Analysis of Drug Resistance and Treatment of Refractory Helicobacter pylori Infection in Patients With Nodular Gastritis / 胃肠病学

Nodular gastritis is directly related to Helicobacter pylori (Hp) infection. Refractory Hp infection has significant impact on the treatment efficacy and prognosis of nodular gastritis. Aims: To analyze the spheroidization and antibiotic resistance of refractory Hp and PPI drug metabolic enzyme CYP2C19 gene polymorphism in patients with nodular gastritis, so as to promote the eradication rate of refractory Hp infection in patients with nodular gastritis. Methods: Refractory Hp infection patients with nodular gastritis from Oct. 2019 to Nov. 2020 at the Second Affiliated Hospital of Baotou Medical College were enrolled. Hp strains were cultured in microaerophilic environment. Immunohistochemistry was used to detect Hp spheroidization. Mutation sites of antibiotic resistance genes and host CYP2C19 gene polymorphism were detected by PCR. According to the results of genetic testing, individualized therapy was given and follow up was performed, the eradication rate of intention-to-treat was calculated. Results: A total of 42 patients with refractory Hp nodular gastritis were enrolled. Among them, lymphocyte accumulation was found in 33.3% patients. Hp spheroidization was found in 2 patients, and the spheroidization rates were 20% and 10%, respectively. There were 25 intensive metabolizer, 15 intermediate metabolizer and 2 poor metabolizer of CYP2C19. Antibiotic resistance gene detection showed that the drug resistance rate of amoxicillin, clarithromycin, levofloxacin, furazolidone, tetracycline, metronidazole were 4.8%, 38.1%, 35.7%, 47.6%, 42.9% and 61.9%, respectively. Twenty-two (52.4%) of the patients developed resistance to 3 or more antibiotics. The total eradication rate of intention-to-treat was 83.3%, of which high-dose dual therapy was 88.9%. Conclusions: Multi-antibiotic resistance and CYP2C19 may be the main reason for the failure of eradication of refractory Hp in nodular gastritis. Hp spheroidization has little effect on the efficacy of eradication therapy. The amoxicillin resistance rate is still significantly lower than that of other antibiotics, and high-dose dual therapy is a better option.

A Case of Gastric Signet Ring Cell Carcinoma in Young Adult with Nodular Gastritis; On Follow-up without Helicobacter pylori Eradication

A 29-year-old man with nodular gastritis diagnosed by previous gastroscopy was referred to our hospital for an evaluation of laryngeal discomport and soreness. The patient had no previous history of eradication for Helicobacter pylori-associated gastritis. Gastroscopy demonstrated the presence of gooseflesh-like nodularities on antrum and whitish discoloring lesion with depression on lesser curvature of lower body. The whitish discoloring lesion with depression was histologically diagnosed a signet ring cell carcinoma by endoscopic biopsy. We report this case of a patient with nodular gastritis who received no eradication therapy and was diagnosed with signet ring cell carcinoma with a review of the literature.

A Case of Gastric Signet Ring Cell Carcinoma in Young Adult with Nodular Gastritis; On Follow-up without Helicobacter pylori Eradication

A 29-year-old man with nodular gastritis diagnosed by previous gastroscopy was referred to our hospital for an evaluation of laryngeal discomport and soreness. The patient had no previous history of eradication for Helicobacter pylori-associated gastritis. Gastroscopy demonstrated the presence of gooseflesh-like nodularities on antrum and whitish discoloring lesion with depression on lesser curvature of lower body. The whitish discoloring lesion with depression was histologically diagnosed a signet ring cell carcinoma by endoscopic biopsy. We report this case of a patient with nodular gastritis who received no eradication therapy and was diagnosed with signet ring cell carcinoma with a review of the literature.

