Helicobacter Pylori Gastritis Research Articles

Topic highlight on texture and color enhancement imaging in gastrointestinal diseases

Olympus Corporation developed texture and color enhancement imaging (TXI) as a novel image-enhancing endoscopic technique. This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting. A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate (ADR) and the mean number of adenomas per procedure (MAP) of TXI compared with those of white-light imaging (WLI) observation (58.7% vs 42.7%, adjusted relative risk 1.35, 95%CI: 1.17-1.56; 1.36 vs 0.89, adjusted incident risk ratio 1.48, 95%CI: 1.22-1.80, respectively). A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI (1.5 vs 1.0, adjusted odds ratio 1.4, 95%CI: 1.2-1.6; 58.2% vs 46.8%, 1.5, 1.0-2.3, respectively). A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure (0.29 vs 0.30, difference for non-inferiority -0.01, 95%CI: -0.10 to 0.08). A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis. A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI (0.71% vs 0.29%). A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI (69.2% vs 52.5% and 85.3% vs 78.7%, respectively). In conclusion, TXI can improve gastrointestinal lesion detection and qualitative diagnosis. Therefore, further studies on the efficacy of TXI in clinical practice are required.

Diagnostic Accuracy of Narrow-Band Imaging in Predicting Helicobacter pylori Gastritis in Patients With Dyspepsia.

Background Helicobacter pylori (H. pylori) is one of the most prevalent causes of chronic gastritis that can lead to gastric cancer if left untreated. Currently, endoscopy and histology are the gold standard tests for the diagnosis of H. pylori gastritis. Recently, studies have shown the utility of narrow-band imaging (NBI) in predicting H. pylori gastritis. Therefore, we aimed to determine the diagnostic accuracy of NBI in predicting H. pylori gastritis in patients with dyspepsia. Methodology After obtaining approval from the Ethical Review Committee, Sindh Institute of Urology and Transplantation, this cross-sectional study was conducted in the outpatient Clinic of Hepatogastroenterology of the institute. Inclusion criteria involved all patients of either gender aged 18 to 65 years with dyspeptic symptoms. We excluded patients with a history of proton pump inhibitor use within two weeks before endoscopy, heart failure, previous gastrectomy, portal gastropathy, cirrhosis, use of antiplatelet medications, non-steroidal anti-inflammatory drugs or anticoagulant medication, and hemorrhagic or thrombophilia disorders. Each patient underwent endoscopy-guided NBI studies followed by biopsies from the antrum and body of the stomach. Multivariate logistic regression analysis was performed for the type of NBI pattern predicting H. pylori infection. The diagnostic accuracy was obtained individually for each NBI type and then for the presence of either two or all three NBI types in predicting H. pylori gastritis. Results Out of the total 775 patients enrolled in the study, abnormal NBI patterns were observed in 401 (51.7%) patients. The presence of abnormal NBI antral mucosal pattern on endoscopy was significantly associated with H. pylori infection (p < 0.001) with excellent diagnostic accuracy. Among the three NBI types, individually, NBI type III had excellent specificity and better diagnostic accuracy in predicting H. pylori gastritis than the other two types. Furthermore, the presence of all three abnormal NBI patterns (I+II+III) together was significantly associated with the presence of H. pylori gastritis with a sensitivity of 94.54%, specificity of 86.55%, and diagnostic accuracy of 90.32%. Conclusions NBI on endoscopy shows excellent diagnostic accuracy in identifying H. pylori gastritis in patients with dyspepsia. However, multicenter studies are required not only to validate our results but also to predict the pre-cancerous lesions on NBI in patients with H. pylori gastritis.

