Could gastric histology be a useful marker for making decision on Helicobacter pylori eradication therapy in patients with dyspepsia?
BACKGROUND
It still remains an open debate whether Helicobacter pylori eradication is beneficial or not for the improvement of symptoms in functional dyspepsia. Differences in geographic distribution, the worldwide H. pylori genetic variability and the fact that the outcome of infection is strongly related to the virulence of the infecting strain are factors that might be driving ongoing controversies.


OBJECTIVE
To study the correlation between gastric histology and H. pylori serology status in patients with dyspepsia.


METHODS
This is a cross-sectional study where 40 consecutive dyspeptic patients (28 women and 12 men, mean age 48.5 years) with endoscopically normal stomachs were selected from the endoscopy unit at a university hospital in Recife, PE, Northeast of Brazil, between March 1998 and July 1999. Patients underwent gastric mucosal biopsy and serological tests (anti-Hp and anti-CagA antibodies). Gastric biopsies were examined using H-E and Giemsa stains and gastritis was classified and graded (mild, moderate or severe) according to 'the updated Sydney System-Houston, 1994'.


RESULTS
Among 40 patients with dyspepsia the gastric histology revealed that about (1/4) had moderate (25%) or severe (2.5%) gastritis. This subgroup of patients also had a greater positive frequency of anti-Hp (100% vs 41%; P = 0.0005) and anti-CagA (91% vs 58%; P = 0.09) antibodies when compared with those with normal histology (27.5%) or mild gastritis (45%).


CONCLUSIONS
Since upper gastrointestinal endoscopy is part of the functional dyspepsia investigation and serology for anti-CagA antibody is not available in daily clinical practice, by biopsying gastric mucosa we would only be able to selectively apply H. pylori eradication therapy for those with histology that best correlate with virulent infecting strains (moderate or severe gastritis)--around (1/4) of our study patients with dyspepsia.
Arruda
Severino Marcos Borba de
SM
Department of Internal Medicine, Division of Gastroenterology, Universidade Federal de Pernambuco, Recife, PE, Brazil. smbarruda@uol.com.br
Forones
Nora Manoukian
NM
Jucá
Norma Thomé
NT
de Barros
Kátia Simone Cezário
KS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood*; D000942:Antigens, Bacterial / Q000276:immunology*; D001426:Bacterial Proteins / Q000276:immunology*; D001706:Biopsy; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003657:Decision Making; D004415:Dyspepsia / Q000209:etiology / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005756:Gastritis / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori / Q000276:immunology* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori