Helicobacter pylori infection is an important factor for the development of several gastrointestinal diseases [1], however, most of those infected do not present any type of symptomatology [2,3]. Nearly more than half of the world population is a carrier of this bacterium and about 3% develop neoplasms, which indicates that other factors such as genetic predisposition, the environment and the strain of the bacterium may be related to pathogenesis. The bacterium colonizes the gastric mucosa and has a greater predilection for the antrum [1,4]. This microorganism produces toxic enzymes, including lipase, urease and some proteases, which deregulate the defensive factors of the epithelium. It also has factors that help in adherence to the host cell, which guarantees the success of the infection [1,6].

For the detection of Helicobacter pylori infection, different diagnostic tests are available that can be invasive or non-invasive. Among the invaders, there are techniques such as the use of biopsy, the urease test, PCR, immunohistochemistry, culture, and the gastric brushing technique, with cytology and culture methods, but the most widely used is the digestive endoscopy biopsy. Among the non-invasive methods, we can mention: marked urea respiratory test, serological tests, fecal antigen PCR and genomic study [2]. In serologic tests for the detection of specific IgG antibodies, antibodies become apparent approximately 21 days after infection and may remain present long after eradication [7-9].

The histological diagnosis obtained from the biopsy is the gold standard study to evaluate the extension of the damage to the gastric tissue caused by the bacteria. The point of this evolution can be diagnosed, having important prognostic and therapeutic value [3].

The patients involved in the study were randomly assigned to the digestive endoscopy service, with a chronic dyspeptic condition, to start the diagnostic investigation, during the month of November 2019. This is a semi-quantitative and cross-sectional study, based on the analysis of the results Histopathological studies of the gastric mucosa obtained by upper gastrointestinal endoscopy. A total of seventy-one endoscopic examinations were performed considering whether or not the gastric mucosal biopsy was performed for the study of Helicobacter pylori. This group of patients corresponds to approximately 40% of the patient’s undergoing endoscopy, the rest being eliminated due to predetermined conditions. The sample was obtained from upper gastrointestinal endoscopy in patients of both sexes, in the age group of 40 to 50 years, whose pathological examination to confirm the bacteria was performed by hematoxylin-eosin microscopy, classifying them into crosses according to their intensity. The analysis was based on tests that demonstrated intermediate or moderate deterioration of bacterial infestation. Patients who used anti-inflammatory, anticoagulant, immunosuppressive, or chemotherapy drugs, as well as those with upper gastrointestinal bleeding, chronic renal failure, chronic inflammatory disease, chronic obstructive pulmonary disease, and gastric surgery were not included in the study. These were divided into two groups: one with patients whose biopsy was positive and the other with a negative result. The exclusion of the study of the accentuated quantification was due to the researchers' proposal to analyze the repercussions found in the mild and moderate amounts of bacteria. No set time period for data collection was determined and patients were admitted until a representative number was reached. The study was approved by the Research Ethics Committee of the Regional Hospital of Vale do Paraíba (004/14) and the Brazil Platform (45397415.0.0000.5501).

RESULTS

When analyzing the data of the 71 patients, we observed that 37 (52.1%) were positive for the presence of bacteria and 34 (47.9%) were negative. The prevalence among those infected was female in 22 cases (59.5%). Taking into account the semiquantitative determination of gastric mucosal biopsy products, the examinations were divided into two subgroups according to the number of bacteria, considering only the mild and moderate degree. In the group where mild intensity was observed, we observed 48.8% of the cases and 51.2% in moderate degree. Regarding the histopathological diagnosis, the presence of one or more results in the same collected sample should be emphasized. 

Table 1.  Distribution of histopathological results according to sex and the presence of Helicobacter pylori bacteria

Of the total examinations in mild degree, 43.6% presented mild chronic active gastritis, 38.4% moderate active chronic gastritis, 33.3% focal intestinal metaplasia in the antral epithelium, 12.8% inactive moderate chronic gastritis and 5.1% mild inactive chronic gastritis. The moderate degree was found in 51.2% of the results and we found 97.5% moderate chronic gastritis, 10.2% foveolar regeneration, 2.5% complete intestinal metaplasia and 2.5% active chronic gastritis. In the group that did not carry the bacteria in histopathological analysis, 48.8% presented mild antral enanthematous gastritis, moderate antral enanthematous gastritis in 29.3%, moderate antral erosive gastritis in 7.3% and 2.4% bulboduodenitis. moderate. A chart representing all values ​​is shown below as Table 1.

Helicobacter pylori-induced gastritis is one of the most common human infections and affects the majority of the world population. The characteristics of this disease, associated with Helicobacter pylori infection, have been extensively studied, but some aspects have not yet been clarified [1,2,7,10,11]. Therefore, a proposed study analyzed 162 studies of pathological biopsy in which a study was carried out for Helicobacter pylori, which found a consistent result with the bibliographies used, and that 49.38% of the patients were positive for the presence of this bacterium. Most cases of Helicobacter pylori are acquired in the family environment by oral-oral and fecal-oral routes during the first five years of life. It is estimated that 50% of the world population is infected with the microorganism [13].

Gastric colonization by Helicobacter Pylori induces histological gastritis in all infected individuals, however, only a minority develops evident clinical signs of this colonization [2]. The risks for the development of pathological processes can be an ulcer or a distal gastric cancer, depending on environmental, bacterial and human factors related to the patrón and the severity of gastritis [3,13]. The high prevalence of infection is it correlates with the also high incidence of gastric adenocarcinoma [14], with a great impact on the lives of affected individuals and on the health system, because of which they are very important for diagnosis and treatment [15]. Glandular atrophy, intestinal metaplasia and dysplasia are lesions of great clinical importance, which can be considered precursors of malignancy [16].

The primary prevention of gastric cancer is aimed at a proper diet and the secondary prevention is aimed at the diagnosis and follow-up of preneoplastic lesions such as atrophy and intestinal metaplasia, based on a scale of severity according to the histological status known as the system Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis/Intestinal-Metaplasia Assessment (OLGIM) [17].

Most of the studied individuals had a moderate degree of infection (50%), being predominant in this sample, moderately active chronic gastritis. Of the infected patients, 8 presented metaplasia, which is more prevalent in the case of moderate active gastritis, which suggests that a greater degree of chronic gastritis is associated with a greater risk of metaplasia. From the total of the exams, we observed 35.8% of focal intestinal metaplasia in the antral epithelium and 10.2% of foveolar regeneration, hallazgos that are related to the gastric malignant degeneration and may have its evolution blocked when we treat the bacterial infection. The researchers conclude that this article demonstrates the importance of the early analysis of gastric mucosal changes in a productive age group preventing the feared malignant transformation.

Younger patients with nodular gastritis are infected with Helicobacter pylori (92%) and this implies that the future could have more cancer risk, as they would be more exposed to this infection [18]. The main 

model of carcinogenesis it involves several molecular changes induced by environmental factors, including Helicobacter pylori infection and its high incidence in the sixth decade of life, in patients with chronic atrophic gastritis and intestinal metaplasia [19].

Patients with atrophy or extensive intestinal metaplasia should be followed up with endoscopy every 3 years, and patients with moderate atrophy or limited intestinal metaplasia only in the vent without follow-up [17].

The authors based on the presented review can conclude that the endoscopic investigation that identifies the presence of precancerous lesions and their identification can also take several years. By means of the endoscopic follow-up in patients with high risk, it can help to identify malignant lesions in an early stage when they are still operable and have a high probability of being cured.a

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