Papel da biópsia da incisura angular no estadiamento da gastrite e na avaliação de risco do câncer gástrico / Role of incisura angularis biopsy in gastritis staging and risk assessment of gastric câncer

ABSTRACT Background: Gastric atrophy (GA) and intestinal metaplasia (IM) are early stages in the development of gastric cancer. Evaluations are based on the Updated Sydney System, which includes a biopsy of the incisura angularis (IA), and the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM) gastric cancer risk staging systems. Objective: To compare the OLGA and OLGIM classifications with and without IA biopsy. In addition, to determine the prevalence of Helicobacter pylori (HP) and pre-neoplastic changes (GA and IM) in different biopsied regions and to identify the exclusive findings of IA. Methods: Observational, prospective, descriptive, unicentric study with 350 patients without a diagnosis of gastric cancer, who underwent upper digestive endoscopy with biopsies at Gastroclínica Itajaí, from March 2020 to May 2022. The histopathological classification of gastritis followed the Updated Sydney System, and the gastric cancer risk assessment followed the OLGA and OLGIM systems. The methodology applied evaluated the scores of the OLGA and OLGIM systems with and without the assessment of the IA biopsy. Statistical analysis was performed using descriptive measures (frequencies, percentages, mean, standard deviation, 95% confidence interval). Ranks were compared using the Kruskal-Wallis or Wilcoxon tests. To analyze the relationship between the frequencies, the bilateral Fisher's exact test was used. Wilson's score with continuity correction was applied to the confidence interval. Results: The median age was 54.7 years, with 52.57% female and 47.43% male patients. The comparison between the used biopsies protocol (corpus + antrum [CA] vs corpus + antrum + incisura angularis [CAI]) and the OLGA and OLGIM stages showed a significant decrease in both staging systems when the biopsy protocol restricted to the corpus and antrum was applied (OLGA CAI vs CA; P=0.008 / OLGIM CAI vs CA; P=0.002). The prevalence of pre-malignant lesions (GA, IM and dysplasia) of the gastric mucosa was (33.4%, 34% and 1.1%, respectively) in the total sample. The antrum region exhibited significantly higher numbers of alteration (P<0.001), except for HP infection, which was present in 24.8% of the patients. Conclusion: Incisura angularis biopsy is important because it increased the number of cases diagnosed in more advanced stages of intestinal metaplasia and atrophy. The study had limitations, with the main one being the relatively small sample size, consisting mostly of healthy individuals, although mostly elderly.

RESUMO Contexto: A atrofia gástrica (AG) e a metaplasia intestinal (MI) são estágios iniciais do desenvolvimento do câncer gástrico. As avaliações são baseadas no Sistema de Sydney Atualizado, que inclui uma biópsia da incisura angular (IA), e nos sistemas de estadiamento de risco de câncer gástrico Operative Link on Gastritis Assessment (OLGA) e Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM). Objetivo: Comparar as classificações OLGA e OLGIM com e sem biópsia da IA. Além disso, determinar a prevalência de Helicobacter pylori (HP) e alterações pré-neoplásicas (AG e MI) em diferentes regiões biopsiadas e identificar os achados exclusivos da IA. Métodos: Estudo observacional, prospectivo, descritivo, unicêntrico, com 350 pacientes sem diagnóstico de câncer gástrico, submetidos à endoscopia digestiva alta com biópsias na Gastroclínica Itajaí, no período de março de 2020 a maio de 2022. A classificação histopatológica da gastrite seguiu o Sistema de Sydney Atualizado, e a avaliação do risco de câncer gástrico seguiu os sistemas OLGA e OLGIM. A metodologia aplicada avaliou os escores dos sistemas OLGA e OLGIM com e sem a avaliação da biópsia da IA. A análise estatística foi realizada por meio de medidas descritivas (frequências, porcentagens, média, desvio padrão, intervalo de confiança de 95%). As classificações foram comparadas usando os testes de Kruskal-Wallis ou Wilcoxon. Para analisar a relação entre as frequências, foi usado o teste exato de Fisher bilateral. O escore de Wilson com correção de continuidade foi aplicado ao intervalo de confiança. Resultados: A idade média foi de 54.7 anos, com 52.57% de pacientes do sexo feminino e 47.43% do sexo masculino. A comparação entre o protocolo de biópsias utilizado (corpo + antro [CA] vs corpo + antro + incisura angular [CAI]) e os estágios OLGA e OLGIM mostrou uma diminuição significativa em ambos os sistemas de estadiamento quando o protocolo de biópsia restrito ao corpo e ao antro foi aplicado (OLGA CAI vs CA; P=0.008 / OLGIM CAI vs CA; P=0.002). A prevalência de lesões pré-malignas (GA, MI e displasia) da mucosa gástrica foi de (33.4%, 34% e 1.1%, respectivamente) na amostra total. A região do antro exibiu um número significativamente maior de alterações (P<0.001), com exceção da infecção por HP, que estava presente em 24.8% dos pacientes. Conclusão: A biópsia de IA é importante porque aumentou o número de casos diagnosticados em estágios mais avançados de MI e AG. O estudo teve limitações, sendo a principal delas o tamanho relativamente pequeno da amostra, composta principalmente por indivíduos saudáveis, embora em sua maioria idosos.

