Gastric Atrophy, Intestinal Metaplasia in Helicobacter pylori Gastritis: Prevalence and Predictors Factors

Gastric atrophy and intestinal metaplasia represent the most important premalignant lesions in gastric carcinogenesis. The severity of gastric mucosal inflammation depends on the bacterium Helicobacter pylori (HP), on the host and on environmental factors. The aim of our study is to determine the prevalence and factors associated with Gastric atrophy and intestinal metaplasia in patients infected with Helicobacter pylori. Methods: This is a prospective study over a period of 4 years (May 2009 - January 2015) conducted in the service of Hepatology and Gastroenterology in hospital university Hassan II of Fez in collaboration with microbiology and molecular biology laboratory and epidemiology service of Faculty of Medicine and Pharmacy Fes. We included in our study all patients aged over 15 years, having ulcerative dyspepsia, peptic ulcer disease, gastritis or esophagitis. Results: During the study period, 1190 patients were included of which 70% had HP infection (N = 833). The average age was 48.21 years [16 - 99 years], sex ratio M/F was 1, 11. 60% of patients were older than 45 years. Chronic smoking was found in 12% of patients. Gastric atrophy was observed in 84% (N = 699) of patients infected with HP. Gastric atrophy was localized in 70% in the antrum and 30% in the fundus and 24% in both. The activity of gastritis (p = 0.0001) and the density of the HP (p = 0.005) were factors associated with atrophy. Intestinal metaplasia was observed in 13.5% of patients (N = 112). The density of HP (p = 0.037) and severe atrophy (p = 0.001) were factors associated with metaplasia. Other factors studied: age, sex, smoking, CagA+ genotype were not associated with either gastric atrophy or intestinal metaplasia. Conclusion: In our study, the prevalence of atrophic gastritis and intestinal metaplasia in patients infected with Helicobacter pylori was 84% and 13.5% respectively, which was a high prevalence. The activity of gastritis, and density of HP were factors associated with atrophy. The density of HP and severe atrophy were factors associated with metaplasia.

Association of serum pepsinogen with degree of gastric mucosal atrophy in an asymptomatic population

BACKGROUND Atrophic gastritis is a precancerous lesion of the stomach.It has been reported that pepsinogen(PG)can reflect the morphology and function of the gastric mucosa,and it is therefore used as a marker for the early diagnosis of atrophic gastritis.AIM To evaluate the diagnostic value of serum PG for degree of gastric mucosal atrophy in asymptomatic Chinese upon physical examination.METHODS Medical data were collected from subjects who underwent transnasal gastroscopy between October 2016 and October 2018.For each study subject,serum PG levels and presence of Helicobacter pylori(H.pylori)infection were investigated.Pathology was evaluated using the Operative Link for Gastritis Assessment(OLGA)classification and Operative Link on Gastric Intestinal Metaplasia Assessment(OLGIM)systems.All statistical analyses were carried out using SPSS statistical software.RESULTS A total of 2256 subjects were enrolled and 1922 cases were finally included in the study.Based on the OLGA grading system,the levels of PGI were slightly decreased,while those of PGII were slightly increased.The PGI/PGII ratio(PGR)was reduced with increasing atrophy.The association between PG and OLGA grading was higher compared with that between PG and the OLGIM grading system.Compared with the OLGA-0 group,a statistically significant difference was observed in the mean age of OLGA-Ⅰ,Ⅲ,and Ⅳ groups(P<0.05).In the H.pylori-positive subjects,the PGR levels were notably lower in the OLGA-Ⅰ,Ⅱ,and Ⅲ groups compared with the OLGA-0 group(P<0.05).H.pylori-positive subjects exhibited significantly higher PGI and PGII serum levels and a significantly lower PGR compared with H.pylori-negative patients in different OLGA groups(P<0.05).CONCLUSION Serum PG levels may represent a non-invasive screening marker for gastric mucosal atrophy in asymptomatic subjects.

Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions

BACKGROUND Advances in endoscopic imaging enable the identification of patients at high risk of gastric cancer.However,there are no comparative data on the utility of standard and magnifying narrow-band imaging(M-NBI)endoscopy for diagnosing Helicobacter pylori(H.pylori)infection,gastric atrophy,and intestinal metaplasia.AIM To compare the diagnostic performance of standard and M-NBI endoscopy for H.pylori gastritis and precancerous conditions.METHODS In 254 patients,standard endoscopy findings were classified into mosaic-like appearance(type A),diffuse homogenous redness(type B),and irregular redness with groove(type C).Gastric mucosal patterns visualized by M-NBI were classified as regular round pits with polygonal sulci(type Z-1),more dilated and linear pits without sulci(type Z-2),and loss of gastric pits with coiled vessels(type Z-3).RESULTS The diagnostic accuracy of standard and M-NBI endoscopy for H.pylori gastritis was 93.3%and 96.1%,respectively.Regarding gastric precancerous conditions,the accuracy of standard and M-NBI endoscopy was 72.0%vs 72.6%for moderate to severe atrophy,and 61.7%vs.61.1%for intestinal metaplasia in the corpus,respectively.Compared to type A and Z-1,types B+C and Z-2+Z-3 were significantly associated with moderate to severe atrophy[odds ratio(OR)=5.56 and 8.67]and serum pepsinogen I/II ratio of≤3(OR=4.48 and 5.69).CONCLUSION Close observation of the gastric mucosa by standard and M-NBI endoscopy is useful for the diagnosis of H.pylori gastritis and precancerous conditions.

