helicobacter pylori infection and its consequences
TRANSCRIPT
![Page 1: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/1.jpg)
Helicobacter pylori Helicobacter pylori infection and its infection and its consequencesconsequences
![Page 2: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/2.jpg)
We pathologists We pathologists knew squat knew squat
about gastritis about gastritis before before H pyloriH pylori
was discovered.was discovered.
![Page 3: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/3.jpg)
H pylori infects the H pylori infects the whole stomach, but whole stomach, but it induces a chronic it induces a chronic gastritis that is most gastritis that is most intense in the antal intense in the antal mucosamucosa
![Page 4: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/4.jpg)
Classic H pylori gastritis: Classic H pylori gastritis: the great blue biopsythe great blue biopsy
![Page 5: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/5.jpg)
Plasmacytosis Plasmacytosis (superficial) in(superficial) in
the lamina propriathe lamina propria
![Page 6: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/6.jpg)
Induced lymphoid follicles Induced lymphoid follicles at the base of the mucosaat the base of the mucosa
![Page 7: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/7.jpg)
Activity withActivity withPMNs in the necksPMNs in the necks
![Page 8: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/8.jpg)
In most cases, the bacteria In most cases, the bacteria can be found in the H and E can be found in the H and E stained section, on the surface stained section, on the surface epithelium, often over the epithelium, often over the intecellular junctions and intecellular junctions and beneath the surface mucus beneath the surface mucus coat. They appear as tiny thin coat. They appear as tiny thin rods often with a bend in the rods often with a bend in the center, like a set of wings.center, like a set of wings.
![Page 9: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/9.jpg)
Bugs on the surface of the epitheliumBugs on the surface of the epitheliumBugs on the surface of the epitheliumBugs on the surface of the epithelium
![Page 10: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/10.jpg)
Often they hide in the detached mucusOften they hide in the detached mucus
![Page 11: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/11.jpg)
Not allNot all H pylori H pylori gastritis is the same gastritis is the same..
There may beThere may be population differencespopulation differences individual differencesindividual differences minimal disease with tons of bugsminimal disease with tons of bugs intense disease with few bugsintense disease with few bugs variable eosinophils variable eosinophils variable activityvariable activity
![Page 12: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/12.jpg)
H pyloriH pylori identification when they identification when they are difficult to find on H&E; are difficult to find on H&E; other stains have been used.other stains have been used.
Silver Silver
Diff-quickDiff-quick
![Page 13: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/13.jpg)
H pyloriH pylori identification when identification when they are difficult to find on H&Ethey are difficult to find on H&E
Immunostain, our current methodImmunostain, our current method
![Page 14: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/14.jpg)
Active Active H pyloriH pylori antral gastritisantral gastritis
![Page 15: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/15.jpg)
H pylori H pylori GastritisGastritis
Untreated Plasmacytosis Activity Bugs Lymphoid hyperplasia
Treated Bugs disappear Activity stops Plasmacytosis recedes Lymphoid follicles atrophy
H pyloriH pylori
killerkiller
![Page 16: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/16.jpg)
H pyloriH pylori
killerkiller
![Page 17: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/17.jpg)
Biopsies that Biopsies that look like look like treated treated H pyloriH pylori gastritis are gastritis are commoncommon
![Page 18: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/18.jpg)
Superficial Superficial PlasmacytosisPlasmacytosis
![Page 19: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/19.jpg)
No activity. No activity. No bugs on No bugs on the surface.the surface.
![Page 20: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/20.jpg)
Usually, this inactive Usually, this inactive chronic gastritis has chronic gastritis has
no no H pyloriH pylori
![Page 21: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/21.jpg)
These days, a few biopsies of inactive chronic These days, a few biopsies of inactive chronic gastritis have bugs gastritis have bugs on immunostainon immunostain,, often deep in often deep in the the pitspits and even in the and even in the glandsglands and and not on the not on the surface.surface. Thid may result from chronic Thid may result from chronic PPI usePPI use
In the pitsIn the pitsIn the glandsIn the glands
![Page 22: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/22.jpg)
Otherwise, this common inactive Otherwise, this common inactive chronic gastritis without chronic gastritis without H pylori H pylori has no name and no literature.has no name and no literature. But we keep seeing it.But we keep seeing it.