Prevalencia y localización gástrica del Helicobacter pylori en pacientes con atrofia y metaplasia intestinal en una institución de alta complejidad en Colombia / Prevalence and Gastric Location of Helicobacter pylori in Patients with Intestinal Atrophy and Metaplasia in a Tertiary Care Institution in Colombia

Resumen Introducción: Helicobacter pylori juega un papel fundamental en la cascada de carcinogénesis del cáncer gástrico tipo intestinal; sin embargo, no existe claridad respecto a su prevalencia en condiciones preneoplásicas que generan cambio en el microambiente de la mucosa. Actualmente se recomienda la vigilancia endoscópica por protocolo de Sydney cada 2 a 3 años, pero no es clara la presencia de H. pylori en la región subcardial y el fondo gástrico. Objetivo: determinar la prevalencia y localización gástrica del H. pylori en pacientes con condiciones preneoplásicas. Materiales y métodos: estudio de corte transversal en adultos con diagnóstico previo de atrofia o metaplasia intestinal que ingresaron a endoscopia de control, a quienes se les tomaron biopsias del antro, cuerpo, incisura angularis, región subcardial y fondo gástrico. Se realizó un análisis descriptivo de los resultados por regiones gástricas. Resultados: se recolectó la información de 160 pacientes con una prevalencia de H. pylori del 37,5 %, la cual fue en aumento de proximal a distal iniciando con una prevalencia de 12,5 % en la región subcardial hasta una prevalencia de 30,6 % en el antro; hubo un patrón similar en la prevalencia de lesiones preneoplásicas. Se observó una mayor presencia de lesiones avanzadas (displasia, carcinoma) en la incisura. Conclusiones: la prevalencia de H. pylori en condiciones premalignas evidenció una mayor presencia en las regiones distales en comparación con las proximales, y es más frecuente en la región antral y menor en la región subcardial. En cuanto a la distribución gástrica de atrofia y metaplasia, se encontró mayor compromiso en el antro y la incisura, y es baja en la región subcardial y el fondo.

Abstract Introduction: Helicobacter pylori infection plays a critical role in the carcinogenesis cascade of intestinal gastric cancer. However, its prevalence in preneoplastic conditions generating changes in the gastric mucosa is unclear. Currently, endoscopic surveillance using the Sydney protocol is suggested every 2 to 3 years, but the presence of H. pylori infection in the subcardial region and gastric fundus is ill-defined. Objective: to determine the prevalence and gastric location of H. pylori infection in patients with preneoplastic conditions. Materials and methods: a cross-sectional study in adults with a previous diagnosis of atrophy or intestinal metaplasia who entered control endoscopy and were antrum, body, incisura angularis, subcardial region, and gastric fundus biopsied. A descriptive analysis of the results by gastric regions was performed. Results: data from 160 patients with a prevalence of H. pylori of 37.5% were collected. It increased from proximal to distal, starting with a 12.5% prevalence in the subcardial region to a 30.6% prevalence in the antrum. In addition, there was a similar pattern in the prevalence of preneoplastic lesions. Furthermore, advanced lesions (dysplasia, carcinoma) were observed in the incisura. Conclusions: the prevalence of H. pylori in precancerous conditions showed a high presence in the distal regions compared to the proximal ones, and it is more frequent in the antrum and lower in the subcardial region. As for the gastric distribution of atrophy and metaplasia, more involvement was found in the antrum and angular notch and lower in the subcardial region and fundus.

Cultivo primario de Helicobacter pylori a partir de biopsias gástricas obtenidas por endoscopia / Primary culture of Helicobacter pylori from endoscopic gastric biopsies

