Antral Mucosa Of Patients Research Articles

Expression of motilin and vascular endothelial growth factorin the antral mucosa in patients with NSAID gastropathy

Expression of motilin and vascular endothelial growth factorin the antral mucosa in patients with NSAID gastropathy

Iron Deficiency Anemia from Large Hyperplastic Antral Mass after YAG Laser Treatment for GAVE

Purpose: Watermelon stomach (WMS), or gastric antral vascular ectasia, is an uncommon but clinically important cause of chronic gastrointestinal (GI) blood loss. The diagnosis is based primarily on the typical endoscopic appearance. We report unusual case of large hyperplastic mass-causing recurrent GI blood loss following Nd:YAG laser treatment. Case Report: A 67-year-old man with history of deep vein thrombosis on warfarin therapy was evaluated for recurrent gastrointestinal blood loss. Endoscopy (EGD) at an outside hospital had revealed single large angioectasia with bleeding on the greater curvature of the stomach that was fulgurated with YAG laser. He had a total of 6 sessions. Patientt did well post ablation and was started back on warfarin therapy. Three years later, he again presented with melanotic stools. A repeat EGD showed a large fungating ulcerated mass on the greater curvature of the stomach (Figure 1). Biopsies showed gastric mucosa with extensive ulceration and underlying granulation tissue. Some of the adjacent glands had a reactive appearance. Helicobacter pylori was negative. An Alcian blue stain showed no evidence of intestinal metaplasia. The mass has remained stable for months with repeated biopsies showing hyperplastic polyp and granulation tissue with reactive changes. The patient continues to ooze blood causing iron deficiency anemia. The patient was referred for surgical antrectomy.Figure: [663]Results: Repeated thermal injury to the antral mucosa in patients with WMS may result in the development of hyperplastic polyps. These may be large, may contribute to significant blood loss with anemia, and may be amenable to conventional polypectomy. In summary, laser photocoagulation appears to be a safe and effective nonsurgical treatment for WMS, however, in a small percentage of patients, hyperplastic polyps may develop in the laser-treated areas. Conclusion: The development of inflammatory polyps appears to be a reactive response of the mucosa to thermal injury. Large hyperplastic masses are rare, as seen in our case, may contribute to significant blood loss with anemia and may require surgical excision.

MicroRNA profiling in duodenal ulcer disease caused by Helicobacter pylori infection in a Western population

Although the connection of microRNAs (miRNAs) to some diseases is well established, their involvement in chronic infections such as Helicobacter pylori has received less attention. The aim was to compare miRNA expression profiling in patients with duodenal ulcer (DU) due to H. pylori infection with that in infected patients without DU and in uninfected patients. The miRNA expression profile was determined by microarrays in antral mucosal samples from well-characterized dyspeptic patients (n = 46). The most significant set of miRNAs was subsequently analysed in an independent validation group of patients (n = 42). Transcripts for IL8, IL12p40, IL12p35 and IL23p19, the signalling molecules MYD88, GATA6, SOCS2 and STAT6 and H. pylori virulence factors cagA and VacA were analysed. Microarray experiments showed that 17 miRNAs were deregulated in the mucosa of H. pylori-infected patients. No significant differences were observed between normal and DU patients. PCR confirmed the up-regulation of miR-9, miR- 146a, miR-155 and miR-650 and the down-regulation of miR-96 and miR-204 in the independent validation set of patients. Importantly, miR-9, miR-96, miR-146a and miR-650 expression was specific to chronic-active gastritis. H. pylori-infected patients showed higher levels of IL8 and IL12p40 mRNAs and lower levels of GATA6 and SOCS2 mRNAs. The antral mucosa of patients with non-active or chronic-active gastritis showed significantly lower levels of GATA6, MYD88, SOCS2 and STAT6 mRNAs compared with patients without gastritis. The down-regulation of these factors was not correlated with the expression of any of the validated miRNAs. The exact role of the miRNA changes observed will require further study.

