La derivación protocolizada a endoscopía asociada a la detección de Helicobacter pylori mediante antígeno en deposiciones disminuye lista de espera para endoscopía y optimiza la detección de lesiones pre-malignas y cáncer gástrico incipiente / Protocolized referral to endoscopy and Helicobacter pylori detected in stools aimed to decrease endoscopy waiting lists

Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC.

Infecção por Helicobacter pylori e lesões precursoras de câncer gástrico: prevalência e fatores associados em um laboratório de referência no Sudeste do Brasil / Helicobacter pylori infection and gastric cancer precursor lesions: prevalence and associated factors in a reference laboratory in southeastern brazil

ABSTRACT BACKGROUND: Helicobacter pylori infection is the most important risk factor for gastric atrophy and intestinal metaplasia, both considered gastric cancer precursor lesions. Therefore, the investigation of the occurrence of H. pylori infection, precursor lesions and associated factors guides the adoption of specific strategies for the control this type of cancer. OBJECTIVE: To evaluate the prevalence of H. pylori infection in patients undergoing upper digestive endoscopy, as well as the prevalence of intestinal metaplasia, atrophy and chronic inflammation and their association with H. pylori infection. METHODS: A retrospective study was performed based on reports of gastric endoscopic biopsies performed in a private laboratory affiliated to the Brazilian Public Health System (SUS). Patients were evaluated for age, gender and type of health service. The samples were evaluated for the presence of H. pylori, and also of chronic inflammation, intestinal metaplasia and glandular atrophy. RESULTS: Of a total of 4,604 patients (mean age 51±16.6), 63.9% were female and 63.1% coming from private health care service. The prevalence of H. pylori infection was 31.7% (n=1,459), and the percentage of infection was significantly higher in patients from public health service (42.0%) in relation to patients from private health service (25.6%). Among H. pylori (+) patients, a higher percentage of intestinal metaplasia (17.7% vs 13.3%) and glandular atrophy (17.6% vs 6.9%) were observed when compared to those H. pylori (-) (P<0.01). From the patients H. pylori (+) with at least one type of precursor lesion (n=418), 161 (38.5%) had metaplasia and chronic inflammation, 160 (38.3%) had atrophy and chronic inflammation and finally 97 (23.2%) presented metaplasia, atrophy and chronic inflammation simultaneously. CONCLUSION: The present study reinforces the association of H. pylori infection with gastric cancer precursor lesions in a Brazilian population, emphasizing the importance of infection prevention measures, as well as the treatment of infected patients, especially in regions with lower socioeconomic levels that show a higher prevalence of infection by H. pylori.

RESUMO CONTEXTO: A infecção por Helicobacter pylori é o fator de risco mais importante para atrofia gástrica e metaplasia intestinal, ambas consideradas lesões precursoras do câncer gástrico. Portanto, a investigação da ocorrência de infecção por H. pylori, das lesões precursoras e dos fatores associados orienta a adoção de estratégias específicas para o controle deste tipo de câncer. OBJETIVO: Avaliar a prevalência de infecção por H. pylori em pacientes submetidos à endoscopia digestiva alta, bem como a prevalência de metaplasia intestinal, atrofia e inflamação crônica e a associação destas com a infecção por H. pylori. MÉTODOS: Foi realizado um estudo retrospectivo com base em laudos de biópsias endoscópicas gástricas realizadas em laboratório privado afiliado ao Sistema Único de Saúde (SUS). Os pacientes foram avaliados quanto à idade, sexo e tipo de serviço de saúde. As amostras foram avaliadas quanto à presença de H. pylori e também de inflamação crônica, metaplasia intestinal e atrofia glandular. RESULTADOS: Do total de 4.604 pacientes (idade média de 51±16,6), 63,9% eram do sexo feminino e 63,1% provenientes de serviços de saúde privado. A prevalência de infecção por H. pylori foi de 31,7% (n=1.459) e o percentual de infecção foi significativamente maior nos pacientes do serviço público de saúde (42,0%) em relação aos pacientes do serviço privado de saúde (25,6%). Entre os pacientes com H. pylori (+), foi observado maior percentual de metaplasia intestinal (17,7% vs 13,3%) e atrofia glandular (17,6% vs 6,9%) quando comparados aos H. pylori (-) (P<0,01). Dos pacientes H. pylori (+) com pelo menos um tipo de lesão precursora (n=418), 161 (38,5%) apresentaram metaplasia e inflamação crônica, 160 (38,3%) apresentaram atrofia e inflamação crônica e, finalmente, 97 (23,2%) apresentaram metaplasia, atrofia e inflamação crônica simultaneamente. CONCLUSÃO: O presente estudo reforça a associação da infecção por H. pylori com lesões precursoras de câncer gástrico em uma população brasileira, enfatizando a importância de medidas de prevenção de infecção, bem como o tratamento de pacientes infectados, principalmente em regiões com níveis socioeconômicos mais baixos que apresentam maior prevalência de infecção por H. pylori.

