Gastric epithelium in the duodenum: its association with Helicobacter pylori and inflammation

Article Abstract:

Helicobacter pylori (H. pylori) is a bacteria that has been associated with gastritis, or stomach inflammation, and duodenal ulcers. Gastric metaplasia (over-growth) is the appearance of stomach tissue in the duodenum at the juncture where the stomach and duodenum meet, and is believed to be caused by enhanced acid production leading to acid injury. H. pylori only infects gastric mucosa, and thus can only occur in the duodenum when gastric metaplasia is present. Duodenal ulcers have been reported to be linked to excess acid production, H. pylori infection, alcohol, smoking and drugs. The presence of gastric metaplasia in the duodenum and its relationship to gender, age, alcohol consumption, cigarette smoking and nonsteroidal anti-inflammatory drug (NSAID) use was evaluated in duodenal biopsies from 471 adults and 47 children with dyspepsia (pain and indigestion). Gastric metaplasia was detected in 31 percent of the biopsies, was more common in males than females, and was more common in adults than children. No direct relationship was found between gastric metaplasia and smoking, alcohol consumption or drug use. The extent of the gastric metaplasia was related to low gastric pH (high acidity), active duodenitis (inflammation of the duodenum), and gastritis caused by H. pylori. All of the biopsy samples showing duodenitis were found to contain H. pylori. It is concluded that the development of gastric metaplasia may be stimulated by the inflammatory injury to the duodenum caused by H. pylori, and that the increase in gastric metaplasia may result in an increase in H. pylori infection, ultimately leading to ulceration. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Infection, Duodenum, Gastric mucosa

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Antral Helicobacter pylori in patients with chronic renal failure

Article Abstract:

Helicobacter pylori (HP, formerly known as Campylobacter pylori) can colonize the duodenum only in the presence of gastric metaplasia (abnormal tissue changes). Dialysis patients with chronic renal failure have a low prevalence of HP despite a high incidence of gastric tissue transformations. To explore this phenomenon, 50 end-stage chronic renal failure patients and a control group of 120 patients, who were being evaluated for upper gastrointestinal conditions, were examined by endoscopy. (An endoscope is a flexible tube with an optical system used, in this case, to observe the inside of the stomach and upper small intestine). Seventeen of the renal disease patients had upper gastrointestinal complaints. For all renal disease and control patients, 1 to 6 endoscopic biopsies were taken from the antrum (pyloric region of the stomach) and examined for active chronic inflammation, chronic inflammation, the presence or absence of lymphoid follicles, intestinal metaplasia and HP. The prevalence of HP in the antrum of the dialysis patients was significantly less than in the control group. In fact, the prevalence of HP in the renal disease cases was similar to the prevalence in healthy adults, and showed no correlation with the presence or absence of upper gastrointestinal symptoms. Additional findings are reported. The low bacterial concentration of HP in patients with end-stage renal failure may be associated with the variety of medications and antibiotics that they are required to take for their illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Chronic kidney failure, Stomach, Biopsy

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Helicobacter pylori (formerly Campylobacter pyloridis/pylori) 1986-1989: a review

Article Abstract:

In 1986, the association of Campylobacter pyloridis/pylori with gastritis and peptic ulcer was described by Goodwin et al. Their report summarized previous literature concerning Campylobacter pyloridis/pylori, now classified as Helicobacter pylori (HP). This review highlights advances in HP research since l986. The suggestion that HP may be a human disease-causing pathogen, rather than a colonizer of damaged tissue, has caused a split in the scientific community. Diagnostic procedures using noninvasive techniques are now available to evaluate patients with gastritis and ulcerative diseases. These tests are based on the production of urease by HP organisms and measure radioactively labelled carbon dioxide from labelled urea. The association of HP with gastritis and duodenal ulcer has been clearly documented, and supports the theory of multifactorial etiology. Host-parasite relationships have been reported, and describe factors relating to the parasite (adherence factors and cytotoxins) and to the host (mucus, prostaglandins, and gastrin). The presence of another possible etiologic agent (a spirillum, which also produces urease) has been noted in chronic active gastritis, mainly in the gastric pits, not attached to the epithelium. The mode of spread of HP organisms may be from mouth to mouth, or via contaminated diagnostic instruments. HP transmission will be the focus of future research; identifying this process offers the promise of disease prevention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Peptic ulcer, Gastritis

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