Gastric mucosal cytokine levels in relation to host interleukin-1 polymorphisms and Helicobacter pylori cagA genotype

ObjectiveThe outcome of a Helicobacter pylori infection is related in part to interrelationships among H. pylori virulence factors and the H. pylori-induced mucosal response. The host inflammatory response is partly governed by polymorphisms in pro-inflammatory genes.Material and methodsCytokine levels (interleukin (IL)-1β, IL-6 and IL-8) were examined in H. pylori-infected and uninfected normal-appearing mucosa from patients with non-ulcer dyspepsia (NUD), margins of gastric ulcers and cancer tissues. Cytokine levels were compared with cagA genotypes and host interleukin (IL)-1 polymorphisms.ResultsThe study comprised 168 Thai patients. All infected patients possessed anti-CagA antibody. Gastric mucosal IL-8 levels were significantly higher in H. pylori-positive cases than in -negative cases in all three tissue types (e.g. 1115 versus 217 pg/mg protein for NUD) (p<0.001). Normal-appearing but H. pylori-infected antral mucosa of patients with cagA type 1a strains had higher IL-8 levels than those with type 2a strains (2632 versus 1036 pg/mg protein) (p<0.005). IL-1B-511T/T carriers had higher antral mucosal IL-1β levels versus non-carriers (pg/mg protein) (T/T=221, T/C=178, C/C=70) (p=0.005). IL-1B-511T/T carriers also had higher IL-1β levels versus non-carriers in H. pylori-negative patients.ConclusionsIt was found that both the host factors (IL-1 polymorphisms) and bacterial factors (cagA type 1a versus type 2a) influenced gastric mucosal cytokine levels. Future studies should concentrate on interactions among host factors (e.g. genetics and tissue responses) and bacterial and environmental factors.

Gene expression in gastric biopsies from patients infected with Helicobacter pylori

Background:Helicobacter pylori infection has protean effects on gene expression in the host gastric mucosa, which have been investigated by gene chip analysis in vitro. In this study the effects of H. pylori infection on host gene expression in the gastric antral mucosa in patients were examined. Methods: One gastric antral biopsy was obtained from a total of 18 untreated patients undergoing routine endoscopic evaluation of chronic abdominal complaints. Nine patients had histologic evidence of H. pylori infection and 9 age- and sex-matched patients had no histologic evidence of H. pylori infection. A microarray analysis was performed using a gene chip containing 35,000 human expressed sequence tags on RNA extracted from endoscopic, gastric antral biopsies, and average gene expression among infected and uninfected patients was compared. Results: Underexpressed genes in infected patients' mucosa included gastric intrinsic factor and several metallothionein isoforms. Overexpressed genes in infected patients' mucosa comprised MHC Class II molecules, immunoglobulin and B-cell activation genes, as well as genes known to induce apoptosis. Changes in expression were confirmed for a subset of genes by SYBR green real-time PCR. Conclusions: Microarray analysis of antral biopsies from patients with and without H. pylori infection revealed differential expression of metal regulatory, immunity and inflammation-related genes.

Serum gastrin and gastrin-immunoreactive cells in the antral mucosa of patients with alcoholic liver disease.

Hypergastrinaemia has been reported in liver cirrhosis; meanwhile, it is unclear whether it is associated with an increase in gastrin cell function. The serum gastrin concentration and the number of gastrin cells in antral biopsies were studied in patients with alcoholic liver disease. Immunocytochemical and quantification techniques were used to localize and determine the number of gastrin cells. Slight non-significantly higher serum gastrin values were observed in the alcoholic liver disease patients compared with controls, but the individual variation within the groups was considerable. The frequency of gastrin cells did not differ between groups. However, the size of the gastrin cell nuclei was larger in patients with liver disease than in controls, indicating increased cellular activity. Alcoholic liver disease, with a disturbed liver function, influences the gastrin cells. The observed alterations may reflect the effect of alcohol and/or malnutrition, or may be secondary to the influence of liver disease on other regulatory peptides.

Development of hyperplastic polyps following laser therapy for watermelon stomach

Background: Our goal was to evaluate the long-term sequelae of repeated thermal injury to the gastric mucosa of patients undergoing laser therapy for watermelon stomach.Methods: A retrospective review of all patients who underwent endoscopic laser therapy for watermelon stomach from 1987 to 1994 was performed to identify patients with antral polyps following laser photoablation therapy. Statistical analysis was performed using the paired t test. Results: Antral hyperplastic polyps as large as 4 cm developed in 4 of 60 patients (7%) and were associated with recurrent anemia in 3. All patients had received significantly more laser thermal energy during the course of therapy for their watermelon stomach. Conventional polypectomy was used to remove the polyps. Conclusions: Repeated thermal injury to the antral mucosa in patients with the watermelon stomach may result in the development of hyperplastic polyps. These may be large, may contribute to significant blood loss with anemia, and are amenable to conventional polypectomy. (Gastrointest Endosc 1996;43:54-6.)

