Sydney Classification Research Articles

Risk factors of atrophic gastritis and intestinal metaplasia in first-degree relatives of gastric cancer patients compared with age-sex matched controls.

Background:To identify whether first-degree relatives (FDRs) of gastric cancer (GC) patients have increased risk for atrophic gastritis (AG) and intestinal metaplasia (IM) in relation to other risk factors of GC.Methods:The study cohort consisted of 224 pairs of age-sex matched controls and FDRs. AG and IM in the gastric mucosa were scored histologically using the updated Sydney classification. Risk of having AG and IM was studied by comparing FDRs to controls. Impacts of age, H. pylori infection, smoking, dietary and socioeconomic factors on the presence of AG and IM were studied.Results:In multivariate regression analysis, FDRs had adjusted OR of 2.69 (95% CI 1.06–6.80, P=0.037) for antral IM in male population. Adjusted OR for antral AG and IM were 9.28 (95% CI 4.73–18.18, P<0.001) and 7.81 (95% CI 3.72–16.40, P<0.001) for the H. pylori infected subjects in total population. Getting old by 5 years increased the ORs of having AG and IM by approximately 1.25 fold (P<0.001). Spicy food increased the OR of antral IM by 2.28 fold (95% CI 1.36–3.84, P=0.002).Conclusions:Family history of GC was an independent risk factor for antral IM in male in our study, which could be one reason for the increase of gastric cancer in the family member of gastric cancer. It could be an evidence for the necessity of frequent endoscopy in the presence of family history of GC compared to general population in male.

What is the impact of Helicobacter pylori density on the success of eradication therapy: A clinico-histopathological study

To investigate the presence of any possible association between H. pylori density in the stomach and the efficacy of triple (lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d. and amoxicillin 1g b.i.d. for 14 days) and bismuth-containing quadruple (colloidal bismuth subcitrate 300 mg q.i.d., lansoprazole 30 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. for 14 days) eradication therapies. Eighty-five cases with H. pylori infection (proved by rapid urease test and histology) were studied. In each case, the density of H. pylori colonization was graded according to the updated Sydney classification. H. pylori eradication was determined via the (14)C-Urea breath test performed 4 weeks after the end of therapy. The eradication rate of H. pylori was 50% (30 out of 60) in the triple therapy and 92% (23 of 25) in the quadruple therapy group. In the triple therapy group, the eradication rate of H. pylori decreased as the initial density of H. pylori increased (density of H. pylori: 1, 58.3%; 2, 54.5%; 3, 52.4%; 4, 38.5%; 5, 33.3%). In two cases with eradication failure after quadruple therapy, the grades of bacterial density were 1 and 3. H. pylori density, as assessed by histological grading, may predict the usefulness of triple therapy. The higher the H. pylori density, the less effective triple therapy will be at successful eradication of H. pylori. Quadruple therapy does not seem to be negatively affected by bacterial density.

Interobserver variation in assessment of gastric premalignant lesions

Either atrophy or intestinal metaplasia of the gastric mucosa are considered premalignant lesions. The new operative link for gastritis assessment staging system is based on the detection of atrophy, and the operative link for assessment of intestinal metaplasia staging system is based on the detection of intestinal metaplasia. Good interobserver agreement is necessary for identification of any premalignant condition. The aim of this study was to compare the agreement between findings of gastric atrophy and intestinal metaplasia by expert and general pathologists and to analyze the possible reasons behind any possible disagreement. Patients with dyspeptic symptoms, aged 55 years and above, without previous Helicobacter pylori eradication were enrolled and analyzed according to the updated Sydney Classification by two expert pathologists and an experienced general pathologist; the results were compared with the consensus driven by the two experts. Gastric biopsy specimens from 121 patients (91 women) were included in the analysis; the mean age of the patients was 67.4 years. H. pylori infection was present in 61.2% of patients. The level of agreement between the general pathologist and the two experts (κ-value) was 0.12, 0.46, and 0.87, respectively, for detecting atrophy in the corpus; 0.77, 0.77, and 0.65, respectively, for detecting intestinal metaplasia in the corpus; 0.06, 0.51, and 0.54, respectively, for detecting atrophy in the antrum; and 0.69, 0.85, and 0.79, respectively, for detecting metaplasia in the antrum. The agreement was substantially higher for intestinal metaplasia than for atrophy. This could result in discrepancies when the operative link for gastritis assessment and operative link for assessment of intestinal metaplasia staging systems are applied and can be caused by differences in the criteria used to define atrophy.

