Refractory iron deficiency anemia as an early manifestation of autoimmune gastritis in a teenager / Anemia ferropénica refractaria como presentación temprana de gastritis autoinmune en un adolescente

Abstract Autoimmune gastritis is an underdiagnosed disease in the pediatric population due to the absence of specific signs and symptoms and late clinical manifestations. Iron deficiency anemia has recently been identified as an early hematological manifestation, allowing an early diagnostic approach. We present the case of a Colombian teenager, with no history of autoimmunity, with refractory iron deficiency. He underwent extension studies; biopsies and serology compatible with autoimmune gastritis were documented, requiring parenteral iron in its evolution. This pathology is underdiagnosed in our context since early diagnosis requires a high index of suspicion to prevent associated complications.

Resumen La gastritis autoinmune es una enfermedad subdiagnosticada en la población pediátrica. Lo anterior se debe a la ausencia de signos y síntomas específicos y manifestaciones clínicas tardías. Recientemente se ha identificado la anemia ferropénica como una manifestación hematológica precoz, lo que permite un enfoque diagnóstico temprano. Se presenta el caso de un adolescente colombiano, sin antecedentes de autoinmunidad, con ferropenia refractaria, en el que se realizaron estudios de extensión y se documentaron biopsias y serología compatible con gastritis autoinmune, con requerimiento de hierro parenteral en su evolución. Esta patología es subdiagnosticada en nuestro medio, ya que el diagnóstico temprano requiere un alto índice de sospecha, lo que permite la prevención de las complicaciones asociadas.

Gênero, idade, achados endoscópicos, urease e Helicobacter pylori: ausência de correlação dentro de uma amostra de população com alta prevalência de câncer gástrico na Amazônia / Gender, age, endoscopic findings, urease and helicobacter pylori: all uncorrelated within a sample of a high gastric cancer prevalence population in amazon

ABSTRACT BACKGROUND: It is widely assumed that gender, age, gastritis and Helicobacter pylori , all have some degree of correlation and, therefore, can synergistically lead to the development of gastric cancer. OBJECTIVE: In this cross-sectional study, we expected to observe the above mentioned correlation in the analysis of medical records of 67 patients of both sexes (female, n=44), mean age ± standard deviation: 41±12 years old, all from Belém (capital of Pará State, Brazilian Amazon), a city historically known as one with the highest gastric cancer prevalence in this country. METHODS: All patients were submitted to upper gastrointestinal endoscopy for gastric biopsy histopathological analysis and rapid urease test. All diagnoses of gastritis were recorded considering its topography, category and the degree of inflammatory activity, being associated or not associated with H. pylori infection. RESULTS: The results show that no statistically relevant associations were found among the prevalences of the observed variables. CONCLUSION: The authors hypothesize that observed risk factors associated to gastric cancer might be lesser synergistic than is usually expected.

RESUMO CONTEXTO: É amplamente assumido que gênero, idade, gastrite e Helicobacter pylori , todos têm algum grau de correlação e, portanto, podem sinergicamente levar ao desenvolvimento de câncer gástrico. OBJETIVO: Neste estudo transversal, esperamos observar a correlação acima mencionada na análise de prontuários de 67 pacientes de ambos os sexos (sexo feminino, n=44), média de idade ± desvio padrão: 41±12 anos, todos de Belém (capital do Estado do Pará, Amazônia Brasileira), uma cidade historicamente conhecida como sendo uma das que apresenta maior prevalência de câncer gástrico no país. MÉTODOS: Todos os pacientes foram submetidos à endoscopia digestiva alta para análise histopatológica da biópsia gástrica e teste rápido da urease. Todos os diagnósticos de gastrite foram registrados considerando sua topografia, categoria e grau de atividade inflamatória, sendo associada ou não associada à infecção por H. pylori . RESULTADOS: Os resultados mostram que não foram encontradas associações estatisticamente relevantes entre as prevalências das variáveis observadas. CONCLUSÃO: Os autores levantam a hipótese de que os fatores de risco associados ao câncer gástrico podem ser menos sinérgicos do que o esperado.

Prevalencia de tipos histológicos de pólipos gástricos en pacientes adultos de un hospital público de Lima-Perú, en el periodo 2007 al 2016 / Prevalence of histological types of gastric polyps in adult patients from a public hospital in Lima-Peru (2007 - 2016)

Objetivos: Determinar la prevalencia de pólipos gástricos detectados mediante endoscopía digestiva alta, en pacientes mayores de 18 años del Hospital Cayetano Heredia, en el periodo 2007-2016. Materiales y métodos: Estudio retrospectivo de corte transversal, realizado con datos de biopsias gástricas de pacientes sometidos a endoscopía digestiva alta entre enero de 2007 y julio de 2016. Se evaluó cambios histológicos asociados, datos demográficos y características endoscópicas, las cuales fueron sometidas a análisis estadístico mediante STATA v14.2. Resultados: En una población de 16 552 endoscopías realizadas, se encontró 407 biopsias compatibles con pólipos gástricos, lo cual da una prevalencia de 2,5%. Los pólipos gástricos fueron más frecuentes en mujeres (62,38%). La mediana de edad fue de 61 años (52-71 años). El tipo histológico más frecuente fue el pólipo glandular fúndico (PGF) (44,85%), seguido de pólipo hiperplásico (38,48%) y adenomatoso (15,23%). La localización más frecuente fue en fondo/cuerpo (48,65%, p=0,001) Se detectó la presencia de Helicobacter pylori (Hp) en el 30,6% de las biopsias compatibles con pólipos. Conclusión: La prevalencia de pólipos gástricos es similar con otras regiones del mundo; los PGF e hiperplásicos son los más frecuentes. Los pólipos adenomatosos estuvieron en mayor relación a cambios como metaplasia y displasia.

Objectives: Establish the prevalence of gastric polyps detected by upper gastrointestinal endoscopy in patients older than 18 years old during the period from 2007 - 2016 in Cayetano Heredia Hospital. Materials and methods: Retrospective cross- sectional study, performed with data from the gastric biopsies reports of patients that have undergone upper gastrointestinal endoscopy between January 2007 and July 2016. Demographic data, endoscopic characteristics of the polyps and associated histological changes of the surrounding gastric mucosa were evaluated, which were subjected to statistical analysis using STATA v14.2. Results: In a population of 16 552 endoscopies, 407 gastric polyps biopsies were found. These results give a prevalence of 2.5% .Gastric polyps were detected predominantly in women (62.38%). The median age was 61 years (52-71 years). The most frequent histological type was the fundic gland polyp (FGP) (44.85%), followed by the hyperplastic (38.48%) and adenomatous (15.23%) polyp. The most frequent location was in the fundus / corpus (48.65%, p = 0.001). The presence of Hp was detected in 30.6% of the biopsies with polyps. Conclusion: The prevalence of gastric polyps is similar to other regions of the world; PGF and hyperplastic are the most frequent. Adenomatous polyps showed a greater relationship with and metaplasia and dysplasia.