Development of hyperplastic polyps following laser therapy for watermelon stomach

<h2>Abstract</h2> <i>Background:</i> Our goal was to evaluate the long-term sequelae of repeated thermal injury to the gastric mucosa of patients undergoing laser therapy for watermelon stomach. <b>Methods:</b> A retrospective review of all patients who underwent endoscopic laser therapy for watermelon stomach from 1987 to 1994 was performed to identify patients with antral polyps following laser photoablation therapy. Statistical analysis was performed using the paired <i>t</i> test. <b>Results:</b> Antral hyperplastic polyps as large as 4 cm developed in 4 of 60 patients (7%) and were associated with recurrent anemia in 3. All patients had received significantly more laser thermal energy during the course of therapy for their watermelon stomach. Conventional polypectomy was used to remove the polyps. <b>Conclusions:</b> Repeated thermal injury to the antral mucosa in patients with the watermelon stomach may result in the development of hyperplastic polyps. These may be large, may contribute to significant blood loss with anemia, and are amenable to conventional polypectomy. (Gastrointest Endosc 1996;43:54-6.)

Interferon gamma and interleukin 4 secreting cells in the gastric antrum in Helicobacter pylori positive and negative gastritis.

Little is known of the function of the T cells in the inflammatory infiltrate in Helicobacter pylori associated gastritis. This study thus measured T cell in vivo activation by enumerating the frequency of interferon gamma (IFN gamma) and interleukin 4 (IL 4) secreting cells isolated from the gastric antral mucosa in patients with or without gastritis and in H pylori positive and negative gastritis. Fifty four samples were examined for cytokine secretion. Four antral biopsy specimens from each patient (n = 51) were taken during diagnostic endoscopy. One was used to estimate histological gastritis and the presence of H pylori, and three of the samples were used to isolate T cells by enzymatic digestion. IFN gamma and IL 4 secreting cells were enumerated by ELISPOT. Thirty four samples had gastritis and 79% of those were H pylori positive. None of the samples from non-inflamed mucosa had H pylori. The numbers of IFN gamma secreting cells per 10(5) T cells were higher in gastritis than in normal mucosa (145 v 20 IFN gamma spots, p < 0.01), and higher in H pylori negative than H pylori positive gastritis (371 v 110 IFN gamma spots, p < 0.05). The frequencies of IL 4 secreting cells did not differ between gastritis and non-inflamed mucosa. In conclusion, there is an increase in IFN gamma secreting cells but not in IL 4 secreting cells in H pylori positive and negative gastritis. It is not known if this TH1 type reaction has a pathogenetic or protective role.

Local cellular and immune response by antral mucosa in patients undergoing treatment for eradication ofHelicobacter pylori

Thirty-six patients with nonhealing or recurrent duodenal ulcers (DU) were treated with omeprazole; 20 mg/day for one month followed by triple therapies (metronidazole, 400 mg three times a day, tetracycline, 500 mg four times a day with either colloidal bismuth, 120 mg four times a day or sucralfate 1 g four times a day. At least two gastric mucosal samples were collected from the antral portion of the stomach and from the duodenum before and immediately after omeprazole therapy and four weeks after completion of triple therapies. Samples were fixed in buffered formaldehyde and glutaraldehyde and examined histologically and histochemically for inflammation, density of H. pylori colonization, and immunohistochemically for the density of gastrin-secreting cells, immunoglobulins (IgA, IgG, IgM), kappa and lambda light chains and T-lymphocyte population. H. pylori colonization of the antral mucosa before treatment was noted in 100% and active gastritis in 86% of patients. The histologically assessed clearance rate after omeprazole treatment was 47.3%, and after triple therapies, 69.5%. The prevalence of gastritis was observed in 63.9% and 33.3% respectively. All therapies were associated with an accumulation of serous fluid, increased population of lymphocytes and plasma cells, and secretion of immunoglobulins, particularly IgG and IgM in the upper part of the lamina propria. These changes, together with increased numbers of T lymphocytes within the crypt epithelium and the lamina propria, were associated with the presence of H. pylori organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of subtypes of intestinal metaplasia in gastric antral mucosa

