RESUMO
OBJECTIVE: To compare the Helicobacter pylori-associated pathology in gastric biopsies taken from patients living at sea level with those taken from patients living at high altitude. METHODS AND RESULTS: We included 38 patients from a hospital in the Andean city of La Oroya, Peru, located at 3700 m in altitude, and 40 control patients taken from Comas Clinic located in the city of Lima at sea level. Fibrepanendoscopy and multiple biopsies were performed in all the patients followed by histopathological examination. In the antrum, patients from the Andean town had a higher prevalence of glandular lymphoid adherence lesions, active germinal centres, moderate to severe chronic atrophic gastritis, intestinal metaplasia and moderate to severe total deep gland loss, than did patients from the coastal town. Furthermore, the severity of the histological lesions seen in the gastric body and cardia was significantly greater in the high-altitude patients than in those from sea level. CONCLUSION: This study suggests that the severity of H. pylori-associated gastric lesions seen on histopathological examination is greater in patients living at high altitude, the cause of which is most probably multifactorial but nonetheless principally altitude related.
Assuntos
Altitude , Gastrite/patologia , Infecções por Helicobacter/complicações , Adolescente , Adulto , Biópsia , Cárdia/microbiologia , Cárdia/patologia , Feminino , Gastrite/complicações , Infecções por Helicobacter/microbiologia , Helicobacter pylori/crescimento & desenvolvimento , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Antro Pilórico/microbiologia , Antro Pilórico/patologia , Índice de Gravidade de DoençaRESUMO
Se ha planteado la posibilidad de una predisposición racial para adquirir la infección del estómago por el Helicobacter pylori. Sin embargo, no se ha tenido en cuenta el nivel socioeconómico de los pacientes. Objetivo: Comparar la prevalencia de la infección por Helicobacter pylori en la población japonesa residente en el Perú y en peruanos nativos, con similares condiciones socioeconómicas. Material y métodos: Estudio prospectivo realizado en el Policlínico Peruano-Japonés (Lima-Perú), donde incluimos a dos grupos de pacientes: japoneses y peruanos nativos con síntomas crónicos del tracto gastrointestinal superior, ambos de nivel socioeconómico medio y alto. Se excluyeron pacientes con úlcera péptica. Para diagnosticar la infección se utilizó la prueba de la ureasa, la Reacción en Cadena de la Polimerasa (PCR) y serología con ELISA IgG. Resultados: Evaluamos 168 pacientes de raza japonesa (edad promedio 54.6±12.62 años, 75% mujeres), y los comparamos con 161 peruanos (edad 42.12±14.48 años, 61.5% mujeres). Utilizando la prueba de la ureasa, la prevalencia de infección por el Helicobacter pylori en peruanos fue de 47.8% y en japoneses de 47.0% (p=0.88). Utilizando PCR, en peruanos fue de 49.7% y en japoneses 43.5% (p=0.28). Conclusiones: En el Perú, las personas de raza y ascendencia japonesa pura comparados con población peruana del mismo estrato social y similar grupo etáreo, tienen similar prevalencia de la infección por el Helicobacter pylori, con lo que podemos postular que en el Perú y en estos grupos étnicos no existe predisposición racial para adquirir la infección.