Objetivo: Determinar la viabilidad del cultivo de la bacteria Helicobacter pylori en Costa Rica por medio de la documentación de toma de muestras, la comparación del diagnóstico histopatológico y la descripción de los diagnósticos asociados a los aislamientos obtenidos con los resultados de la ureasa rápida. Métodos: Investigación descriptiva que involucró a pacientes de entre los 35 y 70 años, de ambos sexos, que asistieron al Servicio de Endoscopia Digestiva del Hospital Clínica Bíblica entre febrero y junio del 2019 para estudio gastroscópico. Se obtuvieron biopsias gástricas para diagnóstico histopatológico, prueba de ureasa rápida y cultivo de Helicobacter pylori. Para este último, se transportaron las biopsias en un medio de transporte semisólido, se maceró el tejido y se cultivó enagar Skirrow y agar selectivo para Helicobacter; una placa de cada medio se incubó a 37 °C en microaerofilia entre 48 horas y 10 días. La positividad del cultivo se realizó por observación de la morfología colonial y la bacteria se identificó por análisis microscópico al fresco, tinción de Gram y pruebas bioquímicas (catalasa, ureasa y oxidasa). Resultados: Se incluyó a 44 pacientes (edad: 50.6 ± 10.0, 54.5% masculinos). Se recuperó Helicobacter pylori en biopsias de 27 pacientes (61.4% de éxito). La recuperación de la bacteria fue similar en el medio Skirrow y en el selectivo para Helicobacter. El porcentaje de éxito de recuperación semanal aumentó durante el estudio hasta alcanzar un éxito del 100% en la semana 11. Se comparó el cultivo con la ureasa rápida en 27 pacientes y la concordancia entre ambos métodos fue de un coeficiente kappa de Cohen de 0.48. El cultivo detectó la bacteria en un 56% de los pacientes, la ureasa rápida en un 37% y la combinación de ambas técnicas permitió la detección en un 60%. El diagnóstico endoscópico más frecuente en los pacientes con cultivo positivo fue la gastritis eritematosa y gastritis crónica superficial y el diagnóstico histopatológico predominante fue gastritis crónica con atrofia gástrica. El diagnóstico por cultivo coincidió con la detección por azul de toluidina en un 80.4% de los casos. Conclusiones: Se puede implementar el cultivo de Helicobacter pylori en Costa Rica. Este estudio tuvo un porcentaje de recuperación de la bacteria de 61.4%. La combinación del método de cultivo con la prueba de ureasa rápida y la detección histológica contribuye a un diagnóstico certero y oportuno. Recomendamos que, con base en protocolos descritos en esta investigación, cada laboratorio estandarice las condiciones que le permitan un buen porcentaje de recuperación y una implementación adaptada a sus actividades de rutina.

Aim: To document the recent experiences on the implementation of sampling and culturing Helicobacter pylori in Costa Rica, to compare it with other diagnostic methods: rapid urease test and histopathology and to describe the diagnoses associated with the obtained isolates. Methods: Descriptive research involving patients who visited the digestive endoscopy department of the Clínica Bíblica hospital in San José, Costa Rica between February and July of 2019 for gastroscopy. Gastric biopsies were obtained and histopathological analysis, rapid urease test, and bacteriological culture for Helicobacter pylori were performed. For culture techniques, the sample was transported in an in-house semi-solid medium. Biopsy fragments were macerated and plated on Skirrow agar and Helicobacterselective in-house agar, and incubated in microaerophilic atmosphere for 48 hours to 10 days. Culture positivity was determined by observation of the colonial morphology and microscopic observation; Gram staining and biochemical tests (urease, catalase, and oxidase) were used for bacterial identification. Results: 44 patients (mean aged 50.6 ± 10.0 years old, 54.5% male) were included in the study. Helicobacter pylori was recovered in biopsies from 27 patients (61.4% success rate). Bacterial growth was similar regardless the culture medium, but the physiological state of the bacteria was better in the Helicobacter-selective agar than in Skirrow. The weekly recovery rate increased to reach a 100% recovery plateau on week 11. Culture was compared with the rapid urease test in 27 patients, and the concordance between both methods using Cohen's kappa coefficient was 0.48. Whilst the culture detected Helicobacter pylori in 56% of the patients, and the rapid urease test in 37%, the combination of both allowed a 60% rate. The most frequent endoscopic diagnosis in patients with positive cultures were erythematous gastritis and chronic superficial gastritis, and the predominant histopathological diagnosis was chronic atrophic gastritis. Culture-based diagnosis was consistent with the histopathology detection of Helicobacter pylori in 80.4% of the cases. Conclusions: The implementation of H. pylori culture in Costa Rica is possible. This study had a 61.4% recovery rate. The combination of culture with rapid urease test and histopathology increases the probability of an accurate and timely diagnosis. We recommend that, based on previously described protocols such as ours, each laboratory adjusts the conditions to allow a good recovery rate and implement H. pylori diagnostic methods most suitable to their routine activities.

