Relationship between Helicobacter pylori infection and gastric follicular hyperplasia. A retrospective study.

BACKGROUND: The occurrence of lymphoid follicles in the gastric mucosa was recently considered to be acquired in respose to infection by Helicobacter pylori. METHODS: In order to investigate whether there is any correlation between follicular hyperplasia and Helicobacter pylori colonization, a morphological study was performed in antral biopsy specimens from 267 patients with H. pylori-associated gastritis, and from 312 subjects with histological evidence of chronic gastritis, but without H. pylori colonization. RESULTS: Follicular hyperplasia was observed in 33 (12.3%) specimens with H. pylori-associated gastritis, and in 56 (9%) samples from non-infected group (p=ns). In both H. pylori-positive and H. pylori-negative specimens lymphoid follicular hyperplasia showed a significant correlation with the degree of the gastritis. In these two groups the prevalence of follicular hyperplasia was also significantly higher in the elderly. CONCLUSIONS: On the basis of these results, we were unable to find any significant correlation between H. pylori infection and occurrence of lymphoid follicular hyperplasia. The appearance of organized follicular structures in the gastric mucosa seems to be acquired in response to multiple events, and not exclusively in consequence of the colonization by Helicobacter pylori.

A retrospective study on the incidence of lymphocytic gastritis in patients with Helicobacter pylori infection.

To investigate the relationship between lymphocytic gastritis and H. pylori infection, antral biopsy specimens from 162 patients with histological evidence of H. pylori infection, and from 177 subjects without colonization were retrospectively examined. Among patients with antral colonization, lymphocytic gastritis was identified in 8 cases (4.9%). Lymphocytic gastritis was not detected in specimens without H. pylori infection. Quantitation of the epithelial lymphocytic infiltration was carried out in all specimens and showed that cases with lymphocytic gastritis had a mean of 35.3 lymphocytes per 100 epithelial cells, compared with a mean of 2.6 and 2.4 respectively in chronic gastritis and normal mucosa. Among the 331 patients without lymphocytic gastritis, specimens colonized by H. pylori had a mean of epithelial lymphocyte counts significantly higher than those observed in both chronic gastritis and normal mucosa. These findings show a positive correlation between antral colonization by H. pylori and occurrence of lymphocytic gastritis, and suggest that the bacteria may have an important role in the induction of such particular form of antral inflammation.

Helicobacter pylori in Barrett's esophagus and in normal or inflamed esophageal mucosa: a retrospective study.

To investigate on the presence and significance of Helicobacter pylori (Hp) in Barrett's mucosa, esophageal biopsy specimens from 34 patients with columnar-lined epithelium were retrospectively examined. The incidence of colonization was compared with that observed in a control group of 76 subjects with normal esophageal mucosa or moderate esophagitis. Three of the 34 Barrett's specimens were Hp-positive and only 1 of these showed evidence of inflamed mucosa (p = NS). We do not find in this study any evidence to support the existence of association between Hp and Barrett's esophagus or esophageal inflammation. The presence of Hp in antral mucosa of all positive cases suggest the possibility that esophageal colonisation might merely be a consequence of reflux from the gastric antrum.

Effect of Helicobacter pylori colonization on quantitative distribution of antral G-cells in apparently healthy subjects and in duodenal ulcer patients. A morphometric study.

To investigate whether antral colonization by Helicobacter pylori (Hp) modifies gastrin-cell population, the number of G-cells was evaluated in antral biopsy specimens from 22 apparently healthy subjects and from 48 duodenal ulcer patients using a morphometric method. The level of serum immunoreactive gastrin in a sample of fasting serum obtained at the time of biopsy was also measured. In healthy subjects the G-cell count (evaluated according to G/I index) and the serum gastrin levels were not significantly different than those found in duodenal ulcer patients. When the antral colonization by Hp was assessed, we found that, both controls and duodenal ulcer Hp-positive patients had a mean G-cell count and fasting serum gastrin levels not significantly higher than in patients without Hp.

Helicobacter pylori and intestinal metaplasia in antral mucosa. A study on their correlation.

To investigate the possible relation between Helicobacter pylori (HP) colonization and incidence of intestinal metaplasia (IM), antral biopsy specimens from a total of 263 subjects (167 had chronic gastritis, 12 gastric cancer, and 84 no histological changes) were examined. IM was observed in 27.7% of the HP positive specimens and in 18.3% of the HP negative biopsies (p = NS). Histochemical characterization of mucins showed that the percentage of HP colonization was not significantly different within various subtypes of IM. We do not find in this study any evidence to support the existence of a pathogenetic role of HP on the morphogenesis of IM in antral mucosa.

[The relationship between dietary intake of vitamin A and risk of gastrointestinal neoplasia]. / Indagine sul rapporto tra consumo alimentare di vitamina A e rischio di neoplasia gastrointestinale.

