Campylobacter pyloridis in peptic ulcer disease: microbiology, pathology, and scanning electron microscopy

Campylobacter pylori in a sample of Finnish population: relations to morphology and functions of the gastric mucosa

The occurrence of Campylobacter pylori (CP) was examined in 179 subjects representing a sample collected from the population of South Finland. In a normal antral and body mucosa CP was present in 5% and 11% and in superficial gastritis (SG) in 71% and 91% of subjects, respectively. In atrophic gastritis (AG) of antrum and body the prevalence of CP decreased significantly with an increasing degree of atrophy, so that CP was not found in severe body AG. Different combinations of antral and body gastritis revealed a characteristic pattern. Campylobacter pylori was lacking when antral and body mucosa were normal, but was present in 41% when normal mucosa was associated with gastritis in the opposite area. In SG affecting diffusely antrum and body, the bacterium was present in every case, but when SG was associated with AG in the opposite area it was lacking in 29% of the subjects. When SG affecting both areas was compared with SG accompanied by different degrees of AG in the body, there was a highly significant decrease of the prevalence of CP in antrum and body along with an increasing degree of AG in the body. This decrease showed a highly significant positive correlation with the acid output. On the whole, acid output correlated well with the occurrence of CP in both antrum and body. Thus the prevalence of CP was 10% in achlorhydria and rose up to 100% in cases with acid output above 30 mmol/h. The presence of CP did not correlate with signs of acute inflammation, but correlated significantly with those of chronic inflammation. No correlation was found in the antrum and a significant negative one in the body, between CP infestation and the extension of intestinal metaplasia. It is concluded that increased pH of gastric contents and mucus secreted by intestinalised glands may create unfavourable conditions for survival of the bacteria and might explain the decrease in the prevalence of CP in the more severe degrees of AG. The present results, however, give no definite answer to the question of the pathogenic significance of CP in the development of chronic gastritis.

Campylobacter pylori gastritis in the acquired immunodeficiency syndrome

Campylobacter pylori has been associated with gastritis, duodenitis, and duodenal ulceration in the immunocompetent individual. It has been described within the superficial mucus layer, in interepithelial junctions, and occasionally in the microcanaliculi of epithelial cells, but never in the lamina propria. We describe a case of invasive C. pylori in a patient with the acquired immunodeficiency syndrome and discuss its clinical presentation and histopathological findings.

In search of an animal model for experimental Campylobacter pylori infection: administration of Campylobacter pylori to rodents

Various mouse strains and Lewis rats were either orally or intravenously infected with high inocula of Campylobacter pylori and bacterial counts in the liver, spleen, heart, kidneys, and the stomach were followed over time. The intravenously infected animals displayed transient bacteremia and colonization of their livers and spleens. A loglinear decrease led to complete bacterial clearance after 72 hours. Oral administration of Campylobacter pylori neither resulted in colonization nor tissue invasion in any of the infected mice, even if infection had occurred under complete drug-induced achlorohydria. We conclude that under the conditions chosen, mice and rats are not suited for an animal model for experimental Campylobacter pylori infection.

Campylobacter pylori in peptic ulcer disease. III. Symptoms and paraclinical and epidemiologic findings

Only a few publications have dealt with the subjective symptoms, the paraclinical findings, or the epidemiology in relation to cultivation of C. pylori. Seventy-two patients answered a questionnaire containing questions about symptoms, dietary habits, smoking, and animal contact. C. pylori was cultivated from the biopsy specimens of 41 of these patients, and 31 were culture-negative. In addition, leukocyte count, differential count, and blood immunoglobulins were measured. In many culture-positive patients a variation in symptoms during the year was found, and symptoms had lasted more than 5 years. This was statistically significant for non-ulcer patients. In addition, we found initial abdominal pain and present vomiting to be significant features, but they did not seem to have any clinical significance. Unlike Marshall & Warren, we did not find ructus to be related to infections with C. pylori. In all other respects we found no differences between culture-negative and culture-positive patients. It was not possible to detect any descriptive variables in patients with C. pylori infections.

