RESUMO
PURPOSE: To evaluate serum levels of high-sensitivity C-reactive protein (hs-CRP) in chronic gastritis patients to predict Helicobacter pylori (HP) infection, inflammatory activity, and precancerous lesions. METHODS: A total of 811 patients with upper gastrointestinal symptoms and histopathological diagnosis of chronic gastritis were enrolled in the study. On endoscopy, five gastric biopsies were taken according to Modified Sydney protocol, which were stained with hematoxylin & eosin and Giemsa. RESULTS: HP infection was found in 28.6% of patients, being significantly more common in specimens with acute and chronic inflammatory activity. Mucosal atrophy, intestinal metaplasia, and dysplasia were found in 20.2%, 18.8% and 2.7% of biopsy specimens. Mean hs-CRP was 1.9±1.6 mg/dl for males and 2.2±1.9 mg/dl for females. hs-CRP average were significantly higher in patients with severe acute inflammation (p:0.049), in patients with severe chronic inflammation (p:0.015) and in those with HP (p: 0.001) . The severity of HP infection increased significantly with the increased degree of acute inflammation, chronic inflammation and hs-CRP level (p=0.001 for both). CONCLUSION: Serum hs-CRP level increases in patients with chronic gastritis, it could be an indicator of severity of acute or chronic mucosal inflammation, and presence of HP infection. Therefore, hs-CRP may aid the diagnosis of chronic gastritis, but it is not associated with pre-cancerous lesions.
Assuntos
Proteína C-Reativa/análise , Gastrite/sangue , Gastrite/patologia , Infecções por Helicobacter/sangue , Infecções por Helicobacter/patologia , Helicobacter pylori , Doença Aguda , Adolescente , Adulto , Análise de Variância , Biópsia , Contagem de Células Sanguíneas , Doença Crônica , Feminino , Mucosa Gástrica/patologia , Gastroscopia/métodos , Humanos , Masculino , Metaplasia/patologia , Pessoa de Meia-Idade , Valores de Referência , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
Abstract Purpose: To evaluate serum levels of high-sensitivity C-reactive protein (hs-CRP) in chronic gastritis patients to predict Helicobacter pylori (HP) infection, inflammatory activity, and precancerous lesions. Methods: A total of 811 patients with upper gastrointestinal symptoms and histopathological diagnosis of chronic gastritis were enrolled in the study. On endoscopy, five gastric biopsies were taken according to Modified Sydney protocol, which were stained with hematoxylin & eosin and Giemsa Results: HP infection was found in 28.6% of patients, being significantly more common in specimens with acute and chronic inflammatory activity. Mucosal atrophy, intestinal metaplasia, and dysplasia were found in 20.2%, 18.8% and 2.7% of biopsy specimens. Mean hs-CRP was 1.9±1.6 mg/dl for males and 2.2±1.9 mg/dl for females. hs-CRP average were significantly higher in patients with severe acute inflammation (p:0.049), in patients with severe chronic inflammation (p:0.015) and in those with HP (p: 0.001) . The severity of HP infection increased significantly with the increased degree of acute inflammation, chronic inflammation and hs-CRP level (p=0.001 for both). Conclusion: Serum hs-CRP level increases in patients with chronic gastritis, it could be an indicator of severity of acute or chronic mucosal inflammation, and presence of HP infection. Therefore, hs-CRP may aid the diagnosis of chronic gastritis, but it is not associated with pre-cancerous lesions.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Proteína C-Reativa/análise , Helicobacter pylori , Infecções por Helicobacter/patologia , Infecções por Helicobacter/sangue , Gastroscopia/métodos , Gastrite/patologia , Gastrite/sangue , Valores de Referência , Biópsia , Contagem de Células Sanguíneas , Índice de Gravidade de Doença , Doença Aguda , Doença Crônica , Análise de Regressão , Estudos Retrospectivos , Análise de Variância , Mucosa Gástrica/patologia , Metaplasia/patologiaRESUMO
ABSTRACT BACKGROUND: Endothelial dysfunction is one of the early stages of vascular diseases. OBJECTIVE: The aim of this study was to investigate the endothelial dysfunction markers in patients with chronic gastritis associated with Helicobacter pylori (H. pylori) infection. METHODS: By a cross sectional study, basic and clinical information of 120 participants (40 patients with positive H. pylori infection, 40 patients with negative H. pylori infection and 40 healthy people) were analyzed. Carotid intima media thickness and flow-mediated dilation levels were measured in all patients and controls. Soluble vascular cell adhesion molecule-1 (sVCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were measured with Elisa for all subjects. IgG level was assessed in chronic gastritis patients. RESULTS: The flow-mediated dilation level in patients with positive H. pylori infection (0.17%±0.09) was significantly lower than those with negative H. pylori infection (0.21% ±0.10, P<0.05) and compared to the control group (0.27% ±0.11, P<0.05). Carotid intima media thickness level in patients with positive H. pylori infection (0.58±0.13 mm) was significantly higher than those with negative H. pylori infection (0.48±0.32 mm, P<0.05) and compared to the control group (0.36±0.44mm, P<0.05). The mean level of sICAM-1 in positive H. pylori infection group (352.16±7.54 pg/mL) was higher than negative H. pylori infection group (332.64±8.75 pg/mL =0.75) and compared to the control group (236.32±12.43 pg/mL, P<0.05). A direct relationship was revealed between flow-mediated dilation and carotid intima media thickness changes and between sICAM-1 and sVCAM-1 associated with the level of H. pylori IgG in chronic gastritis. CONCLUSION: The levels of flow-mediated dilation, carotid intima media thickness and sICAM-1 were higher among patients with positive H. pylori infection. Patients with chronic gastritis associated with H. pylori infection are at risk of endothelial dysfunction due to flow-mediated dilation and carotid intima media thickness abnormalities and increased level of sICAM-1 and sVCAM-1.