A study on dietary intake of retinol and beta-carotene was conducted in 51 patients affected by gastric (23 cases) and colorectal (28 cases) carcinoma, considering the period preceding the onset of their illness. In all patients were measured serum retinol levels. The data were compared with those in 44 control subjects. Mean values of retinol and beta-carotene intake in the two groups showed not significant differences. The mean serum levels of retinol were similar in controls and in cancer patients (68.1 and 66.8 micrograms/dl, respectively). Our data fail to confirm previous observations about relationship between alimentary intake of retinol and beta-carotene and risk of gastrointestinal cancer.

Peptidergic (VIP) nerves in normal human pancreas and in pancreatitis: an immunohistochemical study.

Vasoactive intestinal polypeptide was demonstrated in the nerves of the human normal pancreas and in pancreatitis by light microscope immunohistochemical technique. In specimens of normal pancreas, vasoactive intestinal polypeptide-immunoreactive neuronal cells were present in the autonomic ganglia. These ganglia were found to receive an abundant supply of vasoactive intestinal polypeptide-positive fibre plexuses. Immunoreactive nerve fibres were seen to run in the stroma, in association with secretory acini, ducts and blood vessels. Vasoactive intestinal polypeptide-positive fibres were also seen close to the Langerhans' islets, but no vasoactive intestinal polypeptide-like immunoreactivity was observed in the endocrine cells. In specimens from patients affected by pancreatitis, even in lesioned regions, immunoreactive elements were extremely scarce.

[Tissue carcinoembryonic antigen in normal conditions and neoplastic pathology of the colorectum]. / L'antigene carcino-embrionario tessutale in condizioni normali e nella patologia neoplastica del colon-retto.

Using an immunohistochemical method, carcinoembryonic antigen (CEA) was evaluated in bioptic specimens from 12 colorectal carcinomas, 32 neoplastic polyps and from 12 preparations of normal rectocolonic mucosa. CEA was demonstrated in 7/12 samples of normal mucosa, always localized on the apical pole of the columnar cells. In carcinomatous specimens CEA was found in 11/12 biopsies and showed a localization predominantly intracytoplasmatic or in the surrounding stroma. In 8/12 tumor specimens tested, the histologically normal mucosa bordering the carcinoma exhibited a slight staining for CEA on the apical surface of the glandular cells. Specimens from 27/32 polyps biopsied appeared to contain CEA on the apical pole of the glandular cells. These results confirm that CEA is a normal constituent of the human adult rectocolonic mucosa; the difference in CEA content between benign and malignant mucosa is very likely quantitative rather than qualitative. No indications on the prognosis of the polyps could be obtained from this study.

[The duodenoscopic picture in adult celiac disease]. / Quadri endoscopici duodenali in corso di celiachia dell'adulto.

The duodenal endoscopic pictures were studied in 12 adult coeliacs patients, aged between 18 and 76 years, mean age 41.9 +/- 17.6 yrs. All patients carried out D-xylose absorption test, antigliadin IgA antibodies and distal duodenum biopsy. The more frequent endoscopic picture was the disappearance of Kerckring's folds; nevertheless in 5 patients the loss of Kerckring's folds was associated with duodenal mucosa irregularity. We believe that in future the knowledge of this new endoscopic picture will be useful in coeliac's disease diagnosis.

Intestinal metaplasia of the gastric mucosa: a study of its incidence in various disease states.

The incidence of intestinal metaplasia (IM) was studied in 159 specimens from gastric mucosa. Rare in histologically normal specimens (4%), the IM showed the highest incidence in patients with gastric carcinoma (75%). Intermediate values were observed in chronic atrophic gastritis (25%) and peptic ulcer (21%). Histochemical data shows that type complete-IM was most common in benign conditions; type incomplete-IM and particularly subtype secreting sulphomucins revealed a higher frequence in the mucosa bordering carcinomas.

Mucin histochemistry in Barrett's esophagus.

Specimens from twelve patients with Barrett's esophagus and four additional cases of esophageal carcinoma who had Barrett's epithelium were histologically and by mucin histochemistry examined. Specialized epithelium was observed in 10/12 non cancerous patients. In 9 of these either gastric-fundic or junctional epithelium were seen. All patients with carcinoma had evidence of specialized epithelium. Sulphated mucins were preponderant in biopsies from 7 of the 9 patients with dysplasia either alone or associated with carcinoma. In all 5 specimens with specialized epithelium but without dysplasia or carcinoma, sialomucins were predominant.

[The role of Campylobacter pylori in gastroduodenal pathology]. / Contributo alle indagini sul ruolo del Campylobacter pylori nella patologia gastroduodenale.