Acid secretion and serum gastrin levels in individuals with Campylobacter pylori

Campylobacter pylori may cause gastritis and has been proposed as an etiologic factor in the development of peptic ulcer. However, it may be an acid-sensitive microbe and before it can be implicated in the pathogenesis of peptic ulcer, it should be consistently found in ulcer patients with normal acid secretion. Thirty-six patients with C. pylori by Warthin-Starry stain underwent gastric analysis; 25 were normochlorhydric and 11 hypochlorhydric. Ulcers were present in 19 normochlorhydric patients (10, gastric; 9, duodenal) and 2 hypochlorhydric patients (gastric). Median basal acid output was higher for those with duodenal ulcer (38 mmol/h) than gastric ulcer (28 mmol/h) or miscellaneous endoscopic features (33 mmol/h). The hypergastrinemia seen in 12 patients with negative secretin provocation tests was believed to be due to various nongastrinoma conditions. Campylobacter pylori was found in 6 normogastrinemic patients with elevated acid output and in 1 gastrinoma patient with marked acid hypersecretion. Histologic chronic gastritis was present in all subjects and 29 had active chronic gastritis. Twenty-three patients were taking H2-receptor antagonists at the time of diagnosis which did not seem to interfere with culture results. Using standard acid secretory tests, we conclude that C. pylori can survive in a wide range of acid conditions.

Effect of treatment on Campylobacter pylori in peptic disease: a randomised prospective trial

This study investigated the effect of colloidal bismuth subcitrate and cimetidine on Campylobacter pylori in peptic disease. In 74% of 135 patients with peptic disease diagnosed at endoscopy C pylori was detected before treatment. Compared with cimetidine, colloidal bismuth subcitrate significantly decreased the incidence of C pylori after six weeks of treatment (p less than 0.001). In the colloidal bismuth subcitrate group, subsequent healing of the lesion was correlated with the clearance of C pylori, unlike in the cimetidine group. C pylori was strongly associated with the presence of histological gastritis, which was decreased by colloidal bismuth subcitrate (p less than 0.001).

Clinical spectrum of the upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs. Natural history, symptomatology, and significance

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve rheumatic pain and are in extensive use. Symptomatic complications of NSAIDs requiring the discontinuation of their use occur in 2 to 10 percent of patients with rheumatic diseases in sharp contrast to the common asymptomatic problems of gastroduodenal erosions, ulcerations, and bleeding, with resulting anemia in more than 40 percent of these patients. Opinions concerning the clinical significance of these complications are not uniform. The natural history of the effects of NSAIDs on the gastroduodenal mucosa reveals a sequence of initial subepithelial hemorrhage over a 24-hour period followed by gastroduodenal erosions and ulcerations in the next two weeks. From one week to three months, gastroduodenal erosions and ulcerations disappear in about half of the patients as an adaptation to continuing NSAID ingestion occurs. Hemorrhage may occur at any time in most patients and in a small minority (1 percent) it is massive. Non-aspirin NSAIDs (NANSAIDs) exhibit significantly fewer complications than do aspirin. These complications, however, demand considerable clinical attention and are ordered in a constant hierarchy, suggesting variable risks of complications among agents. NSAIDs are a blessing for those who have chronic pain, but that blessing does not prevent significant asymptomatic complications in the same patients. Prophylaxis for high-risk groups, such as women over the age of 65 years, should be subjected to study.

Peptic ulcer disease in the pediatric population

Peptic ulcer disease occurs in infants, children, and adolescents. Primary and stress ulcers pose a challenge to the pediatrician, who needs to arrange for appropriate diagnostic and therapeutic services. Highlights of our understanding of the pathophysiology, genetics, natural history, diagnosis, and therapy of peptic ulcer disease are presented.

Bacterial gastroenteritis

Acute diarrhea is a major cause of childhood morbidity. Important advances in the understanding of bacterial gastroenteritis have been made in the past two decades. This article reviews the epidemiology, pathogenesis, and methods of diagnosis of bacterial gastroenteritis. Bacterial enteric pathogens common to North America are discussed in more detail.

