Omeprazole (Ome) Or Antireflux Surgery (Ars) In The Long Term Management Of Gastroesophageal Reflux Disease (Gerd): Results Of A Multicentre, Randomised Clinical Trial.

Introduction:The meaning of clonality within autoimmune disease and reactive disease is hitherto ambiguous.So has clonal evolution of T ceils been observed in some skin diseases as lymphomatoid papulosis and PLEVA with and without subsequent development of Non-Hodgkin's lymphoma.In the present study we proved clinical meaning and occurrence of clonal heavy chain ~ (IgH) and T cell receptor T chain (TCRG) rearrangements in H. pyloriassociated chronic gastritis with lymphatic hyperplasia, Material and Methods: Formalin fixed and paraffin embedded biopsy specimens of 23 patients with histologically diagnosed gastritis were investigated by Giemsa staining, immunohistochemical investigation of pan-B cell antigen CD20 and pan-T cell antigen CD3.DNA was extracted according to standard methods.For T-cell receptor analysis two multiplex polymerase chain reactions (PCR) were used as described by Trainor et al (1991).For IgH investigation a seminested PCR for the CDR III region was established by using the method of Wan et al (1990).The PCR products were analyzed with a temperature gradient gel electrophoresis (TGGE) technique and visualized by silver staining.Results: Polyclonal rearrangement patterns were seen in 12 cases.An oligoclonal band pattern could be detected in 6 patients.In 4 of these 6 patients, pseudoclonal band features were produced by hypocellularity phenomenon which may be explained by the DNA amplification of single T and B cells.Five patients showed monoclonal signals.In four of them, who additionally revealed lymphoepithelial destructions in gastric epithelium, development of a low grade B-cell-lymphoma of the mucosa-associated tissue could be observed in sequential biopsies.Only one patient showed clonal rearrangements, which disappeared in sequential biopsies.Histologically, only small lymphoepithelial invasion could be detected in this case.Conclusions: Regularly polyclonal rearrangements of IgH and TCRG can be found in H. pylori-associated chronic gastritis.The interpretation of oligoclonal or monoclonal rearrangement patterns should be related to the number of B and T cells present in the biopsy specimens to exclude false positive results caused by hypocellularity.Oligoclonal and monoclonal rearrangements can be observed within immune reactions according to H. pylori infection.The development of lymphoepithelial destruction with clonal rearrangements may lead to manifestion of MALT-lymphoma.