- Email: [email protected]
Helicobacter pylori infection in a child with gastric augmentation
Helicobacter
pylori By Sinan
Infection Celayir,
Suha
in a Child GGksel,
Timucjn
Istanbul,
Anal,
With and
S.N.
Gastric Cenk
Augmentation
Bijyiiktinal
Turkey
The existence of Helicobacter pylori (HP) infection in those children who had previous bladder augmentation with gastric patch has not been described before. In this report, a girl with bladder exstrophy, who previously underwent gastric augmentation is presented. She had multiple admissions to our unit with persisting urinary symptoms (perineal pain, dysuria, hematuria) and gastric symptoms as well. Enzymelinked immunosorbent assay (ELISA) test results for HP infection were positive, and plasma gastrin level was high.
The histopathologic examination of the biopsy specimen showed HP infection in the gastric part of the reconstructed neobladder. This report indicates that the pediatric surgeon should think about HP infection in gastrocystoplasty patients to eliminate the potential risks of HP colonization. J Pediatr Surg 32:1757-1758. Copyright o 1997 by W.B. Saunders Company.
T
gastrointestinal tract (GI) endoscopy was performed, and gastric tissue samples were taken. Microscopic examination of the gastric mucosal biopsy specimen from the reconstructed bladder showed increased lymphocyte and plasma cell population in the foveolar area and sparce polymorphonuclear cell infiltration. Regenerative changes of the surface epithelium was seen (Fig 1). With modified Giemsa stain, Hpylori was seen in the foveolar spaces (Fig 2). CLOtest findings for HP were negative. Pathological diagnosis was mildly active chronic superficial gastritis associated with H pylori. Histopathologic examination of the native stomach also showed signs of chronic gastritis but no HP could be demonstrated. The patient was treated with antibiotics (amoxicillin and metronidazol) and Hs receptor antagonist (ranitidine) for 4 weeks. The clinical symptoms resolved. The repeated ELISA test results were 80 AU/mL (N = 15 AU/mL) and the gastrin level dropped to 66 pg/mL (N = 0 to 90) at the time of control, but the parents didn’t give permission for cystoscopic control and biopsy.
HE USE OF THE STOMACH for bladder reconstruction and augmentation is still one of the most popular techniques in urologic patients who have severe bladder problems.’ Those gastric patches that were infected with Helicobacterpylori (HP) may bring the risk of cystogastritis and peptic ulcer disease to the neobladder. Helicobacterpylori infection may give rise to serious complications such as ulceration, perforation, and potential carcinogenic risk associated with HP colonization in the reconstructed bladders. In this report, the first case with gastric augmentation and HP infection of the bladder is presented.
CASE
ofPediatric
Surgery,
Vol32,
WORDS:
Helicobacter
pylori,
gastrocystoplasty.
REPORT
A 5-month-old girl was admitted for bladder exstrophy. Her bladder was closed primarily. Because of bilateral vesicouretheral reflux (VUR), bilateral Cohen procedure and Young Dees bladder neck reconstruction was performed at the age of 3 years. VUR persisted after the reimplantation, and urodynamic investigation results showed unstable detrusor contractions that needed medical treatment. At 5 years of age she underwent gastrocystoplasty operation for bladder augmentation combined with ureteral reimplantation. In the postoperative period, Hz-receptor antagonist and prophylactic antibiotics were used for 3 months, and the patient set to clean intermittent catheterization (CIC) program. Despite appropriate medical treatment, she had persisting urinary symptoms such as dysuria, hematuria, perineal pain, and signs of gastritis in the follow-up period. Her family history was positive for peptic ulcer disease and gastritis. Her gastrin level was high (150 pg/mL, n = 0 to 90). Because of her intractable clinical symptoms and persisting postoperative complaints we decide to investigate the patient for a possible Helicobncferpylori (HP) infection. The following studies were done: (1) serology (enzyme-linked immunoassay [ELISA] test) for H pylori (HP), (b) histopathology from the cystoscopic biopsy specimen. ELISA test for HP was 46 AU/mL (n = 15 AU/mL). Upper
Journal
INDEX
No 12 (December),
1997:
pp 1757-1758
DISCUSSION
The use of the stomach for bladder reconstruction and augmentation is still one of the most popular methods.’ This is the first described case of HP infection in augmented bladder. The existence of HP infection in augmented bladder may bring the risks of peptic ulcer disease2L3and potential carcinogenic risk associated with HP colonization.4-6 We think further studies in larger gastrocystoplasty
From the Se&on of Pediatric Urology, Departments of Pediatric Surgery and Pathology, Cerrahpaga Medical Faculty, University of Istanbul, Istanbul, Turkey. Address reprint requests to S.N. Cenk Biiyiikiinal, MD, Hacremin Sok. Ersek Apt. No: 30-32, D-3 80200 Nifantagl, Istanbul, Turkey. Copyright 0 1997 by WB. Saunders Company 0022-3468/97/3212-0026$03.00/O
1757
1758
CELAYIR
Fig 1. Chronic original magnification
superficial x200.1
gastritis
in the
fundic
mucosa
ET AL
(H&E,
series must be performed. Especially adult series of gastrocystoplasty should be evaluated because of high incidence of HP in this age group.2,7 When surgeons plan to use the stomach for bladder augmentation, they should keep in mind the possibility of HP infection. An investigation for HP infection (urea breath test, CLOtest, and/or ELBA) before the operation would be beneficial to exclude the potential risks. With this limited experience, we think CLOtest for gastric bladder may give false-negative results. HP urease activity may be neutralized by very high urine output in a short period. We think this is the reason why we had negative results in CLOtest in this particular patient.
