Lectin-affinity electrophoresis for the detection of AFP microheterogeneities in patients with hepatocellular carcinoma

Our aims were to ascertain the analytical performance and diagnostic efficiency of a new lectin-affinity electrophoresis and antibody-affinity blotting method for separating and identifying fucosylated AFP. We also compared the diagnostic efficiency of fucosylated AFP with that of total AFP in the early diagnosis of neoplastic liver diseases. In 32 patients with hepatocellular carcinoma (HCC) and in 19 subjects with benign liver diseases, total AFP was assayed using an enzyme immunoassay, while AFP fractions (L1, L2 and to cathode L3 fucosylated) were separated using lectin-affinity electrophoresis followed by antibody-affinity blotting. No significant difference was found between the total AFP values of patients with HCC and those of patients with benign liver disease (p > 0.05). In patients with HCC the fucosylation index of AFP (L3%) was significantly higher (p < 0.0001) than that in patients with benign liver disease. Our findings suggest that fucosylated AFP is of diagnostic value in differentiating between hepatocellular carcinoma and benign hepatic diseases, and that its measurement may be useful in the early detection of hepatocarcinoma in patients with chronic liver disease.

Fine-needle biopsy in focal liver lesions: the usefulness of a screening programme and the role of cytology and microhistology

We evaluated the diagnostic usefulness of 244 ultrasound-guided fine-needle biopsies (FNB) in 226 patients with suspected liver malignancies. A malignancy was detected in 166 cases (73%) -145 hepatocellular carcinomas (HCC), 21 metastases; benign lesions were aspirated in 60 cases (27%). The sensitivity of FNB was 93%, with 100% specificity. In the FNB false-negative cirrhotic nodules, a final diagnosis of HCC was reached on repeating the biopsy 1-8 months later. When both cytological and microhistological examinations were performed, the positive correlation between the two techniques was 80%, with a slightly higher sensitivity for microhistology (93%). The malignancies diagnosed were potentially resectable in 26% of cases. We experienced 1 acute complication of FNB and 1 case of needle tract tumour seeding. These results confirm that FNB is useful in diagnosing malignant liver tumours. We believe that US-guided FNB is the first-choice invasive technique for assessing focal benign lesions and malignant tumors in the liver.

Gastric epithelial dysplasia. How clinicopathologic background relates to management

BACKGROUND

Gastric epithelial dysplasia (GED) in metaplastic mucosa is considered the most advanced preinvasive lesion in the multistep morphogenesis of intestinal-type gastric cancer (GC). The rate of GED's evolution into GC is still under debate and probably is related to pathologic and clinical parameters other than the dysplasia itself. The aim of this study was to evaluate whether clinical aspects (sex and age) and/or morphologic variables (GED grade, coexisting atrophic gastritis) are relevant to the outcome of dysplasia, with a view toward initiating the establishment of a rational follow-up protocol for practical GED management.

METHODS

Ninety-three patients harboring GED (G1: 56, G2:34, G3:18) were followed for more than 12 months according to a previously-agreed protocol. Regression, progression, or evolution into GC were detected for each grade of GED. Multivariate analysis was used to check the independence of clinical and pathologic variables in the progression of GED into more severe dysplastic lesions and/or as risk factors for evolution into GC.

RESULTS

Age, male sex, GED grade and grade of coexisting atrophic gastritis proved independent risk factors for GED progression, with no significant interactions. Only GED grade (G2 and G3) was significantly associated with carcinomatous evolution. In G1-GED, age and the grade of coexisting atrophy proved to be independent risk factors for carcinomatous evolution.

CONCLUSIONS

In G1-GED, more stringent follow-up should be recommended for older patients with coexisting high grade atrophic gastritis; stringent follow-up is always mandatory for G2-GED; and a surgical approach is justified in G3-GED.