Clinical advances of interest in the diagnosis and treatment of patients with antiphospholipid syndrome

In this paper we review recent studies and consensus documents that we consider relevant to the diagnosis and treatment of patients with antiphospholipid syndrome (APS). The diagnosis of APS is based on the Sydney classification criteria (2006), in which positive laboratory tests (anticardiolipin antibodies, anti-β2-glycoprotein I antibodies or lupus anticoagulant) are mandatory. However, it is not uncommon to see patients with clinical features highly suggestive of the syndrome in whom these antibodies are persistently negative. Therefore, we summarize the principal clinical and serological findings in a subgroup of patients with seronegative APS in the first series published up to date. In addition, a recent study draws attention to the safety and efficacy of the long-term use of low-molecular-weight heparins in patients with APS not susceptible to warfarin treatment. There is also a subgroup of women with APS and recurrent fetal loss with no response to the standard antithrombotic therapy; in this group the materno-fetal prognosis could be improved by the addition of low-dose prednisolone during the first trimester of pregnancy. Finally, we list the principal recommendations regarding thromboprophylaxis in APS drawn from the expert consensus document elaborated at the meeting held in Galvestone (2010).

Treatment of 139 Pregnancies in Antiphospholipid-positive Women Not Fulfilling Criteria for Antiphospholipid Syndrome: A Retrospective Study

The effect of low-dose aspirin (LDA) on pregnancy outcome in antiphospholipid (aPL)-positive women not fulfilling the criteria for antiphospholipid antibody syndrome (APS) was evaluated retrospectively. We evaluated 139 pregnancies of 114 aPL-positive women not fulfilling the Sydney classification criteria for definite APS (104 treated with LDA, 35 untreated). Inclusion criteria consisted of (1) any titer of aPL and no previous pregnancy or no pregnancy losses (defined as aPL carriers); (2) any titer of aPL and 1 or 2 pregnancy losses before the 10th gestational week. No women had previous thrombosis. The rate of pregnancy loss, gestational age at delivery, and birth weight percentile were compared in the treated and untreated patients. Associations between clinical and laboratory characteristics and pregnancy outcomes were investigated. The rate of pregnancy loss was low in both treated and untreated groups (7.7% vs 2.9%, respectively). There were no statistically significant differences in the rate of pregnancy loss, gestational age at birth, or birth weight percentile in the treated and untreated groups. There were significant associations between gestational age at birth ≤ 34th week and positivity for lupus anticoagulant (p = 0.025) and anti-ß2-glycoprotein I IgG antibodies at titers > 99th (p = 0.016). LDA treatment does not appear to improve pregnancy outcome in low-risk women not fulfilling the criteria for APS. Because antibody profile seems to influence pregnancy outcome, further studies of patients stratified according to their antibody profile are warranted.

