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UI - 20069514 AU - Raderer M AU - Pfeffel F AU - Pohl G AU - Mannhalter C AU - Valencak J AU - Chott A TI - Regression of colonic low grade B cell lymphoma of the mucosa associated lymphoid tissue type after eradication of helicobacter pylori [In Process Citation] LA - Eng DA - 20000112 DP - 2000 Jan IS - 0017-5749 TA - Gut PG - 133-5 SB - A SB - M CY - ENGLAND IP - 1 VI - 46 JC - FVT AA - AUTHOR AB - BACKGROUND: Lymphoma of the mucosa associated lymphoid tissue (MALT) arising in the stomach has been shown to be related to Helicobacter pylori infection, and total regression of gastric lymphoma after successful eradication of H pylori has consistently been reported. MALT-type lymphoma at other localisations, however, has to our knowledge not been linked to H pylori, and eradication of the bacteria has not been studied for management of such lymphomas. PATIENT/METHOD: A 67 year old man was diagnosed with MALT-type lymphoma simultaneously involving the stomach and the colon descendens. In addition to the presence of MALT-type lymphoma, H pylori associated chronic gastritis was diagnosed, and treatment with clarithromycin, metronidazole, and omeprazole was initiated, resulting in its successful eradication. RESULTS: Follow up performed four months later showed regression of the colonic manifestation, whereas the gastric lymphoma did not respond to antibiotic treatment, as assessed by regular follow up for 14 months, in spite of its restriction to mucosa and submucosa. The patient was therefore treated with oral cyclophosphamide (100 mg a day) resulting in partial remission after seven months of continuous treatment. Because of the presence of residual lymphoma, additional irradiation was performed, which led to complete remission of the gastric lymphoma. The patient remains in complete remission 40 months after diagnosis and 26 months after initiation of treatment. CONCLUSION: In the case of concurrent gastric and intestinal low grade MALT-type lymphoma, H pylori eradication may cause regression of the intestinal lesion. AD - Department of Internal Medicine I, Division of Oncology, University of Vienna, Vienna, Austria. RO - O:099 PMID- 0010601069 SO - Gut 2000 Jan;46(1):133-5 UI - 20029795 AU - Mazzucchelli L AU - Blaser A AU - Kappeler A AU - Scharli P AU - Laissue JA AU - Baggiolini M AU - Uguccioni M TI - BCA-1 is highly expressed in Helicobacter pylori-induced mucosa-associated lymphoid tissue and gastric lymphoma [see comments] LA - Eng MH - Aged MH - Anti-Inflammatory Agents, Non-Steroidal/adverse effects MH - B-Lymphocytes/metabolism/pathology MH - Chemokines, CXC/*analysis/biosynthesis MH - Dendritic Cells/metabolism/pathology MH - Gastric Mucosa/cytology/metabolism/*pathology MH - Gastritis/chemically induced/metabolism/pathology MH - *Helicobacter pylori MH - Helicobacter Infections/*complications/pathology MH - Human MH - Immunohistochemistry MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/etiology/*pathology MH - Macrophages/pathology MH - Middle Age MH - Receptors, Cytokine/analysis/biosynthesis MH - Reference Values MH - Support, Non-U.S. Gov't MH - T-Lymphocytes/metabolism/pathology RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 0 (B-lymphocyte chemoattractant) RN - 0 (BLR1 protein) RN - 0 (Chemokines, CXC) RN - 0 (Receptors, Cytokine) PT - JOURNAL ARTICLE DA - 19991209 DP - 1999 Nov IS - 0021-9738 TA - J Clin Invest PG - R49-54 SB - A SB - M SB - X CY - UNITED STATES IP - 10 VI - 104 JC - HS7 AA - Author EM - 200002 AB - Infection with Helicobacter pylori (Hp) induces the formation of lymphoid tissue in the stomach and the occasional development of primary gastric B-cell lymphomas. We have studied the expression of 2 chemokines that attract B lymphocytes, BCA-1 and SLC, in gastric tissue samples obtained from patients with chronic gastritis induced by Hp infection or nonsteroidal anti-inflammatory drugs, as well as from patients with Hp-associated low-grade and high-grade gastric lymphomas. High-level expression of BCA-1 and its receptor, CXCR5, was observed in all mucosal lymphoid aggregates and in the mantle zone of all secondary lymphoid follicles in Hp-induced gastric mucosa-associated lymphoid tissue (MALT). Follicular dendritic cells and B lymphocytes are possible sources of BCA-1, which is not expressed by T lymphocytes, macrophages, or CD1a(+) dendritic cells. Strong expression of BCA-1 and CXCR5 was also detected in the transformed B cells of gastric MALT lymphomas. By contrast, SLC was confined almost exclusively to endothelial cells in and outside the lymphoid tissue. Only scant, occasional SLC expression was observed in the marginal zone of MALT follicles. Our findings indicate that BCA-1, which functions as a homing chemokine in normal lymphoid tissue, is induced in chronic Hp gastritis and is involved in the formation of lymphoid follicles and gastric lymphomas of the MALT type. AD - Institute of Pathology, and Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland. CM - Comment in: J Clin Invest 1999 Nov;104(10):1333-4 PMID- 0010562310 URLF- http://www.jci.org/cgi/content/full/104/10/R49 URLS- http://www.jci.org/cgi/content/abstract/104/10/R49 EDAT- 1999/11/24 09:00 SO - J Clin Invest 1999 Nov;104(10):R49-54 UI - 20011929 AU - Fischbach W TI - [MALT lymphoma of the stomach: current state and perspectives] LA - Ger MH - Antineoplastic Agents/therapeutic use MH - Combined Modality Therapy MH - Comparative Study MH - Gastrectomy MH - Gastroscopy MH - Helicobacter pylori/isolation & purification MH - Helicobacter Infections/drug therapy MH - Human MH - *Lymphoma, Mucosa-Associated Lymphoid Tissue/diagnosis/radiotherapy/therapy MH - Meta-Analysis MH - Multicenter Studies MH - Prognosis MH - Prospective Studies MH - Retrospective Studies MH - Stomach/microbiology/ultrasonography MH - *Stomach Neoplasms/diagnosis/radiotherapy/therapy RN - 0 (Antineoplastic Agents) PT - JOURNAL ARTICLE PT - REVIEW PT - REVIEW, TUTORIAL DA - 19991116 DP - 1999 Oct 1 IS - 0012-0472 TA - Dtsch Med Wochenschr PG - 1142-7 SB - M SB - X CY - GERMANY IP - 39 VI - 124 JC - ECL EM - 200001 AD - Medizinische Klinik II, Klinikum Aschaffenburg. RF - 42 PMID- 0010544686 TT - MALT-Lymphome des Magens. Aktueller Stand und Ausblick. EDAT- 1999/11/02 09:00 MHDA- 1999/11/02 09:00 SO - Dtsch Med Wochenschr 1999 Oct 1;124(39):1142-7 UI - 20005911 AU - D'Elios MM AU - Amedei A