[Ultrasound guided fine-needle aspiration biopsy in the diagnosis of hepatocellular carcinoma]

This retrospective study was undertaken to evaluate the diagnostic usefulness of 244 sonographically guided fine- needle aspiration biopsy in 226 patients with ultrasonographically suspected hepatic malignant lesions. A final diagnosis of malignancy was established in 166 cases (73%) (145 hepatocellular carcinoma, 21 metastasis); benign lesions were aspirated in 60 cases (27%). The diagnostic sensitivity of this technique was 93%, with 100% specificity. When both cytology and microhistology were obtained, the positive correlation of the two techniques was 80% In the series of 244 fine-needle aspiration biopsy the authors had only one acute complication. They report one case of needle tract tumor seeding after biopsy. These results confirm the usefulness of sonographically guided fine-needle aspiration biopsy in diagnosing malignant hepatic tumors. The procedure is simple, safe, free of important side effects. The authors believe that ultrasound guided fine-needle aspiration biopsy represents the first choice of invasive technique in the assessment of hepatic focal benign lesions and malignant tumours.

[Role and behavior of cathepsin B and cathepsin L in gastric cancer]

Cathepsin B and cathepsin L--cysteine proteinases--may play an important role in cancer invasion and metastasis. The authors determined tissue antigen concentrations of cathepsins, using the ELISA method, in 25 patients with gastric cancer (17 males, 8 females, mean age 62, range 31-84). They evaluated the possible relationship that these proteinases may have with the presence of metastases, differentiation and histotype. Significantly higher cathepsin B and cathepsin L antigen levels were found: 1. in gastric cancer tissues vs. normal tissues distant from tumors (CATB: p < 0.05, CATL: p < 0.005); 2. in diffuse vs. intestinal type cancers (p < 0.05); 3. in patients with poorly vs. well-differentiated cancers (p < 0.05); in gastric cancers with vs. without metastasis (p < 0.05). Their results confirm that cathepsin B and L play an important role in gastric cancer invasion and metastasis. Considering the significantly higher cathepsins detected in cancers with metastasis, a poor differentiation and of diffuse histotype, these proteinases could be useful for identification gastric cancer patients with a poor prognosis.

Determinants for the development of chronic atrophic gastritis and intestinal metaplasia in the stomach

This study aimed to identify the factors associated with the development of gastric precancerous changes, in a prospective series of patients undergoing endoscopy. Risk factors and associated mucosal changes were evaluated in 134 endoscoped patients affected by chronic non-atrophic (n = 76) or atrophic gastritis (CAG) (n = 32), with or without intestinal metaplasia (IM), or lacking any major histological changes (n = 26). The following variables were taken into account: age, alcohol consumption, smoking habit, vitamin C intake (using a questionnaire), gastric juice vitamin C (HPLC on gastric juice samples obtained at endoscopy), H. pylori infection, gastric mucosa malondialdehyde (MDA; a measure of free radical production) and extent of CAG in gastric biopsies (only for IM). Tissue MDA levels were significantly higher, and vitamin C levels significantly lower in CAG and IM patients (P = 0.01). Multiple regression analysis showed significant correlations for: CAG vs age (P < 0.02), MDA (< 0.02) and gastric vitamin C (< 0.05); IM vs age (P < 0.0005), CAG (< 0.0005) and MDA (< 0.001). Using stepwise discrimination analysis, the independent variables included in the model were: for CAG, age (P < 0.003), MDA (< 0.05), gastric juice vitamin C (< 0.05); for IM, CAG (P < 0.0005), age (< 0.001), MDA (< 0.03) and vitamin C intake (< 0.05). H. pylori was not included. The major determinants for CAG and IM were age, free radical production (as measured by MDA), vitamin C (for CAG) and vitamin C intake and CAG (for IM).(ABSTRACT TRUNCATED AT 250 WORDS)

Iron storage, lipid peroxidation and glutathione turnover in chronic anti-HCV positive hepatitis

BACKGROUND/AIMS

Little is known about the pathogenesis of liver damage related to hepatitis C virus. The presence of steatosis or increased ferritin levels, and preliminary data on the relevance of iron as a prognostic factor prompted us to ascertain whether hepatitis C virus-related liver damage might be mediated by iron accumulation.