İntestinal Metaplazi ve Gastrik Atrofi Çocuklarda Erişkinlerdeki Kadar Sık Değildir

Objective: Atrophic gastritis and intestinal metaplasia are frequently seen among adult patients and are thought to be premalignant. The prevalence of these lesions among children is not well known. The aim of the study is to investigate the prevalence of gastric atrophy and intestinal metaplasia in children. Material and and Methods: Children with gastrointestinal symptoms admitted to our clinic were evaluated. The data about urea breath test, upper gastrointestinal endoscopy macroscopical findings and histopathological evaluation with modified Sydney classification were evaluated retrospectively from patient records. Results: A total of 357 children underwent upper gastrointestinal system endoscopy. Histopathological evaluation revealed no gastric atrophy but intestinal metaplasia in 2 children. Both of the children had positive urea breath test, gastritis and were positive for Helicobacter pylori histologically. One of these children also had a peptic ulcer. The children underwent endoscopy again after H.pylori eradication therapy, and intestinal metaplasia was not seen on the biopsy materials. Conclusion: Precancerous lesions are very rarely reported among children. These are particularly seen together with H. pylori infection and around 10-years of age. Our results show that intestinal metaplasia is seen in H.pylori positive children and the incidence is very low. The reason of low prevalence is suggested to be depending on the host, microorganism and the pathologists.

Gastrokine 1 Expression in the Human Gastric Mucosa Is Closely Associated with the Degree of Gastritis and DNA Methylation

PurposeGastrokine 1 plays an important role in gastric mucosal defense. Additionally, the Gastrokine 1-miR-185-DNMT1 axis has been shown to suppress gastric carcinogenesis through regulation of epigenetic alteration. Here, we investigated the effects of Gastrokine 1 on DNA methylation and gastritis.Materials and MethodsExpression of Gastrokine 1, DNMT1, EZH2, and c-Myc proteins, and the presence of Helicobacter pylori CagA protein were determined in 55 non-neoplastic gastric mucosal tissue samples by western blot analysis. The CpG island methylation phenotype was also examined using six markers (p16, hMLH1, CDH1, MINT1, MINT2 and MINT31) by methylation-specific polymerase chain reaction. Histological gastritis was assessed according to the updated Sydney classification system.ResultsReduced Gastrokine 1 expression was found in 20 of the 55 (36.4%) gastric mucosal tissue samples and was closely associated with miR-185 expression. The Gastrokine 1 expression level was inversely correlated with that of DNMT1, EZH2, and c-Myc, and closely associated with the degree of gastritis. The H. pylori CagA protein was detected in 26 of the 55 (47.3%) gastric mucosal tissues and was positively associated with the expression of DNMT1, EZH2, and c-Myc. In addition, 30 (54.5%) and 23 (41.9%) of the gastric mucosal tissues could be classified as CpG island methylation phenotype-low and CpG island methylation phenotype-high, respectively. Reduced expression of Gastrokine 1 and miR-185, and increased expression of DNMT1, EZH2, and c-Myc were detected in the CpG island methylation phenotype-high gastric mucosa.ConclusionsGastrokine 1 has a crucial role in gastric inflammation and DNA methylation in gastric mucosa.

Unexpected Changes in the Gastric Remnant in Asymptomatic Patients after Roux-en-Y Gastric Bypass on Vertical Banded Gastroplasty

The aims of this study are to evaluate the macroscopic and microscopic changes in the remnant stomach at mid-term follow-up of patients who underwent a Roux-en-Y gastric bypass on vertical banded gastroplasty (RYGB-on-VBG). The stomach could be reached through a 1.1-cm gastro-gastrostomy with an endoscope of standard size. From January 2009 to July 2010, 51 asymptomatic patients at 4 and 5 years follow-up after RYGB-on-VBG submitted to upper endoscopy. All of them were examined with standard endoscopy with collection of biopsies in gastric fundus, body, and antrum. The macroscopic and microscopic findings were analyzed according to Sydney Classification. The endoscopy of the remnant stomach was technically easy and already showed on macroscopic examination 90 % cases of gastritis (41.2 % mild, 49 % severe) with tendency of severity in the distal stomach part. Histological analysis detected 39.2 % of active gastritis, 50.6 % of quiescent gastritis, 7.8 % of intestinal metaplasia, and 3.9 % of lymphoma-like gastritis. The results surprised us. We found a very high rate of mucosa abnormalities after RYGB-on-VBG. All of the patients have to be regularly controlled in follow-up and treatment has to be introduced when needed. Again, we would like to ask the question: what is happening with the remnant stomach after standard RYGB, banded gastric bapass, or minigastric bypass? Did we reach the time to answer the question?

