Changes in Upper Gastrointestinal Diseases according to Improvement of Helicobacter pylori Prevalence Rate in Korea / 대한소화기학회지

Helicobacter pylori can cause variety of upper gastrointestinal disorders such as peptic ulcer, mucosa associated lymphoid tissue (MALT)-lymphoma, and gastric cancer. The prevalence of H. pylori infection has significantly decreased in Korea since 1998 owing to active eradication of H. pylori. Along with its decrease, the prevalence of peptic ulcer has also decreased. However, the mean age of gastric ulcer increased and this is considered to be due to increase in NSAID prescription. Gastric cancer is one of the leading causes of cancer deaths in Korea and Japan, and IARC/WHO has classified H. pylori as class one carcinogen of gastric cancer. Despite the decreasing prevalence of H. pylori infection, the total number of gastric cancer in Korea has continuously increased from 2006 to 2011. Nevertheless, the 5 year survival rate of gastric cancer patients significantly increased from 42.8% in 1993 to 67% in 2010. This increase in survival rate seems to be mainly due to early detection of gastric cancer and endoscopic mucosal dissection treatment. Based on these findings, the prevalence of peptic ulcer is expected to decrease even more with H. pylori eradication therapy and NSAID will become the main cause of peptic ulcer. Although the prevalence of gastric cancer has not changed along with decreased the prevalence of H. pylori, gastric cancer is expected to decrease in the long run with the help of eradication therapy and endoscopic treatment of precancerous lesions.

Primary gastrointestinal lymphomas - A study of 81 Cases from a Tertiary Healthcare Centre.

Purpose: Retrospective analysis of 81 routinely diagnosed gastrointestinal (GI) lymphoma to illustrate clinicopathological and immunohistochemical characteristics with predisposing condition. Materials and Methods: Age, sex, site, tumour stage, associated pathological features like lympho-epithelial lesion (LEL), atrophic gastritis (AG), intestinal metaplasia (IM) and enteropathy changes were analysed. Requisite immunohistochemical panel was applied wherever needed. Results: There were 55 male and 26 female patients with median age of 54.5 years. Site wise distributions were stomach 40, small intestine 22, colon 4, cecum 2, ileocecum 3, esophagus 1 and multiple sites 9. Histological subtypes were mucosa associated lymphoid tissue lymphoma (MALTOMA) 48, diffuse large B cell lymphoma (DLBL) 21, T cell lymphoma 9 [5 anaplastic large cell lymphoma (ALCL) and 4 enteropathy associated T cell lymphoma (EATL)], immunoproliferative small intestinal disease (IPSID) 2 and follicular lymphoma 1. LEL was present in 31 cases. Of the 19 AG, 8 had associated IM, and 1 case each had associated H Pylori infection and neuroendocrine tumor. Enteropathy was observed in 4 EATL, and one case each of DLBL and high grade MALTOMA. Giardia infection was present in 1 low grade duodenal MALTOMA. Of the 24 resected specimens, 16 were stage IE, 7 stage IIE and 1 stage IV (Mushoff's staging). Conclusion: Primary GI lymphoma was frequently observed in 6 th decade of life with male preponderance. Stomach was the commonest site and high grade MALTOMA being the commonest histological variant. Isolated colonic involvement and intestinal perforations were not infrequent. Rare variants like ALCL and follicular lymphomas were also observed.

Lymphomas of the gastro-intestinal tract - Pathophysiology, pathology, and differential diagnosis.

The gastrointestinal tract (GIT) is the most commonly involved site of extranodal lymphomas. The close association between chronic inflammation and specific GIT lymphomas not only provide interesting insights into the pathobiology of lymphomas but also poses unique diagnostic challenges. A clear understanding of marginal zone and mucosa associated lymphoid tissue (MALT) in health and disease is helpful to place GIT lymphomas in proper context. A wide variety of lymphomas besides MALT lymphomas occur in various parts of the GIT. The characteristic pathological, immunophenotypic, and genetic features of different GIT lymphomas categorized according to World Health Organization (WHO) classification are presented. The epidemiological, clinical, and pathological features of lymphomas occurring in each part of the GIT are summarized and the key points regarding lymphomas at each site are emphasized. A tabular summary of the important differential diagnostic considerations at each site is given and suggestions for a minimal diagnostic work up are provided.

Helicobacter pylori and Iymphoid follicles in primary gastric MALT-Iymphoma in Mexico

Los linfomas gástricos primarios de tipo MALT se han asociado con la infección por Helicobacter pylori. En el Instituto Nacional de Cancerología de la ciudad de México se revisaron en un periodo de 12 años (1982-94) los casos de linfoma gástrico primario MALT. Se buscaron en la mucosa gástrica adyacente a la neoplasia, cambios morfológicos relacionados con la infección: microorganismos morfológicamente compatibles con H pylori, folículos linfoides y gastritis crónica activa. Hubo 23 casos (85 por ciento) de linfomas MALT de grado bajo y cuatro (15 por ciento) de grado alto. En 23 de los 27 casos (85 por ciento, IC 95 por ciento = 72-99 por ciento se identificó H pylori; en 15 de los 23 (65 por ciento IC = 56-74 por ciento) hubo folículo linfoides. En 25 de los 27 casos (93 por ciento, IC = 90-95 por ciento) se encontró gastritis crónica activa. Hubo una asociación estrecha entre la infección por H pylori y el linfoma gástrico primario de tipo MALT. La presencia de folículos linfoides mostró ser un indicador confiable de la infección, además de ser el sustrato fisiopatológico propuesto para los linfomas MALT. Los pacientes en quienes se observaron folículos linfoides deben ser vigilados en forma periódica ya que H pylori es probablemente promotor de la transformación neoplásica

A cirurgia no tratamento do linfoma gástrico primário do tipo Malt / Surgery in the treatment of primary gastric lymphoma of MALT

O autor relata um estudo retrospectivo de 21 prontuários de pacientes portadores de linfoma gástrico primário do tipo MALT submetidos a tratamento cirúrgico exclusivo ou associado à radioterapia e/ou quimioterapia, durante o período de 1982 a 1996 no Hospital do câncer - Ministério da Saúde...O tratamento adjuvante foi preconizado em 10 pacientes e consistiu em radioterapia em três pacientes no estágio IE, quimioterapia em cinco casos, quatro no estágio IE e um no IIE1. A associação de radioterapia e quimioterapia foi realizada em dois pacientes no estágio IE. O seguimento variou de 3 a 132 meses e evidenciou que dois pacientes faleceram por evolução da doença e um por complicações decorrentes da quimioterapia. Considera-se que o linfoma é uma doença pouco frequente, com diagnóstico baseado na endoscopia digestiva alta e que a cirurgia é essencial para o estagiamento e tratamento da doença.