The role of high sensitive C-reactive protein and histopathological evaluation in chronic gastritis patients with or without Helicobacter pylori infection

Abstract Purpose: To evaluate serum levels of high-sensitivity C-reactive protein (hs-CRP) in chronic gastritis patients to predict Helicobacter pylori (HP) infection, inflammatory activity, and precancerous lesions. Methods: A total of 811 patients with upper gastrointestinal symptoms and histopathological diagnosis of chronic gastritis were enrolled in the study. On endoscopy, five gastric biopsies were taken according to Modified Sydney protocol, which were stained with hematoxylin & eosin and Giemsa Results: HP infection was found in 28.6% of patients, being significantly more common in specimens with acute and chronic inflammatory activity. Mucosal atrophy, intestinal metaplasia, and dysplasia were found in 20.2%, 18.8% and 2.7% of biopsy specimens. Mean hs-CRP was 1.9±1.6 mg/dl for males and 2.2±1.9 mg/dl for females. hs-CRP average were significantly higher in patients with severe acute inflammation (p:0.049), in patients with severe chronic inflammation (p:0.015) and in those with HP (p: 0.001) . The severity of HP infection increased significantly with the increased degree of acute inflammation, chronic inflammation and hs-CRP level (p=0.001 for both). Conclusion: Serum hs-CRP level increases in patients with chronic gastritis, it could be an indicator of severity of acute or chronic mucosal inflammation, and presence of HP infection. Therefore, hs-CRP may aid the diagnosis of chronic gastritis, but it is not associated with pre-cancerous lesions.

Helicobacter pylori, gastritis nodular y lesiones premalignas de estómago: un estudio de casos y controles / Helicobacter pylori, nodular gastritis and premalignant stomach lesions: a case-control study

Introducción: La gastritis nodular (GN) es un tipo de gastritis fuertemente relacionada con Helicobacter pylori y puede ser un factor de riesgo para cáncer gástrico. Es una patología altamente prevalente en niños infectados por H. pylori. En Colombia no hay estudios sobre esta entidad y por eso decidimos realizar la presente investigación. Materiales y métodos: Estudio de casos y controles. Caso; gastritis nodular endoscópica e histológica, controles, gastritis crónica sin folículos linfoides a la histología. Población: adultos mayores de 18 años, a quienes se les realizó una endoscopia digestiva alta y que firmaron el consentimiento informado. A todos los pacientes se les tomaron biopsias con el sistema OLGA. Resultados: Se incluyeron 344 pacientes, 172 en cada grupo. Los casos tuvieron 10 años menos que los controles (40,9 vs 50,9, p=0,045). En los casos se encontró H. pylori en el 91,9% vs 47,8% (p < 0,001). Los folículos linfoides fueron más frecuentes en el antro que en el cuerpo (60,5 vs 4,7% p < 0,00001). OLGA II en los casos 6,4% versus 1,2% (p=0,01), OLGA III fue similar. No hubo OLGA IV en ningún paciente En los casos se encontró un cáncer gástrico. Conclusiones: Los pacientes con gastritis nodular son más jóvenes que los controles. El 92% de los casos tenía H. pylori. Recomendaciones. Se recomienda que se investigue y se erradique esa infección en los pacientes con ese tipo de gastritis.

Introduction: Nodular gastritis (GN) is a type of gastritis strongly related to Helicobacter pylori and may be a risk factor for gastric cancer. It is a highly prevalent pathology in children infected with H. pylori. In Colombia there are no studies on this entity and for this reason we decided to carry out the present investigation. Materials and methods: Case studies and controls. Case; endoscopic and histological nodular gastritis, controls, chronic gastritis without lymphoid follicles to histology. Population: adults older than 18 years, who underwent a high digestive endoscopy and signed informed consent. All patients were biopsied with the OLGA system. Results: We included 344 patients, 172 in each group. The cases had 10 years less than the controls (40.9 vs 50.9, p = 0.045). In the cases H. pylori was found in 91.9% vs 47.8% (p <0.001). Lymphoid follicles were more frequent in the antrum than in the body (60.5 vs 4.7% p < 0.00001). OLGA II in cases 6.4% versus 1.2% (p = 0.01), OLGA III was similar. There was no OLGA IV in any patient. In the cases a gastric cancer was found. Conclusions: Patients with nodular gastritis are younger than controls. 92% of the cases had H. pylori. Recommendations: It is recommended that this infection be investigated and eradicated in patients with this type of gastritis.

Comparação entre os achados endoscópicos e o diagnóstico histológico de gastrite antral. Arq Gastroenterol / Comparison between the endoscopic findings and the histological diagnosis of antral gastrites

ABSTRACT BACKGROUND: Gastritis is a very common disorder that is widely distributed worldwide, representing one of the most prevalent pathological entities in Gastroenterology and Digestive Endoscopy. OBJECTIVE: This study aims to analyze the correlation between the endoscopic findings and the histological diagnosis of antral gastritis. METHODS: In this study, 92 reports of upper digestive endoscopy were performed between November 2014 and January 2015, including biopsy of the antral gastric mucosa, comparing the endoscopic and histological findings, which were classified according to the Sidney System. The 92 exams included 35 men and 57 women, ranging in age from 15 to 84 years. The most frequent indication was epigastric pain. RESULTS: Of the 92 examinations analyzed, the histological diagnosis of antral gastritis appeared in 75 exams, 59 endoscopic reports contained the diagnosis of antral gastritis, and 33 endoscopic findings were normal. The kappa coefficient was 0.212 (P<0.05), indicating that there was no significant agreement between the endoscopic findings and the histological diagnosis of antral gastritis. CONCLUSION: We conclude that histology represents the gold standard method for the diagnosis of antral gastritis and that in daily clinical practice, biopsies should always be performed, regardless of the endoscopic findings.

