The association between Campylobacter-like organisms (CLOs) and lesions of the gastric mucosa was studied in 59 consecutive biopsies. Hematoxylin and eosin and Warthin-Starry silver stains, as well as high-resolution light microscopy (HRLM) and transmission electron microscopy (TEM), were used. The organisms were found in intimate contact with foveolar cells showing abundant phagolysosomes and alterations of the intercellular complexes. CLOs also were seen in close proximity of parietal cells in resting phase, some of which showed degenerative changes. The findings are discussed in light of recent reports linking CLOs to the cause of gastritis. (Key words: Campylobacter; Ultrastructure; Gastritis; Peptic ulcer; Parietal cells; Fovelor cells). Am J Clin Pathol 1986; 86: 575-582 SPIRAL MICROORGANISMS have been reported in the gastric mucosa since 1940, 3 but their possible role as pathogens has not been clarified. Recently, these organisms have been found to share many characteristics with the Campylobacter genus, and the term Campylobacterlike organisms (CLOs) has been widely used in referring to them.8 It has been postulated that these organisms may play an etiologic role in peptic ulcer disease, and a hypothetical mechanism has been offered to explain that role.9 This study was conducted to provide morphologic and bacteriologic data on the infection of the gastric mucosa with CLOs and to explore possible mechanisms responsible for lesions and symptoms. Materials and MethodsBiopsies from the gastric antrum and corpus were taken from 59 consecutive patients attending the endoscopy clinic at Charity Hospital in New Orleans between March and September 1985. One tissue fragment was fixed in buffered formalin, embedded in paraffin, and sectioned and stained with hematoxylin and eosin and WarthinStarry silver technics. A second fragment was used for high-resolution light microscopy (HRLM); if CLOs were identified (33 cases), the block was further processed for Departments of Pathology and Internal Medicine (Gastroenterology), Louisiana State University MedicalCenter, New Orleans, Louisiana transmission electron microscopy (TEM) according to methods described previously. 5 In 23 cases, a third tissue fragment was used to prepare smears for Gram's stain and for bacteriologic cultures.For HRLM and TEM, intact biopsies from antrum and corpus were immediately fixed in paraformaldehyde and postfixed in osmium tetroxide according to previously described standard methods.5 After dehydration, the tissue was embedded in Spurr's epoxy, and l-/um sections were cut for HRLM. They were stained with toluidine blue and counterstained with basic fuchsin. This method allowed the microorganisms to be readily recognizable. Four TEM grids per block were stained with uranyl acetate and lead citrate and studied in a Zeiss® electron microscope. The presence of CLOs and their relationship with normal cells was assessed. A systematic search for the presence of microorganisms and for degenerative changes in the epithelial cells was made. Bo...

The gastric pathogen Helicobacter pylori establishes long-term chronic infections that can lead to gastritis, peptic ulcers, and cancer. The species is so diverse that distinctly different strains are generally recovered from each patient. To better understand the dynamics of long-term carriage, we characterized H. pylori isolates from initial and follow-up biopsy specimens from a patient population at high risk of H. pylori infection and gastric cancer. Eighty-five isolates were obtained from 23 patients and were analyzed by genomic restriction enzyme analysis, arbitrarily primed PCR fingerprinting, (random amplified polymorphic DNA analysis), and/or restriction of specific PCR-amplified genes (restriction fragment length polymorphism analysis). A single strain was found in sequential biopsy specimens from 12 of 15 patients (80%) receiving sucralfate. In the remaining three patients treated with sucralfate, two strains were identified in two patients and three strains were identified in the third patient. In contrast, a single strain was found in sequential biopsy specimens from only three of eight patients (37%) receiving bismuth, metronidazole, and nitrofurantoin. Two strains were identified in five other patients receiving bismuth-antibiotic (63%). Immunoglobulin G antibodies to H. pylori were present in the sera of all patients. Thus, H. pylori colonization can persist for long periods (up to at least 4 years), despite high titers of immunoglobulin G antibodies in serum. Resistance to metronidazole was noted in some strains before and/or after treatment, but all strains remained susceptible to amoxicillin, tetracycline, and nitrofurantoin. We conclude that H. pylori genotypes, as measured by several sensitive DNA fingerprinting methods, can remain stable for years in vivo, despite the acquisition or loss of drug resistance, circulating antibody, or exposure to antibiotics or sucralfate.

Patients infected with Helicobacter pylori have abnormally low ascorbic acid concentration in gastric juice. Low vitamin C intake and Helicobacter pylori infection have been related to an increased risk of gastric carcinoma. This report examines the association between ascorbic acid and Helicobacter pylori in patients referred for upper gastrointestinal endoscopy. Elevated gastric pH and the damage to the gastric surface epithelium were inversely associated with the ascorbic acid concentration in gastric juice. We postulate that these two factors mediate the ascorbic acid-decreasing effect of Helicobacter pylori. Patients with nonpremalignant conditions (normal gastric histology, diffuse antral gastritis, or duodenal ulcer) had lower gastric pH, less damage to the gastric epithelium, and higher levels of ascorbic acid in gastric juice than patients with atrophic gastritis, intestinal metaplasia, or dysplasia.