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Abstract
Helicobacter pylori infection is closely related to stomach mucosal pathology as it plays a main role in the occurrence of chronic gastritis, gastric ulcer and it is considered to be a first grade oncogene of gastric carcinoma by the World Health Organization.
Many studies clarified the relationship between H pylori infection and chronic gastritis and gastric ulcer, but very few studies compared between them and in the view of the undoubted importance of H pylori organism, this study examined H pylori infection and other mucosal histopathological feature in cases of chronic gastritis and gastric ulcer in different age groups.
The study included the archival cases of formalin fixed paraffin embedded blocks previously diagnosed as chronic gastritis or gastric ulcer which were received by the pathology laboratory of Suez Canal University Hospital in the period between 1995 and 2005 according to estimated sample size and inclusion and exclusion criteria. Serial sections cut from each block 4-5 micron thick, four slide were prepared from each block, one stained with hematoxylin &eosin, one with giemsa, one with improved toluidin blue and one by cresyl violet. Slides were examined by light microscope; results were recorded and statistically analyzed.
-Age distribution in patients of chronic gastritis ranged from 17 years to 80 years with a mean of 52 years. In gastric ulcer; patients’ age ranged from 20 years to 75 years with mean of 55 years. -Male to female ratio was 7: 5 for chronic gastritis and 4: 1 for gastric ulcer patients.
-There is a significant difference between the two diseases regarding sex distribution.
-The most prominent presentation was dyspepsia which was 66.7% of patients with chronic gastritis and 30% of patients with gastric ulcer. The association between dyspepsia and H pylori infection was statistically significant in chronic gastritis. Hematemesis and melena were more frequent with gastric ulcer. Most of patients presented with more than one symptom.
-The relation between CLD and H pylori infection was insignificant in both diseases.
-The relation between number of endoscopic fragments and positivity for H pylori was statistically significant in case of gastric ulcer.
-Rate of H pylori infection was significantly higher in specimens of gastric ulcer than in specimens of chronic gastritis. Mucosal inflammation was equal in both and regarding activity of inflammation, glandular atrophy and intestinal metaplasia, it was higher in gastric ulcer but there were no statistically significant difference.
-Atrophy and metaplasia were significantly related to H pylori infection in both diseases.
-Higher rates of H pylori infection, atrophy and metaplasia were recorded in older age groups in both diseases.
-The three used special stains were cheap, available, easy to prepare and easy to stain with. Steps are short timed and easy identification of organisms was achieved. The giemsa stain being relatively easier to perform, familiar, and the most easily to identify the organism with.
We concluded that H pylori is a very important factor in both diseases and that the rate of infection with it is markedly higher in gastric ulcer and that the associated pathology although not significantly higher but it seems to be more severe leading with additional factors to ulcer formation. We also concluded that Giemsa stain is available, cheap, and easy to prepare and stain with, rapid and identification of the organism is easy with it.
The study recommended following strictly the Sydney system recommendations regarding number and site of endoscopic biopsy and regarding proper diagnostic