Morfología y repercusiones diagnóstico-terapéuticas de las lesiones preneoplásicas gástricas / Morphology and diagnostic determinants of gastric precancerous conditions

El carcinoma gástrico (CG) de tipo intestinal se origina en un epitelio displásico, que a su vez se desarrolla en medio de una atrofia gástrica (AG) y metaplasia intestinal (MI). La infección por Helicobacter pylori (HP) es la causa más frecuente de AG, causando una pangastritis atrófica multifocal. Entre otras condiciones que producen inflamación crónica de la mucosa gástrica se encuentran también la gastritis autoinmune y la anemia perniciosa. El marco conceptual sobre el cual descansa gran parte de la investigación actual y nuestra comprensión de los cambios que ocurren en la mucosa gástrica se debe a la denominada "cascada de Correa"; quien planteó que la mucosa gástrica crónicamente inflamada, da paso a la AG, que va adquiriendo focos de MI y en dicho epitelio se desarrollará finalmente una displasia (DIS). Se ha acuñado el término lesiones preneoplásicas gástricas (LPG), para referirse a: AG, MI y DIS.Después de la erradicación de HP, se ha demostrado una reducción general de la incidencia de CG; efecto que no es tan claro, cuando la pangastritis por HP ha evolucionado a AG extensa. De tal modo que el efecto de la erradicación de HP medido a través de EC, ha sido poco consistente. La AG grave diagnosticada por histología representa la condición de mayor riesgo. Por otra parte, la MI puede ser de tipo intestinal (delgado-entérica ó incompleta) y la colónica (colónica ó completa) considerándose a esta última, como la variedad de peor pronóstico. El diagnóstico histológico de este tipo de lesiones determina que quien las padece, debe someterse a vigilancia endoscópica. El objetivo de este manuscrito fue resumir la evidencia existente respecto de las LPG, en términos de su caracterización morfológica y sus repercusiones diagnóstico-terapéuticas (significado patológico, graduación del riesgo, vigilancia recomendada; y factores de riesgo).

Gastric carcinoma (GC) of intestinal type, originates from a dysplastic epithelium, which in turn develops in the midst of gastric atrophy (GA) and intestinal metaplasia (IM). Helicobacter pylori (HP) infection is the most frequent cause of GA, causing a multifocal atrophic pangastritis. Among other conditions that produce chronic inflammation of gastric mucosa are also autoimmune gastritis and pernicious anemia. The conceptual framework on which much of current research rests and our understanding of the changes that occur in the gastric mucosa is due to the so-called "Correa waterfall"; who stated that gastric mucosa chronically inflamed, gives way to the GA, which is acquiring foci of IM and in said epithelium a dysplasia (DIS) will eventually develop. The term precancerous conditions (PCC) of the gastric mucosa have been coined to refer to: GA, IM and DIS. After HP eradication, a general reduction in the incidence of GC has been demonstrated; effect that is not so clear, when pangastritis by HP has evolved to extensive GA. Thus, the effect of HP eradication measured through clinical trials has been inconsistent. Severe GA diagnosed represents the highest risk condition. On the other hand, IM can be enteric (grade I), enterocolic (grade II) or colonic (grade III); considering IM III as the variety with the worst prognosis. Histological diagnosis of gastric PCC, determines that the one who suffers them, must undergo endoscopic surveillance. The aim of this manuscript was to update morphological aspects and diagnostic-therapeutic scope of gastric PCC.

