Morphofunctional characteristics of hard palate mucosal epithelium in patients with chronic gastritis

Assessment of oral mucosa status in patients with gastrointestinal diseases relates to one of the most actual problems in modern medical science [1-4]. Clinical observations confirm that the given pathological condition of oral mucosa is accompanied with inflammatory processes, such as stomatitis, gingivitis, glossitis and periodontitis, severity and rate of occurrence of which directly depend on the duration of the disease [2, 7].

 It is worth mentioning that many issues connected with pathological conditions of oral mucosa at chronic gastritis have not been elaborated yet. The majority of existing scientific researches may be defined as either clinical or functional observations, while cytological data on the specific characteristics of hard palate mucosa at aforementioned pathological condition are almost absent.

The objective of the present research is the analyses of hard palate mucosa’s cytogram in patients with chronic gastritis.

The objects of the present scientific research were impression smears of hard palate mucosa obtained from 16 apparently healthy persons (control group) and 16 patients with chronic gastritis.

Obtained impression smears were dried, fixed in acetone alcohol 1 : 1 (within 5 minutes) and then stained according to Romanowsky-Giemsa. The study of smears included the count of 1000 (one thousand) cells, including epithelial cells of six differentiation stages, lymphocytes, segmented neutrophils and mononuclear cells, including the naked nuclei. The present research also included determination of the percent composition of burned-out cells and phagocytes. Data obtained from cytograms of hard palate mucosa has been used for calculation of the following indexes: Epithelial cells differentiation index, Destruction index, Inflammatory-destructive index, Epithelial cells keratinization index, Left shift index and Index of multicellular epithelial complexes.

Obtained data has been processed using professional package of statistic programs – Statsoft “Statistica-6”. Changes of parameters shall be considered as statistically significant at P < 0,05.

Results of cytologic analysis have shown that squamous epithelial cells were the basic cell elements on the cytorgams of hard palate mucosa in healthy persons. Cells of the sixth stage of differentiation (97,84 ± 9,32%) prevailed among them, while epithelial cells of the fifth stage of differentiation (2,13 ± 0,05%) and epithelial cells of the forth stage of differentiation (0,02 ± 0,01%) occurred more rarely. Epithelial cells of the first, second and third stages of differentiation have not been revealed. Small quantities of phagocytes (0,1 ± 0,02%) were revealed among epithelial cells, while burned out cells were absent. The content of segmented neutrophils and mononuclear cells were also insignificant (0,2  ± 0,03% and 0,13 ± 0,03% accordingly). Epithelial cells differentiation index was equal to 597,82 ± 0,17, Epithelial cells keratinization index - 97,84 ± 0,93, Destruction index – 0, Left shift index – 0, and Inflammatory-destructive index – 0,5 ± 0,09 (See table No: 1 for details).

Table No: 1

Indexes on the cytogram of hard palate mucosa in healthy persons and in patients with chronic gastritis

 

Cytological indexes	Statistical indicators	Control	Patients with chronic gastritis
1	2	3	4
Epithelial cells differentiation index	M ± m P	597,82 ± 17,6	564,57 ± 10,69 P 3,4 < 0,05
Left shift index	M ± m P	0 ± 0	0,05 ± 0,03 P 3,4 > 0,05
Epithelial cells keratinization index	M ± m P	97,84 ± 9,32	68,39 ± 7,92 P 3,4 < 0,05
Inflammatory-destructive index	M ± m P	0,5 ± 0,09	1,39 ± 0,04 P 3,4 < 0,05
Epithelial cells destruction index	M ± m P	0 ± 0	1,39 ± 0,04 P 3,4 < 0,05
Index of multicellular epithelial complexes	M ± m P	0,02 ± 0,01	0,01 ± 0,01 P 3,4 > 0,05

 

Notes: P_3,4 – shall mean statistical significance of the mean values in healthy persons and in patients with chronic gastritis.

 

Cytograms of hard palate mucosa impression smears obtained form patients with chronic gastritis have shown that the number of epithelial cells of the sixth stage of differentiation (68,39  ± 7,92%, P < 0,01) was significantly reduced; while number of epithelial cells of the fifth stage of differentiation (29,62  ± 7,28%, P < 0,05) increased; and the number of epithelial cells of the forth stage of differentiation (1,75  ± 1,01%, P < 0,05) was changed insignificantly. Number of epithelial cells of the first, second and third stages of differentiation was also insignificant (0,02 ± 0,01%, P < 0,05; 0,05 ± 1,01%, P < 0,05; 0,16  ± 0,07%, P < 0,05 accordingly). The study of impression smears in control group and among patents with chronic gastritis has shown that multicellular complexes occurred in very rare cases. Number of segmented neutrophils was significantly increased (9,36  ± 1, 1%, P < 0,05) and the number of mononuclear cells was also changed (10,29  ± 5,26%, P < 0,05). It is important to note occurrence of naked nuclei (1,31  ± 0,62 %, P < 0,05) and burned out cells (1,31  ± 0,98 %, P < 0,05), however, these data are unreliable.

Epithelial cells differentiation index has been significantly increased to the following value 564,57 ± 10,69 %, P < 0,05. Epithelial cells keratinization index decreased to 68,39 ± 7,92 %, P < 0,05; Inflammatory-destructive index increased to 13,9 ± 0,04 %, P < 0,05; destruction index increased up to 1,39 ± 0,04 %, P < 0,05; while changes of the left shift index were unreliable (see Table No: 1).

Obtained results show significant changes in hard palate mucosa in patients with chronic gastritis. We must note statistically significant reduction of both epithelial cells differentiation and epithelial cells keratinization rates, which indicates on the reduction of epithelial cells differentiation rate at the last, final stage – keratinization of epithelial cells of the fifth and sixth stages.

Such phenomena were also observed in mucous membrane of cheek, lips, gingiva and tongue at chronic gastritis [3, 4, 7] and at gastric ulcer and duodenal ulcer. Increased number of segmented neutrophils and mononuclear cells in cytograms obtained from patients indicates on the occurrence of inflammatory destructive reactions in hard palate mucosa, which is also confirmed with data of both inflammatory-destructive and destruction indexes.

Thus, obtained changes in the cytograms of hard palate mucosa at chronic gastritis may be explained with neuro-trophical disturbances, systemic hyporesponsiveness, poor immune status, disturbed circulation in microcirculatory bloodstream, and changes in trophism of oral mucosa [2, 3, 4, 7].

Reduction of epithelial cells differentiation rates and occurrence of inflammatory-destructive changes in hard palate mucosa at chronic gastritis shall be considered as on of the diagnostic indicators, which may be used as the criterion for assessing lesion degree of gastric mucosa and treatment efficacy. 

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