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Indian J. Pathol. Microbial.

37: 4; 389-393: 1994

>biol. October 1994


Fungal Colonization in Gastric Ulcers
RP Rex IH et al:
e cream 1 % in the RAMA RAMAN!, ANANTHAKRISHNAN RAMAN!*, GIRIJA R KUMAR!
cruris and tinea SANJIV A RAO*, SHILAJ CHKRA VARTHY** & PG SHIVAN ANDA
rmatol 2: 441-442, Departments of Microbiology, Pathology**, and Medicine*,
Kasturba Medical College, Manipal.
Jwell NR, Forster
t of dermatophyte
1ger and toe-nails
F 86-327, Lamisil),
1gicidal agent. Br J ABSTRACT
'58, 1989.
Until now studies on fungal colonization of gastric ulcers were
1d Artis WM: retrospective involving small series of patients. This prospective
Jtibility testing of study of 50 patients with gastirc ulcers (25 benign and 25 malignant)
nicrocultures with
gmented mycelial
revealed colonization by Candida in 17 (34%) cases. There was no
timicrob Agents significant difference in colonization between benign and malignant
29, 1980. ulcers. Follow up revealed no difference in healing of ulcers with
or without fungal colonization.

al, Key Words : Candida, Gastric ulcers, Benign, Malignant.

2/3/93 INTRODUCTION (25 benign and 25 malignant ulcers) for


presence of fungi, their incidence in
Though oral candidiasis (thrush) is benign and malignant lesions and
a common form of fungal disease, relationship to therapy and healing.
involvement of stomach is a very rare
event. 1 However, in the last few years MATERIAL AND METHODS
fungal colonization of gastric ulcers has
been reported in literature with We prospectively studied 50
increasing frequency 234 Studies on patients (aged 24-75 years) with gastric
occurrence of fungi in gastric ulcers ulcers. Histopathologically proven
have been retrospective involving small benign and malignant ulcer case were
or large sereis of patients24.s. Moreover, included in the study. For fungal
it is not clearly established whether detection, the gastric biopsies w ere
fungal colonization is associated with taken from ulcer base as well as from
delayed healing, malignant lesions or ulcer margins. Smears were prepared
hypochlorhydria. We prospectively from biopsy tissue and s tained by
studied fifty patients with gastric ulcer Gram's method of staining. Tissue was
390 Ramani et al. Indian J. Pathol. Microbiol. October 1994 Indian J. Pathol.

cultured on Sabouraud's dextrose agar males. There appears to be no


slants. Identification and species significant difference in prevalence of
differentiation of the isolated fungi was fungi between benign gastric.ulcers and
done by standard methods 1 malignant ulcers. Fig. 2 and 3 shows
the fungi in benign and malignant
OBS ERVA TIO NS ulcers respectively.

Out of the 50 cases only 17 (34%) DISCUSSION


were positive for fungus. Smear
examination showed fungus only in 11 The prevalence of fungi in gastric
(22%) cases. Candida was the oruy genus ulcers varies widely. Older studies
detected in these ulcers. Out of 17 based on autopsy material reported a
Candida species, 15 were C. alibicans, prevalence of 4% while recent reports
remaining 2 belong to C. tropicalis. Fig. indicate prevalence varying form 5%
1 shows the age distribution. ulcers to 36% i,M. In the present study we
with fungi tended to be present in found 17 (34%) of 50 patients to have
patients of middle-age group. Table 1 fung_us. Prevalence was higher in
shows the sex distribution of patients middie aged patients (69.74%). There
with ulcers, with and without fungi. was no significant difference in the
Ulcers with fungi appeared to occur prevalence of fungi in benign (32%) and
eqully in males and females, though malignant (36%) gastric ulcers. Almost Fig. 2: Phot
overall, ulcers were more common .!_n all our patients in whom fungus was x 50

AGE DISTRIBUTION

9 Ulcers without Funyus Ulcers with Fungus

8 - - 8 8
,..---

7 - - 7

6
6 -
5
5
4 4
4 -
3
3-
2
,...._ 2
2 -
I .
1-

~ I I
~

10 20 30 40 50 60 70 80 90 0 10 20 30 40 50 60 70 80

YEARS - - - - -1- --
Fi,_g. 3: Photor
Fig. 1: Age distribution in cohorts for ulcers with and without fungus. x 500)
oiol. October 1994 Indian J. Pathol. Microbiol. October 1994 Fungal Colanization 391

