Chronic Atrophic Gastritis: Early Diagnosis in a Population WhereHelicobacter pyloriInfection Is Frequent

Abstract

Chronic atrophic gastritis (CAG) is a premalignant condition characterized by loss of gastric antral deep glands. The histologic changes in antral gastric biopsy specimens from 54 Peruvian patients with dyspepsia were studied to detail the development and characteristics of CAG. Ninety-six percent of the biopsies revealed severe superficial mucosal inflammation and 89% showed deep inflammation. Moderate or severe CAG was present in 36 (67%) of the 54 patients. In the early stages of CAG, a glandular lymphoid adherence lesion was noted in 17 (31%) of the 54 biopsy specimens. This lesion consisted of lymphocytes adherent to the antral deep gland cells and was associated with glandular epithelium alterations. The late stage was characterized by small glands, remnants of glands, and gland replacement with a fibrocellular infiltrate or intestinal metaplasia. We propose that the development of CAG probably proceeds via a stereotyped sequence, with an early deep inflammatory component that may trigger local gland destruction and eventual permanent loss.

Helicobacter pylori from Peruvian Amerindians: Traces of Human Migrations in Strains from Remote Amazon, and Genome Sequence of an Amerind Strain

“…Unrooted trees were constructed by Neighbor-Joining (Mega 3.1, http://www.megasoftware.net/). Gastric pathology was scored on antrum and corpus biopsies that had been fixed in pH 7.2 buffered formalin, embedded in paraffin, sectioned, stained with hematoxylin/eosin and graded histologically as described [66].…”

Validation of String Test for Diagnosis of Helicobacter pylori Infections

“…Paraffin sections were cut, Warthin-Starry silver and hematoxylin and eosin stained, and scored for H. pylori microscopically. Pathological criteria were as described previously (21). Biopsy samples positive either by culture or histologically were considered to be H. pylori positive and taken as the "gold standard" against which the sensitivity of the string test was compared.…”

Severe gastritis in the Peruvian Andes

“…The slides were read by experienced pathologists who were blinded to all clinical and endoscopic information. To study morphological changes, each evaluable histological section was assessed with the use of a specially designed format 10 that considered the following characteristics.…”

“…The inflammatory infiltrate involved the entire interfoveolar space but did not extend deeper than the gland neck. The combination of damage to the surface epithelium and superficial inflammatory infiltrate has been called ‘chronic superficial gastritis’ (CSG) and is patchy when caused by H. pylori infection 10 . In Peru CSG is nearly always associated with H. pylori infection 12,13 …”