| Verrucous gastritis is regarded as an endoscopic manifestation of common chronic gastritis in Sydney system and 2012 China chronic gastritis consensus,which belongs to raised type of erosive gastritis.As the clinical symptoms are lack of specificity in the patients with verrucous gastritis,it mainly rely on endoscopic diagnosis.We use verrucous gastritis according to the domestic habits,but there is little to be found in the English literature.Pathologic examination of verrucous gastritis is usually intestinal metaplasia(IM),atrophy even dysplasia or cancerization,so it is considered to be a precancerous disease.In recent years,domestic research of verrucous gastritis has gradually increased,but mostly on the clinical manifestations,examination and treatment of traditional Chinese and Western medicine,but few in-depth study on other aspects,such as the causes,pathogenesis and prognosis.At present,"H.pylori infection is the main cause of chronic gastritis," this view is widely recognized.In addition,many people observed the infection of H.pylori in the patients of verrucous gastritis,by which found that the positive rate was higher than chronic superficial gastritis,and the difference was significant,so that H.pylori may be the main cause of the disease.Helicobacter pylori(H.pylori)is a spiral shaped Gram-negative,microaerophilic bacterium that selectively colonizes the gastric mucous layer of the stomach.It is a urease-,catalase-,and oxidase-positive bacterium that possesses 4 to 6 polar flagella for motility,and several virulence factors which vary with the strain.H.pylori was isolated for the first time in 1983 by Warren and Marshall from gastric biopsy samples of patients with chronic gastritis and peptic ulcer.Then H.pylori has also been recognized by the World Health Organization to be associated with gastric cancer in1994.H.pylori-induced gastritis is the strongest risk factor for gastric cancers,but only a small percentage of infected humans develop malignancy.Thus,the risk of developing a gastric cancer also depends on host responses and environmental factors,as well as strain specific bacterial components.Cluster of differentiation 44(CD44)also known as HCAM,is an importance member of cell adhesion molecules(CAMs)family.CD44 is a cell surface transmembrane glycoprotein that composed of 742 amino acid.Functioning as a receptor for hyaluronic acid(HA)and interacting with ligands such as osteopontin(OPN),CD44 mediates both cell-cell and cell-matrix interactions,thereby playing an essential role in cell adhesion and cell migration.In the past decade,cancer has been recognized as a stem cell disease.In recent years,some researchers identified CD44 as a gastric cancer stem cells(CSCs)marker as CD44+ cells sorted by FACS were able to form tumorspheres under non-adherent culture conditions and gastric tumors after xenografts in immunedeficient mice,whereas CD44-negative sorted cells did not.CD44 expressing cells have CSC features including tumorigenic,able to self-renewal and generate phenotypically diverse cells.But there is no report about CD44 expression in the gastric mucosa of patients with verrucous gastritis at home and abroad.This study aims to investigate the influence of H.pylori and stem cells on the development and progress of verrucous gastritis by examining H.pylori distribution and CSC marker CD44 expression in the gastric mucosa of patients with this disease,and provide a theoretical foundation for the success of H.pylori eradication and verrucous gastritis to gastric cancer.Objective:To investigate the influence of H.pylori and stem cells on the development and progress of verrucous gastritis by examining H.pylori distribution and CSC marker CD44 expression in the gastric mucosa of patients with this disease.Methods:27 cases of gastric mucosa biopsy were used in this experiment,were obtained from the endoscopy center of Second Hospital of Hebei Medical University,which endoscopic manifestations of verrucous gastritis and H.pylori positive by breath test.Each patient was removed one piece of gastric tissue with the biopsy forceps from the median emine of verrucous lesions of gastric antrum near the pylorus and gastric angle close to lesser curvature of the corpus,names respectively for gastric antrum and gastric angle.Then the histopathological morphologic alteration of gastric mucosa were observed by hematoxylin and eosin(HE)staining,and the positive detection rate of H.pylori was estimated by this method.In addition,to further observe the distribution of H.pylori in the two sites of gastric antrum and gastric angle,we use the method of Giemsa staining.Finally,the expression of CD44 was detected by immunohistochemical(IHC)staining.Results:1 HE staining showed gastric angle atrophy occurred at a higher rate compared with gastric antrum,and the difference is statistically significant(P<0.05),while gastric antrum had higher incidence of intestinal metaplasia or dysplasia compared with gastric angle(P<0.05).Comparison of the activity between gastric antrum and gastric angle,the results showed that gastric antrum was higher than gastric angle(P<0.05).In addition,9 of the 27 patients had duodenal bulb inflammation2 Giemsa staining indicated that the distribution of H.pylori in gastric antrum was higher than gastric angle(P<0.05);within group comparison shows H.pylori in gastric antrum was higher than gastric angle when the two parts were atrophy(P<0.05).When H.pylori were positive in two parts of gastric antrum and gastric angle of the same patient,the results showed that the incidence of inflammation or atrophy in gastric angle was higher(P<0.05);On the contrary,other pathological changes such as intestinal metaplasia or dysplasia was higher in gastric antrum.In addition,Giemsa staining on H.pylori positive rate was higher compared with HE staining(P<0.05),indicating that Giemsa staining with high sensitivity and specificity,and H.pylori clear display,more recognizable.3 Immunohistochemical staining showed that the expression of CD44 was increased in turn in the inflammation(OD 0.11±0.02),atrophy(OD 0.20±0.02)and intestinal metaplasia or dysplasia(OD 0.25±0.03)of gastric antrum(P<0.05);compared with H.pylori negative lesions,the expression of CD44 was higher in H.pylori positive lesions(P<0.05).In gastric angle,the expression of CD44 was lower in inflammation,and was higher in other lesions(P<0.05).Conclusion:1 Gastric antrum was mainly intestinal mataplasia or dysplasia,while gastric angle was mainly atrophic;the distribution of H.pylori and the activity of gastric antrum were higher than that of the gastric angle in H.pylori related verrucous gastritis,which showed that the lesion of gastric antrum was more severe.H.pylori might be involved in the occurrence and development of the verrucous gastritis.2 When H.pylori of the two parts were all positive,gastric angle was mainly inflammation or atrophy,while gastric antrum was mainly other pathological changes such as intestinal metaplasia or dysplasia,indicating that H.pylori migration may be occurred when the environment of tissue lesions is not suitable for the survival of H.pylori in gastric antrum.3 Duodenal lesions may occur in patients with verrucous gastritis.4 Cancer stem cell marker CD44 expression in inflammatory lesions was low,while in atrophy and intestinal metaplasia or dysplasia were high which indicated that stem cells may play a role in the development of verrucous gastritis.Furthermore,verrucous gastritis may be a precancerous lesion,but gastric antrum may not be only site which occurred cancer.5 The positive rate of H.pylori is high by Giemsa staining and(or)HE staining compare with single HE staining;multi-site biopsy can increase the positive rate of H.pylori. |
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