Microabscesses in gastric biopsies shown by acridine orange staining

Acridine orange staining of endoscopic biopsies of gastric mucosa was used in 70 patients with various upper gastrointestinal symptoms to identify Campylobacter pylori abscess formations with polymorphonuclear leucocyte infiltration. In comparison with cultures, the staining test proved to be a rapid and reliable test particularly in outpatient clinics as results are available in 6-8 min, thus enabling any necessary treatment to start immediately.

Pathogenetic implications of ultrastructural findings in Campylobacter pylori related gastroduodenal disease

There is now substantial evidence that Campylobacter pylori (Cp) is able to colonize the gastroduodenal mucosa and is responsible for active chronic gastritis, its role in duodenitis, gastric ulceration and duodenal ulceration is still under debate. Cp has a lot of characteristics which are prerequisites for a pathogen: the typical S-shape, the corkscrew-like movement and the powerful urease and protease enzymes. These features allow a rapid movement through the mucous layer to permit access to the apical membranes of the surface mucous cells. There they adhere directly to the membranes and induce several ultrastructural alterations: degeneration of microvilli, depletion of mucous granules and an increase in sialic-acid rich glycoproteins in the apical part of the cytoplasma. Cp weakens the tight-junction complex and is found between the cells and sometimes intracellularly. Cp is phagocytized by invading polymorphonuclear leukocytes and causes an intense inflammatory response. These observations clearly demonstrate pathological alterations which in the cellular level induced by Cp with the result of a disrupted mucosal barrier of the stomach and the duodenum.

Campylobacter pylori is associated with chronic gastritis but not with active peptic ulcer disease

Campylobacter pylori is supposed to be involved in the pathogenesis of gastroduodenal peptic ulcer diseases and chronic gastritis. In order to study whether the Campylobacter pylori in the stomach of peptic ulcer patients is related to ulcer itself or to a co-existing chronic gastritis, we examined the frequency of the bacteria in Giemsa stained histological sections of biopsy specimens from a series of patients with active peptic ulcer and from series of non-ulcer control subjects. We found no difference in the frequency of Campylobacter- positive cases between ulcer patients and non-ulcer controls when the comparison was done within the same category of chronic gastritis; e.g., within the category of chronic superficial gastritis 74% and 78% of cases showed the bacteria in antral biopsies from ulcer patients and from non-ulcer controls, respectively. In both ulcer patients and control subjects, in similar way in both antral and body mucosa, the Campylobacter pylori was strongly associated with chronic superficial gastritis but was more weakly associated with chronic atrophic gastritis, and the bacteria were only occasionally seen in normal mucosa. We conclude that Campylobacter pylori is associated with chronic gastritis in peptic ulcer patients but is not related to active ulcer.

Campylobacter associated gastritis in patients with non-ulcer dyspepsia

Gastric biopsy specimens from 109 patients with non-ulcer dyspepsia were retrospectively examined. Sixty one patients had gastritis and there was a strong correlation with the presence of Campylobacter pyloridis. Ninety eight per cent were positive in large numbers for C pyloridis by histological examination or by culture, or both. Of 48 patients with normal histological results, 21 had evidence of C pyloridis by histological examination or culture, or both, but in small numbers. It is concluded that there is a quantitative rather than a qualitative association between C pyloridis and gastritis.

Culture of the organisms and histochemical identification

The detection of Campylobacter pylori in the upper gastrointestinal tract has important implications for the pathogenesis and treatment of peptic disease. C. pylori is best isolated from biopsies using blood agar or chocolate blood agar incorporating a selective supplement. Plates should be incubated under microaerophilic conditions for five days. A Gram's stain of a biopsy smear provides a more rapid result but the organism may be patchy in its distribution. Of the histochemical methods used, the H & E stain reveals the presence or absence of gastritis and the Warthin-Starry Silver Stain is the most frequently used to detect this organism. The diagnosis of C. pylori infection is now possible in most pathology laboratories.