AU - Manghetti M AU - Costa F AU - Baldari CT AU - Quazi AS AU - Telford JL AU - Romagnani S AU - Del Prete G TI - Impaired T-cell regulation of B-cell growth in Helicobacter pylori--related gastric low-grade MALT lymphoma. LA - Eng MH - Aged MH - Antigens, Bacterial/analysis/physiology MH - Antigens, CD95/physiology MH - B-Lymphocytes/immunology/*pathology MH - Cell Division MH - Chronic Disease MH - Clone Cells MH - Comparative Study MH - Cytokines/metabolism MH - Female MH - Gastritis/immunology/microbiology MH - *Helicobacter pylori/immunology MH - Helicobacter Infections/*complications MH - Human MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/immunology/*microbiology/pathology MH - Male MH - Membrane Glycoproteins/physiology MH - Middle Age MH - Stomach/metabolism/pathology MH - Stomach Neoplasms/immunology/*microbiology/pathology MH - Support, Non-U.S. Gov't MH - T-Lymphocytes/immunology/metabolism/*physiology MH - T-Lymphocytes, Helper-Inducer/pathology RN - 0 (Antigens, Bacterial) RN - 0 (Antigens, CD95) RN - 0 (Cytokines) RN - 0 (Membrane Glycoproteins) RN - 126465-35-8 (perforin) PT - JOURNAL ARTICLE DA - 19991208 DP - 1999 Nov IS - 0016-5085 TA - Gastroenterology PG - 1105-12 SB - A SB - M SB - X CY - UNITED STATES IP - 5 VI - 117 JC - FH3 AA - Author EM - 200002 AB - BACKGROUND & AIMS: Neoplastic B cells of the Helicobacter pylori-related low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma are responsive to T helper cells and sensitive to withdrawal of H. pylori-induced T-cell help. METHODS: The clonal progeny of T cells from the gastric mucosa of 5 patients with MALT lymphoma was compared with that of T-cell clones obtained from 5 H. pylori-infected patients with chronic gastritis. RESULTS: T-cell clones were assessed for specificity to H. pylori, cytokine profile, help for B-cell proliferation, and perforin- or Fas-mediated cytotoxic regulation of B-cell growth. Twenty-eight of 165 CD4(+) gastric clones from MALT lymphoma and 33 of 178 CD4(+) clones from chronic gastritis recognized H. pylori antigens. Cytokine production was similar in the 2 series of clones. All MALT lymphoma-derived clones dose-dependently increased their B-cell help, whereas clones from chronic gastritis lost helper activity at T-to-B-cell ratios greater than 1 because of concomitant cytolytic killing of B cells. T-cell clones from MALT lymphoma had both reduced perforin-mediated cytotoxicity and poor ability to induce Fas-mediated apoptosis. These defects were limited to gastric T cells. CONCLUSIONS: H. pylori-induced T cell-dependent B-cell activation and deficient cytotoxic control of B-cell growth may link H. pylori infection, local T-cell response, and genesis of low-grade gastric MALT lymphoma. AD - Department of Internal Medicine, University of Florence, Florence, Italy. PMID- 0010535873 URLF- http://www.gastro.org/cgi/content/full/117/5/1105 URLS- http://www.gastro.org/cgi/content/abstract/117/5/1105 EDAT- 1999/10/27 09:00 SO - Gastroenterology 1999 Nov;117(5):1105-12 UI - 20001896 AU - Fritscher-Ravens A AU - Petrasch S AU - Tiemann M AU - Wacker H AU - Dorr T AU - Kemmeries G AU - Hilgers W AU - Reinacher-Schick A AU - Kunstmann E AU - Schmiegel W TI - Antigenic phenotyping of lymphoid cells and B cell gene rearrangement in type B gastritis and in gastritis not associated with Helicobacter pylori colonization. LA - Eng MH - Adolescence MH - Adult MH - Aged MH - Aged, 80 and over MH - Antigens, CD/*genetics MH - Colony Count, Microbial MH - Gastritis/*immunology/microbiology MH - *Gene Rearrangement, B-Lymphocyte MH - *Genes, Immunoglobulin MH - Helicobacter pylori/*isolation & purification MH - Human MH - Immunohistochemistry MH - Immunophenotyping MH - Lymphocyte Subsets/immunology MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/immunology/microbiology MH - Middle Age MH - Support, Non-U.S. Gov't RN - 0 (Antigens, CD) PT - CLINICAL TRIAL PT - CONTROLLED CLINICAL TRIAL PT - JOURNAL ARTICLE DA - 19991208 DP - 1999 IS - 0001-5792 TA - Acta Haematol PG - 77-82 SB - M SB - X CY - SWITZERLAND IP - 2 VI - 102 JC - 0S8 AA - Author EM - 200002 AB - Marginal-zone B cells of the mucosa-associated lymphoid tissue (MALT) are the normal counterpart of the neoplastic cells in MALT lymphoma. In both cases these lymphocytes express surface immunoglobulins, but are negative when stained for B cell associated antigens like CD10 and CD23. Furthermore, the B cell gene rearrangement has been found in Helicobacter pylori associated chronic gastritis and in extranodal type of marginal-zone lymphoma. The aim of this study was to quantify the number of IgM-, CD10-, and CD23-positive lymphocytes in patients with type B gastritis and to compare the results with the antigen profile of mononuclear cells in patients with gastritis not associated with H. pylori. Additionally, the immunoglobulin heavy-chain (IgH) gene rearrangement in H. pylori positive and H. pylori negative gastritis was studied. From 23 patients with a positive urease test and/or histologically proven H. pylori infection and chronic gastritis and from 22 patients with H. pylori negative chronic gastritis mucosa biopsy specimens were taken. Single-cell suspensions were obtained following enzymatic digestion. For immunocytochemistry, an alkaline phosphatase-antialkaline phosphatase method was applied. IgH gene rearrangement in formalin-fixed, paraffin-embedded specimens was determined by polymerase chain reaction in 11 patients with chronic gastritis. An increase in mu-positive plasma cells and B lymphocytes was detected in patients with H. pylori positive gastritis as compared with patients with H. pylori negative gastritis (10.0 vs. 3.9%, p < 0.001, and 4.3 vs. 1.6%, p < 0.01, respectively). In both groups, the proportion of CD10- and CD23-positive lymphocytes was <1%. IgH gene rearrangement was not restricted to type B gastritis; single bands were also present in 3 of 7 patients with H. pylori negative chronic gastritis. Our finding of IgH gene rearrangement in some of the patients with H. pylori negative chronic gastritis indicates that additional factors may be critical for these genotypical changes and for the pathogenesis of gastric MALT lymphoma. AD - Department of Internal Medicine, Ruhr University Bochum, Germany. PMID- 0010529510 PID - aha02077 URLF- http://www.online.karger.com/library/karger/renderer/dataset.exe?jcode=AHA &action=render&rendertype=fulltext&uid=AHA.aha02077 