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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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