Avances de interés clínico en el diagnóstico y tratamiento de los pacientes con síndrome antifosfolípido

In this paper we review recent studies and consensus documents that we consider relevant to the diagnosis and treatment of patients with antiphospholipid syndrome (APS). The diagnosis of APS is based on the Sydney classification criteria (2006), in which positive laboratory tests (anticardiolipin antibodies, anti-β2-glycoprotein I antibodies or lupus anticoagulant) are mandatory. However, it is not uncommon to see patients with clinical features highly suggestive of the syndrome in whom these antibodies are persistently negative. Therefore, we summarise the principal clinical and serological findings in a subgroup of patients with seronegative APS in the first series published up to date. In addition, a recent study draws attention to the safety and efficacy of the long-term use of low-molecular-weight heparins in patients with APS not susceptible to warfarin treatment. There is also a subgroup of women with APS and recurrent foetal loss with no response to the standard antithrombotic therapy; in this group the materno-foetal prognosis could be improved by the addition of low-dose prednisolone during the first trimester of pregnancy. Finally, we list the principal recommendations regarding thromboprophylaxis in APS drawn from the expert consensus document elaborated at the meeting held in Galvestone (2010).

Sa1135 Self-Expandable Metal Stents or Surgery in Colonic Obstruction: Which is Better?

Introduction: Endoscopic findings such as erythema are frequently labelled as gastritis. Some previous studies have shown reasonable concordance between endoscopy and histology findings while others demonstrate a very poor correlation. Aims: To study the positive and negative predictive values of endoscopic diagnosis of antral gastritis and gastropathy. Method: 400 consecutive patients who underwent an OGD and had at least two antral biopsies were included in the study retrospectively. The endoscopic results were then compared to the histology reports for concordance. Only endoscopic reports of antral gastritis according to the criteria described by the Sydney classification were considered ‘positive for antral gastritis'. Histologically, those reported as acute or chronic inflammation, Helicobacter-associated gastritis, chemical or reactive gastritis, hypertrophic gastropathy, eosinophilic gastritis, lymphocytic gastritis, collagenous gastritis and granulomatous gastritis were regarded as being ‘positive for antral gastritis'. Results: In total, there were 182 male patients and 218 female patients. The median age was 50.5 ± 17.2 years (range 15 to 91). The endoscopic appearance of the antrum was positive for gastritis in 51.0% (204/400) of patients and was negative in 49.0% (196/400) of patients. The percentages of patients with presence of inflammation on histology were similar in those with or without endoscopic gastritis (65.7% vs 60.7%, p=0.303). Of the 17.3% (69/400) patients who were eventually diagnosed and treated for Helicobacter-associated gastritis on biopsy, 55.1% (38/400) had endoscopic evidence of gastritis and 44.9% (31/400) of patients did not, p=0.267. The positive and negative predictive values of endoscopy in predicting histological antral gastritis were 39.3% and 65.7% respectively. Conclusion: The predictive values of the endoscopic appearance in the diagnosis of antral gastritis is extremely poor. An endoscopically non-inflamed antrum is as likely as an inflamed antrum to harbour significant pathology such as Helicobacter pylori. Hence, it is essential to obtain antral biopsies in all patients.