EDAT- 1999/10/26 09:00 SO - Acta Haematol 1999;102(2):77-82 UI - 99451541 AU - Chang DK AU - Chin YJ AU - Kim JS AU - Jung HC AU - Kim CW AU - Song IS AU - Kim CY TI - Lymph node involvement rate in low-grade gastric mucosa-associated lymphoid tissue lymphoma--too high to be neglected. LA - Eng MH - Adult MH - Aged MH - Female MH - Gastritis/complications/microbiology/pathology MH - Gastroscopy MH - Helicobacter pylori/isolation & purification MH - Helicobacter Infections/complications/drug therapy/pathology MH - Human MH - *Lymphatic Metastasis MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/microbiology/*pathology/therapy MH - Male MH - Middle Age MH - Retrospective Studies MH - Stomach Neoplasms/microbiology/*pathology/therapy MH - Stomach Ulcer/complications/microbiology/pathology MH - Support, Non-U.S. Gov't PT - JOURNAL ARTICLE DA - 19991104 DP - 1999 Jul-Aug IS - 0172-6390 TA - Hepatogastroenterology PG - 2694-700 SB - M CY - GREECE IP - 28 VI - 46 JC - GA7 AA - Author EM - 200001 AB - BACKGROUND/AIMS: Anti-Helicobacter pylori (H. pylori) treatment for low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma has been the subject of attention. The aim of this study was to determine the proportion of such cases which could be suitable candidates for H. pylori eradication for the purpose of cure; we focused on gross morphology and lymph node metastasis. METHODOLOGY: We retrospectively reviewed the medical records of 53 patients diagnosed and treated for gastric MALT lymphoma at Seoul National University Hospital between 1992 and 1996. RESULTS: According to Isaacson's classification, 60% of cases were low-grade, and H. pylori was detected in 88% of them. In low-grade disease, gastroscopy revealed superficial lesions in 56% of cases, ulcerofungating lesions were found in as much as 19%, and ulceroinfiltrating in 25%. Even in low-grade disease, invasion of proper muscle, or deeper, was seen in 28% of patients, and lymph node involvement in 36%; even in low-grade disease confined to mucosa and submucosa, the rate of lymph node involvement was 40%. All cases which, on gastroscopy, appeared to be gastritis or benign ulcer-like lesions were free of lymph node metastasis, but in low-grade disease, this proportion was only 16%. In 33% of cases, pre-operative clinical stage I--as shown by abdominal CT--was found post-operatively to be stage II. The negative predictive value of lymph node detection by CT was 68%. CONCLUSIONS: In low-grade gastric MALT lymphoma, the lymph node involvement rate was too high to be neglected. In detecting lymph node metastasis, the diagnostic accuracy of CT was too low. The proportion of suitable candidates for anti-H. pylori treatment for low-grade gastric MALT lymphoma was not high, and in clinical practice, anti-H. pylori treatment in such cases should at present be very carefully applied. AD - Department of Internal Medicine, Seoul National University College of Medicine, Korea. PMID- 0010522067 EDAT- 1999/10/16 09:00 MHDA- 1999/10/16 09:00 SO - Hepatogastroenterology 1999 Jul-Aug;46(28):2694-700 UI - 99440954 AU - Goyal A AU - Langer JC AU - Zutter M AU - Swanson P AU - Kraus MD AU - Bartlett N AU - Shackelford GD AU - Longtine JA AU - Perlmutter DH TI - Primary gastric plasmacytoma: a rare cause of hypertrophic gastritis in an adolescent. LA - Eng MH - Adolescence MH - Biopsy MH - Case Report MH - Endoscopy, Digestive System MH - Female MH - Gastritis, Hypertrophic/*etiology/pathology MH - Human MH - Plasmacytoma/*complications/pathology MH - Stomach Neoplasms/*complications/pathology PT - JOURNAL ARTICLE DA - 19991124 DP - 1999 Oct IS - 0277-2116 TA - J Pediatr Gastroenterol Nutr PG - 424-30 SB - M CY - UNITED STATES IP - 4 VI - 29 JC - JL6 AA - Author EM - 200001 AB - BACKGROUND: This report describes a 16-year-old patient with gastric rugal hypertrophy caused by a primary gastric plasmacytoma. She had a 3-month history of nausea and burning abdominal pain. Radiographic studies showed giant rugal hypertrophy. Superficial endoscopic gastric biopsies showed mild inflammation with plasma cells of polyclonal origin in the mucosa. When symptoms persisted, she underwent laparoscopic full-thickness gastric biopsy. There was monoclonal plasma cell infiltration histologically diagnostic of plasmacytoma and inconsistent with Helicobacter pylori-associated mucosa-associated lymphoid tissue (MALT) lymphoma. There was no evidence for involvement of the bone marrow or regional lymph nodes. The tumor did not respond to radiotherapy, necessitating total gastrectomy. METHODS: Blood samples were analyzed for interleukin (IL)-6 by enzyme-linked immunosorbent assay. Gastric biopsy and gastrectomy specimens were subjected to immunophenotyping for kappa and lambda light chains, CD45, CD20, and LN1 and to polymerase chain reaction analysis for herpes virus HHV8. RESULTS: There was no elevation in circulating IL-6 levels, militating against a pathogenesis akin to that of Castleman's disease. There was no evidence for infection with the Kaposi's sarcoma-associated herpes virus HHV8, which has recently been found in patients with multiple myeloma. CONCLUSIONS: This diagnosis and the characteristics of the tumor are very unusual, if not unique, for a patient of this age. The diagnostic evaluation of this patient also demonstrates the importance of deep endoscopic or full-thickness biopsies in some children with hypertrophic gastritis. AD - St. Louis Children's Hospital, Department of Pediatrics, Washington University School of Medicine, MO 63110, USA. PMID- 0010512402 EDAT- 1999/10/08 09:00 MHDA- 1999/10/08 09:00 SO - J Pediatr Gastroenterol Nutr 1999 Oct;29(4):424-30 UI - 99431912 AU - Yokota K AU - Kobayashi K AU - Kawahara Y AU - Hayashi S AU - Hirai Y AU - Mizuno M AU - Okada H AU - Akagi T AU - Tsuji T AU - Oguma K TI - Gastric ulcers in SCID mice induced by Helicobacter pylori infection after transplanting lymphocytes from patients with gastric lymphoma. LA - Eng MH - Animal MH - Antibodies, Bacterial/analysis/immunology MH - Autoantibodies/analysis MH - Cell Division MH - *Helicobacter pylori/immunology/physiology MH - Helicobacter Infections/*complications MH - Human MH - *Lymphocyte Transfusion MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/*blood/immunology MH - Mice MH - Mice, SCID MH - Monocytes/pathology MH - Spleen/microbiology/pathology MH - Stomach/immunology/pathology MH - Stomach