Fig original
2.
Helicobacter magnification
py/ori x1,000.)
in
the
foveolar
space
(M.
Giemsa,
In those cases of positive HP infection, surgery must be postponed until the end of a successful medical treatment. In case of severe postoperative hematuria-dysuria syndrome, the surgeon should look for a hidden HP infection.
REFERENCES 1. Nguyen DH, Mitchell ME: Gastric bladder reconstruction. Partial and total bladder reconstruction. Urol Clin North Am l&649-657, 1991 2. Kilbridge PM, Dahms BB, Czinn SJ: Campylobacter pyloriassociated gastritis and peptic ulcer disease in children. AJDC 142: 11491152, 1988 3. Marshall 1994
BJ: Helicobacter
4. The Eurogast
Study Group:
Pylori.
Am J Gastroenterol89:
An international
association
116-128, between
Helicobacter pylori infection and gastric cancer. Lancet 341:1359-1362, 1993 5. Talley NJ, Zinsmeister AR, Weaver A, et al: Gastric adenocarcinoma and Helicobacter pylori infection. J Nat1 Cancer Inst 83:17341739,199l 6. Appelman HD: Gastritis: Terminology, etiology, and clinicopathological correlation’s: Another biased view. Hum Path01 25: 1006-1019, 1994 7. Rowland M, Drumm B: Helicobacter pylori infection and peptic ulcer disease in children. Curr Opin Pediatr 7:553-559, 1995
pylori By Sinan
Infection Celayir,
Suha
in a Child GGksel,
Timucjn
Istanbul,
Anal,
With and
S.N.
Gastric Cenk
Augmentation
Bijyiiktinal
Turkey
The existence of Helicobacter pylori (HP) infection in those children who had previous bladder augmentation with gastric patch has not been described before. In this report, a girl with bladder exstrophy, who previously underwent gastric augmentation is presented. She had multiple admissions to our unit with persisting urinary symptoms (perineal pain, dysuria, hematuria) and gastric symptoms as well. Enzymelinked immunosorbent assay (ELISA) test results for HP infection were positive, and plasma gastrin level was high.
The histopathologic examination of the biopsy specimen showed HP infection in the gastric part of the reconstructed neobladder. This report indicates that the pediatric surgeon should think about HP infection in gastrocystoplasty patients to eliminate the potential risks of HP colonization. J Pediatr Surg 32:1757-1758. Copyright o 1997 by W.B. Saunders Company.
T
gastrointestinal tract (GI) endoscopy was performed, and gastric tissue samples were taken. Microscopic examination of the gastric mucosal biopsy specimen from the reconstructed bladder showed increased lymphocyte and plasma cell population in the foveolar area and sparce polymorphonuclear cell infiltration. Regenerative changes of the surface epithelium was seen (Fig 1). With modified Giemsa stain, Hpylori was seen in the foveolar spaces (Fig 2). CLOtest findings for HP were negative. Pathological diagnosis was mildly active chronic superficial gastritis associated with H pylori. Histopathologic examination of the native stomach also showed signs of chronic gastritis but no HP could be demonstrated. The patient was treated with antibiotics (amoxicillin and metronidazol) and Hs receptor antagonist (ranitidine) for 4 weeks. The clinical symptoms resolved. The repeated ELISA test results were 80 AU/mL (N = 15 AU/mL) and the gastrin level dropped to 66 pg/mL (N = 0 to 90) at the time of control, but the parents didn’t give permission for cystoscopic control and biopsy.
HE USE OF THE STOMACH for bladder reconstruction and augmentation is still one of the most popular techniques in urologic patients who have severe bladder problems.’ Those gastric patches that were infected with Helicobacterpylori (HP) may bring the risk of cystogastritis and peptic ulcer disease to the neobladder. Helicobacterpylori infection may give rise to serious complications such as ulceration, perforation, and potential carcinogenic risk associated with HP colonization in the reconstructed bladders. In this report, the first case with gastric augmentation and HP infection of the bladder is presented.
