Endoscopic Biopsies Of Gastric Mucosa Research Articles

Comparison between Immunochromatographic Test and Enzyme Linked Immunosorbent Assay in Diagnosis of Helicobacter pylori Infection among Gastritis Patients in Khartoum State-Sudan

Background: The gold standard for the diagnosis of Helicobacter pylori infection requires an endoscopic biopsy of gastric mucosa for histological examination, urease test and culture; however serological tests are useful as a screening test for Helicobacter pylori infection.
 Objective: To compare between Immunochromatographic Test and Enzyme Linked Immunosorbent Assay techniques in detection of Helicobacter pylori immunoglobulin gamma antibodies in serum of patients suffer from gastritis.
 Materials and Methods: 245 patients were screened for Helicobacter pylori infections by rapid urease test. Sera from these patients were tested for anti- Helicobacter pylori immunoglobulin gamma antibodies by Enzyme Linked Immunosorbent Assay and Immunochromatographic Test techniques.
 Results: Of 245 patients tested, Immunochromatographic Test positive/negative 114 (46.5%)/131 (53.5%), whereas Enzyme Linked Immunosorbent Assay positive/negative were 124 (50.6%)/121 (49.4%). Sensitivity/ specificity was 67.4%/74.5% and 90.2%/89.3% for Immunochromatographic Test/Enzyme Linked Immunosorbent Assay positive/negative, respectively. The diagnostic accuracy was 71%/89.7% for Immunochromatographic Test/Enzyme Linked Immunosorbent Assay, respectively.
 Conclusion: The Enzyme Linked Immunosorbent Assay technique was found to be more sensitive, specific and accurate compared to the Immunochromatographic Test while The Immunochromatographic Test is commercially available, inexpensive and easy to perform compared to the Enzyme Linked Immunosorbent Assay.

A Rapid Serologic Test and Immunoblotting for the Detection of Helicobacter pylori Infection in Children

The gold standard for the diagnosis of Helicobacter pylori infection requires an endoscopic biopsy of gastric mucosa for histological examination, urease test and culture. Noninvasive serological tests are useful as a screening test for H. pylori infection. The aim of this study was to evaluate the performance of a rapid office-based serologic test, using immunochromatography ICM, and the immunoblotting for the diagnosis of H. pylori infection in Thai children. Eighty-two symptomatic children, 30 boys and 52 girls (mean age 9.2+/-3.8 years; range, 1.2-16.0 years) who had no previous treatment for H. pylori underwent upper endoscopy. Biopsies were obtained from the gastric body and antrum for histopathology and rapid urease test. Serum samples collected from all patients were tested for H. pylori IgG antibodies using ICM (Assure H. pylori Rapid Test, Genelabs Diagnostics, Singapore). Immunoblotting (HelicoBlot 2.1, Genelabs Diagnostics, Singapore) was tested in sera of 75 patients to detect antibodies to specific antigens of H. pylori. Positive H. pylori status was defined as positive for both histology and rapid urease test. Of 82 patients, 25 (30.5%) were H. pylori positive, 56 (68.3%) were H. pylori negative and one was equivocal. ICM assay yielded a positive result in 24 of the 25 H. pylori-positive patients (96.0%) and 3 of the 56 H. pylori-negative patients (5.4%). The immunoblotting yielded a positive result in all of 22 H. pylori-positive patients (100%) and in 2 of the 52 H. pylori-negative patients (3.8%). Obtained ICM's sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 96.0, 94.6, 88.9, 98.1 and 95.1%, with immunoblotting 100.0, 96.2, 91.6, 100.0, and 97.3%, respectively. The immunochromatographic and immunoblot tests are non-invasive, reliable and useful for the diagnosis of H. pylori infection in Thai children.

Light Microscopic and Ultrastructural Evidence of in Vivo Phagocytosis of Helicobacter pylori by Neutrophils

Helicobacter pylori is believed to cause chronic active gastritis. Infection/colonization of the gastric mucosal surface induces a mucosal inflammatory reaction in the form of lymphocytic aggregates, plasma cells and, particularly, neutrophils, which may, in turn, damage the mucosal epithelium. In vitro studies demonstrate that, in culture, the bacilli are readily phagocytosed by neutrophils, this evoking a neutrophilic oxidative burst. However, it has been claimed that neutrophils do not phagocytose H. pylori in vivo. In this study of 19 endoscopic biopsies of gastric mucosa with H. pylori -associated gastritis, Cresyl violet staining for light microscopy and electron microscopy areusedto demonstrate that, in vivo, neutrophils actively phagocytose and destroy the bacilli in the epithelial intercellular space and in the mucin on the surface of the mucosa. Direct contact of neutrophils with H. pylori was observed in 17 of 17 cases by light microscopy and in 4 of 15 cases by electron microscopy. Phagocytosis by neutrophils was seen in 14 of 17 cases by light microscopy and in 3 of 15 cases by electron microscopy. It was most evident in the surface mucus coat where ``wolf packs'' of neutrophils were seen attacking the microbes. Ultrastructurally, neutrophil phagolysosomes contained both intact and partially digested bacteria,convincing evidence that the primary function of neutrophils in chronic active gastritis is to destroy H. pylori organisms. This study leaves open the question of whether, or how, neutrophils damage the gastric mucosa.