Neoplasms/*blood/immunology MH - Stomach Ulcer/*microbiology/pathology MH - Support, Non-U.S. Gov't RN - 0 (Antibodies, Bacterial) RN - 0 (Autoantibodies) PT - JOURNAL ARTICLE DA - 19991028 DP - 1999 Oct IS - 0016-5085 TA - Gastroenterology PG - 893-9 SB - A SB - M SB - X CY - UNITED STATES IP - 4 VI - 117 JC - FH3 AA - Author EM - 200001 AB - BACKGROUND & AIMS: Several studies have indicated that host factors are important in Helicobacter pylori-induced gastroduodenal diseases. We examined the pathological role of host immune responses in H. pylori infection by reconstituting components of the human immune system into severe combined immunodeficient (SCID) mice by transplantation of peripheral blood mononuclear cells (PBMCs) from H. pylori-infected patients. METHODS: PBMCs obtained from patients with mucosa-associated lymphoid tissue (MALT) lymphoma were injected intraperitoneally into SCID mice, designated MALToma-hu-SCID mice. One month after transplantation, H. pylori was administered orally to the mice. The mice were killed and examined for pathological changes and immunologic features. RESULTS: Human lymphocytes were detected in hu-SCID mice, and T- and B-cell functions were preserved for 1 month. Administration of H. pylori led to gastric ulcers with bleeding in the MALToma-hu-SCID mice. The gastric mucosa of control mice injected with Escherichia coli or transplanted with PBMCs from patients with peptic ulcers or gastritis or from healthy volunteers showed no pathological changes. CONCLUSIONS: Host immune responses against H. pylori appear to be involved in the development of gastric ulcers in patients who have MALT lymphoma. AD - Department of Bacteriology, Okayama University Medical School, Okayama, Japan. PMID- 0010500072 URLF- http://www.gastro.org/cgi/content/full/117/4/893 URLS- http://www.gastro.org/cgi/content/abstract/117/4/893 EDAT- 1999/09/29 09:00 MHDA- 1999/09/29 09:00 SO - Gastroenterology 1999 Oct;117(4):893-9 UI - 99418342 AU - Isaacson PG AU - Diss TC AU - Wotherspoon AC AU - Barbazza R AU - De Boni M AU - Doglioni C TI - Long-term follow-up of gastric MALT lymphoma treated by eradication of H. pylori with antibodies [letter] LA - Eng MH - Antibiotics/*therapeutic use MH - Follow-Up Studies MH - *Helicobacter pylori MH - Helicobacter Infections/*drug therapy MH - Human MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/drug therapy/*microbiology MH - Stomach Neoplasms/drug therapy/*microbiology RN - 0 (Antibiotics) PT - LETTER DA - 19990916 DP - 1999 Sep IS - 0016-5085 TA - Gastroenterology PG - 750-1 SB - A SB - M SB - X CY - UNITED STATES IP - 3 VI - 117 JC - FH3 EM - 199911 PMID- 0010490369 EDAT- 1999/09/18 09:00 MHDA- 1999/09/18 09:00 SO - Gastroenterology 1999 Sep;117(3):750-1 UI - 0 AU - Gisbert J AU - Pajares J TI - [Are H. pylori all bad?] LA - SPA PT - JOURNAL ARTICLE DA - 19990907 DP - 1999 Jul 1 IS - 1130-0108 TA - Rev Esp Enferm Dig PG - 508-515 IP - 7 VI - 91 JC - ARX AB - The infection by Helicobacter pylori arises a question of great interest: should the infection be considered a disease in all cases? or, on the contrary, is the microorganism harmful in only some circumstances? The response to these questions is followed by therapeutic implications of great importance, as it is followed by the decision of administering eradication therapy to every patient or only to some individuals. In this article the arguments supporting each of the aforementioned options are reviewed. Firstly, the aphorism recently stated <<The only good H. pylori is a dead H. pylori>> suggests that all microorganisms are harmful and, therefore, generalized H. pylori eradication therapy should be administered to all infected subjects. Among the arguments supporting this attitude are the following: the H. pylori <<healthy>> carrier status does not exist; a high risk of developing peptic ulcer exists in infected patients; H. pylori positive patients are at risk of suffering gastric adenocarcinoma and lymphoma; and, finally, the eradication of the microorganism would reduce the potential reservoir of the infection. On the other hand, the expression <<not all H. pylori strains are created equal: should all be eliminated?>> summarises a more conservative position, that suggests the existence of <<bad>>, <<neutral, or even <<good>> H. pylori, advising the eradication of the microorganism in only some cases. Several arguments supporting this idea, and, therefore, against the generalized use of eradication therapy, have been proposed: H. pylori has colonized humans since immemorial time and, therefore, it can not be very harmful to the human; the bacterium will induce peptic ulcer or gastric cancer in only a minority of infected subjects; the beneficial effect of eradication has been definitively demonstrated in few entities as gastroduodenal ulcer and MALT lymphoma; some strains could be beneficial to the human; generalized administration of antibiotic therapy will cause problems; the H. pylori vaccine represents a more rational alternative; and, finally, the incidence of H. pylori infection is spontaneously decreasing in some regions. In summary, there are strong arguments supporting both of the strategies that are reviewed in the present article, and, therefore, the dilemma <<good H. pylori, bad H. pylori>> remains. AD - Servicio de Aparato Digestivo, Departamento de Medicina, Hospital Universitario de "La Princesa", Universidad Aut#noma de Madrid, Madrid, Espa#a. PMID- 0010477369 TT - #Son todos los H. Pylori <<malos>>? URLF- http://www.masson.es/massonwww/Journal/JournalArticle2.asp?iVol=91&lIdMaga zine=34&lIdInternalCode=122&iStartPage=508&iEndPage=515 EDAT- 1999/09/08 09:00 SO - Rev Esp Enferm Dig 1999 Jul 1;91(7):508-515 UI - 99403777 AU - Chetty R AU - Pillay SV TI - Coexistent gastric MALT lymphoma and Kaposi sarcoma in an HIV positive patient. LA - Eng MH - Case Report MH - Gastrectomy MH - Human MH - HIV Infections/*complications/pathology/surgery MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/*pathology/surgery MH - Male MH - Middle Age MH - Neoplasms, Multiple Primary/*pathology/surgery MH - Sarcoma, Kaposi/*pathology/surgery MH - Stomach Neoplasms/*pathology/surgery PT - JOURNAL ARTICLE DA - 19990917 DP - 1999 Apr IS - 0021-9746 TA - J Clin Pathol PG - 313-6 SB - A SB - M SB - X CY - ENGLAND IP - 4 VI - 52 JC - HT3 AA - Author EM - 199911 AB - A 47 year old HIV positive male presented with haematemesis