© 2004 Current Medicine Group Ltd FISIOLOGÍA DIGESTIVA (BCM II) Clase 7: Gastritis y H. pylori Dr. Michel Baró A.
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© 2004 Current Medicine Group Ltd
FISIOLOGÍA DIGESTIVA (BCM II)
Clase 7: Gastritis y H. pylori
Dr. Michel Baró A.
© 2004 Current Medicine Group Ltd
General classification of gastritis
TABLE 5 - 3. GENERAL CLASSIFICATION OF GASTRITIS
Category
Nomenclature
Diagnostic modality
Etiology
Endoscopic Gastropathy Endoscopy NSAIDs, physiologic stress, alchohol, chemical agents, and idiopathic
Histologic
Acute Acute erosive hemorrhagic gastritis
Endoscopic biopsy and histologic evaluation
NSAIDs, physiologic stress, alchohol, chemical agents, and idiopathic
Chronic
Nonspecific Chronic active superficial gastritis Chronic superficial gastritis Chronic atrophic gastritis
Endoscopic biopsy and histologic evaluation
Helicobacter pylori. autoimmune, and bile reflux
Specific Depends on etiology Endoscopic biopsy and histologic evaluation
Bacterial, viral, fungal parasitic, granulomatous, eosinophilic, and hypertrophic
© 2004 Current Medicine Group Ltd
Gastritis: anti inflamatorios no esteroidales y aspirina (“Gastropatía”)
© 2004 Current Medicine Group Ltd
Alcoholic hemorrhagic gastritis: histologic features
Epitelio intacto
BandasHemorrágicasinterglandulares
Edema
Ausencia deInfiltrado inflmatorio
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Chronic gastritis: nonspecific gastritis (a)
Classifications of chronic gastritis
Category
Nomenclature Etiology
Nonspecific Chronic active superficial gastritis or Chronic superficial gastritis or Chronic atrophic
H. pylori. autoimmune and bile reflux
Specific
Depends on etiology Bacterial, viral, fungal, parasitic, granulomatous, eosinophilic,and hypertrophic
TABLE 5 - 10A. CHRONIC GASTRITIS: NONSPECIFIC GASTRITIS - HELICOBACTER PYLORI
© 2004 Current Medicine Group Ltd
Nonerosive nonspecific gastritis: activity (a)
Gastritis crónica superficial, activa (infiltrado neutrófilos y mononucleares)
© 2004 Current Medicine Group Ltd
Nonerosive nonspecific gastritis: activity (b)
Gastritis crónica superficial (infiltrado sólo mononucleares)
© 2004 Current Medicine Group Ltd
Distributions of nonerosive, nonspecific gastritis
Se asocia a la presencia de H. pyloriÚlcera duodenal 90%Úlcera gástrica 50-80%
Anemia perniciosaGastritis auto-inmune
© 2004 Current Medicine Group Ltd
Chronic gastritis: specific or distinctive gastritis
TABLE 5 - 19. CHRONIC GASTRITIS: SPECIFIC (DISTINCTIVE) GASTRITIS
Infections
Bacterial
Tuberculosis
Syphilis
Phlegmonous and emphysematous gastritis
Viral
Cytomegalovirus
Herpesviruses
Fungal
Candidiasis
Histoplasmosis
Mucormycosis
Cryptococcosis
Aspergillosis
Parasites and Nematodes
Cryptosporidiosis
Strongyloidiasis
Amebiasis
Toxoplasmosis
Pneumocystis carinii infection
Gastrointestinal tract disease
Crohn's disease
Eosinophilic gastroenteritis
Systemic disease
Sarcoid
Graft - vs - host disease
Chronic granulomatous disease
Miscellaneous (unknown association)
Ménétrier's disease
Focal lymphoid hyperplasia
Granulomatous gastritis
© 2004 Current Medicine Group Ltd
Tests for diagnosis of Helicobacter pylori can be categorized
TABLE 6 - 10. TESTS FOR HELICOBACTER PYLORI
INFECTION
Noninvasive
Test Sensitivity, %
Specificity, %
Comments
Serology 88 - 96 86 - 95 Antibody titers do not return to negative after eradication of H. pylori; thus, serology is not a suitable test to document effectiveness of eradication
Urea breath tests 90 - 100 89 - 100 Because this test has high sensitivity and specificity and is noninvasive, when commercially available, it will be useful for documentation of H. Pylori eradiction
Invasive
Test Sensitivity, %
Specificity, %
Comments
Histology 93 - 99 95 - 99 Requires histologic evaluation of mucosal biopsy; thus, it is expensive
Rapid urease test (CLOtestTM, Delta West Limited, Bentley, Western Australia)
89 - 98 93 - 98 Inexpensive, it can provide relatively rapid diagnosis
Culture 77 - 92 100 Technically difficult and accuracy varies with laboratory; also expensive
© 2004 Current Medicine Group Ltd
Association of Helicobacter pylori with gastrointestinal disease
TABLE 6 - 11. ASSOCIATION OF HELICOBACTER PYLORI WITH GASTROINTESTINAL DISEASE
Group Seroprevalence of H. pylori infection, %
Healthy subjects 20
Chronic active gastritis 100
Duodenal ulcer >90
Gastric ulcer 50 - 80
Gastric adenocarcinoma 90
Gastric lymphoma 85
Will vary with age and ethnic group
© 2004 Current Medicine Group Ltd
Stored sera were analyzed for Helicobacter pylori
TABLE 6 - 24. SEROPREVALENCE OF HELICOBACTER PYLORI 6 TO 14 YEARS BEFORE DIAGNOSIS OF GASTRIC CANCER IN NESTED CASE - CONTROL STUDIES
Study Cases, n Controls, n Follow - up, y Odds ratio 95% Confidence interval
Forman [16]gic306rfref16 29 116 6.0 2.8 1.0 to 8.0
Nomura [17]gic306rfref17 109 109 13.0 6.0 2.1 to 17.3
Parsonnet [18]gic306rfref18 108 108 14.2 3.6 1.8 to 7.3
© 2004 Current Medicine Group Ltd
Non-Hodgkin's lymphoma of the stomach
TABLE 6 - 27. HELICOBACTER PYLORI AND GASTRIC NON - HODGKIN'S LYMPHOMAS
Cases, n
Infected, %
Matched controls infected, %
Odds ratio
95% Confidence interval
Gastric non - Hodgkin's lymphoma
33 85 55 6.3 2.0 to 19.9
Nongastric non - Hodgkin's lymphoma
31 65 59 1.2 0.5 to 3.0
P = 0.02
© 2004 Current Medicine Group Ltd
Regression of gastric mucosa-associated lymphoid tissue
TABLE 6 - 31. REGRESSION OF GASTRIC MUCOSA - ASSOCIATED LYMPHOID TISSUE (MALT) LYMPHOMA WITH HELICOBACTER PYLORI ERADICATION
Response to H. pylori eradication Patients, n
Regression of MALT lymphoma 6
Reduction of MALT lymphoma 19
Persistence of MALT lymphoma 4
Status uncertain 3
Total equals 32
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