Chronic gastritis and Helicobacter pylori in digestive form of Chagas' disease

Barbosa, A. J. A.; Queiroz, D. M. M.; Nogueira, A. M. M. F.; Roquette Reis, M. J. A.; Mendes, E. N.; Rocha, G. A.; Romanello, L. M. F.; Troncon, L. E. A.

doi:10.1590/S0036-46651993000200002

Abstracts

Patients with the digestive form of Chagas'disease frequently present chronic gastritis. As the microorganism Helicobacter pylori is now accepted as the most common cause of human chronic gastritis, the present work was undertaken to verify a possible relationship between the presence of this bacterium and inflammatory changes of antral mucosa in chagasic patients. Seventeen chagasics, with megaesophagus and or megacolon were studied. Fragments from two different regions of antral mucosa were obtained by endoscopy, fixed in 4% neutral formaldehyde and embedded in paraffin. The sections were stained by haematoxylin and eosin for histology analysis, and by carbolfuchsin for H. pylori identification. H. pylori was found in 16 (94.1%) chagasic patients, all of them presenting chronic gastritis. Superficial gastritis was seen in 9 (52.9%) while atrophic gastritis was present in 8 (47.1%) patients. H. pylori was present on gastric mucosa of 8 (100%) patients with atrophic gastritis and of 8 (88.8%) patients with superficial gastritis. We concluded that the microorganism H. pylori should be considered a possible factor connected with the etiopathogenesis of chronic superficial and atrophic gastritis frequently observed in patients with the digestive form of Chagas' disease.

Chagas' disease; Megaesophagus; Megacolon; Chronic gastritis; H. pylori

Pacientes com a forma digestiva da doença de Chagas frequentemente apresentam gastrite crônica. Tendo em vista que o microrganismo Helicobacter pylori é hoje considerado a causa mais comum de gastrite crônica no homem, propôs-se a realização deste trabalho para se verificar a possibilidade de esta bactéria estar também associada com as alterações inflamatórias da mucosa gástrica em pacientes com a forma digestiva da doença de Chagas. Fragmentos de duas regiões diferentes da mucosa antral foram obtidos endoscopicamente de 17 pacientes chagásicos com megaesôfago e ou megacolon. Os fragmentos foram processados rotineiramente para inclusão em parafina e cortes de 5 |im de espessura foram corados pela H & E para análise histológica e pela carbolfucsina para a identificação do H. pylori. A bactéria foi encontrada em 16 (94,1%) pacientes, todos eles apresentando gastrite crônica. Gastrite crônica superficial foi observada em 9 (52,9%) enquanto que gastrite crônica atrófica estava presente em 8 (47,1%) pacientes. H. pylori estava presente em todos os pacientes com gastrite crônica atrófica e em 8 (88, 8%) pacientes com gastrite crônica superficial. Conclue-se que o microrganismo H. pylori deve ser considerado como possível fator ligado à etiopatogênese da gastrite crônica superficial e atrófica frequentemente observadas em pacientes com a forma digestiva da doença de Chagas.

ORIGINAL ARTICLES

Chronic gastritis and Helicobacter pylori in digestive form of Chagas' disease

Gastrite crônica e Helicobacter Pylori na forma digestiva da doença de Chagas

A. J. A. Barbosa; D. M. M. Queiroz; A. M. M. F. Nogueira; M. J. A. Roquette Reis; E. N. Mendes; G. A. Rocha; L. M. F. Romanello^I; L. E. A. Troncon^I

^IDepartamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, SP, Brasil

^{Address for correspondence} Address for correspondence: Dr. Alfredo J.A. Barbosa Faculdade de Medicina UFMG Av. Alfredo Balena, 190 CEP 30130 -Belo Horizonte/MG, Brasil