and epigastric pain. A gastrectomy was performed for intractable bleeding. The cause of the haematemesis proved to be a Kaposi sarcoma of the stomach which had resulted in mucosal ulceration. Several other smaller foci of Kaposi sarcoma were also present. Coexistent with the Kaposi sarcoma was a dense lymphoid infiltrate with lymphoid follicles and reactive germinal centres. Centrocyte-like cells caused marked effacement and destruction of gastric glands with the formation of lymphoepithelial lesions, typical of a MALT lymphoma. These cells were of B cell lineage and some expressed the HIV antigen, p24. Follicular dendritic cells and macrophages within germinal centres were also p24 positive. Immunohistochemistry and in situ hybridisation did not detect Epstein-Barr virus. Although Helicobacter pylori was not identified by light microscopy in the sections sampled, this does not preclude its possible role, with other cofactors such as HIV, in the causation of the MALT lymphoma. AD - Department of Pathology, University of Natal School of Medicine, Durban, South Africa. PMID- 0010474529 EDAT- 1999/09/04 09:00 MHDA- 1999/09/04 09:00 SO - J Clin Pathol 1999 Apr;52(4):313-6 UI - 99388373 AU - Axon AT TI - Are all helicobacters equal? Mechanisms of gastroduodenal pathology and their clinical implications. LA - Eng MH - Bacterial Proteins/genetics MH - Duodenal Ulcer/microbiology MH - Helicobacter pylori/classification/immunology/*pathogenicity MH - Helicobacter Infections/complications/*microbiology MH - Human MH - Species Specificity MH - Stomach Diseases/*microbiology MH - Virulence RN - 0 (cytotoxin-associated protein) RN - 0 (vacuolating toxin, Helicobacter pylori) RN - 0 (Bacterial Proteins) PT - JOURNAL ARTICLE PT - REVIEW PT - REVIEW, TUTORIAL DA - 19990922 DP - 1999 Jul IS - 0017-5749 TA - Gut PG - I1-4 SB - A SB - M CY - ENGLAND VI - 45 Suppl 1 JC - FVT AA - Author EM - 199911 AB - Most cases of peptic ulcer disease, gastric mucosa associated lymphoid tissue (MALT) lymphoma and cancer of the distal stomach are complications of Helicobacter pylori infection. However, as with most infections not all patients who contract the infection develop the complications of the disease. The other factors that influence the likelihood of problems arising are the virulence of the infecting organism, the genetic constitution and age of the host, and environmental factors. This paper focuses mainly upon the effect of strain differences and the causation of serious disease. There is considerable genetic variation between the different strains of H pylori, some causing a more severe inflammatory response in the host than others. These strains are also associated with a greater likelihood of causing peptic ulcer, atrophic gastritis and intestinal metaplasia and gastric cancer. There is some evidence to suggest that these more virulent organisms may also protect the host from the development of reflux oesophagitis and possibly cancer in the region of the gastro-oesophageal junction. The major difference between virulent and relatively avirulent organisms depends upon the presence of the cag pathogenicity island, a segment of DNA that has been acquired possibly from another organism and is now incorporated within the helicobacter genome. Its presence is associated with the secretion of the vacuolating toxin which is a protein known to cause damage in cell culture and in vivo. As CagA, one of the proteins produced by the pathogenicity island, is highly antigenic, people infected with more virulent strains can be identified by a blood test. Currently controversy surrounds the question as to whether all patients with H pylori should be treated for infection or whether medication should be reserved for those who already have the complications of the infection, or individuals infected with the more virulent strain of the organism. AD - Centre for Digestive Diseases, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. RF - 28 PMID- 0010457027 URLF- http://www.gutjnl.com/cgi/content/full/45/suppl_1/I1 URLS- http://www.gutjnl.com/cgi/content/short/45/suppl_1/I1 EDAT- 1999/08/24 10:00 MHDA- 1999/08/24 10:00 SO - Gut 1999 Jul;45 Suppl 1:I1-4 UI - 99322352 AU - Taupin A AU - Occhialini A AU - Ruskone-Fourmestraux A AU - Delchier JC AU - Rambaud JC AU - Megraud F TI - Serum antibody responses to Helicobacter pylori and the cagA marker in patients with mucosa-associated lymphoid tissue lymphoma. LA - Eng MH - Antibodies, Bacterial/immunology MH - Antigens, Bacterial/blood MH - Bacterial Proteins/genetics/*immunology MH - Biological Markers/blood MH - Electrophoresis, Polyacrylamide Gel MH - Enzyme-Linked Immunosorbent Assay MH - Female MH - Helicobacter pylori/*immunology MH - Human MH - Immunoblotting MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/*immunology MH - Male MH - Polymerase Chain Reaction MH - Sodium Dodecyl Sulfate RN - 0 (cytotoxin-associated protein) RN - 0 (Antibodies, Bacterial) RN - 0 (Antigens, Bacterial) RN - 0 (Bacterial Proteins) RN - 0 (Biological Markers) RN - 151-21-3 (Sodium Dodecyl Sulfate) PT - JOURNAL ARTICLE DA - 19990831 DP - 1999 Jul IS - 1071-412X TA - Clin Diagn Lab Immunol PG - 633-8 SB - M CY - UNITED STATES IP - 4 VI - 6 JC - CB7 AA - Author EM - 199911 AB - The lymphoma of the mucosa-associated lymphoid tissue (MALT) of the stomach has been linked to Helicobacter pylori infection, but the mechanisms involved in B-cell proliferation remain elusive. In a search for putative H. pylori-specific monoclonal immunoglobulin production, an H. pylori strain was isolated from 10 patients with MALT lymphoma and used to detect the specific serum antibody response to the homologous strain by immunoblotting. Moreover, the antigenicity of the different strains was compared by using each of the 10 sera. We found that the different strains induced highly variable patterns of systemic immunoglobulin G antibody response, although several bacterial antigens, such as the 60-kDa urease B, were often recognized by the different sera. The cagA marker was detected in the strains by PCR with specific primers and by dot blot analysis, and the CagA protein was found in the sera of 4 of the 10 patients by immunoblotting. In conclusion, MALT lymphoma patients, like other patients with H. pylori gastritis, exhibit a polymorphic systemic antibody response, despite an apparently similar antigenic profile. The CagA marker of pathogenicity is not