Helicobacter pylori and gastric neoplasia: evolving concepts

An unusual presentation of Helicobacter pylori infection: so-called "Russell body gastritis"

Helicobacter pylori (H. pylori) is a "slow" bacterial pathogen, which induces several gastroduodenal diseases. Varying degrees of inflammation can be present in the gastric mucosa of patients infected with H. pylori. The case presented here is a male patient suffering from dyspepsia and nausea. His upper gastrointestinal endoscopy revealed pan gastritis. Histological examination of multiple gastric biopsies taken from the body and antrum showed a rare morphological expression of H. pylori gastritis characterized by diffuse plasma cell infiltration with extensive Russell body formation. Diffuse infiltration of plasma cells with Russell bodies in gastric mucosa can cause difficulties in differentiation from neoplastic processes. However, immunohistochemically, the infiltrating cells in the gastric mucosa stained negatively with cytokeratins while they expressed both kappa and lambda light chains showing their polyclonal nature. The presence of diffuse plasma cells with Russell bodies in the gastric mucosa may represent a different presentation of H. pylori gastritis. There are only two case reports of similar presentation and both have been called "Russell body gastritis".

Australian doctors' beliefs and practice regarding Helicobacter pylori

OBJECTIVE

To determine beliefs and behaviours of Australian doctors regarding Helicobacter pylori.

DESIGN

Anonymous reply-paid postal survey mailed in December 1995 and again in March 1996.

SUBJECTS

All members on the mailing lists of the Gastroenterological Society of Australia Endoscopy Section (n = 397) and the Australian Society of Infectious Diseases (n = 264; those without medical qualifications were asked not to reply), and 400 general practitioners (GPs) randomly selected from the Royal Australian College of General Practitioners.

MAIN OUTCOME MEASURES

Differences between specialist groups in belief in a causative association between H. pylori and peptic disease and in use of eradication therapy and pre- and post-treatment testing for H. pylori.

RESULTS

92.6% of doctors believed H. pylori causes duodenal ulcer, with GPs significantly less likely to believe than gastroenterologists (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.00-0.81). In duodenal ulcer, 93.4% of doctors believed H. pylori eradication therapy should be given, but fewer (83.4%) claimed to give it "always or mostly", with GPs less likely to report giving it than gastroenterologists (OR, 0.06; 95% CI, 0.02-0.19). For non-ulcer dyspepsia, gastrointestinal surgeons were more likely than gastroenterologists to believe in a causative link with H. pylori (OR, 5.6; 95% CI, 3.0-10.7) and in a need for eradication therapy (OR, 3.6; 95% CI, 1.7-7.7). Most doctors (79.3%) believed in confirming the presence of H. pylori before eradication therapy in duodenal ulcer. Only 51.6% believed post-eradication testing necessary (45.5%), yet 79.1% reported performing it.

CONCLUSIONS

Significant differences exist between specialist groups in beliefs and self-reported behaviours regarding H. pylori.

Effect of prolonged staining with hematoxylin on detecting Helicobacter pylori in hematoxylin-eosin-stained gastric mucosa

Helicobacter pylori (H. pylori) is identifiable in hematoxylin-eosin (HE)-stained preparations, particularly under a prolonged hematoxylin staining condition. The staining intensity of H. pylori bodies was increased when the hematoxylin staining period was doubled from 5 min, the routine period of Meyer's hematoxylin staining, to 10 min. The staining intensity of the background epithelial nuclei was only mildly increased. Hematoxylin-eosin staining employing a prolonged hematoxylin staining period gave detectability of H. pylori comparable to May-Giemsa and immunoperoxidase staining. The modified HE method is thus very useful and practical for identifying H. pylori in routine gastric biopsy specimens.

Localized accumulation of Russell body-containing plasma cells in gastric mucosa with Helicobacter pylori infection: 'Russell body gastritis'

One of the gastric biopsy specimens taken from a 53-year-old male showed localized accumulation of plasma cells containing Russell bodies, in association with infection of Helicobacter pylori (H. pylori). An endoscopic study demonstrated multiple ulcer scars in the antrum. Immunohistochemically, H. pylori infection was identified both on the surface of the foveolar epithelial cells and in the cytoplasm of macrophages in the lamina propria mucosae. Plasma cells filled with 'Russell bodies', so-called 'Motts cells', were immunoreactive for CD45, CD79a and IgG. This seems to be a previously unrecognized tissue reaction in gastric mucosa associated with H. pylori infection, which we have called 'Russell body gastritis'.

Protection against oral and gastrointestinal diseases: importance of dietary nitrate intake, oral nitrate reduction and enterosalivary nitrate circulation

Over the last 20 years, dietary nitrate has been implicated in the formation of methemoglobin and carcinogenic nitrosamines in humans. This has led to restrictions of nitrate and nitrite levels in food and drinking water. However, there is no epidemiological evidence for an increased risk of gastric and intestinal cancer in population groups with high dietary vegetable or nitrate intake. A reevaluation of our currently very negative perception of dietary nitrates comes from recent research into the metabolism and enterosalivary circulation of nitrate in mammals. These studies showed that nitrate is converted to nitrite in the oral cavity that then "fuels" an important mammalian resistance mechanism against infectious diseases. Moreover, there is now evidence that the conversion of nitrate into oxides of nitrogen prevents the formation carcinogenic nitrosamines.

Review: Helicobacter pylori. Current issues and new directions

The present review outlines current management issues and controversies related to Helicobacter pylori infection. Clearance of this infection markedly reduces the likelihood of duodenal and gastric ulcer recurrence and may result in the regression of low grade primary gastric lymphoma. Recent therapeutic advances have seen the development of simpler drug regimens to treat H. pylori that have fewer side effects and are shorter in duration. Clearance of the infection can be achieved in 80-95% of patients treated, depending on the drug regimen used, compliance with medications and antibiotic sensitivity. In developed nations reinfection is uncommon after successful treatment. Data do not currently support treatment of this infection for non-ulcer dyspepsia or for the prevention of gastric cancer, although whether certain individuals or populations may benefit from such treatment remains to be clarified.