METHODS

We evaluated the degree of hepatic inflammation and steatosis, serum ferritin, transferrin saturation and iron levels, tissue iron concentrations and iron index, liver glutathione and malondialdehyde in 33 males and 20 females with chronic hepatitis C virus- or hepatitis B virus-related hepatitis (42 + 11). We also considered six patients with both alcohol abuse and hepatitis C virus, four males with chronic alcoholic liver disease and four males with genetic hemochromatosis, giving a total of 67. All diagnoses were histologically confirmed. Patients with cirrhosis were excluded.

RESULTS

Our data show that: 1. Steatosis is more frequent in hepatitis C virus and hepatitis C virus+alcohol abuse patients; 2. In males, serum ferritin and tissue iron are significantly higher in hepatitis C virus- than in hepatitis B virus-positive patients (p < 0.01 and 0.05); transferrin saturation is higher (p < 0.05) in hepatitis C virus-positive than in hepatitis B virus-positive patients only when males and females are considered together; 3. Serum ferritin and transferrin saturation only correlate with liver iron (r = 0.833 and r = 0.695, respectively, p = 0.00001); tissue iron is significantly higher in hepatitis C virus- than in hepatitis B virus-positive patients (p < 0.05); 4. In patients with chronic hepatitis, serum ferritin is a better marker of liver iron storage than transferrin saturation, both in males and in females; 5. Hepatitis C virus-positive patients have higher malondialdehyde levels and activation of turnover of glutathione, probably in response to free-radical-mediated liver damage. Females have lower liver iron levels but similar trends.

CONCLUSIONS

These findings suggest that hepatitis C virus-related liver damage is characterized by increased iron storage (possibly induced by the virus) which elicits a free-radical-mediated peroxidation, with consequent steatosis and activation of glutathione turnover.

[Local transcatheter arterial chemoembolization in the palliative treatment of inoperable hepatocellular carcinoma]

Hepatocellular carcinoma is a tumor with high mortality. Adequate oncological therapy is essential to modify the poor prognosis. Transcatheter arterial chemoembolisation has been proposed as a useful and well-tolerated treatment for unresectable carcinoma. In the study 51 patients with unresectable carcinoma (mean age 61.6, range 45-81, Child-Pugh A = 34 patients, Child-B = 13, Child-C = 4; Okuda I = 33 patients, Okuda II = 18) underwent chemoembolisation. A total of 122 procedure were performed, with a median number of 2.4 (range 1-6) per patient. One and two year survivals are 91% and 74% respectively (Child-A: 100% and 82%; Child-B: 100% and 63%; Child-C 0% at 1 year). The difference among the 3 groups is statistically significant (p = 0.001). Median overall survival is 20 months, with 22, 20 and 6 month in Child-A, B and C patients respectively (p = 0.006). Commonly reported side effects and biochemical changes included: fever, pain and increased serum amylase, transaminase levels. One patient developed a liver abscess and died of liver failure. In addition, in 18 patients (35%) mild to severe changes in glucose metabolism were also observed. Mild hyperglycemia was observed in 14 patients, with severe derangement in 4 patients (8%). It is suggested that careful evaluation of glucose metabolism is advisable in patients being considered for chemoembolisation. Their results confirm the usefulness of chemoembolisation in Child-A and B patients with unresectable hepatocellular carcinoma.

Hepatocellular carcinoma in alcoholic cirrhosis: is sex hormone imbalance a pathogenetic factor?

OBJECTIVE

A sex hormone imbalance has been reported in patients with hepatocellular carcinoma (HCC). We investigated the serum levels of eight sex hormones in patients with alcohol-related and non-alcohol-related cirrhosis and HCC.

METHODS

Luteinizing hormone, follicle-stimulating hormone, estradiol, progesterone, testosterone, androstenedione, dehydroepiandrosterone and sex hormone binding globulin were assayed in 81 patients with cirrhosis (59 men, 22 women) and 97 with HCC and cirrhosis (82 men, 15 women). Hepatitis B or hepatitis C virus infection was present in 58% of patients with cirrhosis and 69% of patients with HCC. Alcohol abuse was the aetiopathogenetic factor in the remaining patients.

