Keywords
How to Cite
Abstract
The aim - to identify the frequency of Helicobacter pylori infection, atrophic and metaplastic changes in the gastric mucosa in patients with Barrett's esophagus.
Materials and methods. A retrospective study of 7392 cases of complex esophagogastroscopy with a biopsy of the epithelium of the mucous membrane of the esophagus and stomach, followed by a morphological study, was conducted on the basis of the Medical Centre “Oberig” clinic for the period 2010-2018. Statistical data was performed using the MedStat package. To assess the prevalence of changes in the esophagus and stomach, a 95% confidence interval was calculated using the Fisher angular transformation method. The probability of differences between group averages and relative values was determined using the method of parametric statistics by calculating the t-Student criterion. The difference between the average values was considered significant at p <0.05. To compare the frequencies in different groups, the Pearson chi-square test was used.
Results. Endoscopically cylindrical columnar metaplasia of the esophagus epithelium was detected in 2994 patients (40.5% CI 39.4% -41.6% at a significance level of p = 0.05). In a histological examination, esophageal epithelial metaplasia was confirmed in 2910 patients (39.4% CI 38.3%-40.5%). 876 cases of gastric-type esophagus epithelial metaplasia were diagnosed (30.1%, CI 28.4-31.5%); 2034 cases of intestinal type metaplasia (69.9%, CI 68.2-71.6%). Histological examination of biopsy samples of the gastric mucosa in 5640 (76.3%, CI 75.3-77.3%) patients revealed atrophy of the gastric mucosa. In 2532 cases (34.3%, CI 33.2-35.3%), complete and incomplete intestinal metaplasia of the gastric epithelium was diagnosed. In 4524 (61.2%, CI 60.1-62.3%) patients, Helicobacter pylori was detected. In the presence of H. pylori, gastric esophageal epithelial metaplasia was detected in 510 of 3558 (14.3%, CI 13.2-15.5%, p = 0.05), intestinal metaplasia of the esophagus epithelium - in 966 of 4014 (24.1% CI 22.8 -25.4%, p = 0.05).
Conclusion. Esophageal epithelial metaplasia is a common pathology, accounting for 39.4% among patients who underwent esophagogastroscopy. The presence of a strong connection between intestinal metaplasia of the epithelium of the esophagus and atrophy of the gastric mucosa with intestinal metaplasia of the epithelium of the stomach was found. Esophageal epithelial metaplasia is significantly less common with Helicobacter pylori gastritis, therefore the presence of H. pylori has a protective effect on the occurrence of esophageal epithelial metaplasia.
References
Кuryk O. G., Коlomoiets М. Y., Yakovenko V. О., ТеreshchenkoТ. V., Тkachenko R. P. (2018). Кliniko-morphologichna diagnostyka stravokhodu Barretta [Clinical and morphological diagnosis of Barrett's esophagus]. Clinical surgery, 85(7), 9-12. https://doi.org/10.26779/2522-1396.2018.07.09
Chandrasoma P. T. (2013) Histologic definition of gastro-esophageal reflux disease. Curr. Opin. Gastroenterol., 29, 460-7. https://doi.org/10.1097/MOG.0b013e32836228fa
Chang Y., Liu B., Liu G.S., Wang T., Gong J. (2010) Short-segment Barrett's esophagus and cardia intestinal metaplasia: A comparative analysis. World J Gastroenterol., 16(48), 6151–6154. http://dx.doi.org/10.3748/wjg.v16.i48.6151
Chen C. C., Hsu Y. C., Lee C. T., Hsu C. C., Tai C. M., Wang W. L., Tseng C. H., Hsu C. T., Lin J. T., Chang C. Y. (2016) Central Obesity and H. pylori Infection Influence Risk of Barrett's Esophagus in an Asian Population. PLoS One, 11(12), e0167815. https://doi.org/10.1371/journal.pone.0167815
Er˝oss B., Farkas N.,Vincze Á., Tinusz B., Szapáry L., Garami A., Balaskó M., Sarlós P., Czopf L., Alizadeh H., Rakonczay Z. J, Habon T., Hegyi P. (2018). Helicobacter pylori infection reduces the risk of Barrett’s esophagus: A meta-analysis and systematic review. Helicobacter, 23, e12504. https://doi.org/10.1111/hel.12504
Fischbach L. A., Nordenstedt H., Kramer J. R., Gandhi S., Dick-Onuoha S., Lewis A., El-Serag H.B. (2012). The association between Barrett's esophagus and Helicobacter pylori infection: a meta analysis. Helicobacter, 17, 163-175. https://dx.doi.org/10.1016%2Fj.cgh.2013.08.029
