Pylori-negative Mucosa Research Articles

Simultaneous detection of Helicobacter pylori infection comparing between white light and image-enhanced endoscopy

BackgroundHelicobacter pylori (H. pylori) is associated with gastric cancer. Early and accurate diagnosis of H. pylori infection can reduce risk of gastric cancer. Conventional white light imaging (WLI) and image-enhanced endoscopic (IEE) techniques such as narrow-band imaging (NBI), linked color imaging (LCI) and blue laser imaging (BLI) plays pivotal role in H. pylori diagnosis. This study aimed to determine diagnostic performance of real-time endoscopy between WLI and other IEE techniques for diagnosis of H. pylori infection.MethodsThis prospective study compared endoscopic images by gastroscopy using WLI and IEE techniques (LCI, Magnifying-BLI, and Magnifying-NBI) at Thammasat University Hospital, Thailand between January 2020, and July 2021. All participants underwent gastroscopy. Three biopsies at gastric antrum and two biopsies at body were obtained for H.pylori diagnosis. H. pylori infection was defined as a positive test of either one of the following tests: rapid urease test, histopathology, H. pylori culture.ResultsOf 167 dyspeptic patients undergoing gastroscopy, 100 were enrolled in this study. Overall H. pylori infection was 40%. Patients had the mean age of 59.1 years and 53% were males. Enlarged gastric folds and antral nodularity can predict H. pylori infection with 100% PPV, while fundic gland polyps and red streak provided 100% PPV for exclusion of H. pylori infection on WLI. Sensitivity, specificity, PPV, NPV and accuracy for diagnosis of H. pylori infection for WLI were 80%, 71.7%, 65.3%, 84.3% and 75% respectively, while those for LCI were 90%, 70%, 66.7%, 91.3% and 78% respectively. M-NBI and M-BLI endoscopy demonstrated elongated pits in H. pylori-positive patients. Sensitivity, specificity, PPV, NPV and accuracy for M-BLI were 95%, 80%, 76%, 96% and 86% respectively, whereas those for M-NBI were 92.5%, 86.7%, 82.2%, 94.6% and 89% respectively. Sensitivity of M-BLI was better than WLI, while sensitivities of LCI and M-NBI were also numerically higher than WLI without statistical difference (M-BLI 95%vs.WLI 80%, p = 0.03; M-NBI 92.5%vs.WLI 80%, p = 0.13; LCI 90%vs.WLI 80%, p = 0.22). Sensitivities of all IEE modes were not different from one another (LCI 90%vs.M-BLI 95%, p = 0.50; LCI 90%vs.M-NBI 92.5%, p = 1.00, M-BLI 95%vs.M-NBI 92.5%, p = 1.00).ConclusionsM-BLI significantly improved sensitivity of real-time endoscopic diagnosis of H. pylori infection compared with WLI. Enlarged gastric folds and antral nodularity could be reliable predictors for H. pylori infection, while fundic gland polyps and red streak could be important endoscopic findings for H. pylori-negative mucosa.

Granulomatous Gastritis in Crohn’s Disease - is it Common or Rare: Review Article

Background: Granulomas in gastric biopsy specimens are extremely rare; more than half are associated with Crohn’s disease. In Crohn’s disease, clinical involvement is rare; microscopic disease is more common. Gastric granulomas are found in 9-15%, and a high proportion of Crohn’s patients show upper GI involvement, usually antral. Focal acute inflammation in a background of non-inflamed H. pylori negative mucosa is suggestive of Crohn’s disease and active inflammation in 56% (some inflammatory changes in up to 70%), but only 10% are H. pylori positive. Objective: The aim of the study was to highlight granulomatous gastritis in Crohn’s disease. Conclusion: The incidence of gastric Crohn’s is 10% of the cases. The histological diagnosis of Crohn’s disease on gastric samples is suggested by the presence of 1) a focal distribution; 2) chronic active inflammatory lesions; 3) the absence of the Helicobacter Pylori (HP) organism; and 4) granuloma. Focal stromal abnormalities could be a new diagnostic morphologic pattern in gastric Crohn’s disease, sharing the same value as focal cryptal architectural abnormalities in intestinal involvement. Since the majority of patients with Crohn’s disease lack significant symptoms, the true incidence of the disease depends on whether such pictures are sought for and identified. Keywords: Granulomatous Gastritis, Crohn’s disease, Chronic inflammatory condition