SUMMARY

Patients with the digestive form of Chagas'disease frequently present chronic gastritis. As the microorganism Helicobacter pylori is now accepted as the most common cause of human chronic gastritis, the present work was undertaken to verify a possible relationship between the presence of this bacterium and inflammatory changes of antral mucosa in chagasic patients. Seventeen chagasics, with megaesophagus and or megacolon were studied. Fragments from two different regions of antral mucosa were obtained by endoscopy, fixed in 4% neutral formaldehyde and embedded in paraffin. The sections were stained by haematoxylin and eosin for histology analysis, and by carbolfuchsin for H. pylori identification. H. pylori was found in 16 (94.1%) chagasic patients, all of them presenting chronic gastritis. Superficial gastritis was seen in 9 (52.9%) while atrophic gastritis was present in 8 (47.1%) patients. H. pylori was present on gastric mucosa of 8 (100%) patients with atrophic gastritis and of 8 (88.8%) patients with superficial gastritis. We concluded that the microorganism H. pylori should be considered a possible factor connected with the etiopathogenesis of chronic superficial and atrophic gastritis frequently observed in patients with the digestive form of Chagas' disease.

Key words: Chagas' disease; Megaesophagus; Megacolon; Chronic gastritis; H. pylori.

RESUMO

Pacientes com a forma digestiva da doença de Chagas frequentemente apresentam gastrite crônica. Tendo em vista que o microrganismo Helicobacter pylori é hoje considerado a causa mais comum de gastrite crônica no homem, propôs-se a realização deste trabalho para se verificar a possibilidade de esta bactéria estar também associada com as alterações inflamatórias da mucosa gástrica em pacientes com a forma digestiva da doença de Chagas. Fragmentos de duas regiões diferentes da mucosa antral foram obtidos endoscopicamente de 17 pacientes chagásicos com megaesôfago e ou megacolon. Os fragmentos foram processados rotineiramente para inclusão em parafina e cortes de 5 |im de espessura foram corados pela H & E para análise histológica e pela carbolfucsina para a identificação do H. pylori. A bactéria foi encontrada em 16 (94,1%) pacientes, todos eles apresentando gastrite crônica. Gastrite crônica superficial foi observada em 9 (52,9%) enquanto que gastrite crônica atrófica estava presente em 8 (47,1%) pacientes. H. pylori estava presente em todos os pacientes com gastrite crônica atrófica e em 8 (88, 8%) pacientes com gastrite crônica superficial.

Conclue-se que o microrganismo H. pylori deve ser considerado como possível fator ligado à etiopatogênese da gastrite crônica superficial e atrófica frequentemente observadas em pacientes com a forma digestiva da doença de Chagas.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGMENT

The authors are indebted to Dr. J. L. P. Modena, Head of the Section of Digestive Tract Endoscopy of the University Hospital of Ribeirão Preto who allowed us to use the endoscopic equipment. The authors are also indebted to FAPEMIG/ FINEP/CNPq for the financial support received.