RESUMO CONTEXTO: Gastrite é uma afecção muito comum, de larga distribuição mundial, representando uma das entidades patológicas mais prevalentes em Gastroenterologia e Endoscopia Digestiva. OBJETIVO: Este estudo tem por objetivo analisar a correlação entre os achados endoscópicos e o diagnóstico histológico de gastrite antral. MÉTODOS: Nesse estudo, foram analisados 92 laudos de endoscopia digestiva alta, realizados entre novembro de 2014 e janeiro de 2015, que continham biópsia de mucosa gástrica antral, comparando-se os achados endoscópicos e histológicos, que foram classificados segundo o Sistema Sidney. Os 92 exames analisados englobaram 35 homens e 57 mulheres, com idade variando entre 15 e 84 anos. A indicação mais frequente foi epigastralgia. RESULTADOS: Dentre os 92 exames analisados, o diagnóstico histológico de gastrite antral apareceu em 75 exames, sendo que 59 laudos endoscópicos continham o diagnóstico de gastrite antral e 33 laudos endoscópicos foram normais. O coeficiente kappa foi 0,212 com P<0,05, mostrando que não há concordância significativa entre os achados endoscópicos e o diagnóstico histológico de gastrite antral. CONCLUSÃO: Concluímos que a histologia representa o método padrão-ouro para o diagnóstico de gastrite antral, e que na prática clínica diária, biópsias devem ser sempre realizadas, independente dos achados endoscópicos.

Relación entre Helicobacter pylori y patologías digestivas altas por biopsia y endoscopía en un hospital general en Ica, Perú / Relationship between Helicobacter pylori and high digestive pathologies for biopsy and endoscopy in general hospital of Ica, Peru

Objetivo: Determinar la relación entre Helicobacter pylori y patologías digestivas altas mediante biopsia dirigida por endoscopia en el Hospital Regional de Ica, diciembre 2016 y enero 2017. Material y métodos: Se realizó un estudio observacional descriptivo transversal, cuya muestra estuvo conformada por 228 pacientes escogidos de forma aleatoria, que acudieron a consultorio de procedimientos endoscópicos gastrointestinales del Hospital Regional de Ica durante diciembre del 2016 y enero del 2017. Para determinar la relación entre Helicobacter pylori y patologías digestivas altas, creamos un instrumento de recolección de datos, se realizó el análisis exploratorio, univariado y bivariado (OR, Chi² y ANOVA), en la base de datos SPSS 22. Resultados: La relación entre presencia de Helicobacter pylori y Gastritis crónica (p=0.00) fue significativa, no se encontró relación con otra patología. El proceder de lugares diferentes de Ica se encontró asociado a infección por Helicobacter pylori, siendo un factor protector (OR: 0.25, p=0.04), el ingerir verduras y frutas tienen asociación significativa con la infección, comportándose como factores protectores (p<0.05), y el consumo de carnes y tubérculos incrementan la probabilidad de infectarse con el microorganismo (ORc: 2.63 y ORt: 2.29, p<0.05). Conclusiones: Existe relación entre Gastritis crónica e infección por Helicobacter pylori, consumir verduras y frutas disminuye la probabilidad de infección, mientras que consumir abundantes carnes y tubérculos incrementan el riesgo de infección; y residir fuera de Ica es un factor que disminuye la probabilidad de infectarse. (AU)

Objetive: To determine the relationship between the presence of Helicobacter pylori and upper digestive pathologies by endoscopy-guided biopsy at the Regional Hospital of Ica, December 2016 and January 2017. Materials and Methods: A cross-sectional, observational, descriptive study was performed. 228 randomly selected patients who visited the gastrointestinal endoscopic procedures of the Regional Hospital of Ica during the months of December 2016 and January 2017. To determine the relationship between the presence of Helicobacter pylori and upper digestive pathologies, we created an instrument (OR, Chi² and ANOVA) were analyzed in the SPSS 22 database. Results: The relationship between the presence of Helicobacter pylori and chronic gastritis (p = 0.00) is significant, No relationship was found with other pathology. The procedure of different sites of Ica is associated with Helicobacter infection, being a protective factor (OR: 0.25, p = 0.04), ingesting vegetables and fruits have a significant association with infection, behaving as protective factors (p <0.05), And the consumption of meats and tubers increases the probability of being infected with the microorganism (ORc: 2.63 and ORt: 2.29, p <0.05).Conclusions: There is a relationship between chronic Gastritis and Helicobacter pylori infection, consuming vegetables and fruits reduces the probability of infection, while consuming abundant meats and tubers increase the risk of infection; And residing outside of Ica is a factor that decreases the probability of becoming infected. (AU)

[Retracted Article] Gastric and jejunal histopathological changes in patients undergoing bariatric surgery / [Artigo Retratado] Alterações histopatológicas gástricas e jejunais em pacientes submetidos à cirurgia bariátrica

ABSTRACT BACKGROUND Morbid obesity is a multifactorial disease that is increasingly treated by surgery. OBJECTIVE To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. METHODS This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. RESULTS In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in Helicobacter pylori infection (P=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. CONCLUSION There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.

RESUMO CONTEXTO A obesidade mórbida é doença multifatorial cujo tratamento cirúrgico é cada vez mais indicado. OBJETIVO Avaliar alterações histopatológicas gástricas em obesos e comparar com os submetidos à bypass gastrojejunal e a mucosa jejunal após a operação. MÉTODOS Estudo observacional realizado em hospital público terciário avaliando biópsias endoscópicas de 36 pacientes no pré-operatório e 35 no pós-operatório. RESULTADOS: No pré-operatório 80,6% apresentaram gastrite crônica, 38,9% em atividade (77,1% e 20,1%, respectivamente, no pós-operatório). O grupo pós-operatório apresentou diminuição significativa na infecção por Helicobacter pylory (P=0,0001). Maior comprimento do coto gástrico e tempo de operação superior a dois anos associaram-se a infecção por Helicobacter pylori. A mucosa jejunal foi normal em 91,4% e apresentava leve inflamação crônica inespecífica em 8,6%. CONCLUSÃO Houve diminuição da infecção por Helicobacter pylori após a operação. Maior comprimento do coto gástrico e do tempo de operação associaram-se à infecção por Helicobacter pylori. A mucosa jejunal foi considerada normal na maioria absoluta dos pacientes do grupo pós-operatório.