Age-Related Methylation Patterning of Housekeeping Genes and Tissue-Specific Genes is Distinct Between the Stomach Antrum and Body

The methylation-variable sites around CpG islands are frequently overmethylated in Helicobacter pylori-infected stomachs. Age-related patterns of the overmethylation changes were compared between the fast-growing antrum cells and the slow-growing body cells. A total of 316 H. pylori-positive tissues and 380 H. pylori-negative tissues were obtained by endoscopic biopsy. The methylation-variable sites of ten housekeeping genes and nine tissue-specific genes were semiquantitatively analyzed, based on the ten-level classification of methylation-specific PCR intensity. The overmethylated genes were scored when their methylation levels were higher than an intermediate level of each gene common in the H. pylori-negative mucosa. The age-dependent methylation level of the inactive APC gene observed similarly in the antrum and the body was used as an age standard of methylation variation in a biopsy tissue. The overmethylation of housekeeping genes and stomach-specific genes rapidly increased to a high plateau frequency in the young-aged APC methylation cases (mean age: 43 years) in the H. pylori-positive antrum. In the H. pylori-positive body, most of the overmethylated housekeeping genes slowly increased to a peak frequency in the middle-aged APC methylation cases (mean age: 53 years). The housekeeping gene pairs showed high correlations (Spearman's correlation coefficient > 0.4) in both the antrum and the body. The overmethylation of housekeeping genes rapidly and slowly increased to a high frequency in concordance with a rapid and slow growth of epithelial cells in the H. pylori-infected stomach.

Target biopsy using magnifying endoscopy in clinical management of gastric mucosa‐associated lymphoid tissue lymphoma

We have reported the characteristics of magnified endoscopic images of gastric mucosa-associated lymphoid tissue (MALT) lymphoma before and after treatment. In this study, we investigated the diagnostic efficacy of magnified endoscopic images for target biopsy and evaluation of clinical remission. Twenty-one patients diagnosed with localized gastric MALT lymphoma were enrolled. Magnified endoscopy was performed prior to treatment and at a mean period of 1.8 months (1-6 months) after therapy (Helicobacter pylori eradication in 19 patients and radiation therapy in two patients). Microstructural pattern and abnormal vessels in the lesions were assessed, and corpus mucosa without lymphoma was divided into H. pylori-negative mucosa and H. pylori-positive mucosa. Biopsy was the gold standard in this study. Nonstructural areas with abnormal vessels were observed in all patients before treatment. Fifteen patients achieved pathological complete remission. Disappearance of nonstructural areas and abnormal vessels after therapy was associated with pathological remission. Sensitivities of these findings for diagnosis were 76.9% and 85.7%, respectively, and the specificities were 87.5% and 85.7%, respectively. H. pylori eradication therapy was invalid in three patients with H. pylori-negative mucosa in magnified images. Magnifying endoscopy may be useful for target biopsy of superficial gastric MALT lymphoma in clinical management.

Natural Killer Cell Receptor+ T‐Lymphocytes in Normal and Helicobacter pylori‐Infected Human Gastric Mucosa

