Evaluation de la cytologie dans le diagnostic de l'infection à helicobacter pylori

Our interest in Helicabacter pylori (HP) derived from our rexperience with cytology. Since 1978, we have used touch cytology as a diagnostic method in infections (Debongnie et al 1989a) and cancer of the gastrointestinal tract. After the description of HP by Marshall, and after our initial work on HP (Delmée et al 1987), we asked the cytotechnician to look for HP on smears, helping her with photographs. In fact, she had seen those S shaped forms long before their official description ! Our use of smears before 1983, the official birthdate of HP and thus helped us to approach the natural history of the infection.
The three aims of our study are to evaluate :
1/ Cytology, a diagnostic test for helicobacter pylori infection
We used smears of biopsy (touch cytology) as a routine diagnostic test for the presence of Helicobacter pylori on the gastric mucosal surface.
The test was used in a large number of patients with a variety of diseases of the upper gastrointestinal tract. Cytology was compared first with culture, used as the reference method, than with other diagnostic tests (urease, histology). The intra and interobserved variation of interpretation was assessed.
2/ Helicobacter pylori in diseases of the upper gastrointestinal tract.
Since 1986, we have prospectively evaluated more than 1000 patients with various conditions of the upper gastrointestinal tract including patients with a normal endoscopy and patients with normal mucosa at histology. We approached the relationship between HP infections of the upper gastrointestinal tract in different ways:
- Through the frequency of HP in a normal stomach
- Through the frequency of HP in ulcerative lesions (duodenal ulcer – gastric ulcer – erosions – oesophagitis) and by studying the difference between patients with and without HP for each ulcerative disease.
3/ Natural history of helicobacter pylori infection
Since 1978, we have been storing gastric smears obtained during endoscopy. This allowed us to have a second look at smears retrieved before the description of HP. This gave us the opportunity to examine successive smears for patients with repeated endoscopic examinations. For some patients, the observations periods exceeds 10 years. We thus had the opportunity of analysing the acquisition, the persistence and the eradication of the micro organism