Identificación y evaluación de lesiones gástricas premalignas asociadas a la infección por Helicobacter pylori / Identification and evaluation of premalignant gastric lesions associated with Helicobacter pylori infection

Introducción: La infección por Helicobacter pylori es la causa principal de enfermedades gastroduodenales (gastritis crónica, úlceras pépticas y cáncer gástrico). En Guatemala existen pocos estudios sobre la prevalencia de H. pylori y su relación con enfermedades gastrointestinales, particularmente con cáncer. Objetivos: Identificar la presencia de lesiones premalignas (atrofia gástrica, metaplasia intestinal y displasia) y su relación con la infección por H. pylori en pacientes de consulta externa en unidades de gastroenterología de dos hospitales nacionales de la ciudad de Guatemala. Métodos: El diagnóstico histopatológico y bacteriológico se realizó por medio de las tinciones de H & E y Giemsa, cultivo e identificación bioquímica, detección de anticuerpos específicos mediante la prueba ELISA, diagnóstico molecular por la amplificación del gen glmM y genotipificación por PCR para identificar los genes VacA y CagA. Se analizaron datos clínico-epidemiológicos de los pacientes, la prevalencia de la infección por H. pylori y la genotipificación de la bacteria. Resultados: En 293 de los pacientes estudiados (83 por ciento) se encontró algún tipo de lesión premaligna; las más frecuentes fueron la atrofia gástrica (70 por ciento), metaplasia intestinal (11 por ciento) y displasia gástrica (2 por ciento). El 17 por ciento de los pacientes no presentó lesiones premalignas. Se halló una prevalencia de infección por H. pylori del 58 por ciento, y el gen cagA se detectó en 118 (57 por ciento) de los pacientes infectados. Conclusiones: La mayoría de los pacientes presentó atrofia gástrica (70 por ciento) y el 43,5 por ciento estaba infectado por H. pylori, principalmente con cepas CagA positivo. Este hecho confirma la importancia del estudio de H. pylori y su relación con cáncer gástrico(AU)

Introduction: Helicobacter pylori infection is the main cause of gastroduodenal diseases (chronic gastritis, peptic ulcer and gastric cancer). In Guatemala few studies have been carried out on the prevalence of H. pylori and its relationship with gastrointestinal diseases, particularly with cancer. Objective: To identify the presence of premalignant lesions (gastric atrophy, intestinal metaplasia and dysplasia) and their relationship with H. pylori infection in outpatients in gastroenterology units in two national hospitals in Guatemala City. Methods: Histopathological and bacteriological diagnostic testings were performed by H & E and Giemsa stain, culture and biochemical identification, detection of specific antibodies by ELISA, molecular diagnosis by glmM gene amplification, and genotypification by PCR to identify vacA and cagA genes. Clinical and epidemiological data from patients, prevalence of H. pylori infection, and bacterium genotypification were analyzed. Results: Among the studied patients, 293 (83 percent) presented some type of premalignant lesion. The most prevalent were gastric atrophy (70 percent), intestinal metaplasia (11 percent), and gastric dysplasia (2 percent). Seventeen percent of the patients did not have any premalignant lesions. The prevalence of H. pylori infection was 58 percent, and cagA gene was identified in 118 (57 percent) of the infected patients. Conclusions: The majority of the patients presented gastric atrophy (70 percent), and 43.5 percent were infected by H. pylori, mainly with positive cagA strains. This finding confirms the importance of studying H. pylori and its relationship with gastric cancer(AU)

Relación de los genotipos CagA/VacA del Helicobacter pylori con lesiones precursoras de cáncer gástrico / Relationship of CagA/VacA genotypes of Helicobacter pylori with precursor lesions of gastric cancer

Introducción: El Helicobacter pylori predispone al cáncer gástrico. Los individuos con cepas CagA y VacA s1m1 desarrollan lesiones de la mucosa más graves. El sistema Operative Link on Gastritis Assessment permite determinar el riesgo de cáncer y define la atrofia como la lesión típica de progresión de la gastritis crónica. Objetivo: Relacionar los genotipos CagA y VacA del Helicobacter pylori con lesiones precursoras de cáncer gástrico. Métodos: Se realizó un estudio descriptivo en 62 pacientes. Las variables incluidas fueron los genotipos CagA y VacA del Helicobacter pylori y los estadios de OLGA (0, I, II, III, IV), las cuales se relacionaron. Se emplearon como medidas de resumen para variables cualitativas la frecuencia absoluta y el porcentaje. Para evaluar la asociación entre variables cualitativas se aplicó el test X2 (ji cuadrado). Se aceptó un nivel de significación estadística p ≤ 0,05. Para explorar la relación entre dos variables dicotómicas se utilizó el riesgo relativo. Se trabajó con un nivel de confiabilidad del 95 por ciento. Resultados: El 68 por ciento de los pacientes con atrofia presentaron genotipo CagA y el 55 por ciento genotipo VacA s1m1. El 6 por ciento de los pacientes con CagA se encontraban en estadio 0; 11 por ciento en estadio I; 40 por ciento en estadio II y 16 por ciento en estadio III. El 37 por ciento de los pacientes con VacA s1m1 estaban en estadio II. Conclusiones: Los genotipos CagA y VacA s1m1 fueron los más frecuentes y se relacionaron con la presencia de atrofia gástrica(AU)