Campylobacter pylori

Worldwide Campylobacter pylori is a major cause of active chronic gastritis in man. This curved spiraled microorganism can readily be detected within the mucusgel especially in the antrum, in particular in patients suffering from peptic ulcer disease or non-ulcer dyspepsia, rarely in individuals with normal gastroduodenal mucosa. Increasingly arguments are being presented in support of a pathogenetic role of C. pylori in non-ulcer dyspepsia and in peptic ulcer disease. There is a striking discordance between in vitro antibiotic sensitivity, and in vivo efficacy with respect to suppression or eradication of the organism. At present the combination of colloidal bismuth subcitrate and amoxicilline or tinidazole appears to be encouraging with respect to longterm eradication of this peculiar microorganism. Eradication by antibacterial treatment ultimately may result in histologic normalization of the gastric mucosa. To what extent peptic ulcer disease. There is a striking discordance between in vitro antibiotic sensitivity, and in.

Persistence of Campylobacter pyloridis despite healing of duodenal ulcer and improvement of accompanying duodenitis and gastritis

Campylobacter pyloridis has been associated with antral gastritis and duodenal ulcer. To study the pathogenetic role of these organisms in duodenal ulcer, endoscopic biopsies, two from the first part of duodenum, four from antrum, and four from body and fundus, were taken before and after four weeks of cimetidine treatment (1.2 g/day) from 67 patients with active duodenal ulcer. The biopsies were examined for the presence and severity of any inflammation by two independent pathologists in the absence of any clinical information and for the occurrence and density of Campylobacter pyloridis by culture and Warthin-Starry stain. Before treatment, inflammation was present in 71.1, 100, and 25.8%, while the organisms were present in 34.3, 91.0, and 79.1% of the duodenal, antral, and fundal biopsies, respectively. With complete healing of duodenal ulcer, inflammation was present in 48.9, 98.2, and 30.2%, while the organisms were present in 25, 76.7, and 63.3% of the respective mucosae. With ulcer healing, duodenitis became significantly milder (P less than 0.05). With improvement of gastritis and duodenitis, there was no significant change in the occurrence and density of Campylobacter pyloridis. These findings indicate that healing of duodenal ulcer is not influenced by the presence of Campylobacter pyloridis, which is frequently found in the gastroduodenal mucosa of patients with duodenal ulcer, but does not appear to be associated with mucosal inflammation except in the antrum.

Establishment of gastric Campylobacter pylori infection in the neonatal gnotobiotic piglet

Campylobacter pylori, a gram-negative microaerophilic bacterium, has been implicated in the genesis of human gastritis, dyspepsia, and gastroduodenal ulceration. Previous attempts to reproduce the diseases in conventional laboratory animal species have been unsuccessful. To determine if neonatal gnotobiotic piglets were susceptible to C. pylori, we orally challenged two litters (n = 17) with 10(9) CFU after pretreating them with cimetidine. Controls housed in separate units received nothing or peptone water alone. Piglets were examined 1, 2, 3, and 4 weeks after challenge. Colonization by the bacterium and inflammation of the gastric mucosa persisted throughout the study period. Organisms were revealed by Warthin-Starry silver stain to reside between the mucus layer and the gastric epithelium. Culturing of samples from sites along the gastrointestinal tract revealed that the bacterium colonized essentially only the gastric and proximal duodenal mucosae. Gross pathological changes were restricted to the stomachs of infected piglets and consisted of submucosal edema, increased gastric mucus production, and progressive development of mucosal lymphoid follicles. Microscopic lesions consisted of transient neutrophilic infiltrates followed by diffuse and follicular infiltrations of mononuclear leukocytes into the mucosa and submucosa. Alcian blue-periodic acid-Schiff stains suggested that the infection resulted in the depletion of mucopolysaccharide production by deep gastric glands. These data indicate that gnotobiotic piglets reproduce many of the features of diseases associated with C. pylori in humans.

