Aim-To determine if there is a correlation between the histological findings in the gastric mucosa and the degree of cell proliferation in gastric antral biopsies. Methods-Cell proliferation in gastric antral biopsies was determined by in vitro bromodeoxyuridine labelling. Histological sections were assessed using the Sydney System. Results-There was a positive correlation between antral mucosal cell proliferation and the acute inflammatory cell infiltrate (r = 0.29; p = 0.03). There was a stronger correlation with the chronic inflammatory cell infiltrate (r = 0.53; p < 0.0001) and the density of H pylori colonisation (r = 0.54; p < 0.0001). There was no correlation between gastric epithelial proliferation and the degree of atrophy. Stepwise multiple regression indicates that the only independent predictor of epithelial cell proliferation is the density of H pylori colonisation (p < 0.0001). Conclusions-H pylori increases gastric epithelial cell proliferation through the mucosal inflammatory response and probably by other means. The strong correlation between epithelial proliferation, the chronic inflammatory cell infiltrate, and the density of H pylori colonisation may have implications for gastric carcinogenesis. (J Clin Pathol 1999;52:367-371) Keywords: gastritis; epithelial kineticsWe have shown previously that epithelial proliferation is increased in H pylori gastritis aVecting antral and corpus mucosa.1 2 Eradication of the organism results in antral cell proliferation returning to normal, in contrast to persistent infection where cell proliferation remains increased on long term follow up.1 The increased cellular proliferation may be caused by the inflammatory response stimulated by H pylori infection. In order to establish whether there is a relation between the two, we have studied the relation of both the density of H pylori colonisation of the gastric epithelium and the histological changes within the gastric mucosa with the degree of cell proliferation. We have also explored the relation between antral and corpus epithelial kinetics, and the eVect of patient age, sex, and cigarette smoking.
MethodsPatients undergoing routine diagnostic endoscopy were recruited following informed consent. Those taking non-steroidal antiinflammatory drugs, antibiotics, or bismuth salts were excluded from the study. At endoscopy, biopsies were taken from the antrum (2) and corpus (2) for in vitro bromodeoxyuridine labelling and routine histological processing. This study was approved by the hospital ethics committee.
BROMODEOXYURIDINE LABELLINGTwo antral biopsies for immunostaining were put immediately into RPMI medium without L-glutamine (Gibco) containing bromodeoxyuridine (5 mg/10 ml) and placed in a water bath for 60 minutes at 37°C. They were then placed on filter paper and fixed in formalin. Using a three step immunoperoxidase technique, sections were stained with antibromodeoxyuridine (Dakopatt) antibody (1:20 dilution) for 60 minutes.