Fischbach L. A., Graham D. Y., Kramer J. R., Rugge M., Verstovsek G., Parente P., Alsarraj A., Fitzgerald S., Shaib Y., Abraham N.S., Kolpachi A., Gupta S., Vela M.F., Velez M,. Cole R., Anand B., El Serag H.B. (2014). Association between Helicobacter pylori and Barrett's esophagus: a case-control study. Am J Gastroenterol., 109(3), 357-68. https://dx.doi.org/10.1038%2Fajg.2013.443
Fitzgerald R.C., di Pietro M., Ragunath K., Ang Y., Kang J.Y., Watson P., Trudgill N., Patel P., Kaye P.V., Sanders S., O'Donovan M., Bird-Lieberman E., Bhandari P,, Jankowski J.A., Attwood S., Parsons S.L., Loft D., Lagergren J., Moayyedi P., Lyratzopoulos G., de Caestecker J. (2014). British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut, 63, 7-42. https://doi.org/10.1136/gutjnl-2013-305372
Khandwalla H. E., Graham D. Y., Kramer J. R., Ramsey D. J., Duong N., Green L. K., El-Serag H. B. (2014) Barrett's esophagus suspected at endoscopy but no specialized intestinal metaplasia on biopsy, what's next? Am J Gastroenterol., 109(2), 178-82. https://dx.doi.org/10.1038%2Fajg.2013.408
Kountouras J., Polyzos S.A., Zeglinas C., Tzathas C., Nikolaidis N., Vardaka E., Kountouras C., Anastadiadis S., Anastasiadis K., Giorgakis N., Gavalas E., Tzivras D., Katsinelos P. (2017). Helicobacter pylori-related metabolic syndrome as predictor of progression to esophageal carcinoma in a subpopulation-based Barrett's esophagus cohort. Gastrointest Endosc., 85, 462–463. https://doi.org/10.1016/j.gie.2016.07.017
Malfertheiner P., Megraud F., O'Morain C. A., Gisbert J. P., Kuipers E. J., Axon A. T., Bazzoli F., Gasbarrini A., Atherton J., Graham D.Y., Hunt R.,Moayyedi P., Rokkas T., Rugge M., Selgrad M., Suerbaum S., Sugano K., El-Omar EM. (2017). European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection — the Maastricht V/Florence Consensus Report. Gut, 66(1), 6-30. https://doi.org/10.1136/gutjnl-2016-312288
Pascarenco O. D., Boeriu A., Mocan S., Pascarenco G., Drasoveanu S., Galeanu M., Dobru D. (2014). Barrett's esophagus and intestinal metaplasia of gastric cardia: prevalence, clinical, endoscopic and histological features. J Gastrointestin Liver Dis., 23, 19-25. https://www.ncbi.nlm.nih.gov/pubmed/24689092
Quante M., Quante M., Bhagat G., Abrams J.A., Marache F., Good P., Lee M.D., Lee Y., Friedman R., Asfaha S., Dubeykovskaya Z., Mahmood U., Figueiredo J.L,. Kitajewski J., Shawber C., Lightdale C.J., Rustgi A.K., Wang T.C. (2012). Bile acid and inflammation activate gastric cardia stem cells in a mouse model of Barrett-like metaplasia. Cancer Cell, 21, 36-51. https://dx.doi.org/10.1016%2Fj.ccr.2011.12.004
Rubenstein J. H., Inadomi J. M., Scheiman J., Schoenfeld P., Appelman H., Zhang M., Metko V., Kao J. Y. (2014). Association between Helicobacter pylori and Barrett's esophagus, erosive esophagitis, and gastroesophageal reflux symptoms. Clin Gastroenterol Hepatol., 12, 239-245. https://doi.org/10.1016/j.cgh.2013.08.029
Sharma P., Hawes R.H., Bansal A., Gupta N., Curvers W., Rastogi A., Singh M., Hall M., Mathur S. C., Wani S. B., Hoffman B., Gaddam S., Fockens P., Bergman J. J. (2013). Standard endoscopy with random biopsies vs. narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. Gut, 62, 15 – 21. https://doi.org/10.1136/gutjnl-2011-300962
Sonnenberg A., Turner K.O., Spechler S.J., Genta R.M. (2017). The influence of Helicobacter pylori on the ethnic distribution of Barrett's metaplasia. Aliment Pharmacol Ther., 45, 283-290. https://doi.org/10.1111/apt.13854
Thrift A. P., Pandeya N., Smith K. J., Green A. C., Hayward N. K., Webb P. M., Whiteman D.C. (2012). Helicobacter pylori infection and the risks of Barrett's oesophagus: a population-based case-control study. Int J Cancer, 130(10), 2407-16. https://doi.org/10.1002/ijc.26242
Turner K., Genta R. M. (2016). Barrett's esophagus: the inverse association with non atrophic Helicobacter gastritis is stronger than with atrophic metaplastic gastritis. Gastroenterology, 150, 257-258. https://doi.org/10.1016/S0016-5085(16)30923-4
Zullo A., Hassan C., De Francesco V., Manta R., Romiti A., Gatta L. (2014). Helicobacter pylori infection and gastroesophageal cancer: unveiling a hamletic dilemma. Ann Gastroenterol., 27, 291-293. https://www.ncbi.nlm.nih.gov/pubmed/25331513
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.