RESUMO CONTEXTO: A disfunção endotelial é um dos estágios iniciais de doenças vasculares. OBJETIVO: O objetivo deste estudo foi investigar os marcadores de disfunção endotelial em pacientes com gastrite crônica associada com infecção por Helicobacter pylori (H. pylori). MÉTODOS: Através de estudo cruzado seccional, foram analisadas informações básicas e clínicas de 120 participantes (40 pacientes com infecção pelo H. pylori, 40 pacientes sem infecção pelo H. pylori e 40 pessoas saudáveis). A espessura da camada íntima-média da carótida e níveis de dilatação mediada por fluxo foram medidos em todos os pacientes e controles. A adesão da molécula-1 solúvel (sVCAM-1) à célula vascular e da molécula de adesão intercelular-1 (ICAM-1) foram medidas pelo método Elisa para todas os indivíduos. O nível de H. pylori IgG foi avaliado em pacientes de gastrite crônica. RESULTADOS: O nível de dilatação mediada por fluxo em pacientes com infecção positiva pelo H. pylori foi significativamente menor do que em aqueles com infecção negativa (0,17% ±0, 09) X (0,21% ±0,10) P<0,05 e em relação ao grupo controle (0,27% ±0,11) P<0,05). O nível da espessura da íntima-média da carótida em pacientes com infecção positiva pelo H. pylori foi significativamente maior (0,58±0,13 mm) do que aqueles com negativa (0,48±0,32 mm) P<0,05) e em relação ao grupo controle (0,36±0,44 mm) P<0,05). O nível médio de sICAM-1 grupo de infecção H. pylori positiva (352,16±7,54 pg/mL) foi maior do que o grupo de infecção negativa (332,64±8,75 pg/mL = 0,75) e em relação ao grupo controle (236,32±12,43 pg/mL) P<0,05). Revelou-se uma relação direta entre a dilatação mediada por fluxo e alterações da espessura da íntima-média da carótida e sICAM-1 e sVCAM-1, associada com o nível de H. pylori IgG em gastrite crônica. CONCLUSÃO: Os níveis de dilatação mediada por fluxo, da espessura da íntima-média da carótida e sICAM-1 foram maiores entre os pacientes com infecção positiva pelo H. pylori. Pacientes com gastrite crônica associada a infecção por H. pylori correm o risco de disfunção endotelial, devido à dilatação mediada por fluxo e anormalidades da espessura da íntima-média da carótida e aumento do nível de sICAM-1 e sVCAM-1.