Objective: To compare the prevalence of Helicobacter pylori infection in native Peruvians and Japaneses residing in Peru. METHODS: Prospective study carried out at [quot ]Policlinico Peruano-Japonés[quot ] (Lima-Perú). We included Peruvians and Japaneses residing in Peru with chronic symptoms of the upper gastrointestinal tract. Both groups were from medium to high socioeconomic status. We excluded patients with peptic ulcer. PCR, rapid ureasa test and IgG ELISA were used to diagnose the infection. RESULTS: We evaluated 168 Japaneses (mean age 54.6 +/- 12.62 years, 75% female), and 161 Peruvians (mean age of 42.12 +/- 14.48 years, 61.5% female). Using the rapid ureasa test, the prevalence of Helicobacter pylori infection in Peruvians was 47.8%, and in Japaneses 47.0% (p=0.88). Using PCR, in Peruvians was 49.7% and in Japaneses 43.5% (p=0.28). CONCLUSION: Peruvians and Japaneses residing in Peru have a similar prevalence of Helicobacter pylori infection, after controlling factors such as socioeconomic status and age, suggesting that in Peru and in these ethnic groups, there is no racial predisposition to acquire the infection.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Gastrite/etnologia , Helicobacter pylori , Infecções por Helicobacter/etnologia , Estudos Prospectivos , Fatores Socioeconômicos , Gastrite/diagnóstico , Gastrite/microbiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Japão/etnologia , Peru/epidemiologia , PrevalênciaRESUMO
Se ha planteado la posibilidad de una predisposición racial para adquirir la infección del estómago por el Helicobacter pylori. Sin embargo, no se ha tenido en cuenta el nivel socioeconómico de los pacientes. Objetivo: Comparar la prevalencia de la infección por Helicobacter pylori en la población japonesa residente en el Perú y en peruanos nativos, con similares condiciones socioeconómicas. Material y métodos: Estudio prospectivo realizado en el Policlínico Peruano-Japonés (Lima-Perú), donde incluimos a dos grupos de pacientes: japoneses y peruanos nativos con síntomas crónicos del tracto gastrointestinal superior, ambos de nivel socioeconómico medio y alto. Se excluyeron pacientes con úlcera péptica. Para diagnosticar la infección se utilizó la prueba de la ureasa, la Reacción en Cadena de la Polimerasa (PCR) y serología con ELISA IgG. Resultados: Evaluamos 168 pacientes de raza japonesa (edad promedio 54.6±12.62 años, 75% mujeres), y los comparamos con 161 peruanos (edad 42.12±14.48 años, 61.5% mujeres). Utilizando la prueba de la ureasa, la prevalencia de infección por el Helicobacter pylori en peruanos fue de 47.8% y en japoneses de 47.0% (p=0.88). Utilizando PCR, en peruanos fue de 49.7% y en japoneses 43.5% (p=0.28). Conclusiones: En el Perú, las personas de raza y ascendencia japonesa pura comparados con población peruana del mismo estrato social y similar grupo etáreo, tienen similar prevalencia de la infección por el Helicobacter pylori, con lo que podemos postular que en el Perú y en estos grupos étnicos no existe predisposición racial para adquirir la infección.(AU)
Objective: To compare the prevalence of Helicobacter pylori infection in native Peruvians and Japaneses residing in Peru. METHODS: Prospective study carried out at [quot ]Policlinico Peruano-Japonés[quot ] (Lima-Perú). We included Peruvians and Japaneses residing in Peru with chronic symptoms of the upper gastrointestinal tract. Both groups were from medium to high socioeconomic status. We excluded patients with peptic ulcer. PCR, rapid ureasa test and IgG ELISA were used to diagnose the infection. RESULTS: We evaluated 168 Japaneses (mean age 54.6 +/- 12.62 years, 75% female), and 161 Peruvians (mean age of 42.12 +/- 14.48 years, 61.5% female). Using the rapid ureasa test, the prevalence of Helicobacter pylori infection in Peruvians was 47.8%, and in Japaneses 47.0% (p=0.88). Using PCR, in Peruvians was 49.7% and in Japaneses 43.5% (p=0.28). CONCLUSION: Peruvians and Japaneses residing in Peru have a similar prevalence of Helicobacter pylori infection, after controlling factors such as socioeconomic status and age, suggesting that in Peru and in these ethnic groups, there is no racial predisposition to acquire the infection.(AU)
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gastrite/etnologia , Infecções por Helicobacter/etnologia , Helicobacter pylori , Gastrite/diagnóstico , Gastrite/microbiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Japão/etnologia , Peru/epidemiologia , Prevalência , Estudos Prospectivos , Fatores SocioeconômicosAssuntos