Drug resistance of Helicobacter pylori in nodular gastritis in children / 临床儿科杂志

Objective To analyze the drug resistance of Helicobacter pylori (H.pylori) in nodular gastritis in children and to further explore the rational use of antibiotics for drug-resistant H.pylori strains. Methods A total of 473 children with upper gastrointestinal symptoms undergoing gastroscopy from January 2013 to June 2014 in our hospital were enrolled. Two pieces of gastric antral mucosa in children with nodular gastritis were collected for H.pylori rapid urease test and H.pylori culture. The resistance of H.pylori to amoxicillin, clarithromycin, metronidazole, moxilfoxacin and levolfoxacin was detected by agar dilution method and E-test. Results In 473 cases of nodular gastritis, 258 cases were H.pylori culture-positive. The resistance rate of H. pylori isolates to amoxicillin, clarithromycin, metronidazole, moxilfoxacin, levolfoxacin was 6.2%, 34.9%, 49.2%, 8.9%and 5.0%, respectively. Dual resistance to clarithromycin and metronidazole was 23.3%. Moreover, 405 cases had a family history of H.pylori infection. Conclusions Nodular gastritis is a special sign of H.pylori infection in children. H.pylori infection has obvious familial aggregation. The low resistance rate of H.pylori to amoxicillin in children with nodular gastritis indicates that amoxicillin can be used as the main drug for eradication of H.pylori. Meanwhile, clarithromycin should be applied according to the drug sensitive test due to high resistance rate of H.pylori to clarithromycin.

Analysis of Gene Expression in Helicobacter pylori-associated Nodular Gastritis in Children Using Microarray / 대한소아소화기영양학회지

PURPOSE: Nodular gastritis is a characteristic finding of Helicobacter pylori infection in children. The aim of this study was to evaluate the difference in gene expression in the gastric mucosa of H. pylori-infected and non-infected children, and to analyze the difference in gene expression using cDNA microarray analysis of nodular gastritis caused by H. pylori infection. METHODS: Twelve children (6 boys and 6 girls; mean age 9.8 years) who underwent upper gastrointestinal endoscopy and biopsy at Seoul National University Bundang Hospital were included in the study. The subjects were divided into three groups according to the presence of H. pylori infection and nodular gastritis on endoscopic examination. Gastric mucosa tissue was kept at -70degrees C and RNA was extracted to perform cDNA microarray analysis in each patient. RESULTS: cDNA microarray analysis in children revealed a clear distinction between H. pylori-infected and non-infected gastric mucosa. Specifically, 182 over-expressed genes and 29 under-expressed genes were identified in H. pylori-infected gastric mucosa compared to non-infected mucosa. H. pylori-infected nodular gastritis revealed different gene expression patterns from H. pylori-infected normal gastric mucosa; five genes were over-expressed and five genes were under-expressed. CONCLUSION: In the presence of H. pylori infection, gastric mucosa shows distinct differences in gene expression, and nodular gastritis with H. pylori infection in children may be associated with over- or under-expression of some genes. Further studies are required to clarify the host response and the pathogenesis of nodular gastritis in children.

A Case of Gastric MALT Lymphoma Presenting as Nodular Gastritis in a Child / 대한소아소화기영양학회지

Most cases of mucosa-associated lymphoid tissue (MALT) lymphoma occur in adults. MALT lymphoma is very rare in children. Helicobacter pylori (H. pylori) infection is known to be an important etiologic factor predisposing to the development of gastric MALT lymphoma. A 12-year-old girl was admitted because of intermittent abdominal pain occurring over the preceding 2 years. Nodular gastritis of the stomach was demonstrated on endoscopy. H. pylori infection was confirmed using the rapid urease test and histopathology. Histopathological examination of gastric biopsy specimens revealed lymphoepithelial lesions pathognomonic of MALT lymphoma, and immunohistochemical staining for CD20 was diffusely positive. Therefore, the patient was diagnosed with gastric MALT lymphoma. Clinical manifestations and histopathologic findings compatible with MALT lymphoma improved with the eradication of H. pylori infection. We report a case of primary gastric MALT lymphoma in a child, associated with H. pylori infection and presenting as nodular gastritis.