Prepyloric erosions: an entity of its own among erosive gastric lesions. A morphologic and dynamic study of gastric mucosa in patients with gastric erosions

The morphology and dynamics of the gastric mucosa were examined in 130 patients with gastric mucosal erosions by using mathematical methods based on stochastic principles. The results were compared with those of controls representative of the general population. The progression of antral gastritis was less rapid in erosion patients than in the controls (p less than 0.001), but body gastritis increased with age, as expected. In patients with prepyloric erosions body gastritis showed less rapid progression with age than in the controls (p less than 0.01) or in other erosion patients (p less than 0.05). Antral gastritis increased, as in the controls, and more rapidly than in other erosion patients (p less than 0.01). The preservation of the body mucosa in patients with prepyloric erosions despite ageing is similar to that seen in patients with duodenal ulcer disease, suggesting a common acid-related pathogenesis.

Comparative investigations about three different identification systems for Campylobacter pyloridis from human antrum mucosa

Campylobacter pyloridis (C. p.) which was first isolated in 1983 in Australia by Marshall and Warren from human gastric mucosa has since been associated with chronic gastritis and ulceration of stomach and duodenum. A typical characteristic of this microorganism is very strong urease formation. Therefore, from the appearance of that enzyme in the gastric mucosa colonization with C. p. can be inferred. The investigations reported here were done to compare the cultivation of C. p. as a direct proof of the presence of this microorganism with two different enzymatic procedures to be used as a rapid indirect method for demonstration of the presence of C. p. A total of 100 patients were involved. The results show rather good agreement between all three procedures used (80%), so that, at least for epidemiological surveys, the demonstration of urease may be used as an indirect procedure for the demonstration of the presence of C. p.

Gastric Campylobacter-like organisms, gastritis, and peptic ulcer disease

Although the presence of gastric bacteria has been long established, the recognition and isolation of Campylobacter pylori and similar organisms has opened a new era in the understanding of inflammatory gastroduodenal conditions. Visualization or isolation of gastric Campylobacter-like organisms (GCLOs) is significantly associated with histologic evidence of gastritis, especially of the antrum. Correlation with peptic ulceration also exists but probably is due to concurrent antral gastritis. Outbreaks of hypochlorhydria with concomitant gastritis have been attributed to GCLO infection, and a human volunteer became ill after ingesting C. pylori. Despite rapid microbiologic characterization of the organisms and the epidemiology, pathology, and serology of infection, the pathogenetic significance of GCLOs remains unknown. Whether GCLOs cause, colonize, or worsen gastritis must be considered an unanswered question at present. The efficacy of antimicrobial treatment of GCLO infection on the natural history of gastritis is not presently resolved. Nevertheless, GCLOs are at the least an important marker of inflammatory gastroduodenal disease, and attempts to ascertain their clinical significance are clearly warranted.

Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children

We investigated the presence of Campylobacter pylori colonization of the gastric mucosa and of histologic evidence of gastritis in a prospective study of 71 consecutive children undergoing upper gastrointestinal tract endoscopy and gastric biopsies because of gastrointestinal symptoms. Two tissue samples from the gastric antrum were obtained from 67 of the 71 children (mean age [+/- SD], 11.4 +/- 3.8 years). One sample was evaluated for evidence of gastritis and stained with silver to detect organisms morphologically resembling campylobacter. The second sample was cultured for C. pylori, and a portion was used to perform a urease-screening test for the presence of C. pylori. Antral gastritis was diagnosed histologically in 18 of 67 patients. C. pylori was identified by both culture and silver staining on the antral mucosa in 7 of 10 patients with unexplained gastritis (primary gastritis) but in none of 8 patients with gastritis associated with an identifiable underlying cause (secondary gastritis). C. pylori was not identified in any of the 49 cases with normal histologic features. The urease-screening test was positive in only three of six patients with a positive culture for C. pylori. Duodenal ulcers were diagnosed by endoscopy in five patients. Each of the five had C. pylori on the antral mucosa, but organisms were not identified on the duodenal mucosa. We conclude that the presence of C. pylori on the antral mucosa is specifically associated with primary antral gastritis and may also be associated with primary duodenal ulceration.