CASE
ofPediatric
Surgery,
Vol32,
WORDS:
Helicobacter
pylori,
gastrocystoplasty.
REPORT
A 5-month-old girl was admitted for bladder exstrophy. Her bladder was closed primarily. Because of bilateral vesicouretheral reflux (VUR), bilateral Cohen procedure and Young Dees bladder neck reconstruction was performed at the age of 3 years. VUR persisted after the reimplantation, and urodynamic investigation results showed unstable detrusor contractions that needed medical treatment. At 5 years of age she underwent gastrocystoplasty operation for bladder augmentation combined with ureteral reimplantation. In the postoperative period, Hz-receptor antagonist and prophylactic antibiotics were used for 3 months, and the patient set to clean intermittent catheterization (CIC) program. Despite appropriate medical treatment, she had persisting urinary symptoms such as dysuria, hematuria, perineal pain, and signs of gastritis in the follow-up period. Her family history was positive for peptic ulcer disease and gastritis. Her gastrin level was high (150 pg/mL, n = 0 to 90). Because of her intractable clinical symptoms and persisting postoperative complaints we decide to investigate the patient for a possible Helicobncferpylori (HP) infection. The following studies were done: (1) serology (enzyme-linked immunoassay [ELISA] test) for H pylori (HP), (b) histopathology from the cystoscopic biopsy specimen. ELISA test for HP was 46 AU/mL (n = 15 AU/mL). Upper
Journal
INDEX
No 12 (December),
1997:
pp 1757-1758
DISCUSSION
The use of the stomach for bladder reconstruction and augmentation is still one of the most popular methods.’ This is the first described case of HP infection in augmented bladder. The existence of HP infection in augmented bladder may bring the risks of peptic ulcer disease2L3and potential carcinogenic risk associated with HP colonization.4-6 We think further studies in larger gastrocystoplasty
From the Se&on of Pediatric Urology, Departments of Pediatric Surgery and Pathology, Cerrahpaga Medical Faculty, University of Istanbul, Istanbul, Turkey. Address reprint requests to S.N. Cenk Biiyiikiinal, MD, Hacremin Sok. Ersek Apt. No: 30-32, D-3 80200 Nifantagl, Istanbul, Turkey. Copyright 0 1997 by WB. Saunders Company 0022-3468/97/3212-0026$03.00/O
1757
1758
CELAYIR
Fig 1. Chronic original magnification
superficial x200.1
gastritis
in the
fundic
mucosa
ET AL
(H&E,
series must be performed. Especially adult series of gastrocystoplasty should be evaluated because of high incidence of HP in this age group.2,7 When surgeons plan to use the stomach for bladder augmentation, they should keep in mind the possibility of HP infection. An investigation for HP infection (urea breath test, CLOtest, and/or ELBA) before the operation would be beneficial to exclude the potential risks. With this limited experience, we think CLOtest for gastric bladder may give false-negative results. HP urease activity may be neutralized by very high urine output in a short period. We think this is the reason why we had negative results in CLOtest in this particular patient.
Fig original
2.
Helicobacter magnification
py/ori x1,000.)
in
the
foveolar
space
(M.
Giemsa,
In those cases of positive HP infection, surgery must be postponed until the end of a successful medical treatment. In case of severe postoperative hematuria-dysuria syndrome, the surgeon should look for a hidden HP infection.
REFERENCES 1. Nguyen DH, Mitchell ME: Gastric bladder reconstruction. Partial and total bladder reconstruction. Urol Clin North Am l&649-657, 1991 2. Kilbridge PM, Dahms BB, Czinn SJ: Campylobacter pyloriassociated gastritis and peptic ulcer disease in children. AJDC 142: 11491152, 1988 3. Marshall 1994
BJ: Helicobacter
4. The Eurogast
Study Group:
Pylori.
Am J Gastroenterol89:
An international
association
116-128, between
Helicobacter pylori infection and gastric cancer. Lancet 341:1359-1362, 1993 5. Talley NJ, Zinsmeister AR, Weaver A, et al: Gastric adenocarcinoma and Helicobacter pylori infection. J Nat1 Cancer Inst 83:17341739,199l 6. Appelman HD: Gastritis: Terminology, etiology, and clinicopathological correlation’s: Another biased view. Hum Path01 25: 1006-1019, 1994 7. Rowland M, Drumm B: Helicobacter pylori infection and peptic ulcer disease in children. Curr Opin Pediatr 7:553-559, 1995