associated with this disease. AD - Laboratoire de Bacteriologie, Universite de Bordeaux 2, 33076 Bordeaux Cedex, France. PMID- 0010391879 URLF- http://cdli.asm.org/cgi/content/full/6/4/633 URLS- http://cdli.asm.org/cgi/content/abstract/6/4/633 EDAT- 1999/07/03 10:00 MHDA- 1999/07/03 10:00 SO - Clin Diagn Lab Immunol 1999 Jul;6(4):633-8 UI - 99293719 AU - Ferrer A AU - Lopez-Guillermo A AU - Bosch F AU - Montoto S AU - Hernandez-Boluda JC AU - Camos M AU - Miquel R AU - Campo E AU - Montserrat E TI - [Non-gastric mucosa-associated lymphoid tissue (MALT) lymphomas: analysis of 14 patients] LA - Spa MH - Adult MH - Aged MH - Aged, 80 and over MH - English Abstract MH - Female MH - Human MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/mortality/*pathology MH - Male MH - Middle Age MH - Parotid Neoplasms/*pathology MH - Retrospective Studies MH - Support, Non-U.S. Gov't MH - Survival Rate PT - JOURNAL ARTICLE DA - 19990928 DP - 1999 May 1 IS - 0025-7753 TA - Med Clin (Barc) PG - 577-80 SB - M CY - SPAIN IP - 15 VI - 112 JC - LTQ AA - Author EM - 199912 AB - BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphomas are a well defined group of B-cell non-Hodgkin's lymphomas, that arise in a wide variety of extranodal sites, most frequently in the stomach and related to Helicobacter pylori infection. The aim of the present study was to analyze the presenting features, natural history and outcome in 14 patients with non-gastric MALT lymphoma. PATIENTS AND METHODS: The main clinical data, treatment and outcome were recorded for the 14 patients with non-gastric MALT lymphoma diagnosed at a single institution in a 12 year period. The median age was 68 years and 13 patients were females. Diagnosis was made according to the REAL classification criteria. RESULTS: The initial location was thyroid (3 patients), parotid (three), submaxilar gland (three), skin (two), Waldeyer's ring (one), breast (one), lung (one), small bowel (one), liver (one) and ovary (one). At diagnosis 3 patients had > or = 2 extranodal involved sites. Autoimmune disorders were present in 5 patients: Hashimoto's thyroiditis (three), Sjogren's syndrome (one) and both (one). Two patients had a poor performance status (ECOG > 1) and B-symptoms. Five patients (36%) were in stage IV, two of them because of bone marrow infiltration. All patients had a normal serum LDH level, and 5 had high beta 2-microglobulin level. The treatment consisted in surgical resection (2 patients), surgery and radiotherapy (one), surgery and chemotherapy (two), chemotherapy and radiotherapy (two) and chemotherapy alone (7 patients, three of them with doxorubicin-containing regimens). Twelve patients were evaluable for response. Complete response, partial response and failure rates were 75, 17 and 8%, respectively. Two of the 11 responders progressed, one of them with advanced stage disease. The actuarial 4-year disease-free survival was 77% (CI 95%: 47-100%). After a median follow-up of 3.4 years, 100% of the patients were alive. CONCLUSION: Non-gastric MALT lymphomas may be associated with autoimmune disorders, may present as disseminated disease and have a very good outcome. AD - Servicio de Hematologia, Instituto de Investigaciones Biomedicas August Pi i Sunyer, Barcelona. PMID- 0010365385 TT - Linfomas del tejido linfoide asociado a mucosas (MALT) de localizacion extragastrica: analisis de 14 casos. EA - A EDAT- 1999/06/12 10:00 MHDA- 1999/06/12 10:00 SO - Med Clin (Barc) 1999 May 1;112(15):577-80 UI - 99271199 AU - Vallina E AU - Fresno F AU - Alonso JL AU - Madrigal B AU - Arribas JM TI - [Incidence of primary gastric lymphoma and H. pylori infection in the central zone of Asturias] LA - Spa MH - Aged MH - Cohort Studies MH - English Abstract MH - *Helicobacter pylori MH - Helicobacter Infections/complications/*epidemiology MH - Human MH - Lymphoma, Large-Cell/complications/epidemiology MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/epidemiology MH - Lymphoma, Non-Hodgkin/complications/*epidemiology MH - Spain/epidemiology MH - Stomach Neoplasms/complications/*epidemiology PT - JOURNAL ARTICLE DA - 19990607 DP - 1999 Apr IS - 0212-7199 TA - An Med Interna PG - 175-7 CY - SPAIN IP - 4 VI - 16 JC - A5E AA - Author EM - 199908 AB - OBJECTIVE: We review our experience with primary gastric lymphomas type B of low (MALT) and high grade in a population of 366,635 people during 4 years and after performing 9,268 gastroscopies. RESULTS: The incidence of these lymphomas in our medium is similar to that found in the world population. Possible disagreements among the biopsy histology and that of the subsequent gastrectomy samples is pointed out. CONCLUSIONS: The frequency of H. pylori involvement in our primary gastric lymphomas is similar to that reported in the literature for the age of our patients, for the MALT lymphomas an well as for the type B high grade. AD - Servicio de Patologia Medica, Universidad de Oviedo. PMID- 0010339841 TT - Incidencia de linfomas gastricos primarios y de afectacion por H. pylori en la zona central de Asturias. EA - A EDAT- 1999/05/26 06:00 MHDA- 1999/05/26 06:00 SO - An Med Interna 1999 Apr;16(4):175-7 UI - 99270981 AU - Rossi G AU - Rossi M AU - Vitali CG AU - Fortuna D AU - Burroni D AU - Pancotto L AU - Capecchi S AU - Sozzi S AU - Renzoni G AU - Braca G AU - Del Giudice G AU - Rappuoli R AU - Ghiara P AU - Taccini E TI - A conventional beagle dog model for acute and chronic infection with Helicobacter pylori. LA - Eng MH - Acute Disease MH - Animal MH - Antibodies, Bacterial/immunology MH - Chronic Disease MH - *Disease Models, Animal MH - *Dogs MH - Endoscopy, Gastrointestinal MH - Female MH - *Helicobacter pylori/immunology/isolation & purification MH - *Helicobacter Infections MH - Interleukin-8/metabolism MH - Male MH - Mice MH - Support, Non-U.S. Gov't RN - 0 (Antibodies, Bacterial) RN - 0 (Interleukin-8) PT - JOURNAL ARTICLE DA - 19990628 DP - 1999 Jun IS - 0019-9567 TA - Infect Immun PG - 3112-20 SB - M SB - X CY - UNITED STATES IP - 6 VI - 67 JC - GO7 AA - Author EM - 199909 AB - Helicobacter pylori has been widely recognized as an important human pathogen responsible for chronic gastritis, peptic ulcers, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma. Little is known about the natural history of this infection since patients are usually recognized as having the infection only after years or decades of chronic disease. Several animal models of