Introduction: Helicobacter pylori predisposes to gastric cancer. Individuals with CagA and VacA s1m1 strains develop more severe mucosal lesions. The Operative Link on Gastritis Assessment system allows determining the risk of cancer and defines atrophy as the typical lesion in the progression of chronic gastritis. Objective: Relate the CagA and VacA genotypes of Helicobacter pylori with precursor lesions of gastric cancer. Methods: A descriptive study was carried out in 62 patients. The variables included were the CagA and VacA genotypes of Helicobacter pylori and the OLGA stages (0, I, II, III, IV), which were related. The absolute frequency and the percentage were used as summary measures for qualitative variables. To evaluate the association between qualitative variables, the X2 test (chi-square) was applied. A level of statistical significance p≤0.05 was accepted. To explore the relationship between two dichotomous variables, the relative risk was used. We worked with a confidence level of 95 percent. Development: 68 percent of the patients with atrophy had a CagA genotype and 55 percent had a VacA s1m1 genotype. 6 percent of the patients with CagA were in stage 0; 11 percent in stage I; 40 percent in stage II and 16 percent in stage III. 37 % of the patients with VacA s1m1 were stage II. Conclusions: The CagA and VacA s1m1 genotypes were the most frequent and were related to the presence of gastric atrophy(AU)

ХОДООДНЫ АРХАГ ҮРЭВСЛИЙН ЭМГЭГ ЗАГВАР ҮҮСГЭЖ АНАР-5 НИЙЛМЭЛ ЖОРЫН ҮЗҮҮЛЭХ НӨЛӨӨГ СУДАЛСАН ҮР ДҮН / Шинэ санаа Шинэ нээлт

@#BACKGROUND. The Mongolian traditional medicine Anar-5 is excellent for weak digestion and helps with stomach irritation, loss of appetite, and resulting body weakness. Anar-5 blends punicagranatum, cinnamomum cassia presl, piper longum, cardamom and alpiniaofficinarum. We are establish an experimental animal of chronic gastritis to investigate the effect of traditional medicine Anar-5 on rats gastric mucosa. Methods: In this study, the protective effect preparation in sixty five healthy, male wistar rats were treated with intragastric administration of ammonia water 0.1%. To rats in three experiments for 2 week, 4 week, and 6wk, gastric tissues were examined histopathologically for atrophic changes and blood’s gastrin produced by preparation treatment. Results: After the treatment of animals blood’s gastrin was significantly different from that in control group (p<0.05), and the gastric mucosal inflammation was infiltration of inflammatory cells, decreased thickness of lamina propria. Conclusion: Treatment with preparation from Anar-5 protectived by the chronic gastritis and gastric atrophy.

Prevalencia de Helicobacter pylori y características histopatológicas en biopsias gástricas de pacientes con síntomas dispépticos en un centro de referencia de Medellín / Prevalence of Helicobacter pylori and Histopathological Features in Gastric Biopsies from Patients with Dyspeptic Symptoms at a Referral Center in Medellin

Introducción: Helicobacter pylori produce la infección crónica más prevalente en el mundo, principalmente en países en desarrollo. Objetivo: el principal objetivo de este estudio fue estimar la prevalencia de la infección por H. pylori y gastritis en pacientes con síntomas dispépticos llevados a endoscopia digestiva superior y correlacionarlos con los principales hallazgos histopatológicos. Métodos: se revisaron 2708 biopsias gástricas de pacientes que consultaron por síntomas dispépticos entre el año 2012 y 2013 en la Clínica Diagnóstica Especializada VID de la Congregación Mariana de Medellín, y cuyas biopsias se estudiaron en el laboratorio de dicha institución. Las variables histológicas de los resultados reportados por el patólogo se analizaron con métodos estadísticos. Resultados: la prevalencia de la infección por H. pylori fue del 36,4%; la media de edad de los pacientes infectados fue de 46,5 años (DE 17,1), con un pico de prevalencia en el grupo de 40-49 años, a partir del cual disminuyó. La cantidad de H. pylori se correlacionó con la intensidad de la inflamación y de la actividad; asimismo, la presencia de la bacteria se asoció con metaplasia, folículos linfoides, atrofia y pólipos hiperplásicos. La intensidad de la inflamación se asoció con la cantidad de H. pylori y la actividad neutrofílica. Conclusión: la prevalencia de la infección por H. pylori en este estudio es baja comparada con otras investigaciones, y exhibió un comportamiento inusual en los grupos de edad descritos. La cantidad de H. pylori se correlacionó con la intensidad de la inflamación y de la actividad neutrofílica.

