1/456. Molecular relationships of helicobacter pylori strains in a family with gastroduodenal disease. OBJECTIVE: Few studies have examined the genetic relationships of helicobacter pylori strains affecting family members. Our aim was to do so. methods: We characterized H. pylori isolates obtained from members of a single family presenting with various gastroduodenal diseases to examine H. pylori bacterial genetic similarity. Endoscopic evaluation with gastric mapping was performed on each individual to establish clinical and histological disease. Genomic dna extracted from each H. pylori isolate was used to generate dna fingerprints for each strain by REP-PCR. vacA genotypes and cagA presence were established by PCR. RESULTS: gastrointestinal diseases among the five members of this family included gastric adenocarcinoma in a 52-yr-old man (index patient), gastric MALT-lymphoma in the 73-yr-old mother; intestinal metaplasia (IV) and atrophic gastritis in the 48-yr-old brother; intestinal metaplasia (I-III) in the 47-yr-old brother, and a duodenal ulcer scar in the 42-yr-old sister. REP-PCR dna fingerprints of H. pylori isolates from the index patient, his mother, and both of his brothers were identical or highly similar. By contrast, the H. pylori dna fingerprint from the sister was markedly different from the H. pylori dna fingerprints from the other family members. All isolates had the genotype cagA-positive and vacA slb/ml mosaic genotype. CONCLUSIONS: The dna fingerprints of H. pylori strains obtained from members of this family with malignancy or premalignant histological disease were identical or highly similar and markedly different from the H. pylori dna fingerprint from the sibling with duodenal ulcer disease. All H. pylori isolates within the family possessed genetic markers of enhanced virulence (presence of the cagA gene and vacA sl/ml mosaicism). In addition to host genetics and environmental factors, these findings suggest that infection with genetically similar H. pylori strains is a significant factor in determining the clinical outcome of an infection with H. pylori. ( info) |
2/456. CD4/CD8 double-positive adult T cell leukemia with preceding cytomegaloviral gastroenterocolitis. We present a rare case of adult T cell leukemia (ATL) in which leukemic T cells simultaneously expressed CD4 and CD8 surface antigens and refractory cytomegalovirus (CMV)-induced gastroenterocolitis preceded its clinical onset. A 40-year-old male was admitted to our hospital with abdominal pain and bloody stool. biopsy specimens of the gastric and rectal mucosa indicated CMV-induced gastroenterocolitis. The patient also proved to be seropositive for human T lymphotropic virus type I (HTLV-I). While being administered gancyclovir for CMV infection, he presented hepatomegaly and systemic lymphadenopathy. Monoclonal expansion of lymphoid cells integrated with HTLV-I genome was observed. He underwent a LSG15 regimen and hepatomegaly and lymphadenopathy improved markedly. Gastroenterocolitis also improved, but the symptoms did not disappear completely. CMV-induced diseases are prevalent among immunosuppressed patients. Although there was no evidence that this patient had ATL on admission, it is likely that he was severely immunodeficient. CMV can easily infect damaged mucosa. ATL cells often infiltrate gastrointestinal mucosa and may have triggered CMV gastroenterocolitis in this case. ( info) |
3/456. A case of acute phlegmonous gastritis successfully treated with antibiotics. Acute phlegmonous gastritis is a rare disorder in which bacterial infection occurs in the gastric wall. gastrectomy involving the affected area has been thought to be an effective form of treatment. The authors report a case of a 32-year-old woman who had severe upper abdominal pain without signs of peritoneal irritation. endoscopy showed edematous and reddened gastric mucosa with a mass lesion in the gastric antrum. Endoscopic ultrasonography showed thickening of the antral wall and a low-echoic mass in the gastric antrum, thought to represent a fluid collection. White pus was aspirated from the mass. Localized type of acute phlegmonous gastritis with a gastric abscess was diagnosed. culture of the pus showed streptococcus pneumoniae. Through early diagnosis without laparotomy, the patient's gastritis was successfully treated with antibiotics alone. ( info) |
4/456. Evolution of acute cytomegalovirus gastritis to chronic gastrointestinal dysmotility in a nonimmunocompromised adult. A 30-year-old nonimmunocompromised woman developed chronic gastrointestinal dysmotility as a consequence of acute cytomegalovirus infection. The acute nature of the infection was documented by high immunoglobulin m antibody titer to cytomegalovirus (CMV); the chronicity of the infection was shown by persistence of CMV in biopsy specimens of her gastrointestinal tract over a 21/2-year period. Gastrointestinal dysmotility was confirmed by delayed emptying on gastric nuclear scintigraphy, by retrograde propagation of migrating myoelectric complexes on small intestinal manometry, and by presence of tachygastria on cutaneous electrogastrography. The patient's nausea, vomiting, abdominal pain, and early satiety resolved after a short course of treatment with leuprolide acetate but returned after medication was discontinued. Her symptoms persisted despite clearance of CMV from the gastrointestinal tract after a course of treatment with ganciclovir. These observations show that acute CMV infection can cause gastrointestinal dysmotility in nonimmunocompromised individuals and that the disturbance in gastrointestinal motor function may persist for years after viral infection of the gastrointestinal tract has been eradicated. ( info) |