Assuntos
Humanos , Masculino , Feminino , Artérias Carótidas/fisiopatologia , Helicobacter pylori , Molécula 1 de Adesão Intercelular/sangue , Molécula 1 de Adesão de Célula Vascular/sangue , Gastrite/fisiopatologia , Gastrite/microbiologia , Biomarcadores/sangue , Doença Crônica , Estudos Transversais , Infecções por Helicobacter/fisiopatologia , Infecções por Helicobacter/sangue , Espessura Intima-Media Carotídea , Gastrite/sangue , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Endothelial dysfunction is one of the early stages of vascular diseases. OBJECTIVE: The aim of this study was to investigate the endothelial dysfunction markers in patients with chronic gastritis associated with Helicobacter pylori (H. pylori) infection. METHODS: By a cross sectional study, basic and clinical information of 120 participants (40 patients with positive H. pylori infection, 40 patients with negative H. pylori infection and 40 healthy people) were analyzed. Carotid intima media thickness and ï¬ow-mediated dilation levels were measured in all patients and controls. Soluble vascular cell adhesion molecule-1 (sVCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were measured with Elisa for all subjects. IgG level was assessed in chronic gastritis patients. RESULTS: The ï¬ow-mediated dilation level in patients with positive H. pylori infection (0.17%±0.09) was significantly lower than those with negative H. pylori infection (0.21% ±0.10, P<0.05) and compared to the control group (0.27% ±0.11, P<0.05). Carotid intima media thickness level in patients with positive H. pylori infection (0.58±0.13 mm) was significantly higher than those with negative H. pylori infection (0.48±0.32 mm, P<0.05) and compared to the control group (0.36±0.44mm, P<0.05). The mean level of sICAM-1 in positive H. pylori infection group (352.16±7.54 pg/mL) was higher than negative H. pylori infection group (332.64±8.75 pg/mL =0.75) and compared to the control group (236.32±12.43 pg/mL, P<0.05). A direct relationship was revealed between ï¬ow-mediated dilation and carotid intima media thickness changes and between sICAM-1 and sVCAM-1 associated with the level of H. pylori IgG in chronic gastritis. CONCLUSION: The levels of ï¬ow-mediated dilation, carotid intima media thickness and sICAM-1 were higher among patients with positive H. pylori infection. Patients with chronic gastritis associated with H. pylori infection are at risk of endothelial dysfunction due to ï¬ow-mediated dilation and carotid intima media thickness abnormalities and increased level of sICAM-1 and sVCAM-1.
Assuntos
Artérias Carótidas/fisiopatologia , Gastrite/microbiologia , Infecções por Helicobacter/fisiopatologia , Helicobacter pylori , Molécula 1 de Adesão Intercelular/sangue , Molécula 1 de Adesão de Célula Vascular/sangue , Biomarcadores/sangue , Espessura Intima-Media Carotídea , Doença Crônica , Estudos Transversais , Feminino , Gastrite/sangue , Gastrite/fisiopatologia , Infecções por Helicobacter/sangue , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Recently, a great variety of studies aimed to investigate and even suggest Helicobacter pylori as an important key factor in gastrointestinal and non-gastrointestinal events development. The well-established relationship between bacterial virulence and increased risk for peptic ulcer or gastric carcinoma is not so clear when comparing inflammation markers alterations, such C-reactive protein, with the pathogen. OBJECTIVE: The objective of this study was to evaluate the presence of H. pylori, bacterial virulence and C-reactive protein serum levels in individuals diagnosed with functional dyspepsia. METHODS: Were prospectively included in this study 489 dyspeptic individuals. They fulfill Rome III clinical criteria for the diagnosis of functional dyspepsia with no organic disease at endoscopy. The bacterial infection was established by histology and urease rapid test. The levels of serum C-reactive protein were obtained by immunonefelometry and CagA status of H. pylori positive individuals was determined through an imunoenzimatic assay. RESULTS: Prevalence rate of H. pylori was 66.3% and virulence factor CagA was detected in nearly 43% of positive samples. In addition, it has been noticed an association between Ilex paraguariensis (yerba maté) consumption and pathogen's prevalence. An important effect of bacterial infection on inflammation was only observed in gastric epithelium. CONCLUSION: No systemic response to the pathogen, measured through C-reactive protein levels, was observed, regardless of CagA status. Otherwise, the intake of yerba maté should be considered as a cultural factor possibly related to H. pylori's transmission.
Assuntos
Antígenos de Bactérias/sangue , Proteínas de Bactérias/sangue , Proteína C-Reativa/análise , Dispepsia/microbiologia , Gastrite/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/patogenicidade , Virulência , Biomarcadores/sangue , Dispepsia/sangue , Feminino , Mucosa Gástrica/microbiologia , Gastrite/sangue , Infecções por Helicobacter/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
ABSTRACT Background Recently, a great variety of studies aimed to investigate and even suggestHelicobacter pylori as an important key factor in gastrointestinal and non-gastrointestinal events development. The well-established relationship between bacterial virulence and increased risk for peptic ulcer or gastric carcinoma is not so clear when comparing inflammation markers alterations, such C-reactive protein, with the pathogen. Objective The objective of this study was to evaluate the presence of H. pylori, bacterial virulence and C-reactive protein serum levels in individuals diagnosed with functional dyspepsia. Methods Were prospectively included in this study 489 dyspeptic individuals. They fulfill Rome III clinical criteria for the diagnosis of functional dyspepsia with no organic disease at endoscopy. The bacterial infection was established by histology and urease rapid test. The levels of serum C-reactive protein were obtained by immunonefelometry and CagA status ofH. pylori positive individuals was determined through an imunoenzimatic assay. Results Prevalence rate of H. pylori was 66.3% and virulence factor CagA was detected in nearly 43% of positive samples. In addition, it has been noticed an association between Ilex paraguariensis(yerba maté) consumption and pathogen's prevalence. An important effect of bacterial infection on inflammation was only observed in gastric epithelium. Conclusion No systemic response to the pathogen, measured through C-reactive protein levels, was observed, regardless of CagA status. Otherwise, the intake of yerba maté should be considered as a cultural factor possibly related toH. pylori's transmission.
