© 2004 Current Medicine Group Ltd FISIOLOGÍA DIGESTIVA (BCM II) Clase 7: Gastritis y H. pylori Dr. Michel Baró A.

© 2004 Current Medicine Group Ltd

FISIOLOGÍA DIGESTIVA (BCM II)

Clase 7: Gastritis y H. pylori

Dr. Michel Baró A.


Gastritis: overview of anatomy and histology


Normal fundic mucosa


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


Endoscopic erosive gastritis


Erosive gastritis


Gastritis: anti inflamatorios no esteroidales y aspirina (“Gastropatía”)


Acute erosive hemorrhagic gastritis


Endoscopic gastritis: alcohol

Gastropatía hemorrágica alcohólica


Alcoholic hemorrhagic gastritis: histologic features

Epitelio intacto

BandasHemorrágicasinterglandulares

Edema

Ausencia deInfiltrado inflmatorio


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


Chronic gastritis: nonspecific gastritis (b)


Nonerosive nonspecific gastritis: activity (a)

Gastritis crónica superficial, activa (infiltrado neutrófilos y mononucleares)


Nonerosive nonspecific gastritis: activity (b)

Gastritis crónica superficial (infiltrado sólo mononucleares)


Foveolar hyperplasia


Intestinal metaplasia


Endocrine consequences of chronic atrophic gastritis


Enterochromaffin-like cell hyperplasia


Distributions of nonerosive, nonspecific gastritis

Se asocia a la presencia de H. pyloriÚlcera duodenal 90%Úlcera gástrica 50-80%

Anemia perniciosaGastritis auto-inmune


Serum pepsinogens and chronic gastritis


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


Morphology and taxonomy


Electron micrographs from Helicobacter pylori-infected patient (A)


Electron micrographs from Helicobacter pylori-infected patient (B)


Prevalence by age and country of origin (A)


Prevalence by age and country of origin (B)


Prevalence by ethnic group


Clustering of organism within families


Histologic stains (A)

Warthin.Starry


Histologic stains (B)

Giemsa


Histologic stains (C)

Acridina


Histologic stains (D)

Gimenez


Histologic stains (E)

Hematoxilina-eosina


Urease


Urea breath tests (C13 and C14)


Rapid urease tests


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


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


Helicobacter pylori and chronic active gastritis


Antral (type B) gastritis

95% porta H. pylori


Helicobacter pylori's initiation of mucosal inflammation


Pathway of Helicobacter pylori induction


Lymphoid follicle


Gastric metaplasia


Histology of gastric metaplasia (A) (duodeno)


Histology of gastric metaplasia (B)


Helicobacter pylori and peptic ulcer disease


Helicobacter pylori and peptic ulcer disease


Helicobacter pylori and serum gastrin concentrations


Effect of Helicobacter Pylori eradication


H. Pylori y carcinoma: Epidemiology and geographic data


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


Characteristics of gross pathology


Relationship of Helicobacter pylori to gastric cancer


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


Dense lymphoid infiltrate

Hiperplasia Folicular


Lymphoepithelial lesion

Linfoma MALT

(linfocitos B)


Cytokeratin stains (A) Normal


Cytokeratin stains (B) MALT lymphoma

Linfoma MALT

(linfocitos B)


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


FIN

© 2004 Current Medicine Group Ltd FISIOLOGÍA DIGESTIVA (BCM II) Clase 7: Gastritis y H. pylori Dr. Michel Baró A.

Documents

current medicine group

ethnic group slide

chronic gastritis slide

distinctive gastritis

taxonomy slide

histology slide

starry slide

urease slide