Campylobacter-like organisms in chronic gastritis, peptic ulcer, and gastric carcinoma

Biopsy samples were taken from the gastric mucosa of 209 patients endoscoped for dyspepsia symptoms. Campylobacter-like organisms (CLOs) were cultured from 74 of 179 (41.4%) cases and seen in sections from 110 of 209 (52.6%) cases and in smears from 119 of 209 (56.9%) cases; totally, 145 of 209 cases were positive, giving a rate of 69.4%. CLOs were positive in 45 of the 57 (78.9%) patients with superficial gastritis, in 52 of the 64 (81.3%) with atrophic gastritis, in 18 of the 21 (85.7%) with gastric ulcer, in 12 of the 14 (85.7%) with duodenal ulcer, and in 8 of the 10 (80.0%) with stump gastritis, whereas only a few CLOs were found in 3 of the 15 (20.0%) histologically normal subjects and in 7 of the 28 (25.0%) patients with gastric carcinoma. The organisms seem to live more frequently in diseased mucosa and are chiefly recognized through their characteristic morphology and habitat. A significant association between the presence of CLOs and chronic gastritis or peptic ulcer disease was noted, and the positive rate and the number of CLOs correlated highly with the activity of chronic gastritis. No such correlation was observed in gastric carcinoma. These findings support the view that CLOs may be etiologically related to chronic gastritis and peptic ulceration, even though their precise role still remains to be determined.

Campylobacter-like organisms and gastritis: histopathology, bile reflux, and gastric fluid composition

We studied a prospective series of 107 randomly chosen dyspepsia patients without gastric ulcer for the association of spiral Campylobacter-like organisms (CLO) with features of antral and fundal gastritis and duodenogastric reflux. CLO were observed in 38% of the patients. The scores for all classes of inflammatory cells in both antral and body mucosa were significantly higher in the CLO-positive patients than in the CLO-negative ones (p less than 0.001), and foveolar hyperplasia was also associated with CLO (p less than 0.05). Metaplasia and glandular atrophy in the antral mucosa were significantly commoner in the CLO-positive group (p less than 0.05 and p less than 0.01, respectively). The body gastritis score correlated significantly with age in the CLO-negative patients (R = 0.33, p less than 0.01) but not in the CLO-positive ones. There were no significant differences between the groups with regard to duodenogastric reflux or intragastric pH. The results confirm that CLO are associated with gastritis, most notably superficial gastritis in the body and atrophic gastritis in the antrum, but their aetiological significance remains to be proved.

Campylobacter-like organisms in patients with gastric ulcer

The occurrence of Campylobacter-like organisms (CLO) was studied in the gastric mucosa of 33 patients with gastric ulcer and 33 age- and sex-matched controls with non-ulcer dyspepsia, and the relation of CLO to the severity of gastritis was determined in both groups. CLO was significantly commoner in the ulcer patients (57.5%) than in the non-ulcer cases (33.3%) (p less than 0.05); this was related to a higher frequency of antral atrophic gastritis in the former. It is suggested that CLO may be associated with chronic antral gastritis and hence with gastric ulcer, but the causal relationship remains unclear.

In vitro susceptibility of Campylobacter pyloridis to cimetidine, sucralfate, bismuth and sixteen antibiotics

The in vitro susceptibility of recent Danish human clinical isolates of Campylobacter pyloridis to cimetidine, sucralfate, bismuth subsalicylate and sixteen antimicrobial agents was determined by an agar-dilution technique. Benzylpenicillin was the most active drug (MIC90 = 0.1 microgram/ml); ampicillin, erythromycin, gentamicin and ciprofloxacin were slightly less active. All strains were resistant to 100 micrograms sulfamethizole, and nalidixic acid also had little activity on weight basis. Of the three anti-peptic ulcer drugs, bismuth subsalicylate was most active (MIC90 25 micrograms/ml), but sucralfate and cimetidine also had antibacterial activity, although only little (MIC90 3200 micrograms/ml).

