RESUMO
BACKGROUND & AIMS: Fundic gland polyps (FGPs), the most common type of gastric polyps, have been associated with prolonged proton pump inhibitor therapy and an increased risk of colon cancer. The presence of FGPs has been inversely correlated with Helicobacter pylori infection. We evaluated the prevalence of H pylori-associated gastritis, colonic polyps, and carcinomas in subjects with and without FGPs. METHODS: We analyzed data collected from community-based endoscopy centers in 36 states (plus Washington DC and Puerto Rico) on patients who underwent esophagogastroduodenoscopy (EGD) and colonoscopy between April 2007 and March 2008. Of the 103,385 patients who underwent EGD during this time period, gastric biopsy samples were collected from 78,801 and colonic biopsies from 26,017. Slides of samples from Helicobacter-infected FGPs and FGPs with dysplasia were reviewed. RESULTS: FGPs were detected in 6081 patients (67.8% women). Helicobacter infection was present in less than 0.5% patients with FGPs and 13.0% of those without FGPs (odds ratio [OR], 29.05; 95% confidence interval [CI], 20.4-41.4; P < .0001). Colonic adenomas were detected in 42.3% of women with FGPs and 33.8% of those without (OR, 1.43; 95% CI, 1.26-1.63; P < .001); there was no significant difference in colonic adenomas between men with and without FGPs. CONCLUSIONS: Women had a higher prevalence of FGPs. FGPs were associated with gastroesophageal reflux disease symptoms, gastric heterotopia, hyperplastic colonic polyps (only in men), and colonic adenomas (only in women, especially those over 60 years of age). The presence of FGPs was inversely correlated with H pylori infection, active gastritis, and gastric neoplasia.
Assuntos
Fundo Gástrico/patologia , Mucosa Gástrica/patologia , Gastrite/complicações , Neoplasias Gastrointestinais/epidemiologia , Infecções por Helicobacter/complicações , Pólipos/complicações , Pólipos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Colo/patologia , Colonoscopia , District of Columbia , Endoscopia Gastrointestinal , Feminino , Fundo Gástrico/microbiologia , Helicobacter pylori/isolamento & purificação , Histocitoquímica , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Porto Rico , Adulto JovemRESUMO
We report on a 29-year-old Pakistani man who presented to the clinic with epigastric pain, of one-month duration. He did not report fever, cough, vomiting blood, passing black stools, loss of appetite or diarrhea. However, he had lost 7 kg since his symptoms had begun. Clinical examination was unremarkable. Laboratory results were within normal limits. An abdominal CT scan showed a mass with enhancement in the stomach. Gastric endoscopy revealed an ulcerative mass in the fundus. An endoscopic-biopsy specimen revealed caseating granulomas with acid-fast bacilli. The patient was diagnosed to have primary gastric tuberculosis, and antituberculous medications were initiated. Cultures of the gastric mass subsequently grew Mycobacterium tuberculosis sensitive to isoniazid and rifampcin. Follow-up after six months showed a good response to treatment; an upper gastrointestinal tract endoscopy after six months was normal.
Assuntos
Adulto , Humanos , Masculino , Gastropatias/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Antituberculosos/uso terapêutico , Seguimentos , Gastroscopia , Fundo Gástrico/microbiologia , Imunocompetência , Isoniazida/uso terapêutico , Rifampina/uso terapêutico , Gastropatias/tratamento farmacológico , Gastropatias/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose Gastrointestinal/tratamento farmacológicoRESUMO
We report on a 29-year-old Pakistani man who presented to the clinic with epigastric pain, of one-month duration. He did not report fever, cough, vomiting blood, passing black stools, loss of appetite or diarrhea. However, he had lost 7 kg since his symptoms had begun. Clinical examination was unremarkable. Laboratory results were within normal limits. An abdominal CT scan showed a mass with enhancement in the stomach. Gastric endoscopy revealed an ulcerative mass in the fundus. An endoscopic-biopsy specimen revealed caseating granulomas with acid-fast bacilli. The patient was diagnosed to have primary gastric tuberculosis, and antituberculous medications were initiated. Cultures of the gastric mass subsequently grew Mycobacterium tuberculosis sensitive to isoniazid and rifampcin. Follow-up after six months showed a good response to treatment; an upper gastrointestinal tract endoscopy after six months was normal.