Chronic prostatitis alters the prostatic microenvironment and accelerates preneoplastic lesions in C57BL/6 mice

BACKGROUND: Chronic prostatitis has been supposed to be associated with preneoplastic lesions and cancer development. The objective of this study was to examine how chronic inflammation results in a prostatic microenvironment and gene mutation in C57BL/6 mice. METHODS: Immune and bacterial prostatitis mouse models were created through abdominal subcutaneous injection of rat prostate extract protein immunization (EAP group) or transurethral instillation of uropathogenic E. coli 1677 (E. coli group). Prostate histology, serum cytokine level, and genome-wide exome (GWE) sequences were examined 1, 3, and 6 months after immunization or injection. RESULT: In the EAP and E. coli groups, immune cell infiltrations were observed in the first and last months of the entire experiment. After 3 months, obvious proliferative inflammatory atrophy (PIA) and prostatic intraepithelial neoplasia (PIN) were observed accompanied with fibrosis hyperplasia in stroma. The decrease in basal cells (Cytokeratin (CK) 5+/p63+) and the accumulation of luminal epithelial cells (CK8+) in the PIA or PIN area indicated that the basal cells were damaged or transformed into different luminal cells. Hic1, Zfp148, and Mfge8 gene mutations were detected in chronic prostatitis somatic cells. CONCLUSION: Chronic prostatitis induced by prostate extract protein immunization or E. coli infection caused a reactive prostatic inflammation microenvironment and resulted in tissue damage, aberrant atrophy, hyperplasia, and somatic genome mutation.

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.

Chlamydia trachomatis as a probable cofactor in human papillomavirus infection in aboriginal women from northeastern Argentina

Objectives: High-risk types of human papillomavirus (HPV) are strongly associated with cervical cancer (CC), and Chlamydia trachomatis (CT), the most frequent sexually transmitted bacterial infection (STBI) worldwide, seems to be a risk factor for HPV infection and for CC. It is also known that both agents are more prevalent in vulnerable communities where lack of adequate primary health care is a cause for concern. The aim of this work was to determine the impact of CT and HPV infections in women belonging to an isolated aboriginal population (Pilaga community) from a poor region in Northern Argentina (province of Formosa). For this purpose, a cross-sectional study was performed in all sexually active Pilaga women, who attended a local community-based gynecological health screening project. The polymerase chain reaction (PCR) method on a cervical brush specimen was used to detect both agents. Results: A total of 227 women (20 percent of the total female population of the Pilaga community) were studied and the overall prevalence was 26.4 percent for CT, 46.7 percent for HPV and 16.3 percent for concurrent infection. CT infection was higher in HPV DNA positive (34.2 percent) than in HPV DNA negative women (19 percent; OR: 2.22/95 percent CI = 1.16-4.28 / p = 0.009) and the most prevalent HPV types were HPV-16 (19.4 percent), 6 and 18 (5.3 percent), 58 (3.5 percent) and 33 (3.1 percent). Conclusions: The prevalence of CT and HPV observed in Pilaga women are among the worst registered in Latin America. Also, data collected suggest that chlamydial infection may play an important role in the natural history of HPV infection. On this respect, we propose that the association between these two agents seems to be more related to a mutual potentiation than to the fact that they share a common route of transmission.

Prevalência da infecção por Helicobacter pylori e das lesões precusoras do câncer gástrico em pacientes dispéticos / Prevalence of Helicobacter pylori infection and gastric cancer precursor lesions in patients with dyspepsia

RACIONAL: A infecção pelo Helicobacter pylori é fator importante no desenvolvimento da carcinogênese gástrica, mas somente uma fração dos pacientes infectados irá desenvolver câncer gástrico. A infecção pelo H. pylori determina gastrite crônica não-atrófica, que pode evoluir para gastrite atrófica e metaplasia intestinal e, finalmente, para displasia e adenocarcinoma. OBJETIVO: Estudar a prevalência da infecção pelo H. pylori e das lesões precursoras de câncer gástrico e sua associação, em pacientes submetidos a endoscopia digestiva alta em serviço de referência da região central do Estado do Rio Grande do Sul. MÊTODOS: Foram analisadas retrospectivamente biopsias de corpo e antro gástrico obtidas de pacientes submetidos a endoscopia digestiva alta no período entre 1994 e 2003, nas quais foi realizada pesquisa de H. pylori. As lâminas foram coradas pelo método da hematoxilina-eosina e os achados histológicos foram classificados de acordo com o sistema de Sydney em mucosa normal, gastrite crônica não-atrófica, gastrite atrófica e metaplasia intestinal. As alterações histológicas encontradas foram relacionadas com a presença de infecção pelo H. pylori. RESULTADOS: Biopsias de 2.019 pacientes foram incluídas no estudo. A idade média dos pacientes foi de 52 (±15) anos e 59 por cento eram do sexo feminino. A pesquisa de H. pylori foi positiva em 76 por cento dos pacientes. Mucosa normal, gastrite crônica não-atrófica, gastrite atrófica e metaplasia intestinal foram diagnosticadas em 5 por cento, 77 por cento, 3 por cento e 15 por cento das biopsias, respectivamente. A infecção por H. pylori determinou uma razão de chances 10 vezes (IC95 por cento 6.50 - 17 por cento) maior de se encontrar algum grau de alteração histológica na mucosa gástrica. A razão de chances dos pacientes infectados apresentarem gastrite crônica não-atrófica, foi igual a 3 (IC95 por cento 2,2 - 3,4). A razão de chances dos pacientes infectados apresentarem gastrite...