RESUMO Contexto Recentemente, uma grande variedade de estudos tem investigado e até mesmo sugerido a presença de Helicobacter pylori como um importante fator no desenvolvimento de eventos restritos ou não ao trato gastrointestinal. A relação já bem estabelecida entre virulência bacteriana e risco aumentado para úlcera péptica ou adenocarcinoma gástrico não parece estar tão elucidada quando se comparam alterações de marcadores inflamatórios, como a proteína C-reativa, com a presença do patógeno. Objetivo O objetivo deste estudo foi avaliar a presença da infecção por H. pylori, a virulência bacteriana e os níveis séricos de proteína C-reativa em indivíduos diagnosticados com dispepsia funcional. Métodos Foram incluídos neste estudo, prospectivamente, 489 indivíduos dispépticos. Os pacientes deveriam preencher os critérios clínicos de Roma III para o diagnóstico de dispepsia funcional sem apresentar doença orgânica evidenciada a partir da endoscopia. A infecção bacteriana foi estabelecida por histologia e pelo teste rápido da urease. Os níveis de proteína C-reativa foram quantificados através de imunonefelometria e o status para a presença da CagA dos indivíduos infectados por H. pylorifoi determinado por ensaio imunoenzimático. Resultados A taxa de prevalência de H. pylori foi de 66.3% e o fator de virulência CagA foi detectado em aproximandamente 43% das amostras positivas. Adicionalmente, denotou-se uma associação entre o consumo deIlex paraguariensis (chimarrão) e a prevalência do patógeno. Um importante efeito da infecção bacteriana na inflamação apenas foi observado localmente, no epitélio gástrico. Conclusão Não foi evidenciada resposta sistêmica ao patógeno aferido através dos níveis de proteína C-reativa, independentemente do status para CagA. Por outro lado, o consumo de chimarrão pode ser sugerido como um fator cultural possivelmente relacionado à transmissão de H. pylori.
Assuntos
Humanos , Masculino , Feminino , Proteínas de Bactérias/sangue , Virulência , Proteína C-Reativa/análise , Helicobacter pylori/patogenicidade , Infecções por Helicobacter/microbiologia , Dispepsia/microbiologia , Gastrite/microbiologia , Antígenos de Bactérias/sangue , Biomarcadores/sangue , Estudos Prospectivos , Infecções por Helicobacter/sangue , Dispepsia/sangue , Mucosa Gástrica/microbiologia , Gastrite/sangue , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Chronic tissue damage induced by Helicobacter pylori (HP)-driven inflammation is considered the main risk of gastric carcinoma (GC). EpsteinBarr virus (EBV) infection has also been associated with GC. In this study, we aim to address the role of EBV in inflammatory GC precursor lesions and its added risk to HP infection. METHODS: Antibodies against EBV, HP and the bacterial virulence factor CagA were measured in sera from 525 Mexican and Paraguayan patients with gastric disease. Gastric samples were characterised according to the updated Sydney classification and associations were estimated between antibody responses and severity of both tissue damage and inflammation. RESULTS: We found significant associations (odd ratios and trends) between EBV and HP copositivity and premalignant lesions and intestinal-type GC. The EBV and HP coinfection was also significantly associated with increased infiltration of immune cells. No association was found between EBV and the less inflammation-driven diffuse-type GC. CONCLUSIONS: Our study suggests that EBV co-participates with HP to induce severe inflammation, increasing the risk of progression to intestinal-type GC.