Sa1133 Predictive Value of Endoscopic Diagnosis of Antral Inflamation. Correlation With Histology

Introduction: Endoscopic findings such as erythema are frequently labelled as gastritis. Some previous studies have shown reasonable concordance between endoscopy and histology findings while others demonstrate a very poor correlation. Aims: To study the positive and negative predictive values of endoscopic diagnosis of antral gastritis and gastropathy. Method: 400 consecutive patients who underwent an OGD and had at least two antral biopsies were included in the study retrospectively. The endoscopic results were then compared to the histology reports for concordance. Only endoscopic reports of antral gastritis according to the criteria described by the Sydney classification were considered ‘positive for antral gastritis'. Histologically, those reported as acute or chronic inflammation, Helicobacter-associated gastritis, chemical or reactive gastritis, hypertrophic gastropathy, eosinophilic gastritis, lymphocytic gastritis, collagenous gastritis and granulomatous gastritis were regarded as being ‘positive for antral gastritis'. Results: In total, there were 182 male patients and 218 female patients. The median age was 50.5 ± 17.2 years (range 15 to 91). The endoscopic appearance of the antrum was positive for gastritis in 51.0% (204/400) of patients and was negative in 49.0% (196/400) of patients. The percentages of patients with presence of inflammation on histology were similar in those with or without endoscopic gastritis (65.7% vs 60.7%, p=0.303). Of the 17.3% (69/400) patients who were eventually diagnosed and treated for Helicobacter-associated gastritis on biopsy, 55.1% (38/400) had endoscopic evidence of gastritis and 44.9% (31/400) of patients did not, p=0.267. The positive and negative predictive values of endoscopy in predicting histological antral gastritis were 39.3% and 65.7% respectively. Conclusion: The predictive values of the endoscopic appearance in the diagnosis of antral gastritis is extremely poor. An endoscopically non-inflamed antrum is as likely as an inflamed antrum to harbour significant pathology such as Helicobacter pylori. Hence, it is essential to obtain antral biopsies in all patients.

Su1698 Comparison of Ten-Day, Fifteen-Day Sequential Therapy and Proton-Pump Inhibitor-Based Triple Therapy in Korea: A Prospective Randomized Study

Introduction: Helicobacter pylori (H. pylori) infection affects about 30-50% of adults in developed countries and causes persistent gastric infection and chronic inflammation. H. pylori infection is a major cause of gastric ulcer disease and gastric cancer. Diagnostic tests include histology, rapid urease test (RUT), breath tests and stool antigen tests. Previously, we have introduced a new electrochemical device for rapid H. pylori detection. Aims: To prospectively evaluate the newly developed electrochemical device for H. pylori detection in the clinical setting. Material & Methods: Seventy consecutive patients (43 female, 27 male; mean age 65 years, range 26-85 years) were included. The electrochemical device for H. pylori detection consists of a working and reference electrode between which a biopsy sample was administered. Acquired voltage-values between both electrodes were analysed for characteristics typical forH. pylori infection (ammonia). According to Sydney classification, biopsies were taken from gastric antrum and corpus for electrochemical H. pylori detection, RUT and immunohistochemistry (IHC). RUT results were evaluated after 24 hours. Every patient received 13C-urea breath test. Detection rates for H. pylori were analysed blinded to IHC results, which was designated as the gold standard of H. pylori diagnosis. Results: IHC had a sensitivity, specificity and accuracy of 100%. RUT analysis and 13C-urea breath test received both a sensitivity of 100% and a specificity of 92% and 95%, respectively. Accuracy of RUT was 93% and 96% for 13C-urea breath test. The new electrochemical H. pylori detection method showed a sensitivity of 100%, specificity of 94% and accuracy of 94%, respectively. Definitive results for H. pylori detection with the new device were available within 10 seconds. Conclusion: The new developed electrochemical H. pylori detection method allows rapid and accurate detection of the infection and has therefore the potential to improve H. pylori diagnosis and treatment.