Infecções por Helicobacter , Helicobacter pylori , Adulto , Biópsia , Criança , Países em Desenvolvimento , Feminino , Mucosa Gástrica/microbiologia , Gastrite/etiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/prevenção & controle , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Linfoma de Zona Marginal Tipo Células B/etiologia , Masculino , Úlcera Péptica/etiologia , Peru/epidemiologia , Reação em Cadeia da Polimerase , Fatores Socioeconômicos , Neoplasias Gástricas/etiologiaRESUMO
Helicobacter pylori is an extremely diverse species. The characterization of strains isolated from individual patients should give insights into colonization and disease mechanisms and bacterial evolution. We studied H. pylori isolates from patients in the Japanese-Peruvian Polyclinic in Lima, Peru, by determining metronidazole susceptibility or resistance and by random amplified polymorphic DNA (RAPD) fingerprinting (a measure of overall genotype). Strains isolated from several biopsy specimens from each of 24 patients were studied. Both metronidazole-susceptible and -resistant strains were isolated from 13 patients, whereas strains of more than one RAPD type were isolated from only seven patients. We propose that the homogeneity in RAPD fingerprints for strains isolated from most persons reflects selection for particular H. pylori genotypes during chronic infection in individual hosts and the human diversity in traits that are important to this pathogen. Carriage of related metronidazole-resistant and -susceptible strains could reflect frequent metronidazole use in Peru and alternating selection for resistant and susceptible phenotypes during and after metronidazole therapy.
Assuntos
Infecções por Helicobacter/microbiologia , Helicobacter pylori , Adulto , Idoso , Antibacterianos/farmacologia , Impressões Digitais de DNA , Resistência Microbiana a Medicamentos/genética , Feminino , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Metronidazol/farmacologia , Pessoa de Meia-Idade , Peru/epidemiologia , Técnica de Amplificação ao Acaso de DNA PolimórficoRESUMO
Chronic atrophic gastritis (CAG) is a premalignant condition characterized by loss of gastric antral deep glands. The histologic changes in antral gastric biopsy specimens from 54 Peruvian patients with dyspepsia were studied to detail the development and characteristics of CAG. Ninety-six percent of the biopsies revealed severe superficial mucosal inflammation and 89% showed deep inflammation. Moderate or severe CAG was present in 36 (67%) of the 54 patients. In the early stages of CAG, a glandular lymphoid adherence lesion was noted in 17 (31%) of the 54 biopsy specimens. This lesion consisted of lymphocytes adherent to the antral deep gland cells and was associated with glandular epithelium alterations. The late stage was characterized by small glands, remnants of glands, and gland replacement with a fibrocellular infiltrate or intestinal metaplasia. We propose that the development of CAG probably proceeds via a stereotyped sequence, with an early deep inflammatory component that may trigger local gland destruction and eventual permanent loss.
Assuntos
Gastrite Atrófica/diagnóstico , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Adolescente , Adulto , Idoso , Doença Crônica , Dispepsia/complicações , Dispepsia/diagnóstico , Dispepsia/patologia , Células Epiteliais , Feminino , Mucosa Gástrica/patologia , Gastrite Atrófica/complicações , Gastrite Atrófica/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/patologia , Humanos , Intestinos/patologia , Tecido Linfoide/imunologia , Masculino , Metaplasia/patologia , Pessoa de Meia-IdadeRESUMO
Helicobacter pylori is associated with gastritis, peptic ulcer disease, and gastric cancer. Since gastric cancer is common in Peru, eradication of H. pylori may help to reduce the occurrence of gastric cancer. This study involved three randomized trials to determine the efficacy of four different triple-drug therapy regimens. The most successful regimen was furazolidone combined with bismuth subsalicylate and amoxicillin, which eradicated infection in 82% of patients. Patients successfully treated were followed every 2-3 months to determine the recurrence rate of H. pylori infection. Of 105 patients with H. pylori eradication documented by pathology and culture, 52% (55) returned for follow-up endoscopy, and in 73% (40) of these 55 the infection recurred during the 8-month follow-up period. Thirty-five patients from whom H. pylori was eradicated and who were tested for antibodies to H. pylori remained consistently seropositive. Rapid recurrence of H. pylori infection after successful eradication suggests that measures other than antimicrobial therapy are needed to fight H. pylori in developing countries.