Campylobacter associated gastritis in patients with non-ulcer dyspepsia.

Abstract

SUMMARY 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.Every year about 1% of the total population will seek medical advice about upper abdominal complaints.' In about two thirds of these patients peptic ulcer, oesophagitis, active duodenitis, or gastric and oesophageal cancer are diagnosed. In one third, however, upper gastrointestinal endoscopy or x-ray picture fail to show disease. These patients are therefore diagnosed as having so called non-ulcer dyspepsia. This group of patients is heterogenous, has disorders such as gallstones and motility disorders like the irritable bowel syndrome,2 and is notoriously difficult to manage. Histological examination will often show the presence of gastritis.5Marshall and Warren's report on Campylobacterlike organisms, subsequently designated C pyloridis and their association with gastritis,6 renewed interest in this condition.7 The nature of this association remains controversial,'" 12 but it has been shown that drugs active against C pyloridis can cure gastritis.'3 As yet no exact data are available on the prevalence of C pyloridis associated gastritis among patients with non-ulcer dyspepsia. We therefore studied prospectively the presence of C pyloridis in gastric mucosa of these patients by histological and microbiological examination, in the hope of identifying a subgroup of patients who would possibly benefit from antimicrobial treatment. Patients and methodsWe studied 109 consecutive patients referred to the Accepted for publication 14 July 1987 endoscopy department because of upper abdominal pain. Patients with gastric or duodenal ulcers, reflux oesophagitis, active duodenitis, gastrectomy and carcinoma were excluded. Also excluded were those who had taken corticosteroids, non-steroidal anti-inflammatory drugs, and antibiotics up to two weeks before endoscopy.A standard history was taken from all patients using a questionnaire, which included current complaints, smoking habits, alcohol consumption, medication, and family history of upper abdominal complaints and peptic ulcer disease (table 1).One hundred and nine patients were included, 50 men (mean age 43-3 years, range 18-75) and 59 women (mean age 56-5 years, range 16-82). All patients underwent upper gastrointestinal endoscopy with an Olympus GIF Q gastroscope. The macroscopic appearance of the upper gastrointestinal mucosa was recorded and biopsy specimens were taken from the gastric antrum for culture and histological examination.HISTOLOGY

Helicobacter Pylori Associated Dyspepsia in 208 Patients From Southern Saudi Arabia

“…Also, HP appears to be closely associated with chronic active gastritis (91% of our cases) and its eradication in these cases is desirable. The benefits of eradicating HP patients with non-ulcer dyspepsia have not been fully established [5,27]. Non-ulcer dyspepsia was found in 95 cases in the current study (45.7%) and associated histologically proven gastritis was seen in 63 patients (66%).…”

“…During the last ten years, HP has rapidly gained recognition as an important etiologic factor in peptic ulcer disease [2,3], gastritis [4], and non-ulcer dyspepsia [5], and also has been found in healthy carriers [6].…”

Gastric mucosal density of Helicobacter pylori estimated by real-time PCR compared with results of urea breath test and histological grading

“…The system recommends that histopathologists make semiquantitative evaluations of gastritis, including the density of Helicobacter pylori in biopsy samples [1]. The density of H. pylori in such samples is correlated to the severity of gastritis [2,3]. The bacterial density of H. pylori in the stomach may be a predictive parameter for treatment success [4,5], and may be associated with bacterial virulence factors in ulcer pathogenesis [6].…”

Campylobacter pylori and gastroduodenal disease

“…The prevalence of C. pylori in patients with NUD is 45 to 70% and the prevalence of gastritis is similar (68,77,109,110,126,127), suggesting possible involvement of the organism in the disease. One of the problems with assessing these data is that there is an age-related increase in the prevalence of the organism (43,50,92), and, thus, C. pylori is found in about 50% of asymptomatic individuals 50 to 60 years old.…”

“…Other simpler stains have been suggested recently. These include the Giemsa (103) A number of different media have been used for recovering C. pylori, including 5 to 10% horse blood agar (24,38,98,104), 5 to 10% sheep blood agar (61,68,123,132), chocolate agar (10,14,60,77,80,109), Skirrow medium (24,104,110), and Thayer-Martin medium (10,34,98). A number of investigators found that using antibiotics in the medium to suppress contaminating bacteria was advantageous (19,24,38,61,98,132 Only minimal work has been conducted to establish which of these media is best for isolating the organism.…”