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Panminerva Medica 1999 September;41(3):187-92

lingua: Inglese

Effect of Helicobacter pylo­ri infec­tion, age and epi­the­lial ­cell turn­over in a gen­er­al pop­u­la­tion at ­high risk for gas­tric can­cer

Bal­di­ni L., Pre­to­la­ni S. 1, Bon­vi­cini F., Miglio F. 1, Epi­fa­nio G., Gen­ti­lo­ni Sil­ve­ri N. 2, Stef­a­nel­li M. L. 3, Ber­nar­di M., Gas­bar­ri­ni G. 2

From the Department of Internal Medicine Cardioangiology, Hepatology, University of Bologna, Italy
1 Emergency Medicine Policlinico S. Orsola-Malpighi, Bologna, Italy
2 Department of Internal Medicine Catholic University, Rome, Italy
3 Internal Medicine and Gastroenterology Unit State Hospital, Republic of San Marino, Italy


Background. H. pylo­ri and age are two ­known ­risk fac­tors for atroph­ic gas­tritis and ­high epi­the­lial ­cell turn­over may be an indi­ca­tor for pre­ne­o­plas­tic chang­es in the stom­ach. We ­searched for an asso­ci­a­tion ­between H. pylo­ri, age and gas­tritis in the gen­er­al pop­u­la­tion togeth­er ­with the pro­life­ra­tive ­state ­into the ­antral muco­sa.
Methods. We exam­ined gas­tric biop­sies ­from ­antrum and cor­pus of 117 con­sec­u­tive vol­un­teers ­which ­were endo­scoped dur­ing a pop­u­la­tion ­study in San Marino. H. pylo­ri stat­us was deter­mined by ser­um IgG anti­bod­ies, rap­id ­urease ­test on biop­sies and his­tol­o­gy. Presence of gas­tritis and grad­ing of inflam­ma­tion, activ­ity, intes­ti­nal met­a­pla­sia and atro­phy ­were ascer­tained ­using Sydney System. On a sub­sam­ple of 36 sub­jects with­out endo­scop­ic ­lesions we per­formed an immu­no­his­to­chem­i­cal ­study on gas­tric ­cell pro­life­ra­tion ­using ­PCNA. A com­put­er-aid­ed ­count was ­made on ­stained epi­the­lial ­cells to eval­u­ate label­ing ­index. Statistical anal­y­sis was per­formed ­using χ2 ­test and lin­e­ar regres­sion.
Results. Inflammatory infil­trate (­both activ­ity and mono­nu­cle­ar ­cells), (p<0.0001) and intes­ti­nal met­a­pla­sia (p<0.004) ­were sig­nif­i­cant­ly high­er in H. pylo­ri pos­i­tive sub­jects. Atrophic gas­tritis was ­present in 82% H. pylo­ri pos­i­tive sub­jects vs 17.6% (p<0.0001). Labeling Index was sig­nif­i­cant­ly high­er in H. pylo­ri pos­i­tive sub­jects (p<0.005) and it was cor­re­lat­ed ­with inflam­ma­tion and atro­phy (p=0.001). Elderly H. pylo­ri neg­a­tive sub­jects ­have a low­er ­cell turn­over (p=0.006) but H. pylo­ri infect­ed sub­jects do not ­show any ­decrease of Labeling Index ­with age.
Conclusions. In the gen­er­al pop­u­la­tion of an ­area ­with ­high gas­tric can­cer ­rate, H. pylo­ri infec­tion is asso­ciat­ed ­with atroph­ic gas­tritis and ­with hyper­pro­lif­er­a­tive gas­tric ­cell ­state. These con­di­tions are ­present ­either in ­young and old age and ­increase the neo­plas­tic ­risk of gas­tric muco­sa.

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