AIM： To conduct a detailed histological study of gastritis in adult patients attending an endoscopy clinic at a Kenyan teaching and referral hospital.METHODS： Biopsy specimens from consecutive patients were examined...AIM： To conduct a detailed histological study of gastritis in adult patients attending an endoscopy clinic at a Kenyan teaching and referral hospital.METHODS： Biopsy specimens from consecutive patients were examined and graded according to the Updated Sydney System for H pylori infection, chronic inflammation, neutrophil activity, glandular atrophy and intestinal metaplasia. Also documented were gastric tissue eosinophil counts and presence of lymphoid follicles.RESULTS： The rate of the graded variables, in the antrum and corpus respectively, were as follows： H pylori infection （91%, 86%）, chronic inflammation （98%, 93%）, neutrophil activity （91%, 86%）, glandular atrophy （57%, 15%） and intestinal metaplasia （11%, 2%）. Lymphoid follicles were noted in 11% of cases. Duodenal and gastric ulcers were documented in 32% and 2% respectively. The mean eosinophil count was 5.9 ±0.74 eosinophils/ HPF and 9.58 ± 0.93 eosinophils/HPF in the corpus and antrum respectively. Significant association was found between the degree of H pylori colonisation with chronic inflammation, neutrophil activity and antral glandular atrophy. Biopsies from the antrum and corpus showed significant histopathological discordance for all the graded variables. H pylori negative cases were associated with recent antibiotic use.CONCLUSION： The study the chief cause of gastritis reaffirms that H pylori is in this environment. The majority of patients show a moderate to high degree of inflammation but a low degree of glandular atrophy and intestinal metaplasia. The study shows that interrelationships between the histological variables in this African population are similar to those found in other populations worldwide including non-African populations.展开更多
Helicobacter pylori(H.pylori)is the causative agent of gastritis,peptic ulcer disease,mucosa associated lymphoid tissue lymphoma and gastric cancer(GC).While this bacterium infects 50%of the world’s population,in Afr...Helicobacter pylori(H.pylori)is the causative agent of gastritis,peptic ulcer disease,mucosa associated lymphoid tissue lymphoma and gastric cancer(GC).While this bacterium infects 50%of the world’s population,in Africa its prevalence reach as high as 80%as the infection is acquired during childhood.Risk factors for H.pylori acquisition have been reported to be mainly due to overcrowding,to have infected siblings or parent and to unsafe water sources.Despite this high H.pylori prevalence there still does not exist an African guideline,equivalent to the Maastricht V/Florence Consensus Report of the European Helicobacter and Microbiota Study Group for the management of this infection.In this continent,although there is a paucity of epidemiologic data,a contrast between the high prevalence of H.pylori infection and the low incidence of GC has been reported.This phenomenon is the so-called“African Enigma”and it has been hypothesized that it could be explained by environmental,dietary and genetic factors.A heterogeneity of data both on diagnosis and on therapy have been published.In this context,it is evident that in several African countries the increasing rate of bacterial resistance,mainly to metronidazole and clarithromycin,requires continental guidelines to recommend the appropriate management of H.pylori.The aim of this manuscript is to review current literature on H.pylori infection in Africa,in terms of prevalence,risk factors,impact on human health,treatment and challenges encountered so as to proffer possible solutions to reduce H.pylori transmission in this continent.展开更多
文摘AIM： To conduct a detailed histological study of gastritis in adult patients attending an endoscopy clinic at a Kenyan teaching and referral hospital.METHODS： Biopsy specimens from consecutive patients were examined and graded according to the Updated Sydney System for H pylori infection, chronic inflammation, neutrophil activity, glandular atrophy and intestinal metaplasia. Also documented were gastric tissue eosinophil counts and presence of lymphoid follicles.RESULTS： The rate of the graded variables, in the antrum and corpus respectively, were as follows： H pylori infection （91%, 86%）, chronic inflammation （98%, 93%）, neutrophil activity （91%, 86%）, glandular atrophy （57%, 15%） and intestinal metaplasia （11%, 2%）. Lymphoid follicles were noted in 11% of cases. Duodenal and gastric ulcers were documented in 32% and 2% respectively. The mean eosinophil count was 5.9 ±0.74 eosinophils/ HPF and 9.58 ± 0.93 eosinophils/HPF in the corpus and antrum respectively. Significant association was found between the degree of H pylori colonisation with chronic inflammation, neutrophil activity and antral glandular atrophy. Biopsies from the antrum and corpus showed significant histopathological discordance for all the graded variables. H pylori negative cases were associated with recent antibiotic use.CONCLUSION： The study the chief cause of gastritis reaffirms that H pylori is in this environment. The majority of patients show a moderate to high degree of inflammation but a low degree of glandular atrophy and intestinal metaplasia. The study shows that interrelationships between the histological variables in this African population are similar to those found in other populations worldwide including non-African populations.
文摘Helicobacter pylori(H.pylori)is the causative agent of gastritis,peptic ulcer disease,mucosa associated lymphoid tissue lymphoma and gastric cancer(GC).While this bacterium infects 50%of the world’s population,in Africa its prevalence reach as high as 80%as the infection is acquired during childhood.Risk factors for H.pylori acquisition have been reported to be mainly due to overcrowding,to have infected siblings or parent and to unsafe water sources.Despite this high H.pylori prevalence there still does not exist an African guideline,equivalent to the Maastricht V/Florence Consensus Report of the European Helicobacter and Microbiota Study Group for the management of this infection.In this continent,although there is a paucity of epidemiologic data,a contrast between the high prevalence of H.pylori infection and the low incidence of GC has been reported.This phenomenon is the so-called“African Enigma”and it has been hypothesized that it could be explained by environmental,dietary and genetic factors.A heterogeneity of data both on diagnosis and on therapy have been published.In this context,it is evident that in several African countries the increasing rate of bacterial resistance,mainly to metronidazole and clarithromycin,requires continental guidelines to recommend the appropriate management of H.pylori.The aim of this manuscript is to review current literature on H.pylori infection in Africa,in terms of prevalence,risk factors,impact on human health,treatment and challenges encountered so as to proffer possible solutions to reduce H.pylori transmission in this continent.