Relationship between the presence of helicobacter pylori with inflammatory endoscopic changes in gastroduodenal mucosa / Relação entre a presença do helicobacter pylori com alterações endoscópicas inflamatórias na mucosa gastroduodenal

ABSTRACT Background: The influence of Helicobacter pylori (HP) in inflammatory disorders of the digestive mucosa has been the subject of several studies since socioeconomic, personal and environmental factors were implicated in the bacteria transmission. Aim: To correlate the inflammatory endoscopic findings with HP infection and the onset of mucosal diseases mucous of the upper digestive tract. Method: Comparative observational study, in which were collected data from 2247 patients who underwent upper endoscopy and biopsies for HP with urease test. The patients were divided into two groups: HP+ and HP- (control) in which endoscopic findings were observed for the following changes: esophagitis, esophageal ulcer, gastritis, erosive gastritis, gastric ulcer, bulboduodenitis, bulbar ulcer and without disease. Results: As for esophagitis, there was little disparity in the distribution favorable to HP+ group (HP+ =67.11% and HP- =69.89%) and esophageal ulcer (HP+ =0% and HP- =0, 21%). Gastritis was favorable to HP- group (HP+ =78.34% and HP- =73.63%), as well as erosive gastritis (HP+ = 67,11% and HP- = 64,55%), in bulboduodenitis (HP+ =1,87% and HP- 1,23%), in gastric ulcer (HP+ =2,14% and HP- =2,03%) and in the absence of alterations in the HP+ group (4.81%) with the HP- control group (6,30%), in which there was little disproportion in favor of HP- group, but without statistical significance. As for the bulbar ulcer (HP +=10.16% and HP- =4.48%), there was statistically significant (p=0.00001). Conclusion: There is no difference between HP+ and HP- groups in inflammatory changes in endoscopic gastroduodenal mucosa, except for the relationship between HP and bulbar ulcer.

RESUMO Racional: A influência do Helicobacter pylori (HP) nas alterações inflamatórias das mucosas digestivas tem sido objeto de vários estudos uma vez que fatores socioeconômicos, pessoais e ambientais são implicados na transmissão da bactéria, facilitando-a. Objetivo: Relacionar os achados inflamatórios endoscópicos com a infecção pelo HP e o aparecimento de doenças mucosas do trato digestivo alto. Método: Estudo observacional comparativo, o qual foram coletados dados de 2247 pacientes submetidos à endoscopia digestiva alta e biópsias para HP com teste de urease. Os pacientes foram divididos em dois grupos: HP+ e o controle HP-dentro dos quais foram observados os achados endoscópicos referentes às seguintes alterações: esofagite, úlcera esofágica, gastrite, gastrite erosiva, úlcera gástrica, bulboduodenite, úlcera bulbar e sem doença. Resultados: Quanto à esofagite, observou-se pequena desproporção na distribuição, favorável ao grupo HP+ (HP+ =67,11% e HP- =69,89%) bem como na úlcera esofágica (HP+ =0% e HP- =0,21%). Na gastrite foi favorável ao grupo HP- (HP+ =78.34% e HP- =73.63%), assim como na gastrite erosiva (HP+ = 67,11% e HP- = 64,55%), na bulboduodenite (HP+ = 1,87% e HP- 1,23%), na úlcera gástrica (HP+ =2,14% e HP- =2,03%) e na ausência de alterações no grupo HP+ (4.81%) com o grupo controle HP- (6,30%), nos quais há pequena desproporção favorável ao grupo HP-, porém, sem significância estatística. Já quanto à úlcera bulbar (HP+ =10,16% e HP- =4,48%), houve significância estatística (p=0,00001). Conclusão: Não há diferenciação entre os grupos HP+ e HP- nas alterações endoscópicas inflamatórias na mucosa gastroduodenal, exceto para a relação entre HP e úlcera bulbar.

H. Pylori infection, endoscopic, histological aspects and cell proliferation in the gastric mucosa of patients submitted to roux-en-y gastric bypass with contention ring: a cross sectional endoscopic and immunohistochemical study

ABSTRACT Background Morbid obesity treatment through vertical gastroplasty Roux-en-Y gastric bypass initially used a contention ring. However, this technique may create conditions to the development of potentially malign alterations in the gastric mucosa. Although effective and previously performed in large scale, this technique needs to be better evaluated in long-term studies regarding alterations caused in the gastric mucosa. Objective To analyze the preoperative and postoperative endoscopic, histological and cell proliferation findings in the gastric antrum and body mucosa of patients submitted to the Roux-en-Y gastric bypass with a contention ring. Methods We retrospectively evaluated all patients submitted to Roux-en-Y gastric bypass with a contention ring with more than 60 months of postoperative follow-up. We compared the preoperative (gastric antrum and body) and postoperative (gastric pouch) gastric mucosa endoscopic findings, cell proliferation index and H. pylori prevalence. We evaluated cell proliferation through Ki-67 antibody immunohistochemical expression. Results In the study period, 33 patients were operated with the Roux-en-Y gastric bypass using a contention ring. We found a chronic gastritis rate of 69.7% in the preoperative period (gastric antrum and body) and 84.8% in the postoperative (gastric pouch). H. pylori was present in 18.2% of patients in the preoperative period (gastric antrum and body) and in 57.5% in the postoperative (gastric pouch). Preoperative cell proliferation index was 18.1% in the gastric antrum and 16.2% in the gastric body, and 23.8% in the postoperative gastric pouch. The postoperative cell proliferation index in the gastric pouch was significantly higher (P=0.001) than in the preoperative gastric antrum and body. Higher cell proliferation index and chronic gastritis intensity were significantly associated to H. pylori presence (P=0.001 and P=0.02, respectively). Conclusion After Roux-en-Y gastric bypass with contention ring, there was a higher chronic gastritis incidence and higher cell proliferation index in the gastric pouch than in the preoperative gastric antrum and body. Mucosa inflammation intensity and cell proliferation index in the postoperative gastric pouch were associated to H. pylori presence and were higher than those found in the preoperative gastric antrum and body mucosa.