H. pylori infection, including those with different species of rodents, nonhuman primates, and germ-free animals, have been developed. Here we describe a new animal model in which the clinical, pathological, microbiological, and immunological aspects of human acute and chronic infection are mimicked and which allows us to monitor these aspects of infection within the same individuals. Conventional Beagle dogs were infected orally with a mouse-adapted strain of H. pylori and monitored for up to 24 weeks. Acute infection caused vomiting and diarrhea. The acute phase was followed by polymorphonuclear cell infiltration, interleukin 8 induction, mononuclear cell recruitment, and the appearance of a specific antibody response against H. pylori. The chronic phase was characterized by gastritis, epithelial alterations, superficial erosions, and the appearance of the typical macroscopic follicles that in humans are considered possible precursors of MALT lymphoma. In conclusion, infection in this model mimics closely human infection and allows us to study those phases that cannot be studied in humans. This new model can be a unique tool for learning more about the disease and for developing strategies for treatment and prevention. AD - Department of Animal Pathology, Prophylaxis and Food Hygiene, University of Pisa, 50100 Pisa, Italy. PMID- 0010338528 EDAT- 1999/05/25 06:00 MHDA- 1999/05/25 06:00 URL - http://iai.asm.org/cgi/content/full/67/6/3112 SO - Infect Immun 1999 Jun;67(6):3112-20 UI - 99180739 AU - Dogusoy G AU - Karayel FA AU - Gocener S AU - Goksel S TI - Histopathologic features and expression of Bcl-2 and p53 proteins in primary gastric lymphomas. LA - Eng MH - Adolescence MH - Adult MH - Aged MH - Antigens, CD20/analysis MH - Antigens, Neoplasm/analysis MH - Disease Progression MH - Female MH - Gastritis/complications MH - *Gene Expression Regulation, Neoplastic MH - *Genes, bcl-2 MH - *Genes, p53 MH - Helicobacter pylori/isolation & purification MH - Helicobacter Infections/complications MH - Human MH - Immunophenotyping MH - Lymphatic Metastasis MH - Lymphoma, B-Cell/complications/genetics/metabolism/*pathology MH - Lymphoma, High-Grade/complications/genetics/metabolism/*pathology MH - Lymphoma, Low-Grade/complications/genetics/metabolism/*pathology MH - Lymphoma, Mucosa-Associated Lymphoid Tissue/complications/genetics/metabolism/*pathology MH - Male MH - Middle Age MH - Neoplasm Invasiveness MH - Neoplasm Proteins/*biosynthesis MH - Neoplasm Staging MH - Protein p53/*biosynthesis MH - Proto-Oncogene Proteins c-bcl-2/*biosynthesis MH - Stomach Neoplasms/complications/genetics/metabolism/*pathology MH - Support, Non-U.S. Gov't RN - 0 (Antigens, CD20) RN - 0 (Antigens, Neoplasm) RN - 0 (Neoplasm Proteins) RN - 0 (Protein p53) RN - 0 (Proto-Oncogene Proteins c-bcl-2) PT - JOURNAL ARTICLE DA - 19990708 DP - 1999 IS - 1219-4956 TA - Pathol Oncol Res PG - 36-40 SB - M CY - HUNGARY IP - 1 VI - 5 JC - C3S AA - Author EM - 199909 AB - The aim of this study is to present a histopathologic and immunohistochemical analysis of primary gastric lymphomas which were reclassified according to the concept of mucosa associated lymphoid tissue (MALT). The resected specimens from 41 patients with primary gastric lymphoma were investigated retrospectively. Immunohistochemical study was done to analyze the immunophenotype and bcl-2 and p53 proteins expression. Twenty three of the cases had tumors mainly located in the antrum. Histologically, 12 were low grade and 20 were high grade B-cell lymphoma of MALT, 9 other B-cell nonHodgkin's lymphomas. Helicobacter pylori was identified in 72% of the cases. According to Musshoff's modification, most of the MALT lymphoma cases had stage I or II disease. There was significant difference between low and high grade cases, in respect to depth of invasion in gastric wall. Immunohistochemically, the neoplastic cells in all MALT lymphomas expressed B-cell phenotype. Bcl-2 protein was found to be expressed in 59% and p53 protein expression was detected in 72% of cases. Among the B-cell lymphoma of MALT, bcl-2 positivity decreased and p53 positivity increased significantly as the histological grade advanced. So, an inverse correlation was observed between the expression of bcl-2 and p53. In conclusion, most primary gastric lymphomas are low or high grade B-cell MALT lymphomas and appear to arise in MALT acquired as a reaction to Helicobacter pylori infection. Expression of bcl-2 and p53 in gastric lymphomas may be associated with transformation from low-grade to high-grade disease. AD - University of Istanbul, Cerrahpasa Medical Faculty, Department of Pathology, Istanbul, Turkey. PMID- 0010079376 EDAT- 1999/03/18 03:02 MHDA- 1999/03/18 03:02 URL - http://korb1.sote.hu/por/por.html SO - Pathol Oncol Res 1999;5(1):36-40 UI - 98402441 AU - Tytgat GN TI - Helicobacter infection in man: problems to be solved. LA - Eng MH - Chronic Disease MH - Dyspepsia/microbiology MH - Gastritis/microbiology MH - Gastrointestinal Diseases/*microbiology MH - *Helicobacter pylori MH - *Helicobacter Infections MH - Human MH - Peptic Ulcer/microbiology MH - Stomach Neoplasms/microbiology PT - JOURNAL ARTICLE PT - REVIEW PT - REVIEW, TUTORIAL DA - 19980922 DP - 1998 Jul-Aug IS - 0257-2753 TA - Dig Dis PG - 192-7 SB - M CY - SWITZERLAND IP - 4 VI - 16 JC - DDS AA - Author EM - 199811 AB - Helicobacter pylori (Hp) infection in man has several disease outcomes, varying from asymptomatic chronic gastric inflammation to Hp-associated dyspepsia, pepic ulcer disease, gastric adenocarcinoma, and Malt lymphoma. Particularly controversial is the role of Hp infection in the genesis of chronic dyspeptic symptoms. Only a small percentage of chronic dispeptics have long-lasting remission of the complaints after cure of the infection. It is now well established that healing of the inflammation through microbial eradication cures peptic ulcer disease. The high efficacy of bismuth or PPI triple and quadruple therapies is overshadowed by the rising resistance to metronidazole and clarithromycin. The exact role of Hp in gastric carcinogenesis in the various geographical areas needs further study. The results of ongoing trials, evaluating the long-term outcome of Hp cure, on cancer rates are anxiously awaited. The acquisition rate of new knowledge through basal and clinical Hp research has rarely been witnessed in medicine. AD - Department of