FISIOLOGÍA DIGESTIVA (BCM II)
Clase 7: Gastritis y H. pylori
Dr. Michel Baró A.
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Gastritis: overview of anatomy and histology
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Normal fundic mucosa
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General classification of gastritis
TABLE 5 - 3. GENERAL CLASSIFICATION OF GASTRITIS
Category
Endoscopic
Diagnostic
modality
Etiology
Gastropathy
Endoscopy
NSAIDs, physiologic stress,
alchohol, chemical agents, and
idiopathic
Acute erosive hemorrhagic
gastritis
Endoscopic biopsy
and histologic
evaluation
NSAIDs, physiologic stress,
alchohol, chemical agents, and
idiopathic
Nomenclature
Histologic
Acute
Chronic
Chronic active superficial gastritis
Nonspecific Chronic superficial gastritis
Chronic atrophic gastritis
Specific
Depends on etiology
Endoscopic biopsy
and histologic
evaluation
Endoscopic biopsy
and histologic
evaluation
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Helicobacter pylori. autoimmune,
and bile reflux
Bacterial, viral, fungal parasitic,
granulomatous, eosinophilic, and
hypertrophic
Endoscopic erosive gastritis
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Erosive gastritis
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Gastritis: anti inflamatorios no esteroidales y aspirina (“Gastropatía”)
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Acute erosive hemorrhagic gastritis
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Endoscopic gastritis: alcohol
Gastropatía hemorrágica alcohólica
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Alcoholic hemorrhagic gastritis: histologic features
Epitelio intacto
Bandas
Hemorrágicas
interglandulares
Edema
Ausencia de
Infiltrado
inflmatorio
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Chronic gastritis: nonspecific gastritis (a)
TABLE 5 - 10A. CHRONIC GASTRITIS: NONSPECIFIC GASTRITIS - HELICOBACTER PYLORI
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
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Chronic gastritis: nonspecific gastritis (b)
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Nonerosive nonspecific gastritis: activity (a)
Gastritis crónica superficial, activa (infiltrado neutrófilos y mononucleares)
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Nonerosive nonspecific gastritis: activity (b)
Gastritis crónica superficial (infiltrado sólo mononucleares)
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Foveolar hyperplasia
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Intestinal metaplasia
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Endocrine consequences of chronic atrophic gastritis
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Enterochromaffin-like cell hyperplasia
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Distributions of nonerosive, nonspecific gastritis
Se asocia a la presencia
de H. pylori
Úlcera duodenal 90%
Úlcera gástrica 50-80%
Anemia perniciosa
Gastritis auto-inmune
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Serum pepsinogens and chronic gastritis
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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
To xoplasmosis
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
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Morphology and taxonomy
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Electron micrographs from Helicobacter pylori-infected patient
(A)
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Electron micrographs from Helicobacter pylori-infected patient
(B)
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Prevalence by age and country of origin (A)
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Prevalence by age and country of origin (B)
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Prevalence by ethnic group
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Clustering of organism within families
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Histologic stains (A)
Warthin.Starry
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Histologic stains (B)
Giemsa
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Histologic stains (C)
Acridina
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Histologic stains (D)
Gimenez
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Histologic stains (E)
Hematoxilina-eosina
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Urease
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Urea breath tests (C13 and C14)
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Rapid urease tests
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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
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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
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Helicobacter pylori and chronic active gastritis
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Antral (type B) gastritis
95% porta H. pylori
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Helicobacter pylori's initiation of mucosal inflammation
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Pathway of Helicobacter pylori induction
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Lymphoid follicle
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Gastric metaplasia
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Histology of gastric metaplasia (A) (duodeno)
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Histology of gastric metaplasia (B)
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Helicobacter pylori and peptic ulcer disease
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Helicobacter pylori and peptic ulcer disease
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Helicobacter pylori and serum gastrin concentrations
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Effect of Helicobacter Pylori eradication
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H. Pylori y carcinoma: Epidemiology and geographic data
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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
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Characteristics of gross pathology
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Relationship of Helicobacter pylori to gastric cancer
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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
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Dense lymphoid infiltrate
Hiperplasia
Folicular
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Lymphoepithelial lesion
Linfoma MALT
(linfocitos B)
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Cytokeratin stains (A) Normal
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Cytokeratin stains (B) MALT lymphoma
Linfoma MALT
(linfocitos B)
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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 l ymphoma
19
Persistence of MALT lymphoma
4
Status uncertain
3
Total equals 32
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FIN
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