GRADING HELICOBACTER-PYLORI GASTRITIS IN DYSPEPTIC PATIENTS

Helicobacter pylori-like organisms (Hp) and polymorphonuclear leucocyt es (PMNs) in 2614 gastroduodenal biopsies from (602 patients with dysp epsia, in Al Ain, United Arab Emirates, between October 1990 and Octob er 1992, were histologically graded to determine the prevalence of Hp gastritis and their utilization in the evaluation of treatment efficac y in these patients. Symptoms of functional dyspepsia included, in ord er of frequency, abdominal pain or discomfort, flatulence, burning sen sation, regurgitation, fullness, nausea, vomiting, bloating and belchi ng. The biopsies were paraffin embedded, sectioned and stained with he matoxylin and eosin (H and E) to grade the inflammation. In addition t o H and E, several special stains including modified Giemsa (MG), Whar thin-Starry silver and cold Ziehl-Neelsen stains were utilized to clea rly identify Hp organisms. Giemsa method was found to be superior to o ther special stains in visualizing the Hp organisms in paraffin sectio ns, and was utilized in every case. Two immunohistochemical markers fo r B cells (CD20) and T cells (CD45RO) were utilized for labeling lymph ocytes infiltrating the lamina propria of the gastroduodenal biopsies in formalin-fixed paraffin-embedded sections. H and E and MG stained s ections were utilized to count PMNs and Hp, and were graded 0, 1, 2, a nd 3, corresponding to none, mild, moderate, and severe grades of the Sydney system for classification of gastritis, respectively. Of the to tal initial 2318 endoscopic biopsies, 98.8% of the patients had suitab le biopsies for histologic evaluation. Unsuitable biopsies were recove red from patients with gastric carcinoma. Inflammation was seen in 98. 5% of 595 patients with suitable biopsies. In 74.5% of these patients the inflammation was active; 37.5, 32.5 and 4.5% had mild, moderate an d severe active inflammation, respectively. In the remaining 24% of th e 595 patients, the gastritis was chronic without activity or atrophic changes. As many as 73.6% of the patients with suitable biopsies were Hp positive; 39.8, 29.1 and 4.7% had grades 1, 2 and 3 Hp, respective ly. Intestinal metaplasia was found in 28.9% of the 602 patients, and was seen more often in Hp positive than Hp negative patients (34.5 vs 14%, P < 0.005, for d.f. = 1; chi(2) = 10.35). Of the Hp positive pati ents, 172 and 46 patients attended the first and second follow-up endo scopy visits, respectively. The triple treatment was composed of one d ose of tinidazole (2 gm), doxycycline, 200 mg initial dose and 100 mg daily for two weeks, and bismuth subcitrate (Gist-Brocades nv, Delft, The Netherlands), 2 tablets twice daily for 4 weeks. After triple drug treatment, eradication of Hp was accomplished, histologically, in 38. 4 and 45.7% of the patients on first and second follow-up visits, resp ectively. Thus, the Sydney system-based grading scale provides an obje ctive histological evaluation of Hp gastritis for accurate prevalence studies, and may prove to be of value in estimating treatment efficacy .