RESUMO Contexto O tratamento da obesidade mórbida através da gastroplastia vertical com derivação gastrojejunal em Y de Roux inicialmente utilizou o anel de contenção. No entanto, essa técnica pode criar condições para o desenvolvimento de alterações potencialmente malignas na mucosa gástrica. Apesar de eficaz e realizada anteriormente em grande escala, essa técnica precisa ser melhor avaliada em estudos de longo prazo em relação às alterações causadas na mucosa gástrica. Objetivo Analisar os achados endoscópicos, histológicos e da proliferação celular na mucosa do antro e corpo gástricos no pré-operatório e no pós-operatório de pacientes submetidos à derivação gastrojejunal em Y de Roux com anel de contenção. Métodos Avaliamos retrospectivamente todos os pacientes submetidos à derivação gastrojejunal em Y de Roux com anel de contenção e mais de 60 meses de seguimento pós-operatório. Comparamos os achados endoscópicos da mucosa gástrica, o índice de proliferação celular e a prevalência do H. pylori no pré-operatório (antro e corpo gástricos) e no pós-operatório (bolsa gástrica). Avaliamos a proliferação celular pela expressão imuno-histoquímica do anticorpo Ki67. Resultados No período do estudo, 33 pacientes foram operados com a derivação gastrojejunal em Y de Roux usando anel de contenção. Encontramos a taxa de gastrite crônica de 69,7% no período pré-operatório (antro e corpo gástrico) e 84,8% no pós-operatório (bolsa gástrica). O H. pyloriestava presente em 18,2% dos pacientes no período pré-operatório (antro e corpo gástrico) e em 57,5% no pós-operatório (bolsa gástrica). O índice de proliferação celular pré-operatório foi de 18,1% no antro gástrico e 16,2% no corpo gástrico, e de 23,8% na bolsa gástrica no pós-operatório. O índice de proliferação celular pós-operatório na bolsa gástrica foi significantemente maior (P=0,001) do que no antro e corpo gástrico no pré-operatório. O maior índice de proliferação celular e a intensidade da gastrite crônica na bolsa gástrica associaram-se significantemente à presença do H. pylori(P=0,001 e P=0,02, respectivamente). Conclusão Após a derivação gastrojejunal em Y de Roux com anel de contenção, houve maior incidência de gastrite crônica e maior índice de proliferação celular na bolsa gástrica do que no antro e corpo gástricos no pré-operatório. A intensidade da inflamação da mucosa e o índice de proliferação celular encontrados na bolsa gástrica no pós-operatório associaram-se à presença doH. pylori e foram maiores do que os encontrados na mucosa gástrica do antro e corpo gástricos no pré-operatório.

Conventional videoendoscopy can identify helicobacter pylori gastritis? / A videoendoscopia convencional pode identificar as gastrites por helicobacter pylori?

ABSTRACT Background: Studies with latest technologies such as endoscopy with magnification and chromoendoscopy showed that various endoscopic aspects are clearly related to infection by Helicobacter pylori (HP). The description of different patterns of erythema in gastric body under magnification of images revived interest in identifying these patterns by standard endoscopy. Aim: To validate the morphologic features of gastric mucosa related to H. pylori infection gastritis allowing predictability of their diagnosis as well as proper targeting biopsies. Methods: Prospective study of 339 consecutive patients with the standard videoendoscope image analysis were obtained, recorded and stored in a program database. These images were studied with respect to the presence or absence of H. pylori, diagnosed by rapid urease test and/or by histological analysis. Were studied: a) normal mucosa appearance; b) mucosal nodularity; c) diffuse nonspecific erythema or redness (with or without edema of folds and exudate) of antrum and body; d) mosaic pattern with focal area of hyperemia; e) erythema in streaks or bands (red streak); f) elevated (raised) erosion; g) flat erosions; h) fundic gland polyps. The main exclusion criteria were the use of drugs, HP pre-treatment and other entities that could affect results. Results: Applying the exclusion criteria, were included 170 of the 339 patients, of which 52 (30.58%) were positive for HP and 118 negative. On the positive findings, the most associated with infection were: nodularity in the antrum (26.92%); presence of raised erosion (15.38%) and mosaic mucosa in the body (21.15%). On the negative group the normal appearance of the mucosa was 66.94%; erythema in streaks or bands in 9.32%; flat erosions 11.86%; and fundic gland polyps 11.86%. Conclusion: Endoscopic findings are useful in the predictability of the result and in directing biopsies. The most representative form of HP related gastritis was the nodularity of the antral mucosa. The raised erosion and mucosa in mosaic in the body are suggestive but not specific to the infection. The other forms were not conclusive of the presence of HP.

RESUMO Racional: Estudos com tecnologias mais recentes como endoscopia com magnificação e cromoscopia mostraram que vários aspectos endoscópicos estão claramente associados à infecção por Helicobacter pylori. A descrição de padrões diferenciados de enantema no corpo gástrico através da magnificação de imagens reavivou o interesse na identificação desses padrões pela endoscopia convencional. Objetivo: Validar os padrões morfológicos de mucosa gástrica usando videogastroendoscopia convencional relacionados à gastrite por infecção por Helicobacter pylori, permitindo previsibilidade do seu diagnóstico e o direcionamento de biópsias. Métodos: Estudo prospectivo de 339 pacientes consecutivos com análise das imagens de videogastroendoscopia obtidas, gravadas e armazenadas em banco de dados. Estas imagens foram estudadas com relação à presença ou não do Helicobacter pylori diagnosticado por teste rápido de urease e/ou por pesquisa direta por estudo anatomopatológico. Foram estudados: a) aspecto normal da mucosa; b) nodularidade da mucosa; c) enantema inespecífico difuso de antro e corpo; d) enantema em mosaico ou salpicado; e) enantema em estrias ou faixas; f) erosões elevadas; g) erosões planas; h) pólipos de glândulas fúndicas. Os principais critérios de exclusão foram o uso de medicamentos, tratamento prévio de HP e outras entidades que pudessem interferir nos resultados. Resultados: Aplicando os critérios de exclusão, incluíram-se 170 dos 339 pacientes sendo 52 (30,58%) positivos para Helicobacter pylori e 118 negativos. No grupo positivo os achados que mais se associaram com a infecção foram: nodularidade no antro (26,92%); presença de erosões elevadas (15,38%) e mucosa em mosaico no corpo (21,15%). No grupo negativo o aspecto normal da mucosa foi de 66,94%; enantema em estrias ou faixas em 9,32%; erosões planas em 11,86%; e pólipos de glândulas fúndicas 11,86%. Conclusão: Achados endoscópicos são úteis na previsibilidade de localização e direcionamento de biópsias na pesquisa do HP. A mais representativa forma de gastrite por HP foi o achado de nodularidade na mucosa antral. As erosões elevadas e mucosa em mosaico no corpo são sugestivas, mas não específicas da infecção. As demais formas não foram conclusivas da presença do HP.

