Journal of Clinical & Experimental Pathology
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Increased expression of inducible nitric oxide synthase (iNOS) is observed in patients with chronic inflammatory diseases
of the gastrointestinal tract leading to sustained production of nitric oxide (NO). Since a causal relationship between H.
pylori CagA+ strains infection and gastric cancer has been suggested, therefore, our aim was to evaluate the significance of
iNOS expression in gastric H. pylori CagA+ strains induced lesions with correlation to endoscopic and pathological diagnoses.
From 84 dyspeptic patients, endoscopic 4 antral gastric biopsies were obtained for detection of H. pylori by histopathological
assessment (Giemsa staining), urease test and gene expression of H. pylori using PCR assay. Immunohistochemical staining for
iNOS expression and quantitative detection of anti-CagA antibodies were performed. Anti-CagA antibodies seropositivity and
iNOS immunoexpression were significantly related to H. pylori infection. The positive rates of iNOS immunostaining increased
with the lesion progression from chronic superficial gastritis to chronic atrophic gastritis to intestinal metaplasia (45.2%, 87.5%
and 92.8% respectively). Positive immunostaining rates of iNOS correlated significantly with H. pylori CagA seropositivity with
respect to both endoscopic and pathologic diagnoses. In conclusion, CagA+ H. pylori strains are associated with enhanced
immunoexpression of iNOS in H. pylori-related gastric diseases, therefore they might contribute as risk cofactors that conduces
to gastric carcinogenesis. Given the high prevalence of H. pylori gastric diseases among Egyptian patients, prompt identification
of gastric infections caused by H. pylori harboring CagA virulence factor is necessary for the early eradication of infection before
the development of pre-neoplastic lesions.
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