Severe Mucosal Atrophy Research Articles

Neoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis

BACKGROUND & AIMS: Some patients with ulcerative colitis (UC) receiving an ileal pelvic pouch with ileoanal anastomosis (IPAA) develop persistent severe villous atrophy in the pouch mucosa. To investigate if mucosal atrophy indicates a risk for subsequent neoplastic transformation of the ileal pouch mucosa, a follow-up study was undertaken. METHODS: Seven patients with UC and an IPAA in whom persistent severe atrophy (type C) developed and 14 control patients with no or only slight atrophy (type A) were prospectively surveyed by flexible videoendoscopy with multiple biopsies for assessment of possible neoplastic changes. RESULTS: The median time of the pouch in function was 9 years for both groups. Dysplasia was found in 5 of 7 patients in the type C group (71%) compared with none in the type A group (P < 0.001). Four patients had low-grade dysplasia, and 1 patient had sequential multifocal development into high-grade dysplasia. Multifocal DNA aneuploidy was found in 2 patients, 1 with low-grade and 1 with high-grade dysplasia. CONCLUSIONS: Patients with UC and a long- standing IPAA who develop persistent severe mucosal atrophy are at risk also of neoplastic transformation of the pouch mucosa. (Gastroenterology 1997 May;112(5):1487-92)

Gastritis Classified in Accordance with the Sydney System in Patients with Primary Sjögren's Syndrome

Background: According to some earlier reports, chronic atrophic gastritis is a common finding in Sjögren's syndrome. However, the findings are controversial. The aim of this study was to investigate the occurrence of gastritis classified in accordance with the Sydney System in patients with primary Sjögren's syndrome. Methods: Thirty-two consecutive patients (27 women, 5 men) with primary Sjögren's syndrome, and 64 age-and sex-matched control subjects with dyspepsia underwent gastroscopic examination. Mucosal biopsy specimens were taken from the gastric antrum and corpus. Results: Eight (25%) patients with Sjögren's syndrome and three (4.1%) control subjects had atrophic antral gastritis (P = 0.01). Atrophic corpus gastritis was more frequently found in control subjects, but the difference was not statistically significant. None of the subjects had severe (grade 3) atrophy. Gastric inflammation, in either the corpus or antrum, was found in 85% of patients with Sjögren's syndrome and in 61% of control subjects (P = 0.02). Helicobacter pylori was present in 31% of Sjögren's syndrome patients and in 39% of controls (NS). Conclusions: In patients with primary Sjögren's syndrome mild atrophic changes in the antrum were common, but severe mucosal atrophy was rare. Compared with control subjects, gastric inflammation was seen more often in patients with Sjögren's syndrome.

Helicobacter pylori serology in chronic gastritis with antral atrophy and negative histology for Helicobacter-like organisms.

It has been suggested that there may be a correlation between Helicobacter pylori (Hp) infection and precancerous lesions of the stomach. However, histological evaluation of bacterial colonization in chronic atrophic gastritis shows a relatively low prevalence of the microorganism, which does not support the hypothesis. The aim of our study was to investigate the Hp serology in 95 patients with chronic gastritis with antral atrophy, with (27 cases) and without (68 cases) intestinal metaplasia, and without Helicobacter-like organisms in antral and corpus biopsy specimens. For all subjects, serum anti-Hp immunoglobulin IgG was identified by a fluorescent immunoenzymatic method (Helori-test; Eurospital), and mucosal atrophy and activity were graded histologically (Sydney System score). The serum Hp-antibody status documented the presence of current bacterial infections in 64 of 95 (67.4%) patients and previous infections in another 17 subjects. In only 14.7% of cases was there no evidence of current or previous infection. These subjects had less severe mucosal atrophy and lower inflammatory scores. In addition, there were no cases of intestinal metaplasia in such subjects. The high prevalence of Hp infection confirms the primary role of the microorganism in the pathogenesis of chronic gastritis with antral atrophy, although the bacterium is no longer present in the advanced stages of such disease. The histological evaluation of Hp colonization following the criteria of the Sydney System appears from our study to underestimate the true prevalence of the infection in the stomach when there is mucosal atrophy.

Serological markers identify histologically latent coeliac disease among first-degree relatives.

