An 87-year-old,Japanese woman was shown to have a submucosal tumor-like lesion with a deep,central ulceration covered with thick,whitish exudate in the stomach.Biopsy showed Candida tropicalis but not Helicobacter pyl...An 87-year-old,Japanese woman was shown to have a submucosal tumor-like lesion with a deep,central ulceration covered with thick,whitish exudate in the stomach.Biopsy showed Candida tropicalis but not Helicobacter pylori(H.pylori).She had no predisposing factors or history of peptic ulcers nor had taken non-steroidal anti-inflammatory drugs(NSAIDs),diagnosed with Candida-associated gastric ulcer.Though cured of the lesion,she developed another ulcer in a different position,in which Candida was demonstrated but H.pylori was undetectable.This is the first case of recurrent Candida-associated gastric ulcer in the world.Detected in both the original and recurrent lesions in an H.pylori-negative patient with no antecedent ulcers who had not taken NSAIDs,Candida is considered,contrary to the prevailing opinion,to play an etiologic role in ulcer formation.展开更多
AIM: To determine the pattern of secreted mucin expression in Helicobacter pylori (H. pylori)-related, nonsteroidal anti-inflammatory drug (NSAID)-related and idiopathic gastric ulcers. METHODS: We randomly selected 9...AIM: To determine the pattern of secreted mucin expression in Helicobacter pylori (H. pylori)-related, nonsteroidal anti-inflammatory drug (NSAID)-related and idiopathic gastric ulcers. METHODS: We randomly selected 92 patients with H. pylori-associated (n = 30), NSAID-associated (n = 18), combined H. pylori and NSAID-associated gastric ulcers (n = 24), and patients with idiopathic gastric ulcers (n = 20). Immunohistochemistry for T-cell CD4/CD8, andfor mucin 5AC (MUC5AC) and mucin 6 (MUC6), was performed on sections of the mucosa from the ulcer margin. Inflammation score was assessed according to the Sydney system. RESULTS: MUC5AC was expressed on the surface epithelium (98.9%) and neck glands (98.9%) with minimal expression in the deep glands (6.5%). MUC6 was strongly expressed in the deep glands (97.8%), variable in the neck glands (19.6%) and absent in the surface epithelium (0%). The pattern of mucin expression in idiopathic ulcer margins was not different from the expression in ulcers associated with H. pylori, NSAIDs, or combined H. pylori and NSAIDs. CD4/CD8 ratio was higher in H. pylori-positive patients (P = 0.009). Idiopathic ulcers are associated with hospitalized patients and have higher bleeding and mortality rates. CONCLUSION: Idiopathic ulcers have a unique clinical profile. Gastric mucin expression in idiopathic gastric ulcers is unchanged compared with H. pylori and/or NSAID-associated ulcers.展开更多
文摘An 87-year-old,Japanese woman was shown to have a submucosal tumor-like lesion with a deep,central ulceration covered with thick,whitish exudate in the stomach.Biopsy showed Candida tropicalis but not Helicobacter pylori(H.pylori).She had no predisposing factors or history of peptic ulcers nor had taken non-steroidal anti-inflammatory drugs(NSAIDs),diagnosed with Candida-associated gastric ulcer.Though cured of the lesion,she developed another ulcer in a different position,in which Candida was demonstrated but H.pylori was undetectable.This is the first case of recurrent Candida-associated gastric ulcer in the world.Detected in both the original and recurrent lesions in an H.pylori-negative patient with no antecedent ulcers who had not taken NSAIDs,Candida is considered,contrary to the prevailing opinion,to play an etiologic role in ulcer formation.
基金Beilinson Hospital Gastroenterology Department Trust Fund
文摘AIM: To determine the pattern of secreted mucin expression in Helicobacter pylori (H. pylori)-related, nonsteroidal anti-inflammatory drug (NSAID)-related and idiopathic gastric ulcers. METHODS: We randomly selected 92 patients with H. pylori-associated (n = 30), NSAID-associated (n = 18), combined H. pylori and NSAID-associated gastric ulcers (n = 24), and patients with idiopathic gastric ulcers (n = 20). Immunohistochemistry for T-cell CD4/CD8, andfor mucin 5AC (MUC5AC) and mucin 6 (MUC6), was performed on sections of the mucosa from the ulcer margin. Inflammation score was assessed according to the Sydney system. RESULTS: MUC5AC was expressed on the surface epithelium (98.9%) and neck glands (98.9%) with minimal expression in the deep glands (6.5%). MUC6 was strongly expressed in the deep glands (97.8%), variable in the neck glands (19.6%) and absent in the surface epithelium (0%). The pattern of mucin expression in idiopathic ulcer margins was not different from the expression in ulcers associated with H. pylori, NSAIDs, or combined H. pylori and NSAIDs. CD4/CD8 ratio was higher in H. pylori-positive patients (P = 0.009). Idiopathic ulcers are associated with hospitalized patients and have higher bleeding and mortality rates. CONCLUSION: Idiopathic ulcers have a unique clinical profile. Gastric mucin expression in idiopathic gastric ulcers is unchanged compared with H. pylori and/or NSAID-associated ulcers.