Assuntos
Gastropatias/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Seguimentos , Fundo Gástrico/microbiologia , Gastroscopia , Humanos , Imunocompetência , Isoniazida/uso terapêutico , Masculino , Rifampina/uso terapêutico , Gastropatias/tratamento farmacológico , Gastropatias/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose Gastrointestinal/tratamento farmacológicoRESUMO
BACKGROUND: The mucosa distal to the endoscopic mucosal change zone can have easily diagnosed early alterations, in patients with chronic gastroesophageal reflux. AIM: To determine the type of mucosa existent in the zone distal to the squamous-columnar junction in patients with chronic gastroesophageal reflux without intestinal metaplasia. PATIENTS AND METHODS: One hundred thirty four controls and 208 patients with chronic gastroesophageal reflux lasting two years were studied. Forty three of these patients had a normal endoscopy, 54 had an erosive esophagitis and 111 had a short columnar epithelium covering the distal esophagus, without intestinal metaplasia. In all subjects, four biopsies were obtained from a zone distal to the squamous-columnar junction and two from the distal gastric antrum. RESULTS: In 59% of control subjects, fundic mucosa was present in the zone distal to the squamous-columnar junction. Cardial mucosa was present in the rest. In patient with chronic gastroesophageal reflux, cardial mucosa was predominant. Helicobacter pylorii infection decreased along with increasing extension of cardial mucosa covering the distal esophagus. CONCLUSIONS: In patients with chronic gastroesophageal reflux there is a metaplasia of fundic mucosa towards cardial mucosa. On the other hand, Helicobacter pylorii infection decreases gradually.
Assuntos
Esôfago de Barrett/etiologia , Mucosa Gástrica/patologia , Refluxo Gastroesofágico/patologia , Infecções por Helicobacter/patologia , Helicobacter pylori , Adolescente , Adulto , Idoso , Biópsia , Cárdia/microbiologia , Cárdia/patologia , Estudos de Casos e Controles , Doença Crônica , Endoscópios Gastrointestinais , Feminino , Fundo Gástrico/microbiologia , Fundo Gástrico/patologia , Mucosa Gástrica/microbiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/microbiologia , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A prospective study was performed in 190 control subjects and in 236 patients with different degrees of endoscopic esophagitis in order to determine the prevalence of Helicobacter pylori infection at duodenal gastric and esophageal mucosa and its correlation with histological findings. All patients with pathologic gastroesophageal reflux had 24-h pH monitoring studies confirming the presence of acid reflux into the esophagus. Besides the endoscopic findings, biopsies were taken from the duodenal bulb, gastric antrum, gastric fundus and distal esophagus or at the specialized columnar epithelium in patients with Barrett's esophagus. Patients with pathological gastroesophageal reflux were divided into three groups: 55 with absence of endoscopic esophagitis (gastroesophageal reflux), 81 patients with erosive esophagitis and 100 patients with Barrett's esophagus. There was no H. pylori infection present at duodenal or esophageal mucosa or at the specialized columnar epithelium of the distal esophagus in any case. The prevalence of H. pylori infection at gastric antrum was similar in controls and in any group of patients with reflux disease (20-25% of H. pylori infection). No differences in age and sex distribution were seen. H. pylori infection at gastric fundus was very low (less than 5%). The presence of HP infections was correlated with the finding of chronic active superficial or athrophic gastritis while, in the absence of H. pylori infection, gastric mucosa was normal. In the presence of intestinal metaplasia, no H. pylori infection occurred. Based on these findings, it seems that there is no significant evidence for an important pathogenic role for H. pylori infection in the development of pathologic chronic gastroesophageal reflux, erosive esophagitis or Barrett's esophagus, and the presence of antral gastritis in patients with Barrett's esophagus is closely related to the presence of H. pylori infection, and probably not related to an increased duodenogastric reflux.