RESULTS

In men, mean testosterone levels were at the lower limit of the normal range for both patients with HCC and for controls with cirrhosis. Mean estradiol levels were increased both in patients with HCC and in those with cirrhosis, but patients with alcohol-related HCC had higher estradiol levels (P = 0.0002). An index of sex hormone imbalance, the estradiol to testosterone ratio (ETR), was calculated. The ETR was significantly higher in patients with alcohol-related HCC (P = 0.0002). Multiple regression analysis showed that the ETR correlated best with patients' diagnosis (P < 0.05). In women, the ETR was significantly lower in patients with HCC than in controls with cirrhosis.

CONCLUSIONS

Men with alcohol-related HCC are characterized by an oestrogen and androgen imbalance and have a higher ETR than patients with other types of liver damage. Since sex hormones modulate hepatocellular proliferation, our data suggest that a sex hormone imbalance plays a role in hepatocarcinogenesis in patients with alcohol-related cirrhosis.

Zinc, iron, and peroxidation in liver tissue. Cumulative effects of alcohol consumption and virus-mediated damage--a preliminary report

In an attempt to elucidate further the mechanisms involved in alcohol-mediated liver damage and the correlation between alcohol and viruses in chronic liver lesions, we determined the levels of liver glutathione (GSH), thiobarbituric acid reactive substances (TBARS), iron (Fe), and zinc (Zn) in 31 patients with chronic viral hepatitis (CAH), 6 with alcohol-related chronic hepatitis (CALD), 6 with alcoholic cirrhosis (AC), 8 with primary biliary cirrhosis (PBC), and 10 healthy controls (C). Liver GSH was significantly lower in CALD and AC patients (p < 0.005). TBARS levels were significantly higher in CAH, CALD, and PBC patients (p < 0.001, < 0.02, and < 0.001, respectively). In CAH patients, alcohol consumption correlated inversely with GSH and directly with TBARS (p < 0.05). Patients with both CAH and alcohol abuse had a further reduction in liver GSH levels (p < 0.005). Tissue levels of Fe were significantly increased in CALD and AC patients with respect to controls and CAH patients, whereas no significant difference was observed in Zn. These data confirm that patients with chronic ethanol exposure reveal a depletion in liver GSH content clearly correlated with an increase in lipid peroxidation and Fe liver storage. On the other hand, these findings appear to suggest no significant change in Zn levels in chronic hepatitis.

Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter prospective follow-up study. Interdisciplinary Group on Gastric Epithelial Dysplasia

BACKGROUND/AIMS

Because the precancerous significance of gastric epithelial dysplasia (GED) is still under debate, this study attempts to ascertain whether a prospective follow-up of GED can contribute to clarifying its clinical and pathological relationships with gastric cancer (GC).

METHODS

One hundred twelve patients with mild (G1), moderate (G2), and severe (G3) GED or diagnosed as indefinite for dysplasia were prospectively followed up with a standardized endoscopic and bioptic protocol.

RESULTS

Evaluation of GED outcome refers only to 93 patients with a follow-up period longer than 12 months. Regression of dysplasia was documented in 36%, 27%, and 0% of G1, G2, and G3 GED cases, respectively. Progression to more severe dysplasia or evolution into GC was detected in 21%, 33%, and 57% of G1, G2, and G3 GED cases, respectively. Evolution into GC was documented for all grades of dysplasia and correlated significantly with high-grade atrophic gastritis. A high prevalence of early GC (86.9%) was also observed.

CONCLUSIONS

GED is a pre-invasive lesion, and carcinomatous evolution increases proportionally with its histological grade. Bioptical follow-up is mandatory for all histological grades of GED and significantly increases the likelihood of GC being detected in its early stages.