Helicobacter pylori infection is associated with development of chronic inflammation and infiltration of immune cells into the gastric mucosa. As unconventional T-lymphocytes expressing natural killer cell receptors are considered to play central roles in the immune response against infection, a study investigating their frequencies in normal and H. pylori-infected gastric mucosa was undertaken. Flow cytometry was used to quantify T-cells expressing the natural killer cell markers CD161, CD56, and CD94 in freshly isolated lymphocytes from the epithelial and lamina propria layers of gastric mucosa. Thirteen H. pylori-positive and 24 H. pylori-negative individuals were studied. CD94(+) T-cells were the most abundant (up to 40%) natural killer receptor-positive T-cell population in epithelial and lamina propria layers of H. pylori-negative gastric mucosa. CD161(+) T-cells accounted for about one-third of all T-cells in both compartments, but the lowest proportion were of CD56(+) T-cells. Compared with H. pylori-negative mucosa, in H. pylori-infected mucosa the numbers of CD161(+) T-cells were significantly greater (p = .04) in the epithelium, whereas the numbers of CD56(+) T-cells were lower (p = .01) in the lamina propria. A minor population (< 2%) of T-cells in both mucosal layers of H. pylori-negative subjects were natural killer T-cells, and whose proportions were not significantly different (p > .05) to those in H. pylori-infected individuals. The predominance, heterogeneity, and distribution of natural killer cell receptor-positive T-cells at different locations within the gastric mucosa reflects a potential functional role during H. pylori infection and warrants further investigation.

Effect of Helicobacter pylori eradication on oncogenes and cell proliferation

Helicobacter pylori , the main cause of chronic gastritis, is a class 1 gastric carcinogen. However, it remains unclear whether H. pylori affects molecular alterations in chronic gastritis. Thus, this study was designed to investigate the effect of H. pylori eradication on the expression of human telomerase RNA (hTR), human telomerase reverse transcriptase (hTERT), c-myc and proliferation nuclear cell antigen (PCNA) in H. pylori associated chronic gastritis. hTR was determined by in situ hybridization, hTERT, c-myc and PCNA were detected by immunohistochemistry using stomach tissues obtained from 39 H. pylori-infected and 21 H. pylori-negative patients with chronic gastritis before and after H. pylori eradication therapy or treatment for symptom relief only. Levels of hTR, hTERT, c-myc and PCNA were significantly higher in H. pylori-infected mucosa (51.3%, 53.8%, 53.8% and 16.8 +/- 5.8, respectively) when compared to H. pylori-negative mucosa before therapy (19.0%, 23.8%, 28.6%, 8.8 +/- 3.4, respectively; P < 0.05 in all cases). In patients with successful eradication of H. pylori the levels of hTR, hTERT, c-myc and PCNA (55.5%, 59.3%, 59.3%, 16.8 +/- 5.8, respectively) were significantly reduced after the therapy (22.2%, 22.2%, 14.8%, 7.0 +/- 5.0, respectively; P < 0.05 in all cases). In the H. pylori failed eradication and H. pylori-negative groups, there was no statistical difference in all four measurements. H. pylori infection may induce the overexpression of hTR, hTERT, c-myc and stimulate cell proliferation. Eradication of H. pylori may reverse the aberrant expression of these oncoproteins and thus correct the abnormal cell proliferation.

Reactive oxygen species activity, mucosal lipoperoxidation and glutathione in Helicobacter pylori-infected gastric mucosa.

Helicobacter pylori is considered as the major pathogen in Helicobacter pylori-associated gastroduodenal disease, but the mechanism of its action has not been fully explained. This study was performed to assess the reactive oxygen species activity and the damage in Helicobacter pylori-infected gastric mucosa. Gastric biopsy specimens were obtained from 308 patients undergoing endoscopy. Gastric mucosal damage was assessed by using luminol enhanced chemiluminescence, thiobarbituric acid-reactive substance, and mucosal glutathione. The chemiluminescence and thiobarbituric acid-reactive substance-equivalent levels in the mucosa of patients with Helicobacter pylori-positive gastric mucosa (43.8 +/- 134.9 c.p.m./microg tissue, 157.0 +/- 96.2 nmol/g tissue, respectively) were significantly higher than in those with Helicobacter pylori-negative mucosa (6.8 +/- 20.3 c.p.m./microg tissue, 110.0 +/- 51.6 nmol/g tissue, respectively; P=0.000, P=0.016, respectively). The glutathione levels in the mucosa of patients with Helicobacter pylori-positive gastric mucosa (159.3 +/- 76.6 nmol/microg tissue) were significantly lower than in those with Helicobacter pylori-negative gastric mucosa (212.3 +/- 134.3 nmol/microg tissue; P=0.008). After the data were divided according to the presence of Helicobacter pylori, there were no significant differences in chemiluminescence, thiobarbituric acid-reactive substance, and glutathione among the different macroscopic findings within Helicobacter pylori-positive and -negative gastric mucosa. Helicobacter pylori infection plays a pathological role in many gastrointestinal diseases through excessive mucosal-reactive oxygen species production, pronounced membrane damage, and the depletion of gastric anti-oxidants.