Assuntos
Esôfago de Barrett/microbiologia , Esofagite Péptica/microbiologia , Esôfago/microbiologia , Refluxo Gastroesofágico/microbiologia , Infecções por Helicobacter , Helicobacter pylori , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Refluxo Duodenogástrico/microbiologia , Duodeno/microbiologia , Epitélio/microbiologia , Feminino , Fundo Gástrico/microbiologia , Mucosa Gástrica/microbiologia , Gastrite Atrófica/microbiologia , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Humanos , Concentração de Íons de Hidrogênio , Mucosa Intestinal/microbiologia , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial , Mucosa/microbiologia , Prevalência , Estudos Prospectivos , Antro Pilórico/microbiologia , Fatores SexuaisRESUMO
The prevalence of Helicobacter pylori infection was studied in 152 subjects with a normal upper gastrointestinal endoscopy, 125 with duodenal ulcer, 25 with gastric ulcer, 46 with erosive gastritis and 9 with erosive duodenitis. Two biopsies from duodenum, antrum and fundus were obtained from each subject during endoscopy for histological diagnosis and Helicobacter pylori search. None of the patients with normal endoscopy and 2% of patients with duodenal ulcers had Helicobacter pylori in duodenal biopsies. These last patients had a significantly higher frequency of Helicobacter pylori in the antrum (71%) than the rest of the studied groups. Five percent of subjects with normal endoscopy and 5% of those with duodenal ulcers had Helicobacter pylori in the antrum. An active gastritis was demonstrated in almost all patients with Helicobacter infection. Intestinal metaplasia occurred almost exclusively in the absence of Helicobacter pylori infection.
Assuntos
Úlcera Duodenal/microbiologia , Duodenite/microbiologia , Gastrite/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Úlcera Gástrica/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Úlcera Duodenal/patologia , Duodenite/patologia , Duodeno/microbiologia , Endoscopia Gastrointestinal , Feminino , Fundo Gástrico/microbiologia , Gastrite/patologia , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/patologia , Humanos , Intestinos/microbiologia , Intestinos/patologia , Masculino , Metaplasia , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Antro Pilórico/microbiologia , Úlcera Gástrica/patologiaRESUMO
The prevalence of helicobacter pylori infection was studied in 152 subjects with a normal upper gastrointestinal endoscopy, 125 with duodenal ulcer, 25 with gastric ulcer, 46 with erosive gastritis and 9 with erosive duodenitis. Two biopsies fron duodenum, antrum and fub¿ndus were obtained from each subject during endoscopy for histological diagnosis and Helicobacter pylori search. None of the patients with normal endoscopy and 2 percent of patients with duodenal ulcer had Helicobacter pylori in duodenal biopsies. These last patients had a significantly higher frecuency of Helicobacter pylori in the antrum (71 percent) than the rest of the studied groups. Five percent of subjects with normal endoscopy and 5 percent of those with duodenal ulcer had Helicobacter pylori in the antrum. An active gastritis was demonstrated in almost all patients with Helicobacter infection. Instestinal metaplasia occurred almost exclusively in the abscence of Helicobacter Pylori infection
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Helicobacter pylori/isolamento & purificação , Duodenite/microbiologia , Gastrite/microbiologia , Úlcera Duodenal/microbiologia , Úlcera Gástrica/microbiologia , Helicobacter pylori/patogenicidade , Gastroscopia , Duodeno/microbiologia , Gastroenteropatias/microbiologia , Gastroenteropatias/patologia , Metaplasia/microbiologia , Antro Pilórico/microbiologia , Fundo Gástrico/microbiologiaRESUMO
Tightly spiralled bacteria ("Gastrospirillum suis") were seen in the pyloric mucosa of the stomach of 13 (10.8%) of 120 pigs that appeared clinically healthy at slaughter and in the fundic mucosa of three (5.0%) out of 60 pigs. The spiral organism could not be cultured from any pig. Chronic gastritis was observed in the pyloric mucosa of 53 (44.2%) of 120 pigs and in the fundic mucosa of 7 (11.7%) of 60 pigs. The 13 pigs with spiral bacteria in the pyloric region comprised one animal (7.7%) with normal pyloric mucosa, two (15.4%) with "borderline gastritis", and 10 (76.9%) with chronic gastritis--in one instance accompanied by signs of activity (numerous polymorphonuclear cells). The three pigs with spiral bacteria in the fundic mucosa comprised two animals with a normal fundic region and one with "borderline gastritis". The presence of the spiral bacterium was significantly associated with pyloric gastritis (p = 0.013) and with numbers of lymphoid follicles (p = 0.014).
