Primary gastric fundus tuberculosis in immunocompetent patient: a case report and literature review

We report on a 29-year-old Pakistani man who presented to the clinic with epigastric pain, of one-month duration. He did not report fever, cough, vomiting blood, passing black stools, loss of appetite or diarrhea. However, he had lost 7 kg since his symptoms had begun. Clinical examination was unremarkable. Laboratory results were within normal limits. An abdominal CT scan showed a mass with enhancement in the stomach. Gastric endoscopy revealed an ulcerative mass in the fundus. An endoscopic-biopsy specimen revealed caseating granulomas with acid-fast bacilli. The patient was diagnosed to have primary gastric tuberculosis, and antituberculous medications were initiated. Cultures of the gastric mass subsequently grew Mycobacterium tuberculosis sensitive to isoniazid and rifampcin. Follow-up after six months showed a good response to treatment; an upper gastrointestinal tract endoscopy after six months was normal.

Difference in the distribution pattern of Helicobacter pylori and grade of gastritis in the antrum and in the body between duodenal ulcer and benign gastric ulcer patients

OBJECTIVES: To investigate the relationship between the Helicobacter pylori (H. pylori) colonization and the grade of gastritis in the antrum and in the body of patients with duodenal ulcer (DU) or benign gastric ulcer (BGU). METHODS: This study was performed in H. pylori-positive 220 DU patients and 180 BGU patients. H. pylori density was evaluated by modified Giemsa staining and CLO test, and gastritis grade was graded by H+ACY-E staining in the antrum and in the body. RESULTS: H. pylori grade by Giemsa staining was 1.24 in the antrum and 0.82 in the body for DU group (p +ADw- 0.01), and those of BGU group were slightly reversed, 0.83 and 0.87, respectively, but without statistical significance. Similarly H. pylori grade by CLO test was 3.1 in the antrum and 2.8 in the body for DU group (p +ADw- 0.01), and those of BGU group 2.3 and 2.6 (p +ADw- 0.05), respectively. In contrast, gastritis grade was 1.7 in the antrum and 1.2 in the body for DU group (p +ADw- 0.01), and those of BGU group 1.6 and 1.3 (p +ADw- 0.01), respectively, similar to those of DU. However, there was a correlation between H. pylori grade and gastritis grade in the antrum and in the body, not only in DU but also in BGU group (p +ADw- 0.01). CONCLUSION: In spite of different distribution patterns of H. pylori between DU group and BGU group, gastritis grade of the antrum was significantly higher than that of the body in both DU and BGU. However, gastritis is correlated with H. pylori density not only in DU but also in BGU patients. It looks like the inflammatory reaction to H. pylori is stronger in the antrum than in the body.

Presencia de helicobacter pylori en el duodeno, antro y fundo de sujetos controles y pacientes con úlcera duodenal, úlcera gástrica, gastritis o duodenitis erosiva: análisis histológico de 357 sujetos / Presence of helicobacter pylori in duodenum, antrum and fundus in control subjects and in patients with duodenal ulcer, gastric ulcer, gastritis or erosive duodenitis: histological analysis of 357 subjects

The prevalence of helicobacter pylori infection was studied in 152 subjects with a normal upper gastrointestinal endoscopy, 125 with duodenal ulcer, 25 with gastric ulcer, 46 with erosive gastritis and 9 with erosive duodenitis. Two biopsies fron duodenum, antrum and fub¿ndus were obtained from each subject during endoscopy for histological diagnosis and Helicobacter pylori search. None of the patients with normal endoscopy and 2 percent of patients with duodenal ulcer had Helicobacter pylori in duodenal biopsies. These last patients had a significantly higher frecuency of Helicobacter pylori in the antrum (71 percent) than the rest of the studied groups. Five percent of subjects with normal endoscopy and 5 percent of those with duodenal ulcer had Helicobacter pylori in the antrum. An active gastritis was demonstrated in almost all patients with Helicobacter infection. Instestinal metaplasia occurred almost exclusively in the abscence of Helicobacter Pylori infection

Comparación entre la prueba de la ureasa (CLOtest) y la histología en el diagnóstico del Campylobacter pylori / Comparison of urease test (CLOtest) and histology in the diagnosis of Campylobacter pylori

El campylobacter pylori ha sido implicado en la patogénesis de la úlcera péptica, dispepsia no ulcerosa y en la gastritis crónica. El C. pylori produce grandes cantidades de ureasa lo cual ha sido utilizado como base bioquímica para su identificación en pruebas diagnósticas rápidas y sencillas. En este estudio presentamos el uso de una prueba rápida de ureasa (CLOtest) en la detección del C. pylori. Estudiamos 46 pacientes consecutivos a los cuales se les practicó biopsia de mucosa gástrica en antro y fundus para estudio histológico y CLOtest. Todos los pacientes tuvieron gatritis crónica en histología. En 22 pacientes (48%) el C. pylori fue identificado por CLOtest y/o histología. En 18 pacientes (39%) el CLOtest fue positivo y en 16 pacientes (35%) la histología fue positiva. En 12 pacientes (26%) el C. pylori se evidenció por ambos métodos. No hubo diferencias en cuanto a la presencia del C. pylori en fundus y antro. Sin embargo, en 2 pacientes (4%) el C. pylori fue positivo en fundus y negativo en antro. En 9 pacientes (20%) el C. pylori fue positivo en antro y negativo en fundus. El CLOtest es una prueba sencilla rápida y sensible que permite al endoscopista diagnosticar la infección por C. pylori en la sala de endoscopia