Chemokine mRNA expression in gastric mucosa is associated with Helicobacter pylori cagA positivity and severity of gastritis.

AIM: To investigate the association between the quantity of gastric chemokine mRNA expression, severity of gastritis, and cagA positivity in Helicobacter pylori associated gastritis. METHODS: In 83 dyspeptic patients, antral...

Enhanced levels of C-X-C chemokine, human GROalpha, in Helicobacter pylori-associated gastric disease.

C-X-C Chemokines play an important role for neutrophil extravasation through microvessels. Although the level of interleukin (IL)-8 is known to increase in the Helicobacter pylori-infected gastric mucosa, another C-X-C chemokine, GROalpha, has not been evaluated in the H. pylori-associated gastric mucosal injury. The present study was designed to investigate gastric contents of GROalpha in relation to those of IL-8 in the gastric mucosa of H. pylori-infected peptic ulcer patients. Thirty-eight patients with gastric ulcer and 41 with gastritis underwent endoscopy with informed consent and 49 were found to be H. pylori positive and 30 H. pylori negative. Biopsies from the gastric corpus were performed in each patient to examine the H. pylori colonization by bacterial culture, the rapid urease test and histological specimens as well as measurement of the contents of human GROalpha and IL-8. Helicobacter pylori infection was eradicated in 21 patients by triple therapy (lansoprazole 30 mg, amoxycillin 2.0 g, clarithromycin 600 mg; 2 weeks). The samples for GROalpha and IL-8 assay were homogenized in 0.02% aprotinin containing phosphate-buffered solution and the mucosal contents of GROalpha and IL-8 in the supernatants were quantified by sandwich enzyme immunoassay methods. The levels of GROalpha and IL-8 in H. pylori-positive gastric mucosa were significantly higher than those in the H. pylori-negative mucosa. There was a significant linear correlation between the levels of GROalpha and IL-8 (r = 0.798, P < 0.01). After the eradication of H. pylori by the triple therapy, the levels of GROalpha and IL-8 were significantly decreased. The GROalpha showed an increase in the H. pylori-positive gastric mucosa in a similar fashion as IL-8 contents, suggesting a pathogenetic role for GROalpha in H. pylori-associated gastric mucosal injury.

Association of antral mucosal levels of interleukin 8 and reactive oxygen radicals in patients infected with Helicobacter pylori.

