Assessment of Cell Proliferation in Helicobacter pylori associated gastric epithelial diseases

  • Neeraj Dhameja Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
  • Ritambra Nada Professor, Department of Histopathology, PostGraduate Institute of Medical Education and Research, Chandigarh
  • Deepak Kumar Bhasin Professor and Head, Department of Gastroenterology, PostGraduate Institute of Medical Education and Research, Chandigarh.
  • Kusum Joshi Professor &Head, Department of Histopathology, PostGraduate Institute of Medical Education and Research, Chandigarh.
Keywords: Atrophy, Carcinoma, Chronic active gastritis, Dysplasia, Intestinal metaplasia, Helicobacter pylori, Proliferative Index

Abstract

Background: Alterations in cell proliferation and apoptosis as a result of Helicobacter Pylori infection can contribute to carcinogenesis. This study was planned to assess cellular proliferation during chronic active gastritis with or without H. Pylori, atrophy, intestinal metaplasia, dysplasia and carcinoma. Effect of H. Pylori eradication on cell proliferation was also studied.Methods: Ki67 immunostaining was done to calculate proliferative index (PI) in H. pylori associated gastric diseases.  Gastric biopsies of 160 patients with dyspepsia were selected comprising of 20 cases each of  following groups 1) Normal control 2) H .pylori positive chronic  active gastritis before  and after treatment  3)H. pylori negative chronic active gastritis  4) Atrophy  5) Intestinal metaplasia  6) Dysplasia  7) Gastric adenocarcinoma Result: There was increased proliferative index (PI) in H. pylori positive and negative chronic active gastritis as compared to normal controls. However, the PI in H. pylori positive chronic active gastritis was significantly higher than  that of H. pylori negative chronic active gastritis. Increased proliferation was persistent in atrophy, intestinal metaplasia, dysplasia and carcinoma. There was significant  increase in PI in foveolar regions in chronic active gastritis, intestinal metaplasia and dysplasia . After H. pylori eradication, there was marked reduction in  PI. Conclusion: H. pylori infection results in increased gastric epithelial cell proliferation which persists in the premalignant stages of atrophy, intestinal metaplasia, dysplasia and carcinoma. Presence of H. pylori augments proliferation resulting from inflammation and eradication of H. pylori reduces proliferation.. This increased proliferation may be one of the mechanism of H. pylori associated  carcinogenesis.

Author Biography

Neeraj Dhameja, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
Assistant Professor, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.

References

1. Warren JR, Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. The Lancet 1983;321:1273-75.
2. Eurogast study group. An international association between Helicobacter pylori and gastric cancer. The Lancet 1993;341:1359-63.
3. Sipponen P. Gastric cancer- A Long Term Consequece of Helicobacter pylori infection? Scand J Gastroenterol Suppl. 1994;201:24-7.
4. Sipponen P, Hyvärinen H. Role of Helicobacter pylori in the Pathogenesis of Gastritis, Peptic ulcer and Gastric cancer. Scand J Gastroenterol Suppl. 1993;196:3-6.
5. Sipponen P, Kosunen TU, Valle J, Riihelä M, Seppälä K. Helicobacter pylori infection and chronic gastritis in gastric cancer. J Clin Pathol 1992;45:319-23.
6. Rokkas T, Filipe MI, Sladen GE. Detection of an increased incidence of early gastric cancer in patients with intestinal metaplasia type III who are closely followed up. Gut 1991;32:1110-13.
7. Jass JR. Role of intestinal metaplasia in the histogenesis of gastric carcinoma. J Clin Pathol 1980;33:801-10.
8. Correa P. Is gastric carcinoma an infectious disease? N Engl J Med 1991;325(16):1170-71.
9. Lipkin M. Biomarkers of Increased Susceptibility to Gastrointestinal Cancer . New Application to Studies of Cancer Prevention in Human Subjects. Cancer Res 1988;48:235-45.
10. Brenes F, Ruiz B, Correa P, Hunter F, Rhamakrishnan T, Fontham E,et al. Helicobacter pylori causes hyperproliferation of the gastric epithelium: pre and post eradication indices of proliferating cell nuclear antigen. Am J Gastroenterol 1993;88(11):1870-5.
11. Bechi P, Balzi M, Becciolini A, Maugeri A, Raggi CC, Amorosi A,et al. Helicobacter pylori and cell proliferation of the gastric mucosa: possible implication for gastric carcinogenesis. Am J Gastroenterol 1996;91:271-6.
12. Peek RM, Moss SF, Tham KT, Perez-Perez GI, Wang S, Miller GG, et al. Helicobacter pylori Cag A+ strains and dissociations of gastric epithelial cell proliferation from apoptosis. J Natl. Cancer Inst. 1997;89(12):863-8.
13. Cahill RJ, Xia H, Kilgallen C, Beattie S, Hamilton H, Colm O' Morain. Effect of Eradication of Helicobacter pylori Infection on Gastric Epithelial Cell Proliferation. Dig Dis Sci 1995;40:1627-31.
14. Murakami K, Fujioka T, Kodama R, Kubota M, Tokieda M, Nasu M. Helicobacter pylori infection accelerates human gastric mucosal cell proliferation. J Gastroenterol 1997;32:184-8.
15. Fan XG, Kelleher D, Fan XJ, Xia HX, Keeling PW. Helicobacter pylori increases proliferation of gastric epithelial cells. Gut 1996;38:19-22.
16.Tseng HH, Hsu PI, Chen HC, Lai KH, Lo GH, et al. Compartment theory in Helicobacter pylori - associated gastric carcinogenesis. Anticancer Res. 2003;23:3223-9.
17. Ren H, Yi C. Role of Helicobacter pylori infection in pathogenesis of gastric adenocarcinoma. J Tongji Med Uni. 1999;19:127-30.
18. Peek RM, Wirth HP, Moss SF, Yang M, Abdalla AM, Tham KT, et al. Helicobacter pylori alters gastric epithelial cell cycle events and gastrin secretion in Mongolian gerbils. Gastroenterology 2000;118:48-59.
19. Hirasawa R, Tatsuta M, Iishi H, Yano H, Baba M, Uedo N, et al. Increase in apoptosis and decrease in ornithine decarboxylase activity of the gastric mucosa in patients with atrophic gastritis and gastric ulcer after successful eradication of Helicobacter pylori. Am J Gastroenterol 1999;94:2398-02.
20. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The Updated Sydney system. International Workshop on the Histopathology of Gastritis. Am J Surg Pathol 1996;20:1161-81.
21. Correa P. A human model of gastric carcinogenesis. Cancer Res 1988;48:3554-64.
22. Lynch DA, Mapstone NP, Clarke AMT, Cobala GM, Jackson P, Morrison L, et al. Cell proliferation in Helicobacter pylori associated gastritis and the effect of eradication therapy. Gut 1995;36:346-50.
23. Fraser AG, Sim R, Sankey EA, Dhillon AP, Pounder RE. Effect of eradication of Helicobacter pylori on gastric epithelial cell proliferation. Aliment Pharmacol Ther 1994;8:167-73.
24. Panella C, Ierardi E, Polimeno L, Balzano T, Ingrosso M, Amoruso A, ¨et al. Proliferative Activity of Gastric Epithelium in Progressive Stages of Helicobacter pylori Infection. Dig Dis Sci 1996;41:1132-38.
25. Ierardi E, Francavilla R, Panella C. Effect of Helicobacter pylori eradication on intestianl metaplasia and gastric epithelium proliferation. Ital J Gastroenterol Hepatol 1997;29:470-5.
Published
2016-05-07
Section
Original Article