Article

Pathologie Infectleuse de l'estomac:Helicobacter pylori et autres germes

Laboratoire ANAP rue A.-Lambiotte, 14478 B-1030 Bruxelles (Belgique)
Acta Endoscopica (Impact Factor: 0.16). 32(2):125-132. DOI: 10.1007/BF03016651

ABSTRACT Helicobacter pylori représente de ioin la majeure partie des infections. Après une phase aiguë de courte durée, la plupart des gastrites dues
à l'Helicobacter évoluent sur un mode chronique. Leurs caractéristiques histologiques principales résultent d'altérations
dégénératives et régénératives épithéliales et d'une réponse cellulaire inflammatoire de la lamina propria. Les lésions peuvent
être classées selon le système de Sydney (revu à Houston, 1994). La détection d'Hp repose sur des colorations spéciales telles
que le Giemsa ou le Crésyl violet. L'immunocytochimie peut s'avérer utile lorsque les germes sont rares (certaines gastrites
aiguës, après traitement par antibiotiques…).

Un autre germe moins fréquent du groupe des Helicobacter est l'Helicobacter heilmannii qui contamine probablement l'homme à partir des animaux de compagnie; il produit des lésions très semblables à celles d'Hp.

CMV peut s'observer aussi bien chez l'individu immunocompétent qu'immunodéficient; il induit une grande variété de lésions
mimant parfois une atteinte cancéreuse.

Différentes mycoses peuvent se localiser à l'estomac essentiellement au niveau des tissus nécrotiques provenant des cancers
ou des ulcères. Chez les patients immunodéficients, la localisation gastrique s'inscrit souvent dans un cadre plus général.

Les autres germes parfois observés dans l'estomac, qu'ils soient bactériens, fungiques ou parasitaires sont extrêmement rares.

Helicobacter pylori represents the overwhelming part of gastric infectious pathology leaving far behind all the other bacteria. After a short
acute phase, most Hp gastritis evolve on a chronic mode. Their main histological characteristics are made of epithelial degenerative
and regenerative alterations and cellular inflammatory response of the lamina propria. The lesions can be graded according
to the Sydney System (revisited Houston from 1994). The detection of Hp can rely upon special stains such as Giemsa or Cresyl
Violet. Immunocytochemistry can be helpful when the germs are scarce (some acute gastritis, after antibiotic treatment…).

Another much less frequent Helicobacteris Helicobacter heilmannii which probably results from contaminations by pets and produces lesions very similar to those of Hp.

CMV can be observed in immunocompetent as well as immunodeficient hosts; it induces a variety of lesions, sometimes mimicking
cancer.

Various fungi can localise to the stomach mostly in necrotic tissues from cancers or ulcers. In immunodeficient patients,
the lesions can extend to various systems.

The other germs, sometimes observed in the stomach, either bacterial, fungal or parasitic are quite rare.

0 Bookmarks
 · 
311 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: We analyzed 2 antral and 1 corpus full-thickness random endoscopic gastric mucosal samples obtained from 946 patients with duodenal ulcers (6077 biopsies) and from 281 patients with nonsteroidal anti-inflammatory drug-associated gastric ulcers (1794 biopsies). We stained tissue sections with hematoxylin and eosin and Warthin-Starry silver stain and immunostained them with polyclonal antibodies against Helicobacter pylori. Hematoxylin- and eosin-stained sections from 6 patients with Helicobacter heilmannii (18 biopsies) and 23 randomly selected patients with H. pylori (68 biopsies) were evaluated and semiquantitated for the presence of acute inflammation, chronic inflammation, glandular atrophy, intestinal metaplasia, H. pylori, H. heilmannii, lymphoid follicles, or vasodilatation. Additional specimens were obtained for H. pylori culture, a CLO test, and serologic examination. H. heilmannii was detected in 6 (0.49%) of 1227 patients (14 [0.18%] of 7871 biopsies). Of these, 4 (0.42%) of 946 were patients with duodenal ulcers (9 [0.15%] of 6077 biopsies), and 2 (0.71%) of 281 were patients with nonsteroidal anti-inflammatory drug-associated gastric ulcers (5 [0.28%] of 1794 biopsies). We found H. heilmannii with hematoxylin and eosin stain, Warthin-Starry stain, and immunoperoxidase stain for H. pylori. Culture for H. pylori was negative in the four patients with duodenal ulcers. The CLO and serologic tests were positive in three of five and five of five patients, respectively. Our results indicate that H. heilmannii, like H. pylori, is associated with peptic ulcer disease (both active and inactive gastritis) and that it preferentially colonizes the gastric antrum. The severity of the H. heilmannii-associated gastritis is less intense and lymphoid aggregates are less common than in H. pylori-associated gastritis. Morphologic detection seems to be the method of choice for detecting H. heilmanni. Immunoperoxidase stain specific for H. pylori also stains H. heilmannii, indicating cross-reacting antigenic epitopes between H. heilmannii and H. pylori.
    Modern Pathology 06/1999; 12(5):534-8. · 5.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Children (227) undergoing endoscopy for upper gastrointestinal symptoms were investigated for the presence of Helicobacter pylori infection. The histological response to H. pylori infection and the presence of antral nodularity and peptic ulceration were noted. Symptomatic adults (258) undergoing endoscopy were also investigated for the presence of nodularity. H. pylori infection was detected histologically in 32 of 227 (14.1%) children. Of those children infected with H. pylori, half (50%) had antral nodular gastritis. Of 139 H. pylori-positive adults 22 (15.8%) showed nodularity. The active component of the histological response was found to be minimal or lacking in the majority of children infected with H. pylori. Twelve of the 227 children (5.3%) had peptic ulcer disease. Of these, nine were duodenal and three gastric ulcers. Of the nine children with duodenal ulceration three (33%) were infected with H. pylori. As a result of this study we conclude that (a) although antral nodularity occurs more frequently in children it is not exclusive to childhood, (b) the polymorphonuclear response in children is less than that reported in adults, and (c) peptic ulcer disease is rare in children and the present study would suggest that in children it is less frequently associated with H. pylori infection than in adults.
    Journal of Pediatric Gastroenterology and Nutrition 03/1993; 16(2):120-5. · 2.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: An intensive histological search for Helicobacter pylori in gastric biopsy specimens has led to the detection of other spiral shaped bacteria in the human gastric mucosa. The clinical and morphological findings of 39 cases (0.25% of all gastric biopsies performed in the observation period) are reported for 34 patients (87.2%) complaining of upper abdominal discomfort. Five patients (12.8%) had chronic gastritis and 34 (87.2%) chronic active gastritis. The organisms were seen by light microscopy deep in the gastric foveolae and intracellularly. The scanning and transmission electron microscopic findings show bacteria which invade and damage gastric mucosal cells. These organisms are similar to the spiral shaped bacteria found in the stomachs of cats and dogs and non-human primates. In eight patients organisms were not detected after four weeks of treatment with bismuth salts. The disappearance of the organisms coincided with resolution of the chronic active gastritis and the symptoms.
    Gut 03/1991; 32(2):137-40. · 10.73 Impact Factor

Full-text (2 Sources)

Download
6 Downloads
Available from
Aug 12, 2014