Association of autoimmune type atrophic corpus gastritis with Helicobacter pylori infection

AIM:To study the association between Helicobacter pylori(H.pylori)infection and autoimmune type atrophic gastritis. METHODS:Twenty-three patients with different grades of atrophic gastritis were analysed using enzyme immunoassay-based serology,immunoblot-based serology,and histology to reveal a past or a present H.pylori infection.In addition,serum markers for gastric atrophy(pepsinogenⅠ,pepsinogenⅠ/Ⅱand gastrin)and autoimmunity[parietal cell antibodies(PCA), and intrinsic factor(IF),antibodies]were determined. RESULTS:Of the 14 patients with severe gastricatrophy,as demonstrated by histology and serum markers,and no evidence for an ongoing H.pylori infection,eight showed H.pylori antibodies by immunoblotting.All eight had elevated PCA and 4/8 also had IF antibodies.Of the six immunoblot-negative patients with severe corpus atrophy,PCA and IF antibodies were detected in four.Among the patients with low to moderate grade atrophic gastritis(all except one with an ongoing H.pylori infection),serum markers for gastric atrophy and autoimmunity were seldom detected.However,one H.pylori negative patient with mild atrophic gastritis had PCA and IF antibodies suggestive of a pre-atrophic autoimmune gastritis. CONCLUSION:Signs of H.pylori infection in autoimmune gastritis,and positive autoimmune serum markers in H.pylori gastritis suggest an etiological role for H.pylori in autoimmune gastritis.

养胃理气汤对胃黏膜萎缩和肠上皮化生的影响

目的:观察养胃理气汤对慢性萎缩性胃炎(CAG)胃黏膜萎缩和肠上皮化生的变化以及环氧合酶-2(COX-2)表达的影响。方法:52例胃黏膜萎缩并肠化生和不典型增生的CAG患者随机分治疗组30例,用养胃理气汤治疗;对照组22例,用胃复春片治疗。疗程均为3个月。观察治疗前后症状及胃镜所见与病理变化,并用免疫组化方法检测胃黏膜COX-2蛋白的表达。结果:养胃理气汤治疗后临床症状及病理改善明显优于治疗前(P<0.05);胃黏膜COX-2的表达较治疗前明显下降(P<0.05)。治疗组临床症状改善、病理变化以及胃黏膜COX-2蛋白的表达与对照组比较,差异无显著性意义。结论:养胃理气汤能有效治疗CAG,其作用可能通过减少胃黏膜COX-2蛋白表达,并促进黏膜修复有关。

疣状胃窦炎与幽门螺杆菌感染、营养状态及胃黏膜萎缩的相关性

背景:英文文献中鲜有关于疣状胃窦炎(VG)的报道。本研究旨在分析VG的临床和内镜特征,重点关注幽门螺杆菌(Hp)感染、营养及胃黏膜萎缩。方法:本回顾性研究的对象为接受常规靛蓝胭脂红染色内镜检查的患者,对其中VG阳性与VG阴性病例进行比较。基于疣状病变的数量和分布,将VG进一步分为经典型和多灶型。收集人口统计学、临床及内镜资料,包括体质指数、血清白蛋白、胆固醇、胃黏膜萎缩、反流性食管炎、Barrett食管及Hp感染情况等。采用单因素和多因素分析明确VG发生的相关因素。结果:我们分析了621例常规内镜检查病例的相关资料,发现VG病例(352例)体质指数相对较高(OR 1.12,95%CI:1.05-1.18,P<0.01),更多伴随反流性食管炎(OR 1.96,95%CI:1.10-3.28,P<0.01),Hp阴性者比例更高,无论既往有Hp根治史(OR 9.94,95%CI:6.00-16.47,P<0.01)还是无Hp根治史(OR 6.12,95%CI:3.51-10.68,P<0.01)。与经典型VG相比,多灶型VG病例更多出现胃黏膜萎缩,包括闭锁型萎缩(OR 9.90,95%CI:4.04-21.37,P<0.001)和开放型萎缩(OR 8.10,95%CI:3.41-19.24,P<0.001)。年龄、性别、总胆固醇、血清白蛋白及胆汁色胃液方面的组间差异均无统计学意义。结论:VG的发生与高体质指数、反流性食管炎及Hp阴性有关;多灶型VG则多伴有胃黏膜萎缩。这些结果提示VG可能是一种由高胃酸状态、胃负荷过重及胃黏膜脆弱所引起的生理现象。