Medium supplementation for growth of Campylobacter pyloridis

Experiments were conducted to define the growth requirements of Campylobacter pyloridis, a newly discovered organism associated with gastritis and peptic ulcers. Two clinical isolates were streaked onto various media, and growth was assessed semiquantitatively according to relative colony size and extent of growth through the streak. The growth obtained on fresh chocolate agar, composed of GC agar base (Difco Laboratories, Detroit, Mich.) plus 1% hemin, was used as a reference. The organism grew on both GC agar base and Mueller-Hinton agar without supplementation, but less well than on chocolate agar. No growth occurred on tryptic soy or brucella agar. Supplementation of brucella agar with 1 or 5% horse serum or 0.1 or 1.0% cornstarch supported growth to about the same level as GC agar base alone. Supplementation with hog gastric mucin or methyl cellulose supported weak growth. GC agar base with 1% starch or 0.2% charcoal supported growth as well as chocolate agar. Experiments with brucella broth provided similar results. Cornstarch and methyl cellulose partially replaced the requirement for serum, but methyl cellulose and hog gastric mucin did not. These results show that some form of supplementation is necessary for growth of C. pyloridis. This can be starch, serum, charcoal, or hemin, but hemin is not an absolute requirement for growth.

Assessment of Campylobacter-like organisms in the postoperative stomach, iatrogenic gastritis, and chronic gastroduodenal diseases: preliminary observations

Campylobacter-like organisms (provisionally named C. pyloridis) were demonstrated in gastric biopsy specimens by histopathologic analysis and bacterial culture. C. pyloridis organisms were found in 12 of 26 patients (46%) with gastric or duodenal ulcer but in none of 10 healthy volunteers without histologic evidence of gastritis. Iatrogenic antral gastritis, induced by 7 days of treatment with nonsteroidal anti-inflammatory drugs, was not associated with the presence of C. pyloridis. Organisms were found in 6 of 24 patients who had undergone gastric operations, but the prevalence of C. pyloridis was not higher in those with symptoms of alkaline reflux gastritis than in asymptomatic postgastrectomy control patients. We conclude that C. pyloridis is less common in patients with drug-induced and postoperative gastritis than in patients with peptic ulcer.

Campylobacter pyloridis in peptic ulcer disease. I. Gastric and duodenal infection caused by C. pyloridis: histopathologic and microbiologic findings

In this study 153 patients with dyspepsia were biopsied in the gastric antrum and duodenum. All specimens were investigated histopathologically and microbiologically for the presence of Campylobacter pyloridis, and the type of inflammation was recorded in accordance with Morson's criteria. C. pyloridis was found beneath the mucus close to the epithelial cells and mostly in connection with granulocytic infiltration (active gastritis). C. pyloridis was cultured from all of 10 patients with histologically active gastritis and active duodenitis, in 86% of 64 patients with active gastritis and morphologically normal duodenum, and in only 5% of 79 patients without morphologic gastric and duodenal changes. The close relation between active gastritis and C. pyloridis shows that C. pyloridis plays an important role in gastric inflammation, as it fulfils the criterion for a localized bacterial infection.

Invasion of campylobacter-like organisms in the duodenal mucosa in patients with active duodenal ulcer

The ultrastructure of campylobacter-like organisms found within duodenal biopsy specimens from 7 of 24 patients (28%) with active duodenal ulcer is described. Their curved shape and variable size are similar to what has previously been reported in descriptions of light microscopies. The organisms were found at the edge of active duodenal ulcers exclusively near neutral-mucous producing antral cells, to which they can adhere. The presence of these bacteria within cells and in the intercellular fluid implies that they can penetrate through the cell membrane or through tight intercellular junctions. The occurrence of these bacteria as well as numerous polymorphonuclear leukocytes in the afflicted regions suggests that the bacteria originally described by Warren and Marshall are indeed pathogenic and that their influence on ulcer healing should be included in designing treatment protocols.

