title: Helicobacter pylori-associated chronic atrophic gastritis involving the gastric body and severe disease by Vibrio cholerae.
abstract: Evidence has associated chronic infection by Helicobacter pylori with chronic gastritis, low gastric acid production and an increased risk of life-threatening cholera. However, the relationship of specific patterns of histological damage in the gastric mucosa associated with H. pylori infection and the occurrence of cholera has not been described. The purpose of this study was to compare the gastric pH and histopathological findings in gastric biopsies taken from patients with severe diarrhoeal disease due to Vibrio cholerae with those taken from a control (cholera-negative) population. Thirty-five H. pylori-positive patients who had severe dehydration from culture-confirmed cholera (cases) and 40 patients with H. pylori but with no history of cholera (controls) were recruited. Gastric pH was measured and multiple biopsies were taken from the gastric antrum and body for histopathological examination. The results revealed that patients with severe cholera had a significantly higher prevalence of hypochlorhydria at endoscopy compared with controls. Furthermore, cases had significantly more chronic atrophic gastritis (45.7% vs. 12.5%; P=0.002) and intestinal metaplasia (37.1% vs. 2.5%; P<0.01) in the gastric body than controls. Our findings suggest that the nature and location of these gastric lesions may predispose a subset of H. pylori-infected individuals to severe disease by V. cholerae.
authors.affiliation: The Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Calle Honorio Delgado 430, San Martin de Porres, Lima 31, Peru.
authors.forename: Raúl
authors.initials: R
authors.lastname: León-Barúa
authors.forename: Sixto
authors.initials: S
authors.lastname: Recavarren-Arce
authors.forename: Erick
authors.initials: E
authors.lastname: Chinga-Alayo
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez-Ulloa
authors.forename: David N
authors.initials: DN
authors.lastname: Taylor
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
authors.forename: Dominique
authors.initials: D
authors.lastname: Eza
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002771:Cholera / Q000150:complications / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000150:complications / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D010568:Peru