Diagnostic Accuracy of Gastroscopy with Narrow Band Imaging for the Diagnosis of Helicobacter Pylori Gastritis

Helicobacter pylori infection promotes stomach cancer and chronic gastritis globally. Endoscopic features that may identify H. pylori are being explored. Objective: Narrow Band Imaging (NBI) is used to identify and treat H. pylori gastritis before biopsy since most patients are lost to follow-up or follow-up is too late. H. pylori gastritis may be treated early to improve quality of life and gastrointestinal concerns. Methods: This cross-sectional study at Department of Gastroenterology, Liaquat National Hospital, Karachi, conducted between 1st March 2022 till 28th February 2023, included 150 patients. Patients with gastritis on endoscopy were evaluated for the presence of H. pylori with Narrow band Imagining. Findings were compared with histopathology as gold standard. Results: Mean age of the patients was 41.87 ± 12.5 years. Male participants were 71 (47.3%). The most common admission complaints were nausea, appetite loss, and abdominal distension. The diagnostic accuracy of NBI for the detection of H. pylori was 85% sensitivity, 88% specificity, 88% positive predictive value, 87% negative predictive value and overall accuracy of 88%. NBI endoscopy was cheaper and took less time to diagnose (27 minutes vs. 37 minutes). NBI endoscopy is more effective and cost-effective than standard gastroscopy. Conclusions: The data confirm the high incidence of H. pylori in gastrointestinal patients. NBI endoscopy is more effective and cost-effective than standard gastroscopy.

Mucosal Immunity Related to CD8+ T Lymphocytes in Children with Helicobacter pylori Gastritis.

We investigated the role of CD8+T cells as host immune factors in pediatric patients with Helicobacter pylori gastritis. Gastric mucosal tissue and blood samples were collected from 39 children, including 11 children with H. pylori infection and 28 children as controls. Anti-CD8 and anti-T-bet antibodies were used for immunohistochemistry of the gastric mucosa. For the cell surface and intracellular staining, peripheral blood mononuclear cells were stained with anti-IL7Rα, anti-CX3CR1, anti-CD8, anti-T-bet, and anti-IFN-γ antibodies. Cytokines of sera such as tumor necrosis factor alpha (TNF-α) and CX3CL1 were analyzed using enzyme- linked immunosorbent assay (ELISA). In the immunohistochemistry of gastric mucosa, the frequency of CD8+ and T-bet+ T cells cells was higher in the H. pylori-positive group than in the control group (26.9± 7.8% vs. 16.9±3.3%, p<0.001; 5.0±2.5% vs. 2.2±0.7%, p=0.001). Between the control and H. pylori-positive groups, the frequency of IL-7RαlowCX3CR1+ CD8+ and T-bet+ INF-γ+ CD8+ T cells were not significantly different between surface and intracellular staining, respectively (40.4±24.0% vs. 38.2±17.8%, p=0.914; 40.4±24.0% vs. 38.2±17.8%, p=0.914). In the ELISA, no significant differences in TNF-α and CX3CL1 concentrations were observed between the control and H. pylori-positive groups (34.3±12.1 pg/mL vs. 47.0±22.6 pg/mL, p=0.114/0.5± 0.1 pg/mL vs. 0.5±0.1 pg/mL, p=0.188). CD8+ T and Th1 cells, which secrete IFN-γ, might play important roles in the mucosal immunity of the stomach in children with H. pylori infection.

Iron and Vitamin B12 Deficiency in Patients with Autoimmune Gastritis and Helicobacter pylori Gastritis: Results from a Prospective Multicenter Study.