Detection of Campylobacter pyloridis in patients with antrum gastritis and peptic ulcers by culture, complement fixation test, and immunoblot

The association of Campylobacter pyloridis with antrum gastritis and peptic ulcers was described. We investigated antral biopsies from 180 patients who underwent gastroscopy. By culture or Gram stain or both, we found overall 98 (54%) of them to be positive for C. pyloridis. In the various groups the following percentages were found to be positive: normal antral mucosa 3% (n = 30); moderate superficial antrum gastritis, 49% (n = 83); severe superficial antrum gastritis, 86% (n = 44); duodenal ulcer, 83% (n = 54); and gastric ulcer, 72% (n = 18). A serological screening that used a complement fixation test yielded the following results: highest rates of positive complement fixation titers were seen in patients with severe gastritis and those with duodenal ulcers, both with 79%; the lowest incidence was in a group of 20 blood donors, with 5%. Positive complement fixation titers in gastritis patients also correlated well with characteristic patterns on immunoglobulin G and A immunoblots, while there was no specific reactivity observed on immunoglobulin M immunoblots.

Campylobacter pyloridis and associated gastritis: investigator blind, placebo controlled trial of bismuth salicylate and erythromycin ethylsuccinate

An investigator blind trial was performed comparing bismuth salicylate, erythromycin ethylsuccinate, and placebo in the treatment of Campylobacter pyloridis associated gastritis in patients without peptic ulceration. Fifty patients fulfilled the study criteria. There was a strong correlation between the presence of C pyloridis and histologically confirmed gastritis. Clearance of organisms led to improvement of the gastritis. C pyloridis was cleared from 15 patients; of these, 13 had gastritis initially, which resolved in 12. Conversely, gastritis resolved in only four of 32 patients not cleared of organisms (p less than 0.0001). There was significantly greater improvement in endoscopic appearances in the patients cleared of C pyloridis compared with those whose infection persisted (p less than 0.001). In the three treatment groups organisms were cleared from 14 of 18 patients receiving the locally active bismuth salicylate, only one of 15 patients receiving erythromycin ethylsuccinate, and none of 17 patients taking placebo. These findings suggest that the ideal antimicrobial for the successful eradication of C pyloridis associated gastritis should be locally active, stable at low pH, and should penetrate gastric mucus. The resolution of gastritis and improvement in endoscopic appearances associated with clearance of C pyloridis support the view that these organisms may play a part in this condition.

Susceptibility of Campylobacter pyloridis to three macrolide antibiotics (erythromycin, roxithromycin [RU 28965], and CP 62,993) and rifampin

The presence of Campylobacter pyloridis in the gastric mucosa was recently linked to peptic ulcer disease. This study compared the inhibitory activity of three macrolide compounds (erythromycin, roxithromycin [RU 28965], and CP 62,993) and rifampin against 10 clinical isolates of C. pyloridis. The macrolides were equally effective against the test strains, with MICs ranging from 0.06 to 0.5 microgram/ml; rifampin was less active, with MICs ranging from 0.25 to greater than 1 microgram/ml. Erythromycin and the two new macrolide derivatives are potentially useful agents in the treatment of infections caused by C. pyloridis.

Colloidal bismuth subcitrate and ranitidine in the short-term treatment of benign gastric ulcer. An endoscopically controlled trial

Colloidal bismuth subcitrate (CBS) in the form of a chewable tablet has been compared with ranitidine in the short-term treatment of benign gastric ulcers. Eighty patients were admitted to this randomised single blind study. Endoscopic control was carried out after 4 weeks, and after 8 weeks when healing was incomplete or had not occurred at the 4-week examination. After 1 month of therapy the healing rates were 70% with CBS and 62.5% with ranitidine (P = not significant). At two months the corresponding cure rates were 87.5% and 79%, respectively (P = not significant). Antacid consumption was higher in the group treated with ranitidine, but the difference was not statistically significant. Patient cooperation was good and similar in the two groups. These findings confirm that CBS, in tablet form, is at least as effective as ranitidine in the acute treatment of benign gastric ulcers.