Activation of NF-κB and AP-1 Mediates Hyperproliferation by Inducing β-Catenin and c-Myc in Helicobacter pylori-Infected Gastric Epithelial Cells

PURPOSE: In the gastric mucosa of Helicobacter pylori (H. pylori)-infected patients with gastritis or adenocarcinoma, proliferation of gastric epithelial cells is increased. Hyperproliferation is related to induction of oncogenes, such as β-catenin and c-myc. Even though transcription factors NF-κB and AP-1 are activated in H. pylori-infected cells, whether NF-κB or AP-1 regulates the expression of β-catenein or c-myc in H. pylori-infected cells has not been clarified. The present study was undertaken to investigate whether H. pylori-induced activation of NF-κB and AP-1 mediates the expression of oncogenes and hyperproliferation of gastric epithelial cells. MATERIALS AND METHODS: Gastric epithelial AGS cells were transiently transfected with mutant genes for IκBα (MAD3) and c-Jun (TAM67) or treated with a specific NF-κB inhibitor caffeic acid phenethyl ester (CAPE) or a selective AP-1 inhibitor SR-11302 to suppress activation of NF-κB or AP-1, respecively. As reference cells, the control vector pcDNA was transfected to the cells. Wild-type cells or transfected cells were cultured with or without H. pylori. RESULTS: H. pylori induced activation of NF-κB and AP-1, cell proliferation, and expression of oncogenes (β-catenein, c-myc) in AGS cells, which was inhibited by transfection of MAD3 and TAM67. Wild-type cells and the cells transfected with pcDNA showed similar activities of NF-κB and AP-1, proliferation, and oncogene expression regardless of treatment with H. pylori. Both CAPE and SR-11302 inhibited cell proliferation and expression of oncogenes in H. pylori-infected cells. CONCLUSION: H. pylori-induced activation of NF-κB and AP-1 regulates transcription of oncogenes and mediates hyperproliferation in gastric epithelial cells.

Correlations between the CagA Antigen and Serum Levels of Anti-Helicobacter pylori IgG and IgA in Children

We tested correlations between anti-Helicobacter pylori IgG and IgA levels and the urease test, anti-CagA protein antibody, degree of gastritis, and age. In total, 509 children (0-15 years) were enrolled. Subjects were stratified as 0-4 years (n = 132), 5-9 years (n = 274), and 10-15 years (n = 103) and subjected to the urease test, histopathology, ELISA, and western blot using whole-cell lysates of H. pylori strain 51. The positivity rate in the urease test (P = 0.003), the degree of chronic gastritis (P = 0.021), and H. pylori infiltration (P < 0.001) increased with age. The median titer for anti-H. pylori IgG was 732.5 IU/mL at 0-4 years, 689.0 IU/mL at 5-9 years, and 966.0 IU/mL at 10-15 years (P < 0.001); the median titer for anti-H. pylori IgA was 61.0 IU/mL at 0-4 years, 63.5 IU/mL at 5-9 years, and 75.0 IU/mL at 10-15 years (P < 0.001). The CagA-positivity rate was 26.5% at 0-4 years, 36.5% at 5-9 years, and 46.6% at 10-15 years for IgG (P = 0.036), and 11.3% at 0-4 years, 18.6% at 5-9 years, and 23.3% at 10-15 years for IgA (P < 0.001). Anti-H. pylori IgG and IgA titers increased with the urease test grade, chronic gastritis degree, active gastritis, and H. pylori infiltration. Presence of CagA-positivity is well correlated with a high urease test grade and high anti-H. pylori IgG/IgA levels.

Ingesta de cáusticos en niños, experiencia de 3 años / Ingestion of caustic substances in children: 3 years of experience

Introdución: La ingesta accidental de cáusticos en pediatría no dispone de un consenso claro de actuación. El objetivo de este estudio fue caracterizar la población pediátrica atendida por ingesta de cáusticos en un centro asistencial. Pacientes y método: Estudio descriptivo de los pacientes atendidos en nuestro hospital por la ingesta de cáusticos durante el período 2008-2011. Resultados: Se atendieron 12 pacientes, edad media de 3,8 años (1-13 años). Predominio de varones (58,8%). Un 58,3% ingirió producto alcalino y un 41,6% ácido. El 58,3% no refería sintomatología, el resto refirió vómitos (33,3%), odinofagia (16,6%), hematemesis (8,3%), sialorrea (8,3%) y dificultad respiratoria (8,3%). El 75% presentaron lesiones en la cavidad oral. Todos, salvo un caso, fueron accidentales. Se realizó endoscopia al 100% entre las 12 y 24 h postingesta con hallazgos patológicos en un 41,6%. En el grupo ingesta de álcalis 2 pacientes presentaron lesiones (16,6%): una esofagitis grado 2B y una grado 3. En el grupo ingesta de ácidos 4 pacientes (33,3%) presentaron lesiones: una esofagitis aguda grado 1-2A, 2 gastritis agudas no erosivas y una gastritis aguda hemorrágica. Se realizó endoscopia de control según los hallazgos endoscópicos previos. Solo 2 presentaron complicaciones posteriores. Conclusiones: Destacamos la valoración endoscópica en las primeras 24 h en todas las ingestas sintomáticas y deliberadas, así como la reevaluación estrecha en las ingestas ácidas, por asociar lesiones diferidas.

Introduction: There is no clear consensus on the management of accidental ingestion of caustic substances in paediatrics. The aim of this study was to determine the profile of the paediatric population treated due to caustic ingestion in a Healthcare Centre. Patients and method: A descriptive study was conducted on patients treated for the ingestion of caustic substances in our hospital during the period 2008-2011. Results: A total of 12 patients were treated, with a mean age of 3.8 years (1-13 years), with the majority males (58.8%). An alkaline product was ingested by 58.3%, and an acid by 41.6%. The majority (58.3%) did not refer to symptoms and the remainder referred to vomiting (33.3%), odynophagia (16.6%), haematemesis (8.3%), hyper-salivation (8.3%) and shortness of breath (8.3%). Oral cavity lesions were observed in 75% of cases. All, except one, were accidental. An endoscopy was performed on all of them (100%) between 12 and 24 hours post-ingestion, with pathological findings in 41.6%. In the group that ingested an alkali, 2 (16.6%) patients had lesions, one a grade 2B and one a grade 3 oesophagitis. In the acid ingestion group, 4 (33.3%) patients had lesions; one grade 1-2A oesophagitis, two acute non-erosive gastritis, and one acute haemorrhagic gastritis. A follow-up endoscopy was performed depending on the previous endoscopic findings. Only two patients presented with complications. Conclusions: Emphasis is placed on the endoscopic evaluation in the first 24 hours of deliberate asymptomatic ingestions, as well as a strict follow-up in those that ingested acids, due to delayed associated lesions.