Assuntos
Infecções por Vírus Epstein-Barr/patologia , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Herpesvirus Humano 4/isolamento & purificação , Gastropatias/sangue , Gastropatias/microbiologia , Adulto , Estudos de Casos e Controles , Infecções por Vírus Epstein-Barr/sangue , Infecções por Vírus Epstein-Barr/microbiologia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Gastrite/sangue , Gastrite/microbiologia , Gastrite/patologia , Infecções por Helicobacter/sangue , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/virologia , Humanos , América Latina , Masculino , México , Pessoa de Meia-Idade , Paraguai , Gastropatias/patologia , Gastropatias/virologia , Neoplasias Gástricas/sangue , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologiaRESUMO
Eosinophilic Gastroentertis (EG) is a very rare disease, characterized by focal or difuse eosinophilic infiltration of the gastrointestinal tract. The clinical presentation is variable and depends on the histological and the extension layer involved. We report a case of eosinophilic gastroenteritis whose main presentation was ascites with peripheral eosinophilia and chronic intermittent diarrhea in a patient with a history of atopy. Upper endoscopy showed severe multifocal erythematous gastritis, the ascitic fluid showed elevated WBC with eosinophilia, with a SAAG (Serum albumin ascites gradient) of less 1.1. The patient was treated with corticoesteroids with remission of clinical manifestation.
Assuntos
Ascite/etiologia , Enterite/complicações , Eosinofilia/complicações , Gastrite/complicações , Adulto , Anti-Inflamatórios/uso terapêutico , Diarreia/etiologia , Enterite/sangue , Enterite/diagnóstico , Enterite/tratamento farmacológico , Enterite/patologia , Eosinofilia/sangue , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Eosinofilia/etiologia , Eosinofilia/patologia , Feminino , Gastrite/sangue , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastrite/patologia , Humanos , Prednisona/uso terapêuticoRESUMO
OBJECTIVE: Gastritis induced by Helicobacter pylori can cause the onset of gastric cancer, and H. pylori cytotoxin associated gene A (cagA) is considered to be an important factor for its development. We investigated the relationship between the grades of gastritis and cagA phenotype in Japanese and Brazilian patients. MATERIAL AND METHODS: We studied 47 Brazilian and 47 age-, gender-matched Japanese patients. Status of H. pylori infection, the degree of histologic gastritis, and the levels of serum pepsinogen levels were evaluated. DNA was extracted from paraffin-embedded sections and a portion of the cagA gene was amplified using the polymerase chain reaction, followed by direct sequencing of the fragment. We investigated the cagA subtype using a newly developed restriction fragment length polymorphism (RFLP) system. RESULTS: In H. pylori-positive patients, the grades of histological and serological gastritis were more prominent in the Japanese subjects than their Brazilian counterparts, although no difference was detected in the H. pylori-negative subjects. According to cagA phenotype analysis, our RFLP system was helpful for evaluating cagA phenotype, and we found that the prevalence of the East Asia subtype was significantly higher in the Japanese subjects than in the Brazilian. CONCLUSION: Infection with H. pylori possessing the East Asian cagA gene contributes to the progression of gastritis.
Assuntos
Antígenos de Bactérias/genética , Proteínas de Bactérias/genética , DNA Bacteriano/análise , Gastrite/microbiologia , Gastrite/patologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Adulto , Brasil , Feminino , Gastrite/sangue , Gastrite/complicações , Genes Bacterianos , Infecções por Helicobacter/complicações , Infecções por Helicobacter/patologia , Humanos , Japão , Masculino , Pepsinogênio A/sangue , Pepsinogênio C/sangue , Fenótipo , Polimorfismo de Fragmento de Restrição , Análise de Sequência de DNA , Índice de Gravidade de DoençaRESUMO
Diseases resulting from Helicobacter pylori infection appear to be dependent on a host of genetic traits and virulence factors possessed by this microorganism. This paper aimed to investigate the association between the ABO histo-blood groups and H. pylori cagA infections. Genomic DNA samples (n = 110) of gastric biopsies obtained from patients with endoscopic diagnosis of peptic ulcers (n = 25) and chronic active gastritis (n = 85) were analyzed by PCR using specific primers for the cagA gene. Of the samples, 66.4 percent (n = 73) tested positive and 33.6 percent (n = 37) negative for the gene. The cagA strain was predominant in peptic ulcers (n = 21; 84.0 percent) compared with chronic active gastritis (n = 52; 61.2 percent) (p = 0.05; OR 3.332; 95 percent CI: 1.050-10.576). Additionally, the cagA strain was prevalent in the type O blood (48/63; 76.2 percent) compared with other ABO phenotypes (25/47; 53.2 percent) (p = 0.01; OR 2.816; 95 percent CI: 1.246-6.364). These results suggest that H. pylori cagA infection is associated with the O blood group in Brazilian patients suffering from chronic active gastritis and peptic ulcers.(AU)