Hepatocellular carcinoma in primary biliary cirrhosis

Primary biliary cirrhosis is considered a low risk for the development of hepatocellular carcinoma. We evaluated the incidence of hepatocellular carcinoma in a cohort of 89 female primary biliary cirrhosis patients and, as a control group in 73 female patients with cirrhosis of a different etiology. The patients underwent ultrasound and alfa-fetoprotein determination every 6 months. Two patients developed hepatocellular carcinoma in the primary biliary cirrhosis and three in the control group, respectively. The Relative Risk for hepatocellular carcinoma in primary biliary cirrhosis patients was 0.7. However, when considering only stage IV, primary biliary cirrhosis patients with cirrhosis, the Relative Risk was actually 1.5 with respect to controls, with 1.4% cases of hepatocellular carcinoma per year. These data suggest that the risk of hepatocellular carcinoma is similar in female patients with primary biliary cirrhosis and in female patients with cirrhosis of a different etiology.

CCL4-induced liver cirrhosis and hepatocellular carcinoma in rats: relationship to plasma zinc, copper and estradiol levels

A number of biochemical events accompany the development of chronic liver disease and its evolution into hepatic cancer. Low plasma zinc and high plasma copper levels have been observed in individuals with advanced hepatocellular liver disease. Moreover, many investigators have demonstrated an increase in serum estradiol levels in individuals with chronic liver disease and hepatocellular carcinoma (HCC). In the present study, the relationship between these biochemical events and HCC was investigated in an animal model. Specifically, carbon tetrachloride (CCL4) was administered intragastrically to 20 female Sprague Dawley rats for 30 weeks. All 20 animals developed cirrhosis. Six (30%) developed HCC. Significantly higher serum estradiol, zinc and copper levels were observed in the rats developing HCC as compared with those with cirrhosis alone (P < or = 0.05, 0.01 and 0.001, respectively). A trend toward increased serum levels of progesterone, ALT and total bilirubin (0.1 > or = P < or = 0.05) was found in the animals developing HCC. No differences in serum testosterone and alkaline phosphatase levels were noted between animals with and without HCC. These studies demonstrate that in animals with experimental CCL4-induced cirrhosis and HCC serum levels of estradiol, zinc and copper are increased, as is the case in man.

Pathology and ploidy in the prognosis of gastric cancer with no extranodal metastasis

BACKGROUND

The prognostic relevance of morphology in advanced gastric cancer is well known. Data on tumor cell DNA content are still inadequate and contradictory.

METHODS

Morphologic parameters and DNA ploidy were evaluated in 76 gastric cancer patients with no extranodal metastases (Stage I, 10 cases; Stage II, 20 cases; and Stage III, 46 cases), using formalin-fixed paraffin-embedded tissue. All cases were followed for at least 6 years after surgery or until death.

RESULTS

Among the potential prognostic factors analyzed by Mantel-Cox and generalized Wilcoxon statistics, male sex (P = 0.02), cardiac location of neoplasia (P = 0.02), deeper infiltration of the gastric wall (P = 0.001), vascular neoplastic invasion (P = 0.006), metastatic lymph nodes (P = 0.001), pathologic stage (P = 0.0001), and aneuploidy (P = 0.01) were significantly associated with lower survival rate. Testing of all of the above-mentioned variables by the Cox stepwise multiple regression model disclosed that factors independently associated with survival were stage (P = 0.0001), ploidy (P = 0.0006), and vascular carcinomatous invasion (P = 0.01).

CONCLUSIONS

In gastric cancer with no extranodal metastases, DNA ploidy was found to be the most significant prognostic parameter after pathologic stage.