Iron and vitamin B12 deficiencies are common in patients with atrophic gastritis, but there are limited data on the prevalence of these deficiencies in different types of atrophic gastritis. This multicenter, prospective study assessed micronutrient concentrations in histologically confirmed autoimmune gastritis (AIG, n = 45), Helicobacter pylori-related non-autoimmune gastritis (NAIG, n = 109), and control patients (n = 201). A multivariate analysis was performed to determine factors influencing those deficiencies. The median vitamin B12 concentration was significantly lower in AIG (367.5 pg/mL, Q1, Q3: 235.5, 524.5) than in NAIG (445.0 pg/mL, Q1, Q3: 355.0, 565.0, p = 0.001) and control patients (391.0 pg/mL, Q1, Q3: 323.5, 488.7, p = 0.001). Vitamin B12 deficiency was found in 13.3%, 1.5%, and 2.8% of AIG, NAIG, and control patients, respectively. Similarly, the median ferritin concentration was significantly lower in AIG (39.5 ng/mL, Q1, Q3: 15.4, 98.3 ng/mL) than in NAIG (80.5 ng/mL, Q1, Q3: 43.6, 133.9, p = 0.04) and control patients (66.5 ng/mL, Q1, Q3: 33.4, 119.8, p = 0.007). Iron deficiency and iron deficiency adjusted to CRP were present in 28.9% and 33.3% of AIG, 12.8% and 16.5% of NAIG, and 12.9% and 18.4% of controls, respectively. Multivariate analysis demonstrated that AIG patients had a higher risk of developing vitamin B12 deficiency (OR: 11.52 [2.85-57.64, p = 0.001]) and iron deficiency (OR: 2.92 [1.32-6.30, p = 0.007]) compared to control patients. Factors like age, sex, and H. pylori status did not affect the occurrence of vitamin B12 or iron deficiency. Iron and vitamin B12 deficiencies are more commonly observed in patients with AIG than in those with NAIG or control patients. Therefore, it is essential to screen for both iron and vitamin B12 deficiencies in AIG patients and include the treatment of micronutrient deficiencies in the management of atrophic gastritis patients.

Dynamic tuft cell expansion during gastric metaplasia and dysplasia.

Tuft cells are chemosensory cells associated with luminal homeostasis, immune response, and tumorigenesis in the gastrointestinal tract. We aimed to elucidate alterations in tuft cell populations during gastric atrophy and tumorigenesis in humans with correlative comparison to relevant mouse models. Tuft cell distribution was determined in human stomachs from organ donors and in gastric pathologies including Ménétrier's disease, Helicobacter pylori gastritis, intestinal metaplasia (IM), and gastric tumors. Tuft cell populations were examined in Lrig1-KrasG12D , Mist1-KrasG12D , and MT-TGFα mice. Tuft cells were evenly distributed throughout the entire normal human stomach, primarily concentrated in the isthmal region in the fundus. Ménétrier's disease stomach showed increased tuft cells. Similarly, Lrig1-Kras mice and mice overexpressing TGFα showed marked foveolar hyperplasia and expanded tuft cell populations. Human stomach with IM or dysplasia also showed increased tuft cell numbers. Similarly, Mist1-Kras mice had increased numbers of tuft cells during metaplasia and dysplasia development. In human gastric cancers, tuft cells were rarely observed, but showed positive associations with well-differentiated lesions. In mouse gastric cancer xenografts, tuft cells were restricted to dysplastic well-differentiated mucinous cysts and were lost in less differentiated cancers. Taken together, tuft cell populations increased in atrophic human gastric pathologies, metaplasia, and dysplasia, but were decreased in gastric cancers. Similar findings were observed in mouse models, suggesting that, while tuft cells are associated with precancerous pathologies, their loss is most associated with the progression to invasive cancer.

Mechanism of Weiwei granules in the treatment of chronic active Helicobacter pylori gastritis with atrophy based on the TLR4/NF-κB/COX-2 inflammatory signaling pathway.