histopathologic analysis of chronic inflammatory infiltrate in patients of H. pylori associated chronic gastritis

To determine the relationship between H. pylori density with severity of chronic inflammatory infiltrate. A cross-sectional study. The study was carried out in the Department of Pathology [Histopathology], Army Medical College, National University of Sciences and Technology [NUST] Islamabad, from Nov 2011 to Nov 2012. Gastric antral biopsies of H. pylori associated chronic gastritis were included in the study. Demographic characteristics and relevant clinical information were collected. First hundred biopsies of H. pylori associated chronic gastritis were assessed for density of H. pylori and chronic inflammatory infiltrate. Histopathological features like lymphoid aggregates, ulcer slough, superficial epithelial damage, dysplasia and nuclear reactive changes were simply assessed in case of their presence or absence. A sigruficant moderate positive correlation was found between grades of H. pylori and chronic inflammatory infiltrate [rs= 0.636]. Insigruficant correlation was found with lymphoid aggregates, superficial epithelial damage, dysplasia and nuclear reactive changes. In conclusion this study corroborated the determination of histopathological parameters and depicted that, the greater the density of H. pylori mfection, the greater the degrees of chronic inflammatory infiltrate

Differences in Features and Course of Mucosal Type Eosinophilic Gastroenteritis between Korean Infants and Children

Eosinophilic gastroenteritis (EGE) is a disorder characterized by eosinophilic infiltration of the bowel wall and various gastrointestinal (GI) manifestations. This study aimed to evaluate the characteristics of EGE in infants and children. A total of 22 patients were diagnosed with histologic EGE (hEGE) or possible EGE (pEGE). Serum specific IgE levels, peripheral eosinophil counts, and endoscopic biopsies were carried out. In the hEGE group (n = 13), initial symptoms included hematemesis, abdominal pain, and vomiting. Three of the subjects had normal endoscopic findings. Eight patients were categorized into the infant group and 5 into the child group. All patients in the infant group showed clinical improvement after switching from cow's milk feeding to special formula or breast feeding. The infant group showed a higher eosinophil count in the gastric mucosal biopsy than the child group. In the pEGE group (n = 9) initial symptoms included hematemesis, abdominal pain, and vomiting. Seven patients in this group showed a good response to treatment with restriction of the suspected foods and/or the administration of ketotifen. Both hEGE and pEGE groups showed clinical improvement after restriction of suspected foods in the majority of cases and also showed a similar clinical course. EGE should be considered in the differential diagnosis of patients with chronic abdominal pain, vomiting, and hematemesis of unknown cause. The infant group may have a better prognosis than the child group if treated properly.

Gastritis enfisematosa como causa infrecuente de abdomen agudo / Emphysematous gastritis as an infrequent cause of acute abdominal pain

La gastritis enfisematosa (GE) es una entidad poco frecuente, descripta por primera vez por Fraenkel en 1889. Se caracteriza por la invasión de la pared gástrica por gérmenes productores de gas, y se asocia a una alta morbimortalidad. Se describen en la bibliografía diferentes factores de riesgo que favorecerían su desarrollo, entre ellos ingesta de cáusticos, diabetes, abuso de alcohol, isquemia gástrica y cirugía de estómago. El cuadro clínico se caracteriza por dolor abdominal agudo y progresivo asociado a repercusión sistémica, sepsis severa, shock séptico, disfunción orgánica múltiple y muerte. Los métodos de diagnóstico por imágenes cumplen un rol fundamental en su abordaje, siendo la tomografía computada multidetector (TCMD) el método de elección, ya que cuenta con la capacidad de mostrar la presencia de gas en el interior de la pared gástrica (neumatosis gástrica) en asociación con el aumento de su espesor, siendo estos dos hallazgos la clave en el diagnóstico. También se encuentra presente un aumento de la densidad del tejido perigástrico compatible con cambios de tipo inflamatorio o infeccioso, y en algunas ocasiones se asocia a neumatosis portal. Se realiza una actualización del tema enfatizando el rol de la TCMD para su diagnóstico.

Emphysematous gastritis (EG) is a rare entity first described in 1889. It is characterized by the invasion of the gastric wall by gas-producing bacteria, and is associated with high morbidity and mortality. The clinical picture is characterized by acute abdominal pain associated with progressive systemic repercussions, severe sepsis, septic shock, multiple organ dysfunction, and death. Imaging methods play a fundamental role in the diagnosis. Multidetector Computed Tomography (MDCT) is the method of choice, since it has the ability to show the presence of gas within the gastric wall (gastric pneumatosis) in association with increased wall thickness. These two features are key findings for diagnosis. Increased density of perigastric tissue is frequently present, due to infectious or inflammatory changes; sometimes portal pneumatosis is present as well. An update on EG is presented, emphasizing the role of MDCT in diagnosis.

Histological and endoscopic features of the stomachs of patients with Chagas disease in the era of Helicobacter pylori

Introduction Most studies that have evaluated the stomachs of patients with Chagas disease were performed before the discovery of Helicobacter pylori and used no control groups. This study compared the gastric features of chagasic and non-chagasic patients and assessed whether gastritis could be associated with Chagas disease. Methods Gastric biopsy samples were taken from patients who underwent endoscopy for histological analysis according to the Updated Sydney System. H. pylori infection was assessed by histology, 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR), serology and the 13C-urea breath test. Patients were considered H. pylori-negative when all of these diagnostic tests were negative. Clinical and socio-demographic data were obtained by reviewing medical records and using a questionnaire. Results The prevalence of H. pylori infection (70.3% versus 71.7%) and chronic gastritis (92.2% versus 85%) was similar in the chagasic and non-chagasic groups, respectively; such as peptic ulcer, atrophy and intestinal metaplasia. Gastritis was associated with H. pylori infection independent of Chagas disease in a log-binomial regression model. However, the chagasic H. pylori-negative patients showed a significantly higher grade of mononuclear (in the corpus) and polymorphonuclear ...