A prospective gastroscopic-bioptic study of 533 patients was performed to assess the prevalence and distribution of intestinal metaplasia (IM) and its subtypes in the antral mucosa of patients with various upper intestinal disorders and to assess whether the presence of certain IM subtypes might be of help in selecting patients for careful endoscopic-bioptic surveillance in the screening for gastric carcinoma. IM was found in 135 patients (25.3%). Its prevalence increased with age (P < 0.001) and was strongly associated with intestinal-type carcinoma as compared to diffuse-type carcinoma (P < 0.001), gastritis (P < 0.001), and gastric ulcer (P < 0.05). Type I IM was predominant (98.5%), whereas types II and III IM, respectively, were found in 77.8% and 15.6% of the patients with IM. No difference in the prevalence of type I and II IM was found among the various gastric disease states. Type III IM was strongly associated with intestinal-type carcinoma as compared to either benign lesions (P < 0.01) or diffuse-type carcinoma. These results suggest that type III IM may play a special role in the histogenesis of intestinal-type carcinoma and suggest that the finding of this IM subtype in gastric biopsies may possibly be of help in identifying patients at greater risk of developing carcinoma.

Gastrin- and Somatostatin-Immunoreactive Cells of the Antral Mucosa in Patients with Duodenal or Gastric Ulcers: An Immunocytochemical Study

Gastrin- and somatostatin-immunoreactive cells in biopsies taken from the prepyloric portion of the antrum from 15 patients with duodenal ulcer, 16 patients with gastric ulcer, and a control group of 19 patients without histopathological alterations of the antral mucosa were studied using peroxidase anti-peroxidase and immunogold-silver staining methods in combination with morphometry. Numerical densities and sizes (immunoreactive areas) of the cells demonstrated were measured and compared between all three groups. Gastrin- and somatostatin-immunoreactive cells were located most frequently in the lower midzone of the gastric crypts. None of the parameters measured showed a correlation with age or sex. The group with duodenal ulcer tended to exhibit gastrin- and somatostatin-cell-hyperplasia whereas the size of both cell types remained unchanged. In comparison with the control group, the numerical density of gastrin-immunoreactive cells was significantly increased in gastric ulcer patients, whereas the numerical density of somatostatin-immunoreactive cells was decreased in this group. Immunoreactive areas of both cell types were significantly increased in patients with gastric ulcer.

Duodenal ulcer and chronic gastritis.

The histological aspect of fundic and antral mucosa of patients with endoscopically proven duodenal ulcer was investigated and compared with that observed in asymptomatic controls of similar age. Fundic gastritis was less frequent in ulcer patients than in controls. In contrast the chronic inflammatory lesions of the antral mucosa were more frequent, more severe and appeared at an earlier age in ulcer patients than in controls.

Gastrin and G-cells in the antral mucosa of patients with pernicious anaemia, acromegaly and hyperparathyroidism and in a Zollinger-Ellison tumour of the pancreas.

Abstract. In extracts of human gastric biopsies gastrin has been estimated with an immunochemical method. In the same biopsies G‐cells have been localized with an immunohistological method using peroxidase‐labelled antibodies and the endocrine cells investigated electron‐microscopically. Gastrin and G‐cells could be found regularly in the antral mucosa and only in insignificant amounts or not at all in the fundic mucosa of six normal persons. With the same methods gastrin and G‐cells could be demonstrated in the antral mucosa of rats and guinea‐pigs. The gastrin content of the antral mucosa of six patients with pernicious anaemia and achlorhydria with elevated serum gastrin levels was more than 20 times higher than in the controls and the G‐cells were significantly more numerous. Besides hyperplasia of the G‐cells, increased secretory activity was found electron‐microscopically. The gastrin release from the G‐cells seems to take place mainly via intracellular dissolution of the granule content within the membranous sacs. Although the number of other endocrine cells was increased in pernicious anaemia the ultrastructural identity of the G‐cells could be established by comparison with the cells of a Zollinger‐Ellison tumour. This tumour contained gastrin and gave a positive immunohistological reaction for this hormone. Also, the fundic mucosa of patients with pernicious anaemia contained gastrin and G‐cells, but considerably less than the antral mucosa. Hyperplasia of G‐cells was found in six cases of acromegaly, four of which also had a significantly increased gastrin content of the antral mucosa. This finding suggests a trophic function of the hypophysis, especially growth hormone, on the G‐cells. Hyperplasia of the G‐cells in the antral mucosa of three patients with primary hyperparathyroidism and increased gastrin content in two of the three cases also suggest a trophic function of the serum calcium level on the G‐cells.