Our paper aimed to elucidate the mechanism of Weiwei granules in the treatment of Helicobacter pylori (Hp)-positive chronic atrophic gastritis (CAG) based on the TLR4/NF-κB/COX-2 inflammatory signaling pathway. Hp-positive CAG patients were randomized into the control group (treated with quadruple therapy) or the observation group (treated with Weiwei granules based on the control group). The clinical efficacy, Hp clearance rate, and efficacy of traditional Chinese medicine (TCM) symptoms were compared between the two groups after six months of treatment. The scores of various histopathology variables, serum levels of inflammatory factors (interleukin-6 [IL-6], interleukin-8 [IL-8], and tumor necrosis factor-alpha [TNF-α]), gastrin-17 (G-17) and motilin (MTL), pepsinogen (PG) I and PG II, as well as serum levels of gastrointestinal hormone endothelin (ET), epidermal growth factor (EGF), and calcitonin gene-related peptide (CGRP), were compared between the two groups before and after treatment. TLR4, NF-κB, and COX-2 mRNA levels were compared in gastric mucosal tissues before and after treatment in the two groups. After treatment, the clinical efficacy, Hp clearance rate, and efficacy of TCM symptoms of patients in the observation group were higher than those in the control group. After treatment, the scores of various histopathology variables, serum levels of inflammatory factors (IL-6, IL-8, and TNF-α), gastrointestinal hormones (ET and EGF), and the expression levels of TLR4, NF-κB, and COX-2 mRNA in the gastric mucosal tissues were lower and G-17, MTL, CGRP, and PG I levels were higher in the observation group than in the control group. Weiwei granules can effectively improve Hp-positive CAG patients and reduce the expression levels of TLR4, NF-κB, and COX-2.

Reappraisal of the role of Helicobacter pylori in chronic spontaneous urticaria

Aims: Chronic spontaneous urticaria (CSU) is one of the most prevalent skin disorders. Helicobacter pylori (HP) infection has been linked to CSU, and HP eradication therapy has been questioned as a viable treatment option. However, studies have produced contradictory results. In addition, recent studies suggest that gastritis, rather than HP bacteria, may be responsible for CSU symptoms. Herein, we aimed to ascertain the prevalence of HP infection in CSU, explore associations between HP infection, gastritis, and CSU severity or treatment response in CSU, and investigate the impact of HP eradication therapy on the CSU course.&#x0D; Methods: We retrospectively analyzed CSU patients who were investigated for HP infection. Patient characteristics, in-clinic urticaria activity scores (ic-UAS) and urticaria control test (UCT) scores, and CSU treatment responses were compared across different patient groups. &#x0D; Results: The study included 325 CSU patients, of whom 57.2% were HP-positive and 60.9% had gastritis. The mean baseline ic-UAS showed no difference between HP-positive and HP-negative patients (2.55±2 vs 2.45±1.98, p&gt;0.05) or between patients with and without gastritis (2.33±2 vs 2.51±2, p&gt;0.05). HP-positive patients had higher rates of elevated CRP levels (45% vs 29.9%, p=0.023) and ASST positivity (54.8% vs 29.8%, p0.05).&#x0D; Conclusion: Over half of CSU patients have been found to be infected with HP. However, the HP bacterium itself, the eradication of HP, or gastritis have no significant effect on CSU severity or treatment response.

Study of Helicobacter Pylori Gastritis in Diabetic Versus Non-Diabetic Patients

Study of Helicobacter Pylori Gastritis in Diabetic Versus Non-Diabetic Patients

Histopathological Changes in the Gall Bladder Mucosa Associated with Helicobacter Pylori Gastritis

Objective: To identify Helicobacter Pylori (HP) gastritis-associated histopathological changes in Gall Bladder (GB) mucosa in patients undergoing cholecystectomy. Methodology This prospective comparative cross-sectional study was conducted in the Gastroenterology department of Liaquat National Hospital, Karachi, Pakistan, from December 2021 to December 2022. The study included all patients admitted with a diagnosis of any Gall Bladder pathology and those who were electively scheduled for cholecystectomy. Participants were categorized into two groups based on the presence of HP: group A (HP positive) and group B (HP negative) in gastric mucosa before cholecystectomy. HP detection was performed using various methods, including HP stool antigen (HPSA), Urea breath test (UBT), HP antibodies, and biopsy confirmation through gastroscopy. Results: The mean age of patients in group A was 42.88 ± 8.28 years, and in group B, it was 43.35 ± 8.74 years (p=0.458). According to the GB histological findings, Chronic cholecystitis with focal Cholesterolosis was significantly more common in group A (75.4%), while Chronic cholecystitis alone was significantly higher in group B (66.2%) (p=0.001). Dysplasia was observed more frequently in group B compared to group A. Erosion was more prevalent in group A, patients than in group B (p=0.001). Although symptom improvement in the HP positive group with persistent symptoms post-eradication was not statistically significant, it did show some improvement (p=0.527). Conclusion: The histological findings of chronic cholecystitis with focal Cholesterolosis were significantly higher in the HP positive group compared to the HP negative group, while chronic cholecystitis alone was significantly more common in the HP gastritis negative group. Some HP gastritis group patients experienced symptom improvement after HP eradication.