Genotipificación de los factores de virulencia vacA y cagA de Helicobacter pylori en individuos de dos regiones de Colombia con riesgo opuesto de cáncer gástrico / Genotyping of Helicobacter pylori virulence factors vacA and cagA in individuals from two regions in Colombia with opposing risk for gastric cancer

Introducción. La prevalencia de infección por Helicobacter pylori es alta en Colombia; en la zona andina las tasas de cáncer gástrico son altas mientras que en las zonas costeras son bajas. Los genotipos de H. pylori cagA positivo y vacA s1 y m1 se asocian con un mayor riesgo de cáncer gástrico. Objetivo. Determinar las diferencias en las frecuencias de los genotipos de H. pylori asociados a virulencia en dos regiones de Colombia con riesgo opuesto de cáncer gástrico. Materiales y métodos. Se analizaron 401 biopsias del antro gástrico provenientes de 401 individuos con diagnóstico de gastritis no atrófica, gastritis atrófica o metaplasia intestinal; 256 se obtuvieron en la zona de alto riesgo (Tunja y Bogotá) y, 145, en la zona de bajo riesgo (Barranquilla, Santa Marta y Cartagena). La genotipificación de los genes de virulencia cagA y vacA se hizo mediante reacción en cadena de la polimerasa (PCR). Resultados. No se observó diferencia en la frecuencia de infección por H. pylori entre las dos zonas (77,3 Vs . 77,9 %, p=no significativo, ns). La presencia de cagA fue mayor en la zona de bajo riesgo (77,9 Vs . 69,2 %, p=ns). El alelo vacA s1 también fue más prevalente en la zona de bajo riesgo (61,8 Vs . 72,0 %, p=ns). El alelo vacA m1 presentó mayor prevalencia en la zona de alto riesgo (57,2 Vs . 42,8 %, p=ns). La combinación cagA positivo s1m1 también fue más frecuente en la zona de bajo riesgo (48,9 Vs . 38,9 %, p=ns). Conclusiones. Las diferencias en el riesgo de cáncer gástrico en estas dos zonas no pueden explicarse por las diferencias en la prevalencia de infección por H. pylori o en la virulencia de las cepas circulantes.

Introduction: The overall prevalence of Helicobacter pylori infection is high in Colombia; however, in the country´s Andean region, gastric cancer rates far surpass those in coastal areas. Helicobacter pylori genotypes cagA positive and vacA s1 and m1 are associated with an increased risk of gastric cancer. Objective: To compare the distribution of H. pylori genotypes associated with virulence in two regions in Colombia with opposing risk for gastric cancer. Materials and methods: Four hundred and one gastric antral biopsies were obtained and analyzed from 401 individuals diagnosed with non-atrophic gastritis, atrophic gastritis and intestinal metaplasia: 256 came from the high-risk area cities of Tunja and Bogotá, and 145 from the low-risk area cities of Barranquilla, Santa Marta and Cartagena. Genotyping of virulence genes vacA and cagA was performed by PCR. Results: No difference was observed in the frequency of H. pylori infection between the two areas (77.3% vs 77.9 %, p=non significant, ns). The presence of cagA was higher in the low-risk area (77.9% vs. 69.2 %, p=ns). The vacA s1 allele was also more prevalent in the low-risk area (61.8 % vs 72.0 %, p=ns). The vacA m1 allele was more prevalent in the high-risk area (57.2 % vs 42.8 %, p=ns). The cagA positive s1m1 combination was also more frequent in the low-risk area (48.9% vs 38.9%, p=ns). Conclusions: The differences in the risk of gastric cancer in these two geographic areas cannot be explained by differences in the prevalence of infection by H. pylori or by differences in the virulence of circulating strains.

FOCAL ENHANCED GASTRITIS AND MACROPHAGE MICROAGGREGATES IN THE GASTRIC MUCOSA: potential role in the differential diagnosis between Crohn’s disease and ulcerative colitis / Gastrite focal e microagregados de macrófagos na mucosa gástrica: uso potencial no diagnóstico diferencial entre doença de Crohn e colite ulcerativa

Context and Objectives Focally enhanced gastritis and macrophage microaggregates are found in the upper gastrointestinal involvement of Crohn’s disease, and may reflect an underlying defective innate immunity. These features, however, are also described in patients with Helicobacter pylori infection. The role of these gastric abnormalities in the diagnosis of Crohn’s disease was assessed in a population with high prevalence of H. pylori infection. Methods Thirty-seven Crohn’s disease, 26 ulcerative colitis, and 30 control patients were included. The H. pylori status was evaluated by the rapid urease test and histology. The presence of focally enhanced gastritis and macrophage microaggregates was recorded. Results Focally enhanced gastritis was present in 24% of Crohn’s disease patients, 4% of ulcerative colitis patients and 11.5% of controls, presenting an overall sensitivity and specificity for Crohn’s disease of 24% and 88%, respectively. Macrophage microaggregates were found in all groups, but were only detected in ulcerative colitis and controls in association with H. pylori infection, with an overall sensitivity and specificity for Crohn’s disease of 61% and 69%, respectively. In the absence of H. pylori infection, focally enhanced gastritis and macrophage microaggregates were significantly associated with Crohn’s disease (P<0.02 and P = 0.001 respectively). Conclusions Focally gastritis and macrophage microaggregates are suggestive of Crohn’s disease only in H. pylori-negative specimens. HEADINGS - Crohn’s disease. Ulcerative colitis. Gastritis. Macrophages. Helicobacter pylori. .

Contexto e objetivos Gastrite focal e microagregados de macrófagos são encontradas no acometimento gástrico da doença de Crohn, e podem refletir um defeito subjacente na imunidade inata. Estas características, no entanto, são também descritas em pacientes com infecção por Helicobacter pylori. O papel destas anormalidades gástricas no diagnóstico da doença de Crohn foi avaliada em uma população com alta prevalência de infecção por H. pylori. Métodos Trinta e sete pacientes com doença de Crohn, 26 pacientes com colite ulcerativa e 30 pacientes-controle foram incluídos. O status de infecção por H. pylori foi avaliado pelo teste da urease e histologia. A presença de gastrite focal e microagregados de macrófagos foi avaliada. Resultados Gastrite focal estava presente em 24% dos pacientes com doença de Crohn, 4% dos indivíduos com colite ulcerativa e 11,5% dos controles, apresentando uma sensibilidade e especificidade para doença de Crohn de 24% e 88%, respectivamente. Microagregados de macrófagos foram encontrados em todos os grupos, mas foram apenas detectados em colite ulcerativa e controles em associação com infecção por H. pylori, com sensibilidade e especificidade para doença de Crohn de 61% e 69%, respectivamente. Na ausência da infecção por H. pylori comprovada, gastrite focal e microagregados de macrófagos foram significativamente associados com doença de Crohn (P<0,02 e P = 0,001, respectivamente). Conclusões Gastrite focal e microagregados de macrófagos são sugestivos de doença de Crohn apenas em pacientes com avaliação dignóstica negativa para H. pylori. .