FOXP3+ Regulatory T Cells in Children with Helicobacter Pylori Infection

Despite an intensive pro-inflammatory response, the immune system is unable to clear the organism in Helicobacter pylori gastritis. Regulatory T (Treg) cells, which suppress the immune response of antigen-specific T cells, have recently been demonstrated to play a key role in chronic inflammation by immunologic tolerance. The purpose of our study was to investigate the histopathology, FOXP3+CD4+CD25(high)Treg (FOXP3+Treg) cell expression, and immune responses in children with H. pylori infection. Twenty-four H. pylori -positive and 24 H. pylori -negative children who underwent esophagogastroduodenoscopy for dyspeptic symptoms were included. Histopathologic grading according to the updated Sydney classification and immunohistochemical stains for FOXP3, transforming growth factor-β1 (TGF-β1), and CD4 were performed. Histopathologic bacterial density score, gastritis activity score, and chronic inflammation score were higher in the H. pylori -positive group than in the negative group (P < 0.01). The number of FOXP3+Treg cells and CD4+T cells and the grade of TGF-β1 expression were significantly increased in the H. pylori -positive group compared to the negative group (P < 0.01). The number of FOXP3+Treg cells correlated positively with the grade of TGF-β1 expression regardless of H. pylori status (P < 0.05). The number of FOXP3+Treg cells and the grade of TGF-β1 expression correlated positively with H. pylori density, gastritis activity score, and chronic inflammation score regardless of H. pylori status (P < 0.01). These findings indicate that FOXP3+Treg cells could play a role in persistent H. pylori infection.

Is There a Difference between Endoscopic Finding andHelicobacter pyloriInfection in Patients with Chronic Gastritis?

Background/Aims: This study verifies whether endoscopic findings differ according to the infection of Helicobacter pylori in patients with chronic gastritis. Materials and Methods: The study surveyed upper gastrointestinal symptoms of 382 patients with chronic gastritis and conducted esophagogastroduodenoscopy. The endoscopic findings were classified according to the Sydney classification, as edema, erythema, friability, exudates, flat erosion, raised erosion, rugal hyperplasia, atrophy, visibility of vascular pattern, intramural bleeding spot, nodularity, respectively in antrum, body, fundus. Results: 1) The average age of 382 patients was 52.3 years and there were 176 males and 206 females. 2) Among 382 patients, 167 (43.7%) had epigastric pain syndrome and 215 (56.3%) had postprandial distress syndrome. 3) Among 167 patients with epigastric pain syndrome, 85 (51.1%) patients were infected with H. pylori, while 82 (48.9%) patients were uninfected. Among 215 patients with postprandial distress syndrome, patients infected with H. pylori were 102 (47.6%), while those uninfected with H. pylori were 113 (52.4%). This shows no difference between patients with and without H. pylori infection (P＞0.05). 4) Compared to patients uninfected with H. pylori, those infected with H. pylori had more erythema (70.2% vs. 66.4%, P＞0.05) in antrum, (48.5% vs. 45.2%, P＞0.05) in body, and (36.4% vs. 32.7%, P＞0.05) in fundus, which shows no difference (P＞0.05). Conclusions: Patients infected with H. pylori tend to show more erythema, while those uninfected with H. pylori showed more atrophy. However, such difference between two groups was statistically insignificant, leading to a conclusion that endoscopic findings do not differ according to H. pylori infection. (Korean J Helicobacter Up Gastrointest Res 2012;12:178-182)

Gastric Precancerous lesions among Nigerians with Chronic Gastritis

To investigate the frequency of precancerous lesions in H. pylori gastritis in Nigerians Previously, the slides of all endoscopic gastroduodenal biopsies seen at the Pathology Department of Obafemi Awolowo University Teaching Hospital, Ile-Ife between 1994 and 2003 were reviewed and published. The current review examined interplay of intestinal metaplasia, glandular atrophy and epithelial dysplasia with H.pylori. The H.pylori, intestinal metaplasia and glandular atrophy were graded based on updated Sydney classification scheme while Vienna classification was used for dysplasia. Out of 1036 biopsies seen during the study period, 135 (13%) had associated precancerous lesions. Intestinal metaplasia was the commonest (9.2%), followed by severe atrophic gastritis (4.3%) and low grade dysplasia (0.7%) occurring either alone or in various combinations. Most of these lesions were seen in patients above 40 years of age and over 80% were H.pylori positive. Frequency of precancerous lesions is low among Nigerians with H.pylori gastritis. Intestinal metaplasia was the commonest lesion and was mostly type I with relatively low risk for gastric cancer development. The relatively high prevalence H.pylori infection among these cases could have resulted from repeated infection and most were localised to the corpus relative to the antral region where the precancerous lesions were seen.