Effect of treatment of Helicobacter pylori with combination antibiotic therapy on iron deficiency anemia in patient with H. pylori-associated gastritis

Background: The failure to identify a cause of iron deficiency in a substantial subset of patients with low iron stores raises the question of whether there are additional as of yet unexplained causes of iron depletion. Recently, there has been a growing body of evidence to suggest a relationship between Helicobacter pylori gastritis and iron deficiency anemia (IDA) in the absence of peptic ulcer disease. Aims and Objectives: Therefore, the present study was undertaken to investigate the effect of treatment of H. pylori with combination antibiotic therapy on IDA in patient with H. pylori-associated gastritis. Materials and Methods: The present study was carried out at a tertiary care hospital catering to a large population in south Solapur and nearby areas. The study was conducted for 2 years. All patients with IDA attending outpatient department and admitted to the hospital for 2 years, were included in the present study. All patients who have IDA according to the World Health Organization criteria, as a hemoglobin concentration &lt;13 g/dL for men and &lt;12 g/dL for women, a mean corpuscular volume (MCV) &lt;75 fL and a serum ferritin level &lt; 30 ng/mL, both in-patient and outpatient setting were evaluated with detail history, clinical examination, and investigation. Results: Baseline hemoglobin (Hb) in group I is 8.99±1.23, while in group II 7.55±2.08.All the parameters are comparable in groups I and II except baseline Hb%. There is a significant increase in Hb, packed cell volume (PCV), MCV, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) after 2 months of treatment with oral iron therapy. There is a significant increase in Hb, PCV, MCV, MCH, and MCHC after 2 months of treatment with oral iron and triple therapy for H. pylori. Conclusion: Treatment of H. pylori infection was associated with more rapid and significant response to oral iron therapy in IDA as compared with the use of iron therapy alone.

Assessing cancer in people with profound and multiple disabilities

BackgroundCancers are as common in individuals with intellectual disabilities as in the general population (GP). For the subgroup of people with profound and multiple disabilities (PMD) who present with both severe intellectual disability and major motor disorders, the frequency and distribution of cancers are currently not known, preventing proper cancer surveillance.MethodsWe carried out a systematic and synthetic review of the medical literature, including a focused search of Japanese data.ResultsThe total risk of cancer in individuals with PMD is thought to be lower than in the GP, possibly due to a shorter life expectancy. They have reduced exposure to cancer risk factors, such as alcohol, tobacco, sunlight, human papillomavirus infection, occupational toxins, and being overweight. On the other hand, individuals with PMD present a greater frequency of gastroesophageal reflux disease, Helicobacter pylori gastritis, chronic cystitis, and cryptorchidism, which increase the risk for cancer of the esophagus, stomach, urinary bladder, and testes. In addition, certain genetic disorders underlying compromised motor and cognitive functions are associated with higher risk of childhood cancers. An analysis of 135 cancers in persons with PMD in Japan suggested that they present a particular tumor profile, with certain cancers rarer than in the GP, whereas cancers of the digestive tract are frequent. Cancers of the digestive tract occurred significantly earlier than in the GP (colon: average age 48.3 years vs. 71.3 years in the GP, esophagus: 39 years vs. 72 years in the GP). An increasing number of therapeutic successes in children and adults with PMD have been reported in different countries when cancers are discovered early.ConclusionIndividuals with PMD must be appropriately monitored for cancer. Screenings for breast and colon cancer, as well as regular monitoring of the esophagus, stomach, urinary bladder, and testicles, are necessary. Population-based epidemiological studies are needed to better understand risk factors, frequency, and distribution of cancers in the PMD population.