BACKGROUND: Helicobacter pylori infection has been considered to play significant role in gastric carcinogenesis, but only a minority of people who harbor this organism will develop gastric cancer. H. pylori infection first causes chronic non atrophic gastritis. Chronic non atrophic gastritis may evolve to atrophic gastritis and intestinal metaplasia and finally to dysplasia and adenocarcinoma. AIMS: To estimate the prevalence of H. pylori infection and the precancerous gastric lesions and their relationship, in patients with dyspeptic symptoms who underwent upper gastrointestinal endoscopy at a reference center in the central region of Rio Grande do Sul state, Brazil. METHODS: We analyzed gastric biopsies taken from corpus and antrum of patients who underwent upper gastrointestinal endoscopy for H. pylori detection, between 1994 and 2003. According to Sydney system, chronic non atrophic gastritis, atrophic gastritis and intestinal metaplasia were diagnosed by histological examination (H-E stain). The histological diagnoses were related to H. pylori infection status. RESULTS: Biopsies from 2,019 patients were included in the study. Patients mean age was 52 (±15) and 59 percent were female. Seventy six percent had H. pylori infection. Normal mucosa, chronic non atrophic gastritis, atrophic gastritis and intestinal metaplasia were diagnosed in 5 percent, 77 percent, 3 percent and 15 percent, respectively. The OR for any degree of gastric mucosa lesion in infected patients was 10 (CI95 percent 6.50 - 17 percent). The OR for infected patients had chronic non atrophic gastritis was 3 (CI95 percent 2,2 - 3,4). The OR for infected patients had atrophic gastritis or intestinal metaplasia was less than 1. CONCLUSIONS: The prevalence of H. pylori infection in this population was high (76 percent) and infected individuals had the probability 10 folds greater than non infected individuals to have any lesion of gastric mucosa. The prevalence...

Relation between gallbladder neoplasm and Helicobacter hepaticus infection.

OBJECTIVE: The main objective of this study was to see the various histopathological changes in the gallbladder with cholelithiasis and to correlate them with Helicobacter hepaticus infection. METHODS: A total of 380 cholecystectomy specimens were received during a study period from 2058/11/29 to 2059/11/4 at Department of Pathology, TU Teaching Hospital, Institute of Medicine. RESULTS: Among 380 cases, 249 (65.53%) were found to have chronic cholecystitis, 52 (13.68%) cholesterolosis, 29 (7.63%) adenomyosis, 20 (5.26%) metaplasia, 15 (3.95%) low grade dysplasia, 10(2.63%) malignancy, 4(1.05%) xanthogranulomatous change and 1(0.26%) carcinoma in situ. Out of these, 100 cases that were willing to provide gallbladder for study were taken as a study group. Sections were stained with Haematoxylin & Eosin for microscopic features and with Warthin Starry Silver stain for Helicobacter hepaticus. Among the study group, 43% cases were found to have chronic cholecystitis, 17% adenomyosis, 13% cholesterolosis, 9% low grade dysplasia, 9% metaplasia, 7% malignancy, 1% carcinoma in situ and 1% xanthogranulomatous change. All the malignant cases were found to be Adenocarcinoma. Out of total 100 cases, 82% cases were found to have Helicobacter hepaticus infection. Only one out of 7 malignant cases (14.29%) was found to be negative for Helicobacter Hepaticus infection. Gallbladder neoplasm was found to be common in Nepal comprising 2.63%. Helicobacter hepaticus infection was found in 82% of gallbladders and it was found in 87.5% of malignant cases. Whether Helicobacter hepaticus that might be the number one cause for the gallstone formation that ultimately leads to malignancy or itself acts as a risk factor for the pathogenesis of carcinoma gallbladder is yet to be determined.