Lossless Compression of JPEG2000 Whole Slide Images Is Not Required for Diagnostic Virtual Microscopy

The use of lossy compression in medical imaging is controversial, although it is inevitable to reduce large data amounts. In contrast with lossy compression, lossless compression does not impair image quality. In addition to our previous studies, we evaluated virtual 3-dimensional microscopy using JPEG2000 whole slide images of gastric biopsy specimens with or without Helicobacter pylori gastritis using lossless compression (1:1) or lossy compression with different compression levels: 5:1, 10:1, and 20:1. The virtual slides were diagnosed in a blinded manner by 3 pathologists using the updated Sydney classification. The results showed no significant differences in the diagnosis of H pylori between the different levels of compression in virtual microscopy. We assume that lossless compression is not required for diagnostic virtual microscopy. The limits of lossy compression in virtual microscopy without a loss of diagnostic quality still need to be determined. Analogous to the processes in radiology, recommendations for the use of lossy compression in diagnostic virtual microscopy have to be worked out by pathology societies.

Protease-Activated Receptor-2 (PAR2) in Human Gastric Mucosa as Mediator of Proinflammatory Effects in Helicobacter pylori Infection

Protease-activated receptors (PAR) are seven transmembrane receptors that are expressed throughout the gastrointestinal tract. In vitro experiments using gastric tumor cell lines, murine models and one clinical study provided evidence for a potential role of PAR2 in Helicobacter pylori-induced gastritis. To investigate PAR2 expression in H. pylori-infected patients and correlation with proinflammatory IL-8, IL-1β as well as histologic changes of the mucosa. Furthermore, PAR2 expression was studied in context to mucosal amounts of secretory leukocyte protease inhibitor (SLPI), a putative regulator of PAR2. Twenty-two H. pylori-infected patients and 72 H. pylori-negative subjects underwent upper GI endoscopy. In antrum-derived mucosal biopsies, PAR2, IL-1β, IL-8, and SLPI expression was analyzed by quantitative RT-PCR, and in part by ELISA and immunohistochemistry. Histopathologic evaluation of gastritis was performed according to the updated Sydney classification. IL-8 gene expression was 5-fold increased in the mucosa of H. pylori-infected patients compared with non-infected (p < .0001), whereas no differences for PAR2 and IL-1β mRNA amounts were observed between both groups. PAR2 gene expression correlated positively with transcript levels of IL-8, IL-1β as well mucosal SLPI levels in H. pylori-infected patients (r: 0.47-0.84; p < .0001), whereas no correlation was found with the degree of gastritis. PAR2 represents an additive pathway of IL-8 secretion and proinflammatory effects in H. pylori-induced gastritis. Reduced SLPI levels leading to higher serine protease activities in the mucosa of infected subjects might regulate PAR2 activation.