Two-tiered deep-learning-based model for histologic diagnosis of Helicobacter gastritis.

Helicobacter pylori (HP) infection is the most common cause of chronic gastritis worldwide. Due to the small size of HP and limited resolution, diagnosing HP infections is more difficult when using digital slides. We developed a two-tier deep-learning-based model for diagnosing HP gastritis. A whole-slide model was trained on 885 whole-slide images (WSIs) with only slide-level labels (positive or negative slides). An auxiliary model was trained on 824 areas with HP in nine positive WSIs and 446 negative WSIs for localizing HP. The whole-slide model performed well, with an area under the receiver operating characteristic curve (AUC) of 0.9739 (95% confidence interval [CI], 0.9545-0.9932). The calculated sensitivity and specificity were 93.3% and 90.1%, respectively, whereas those of pathologists were 93.3% and 84.2%, respectively. Using the auxiliary model, the highlighted areas of the localization maps had an average precision of 0.5796. HP gastritis can be diagnosed on haematoxylin-and-eosin-stained WSIs with human-level accuracy using a deep-learning-based model trained on slide-level labels and an auxiliary model for localizing HP and confirming the diagnosis. This two-tiered model can shorten the diagnostic process and reduce the need for special staining.

Surveillance of Helicobacter pylori resistance over 22 Years (2000-2021) in Northern Spain

Helicobacter pylori gastritis is considered an infectious disease, regardless of symptoms and stage of disease. Most consensus documents recommend empirical therapy based on local antimicrobial susceptibility patterns. We aimed to provide clinically useful information about primary and secondary antimicrobial resistance to antimicrobials commonly prescribed for H. pylori. Overall, 31,406 gastroduodenal biopsies and 2,641 string tests from patients over 15 years of age were plated on selective media, isolating H. pylori in 36.7% of biopsies and 50.7% of string tests. Susceptibility testing could be performed in 96.6% (12,399/12,835) of H. pylori isolates. Polymerase chain reaction (PCR) was also used to detect H. pylori and its resistance to clarithromycin, providing susceptibility data for 112 patients with negative culture results. Resistance to amoxicillin and tetracycline was unusual (0.6% and 0.2%, respectively). Rates of primary resistance to clarithromycin and metronidazole remained steady over the 22-year study period, at around 14% for clarithromycin and 30% for metronidazole, while primary resistance to levofloxacin tripled (from 7.6% in 2000 to 21.7% in 2021, P < 0.001) and increased with patient age. Notably, 1.8% of isolates were multiresistant to clarithromycin, metronidazole, and levofloxacin. Overall, secondary resistance rates were higher (P < 0.0001) than primary resistance rates for clarithromycin (42.5% vs 14.1%), metronidazole (40.9% vs 32%), and levofloxacin (21.5% vs 17.1%). Determination of susceptibility for H. pylori by culture and/or PCR in patients undergoing endoscopy could facilitate the implementation of tailored therapy and guide the choice of empirical therapy when susceptibility testing cannot be performed, potentially helping limit the emergence of antimicrobial resistance.

The usefulness of transabdominal ultrasound elastography in Helicobacter pylori gastritis in children.

