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World J Gastroenterol. Mar 7, 2009; 15(9): 1105-1112
Published online Mar 7, 2009. doi: 10.3748/wjg.15.1105
Indistinguishable cellular changes in gastric mucosa between Helicobacter pylori infected asymptomatic tribal and duodenal ulcer patients
Dhira Rani Saha, Simanti Datta, Santanu Chattopadhyay, Rajashree Patra, Ronita De, Krishnan Rajendran, Abhijit Chowdhury, Thandavaryan Ramamurthy, Asish Kumar Mukhopadhyay
Dhira Rani Saha, Division of Histology & Electron microscopy. National Institute of Cholera and Enteric Diseases, P 33, CIT Road, Scheme XM, Beliaghata, Kolkata 700010, India
Simanti Datta, Abhijit Chowdhury, School of digestive diseases, Institute of Post Graduate Medical Education and Research, 244 AJC Bose Road, Kolkata 700020, India
Santanu Chattopadhyay, Rajashree Patra, Ronita De, Thandavaryan Ramamurthy, Asish Kumar Mukhopadhyay, Division of Bacteriology, National Institute of Cholera and Enteric Diseases, P 33, CIT Road, Scheme XM, Beliaghata, Kolkata 700010, India
Krishnan Rajendran, Data management Division, National Institute of Cholera and Enteric Diseases, P 33, CIT Road, Scheme XM, Beliaghata, Kolkata 700010, India
Author contributions: Saha DR and Mukhopadhyay AK designed the research; Chowdhury A performed the endoscopy and collected the biopsy samples; Chowdhury A, Dutta S and De R managed the patient data; Datta S, Chattopadhyay S, Patra R and De R processed and performed the genetic analysis of H pylori strains; Saha DR performed the histology; Chattopadhyay S, Patra R, Saha DR and Mukhopadhyay AK analysed the results; Rajendran K did the statistical analysis of data; Mukhopadhyay AK and Saha DR drafted the paper; Mukhopadhyay AK and Ramamurthy T revised the manuscript with intellectual inputs.
Correspondence to: Asish Kumar Mukhopadhyay, PhD, Division of Bacteriology, National Institute of Cholera and Enteric Diseases, P 33, CIT Road, Scheme XM, Beliaghata, Kolkata 700010, India. asish_mukhopadhyay@yahoo.com
Telephone: +91-33-23701176
Fax: +91-33-23705066
Received: November 12, 2008
Revised: January 16, 2009
Accepted: January 23, 2009
Published online: March 7, 2009
Abstract

AIM: To investigate the changing pattern of different histological parameters occurring in the stomach tissue of Helicobacter pylori (H pylori) infected tribal populations and duodenal ulcer patients among ethnic Bengalis and correlation of the genotypes of H pylori with different histological parameters.

METHODS: One hundred and twelve adult individuals were enrolled into this study between 2002 and 2004. Among them, 72 had clinical features of duodenal ulcer (DU) from ethnic Bengali population and 40 were asymptomatic ethnic tribals. Endoscopic gastric biopsy samples were processed for histology, genotyping and rapid urease test. Histologically, haematoxylin and eosin staining was applied to assess the pathomorphological changes and a modified Giemsa staining was used for better detection of H pylori. For intestinal metaplasia, special stainings, i.e. Alcian blue periodic acid-Schiff and high iron diamine-Alcian blue staining, were performed. PCR was performed on bacterial DNA to characterize the presence or absence of virulence-associated genes, like cagA, and distribution of different alleles of vacA and iceA.

RESULTS: Intraglandular neutrophil infiltration, a hallmark of activity of gastritis, was present in 34 (94%) of tribals (TRs) and 42 (84%) of DU individuals infected with H pylori. Lymphoid follicles and aggregates, which are important landmarks in H pylori infection, were positive amongst 15 (41%) of TRs and 20 (40%) of DU subjects. Atrophic changes were observed in 60% and 27.7%, respectively, among DU cases and tribals (P > 0.003). Metaplastic changes were detected in low numbers in both groups. Moderate to severe density distribution of H pylori in the gastric mucosa was 63% among TRs, whereas it was 62% in DU subjects. There were no significant differences in the distribution of virulence-associated genes like cagA, vacA and iceA of H pylori strains carried by these two populations.

CONCLUSION: Our study showed almost similar distribution of inflammatory cells among asymptomatic tribals and DU Bengali patients. Interestingly, the tribal population are free from any clinical symptoms despite evidence of active histologic gastritis and infection with H pylori strains carrying similar virulence markers as of strains isolated from patients with DU. There was an increased cellular response, especially in terms of neutrophil infiltration, but much lower risk of developing atrophy and metaplastic changes among the tribal population.

Keywords: Helicobacter pylori; Tribal; Neutrophil; Mononuclear cells infiltration; Lymphoid follicles