Persistent nausea and anorexia after marrow transplantation: a prospective study of 78 patients.

Persistent nausea, vomiting, anorexia, and poor oral intake are common after hematopoietic cell transplantation. In the past, herpesvirus infections and acute intestinal graft-versus-host disease (GVHD) were the most common causes. We studied 76 patients with 78 episodes of these symptoms to discern the causes. Diagnoses were based on histology of skin and intestinal biopsy specimens, viral cultures, and responses to therapy. The mean day of study entry was day 57+/-31.3 posttransplant. Acute GVHD was the most common cause of symptoms, affecting 63 patients (81%) as the sole cause of symptoms and an additional 4 patients (5%) who had other concurrent causes. Patients with GVHD had marrow donors who were unrelated or HLA-mismatched in 27/63 cases. Gastric edema, erythema, and apoptotic epithelial cells were the most useful findings for the diagnosis of GVHD. Prednisone therapy (1-2 mg/kg/day) was effective in 58 of 63 patients (92%). Infection by herpes simplex virus, cytomegalovirus, or Candida was found in six patients, three of whom had concurrent GVHD. Other causes of symptoms were medications (one patients), parenteral nutrition (one patient), and sagittal sinus thrombosis (one patient). Acute GVHD is now the dominant cause of persistent nausea and anorexia in marrow transplant patients who are beyond day 20 posttransplant. The diagnosis can be made clinically in most cases and confirmed by endoscopic biopsy of gastric mucosa. Infections, medications, and rare cases of central nervous system disease are much less common.

The Value of PCNA and AgNOR Staining in Endoscopic Biopsies of Gastric Mucosa

The aim of the present study was to examine the usefulness of the quantification of PC10-positive-cells and of Argyrophilic Nucleolar Organizer Regions (AgNORs) in gastric biopsies for the identification of gastric mucosal proliferative lesions. Fifty seven paraffin-embedded endoscopic biopsies were classified into four histologic groups: normal, inflammatory, dysplastic and neoplastic mucosa. The percentage of PC10-positive cells was determined by immunohistochemistry. The AgNOR parameters determined included the total number of all identifiable silver precipitations in the nucleus, the mean number of silver precipitations per cluster, and the presence of morphologically heterogenous silver precipitations. Group comparisons were performed using the Kruskall Wallis and Dunn non-parametric tests with a significance level of 5%. A discriminant analysis (followed by the jack-knife procedure) was performed using the three AgNOR parameters plus the percentage of PCNA-positive cells as the independent variables and histological groups as the dependent variable. All three AgNOR parameters, as well as the percentage of PCNA-stained nuclei, showed their highest values in the carcinoma group. However, no good differentiation among the four histologic groups was obtained using only one of these parameters, since there was always considerable overlap among them. By combining all the parameters in a linear discriminant analysis, we obtained a correct classification in 48 out of 57 cases. Within the classification errors there was only one false positive carcinoma, which was in fact a dysplasia and only one false negative carcinoma erroneously classified as dysplasia. The number of cells with heterogenous AgNORs was the most important parameter for the discriminant analysis. No correlation between PCNA values and the AgNOR parameters could be found, thus indicating that they do not represent the same phenomenon in the cell cycle. We concluded that the use of a combination of various proliferation parameters in a linear discriminant analysis may be helpful for differentiating gastric mucosal lesions. The peculiar AgNOR morphology is an important variable which should be taken in consideration in quantitative studies. PCNA and AgNORs seem to represent different physiological phenomena in the cell cycle.

Microabscesses in gastric biopsies shown by acridine orange staining.

Acridine orange staining of endoscopic biopsies of gastric mucosa was used in 70 patients with various upper gastrointestinal symptoms to identify Campylobacter pylori abscess formations with polymorphonuclear leucocyte infiltration. In comparison with cultures, the staining test proved to be a rapid and reliable test particularly in outpatient clinics as results are available in 6-8 min, thus enabling any necessary treatment to start immediately.