Assuntos
Mucosa Gástrica/microbiologia , Helicobacter pylori/isolamento & purificação , Animais , Doença Crônica , Feminino , Fundo Gástrico/microbiologia , Fundo Gástrico/patologia , Mucosa Gástrica/patologia , Gastrite/microbiologia , Gastrite/patologia , Gastrite/veterinária , Helicobacter pylori/crescimento & desenvolvimento , Masculino , Piloro/microbiologia , Piloro/patologia , Suínos , Doenças dos Suínos/microbiologia , Doenças dos Suínos/patologiaRESUMO
El campylobacter pylori ha sido implicado en la patogénesis de la úlcera péptica, dispepsia no ulcerosa y en la gastritis crónica. El C. pylori produce grandes cantidades de ureasa lo cual ha sido utilizado como base bioquímica para su identificación en pruebas diagnósticas rápidas y sencillas. En este estudio presentamos el uso de una prueba rápida de ureasa (CLOtest) en la detección del C. pylori. Estudiamos 46 pacientes consecutivos a los cuales se les practicó biopsia de mucosa gástrica en antro y fundus para estudio histológico y CLOtest. Todos los pacientes tuvieron gatritis crónica en histología. En 22 pacientes (48%) el C. pylori fue identificado por CLOtest y/o histología. En 18 pacientes (39%) el CLOtest fue positivo y en 16 pacientes (35%) la histología fue positiva. En 12 pacientes (26%) el C. pylori se evidenció por ambos métodos. No hubo diferencias en cuanto a la presencia del C. pylori en fundus y antro. Sin embargo, en 2 pacientes (4%) el C. pylori fue positivo en fundus y negativo en antro. En 9 pacientes (20%) el C. pylori fue positivo en antro y negativo en fundus. El CLOtest es una prueba sencilla rápida y sensible que permite al endoscopista diagnosticar la infección por C. pylori en la sala de endoscopia
Assuntos
Fundo Gástrico/patologia , Infecções por Helicobacter/diagnóstico , Antro Pilórico/patologia , Urease , Biópsia , Fundo Gástrico/microbiologia , Gastrite/diagnóstico , Gastrite/etiologia , Gastrite/patologia , Helicobacter pylori/patogenicidade , Antro Pilórico/microbiologiaRESUMO
Campylobacter pylori has been implicated in the pathogenesis of peptic ulcer, non-ulcer dyspepsia and chronic gastritis. C. pylori produces large amounts of urease which has been used as a biochemical support to identify the microorganism. In this study, we described the use of a rapid urease test (CLOtest) to detect C. pylori. In 46 consecutive patients, biopsy of fundus and antrum were obtained for histology and CLOtest. All specimens showed chronic gastritis. In 22 patients (48%) C. pylori was identified either by histology or CLOtest. In 18 patients (39%) CLOtest was positive and in 16 patients (35%) histology was positive. In 12 patients (26%) C. pylori was identified by both tests. There was no difference in relation to the presence of C. pylori in fundus and antrum. However, in 2 patients (4%) C. pylori was positive in fundus and negative in antrum. In 9 patients (20%) C. pylori was positive in antrum and negative in fundus. CLOtest is a simple, sensitive and rapid test that enables the endoscopist to diagnose C. pylori infection in the endoscopy room.