Introduction: Helicobacter pylori infection is considered to be the most prevalent chronic infection in the world. It occurs primarily in developing countries. Objective: The main objective of this study was to estimate the prevalence of H. pylori infections and gastritis in patients with dyspeptic symptoms who underwent upper endoscopy and correlate endoscopic findings with principal histopathological findings. Methods: We reviewed 2,708 gastric biopsies from patients who had come to the VID Specialized Diagnostic Clinic of the Congregación Mariana in Medellín because of dyspeptic symptoms in 2012 and 2013. Biopsies were studied in the VID Clinical Laboratory of the Congregación Mariana. Histological variables of the results reported by the pathologist were analyzed with statistical methods. Results: The prevalence of H. pylori infection was 36.4%, the average age of infected patients was 46.5 years (SD: 17.1) with a peak prevalence in the group between 40 and 49 years. Prevalence decreased after age 49. The amount of H. pylori was correlated with the intensity of inflammation and activity. The presence of the bacteria was associated with the presence of metaplasia, lymphoid follicles, atrophy and hyperplastic polyps. The intensity of inflammation was associated with the amount of H. pylori and neutrophil activity. Conclusion: The prevalence of H. pylori infection in our study is low compared with other research and exhibited unusual behavior by age group. The amount of H. pylori was correlated with the intensity of inflammation and neutrophil activity.

Aumento de detección de lesiones gástricas premalignas mediante protocolo Sydney en comparación con biopsias no protocolizadas / Increased detection of premalignant gastric lesions through Sydney protocol in comparison with non-protocolized gastric biopsies

Introduction: Gastric cancer (GC) is the leading cause of cancer mortality in Chile. The development ofgastric adenocarcinoma its preceded by a histopathologic cascade composed of gastric atrophy, intestinal metaplasia and gastric dysplasia. Sydney protocol has been proposed as the standard method for diagnosingthese conditions. The aim of this research study was to establish whether Sydney protocol increase thedetection of premalignant gastric lesions, as gastric atrophy and intestinal metaplasia, compared to non protocolizedendoscopies/biopsies. Methods: Upper gastroduodenal endoscopies (GDE) from Hospital Clí-nico Universidad Católica de Chile between April-May 2015 and April-May 2016 was analyzed. Patientswith histological study with 18 years-old or older were included. Patients with history of GC or malignantlesions at GDE where excluded. Detection of gastric atrophy, intestinal metaplasia and suggestive findingsof autoimmune gastritis where compared between Sydney protocol and non-protocolized endoscopies/biopsies...

Introducción: El cáncer gástrico (CG) es la principal causa de muertes por cáncer en Chile. El desarrollo del adenocarcinoma gástrico es precedido por una cascada histopatológica (gastritis; atrofia gástrica/AG; metaplasia intestinal/MI). Se ha propuesto la biopsia del cuerpo, ángulo y antro a través del protocolo de Sydney para la búsqueda de estas condiciones. Objetivo: Determinar la diferencia en la detección delesiones premalignas gástricas a través del protocolo de Sydney comparado con el estudio endoscópico habitual. Métodos: Se analizaron las endoscopias digestivas altas (EDA) realizadas en el Centro de Endoscopia Digestiva del Hospital Clínico de la Universidad Católica en los períodos entre abril y mayo del 2015 y 2016. Se incluyeron las EDA de pacientes mayores de 18 años con estudio histológico. Fueron excluidos los pacientes con antecedente personal de CG o lesiones de aspecto maligno macroscópicas. Se comparó la detección de AG, MI y gastritis autoinmune (GA) en el estudio histológico entre los pacientes con protocolo Sydney y el estudio endoscópico no protocolizado...

Gastric Autoantigenic Proteins in Helicobacter Pylori Infection

PURPOSE: This study tried to identify novel gastric autoimmune antigens that might be involved in aggravating the atrophic gastritis among patients with Helicobacter pylori infection using two-dimensional immunoblotting analysis. MATERIALS AND METHODS: Proteins from gastric mucosal antrectomy specimens and AGS cells (gastric adenocarcinoma cell lines derived from a Caucasian patient who had received no prior therapy) were 2-dimensionally immunoblotted separately with a pool of 300 sera from H. pylroi-infected patients at Gyeongsang National University Hospital. RESULTS: Thirty-eight autoantigenic proteins including alcohol dehydrogenase [NADP+], alpha enolase, gastrokine-1, gastric triacylglycerol lipase, heat shock 70 kDa protein 1, and peroxiredoxin-2 were identified in the gastric mucosal tissue. Fourteen autoantigenic proteins including programmed cell death 6-interacting protein, serum albumin and T-complex protein 1 subunit gamma were identified in the AGS cells. Albumin, alpha-enolase, annexin A3, cytoplasmic actin 1, heat shock cognate 71 kDa protein and leukocyte elastase inhibitor were commonly observed autoantigenic proteins in both gastric mucosal tissue and AGS cells. Alpha-enolase, glutathione S-transferase P, heat shock cognate 71 kDa protein, heat shock 70 kDa protein 1, human mitochondrial adenosine triphosphate synthase (ATP) subunit beta, mitochondrial 60 kDa heat shock protein, peroxiredoxin-2, 78 kDa glucose-regulated protein precursor, tyrosine-protein phosphatase non-receptor type 11 and Tryptophan-Aspartic acid (WD) repeat-containing protein 1 showed 60% or higher amino acid positivity. CONCLUSION: These newly identified gastric autoimmune antigens might be useful in the control and prevention of gastroduodenal disorders, and might be valuable in breaking the vicious circle that exists in gastroduodenal disorders if their pathophysiological roles could be understood in the progress of chronic atrophic gastritis, gastroduodenal ulcers, intestinal metaplasia, and gastric carcinogenesis.