![Page 23: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/23.jpg)
Chronic Chronic inactiveinactive gastritis, gastritis,with no bugs: WHY?with no bugs: WHY?
Biopsy missed bugsBiopsy missed bugs different causedifferent cause proton pump inhibitorsproton pump inhibitors antibioticsantibiotics
![Page 24: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/24.jpg)
Approach to patients with Approach to patients with heartburn and dyspepsiaheartburn and dyspepsia
First, acid suppression, First, acid suppression, commonly commonly Proton Proton Pump Inhibitors (PPIs)Pump Inhibitors (PPIs)If no response, then upper If no response, then upper endoscopy and potential endoscopy and potential biopsiesbiopsies
![Page 25: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/25.jpg)
Protein pump inhibitor effectsProtein pump inhibitor effectsParietal cell acid secretionParietal cell acid secretion
HypergastrinemiaHypergastrinemia Parietal cell hypertrophy: Parietal cell hypertrophy: snoutssnouts ?Parietal cell hyperplasia?Parietal cell hyperplasia ?Polyps containing fundic glands?Polyps containing fundic glands ECL cell stimulation in humans ECL cell stimulation in humans unclearunclear
antral pHantral pH
![Page 26: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/26.jpg)
Protein pump inhibitor effectsProtein pump inhibitor effectsParietal cell acid secretionParietal cell acid secretion antral pHantral pH
Treats antral Treats antral H pylori:H pylori:Bugs migrate proximally Bugs migrate proximally or deeply or deeply activity disappearsactivity disappears Plasmacytosis recedesPlasmacytosis recedes lymphoid follicles atrophylymphoid follicles atrophy
![Page 27: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/27.jpg)
H pyloriH pyloriCauses:Causes:
peptic ulcers ( mechanism peptic ulcers ( mechanism unknown), unknown), a clinical diseasea clinical disease chronic active gastritis, chronic active gastritis, mostly antralmostly antral, , not a clinical not a clinical diseasedisease
![Page 28: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/28.jpg)
Complications of H pylori infectionPeptic ulcers, mainly in the duodenumAdenocarcinoma, secondary to dysplasias that develop in atrophic gastritis (see atrophic gastritis module for definitions and diagnostic criteria)B cell lymphomas, both low and high grade, probably developing in the induced lymphoid follicles at the base of the mucosa
![Page 29: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/29.jpg)
There is a second There is a second bacterium that causes an bacterium that causes an active chronic gastritis, active chronic gastritis, similar to, but less similar to, but less intense than, intense than, H pylori H pylori gastritis.gastritis.
![Page 30: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/30.jpg)
Helicobacter heilmanniiHelicobacter heilmannii
![Page 31: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/31.jpg)
Helicobacter heilmannii is Helicobacter heilmannii is really rare around here.really rare around here.The bugs:The bugs: 7-10 microns7-10 microns Urease +Urease + Dog and cat transmittedDog and cat transmitted
The disease:The disease: 39 cases in 15,180 antral bxs 39 cases in 15,180 antral bxs (Heilmann & Borchard, Gut 32:137, 1991(Heilmann & Borchard, Gut 32:137, 1991 Antrum 100%; body 20%Antrum 100%; body 20% Chronic active -it is, less than H pyloriChronic active -it is, less than H pylori
![Page 32: Helicobacter pylori infection and its consequences](https://reader035.vdocuments.us/reader035/viewer/2022081508/56649c8e5503460f94946f50/html5/thumbnails/32.jpg)
H heilmanniiH heilmannii comes from household comes from household pets, so don’t share eating utensiles with pets, so don’t share eating utensiles with your cats and dogs unless you eat first.your cats and dogs unless you eat first.