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
It has recently been suggested that there is an association between infectious gastroenteritis and irritable bowel syndrome with chronic diarrhea; and a striking similarity between the microscopic lesion observed in this condition and the lesion described in microscopic colitis (MC). As in developed countries MC is found in only 12.6 to 15% of patients with chronic diarrhea, we thought it worthwhile to investigate in Perú, a developing country with high prevalence of infectious gastroenteritis, the prevalence of MC also in patients with chronic diarrhea. One hundred and ten patients with chronic diarrhea underwent biopsies from the right and left colon, and the biopsies were examined histologically to detect MC of lymphocytic or collagenous type.MC was present in 44 (40%) of the 110 patients with chronic diarrhea, being of lymphocytic type in 42, and of collagenous type in. The prevalence of MC observed in Peruvian patients with chronic diarrhea is high when compared to reports from developed countries. This finding supports the idea that infectious gastroenteritis may, under certain conditions, precipitate the appearance of MC, probably by an autoimmune reaction.
Assuntos
Colite/complicações , Colo/patologia , Diarreia/complicações , Mucosa Intestinal/patologia , Síndromes de Malabsorção/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Doença Crônica , Colite/epidemiologia , Colite/patologia , Colonoscopia , Diarreia/epidemiologia , Diarreia/patologia , Feminino , Humanos , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/patologia , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Balamuthia mandrilaris amoebiasis is a fatal disease. It primarily affects the nasal pyramid or the skin, producing granulomatous amoebic lesions. The amoeba spread from the primary nasal lesion to the meninges where they infiltrate vessels. Thrombotic amoebic angitis produce infarcts of the central nervous system substance which then become infiltrated by amoeba. The primary cutaneous lesion can be present for weeks or even months. However, the appearance of neurological disease predicts a poor prognosis, in which death usually occurs within a few days or weeks.
Assuntos
Amebíase/patologia , Doenças do Sistema Nervoso Central/microbiologia , Doenças do Sistema Nervoso Central/patologia , Adolescente , Adulto , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Meninges/patologia , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Adulto , Idoso , Amoxicilina/uso terapêutico , Bismuto/uso terapêutico , Quimioterapia Combinada , Feminino , Seguimentos , Furazolidona/uso terapêutico , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Compostos Organometálicos/uso terapêutico , Peru , Recidiva , Salicilatos/uso terapêutico , Tetraciclina/uso terapêutico , Tinidazol/uso terapêuticoAssuntos
Gastrite/microbiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Adolescente , Adulto , Fatores Etários , Biópsia , Doença Crônica , Feminino , Gastrite/epidemiologia , Gastrite/patologia , Gastrite/fisiopatologia , Infecções por Helicobacter/patologia , Infecções por Helicobacter/fisiopatologia , Humanos , Masculino , Peru/epidemiologia , Prevalência , Índice de Gravidade de DoençaRESUMO
A review is done on the evidence in favor of a link between Helicobacter pylori infection and gastric cancer of the intestinal type. In countries at high risk of gastric cancer, like Perú, Hp infection begins early in life and is highly frequent and persistent. When Hp colonizes the gastric mucosa, it causes active chronic gastritis. Initially, the gastritis is of the superficial type. With time, and probably as a result of the concurrent action of nutritional, epidemiologic and immunologic modulating factors, chronic superficial gastritis may give rise to a progressive gastric pathology that leads to gastric premalignant lesions (chronic atrophic gastritis, intestinal metaplasia and dysplasia of the gastric mucosa) and increases the predisposition to gastric cancer. The principal modulating factors are described. The epidemiology of gastric premalignant lesions in Perú is also described. Finally, a discussion is done on the effect that eradication of Hp infection might have on the prevalence of gastric cancer.
Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori , Neoplasias Gástricas/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Estudos Transversais , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/terapia , Humanos , Pessoa de Meia-Idade , Peru/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/prevenção & controleRESUMO
We compared the prevalence of gastric metaplasia of the duodenal mucosa (GM) and its characteristics in 204 Peruvian patients from a low socioeconomic level with the corresponding prevalence reported in dyspeptic patients from a developed country, the United Kingdom. Gastric metaplasia was significantly less prevalent in the Peruvian than in the United Kingdom series. However, when present, GM was not significantly different in extent or frequency of colonization by Helicobacter pylori or association with active duodenitis, despite a higher prevalence of H. pylori-associated gastritis. Hypochlorhydria was markedly more frequent in the Peruvian than in the United Kingdom series. The finding of a low prevalence of H. pylori-colonized GM in patients with previously reported low prevalence of duodenal ulcer gives further support to a pathogenic link between both conditions.