Recebido para publicação em 13/3/1992

Aceito para publicação em 3/3/1993

1. BARBOSA, A.J.A.; QUEIROZ, D.M.M.; MENDES, E.N.; ROCHA, G.A.; LIMA Jr., G.F. & OLIVEIRA C.A. - Immunocytoquimical identification of Campylobacter pylori in gastritis and correlation with culture. Arch. Path. Lab. Med., 112: 523-525, 1988.
2. BARBOSA, A.J.A.; QUEIROZ, D.M.M.; MENDES, E.N.; ROCHA, G.A.; CARVALHO, A.S.T. & ROQUETE, M.L.V. - Campylobacter pylori - associated acute gastritis in a child. J. clin. Path., 42: 779, 1989.
3. BUCK, G.E.; GOURLEY, W.K.; LEE, W.K.; LUBRAMANYAN, K.; LATIMER, J.M. & DINUZZO, A.R. - Relation of Campylobacter pyloridis to gastritis and peptic ulcer. J. infect. Dis., 153: 664-669, 1986.
4. COELHO, L.G.V.; DAS, S.S.; KARIM, Q.N.; WALKER M.M.; QUEIROZ, D.M.M.; MENDES, E.N.; LIMA Jr., G.F.; OLIVEIRA, C.A.; BARON, J.H. & CASTRO, L.P. - Campylobacter pyloridis in the upper gastrointestinal tract: a Brazilian study. Arq. Gastroent. (S. Paulo), 24: 5-9, 1987.
5. COSTA, R.B. & ALCANTARA, F.G. - Gastropatia chagásica crônica. Rev. bras. Med., 22: 667-671, 1965.
6. DIXON M.F.; O'CONNOR, H.J.; AXON, A.T.R.; KING, R.F.J.G. & JOHNSTON, D. - Reflux gastritis: distinct histopathological entity? J. clin. Path., 39: 524-530, 1986.
7. DRUMM, M.B.; SHERMAN, P.; CUTZ, E. & KARMALI, H. - Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children. Amer. J. Gastroent., 83: 202-203, 1988.
8. FREYTES, M.A. - Secreción gastrica en chagasicos cronicos. Pren. med. argent., 54: 1289 -1295, 1967.
9. GRAHAM, D.Y. - Campylobacter pylori and peptic ulcer disease. Gastroenterology, 96: 615-625, 1989.
10. JONES, D.M.; LESSELLS, A.M. & ELDRIDGE J. - Campylobacter-like organisms on the gastric mucosa: culture, histologic and serological studies. J. clin. Path., 37: 1002-1006, 1984.
11. KOBERLE, F. - Patogenia da molestia de Chagas; estudo dos órgăos musculares ocos. Rev. goiana Med., 3: 155-180, 1957.
12. MARSHALL, D.J. & WARREN, J.R. - Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet, 1: 1311-1315, 1984.
13. MARSHALL, B.J.; McGECHIE, O.B.; ROGERS, P.A. & GLANCY, R.J. - Pyloric Campylobacter infections and gastroduodenal disease. Med. J. Aust., 142: 439-444, 1985.
14. MORRIS, A. & NICHOLSON, G. - Ingestion of Campylobacter pyioridis causes gastritis and raised fasting gastric pH. Amer. J. Gastroent., 82: 192-199. 1987.
15. OLIVEIRA, R.B.; TRONCON, L.E.A.; MENEGHELLI, U.G.; PADOVAN, W.; DANTAS, R.O. & GODOY, R.A. - Impaired gastric accommodation to distension and rapid gastric emptying in patients with Chagas' disease. Dig. Dis. Sci., 25: 790-794, 1980.
16. PADOVAN, W.; MENEGHELLI, V.G. & GODOY, R.A. - Gastric secretory and motility studies in chronic chagasic patients. Dig. Dis. Sci., 22: 618- 622, 1977.
17. PADOVAN, W.; GODOY, R.A.; MENEGHELLI, U.G.; OLIVEIRA, R.B. & TRONCON, L.E.A. - Acid and pepsin secretion in chronic Chagas' disease patients in response to graded doses of pentagastrin and pentagastrin plus bethanecol. Digestion, 23: 48-56, 1982.
18. PORTO, C. - Gastropatia chagásica crônica. Rev. goiana Med., 1: 43-54, 1955.
19. QUEIROZ, D.M.M.; BARBOSA, A.J.A.; MENDES, E.N.; ROCHA, G.A.; CISALPINO, E.O.; LIMA Jr., G.F. & OLIVEIRA, C.A. - Distribution of Campylobacter pylori and gastritis in the stomach of patients with and without duodenal ulcer. Amer. J. Gastroent., 83: 1370, 1988.
20. REZENDE, J.M.; ROSA, H.; VAZ, M.G.M.; ANDRADE-SA, N.; PORTO, J.D.; NEVES, J. & XIMENES, J.A.A. - Endoscopia no megaesôfago. Estudo prospectivo de 600 casos. Arq. Gastroent. (S. Paulo), 22: 53-62, 1985.
21. ROCHA, G.A.; QUEIROZ, D.M.M.; MENDES, E.N.; BARBOSA, A.J.A.; UMA Jr., G.F. & OLIVEIRA, C.A. - Helicobacter pylori acute gastritis: histological, endoscopical, clinical, and therapeutic features. Amer. J. Gastroent., 86: 1592-1595, 1991.
22. ROCHA, G.A.; QUEIROZ, D.M.M.; MENDES, E.N.; LAGE, A.P. & BARBOSA, A.J.A. - Simple carbolfuchsin staining for demonstrating C. pylori and other spiral in the gastric mucosa. J. clin. Path., 42: 1004-1005, 1989.
23. TAFURI, W.L. - Light and electron microscope studies of the autonomic nervous system in experimental and human American trypanosomiasis. Virchows Arch. Abt. A. path. Anat. Hist., 354: 136-149, 1971.
24. TRONCON, L.E.A.; OLIVEIRA, R.B.; MENEGHELU, V.G.; DANTAS, R.O. & GODOY, R.A. - Plasma gastrin and gastric acid responses to insulin hypoglycemia in Chagas' disease. Braz. J. med. biol. Res., 18: 273-278, 1985.
25. TRONCON, L.E.A.; REZENDE-FILHO, J. & IAZIGI, N.- Duodenogastric reflux in Chagas' disease. Dig. Dis. Sci., 33: 1260-1264, 1988.
26. WHITEHEAD, R.; TRUELOVE, S.C. & GEAT, M.W.U. - The histological diagnosis of chronic gastritis in fibreoptic gastroscope biopsy specimens. J. clin. Path., 25: 1-11, 1972.
27. WYATT, J.I.; RATHBONE, B.J. & HEATLEY, R.V. - Local immune response to gastric Campylobacter infection in non-ulcer dyspepsia. J. clin. Path., 38: 863-870, 1986.