Helicobacter pylori can colonize the submucosal layer as well as the mucosa in the stomach. Inflammation and erosions cause both mucosal and submucosal thickening in patients with Helicobacter pylori gastritis. Elastography is a method for measuring the elasticity and hardness of tissues by visualization of their response to the applied force. Hard tissues respond to applied compression differently compared to soft tissues. Hard tissues displace as a whole without deforming as opposed to soft tissues. In this study, we investigated the diagnostic performance of transabdominal ultrasound elastography in detecting Helicobacter pylori gastritis in children. Nineteen children (group 1) with Helicobacter pylori gastritis, 33 children (group 2) with Helicobacter pylori (-) gastritis and 37 healthy children (group 3) were included the study. These groups were compared in terms of their strain index values. Ultrasonographic examinations were performed with a single transducer at 1.8-6.2 MHz frequency range. Both group 1 and 2 had significantly higher strain index values compared to the control group (2.7, 2.2 and 1.4 respectively). Additionally, the mean strain index value was significantly higher in group 1 compared to group 2. Transabdominal ultrasound elastography has diagnostic value in differentiating Helicobacter pylori (+) gastritis from Helicobacter pylori (-) gastritis as well as in the diagnosis of gastritis in children.

Pathologie infectieuse du tube digestif : diagnostics à ne pas manquer

The recent context of COVID-19 has renewed the interest of pathologists in diseases of infectious origin. This interest is even stronger in the gastrointestinal tract where symptoms are aspecific, often frustrating with a normal endoscopic appearance sometimes leading to diagnostic erraticity. In this context, systematic biopsies performed by the clinician are sometimes the only way to reach a diagnosis. Nevertheless, the precise diagnosis of these pathologies requires a good knowledge of the context in which they occur, the histopathological aspect and a rigorous analysis using special stains and/or immunohistochemical analyses. Some infectious diseases of the gastrointestinal tract are well known to pathologists who are widely called upon to diagnose them (Helicobacter pylori gastritis, Candida albicans oesophagitis or CMV colitis), but others are more difficult to diagnose. In this article, we will present, after having recalled the various useful special stains, rare or difficult to diagnose bacterial or parasitic pathologies "not to be missed" in the digestive tract.

Increased IL-17A Serum Levels and Gastric Th17 Cells in Helicobacter pylori-Infected Patients with Gastric Premalignant Lesions

Background:Helicobacter pylori infection is characterized by an inflammatory infiltrate that might be an important antecedent of gastric cancer. The purpose of this study was to evaluate whether interleukin (IL)-17 inflammation is elicited by gastric T cells in Helicobacter pylori patients with gastric intestinal metaplasia and dysplasia (IM/DYS). We also investigated the serum IL-17A levels in Helicobacter pylori patients with gastric intestinal metaplasia and dysplasia, and patients with Helicobacter pylori non-atrophic gastritis (NAG). Methods: the IL-17 cytokine profile of gastric T cells was investigated in six patients with IM/DYS and Helicobacter pylori infection. Serum IL-17A levels were measured in 45 Helicobacter pylori-infected IM/DYS patients, 45 Helicobacter pylori-infected patients without IM/DYS and in 45 healthy controls (HC). Results: gastric T cells from all IM/DYS patients with Helicobacter pylori were able to proliferate in response to Helicobacter pylori and to produce IL-17A. The Luminex analysis revealed that IL-17A levels were significantly increased in Helicobacter pylori IM/DYS patients compared to healthy controls and to Helicobacter pylori gastritis patients without IM/DYS (452.34 ± 369.13 pg/mL, 246.82 ± 156.06 pg/mL, 169.26 ± 73.82 pg/mL, respectively; p < 0.01, p < 0.05). Conclusions: the results obtained indicate that Helicobacter pylori is able to drive gastric IL-17 inflammation in IM/DYS Helicobacter pylori-infected patients, and that IL-17A serum levels are significantly increased in Helicobacter pylori-infected patients with IM/DYS.