Helicobacter pylori and histopathological findings in patients with dyspepsia

Although Helicobacter pylori infection has been reported to be more frequent in patients with dyspepsia, whether it should be treated in dyspepsia remains controversial. This study was carried out to compare the histopathological changes in Helicobacter pylori-positive and -negative dyspepsia patients. A total of 461 patients with Helicobacter pylori-positive dyspepsia seen in our institution were enrolled in the study. The control group was formed from 100 Helicobacter pylori-negative dyspepsia patients. Subjects underwent an upper gastrointestinal endoscopy, and biopsy specimens were taken from the gastric antrum and corpus. All of the cases were evaluated according to the Sydney classification, and the relation of Helicobacter pylori with chronic inflammation, atrophy, intestinal metaplasia, and activity was investigated by two pathologists. Activity, inflammation and intestinal metaplasia were found in 10 (10%), 70 (70%) and 10 (10%) of Helicobacter pylori (-) patients, respectively, and the numbers increased with increasing Helicobacter pylori intensity when compared with Helicobacter pylori (+) patients (p<0.01, p<0.01 and p<0.05, respectively). Atrophy was found in 27 (5.5%) of all cases (in 10 Helicobacter pylori (-) patients and in 17 Helicobacter pylori (+) patients), but no significant relation was found with increasing Helicobacter pylori intensity (p>0.05). There was no significant difference between corpus alone or antrum alone Helicobacter pylori (+) and both corpus/antrum (+) patients in regards to the presence of activity, inflammation, intestinal metaplasia, and atrophy (p>0.05). Determination of the degree of morphological changes accompanying Helicobacter pylori infection in dyspepsia is important in the follow-up and treatment of patients. As activity, inflammation and intestinal metaplasia increase with increasing Helicobacter pylori intensity in dyspepsia patients, Helicobacter pylori eradication treatment can be recommended in these patients.

Endoscopic Finding According to Symptoms in Patients with Functional Dyspepsia

Background/Aims: This study verifies whether endoscopic findings differ according to the symptoms of patients with functional dyspepsia. Materials and Methods: This study surveyed upper gastrointestinal symptoms in 325 patients with functional dyspepsia and conducted esophagogastroduodenoscopy. The endoscopic findings were classified according to the Sydney classification, as edema, erythema, friability, exudates, flat erosion, raised erosion, rugal hyperplasia, atrophy, visibility of vascular pattern, intramural bleeding spot, nodularity, respectively in antrum, body and fundus. Results: 1) The average age of 325 patients was 47.8 years. There were 134 males and 191 females among the 325 patients. 2) Among 325 patients, 134 (41.2%) had epigastric pain syndrome, 169 (52.0%) had postprandial distress syndrome, and 22 (6.7%) had unspecific dyspepsia. 3) Compared to postprandial distress syndrome patients, those with epigastric pain syndrome had more erythema (85.1% vs. 60.2%, P＜0.01)and raised erosion (26.0% vs. 18.9%, P=0.01) in antrum, and more erythema (59.0% vs. 36.7%, P=0.02) in body. 4) Compared to epigastric pain syndrome patients, those with postprandial distress syndrome had more atrophy (23.7% vs. 10.4%, P=0.04) in fundus. Conclusions: Erythma and raised erosion were more frequently observed in antrum of epigastric pain syndrome patients, and atrophy was frequently observed in fundus of postprandial distress syndrome patients, through endoscopy. (Korean J Helicobacter Upper Gastrointest Res 2011;11:124-128)

Multifaceted Assessment of Chronic Gastritis: A Study of Correlations between Serological, Endoscopic, and Histological Diagnostics

Aim. Chronic gastritis was assessed serologically, endoscopically and histologically to identify correlations between these methods. Methods. Subjects comprised 319 patients who had provided informed consent. Serological assessment of chronic gastritis was based on the pepsinogen test method. Endoscopic gastritis and histological gastritis were assessed and scored according to the Kimura-Takemoto classification system and the updated Sydney classification system respectively, and correlations between these three methods were studied. Results. Pepsinogen I/II ratio showed a significant correlation to the extent of mononuclear cell infiltration of the gastric corpus. When histological gastritis was divided, on the basis of the distribution of mononuclear cell infiltration, into gastritis limited to the antrum and corpus gastritis, these types were distinguished with high accuracy using a pepsinogen I/II ratio of 3 as the cutoff. A good correlation was also seen between pepsinogen I/II ratio and development of atrophy in endoscopic gastritis, where groups with and without advanced atrophy were also distinguished with high accuracy using a cutoff value of 3. Conclusion. Significant correlations exist between serum pepsinogen levels, endoscopic gastritis, and histological gastritis. Pepsinogen I/II ratio allows prediction of the existence of endoscopic gastritis and histological gastritis, or the extent of their development, with high accuracy.