Effect of age on gastric acid, pepsin, pepsinogen group A and gastrin secretion in peptic ulcer patients

To verify the effect of age on gastric secretions in gastric (GU) and duodenal ulcer (DU) patients, we carried out a retrospective study evaluating basal and stimulated gastric acid secretion in 427 peptic ulcer subjects aged between 12 and 73 years (GU = 74, DU = 353) in addition to studying gastric juice pepsin, serum pepsinogen group A (PGA) and gastrin in 175 patients (GU = 28, DU = 147). All subjects were then divided into groups according to their sex and age (< 30, 30-39, 40-49, 50-59 and > 60 years). Basal, maximal and peak acid outputs (BAO, MAO, PAO) were unchanged in the various age groups, though MAO and PAO were higher in males than females and in DU than in those with GU, even in the elderly (> 60 years). Pepsin and gastrin levels were unchanged at the various ages in GU and DU, while PGA was higher in males with DU aged 50 or over. This demonstrates that acid, pepsin and gastrin secretions do not change with age in ulcer patients. Acid secretion retains its typical distribution according to pathology (DU > GU) and sex (males > females), and also appears to have a fundamental pathogenetic role in peptic ulcer in the elderly.

A new method for detecting anti Helicobacter pylori antibodies: an analytical and clinical evaluation

The diagnosis of Helicobacter pylori (Hp) infection is an important goal in clinical practice. In this paper we evaluated 1. the analytical reliability of a new second-generation antigen based enzyme immunoassay (Cobas Core Anti Helicobacter pylori EIA) in detecting anti-Hp IgG antibodies, and 2. the behaviour of anti-Hp IgG in patients with chronic atrophic and non-atrophic gastritis as compared to healthy controls. The findings from the dilution curve, the values of intra and inter assay coefficients of variations (never above 10%) and of the recovery test (between 96 and 109%), confirm that the method is reliable. Serum IgG anti-Hp levels were found to be significantly higher in patients with histologically identified Hp infection, than in those negative at histology. Furthermore, the grade of histological positivity was correlated with serum IgG levels. However, we found a discrepancy between a low prevalence of Hp staining and a high prevalence of Hp seropositivity in patients with chronic atrophic or non-atrophic gastritis, but not in controls. This suggests that IgG serum determination may be more useful than histology in determining a present or previous infection in patients with chronic atrophic or non-atrophic gastritis.

Prevalence of Helicobacter pylori infection in patients with precancerous changes and gastric cancer

Several papers suggested a role for H. pylori infection in gastric cancer. We evaluated the prevalence of H. pylori infection in an endoscopic population of patients with gastric precancerous conditions and lesions by studying biopsies from 252 patients and recording the presence and degree of H. pylori infection. Patients were subgrouped as follows: chronic non-atrophic gastritis (CG), chronic atrophic gastritis (CAG), intestinal metaplasia (IM), epithelial dysplasia (ED) and gastric cancer (K). As control populations, patients with duodenal ulcer (DU) and patients with no endoscopic and histologic damage (CO) were investigated. H. pylori infection rate increased with age, but became significantly lower (P < 0.001) with the progression of gastric mucosal damage: DU 85%, CG 72%, CAG 58%, particularly in the antral type (39%), IM 63% overall, ED 44% and K 35%. The density of colonization showed the same trend (P < 0.001). Of the K patients, only 36% were H. pylori positive in the adjacent mucosa. Anti-H. pylori antibodies (IgG, IgA and IgM) were also tested. A concordance in the diagnosis between histology and serology was obtained in 82% of the cases. In our experience, H. pylori infection correlates inversely with the presence of gastric precancerous changes and cancer. A cautious interpretation of the epidemiological data regarding H. pylori infection and gastric cancer is therefore, in our opinion, mandatory.

Sex hormones and trace elements in rat CCL4-induced cirrhosis and hepatocellular carcinoma

Several biochemical events accompany and mediate the development of chronic liver disease and its evolution into cancer. Low plasma zinc and high copper levels have been observed in various liver diseases, such as liver cirrhosis and viral hepatitis, while increased oestradiol levels have been documented in chronic liver damage and hepatocellular carcinoma. We administered CCL4 intragastrically to 10 female Sprague Dawley rats for 30 weeks. All animals developed cirrhosis and four also developed hepatocellular carcinoma. Plasma levels of zinc, copper and oestradiol were significantly higher in the latter group than in animals with simple cirrhosis. Progesterone, AST and bilirubin showed a trend toward significant differences whereas testosterone and ALP levels were unchanged. These findings add to the evidence that sex hormones and trace elements are involved in the process of the development of chronic liver damage and carcinogenesis.