Incomplete Intestinal Metaplasia Is Rare in Autoimmune Gastritis

Background: Incomplete intestinal metaplasia (IM) is reportedly associated with higher gastric cancer (GC) risk than its complete variant. AGA Guidelines recommend including IM subtyping in routine pathology reports. This study assesses the prevalence of complete versus incomplete IM in gastric conditions with different GC risks. Methods: IM subtyping (complete vs. incomplete) and grading (IM extension: G1: ≤30%; G2: >30%) were assessed in 386 patients with IM + ve gastric biopsy sets that included both antral and oxyntic samples. Cases were categorized as: (a) IM foci in otherwise normal mucosa (n = 59); (b) Helicobacter pylori gastritis (n = 138); (c) reactive gastropathy (141); and (d) autoimmune atrophic gastritis (AIG, n = 48). Odds ratios (OR) and their 95% CI were used in comparing the prevalence of incomplete IM and the correlation between subtype and IM extension. Results: Incomplete IM was present in 37.7% of patients with H. pylori gastritis, 8.3% of those with AIG 5.0% of those with reactive gastropathy, and none of those with otherwise normal mucosa. Incomplete IM was strongly associated with more extensive (G2-IM) mucosal intestinalization (OR = 6.69; 95% CI = 2.77–9.40). Conclusion: Incomplete IM is significantly more prevalent in conditions (H. pylori gastritis) known to carry a higher risk of GC and is strongly associated with its extension. The low prevalence of incomplete IM in AIG (8.3%) and reactive gastropathy (5.2%) is in keeping with the low GC risk associated with these conditions.

Endoscopic diagnosis of Helicobacter pylori gastritis using white light imaging and texture and color enhancement imaging.

Background and study aims Texture and color enhancement imaging (TXI) is a new image-enhanced endoscopy that augments subtle tissue differences and color changes in gastric mucosa. This study aimed to compare the usefulness of TXI and white light imaging (WLI) for diagnosing Helicobacter pylori gastritis. Patients and methods We retrospectively prepared one image set with 22 endoscopic images acquired by WLI and TXI from 60 consecutive patients individually. Five endoscopists independently reviewed the randomly displayed image sets and assessed the H. pylori infection status on endoscopy according to the Kyoto Classification of Gastritis. The primary endpoints were the accuracies of WLI and TXI in diagnosing H. pylori -active gastritis. The correlation of the endoscopic features with the three H. pylori infection statuses (current infection, past infection, and noninfection) was also evaluated. Results Diagnostic accuracy for active gastritis was significantly higher in TXI than in WLI (85.3 % vs. 78.7 %; P = 0.034). All the specific endoscopic features associated with H. pylori infection statuses had a higher odds ratio with TXI than with WLI. Additionally, interobserver agreement among the five reviewers was higher in TXI than in WLI, except for one pair. Conclusions TXI may improve the endoscopic diagnosis accuracy for H. pylori infection.

Adolesanlarda B12 eksikliği ve Helikobakter Pylori Sıklığı

Abstract:&#x0D; Aim: Low intake of Vitamin B12 (vit B 12) with malabsorptions are the most critical factors causing the deficiency. Vit B 12 deficiency has also been associated with Helicobacter pylori (HP) gastritis in previous studies. This study's main goal is to find a similar relation with recent studies or an opposite conclusion. For this purpose we choose the most suitable group; patients with the same two diseases HP gastritis and vit B 12 deficiency.&#x0D; Patients and methods: The whole study was conducted retrospectively. İn the study we included 19 patients (mean age: 15.6 ± 1.3 years ). The B12 levels of patients undergoing upper gastroscopy for any reason were studied. We tried to figure out whether B12 deficiency and HP positivity were statistically significant. The Electrochemiluminescence immunoassay method has been used for serum vit B12 level measurement. &#x0D; Results: There are 15 (62.5%) patients with neurological symptoms and 6 (25.0%) patients with fatigue and weakness. Only 3 (12.5 %) patients have no symptoms. There was no statistical significance between these groups (p=0.224). There are 18 (75%) patients with HP positivity. HP positive and negative patients have levels of B12 108.6 ± 31.1 pg/mL and 113.5 ± 41.2 pg/mL respectively (p=973).&#x0D; &#x0D; Conclusion: There were no statistical significance with vitamin B 12 levels in HP-positive patients and HP-negative patients. İt sure be beneficial to use a bigger aspect patients group to have better results between HP infection and vitamin B 12 deficiency relation.