Serological markers detect asymptomatic coeliac disease among first-degree relatives of patients with sprue. However, some relatives with coeliac disease-related antibodies have 'normal' jejunal mucosa by conventional histology. Whether these serological abnormalities represent false-positives or are consequences of gluten sensitivity is not known. Our aim was to evaluate, through quantitative histology, intestinal biopsies of asymptomatic relatives of probands seeking abnormalities consistent with latent coeliac disease. Fifty-nine intestinal biopsies obtained from asymptomatic relatives were evaluated; 40 samples were suitable for histological quantification. Seven samples showed severe mucosal atrophy (coeliac disease) and 33 were considered as 'normals'. In the 'normal' group, nine samples were obtained from patients with one or more positive serological tests and 24 from those with negative tests. Morphometry was compared for samples obtained from healthy control individuals (n = 10) and for those from coeliac patients (n = 7). Serological tests used were: antigliadin antibodies type immunoglobulin (Ig)A and IgG (enzyme-linked immunosorbent assay), antirrecticulin antibody (immuno-fluorescence) and endomysial antibody (immunofluorescence). Biopsy samples were obtained with endoscopic forceps from the distal duodenum (second portion). Quantitative histology of duodenal biopsies was performed with a computerized image analysis system. Relatives with positive serology showed shorter villi (P < 0.05) and higher number (P < 0.01) and numerical density (P < 0.01) of intraepithelial lymphocytes in crypts than healthy controls. Numerical density of intraepithelial lymphocytes in crypts in antibody-positive patients was significantly higher than that observed in relatives with negative serology (P < 0.03). Four of nine (44%) relatives with positive serology had a number of intraepithelial lymphocytes in crypts within the range of coeliac disease patients. However, only one patient with negative serology (4%) was in this range. Our study shows quantitative histological evidence that relatives of probands with positive coeliac disease-related serology are not false-positives, and that they should be considered as individuals with latent coeliac sprue.

Gastritis Associated with Infection by Helicobacter pylori: Comparative Pathology in Humans and Swine

Infection of humans with Helicobacter pylori elicits a multifocal, active, chronic inflammatory response and moderate to severe atrophy of the gastric mucosa. Currently, piglets are the only reported animal model of H. pylori infection. Our objective was to compare the inflammatory response induced in humans with that induced in piglets by H. pylori infection. Samples of gastric mucosa were obtained from H. pylori-infected and uninfected piglets and humans. The composition of the inflammatory cell infiltrate and mucosal atrophy were evaluated by histomorphometric analysis of the biopsied gastric tissue. Infection with H. pylori resulted in a three-fold increase in the volume of inflammatory cells in the gastric mucosa of both humans and piglets. In H. pylori-infected humans, neutrophils composed the bulk of the cellular infiltrate; in piglets, the primary inflammatory cell was the lymphocyte. Both humans and piglets had severe epithelial cell vacuolation and significant reduction of the gastric mucosal surface area. We concluded that pathologic processes induced by infection with H. pylori, which include relatively severe mucosal inflammation, mucosal atrophy, and epithelial vacuolation, are similar in piglets and humans but that the primary inflammatory cell types are distinctly different in the two species.

Chronic Gastritis Profiles in Sibs of Probands Calculated to Carry a Highly Increased Risk of Gastric Carcinoma

Of 1161 subjects consisting of 4 family samples (gastric carcinoma patient relatives, pernicious anaemia, duodenal ulcer and control families) 18 subjects representing 17 families had distinct atrophic changes in the gastric mucosa that were considered on the basis of risk calculations to carry an at least 7-fold risk to develop gastric carcinoma. Twelve of these 18 subjects could be used as probands and their 41 sibs were subjected to a closer statistical analysis. Sibs of probands having a very high relative risk of gastric carcinoma (18-fold or more) differed markedly from the general population. All sibs had some form of atrophic gastritis and there was a significantly higher than expected prevalence of subjects with severe corpus mucosal atrophy. It is concluded that sibs of subjects with severe atrophic changes may carry an increased risk of gastric malignancy.

Mucosal Morphology and Histochemistry of the Continent Cecal Reservoir for Urine

Biopsy studies were made of the continent cecal reservoir and its ileal nipple valve in 13 patients with up to 9 years of postoperative observation. The morphology of the cecal mucosa was well preserved, showing only minor atrophy with slightly reduced villous height. Nonprogressive increase of inflammatory cells was found interstitially and there was a slight increase of collagen fibers. Histochemical studies revealed a shift, probably originating soon after the urinary diversion, from sulfomucins to sialomucins in most patients. Presumably, this shift was a secondary, nonspecific phenomenon. No correlation was found between the type of mucin and the result of urine culture. Ileal valve biopsies revealed severe mucosal atrophy and a considerable increase in the amount of collagen fibers.

INFANCY CELIAC DISEASE WITHOUT DIARRHEA

Three infants presented at about 1 year of age with failure to thrive, anorexia, vomiting, varying degrees of constipation, but no diarrhea. They were found to have severe mucosal atrophy characteristic of celiac disease. Each infant had fecal retention on admission, none had steatorrhea, and they all thrived well on gluten-free, milk-containing diets. Other investigations, including sugar tolerance tests, mucosal lactase, and dipeptidases were confirmatory. High IgA levels were found in each infant and low IgM in one. Although occurrence of celiac disease without diarrhea or steatorrhea is recognized in older children and adults, it must also be considered as a cause of failure to thrive in infants without these symptoms, particularly when other causes cannot be found.