Ultrastructural morphology of Helicobacter pylori in post vagotomy dyspepsia.

31 patients of peptic ulcer (PU) treated in the past by vagotomy with Gastrojejunostomy (GJ)/pyloroplasty, later presented with dyspesia. These postvagotomy dyspeptic patients were investigated. Antral and corpus endoscopic biopsies were taken to evaluate for Helicobacter pylori (Hp) infection by inhouse rapid urease test (RUT), histopathological examination and scanning electron microscopy (SEM). Dyspepsia score was done in both pre and post treatment phase. Hp positive patients were randomised to receive anti H. pylori therapy. Hp eradication was recorded by repeat RUT and endoscopic biopsy followed by SEM. Coccoid form of Hp were detected in 76.92% cases of vagotomy with gastrojejunostomy (GJ) and coccobacillary forms of Hp were seen in 75% cases of pyloroplasty. After treatment with anti Hp therapy coccoid forms persisted in 69.23% of GJ cases, whereas 22% of pyloroplasty cases showed coccoid transformation. Anti Hp therapy did not reveal any statistically significant improvement in 'Dyspepsia Score' in GJ group, whereas it improved significantly in pyloroplasty group (p=0.002).

Changes in the evolution of the antigenic profiles and morphology during coccoid conversion of Helicobacter pylori

OBJECTIVES: The significance of the coccoid forms of H. pylori is still controversial and the questions of whether these forms are viable and infective or degenerative are still open. We induced conversion from rod to coccoid forms and studied morphological changes and antigenic evolutions during this conversion and, thereby, elucidated the viability of coccoid forms. METHODS: The H. pylori strain (C001) used for Western blotting was isolated from the patient with gastric cancer. The antigenic evolution during coccoid conversion of H. pylori was studied by Western blotting, using different sera from thirty patients known to be culture positive. These sera were used to reveal the total antigens of the strain cultured for 2 days (100% rod) and 15 days (> 99% coccoid). After SDS-PAGE, with 10% separating gel of total antigens (rod and coccoid), transblotting (Trans-Blot electrophoretic cell, Bio-Rad) was taken onto a nitrocellulose membrane (Bio-Rad). Then, the blots, with human sera diluted at 1/100, were developed with color reaction by goat serum anti-human IgG with alkaline phosphatase and BCIP. RESULTS: The antigenic profiles were not changed in 46.7% (14/30 cases) and were changed in 53.3% (16/30 cases) during coccoid conversion. Antigenic fractions changed during coccoid conversion were protein band at 120 kDa and band at 35 kDa, and were not detected in coccus forms. The rest of the profiles were identical between rod and coccoid forms. The protein which disappeared include CagA (120 kDa) and porin, or adhesin (35 kDa). The morphological changes during coccoid conversion were U shaped at day 7, doughnut shaped at day 9 and full coccoid at day 15. CONCLUSIONS: The results showed that coccoid forms of H. pylori retain cellular structures similar to rod form, and some of the antigens (CagA and porin) disappeared during coccoid conversion. Therefore, coccoid form might be viable and represent one of the stages of H. pylori biological cycle.

comparative ultrastructural study of the helicobacter pylori in duodenal ulcer patients before and after treatment

To study the ultrastructural findings of gastric antral mucosa and Helicobacter pylori in 10 normal subjects and 30 duodenal ulcer patients before and after treatment. Three antral biopsies were taken from each control and duodenal ulcer patients for a rapid urease test, histopathology and electron microscopic study. All patients underwent a thorough upper gastrointestinal endoscopy before and four weeks after medical treatment of their ulcers. Electron microscopic examination showed a normal gastric mucosa and few numbers Helicobacter pylori in 6 normal controls. However, in duodenal ulcer patients before treatment, electron microscopy showed different patterns of contact between the gastric mucosa and Helicobacter pylori. The more severe damage of epithelial tissue was accompanied by less mucus secretion and a large number of bacteria. Successful eradication of Helicobacter pylori after medical treatment was associated with normalization of gastric mucosa and disappearance of symptoms in 93.3% of our patients. In duodenal ulcer patients, Helicobacter pylori infection was accompanied by destruction of gastric glands, vacuolation of the lining epithelium and atrophic changes of the microvilli. Ulcer healing and eradication of Helicobacter pylori resulted in normalization of the gastric epithelium at the electron microscopic level which we think is more accurate and reliable compared with different diagnostic methods

Diagnosis of Helibacter pylori: comparison of an urease test, histological visualization of curved bacteria and culture

Se investigo la presencia de Helicobacter pylori en 189 pacientes, mediante cultivo, visualizacion microscopica de organismos parecidos a Campylobacter (OPC) y una prueba rapida de ureasa. La bacteria se aislo de 136 (72 por cento) casos y en 98 de ellos se obserbaron OPC. La especificidad, sensibilidad y los valores predictivos positivo y negativo para la visualizacio microscopica de OPC fueron: 0.77, 0.73, 0.97 y 0.51 respectivamente. La prueba de ureasa fue positiva en 98 de los pacientes positivos por cultivo. La especificidad y los valores predctivos positivo y negativo para la prueba de ureasa fueron: 0.83, 0.72, 0.92 y 0.54 respectivamente. Cuando se comparo la prueba de urease con el diagnostico de H. pylori realizado combinando el cultivo con la visualizacion microscopica de OPC, su especificidad, sensibilidad y los valores predictivos positivo y negativo fueron: 0.95, 0.71, 0.98 y 0.48 respectivamente. Esta ultima condicion no es real por cuanto microscopicamente otras bacterias diferentes de H. pylori podrian ser erroneamente clasificadas como OPC.