1. Helicobacter pylori infection is characterized by an infiltration of neutrophils in the gastric mucosa. Neutrophil activation is an important source of reactive oxygen radicals, which cause tissue damage. Studies have shown that in Helicobacter pylori-infected patients there is increased mucosal production of interleukin 8. However, the role of interleukin 8 in the Helicobacter pylori-related inflammatory process and its relationship with reactive oxygen radicals remains to be clarified. The aims of this study were to investigate if there is any association between antral mucosal levels of interleukin 8 and reactive oxygen radicals and their relationship to gastric antral inflammation. 2. Fifty-two patients referred for endoscopy were recruited into the study. Gastric antral biopsies were taken for histology, culture and measurement of interleukin 8 and chemiluminescence (measuring reactive oxygen radicals). Interleukin 8 was measured by ELISA and the result expressed as pg/mg biopsy. Luminol-enhanced chemiluminescence was measured as mV min-1 mg-1 biopsy. Antral inflammation was assessed by a pathologist in a blinded fashion. 3. Antral mucosal levels of interleukin 8 and reactive oxygen radicals were significantly higher in Helicobacter pylori-colonized mucosa than in Helicobacter pylori-negative mucosa. After the eradication of Helicobacter pylori in patients with duodenal ulcer the median values (ranges) of interleukin 8 and reactive oxygen radicals fell from 1.21 (0.10-2.40) to 0.65 (0.00-1.60) and from 110.0 (10.0-959.0) to 14.5 (0.0-85.0) respectively. There was a positive correlation between interleukin 8 concentration and chemiluminescence response in the antral mucosa (r = 0.72). A higher interleukin 8 concentration was associated with greater neutrophil infiltration (r = 0.72) and mononuclear cell infiltration (r = 0.55); the magnitude of the chemiluminescence response was also positively associated with neutrophil (r = 0.77) and mononuclear cell infiltration (r = 0.59). 4. Interleukin 8 concentration is associated with an infiltration of neutrophils and mononuclear cells and is correlated with the production of reactive oxygen radicals in antral gastric mucosa infected with Helicobacter pylori. These findings suggest that interleukin 8 may be important in attracting and activating phagocytes to release reactive oxygen radicals, thereby causing mucosal damage.

Serial change of gastric mucosa after challenging with Helicobacter pylori in the cynomolgus monkey

The aim of this study was to clarify the change of the gastric mucosa following inoculation with Helicobacter pylori (H. pylori). Two pairs of cynomolgus monkeys received either H. pylori of human origin (group A) or H. pylori of monkey origin (group B) by intragastric inoculation at a dose of 10(9) CFU. After inoculation, endoscopical observation and biopsies were done every 7 days for one month. The bacteria in the biopsy samples were cultured quantitatively. The content of intracellular PAS-AB positive substance was quantitatively analyzed with the image analyzing system. Results were as follows: 1) Before inoculation, the gastric mucosa was endoscopically normal and free from H. pylori. 2) The quantity of H. pylori varied from 0 to 10(3) CFU/0.1 g tissue in group A and from 10 to 10(6) CFU/0.1 g tissue in group B. 3) Severe erosion was seen in group B, while mild mucosal erythema and erosion were observed in group A. 4) There was a correlation between the quantity of H. pylori and histological activity (Rauws' gastritis score). 5) The PAS-AB positive substance in H. pylori-positive mucosa was less than that in H. pylori-negative mucosa. In conclusion, gastric mucosal changes of varying degrees were brought about after inoculation of H. pylori depending on the quantity of bacilli in the gastric tissue.

Eicosanoid synthesis and Helicobacter pylori associated gastritis: Increase in leukotriene C4 generation associated with H. pylori colonization

The importance of pro-inflammatory leukotriene C 4 in Helicobacter pylori ( H. pylori) associated gastritis in man is unknown. Fresh gastric biopsy specimens from 28 dyspeptic patients were obtained: 10 showed normal antral histology with no evidence of H. pylori, the remaining 18 patients exhibited histological gastritis and were H. pylori positive as assessed by histology, culture and urease test. Twelve of these 18 patients received 240 mg twice daily colloidal bismuth subcitrate for four weeks before re-endoscopy. Gastric biopsies from H. pylori positive patients were incubated under basal and Ca 2+-ionophore mediated conditions: Radioimmunoassay analysis of the supernatant showed basal release of prostaglandin E 2 and leukotriene C 4 was slightly but not significantly elevated in H. pylori positive mucosa. However in H. pylori positive mucosa there was an 85% increase in leukotriene C 4 synthesis when biopsies were incubated with ionophore, compared to only 13% increase in H. pylori negative mucosa ( p<0.02). After eradication of H. pylori by colloidal bismuth subcitrate, there was a clearance of inflammatory cell infiltrate as assessed by histology and a significant reduction in ionophore-mediated leukotriene C 4 formation compared with before treatment ( p<0.02). These results suggest that H. pylori gastritis is associated with increased capacity to generate leukotriene C 4, which may amplify the damaging effects of the bacteria on gastric mucosa.