 200 patients with a follow-up of 5 years. An observation endoscopic study.

OBJECTIVES: As data on the long-term effects of Helicobacter pylori infection are limited, our aim was to review patients seen repeatedly at endoscopy with biopsies for a minimal period of 5 years. METHODS: The records of 200 patients who had at least two endoscopic examinations with antral biopsies and touch cytology (imprints from biopsies) with an interval of at least 60 months between the first and the last endoscopy. Helicobacter pylori diagnosis was based on the smear. RESULTS: At the first endoscopy, 57% had Helicobacter pylori on the smear, 70% had chronic gastritis on biopsy. During a mean follow-up of 70 months, a colonization rate of 3% per year and an eradication rate of 1% per year were observed. Helicobacter pylori status remained unchanged in 89%. During follow-up, duodenal ulcer was diagnosed at endoscopy in 21 patients, with a significantly (p < 0.05) higher frequency in Helicobacter pylori positive patients, in the presence of gastritis and in men. In two patients, the sequence of colonization and later duodenal ulcer was observed. CONCLUSION: Our retrospective observation study based on endoscopy confirms the chronicity of Helicobacter pylori infection and the low incidence of colonization and eradication. Duodenal ulcer occurred more frequently in Helicobacter pylori positive patients.

Prospective evaluation of the diagnostic accuracy of liver ultrasonography.

Liver ultrasound was prospectively evaluated in 104 subjects who underwent liver biopsy, including 24 patients without evidence of liver disease (controls), and 80 with a broad spectrum of liver pathology. Ultrasonography was very specific (100%) and moderately sensitive (70%) in the detection of liver pathology, and hepatic neoplasms, steatosis, and fibrosis were detected by ultrasound in 80%, 80%, and 67% of cases respectively. In addition, ultrasonography diagnosed other pathologies--mainly biliary tract disease and abdominal neoplasms--in 26% of the patients.