| We report about two cases of combined gastric lymphoma and gastric carcinoma with one of them representing a case of early gastric high grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) with co-existing early gastric adenocarcinoma. In contrast to most previously reported similar cases, in both of our cases the definitive diagnosis of gastric lymphoma and carcinoma was obtained preoperatively. This, however, seems to be in future times an essential prerequisite for employing minimal invasive methods such as eradication therapy in the case of diagnosed early lymphoma and endoscopic treatment for early gastric carcinomas. These methods have been proven to be an effective and beneficial alternative treatment especially with regard to the life quality of the patients. ( info) |
6/456. Autoimmune atrophic gastritis with hypergastrinemia. Elevation in fasting serum gastrin levels was found in three patients being evaluated for persistent upper abdominal pain without radiographic evidence of peptic ulcer disease. Fiberoptic endoscopy of the upper gastrointestinal tract in each patient revealed characteristic changes of chronic atrophic gastritis. Gastric biopsies showed diffuse chronic inflammation in the lamina propria, a decrease in the number of parietal cells, and "intestinalization" of gastric mucosa. Total achlorhydria was demonstrated after a maximal histalog stimulus; however, serum levels of vitamin B12 and schilling test values were normal in all three patients. Parietal cell antibodies were found in the serum in all patients in a dilution of 1:20 to 1:80. These cases represent autoimmune (type A) chronic atrophic gastritis and should be distinguished from chronic simple (type B) gastritis, in which serum gastrin levels are normal and no parietal cell antibodies are found in the serum. patients with autoimmune gastritis should be observed at frequent intervals for the occurrence of pernicious anemia or gastric carcinoma. ( info) |
7/456. myocardial infarction in a pre-menopausal woman with angiographically normal coronary arteries. A young pre-menopausal non-drug-addict woman without risk factors for coronary artery disease suffered from a non-Q-wave acute myocardial infarction. She presented with epigastric pain and vomiting. Diagnosis of acute myocardial infarction was not suspected at first because of her young age and lack of risk factors. She was treated for gastritis but worsening of epigastric pain and its radiation to chest warranted the diagnosis of acute myocardial infarction, which was confirmed by serial serum cardiac enzymes. Subsequent coronary angiogram revealed normal coronary arteries. ( info) |
8/456. Collagenous gastritis and collagenous colitis: a report with sequential histological and ultrastructural findings. The case is reported of a young adult man with collagenous gastritis, an extremely rare disorder with only three case reports in the English literature, who subsequently presented with collagenous colitis. Sequential gastric biopsies showed a notable increase in thickness of the subepithelial collagen band. Ultrastructural study of gastric and rectal mucosa showed the characteristic subepithelial band composed of haphazardly arranged collagen fibres, prominent degranulating eosinophils, and activated pericryptal fibroblasts. ( info) |
| The spiral bacteria, helicobacter heilmannii (H. heilmannii), distinct from helicobacter pylori (H. pylori), was found in the gastric mucosa of a 71-year-old man without clinical symptoms. The endoscopic examination revealed erosive gastritis. Rapid urease test from the antral specimen was positive, but both culture and immunohistological staining for H. pylori were negative. touch smear cytology showed tightly spiral bacteria, which were consistent with H. heilmannii. At the second endoscopy after medication regimen for eradication of H. pylori, inflammation was decreased and the rapid urease test was negative. The second cytology showed no evidence of H. heilmannii. Anti-H. pylori therapy may be a useful medication for H. heilmannii. ( info) |
| This patient, who had a history of osteoarthritis, had severe hepatitis 5 weeks after being started on diclofenac for increasing pain in the joints. A week before the onset of hepatitis, the patient complained of upper gastrointestinal symptoms and was treated for gastritis. Seven days later, she had full-blown, severe hepatitis. diclofenac was immediately stopped, leading to a complete restoration of liver functions over the course of the next few months. We highlight the importance of having a high index of suspicion for hepatic side effects of diclofenac and emphasize the need for increased awareness of this rare but potentially serious problem. We also review relevant literature regarding incidence and management. ( info) |