El gastroenterólogo y la gastritis crónica en la práctica clínica diaria: [revisión] / The gastroenterologist and chronic gastritis in daily clinical practice: [review]

La gastritis crónica con atrofia y metaplasia intestinal, producida fundamentalmente por H. pylori es el principal factor de riesgo para cáncer gástrico (CG). Sin embargo, no es vigilada de manera sistemática por el gastroenterólogo. Recientemente, se ha propuesto el sistema OLGA para el estadiaje de la atrofia y estratificación del riesgo para CG en grupos 0-IV, siendo el III/IV los que tienen mayor riesgo y ameritan vigilancia. Se revisa la evidencia sobre la utilidad de implementar en la práctica diaria este sistema de puntaje y con base en los resultados discutidos, se dan recomendaciones sobre cómo seguir a los pacientes con gastritis crónica.

Chronic gastritis with atrophy and intestinal metaplasia, produced fundamentally by H. pylori, is the principal risk factor for gastric cancer (GC). Despite this, gastroenterologists do not systematically screen patients for GC. Recently a staging system for atrophy and GC has been proposed by the Operative Link for Gastritis Assessment (OLGA). It categorizes stages from 0 to IV. Stages III and IV have the highest levels of risk and merit close attention by physicians. This article reviews the evidence regarding the usefulness of integrating this staging system into daily practice. Based on the results discussed recommendations are made about how to follow up on patients with chronic gastritis.

Gastric atrophy and Helicobacter pylori infection in children.

Aim: To assess the prevalence of gastric atrophy (GA) in Tunisia (a high prevalence region for Helicobacter pylori), and describe its histological, clinical and endoscopic features in children. Methods: 345 children, 151 male and 194 female, mean age 8.6 ± 3.7 years, underwent upper gastrointestinal (UGI) endoscopy with gastric biopsies for recurrent abdominal pain (n=232, 67.2%), vomiting (n=72, 20%) associated with or without upper gastrointestinal bleeding (n=59, 17.1%) and miscellaneous causes (n=53, 15.4 %). Biopsies performed both in the gastric antrum (n=2) and corpus (n=2) were analysed for histological assessment according to the updated Sydney classification system and bacterial culture. A positive result was recorded where histology and/or culture were positive, confirming the presence of H. pylori infection (H. pylori +ve). A negative result was recorded when both tests were concomitantly negative (H. pylori -ve). Results: 9.3% (32/345) of the total population, and 14.5% (32/221) of chronic gastritis patients exhibited GA, M/F: 16/16, mean age (SD) 9.4 (3.4) years. Amongst the 32 children with GA, 30 (93.7%) were H. pylori +ve and 2 (6.3%) were H. pylori -ve. GA was localised in the antrum (n=26, 81.2%), the fundus (n=2, 6.3%) and was also seen in both (n=4, 12.5%). GA was categorised as mild, grade 1 (n=18, 56.3%); moderate, grade 2 (n=13, 46.6%); and severe, grade 3 (n=1, 3.1%). GA was associated with mild active gastritis in 18 cases (56.3%). The prevalence of moderate or severe antral GA was detected in 9/26 (34.6%) of H. pylori +ve vs. any of H. pylori -ve ( p=0.4), whereas GA in the corpus was detected in 1/2 (50%) vs. none, respectively. None exhibited intestinal metaplasia. There were no clinical features specific to this pathology. UGI endoscopy in GA patients showed nodular gastritis (n=17, 53.1%), congestive gastritis (n=9, 28.1%), and normal tissue (n=6, 18.8%). GA was significantly associated with H. pylori infection (p<0.0001) and nodular gastritis (p<0.005). Conclusion: GA was found in 9.3% of Tunisian children undergoing UGI endoscopy and was significantly associated with H. pylori infection and nodular gastritis.