A Case of Gastric MALT Lymphoma Presenting as Nodular Gastritis in a Child / 대한소아소화기영양학회지

Most cases of mucosa-associated lymphoid tissue (MALT) lymphoma occur in adults. MALT lymphoma is very rare in children. Helicobacter pylori (H. pylori) infection is known to be an important etiologic factor predisposing to the development of gastric MALT lymphoma. A 12-year-old girl was admitted because of intermittent abdominal pain occurring over the preceding 2 years. Nodular gastritis of the stomach was demonstrated on endoscopy. H. pylori infection was confirmed using the rapid urease test and histopathology. Histopathological examination of gastric biopsy specimens revealed lymphoepithelial lesions pathognomonic of MALT lymphoma, and immunohistochemical staining for CD20 was diffusely positive. Therefore, the patient was diagnosed with gastric MALT lymphoma. Clinical manifestations and histopathologic findings compatible with MALT lymphoma improved with the eradication of H. pylori infection. We report a case of primary gastric MALT lymphoma in a child, associated with H. pylori infection and presenting as nodular gastritis.

Nodular Gastritis and Pathologic Findings in Children and Young Adults with Helicobacter pylori Infection

PURPOSE: The aim of this study was to investigate the pathologic characteristics of nodular gastritis in children and young adults infected with Helicobacter pylori (H. pylori). MATERIALS AND METHODS: A total of 328 patients were enrolled in this study, and the diagnosis of H. pylori infection was done with gastroduodenal endoscopy concomitant with a CLO

The Diagnostic Usefulness of Endoscopic Findings and Detection Rates of CLO and HpKit Test for Helicobacter pylori Infection in Children

PURPOSE: We performed this study to evaluate the diagnostic usefulness of endoscopic finding of nodular gastritis, CLO and HpKit test for H. pylori infection in children. METHODS: Gastroduodenal endoscopy and mucosal biopsy were performed on 212 children who visited our hospital between Jul. 1999 and May 2000 due to abdominal pain. We performed CLO and HpKit test for H. pylori with the time interval of 15, 30 minutes, 1, 2, 3, 24, 48, 72, 96, 120 and 144 hours. Histological examination of H. pylori was made by H-E or Alcian yellow stain with biopsy specimens. Sensitivity, specificity, positive predictive and negative predictive value of nodular gastritis, CLO and HpKit test were calculated from the analysis of above data. RESULTS: Sensitivity and specificity of 3 hour-CLO test was 68.4% and 100% respectively. Sensitivity and specificity of 3 hour-HpKit test was 65.8% and 100% respectively. No significant difference in sensitivity and specificity was found between in 3 hour-CLO and HpKit test(P>0.05). Sensitivity of CLO test increased as time lapsed, but corresponding specificity did not decrease as time lapsed(sensitivity and specificity at 144 hours : 89.5% and 94.8% respectively). However, sensitivity of HpKit test increased as time lapsed, but specificity markedly decreased. Sensitivity and specificity of the nodular gastritis was 78.9% and 93.7% respectively. CONCLUSION: Both CLO and HpKit test have relatively low sensitivity and specificity for the detection of H. pylori in 3 hours of testing in children. The endoscopic finding of nodular gastritis is another good standard in the diagnosis of H. pylori infection in children.

Clinical study on chronic nodular gastritis / 中华消化内镜杂志

Objective To investigate the difference between nodular gastritis and atrophy gastritis.Methods During 2004.4～2005.3, the clinical, endoscopic and pathological findings of nodular gastritis and atrophy gastritis were analysed.Results Nodular gastritis is usually classified as nodular type A(nodular gastritis) and type B(atrophic gastritis with nodular changes). The endoscopic appearance of nodular gastritis was characterized as uniform miliary pattern and predominantly affected young women. The incidence of dyspeptic symptom was higher in patients with nodular gastritis than in atrophy gastritis. Nodular gastritis in adults is caused by Helicobacter pylori infection. Antral biopsy specimens showed lymphoid follicle formation and/or marked lymphoid aggregates. The prevalence of lymphoid follicle formation in the antrum was higher in patients with nodular gastritis than atrophy gastritis. Moderate to severe atrophy gastritis also usually has the same nodular endoscopic appearance,but that is not uniform and intensive.Conclusion Nodular gastritis is a very special gastritis with Helicobacter pylori infection and is different from atrophy gastritis.It is worth to be noticed.