Biopsy specimens from the gastric antral mucosa of 194 patients with upper gastrointestinal symptoms were studied with the Warthin-Starry silver stain to demonstrate the presence of Campylobacter Pylori (CP). Of these patients, 44 had peptic ulcer visible on endoscopic investigation. Spiral bacteria were detected in 70 out of 75 specimens with histologically active gastritis (93%), in 34 of 54 specimens with inactive form of gastritis (63%) and in 26 of 65 specimens without morphological changes (40%). Of 44 patients found to have gastric or duodenal ulcers, 33 also had bacteria. No significant differences between patients with endoscopically visible peptic ulcer and those without ulcer were seen. Our results indicate a close relationship between the active form of chronic gastritis and Campylobacter; however they do not show a definite association with peptic ulcer.

Morphological study of the gastric antral mucosa colonized by campylobacter pylori.

Antral biopsies from 56 patients who underwent gastroscopy for upper gastrointestinal symptoms were studied by transmission electron microscopy. Campylobacter pylori was demonstrated in specimens from 39 patients. The bacteria were present in 3 of the 8 normal specimens and in 36 of the 48 cases with chronic gastritis. Electron microscopy showed that organisms were located deep the mucous layer in intimate relation with the luminar surface of the antral epithelium. No ultra-structural evidence was found to suggest bacterial invasion of the mucosa or phagocitic ingestion by neutrophils. Our results indicate a close correlation between active inflammation and Campylobacter pylori.

[Manometric evaluation of esophageal motor activity during diabetes mellitus]. / Valutazione manometrica dell'attività motoria esofagea in corso di diabete mellito.

Intraluminal manometry was used to assess the motor activity of the oesophagus and upper (UES) and low (LES) oesophageal sphincter in 10 patients, 5 female and 5 male, average age 35.9 range 17-50, suffering from insulin-dependent diabetes mellitus. Non-invasive cardiovascular tests were also performed to evaluate autonomous neuropathy together with control tests of glyco-metabolic compensation (fructosamine and HbA1c). An increase in the basic tone of the UES was observed in 8 patients while in 3 this was associated with its incomplete release. Five patients evidenced aspecific motor disturbance such as spontaneous motor activity characterised by repetitive segmentary waves at times with biphasic appearance. IOS activity was within normal limits. It is considered that these disturbances may be attributable to the autonomous neuropathy that often complicates diabetes mellitus and that oesophageal motor disturbance, albeit aspecific, should be considered an early sign of autonomous neuropathy. It is therefore though that manometric oesophageal study may be considered a useful investigative tool for early evidencing of disturbances linked to autonomous neuropathy.

[Gastric transit of a radiolabelled liquid meal in a group of patients with insulin-dependent diabetes mellitus]. / Studio del transito gastrico di un pasto liquido radiomarcato in un gruppo di pazienti affetti da diabete mellito insulino-dipendente.

The functional alterations in the digestive tract observable during diabetes mellitus are frequent albeit often asymptomatic. They affect several different districts and are still not clearly defined aetiopathogenetically. It was therefore decided to evaluate the gastric transit times of a balanced liquid meal labelled with 99-Tc-colloidal sulphide in a group of patients suffering from insulin-dependent diabetes and in a group of 10 controls. The anatomical integrity of the oesophago-gastro-duodenal tract has been evaluated by endoscopy and histology. Transit times (T/2) proved significantly increased in diabetics (92.38 +/- 33.397 minutes) compared to the controls (48.63 +/- 16.423 minutes), p 0.001. No correlation was observed between gastric transit times, duration of the diabetic disease, degree of glyco-metabolic compensation and presence of autonomous neuropathy.

A case of classical Kaposi's sarcoma in B-cell chronic lymphocytic leukemia (B-CLL).

We report a case of classical Kaposi's sarcoma (KS) in a patient affected by B-cell chronic lymphocytic leukemia for 2 years and who had not received any antiblastic treatment. At the ultrastructural analysis the leukemic cell showed rather immature features, and the immunologic phenotype (absence of detectable cytoplasmic Ig, and expression only of the DR, B2 and IgD lambda molecules on the surface membrane) proved its intermediate level of maturity, its monoclonality and relative rarity. The patient presented a complex immunologic deficiency, revealed not only by the monoclonality of the B lymphocytes and their low degree of maturity, but also by the almost total absence of T helper lymphocytes, by the high reduction in NK activity, by the very scarce proliferative response to the polyclonal mitogens PHA, ConA and PWM, and by a complete anergy to the skin test of delayed reactivity. The search for antibodies against the viruses EBV, CMV, HTLV-I and HTLV-III in the serum was negative. At the HLA typing, the patient was DR5, as are most classical KS and/or B-CLL patients. The data are discussed in relation to documented non-casual association between B-CLL and KS. We stress that immunosuppression may play an important role in the pathogenesis of both diseases and the possibility of their being conditioned by common genetic HLA-associated factors of predisposition.