Atrofia gástrica en niños: Características clínicas, endoscópicas y anatopatológicas

La atrofia gástrica en niños es rara, existen pocos datos sobre la prevalencia de atrofia gástrica o metaplasia intestinal en estas edades. Objetivo: investigar y describir las características clínicas, endoscópicas y anatopatológicas de pacientes pediátricos con gastritis crónica que tenían reporte de atrofia gástrica, para identificar factores etiológicos asociados a esta patología. Pacientes, Materiales Y Métodos: Se revisaron las historias clínicas de los pacientes atendidos en la Unidad desde 1994 a 2006, con reporte de biopsia con gastritis crónica y atrofia gástrica. Resultados: 23 niños con gastritis crónica y atrofia gástrica, una prevalencia general de 0,98%; con respecto a pacientes infectados con H. pylori la prevalencia de atrofia gástrica fue de 1,20% y en los no infectados de 0,71%. Se determino que la bacteria se identifico con más frecuencia en las biopsias, con una diferencia significativa con respecto al grupo de gastritis crónica y atrofia gástrica sin infección (p = 0.0001); la presencia de cúmulos linfoides, fue mas frecuente entre infectados (p = 0.0001). La atrofia gástrica focal leve se detectó en el 86,95% (20/23), 2 atrofia moderada y una severa. Se encontró que la atrofia gástrica focal leve fue más reportada en gastritis crónica moderada (p = 0.0004). Discusión: existe atrofia gástrica en niños con un predomino entre los infectados con H pylori. Se debe seguir un programa de vigilancia endoscópica para determinar la frecuencia de los cambios histológicos en la edad pediátrica, las estrategias de prevención y su consideración en el desarrollo de lesiones neoplásicas.

Gastric atrophy in children is rare, few data exists about atrophy and metaplasia prevalence at these ages. Aims: To investigate and describe clinical, endoscopic and histological characteristics in pediatric patients with chronic gastritis who had gastric atrophy in order to identify etiologic factors asociated with this patology. Patients, Materials And Methods: clinical histories of patients attended in the unit from 1994 to 2006, with report of chronic gastritis, were reviewed. Results: 23 children with chronic gastritis and gastric atrophy, with a general prevalence of 0, 98%. In patients with Helicobacter pylori infection, the prevalence of gastric atrophy was 1, 20% and in non infected patients was 0, 71%. It was determined that the bacteria was identified more frequently in biopsies with chronic gastritis and atrophy with infection with a significative difference (p=0, 0001). The presence of limphoid cumulus was more frecuent among infected patients (p=0, 0001). Mild gastric atrophy was detected in 86, 95% (20/23), 2 moderate atrophy and one severe atrophy. It was found that mild gastric atrophy was reported in mayor number in moderate chronic gastritis (p=0, 0004). Discussion: Gastric atrophy exists in children with a predominance among Helicobacter pylori infected children. There has to be an endoscopic vigilance program to determine the frecuency of histologic changes in pediatric ages, prevention strategies and its consideration in the development of neoplasic lesions.

Efecto de la erradicación del helicobacter pylori sobre la secreción ácida gástrica

Introducción: La infección por Helicobacter pylori afecta la secreción ácida gástrica. La inflamación antral generalmente se asocia con una hipersecreción ácida gástrica. Cuando el cuerpo gástrico se afecta, la secreción ácida está atenuada. Examinamos los efectos la erradicación del H. pylori sobre la secreción ácida gástrica. Métodos: Estudiamos 66 pacientes con gástricos crónica inducida por H. Pylori. Los pacientes se clasificaron histológicamente por el hallazgo de la biopsia y se estudio la secreción ácida gástrica antes y 16 semanas después de la erradicación. La severidad de la atrofia gástrica lo indicó la aclorhidria total. Resultados: La secreción ácidos se recupero hacia la normalidad tanto en los hipersecretores y en los hiposecretores de una manera significativa. Sin embargo, en la atrofia gástrica severa no hubo recuperación en el tiempo durante el cual se hizo la investigación. Conclusión: La secreción ácida gástrica tiende a retomar a la normalidad después de la erradicación del H. Pylori, aunque los mecanismos precisos por lo cual sucede esto aún no está clara. En el caso de la secreción o no sucede o requiere tiempos mayores a 4 meses.

Introduction: Helicobacter pylori infection affects gastric acid secretion. The antral inflammation is generally associated with gastric acid hypersecretion. When the gastric body is affected, acid secretion is attenuated. We examined the effects of the eradication of the H. pylori on gastric acid secretion. Methods: We studied 66 gastric patients with chronic gastritis induced by H. Pylori. Patients were histologically classified through biopsy findings and the study of gastric acid secretion before and 16 weeks after the eradication. The severity of gastric atrophy indicated total achlorhydria. Results: acid secretion returned to normal levels in both, patients with hypersecretion and with hyposecretion in a significant manner. Nevertheless, in severe gastric atrophy there was no recovery in the time elapsed during the investigation. Conclusion: gastric acid secretion tends to return to normal levels after H.Pylori eradication, although the precise mechanisms involved are not yet clear. In case secretion does not happen, time required is longer than 4 months.