Address for correspondence:

Dr. Alfredo J.A. Barbosa

Faculdade de Medicina UFMG

Av. Alfredo Balena, 190

CEP 30130 -Belo Horizonte/MG, Brasil

Publication Dates

Publication in this collection
27 July 2006
Date of issue
Apr 1993

History

Accepted
03 Mar 1993
Received
13 Mar 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BARBOSA, A.J.A.; QUEIROZ, D.M.M.; MENDES, E.N.; ROCHA, G.A.; LIMA Jr., G.F. & OLIVEIRA C.A. - Immunocytoquimical identification of Campylobacter pylori in gastritis and correlation with culture. Arch. Path. Lab. Med., 112: 523-525, 1988.

[2] 2. BARBOSA, A.J.A.; QUEIROZ, D.M.M.; MENDES, E.N.; ROCHA, G.A.; CARVALHO, A.S.T. & ROQUETE, M.L.V. - Campylobacter pylori - associated acute gastritis in a child. J. clin. Path., 42: 779, 1989.

[3] 3. BUCK, G.E.; GOURLEY, W.K.; LEE, W.K.; LUBRAMANYAN, K.; LATIMER, J.M. & DINUZZO, A.R. - Relation of Campylobacter pyloridis to gastritis and peptic ulcer. J. infect. Dis., 153: 664-669, 1986.

[4] 4. COELHO, L.G.V.; DAS, S.S.; KARIM, Q.N.; WALKER M.M.; QUEIROZ, D.M.M.; MENDES, E.N.; LIMA Jr., G.F.; OLIVEIRA, C.A.; BARON, J.H. & CASTRO, L.P. - Campylobacter pyloridis in the upper gastrointestinal tract: a Brazilian study. Arq. Gastroent. (S. Paulo), 24: 5-9, 1987.

[5] 5. COSTA, R.B. & ALCANTARA, F.G. - Gastropatia chagásica crônica. Rev. bras. Med., 22: 667-671, 1965.

[6] 6. DIXON M.F.; O'CONNOR, H.J.; AXON, A.T.R.; KING, R.F.J.G. & JOHNSTON, D. - Reflux gastritis: distinct histopathological entity? J. clin. Path., 39: 524-530, 1986.

[7] 7. DRUMM, M.B.; SHERMAN, P.; CUTZ, E. & KARMALI, H. - Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children. Amer. J. Gastroent., 83: 202-203, 1988.

[8] 8. FREYTES, M.A. - Secreción gastrica en chagasicos cronicos. Pren. med. argent., 54: 1289 -1295, 1967.

[9] 9. GRAHAM, D.Y. - Campylobacter pylori and peptic ulcer disease. Gastroenterology, 96: 615-625, 1989.

[10] 10. JONES, D.M.; LESSELLS, A.M. & ELDRIDGE J. - Campylobacter-like organisms on the gastric mucosa: culture, histologic and serological studies. J. clin. Path., 37: 1002-1006, 1984.

[11] 11. KOBERLE, F. - Patogenia da molestia de Chagas; estudo dos órgăos musculares ocos. Rev. goiana Med., 3: 155-180, 1957.

[12] 12. MARSHALL, D.J. & WARREN, J.R. - Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet, 1: 1311-1315, 1984.