~ars to be no
in prevalence of
~astric .ulcers and
. 2 and 3 shows
and malignant

f fungi in gastric
r. Older studies
1terial reported a
ile recent reports
rarying form 5%
'resent study we
patients to have
was higher in
' (69.74%). There
:iifference in the
benign (32%) and
Fig. 2: Photomicrograph of benign ulcer showing hyphae of Candida (PAS ,
ric ulcers. Almost
x 500).
horn fungus was

I .

60 70 so
Fig. 3: Photomicrograph of malignant ulcer showing hyphae of Candida (PAS,
ut fungus. x 500). -
392 Ramani et al. Indian J. Pathol. Microbial. October 1994 Indian J. Pathol. i

TABLE 1 ulcers in <


Gastroenterol
Fungal colonization in benign and malignant ulcers in males and females
4. Peters M, WE
Male Female Total Fungal infe
gastroduoden
and patho
With fungus 6 3 9 Gastroenterolo
Benign
ulcers 5. Loffeld RJLF.
Without fungus 11 5 16 JW, Flendrio
(25) JP: Fungal c<
ulcers. Am JG
With fungus 6 2 8 1988.
Malignant
ulcers
Without fungus Reprint Reque~
(25) 15 2 17

Total 38 12 50 Receivec

isolated were on Hz receptor antagonist to heal within the same period of time.
and our observation confirms earlier
reports.6 Nichols and Henry6 attributed In conclusion we feel that the
the role of Hz receptor blocking drugs presence of fungi in gastric ulcers is
in facilitating growth of fungi by raising due to colonization and has little clinical
the gastric pH. Secondary involvment significance. The use of antimycotic
of the stomach by Candida following therapy, to improve the healing is
vagotomy has been reported with probably not justified.
increasing frequency. 7 In a recent study8
invasive candidiasis, was seen in 2 of REFERENCES
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treatment and in 6 of 20 (30%) patients 1. Rippon JW: Medical Mycology. The
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gastric ulcers is more likely related to Saunders Company, Philadelphia. 682-
698, 1982.
the rise of gastric pH than disseminated
malignancy. Loffold et al 5 found 2. Antioniote A, Codluppi PL and Rigo
significantly slower healing initially in GP.: fungal infection of benign gastric
gastric ulcers with fungi but ultimately ulcer : clinical and endoscopic features.
healing occurred within the same Ital J Gastroenterol 16: 297-299, 1984.
period of time as the normal. Our
follow up results of both groups show 3. Neoman A, Avdor I and Kodish U:
that all ulcers heal or show tendency Candida infection of benign gastric
L October 1994 Indian J. Pathol. Microbial. October 1994 Fungal Colanization 393

ulcers in aged patients. Am J 6. Nichols PE and He_n ry K. : Gastritis


Gastroenterol 75: 211-213, 1981 and cimetidine : A possible
ind females explanation. Lancet 2: 1095-1096, 1978.
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Fungal infection associated with 7. Brooks JR, Smith HF and Pease FB :
Total gastroduodenal ulceration: Endoscopic Bacterology of the stomach
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9 Gastroenterology 78: 350-354, 1980 Ann. Surg. 179: 859-862, 1974.

5. Loffeld RJLF, Loffeld BCAJ, Arends 8. Singh S, Singh N, Kochhar R, Talwar


16 JW, Aendrio JA and Van spresuwel P and Mehta SK. : Cimetidine therapy
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8 1988. 21-22, 1992.

Reprint Request: Dr. P.G. Shivananda, Professor Department of Microbiology,


17 Kasturba Medical College Manipal

50 Received - 23/7 /92 Modified - 28/10/92 Accepted - 31/12/92

period of time.

feel that the


1stric ulcers is
las little clinical
Jf antimycotic
:he healing is

Mycology . The
i the Pathogenic
nd edition, WB
'hiladelphia. 682-

ppi PL and Rigo


of benign gastric
loscopic features.
1: 297-299, 1984.

[ and Kodish U:
f benign gastric