Early and advanced gastric cancer in the follow-up of moderate and severe gastric dysplasia patients. A prospective study. I.G.G.E.D.--Interdisciplinary Group on Gastric Epithelial Dysplasia

The role of gastric epithelial dysplasia (GED) as a biological and morphological precursor of gastric cancer has been widely investigated, but few studies have prospectively evaluated the risk of its evolution into gastric cancer. In 1985, a prospective multicenter follow-up study was undertaken on patients with high-grade (moderate or severe) GED. The study involved 49 patients, with a follow-up currently averaging 18.8 months (range: 1-70) and a mean number of 4 endoscopies (range: 2-10). Follow-up was abandoned when 2 subsequent control endoscopies and a 1-year period were negative for GED, or when neoplasia was detected. Gastric cancer was diagnosed in 16 cases (33%). The cancer was detected at an early stage in 10 patients (62%). Eleven cases (59%) were diagnosed within 1 year of follow-up and 5 cases after 13, 18, 21, 24 and 39 months, respectively. Cancer was associated with 36% of moderate GED cases and with 80% of severe cases. Dysplastic changes were no longer detectable at follow-up in 27% of the moderate cases and in 10% of the severe cases. The relative risks for the two lesions being associated with or evolving into gastric cancer were 26 and 132, respectively. In conclusion, high-grade (moderate or severe) GED is frequently associated with or evolves into gastric cancer. The follow-up of patients considerably enhances the chances of diagnosing gastric cancer in its early stages, thus making such an approach mandatory.

Pathology of the gastric antrum and body associated with Helicobacter pylori infection in non-ulcerous patients: is the bacterium a promoter of intestinal metaplasia?

A series of 115 consecutive, non-ulcerous, dyspeptic patients were examined for Helicobacter pylori (H. pylori) colonization in the gastric antral and/or body mucosa using Giemsa staining. Findings were correlated with the presence and degree of activity of superficial gastritis, deep gastritis, atrophic gastritis and with the presence of intestinal metaplasia. The prevalence of H. pylori positivity was 61.7%. In 59 of the 71 positive patients (83%), H. pylori was detected in the antrum or in both the antral and oxyntic mucosa. In the remaining 12 positive patients, H. pylori was detected only in the oxyntic mucosa nad in all these cases, the antrum showed intestinal metaplasia associated with atrophic gastritis (25%). In both antral and oxyntic mucosa, the activity of the gastritis was significantly correlated with H. pylori colonization. Linear logistic regression analysis showed that in patients with intestinal metaplasia the presence of H. pylori infection was significant in predicting the presence of more extensive intestinal metaplasia after adjusting for age. The prevalence of intestinal metaplasia types II and III was 65.5% in the H. pylori positive and 25% in the H. pylori negative patients. The antral mucosa is thought to be the elective site for H. pylori related histological lesions. At a later stage, H. pylori can be detected only in the oxyntic area while the antral mucosa shows extensive metaplastic or atrophic lesions. We would suggest that H. pylori plays a promotional role in the morphogenesis of intestinal metaplasia.

Changes in parietal and mucous cell mass in the gastric mucosa of normal subjects with age: a morphometric study

Whether or not the gastric mucosa undergoes significant changes in normal aging subjects is still open to debate. In 51 subjects undergoing endoscopy and lacking any significant endoscopic or histologic modification we evaluated mucosal thickness, gland number, numbers of parietal, chief and mucous cells at the fundus and of mucopeptic cells at the antrum, with a morphometric method, subgrouping the patients according to their age class. Our findings demonstrate that the number of parietal cells tends to increase with age and, on the other hand, the number of mucous cells is reduced in elderly subjects (p < 0.05). When considering the parietal-to-mucous cell ratio, this is significantly increased (p = 0.0005) with age. Acid secretion being an offensive factor and mucus a fundamental component of the gastric mucosal barrier, these findings suggest an increased susceptibility of the gastric mucosa to damage in the elderly.