Gastroenterology-Hepatology, Academic Medical Center, Amsterdam, The Netherlands. RF - 17 PMID- 0009732178 EDAT- 1998/09/10 02:03 MHDA- 1998/09/10 02:03 URL - http://www.online.karger.com/library/karger/renderer/dataset.exe?jcode=DDI &action=render&rendertype=fulltext&uid=DDI.ddi16192 SO - Dig Dis 1998 Jul-Aug;16(4):192-7 UI - 98127765 AU - Marzio L AU - Angelucci D AU - Grossi L AU - Diodoro MG AU - Di Campli E AU - Cellini L TI - Anti-Helicobacter pylori specific antibody immunohistochemistry improves the diagnostic accuracy of Helicobacter pylori in biopsy specimen from patients treated with triple therapy. LA - Eng MH - Adult MH - Aged MH - Amoxicillin/administration & dosage MH - Anti-Infective Agents/administration & dosage MH - Anti-Ulcer Agents/administration & dosage MH - Antibodies, Bacterial/*analysis MH - Biopsy MH - Drug Therapy, Combination MH - Female MH - Gastritis/drug therapy/*microbiology/pathology MH - Helicobacter pylori/*immunology MH - Helicobacter Infections/*diagnosis/drug therapy/pathology MH - Human MH - Immunohistochemistry MH - Male MH - Metronidazole/administration & dosage MH - Middle Age MH - Omeprazole/administration & dosage MH - Penicillins/administration & dosage MH - Pyloric Antrum/microbiology/pathology MH - Support, Non-U.S. Gov't RN - 0 (Anti-Infective Agents) RN - 0 (Anti-Ulcer Agents) RN - 0 (Antibodies, Bacterial) RN - 0 (Penicillins) RN - 26787-78-0 (Amoxicillin) RN - 443-48-1 (Metronidazole) RN - 73590-58-6 (Omeprazole) PT - JOURNAL ARTICLE DA - 19980225 DP - 1998 Feb IS - 0002-9270 TA - Am J Gastroenterol PG - 223-6 SB - M SB - X CY - UNITED STATES IP - 2 VI - 93 JC - 3HE AA - Author EM - 199804 AB - OBJECTIVE: To investigate the effectiveness of immunohistochemical technique to detect Helicobacter pylori (H. pylori) in patients treated with triple therapy. METHODS: Forty patients (18 men, 22 women, mean age 43 years) with active antral gastritis, H. pylori positive at urease test, culture, and histology, were treated for 1 wk with omeprazole, amoxicillin, and metronidazole. Gastritis was scored according to Sydney criteria. Two months after the end of therapy, endoscopy, urease test, culture, and histology were repeated. RESULTS: Culture and histology were negative in 32 (80%) of treated cases. Biopsy specimens of the eradicated group were stained with immunohistochemical technique using an anti-H. pylori specific polyclonal antibody. In 12 of 32 (37.5%) patients, clusters of round or vibrio-shaped bacteria, unidentified at histology, were stained by the specific anti-H. pylori antibody. After triple therapy, at histology all patients were found with improved gastritis. In six patients however, mucosal-associated lymphoid tissue (MALT) appearance, present before therapy, persisted after therapy. In five of six patients with MALT, immunostaining with anti-H. pylori antibody was positive. CONCLUSIONS: The immunohistochemical technique is more accurate than classical methods in identifying H. pylori after specific therapy. This method should, therefore, be used in all studies that aim to achieve eradication. Whether the H. pylori identified at immunohistochemistry is able to reactivate and induce recrudescence of infection remains to be clarified. AD - Institute of Fisiopatologia Medica, Universita G. D'Annunzio, Chieti, Italy. PMID- 0009468247 EDAT- 1998/02/19 04:54 MHDA- 1998/02/19 04:54 SO - Am J Gastroenterol 1998 Feb;93(2):223-6 UI - 98059441 AU - Misiewicz JJ TI - Is the only good Helicobacter a dead Helicobacter? LA - Eng MH - Anti-Infective Agents/pharmacology/*therapeutic use MH - Drug Resistance, Microbial MH - Helicobacter pylori/*drug effects MH - Helicobacter Infections/*drug therapy MH - Human RN - 0 (Anti-Infective Agents) PT - JOURNAL ARTICLE PT - REVIEW PT - REVIEW, TUTORIAL DA - 19980115 DP - 1997 Jul IS - 1083-4389 TA - Helicobacter PG - S89-91 SB - M CY - UNITED STATES VI - 2 Suppl 1 JC - CY4 AA - Author EM - 199803 AB - BACKGROUND: Vast numbers of therapeutic studies of various drug regimens used for the cure of H. pylori infection have been published. However, many of these studies have been uncontrolled, included small numbers of patients, were published only as abstracts, differed widely in dosage sizes, schedules and durations and were of insufficient statistical power to make meaningful statements concerning their efficacy. Furthermore, there are no clear or universally accepted guidelines for the treatment of H. pylori infection. Thus, there remains profound confusion among practitioners on whom and how to treat. OBJECTIVE: To critically review the currently available management strategies for H. pylori infection. METHODS: Review of the literature. RESULTS: Treatment of H. pylori requires the use of multiple drug regimens (triple therapy) which can be expensive and is often associated with side effects. Bad choice of treatments, poor patient counseling and compliance will lead to the emergence of resistant H. pylori strains. Resistance to H. pylori to metronidazole is already widespread and resistance to other antimicrobial agents is increasing. The resource/financial implications are not negligible. CONCLUSIONS: The introduction of kits that will enable the identification of pathogenic strains of H. pylori in the office setting may decrease the number of patients being given H. pylori eradication therapy, but much more evidence is needed to establish the practical value of such tests. In the meantime, as many clinicians adhere to the idea that the only good H. pylori is a dead H. pylori, the best practical policy option is education concerning the correct diagnostic methodology, correct choice of patients and the correct choice of treatment regimens. The discovery of Helicobacter pylori (H. pylori) has revolutionized our concepts of etiology, pathophysiology and treatment of many foregut diseases. Gastritis, gastric ulcer (GU), duodenal ulcer (DU), gastric cancer, MALT gastric lymphoma and other conditions are now regarded as being independent on the colonization of the stomach by H. pylori. Many aspects of pathophysiology, such as the abnormalities of gastric acid secretion in duodenal ulcer disease, now for the first time fall into a logical and comprehensible pattern. AD - Department of Gastroenterology and Nutrition, Central Middlesex Hospital, London, UK. RF - 11 PMID- 0009432362 EDAT- 1998/02/12 05:00 MHDA- 1998/02/12 05:00 SO - Helicobacter 1997 Jul;2 Suppl 1:S89-91