[13] 13. MARSHALL, B.J.; McGECHIE, O.B.; ROGERS, P.A. & GLANCY, R.J. - Pyloric Campylobacter infections and gastroduodenal disease. Med. J. Aust., 142: 439-444, 1985.

[14] 14. MORRIS, A. & NICHOLSON, G. - Ingestion of Campylobacter pyioridis causes gastritis and raised fasting gastric pH. Amer. J. Gastroent., 82: 192-199. 1987.

[15] 15. OLIVEIRA, R.B.; TRONCON, L.E.A.; MENEGHELLI, U.G.; PADOVAN, W.; DANTAS, R.O. & GODOY, R.A. - Impaired gastric accommodation to distension and rapid gastric emptying in patients with Chagas' disease. Dig. Dis. Sci., 25: 790-794, 1980.

[16] 16. PADOVAN, W.; MENEGHELLI, V.G. & GODOY, R.A. - Gastric secretory and motility studies in chronic chagasic patients. Dig. Dis. Sci., 22: 618- 622, 1977.

[17] 17. PADOVAN, W.; GODOY, R.A.; MENEGHELLI, U.G.; OLIVEIRA, R.B. & TRONCON, L.E.A. - Acid and pepsin secretion in chronic Chagas' disease patients in response to graded doses of pentagastrin and pentagastrin plus bethanecol. Digestion, 23: 48-56, 1982.

[18] 18. PORTO, C. - Gastropatia chagásica crônica. Rev. goiana Med., 1: 43-54, 1955.

[19] 19. QUEIROZ, D.M.M.; BARBOSA, A.J.A.; MENDES, E.N.; ROCHA, G.A.; CISALPINO, E.O.; LIMA Jr., G.F. & OLIVEIRA, C.A. - Distribution of Campylobacter pylori and gastritis in the stomach of patients with and without duodenal ulcer. Amer. J. Gastroent., 83: 1370, 1988.

[20] 20. REZENDE, J.M.; ROSA, H.; VAZ, M.G.M.; ANDRADE-SA, N.; PORTO, J.D.; NEVES, J. & XIMENES, J.A.A. - Endoscopia no megaesôfago. Estudo prospectivo de 600 casos. Arq. Gastroent. (S. Paulo), 22: 53-62, 1985.

[21] 21. ROCHA, G.A.; QUEIROZ, D.M.M.; MENDES, E.N.; BARBOSA, A.J.A.; UMA Jr., G.F. & OLIVEIRA, C.A. - Helicobacter pylori acute gastritis: histological, endoscopical, clinical, and therapeutic features. Amer. J. Gastroent., 86: 1592-1595, 1991.

[22] 22. ROCHA, G.A.; QUEIROZ, D.M.M.; MENDES, E.N.; LAGE, A.P. & BARBOSA, A.J.A. - Simple carbolfuchsin staining for demonstrating C. pylori and other spiral in the gastric mucosa. J. clin. Path., 42: 1004-1005, 1989.

[23] 23. TAFURI, W.L. - Light and electron microscope studies of the autonomic nervous system in experimental and human American trypanosomiasis. Virchows Arch. Abt. A. path. Anat. Hist., 354: 136-149, 1971.

[24] 24. TRONCON, L.E.A.; OLIVEIRA, R.B.; MENEGHELU, V.G.; DANTAS, R.O. & GODOY, R.A. - Plasma gastrin and gastric acid responses to insulin hypoglycemia in Chagas' disease. Braz. J. med. biol. Res., 18: 273-278, 1985.

[25] 25. TRONCON, L.E.A.; REZENDE-FILHO, J. & IAZIGI, N.- Duodenogastric reflux in Chagas' disease. Dig. Dis. Sci., 33: 1260-1264, 1988.

[26] 26. WHITEHEAD, R.; TRUELOVE, S.C. & GEAT, M.W.U. - The histological diagnosis of chronic gastritis in fibreoptic gastroscope biopsy specimens. J. clin. Path., 25: 1-11, 1972.

[27] 27. WYATT, J.I.; RATHBONE, B.J. & HEATLEY, R.V. - Local immune response to gastric Campylobacter infection in non-ulcer dyspepsia. J. clin. Path., 38: 863-870, 1986.

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