Over the years, Inform Diagnostics has presented a diverse array of research
studies from The Inform Diagnostics Research Institute at the Annual
Scientific Meeting of the American College of Gastroenterology. At the
2013 meeting in San Diego, presented research topics included Helicobacter-negative
Chronic Active Gastritis, Intestinal Spirochetosis, Gastric Pathology
in HIV-positive patients, and the association between Eosinophilic Esophagitis
and Inflammatory Bowel Disease.
Low Prevalence of Colon Polyps in Patients with Diarrhea and Microscopic Colitis
Figure 1 – Age-specific prevalence of hyperplastic polyps and adenomas
in patients with MC and controls
This study found that among patients with diarrhea, those with microscopic
colitis have a significantly lower prevalence of polyps than those without
microscopic colitis. Regulatory T cells (CD4+ and CD8+) were highly represented
in microscopic colitis, suggesting that immunomodulation may exert an
inhibitory effect on epithelial proliferation.
Intestinal Spirochetosis is Associated with Diarrhea, Weight Loss and Abdominal
Pain: A Study of 447 Patients and 1.2 Million Controls
This large study with combined clinical and pathologic data provided solid
evidence that intestinal spirochetosis is associated with significant
lower gastrointestinal manifestations. Diarrhea and abdominal pain were
the main presenting symptoms in patients with spirochetosis, and their
frequency was significantly higher than in controls.
Figure 2 – This biopsy specimen shows the characteristic features
of H. pylori chronic active gastritis; however, no organisms could be
visualized in either this or other specimens from the same patient.
Figure 3 – In high-prevalence zones, H. pylori infection peaked in
the 5th decade and declined later in life (solid red line); in low-prevalence
areas it increased steadily in each decade (solid blue line). In contrast,
the prevalence of Helicobacter-negative-gastritis was very low in both
zones (dotted red and blue lines), both showing only a small increase with age.
Helicobacter-negative Chronic Active Gastritis is an Independent Nosologic
Entity, Not Merely Missed Helicobacter Infection: A Nationwide Study of
Although H. pylori DNA has been demonstrated in a small proportion of biopsy
specimens with apparent H. pylori-negative chronic active gastritis, the
vast majority of these cases remain unexplained. Our epidemiologic data
confute the concept that H. pylori-negative gastritis merely represents
a subset of H. pylori-positive gastritis in which organisms are not seen
(“missed infections”). Other yet undetected bacteria or viruses
could be responsible for this entity, found in 1% to 4% of all patients
who have gastric biopsies.
Gastric Pathology in HIV-Infected Patients
This study found that H. pylori infection is more prevalent in HIV-positive
patients than HIV-negative patients (14% versus 10%, respectively). This
result was based on the highly sensitive and specific immunohistochemical
demonstration of organisms in the stomach. However, the overall data suggest
that HIV infection does not affect gastric mucosal responses in a statistically
Esophageal Eosinophilia and Gastric Mucosal Pathology: Is There a Link?
This study confirmed the inverse relationship between EoE and H. pylori
and its sequelae. Surprisingly, conditions that are clearly unrelated
to H. pylori (e.g. reactive gastropathy) or uncertainly linked to H. pylori
(e.g. autoimmune gastritis) were also less likely in patients with EoE.
Finally, our epidemiologic data are inconsistent with the concept that
H. pylori-negative gastritis represents a subset of H. pylori-positive
gastritis in which organisms are not seen (“missed infections”).
Eosinophilic Esophagitis is Associated with an Increased Prevalence of
Inflammatory Bowel Disease
Figure 4 – Typical biopsy specimen from the mid-esophagus of a patient with EoE.
Figure 5 – Prevalence of UC and Crohn’s patients with HPF,
and in the two groups with increasing numbers of eos/HPF.
In this study, patients with increased esophageal eosinophils, particularly
those with >60 eos/HPF, were almost twice as likely to have concurrent
IBD as patients with a normal esophagus. In addition, this increase was
most evident in patients with UC; UC was progressively more frequent as
the number of eosinophils increased.
Unexpected Candidiasis in the Endoscopically Normal Esophagus
This study found that 1.7% of patients with histologically documented fungal
esophagitis had an endoscopically normal esophagus. These patients were
more likely to present with dyspepsia and abdominal pain than dysphagia
and were younger than those who had esophageal candidiasis and an endoscopic