Apparent Reversal of Early Gastric Mucosal Atrophy after Triple Therapy for Helicobacter pylori

Helicobacter pylori may be difficult to detect in individuals with intestinal metaplasia or atrophic gastritis, even though bacteria may persist in the mucosa in low numbers, maintaining elevated serum H. pylori antibody levels. We report a patient with marked, endoscopically visible gastric mucosal changes and focal changes of histological atrophic gastritis, who was negative for H. pylori on urease test, culture, and histology, but had positive H. pylori serology. When treated with triple therapy and reassessed at 6 months, his H. pylori antibody titer fell to low/negative levels, abnormal mucosa was replaced by a velvety, normal lining, and the previous evidence of histological atrophic gastritis was no longer detectable.     

Difference in Degree of Mucosal Atrophy between Elevated and Depressed Types of Gastric Epithelial Tumors

Background: The significance of atrophy in the background mucosa and Helicobacter pylori infection in the morphogenesis of gastric epithelial tumors has not yet been investigated. Methods: The degree of mucosal atrophy, as determined by a histological analysis and the serum pepsinogen (PG) levels, and H. pylori status were investigated in patients with elevated adenoma (EA group; n = 40), elevated early cancer of intestinal type (ECI group; n = 30), depressed early cancer of intestinal type (DCI group; n = 37) and depressed early cancer of diffuse type (DCD group; n = 33), and the findings were then compared to those in 91 controls. Results: At all sites of the stomach, the histologic score of atrophy was higher in the EA group and in the ECI group than in the controls. In the DCI group, the histologic score of atrophy in the antrum was higher than in the controls, but no such difference in the score was found in the DCD group. The PG I/II ratios in the EA, ECI and DCI groups were significantly lower than in the controls, and the value was also different between the ECI and DCI groups. While H. pylori prevalence was higher in all groups than in the controls, a logistic regression analysis which included the grade of atrophy as a determinant revealed the infection to be an independent associated factor for the DCD group. Conclusions: The difference in the background mucosal atrophy seems to contribute to different macroscopic types in gastric epithelial tumors. This seems to be the case especially for cancer of intestinal type.     

Serum Anti-Helicobacter pylori IgG Antibody Titer in H. pylori-negative Cases with a Different Gastric Mucosal Atrophy Status

Objective This retrospective study was performed to investigate the anti-Helicobacter pylori IgG antibody serum titers in H. pylori-negative subjects with different degrees of gastric mucosal atrophy including C0 grade atrophy. Methods The absence of H. pylori infection was determined based on both negative serum anti-H. pylori IgG antibody test findings and no endoscopic evidence of that infection. Cases negative for the antibody and with positive endoscopic findings of H. pylori infection were defined as H. pylori-positive. The serum anti-H. pylori IgG antibody titers were analyzed in H. pylori-negative (n=1,087), -positive (n=69), and post-eradicated (n=278) subjects. Results The serum antibody titer in subjects with H. pylori-positive endoscopy findings was significantly higher than that in H. pylori-negative subjects, even when the serum titer indicated a negative result. In addition, the anti-H. pylori IgG antibody serum titer was higher in H. pylori-negative subjects with a greater degree of gastric mucosal atrophy. In a comparison between H. pylori-negative C0 and C1 gastric mucosal atrophy cases, the antibody serum titer in those classified as C0 was significantly lower. An analysis of H. pylori post-eradicated cases showed that the serum antibody titer decreased over time after successful eradication. Conclusion The disappearance of H. pylori infection in H. pylori-negative individuals may occur later in those with a greater degree of gastric mucosal atrophy. The serum antibody titer difference between the H. pylori-negative C0 and C1 groups might have been caused by the differences in distribution between H. pylori-uninfected subjects and those in whom the infection had disappeared, thus additional investigation is needed to clarify the significance of gastric mucosal classification including the C0 grade.     

A Polymorphism of microRNA 27a Genome Region Is Associated With the Development of Gastric Mucosal Atrophy in Japanese Male Subjects

Noncoding microRNAs regulate the expression of various mRNAs. We attempted to clarify the relationship between miR-27a genome polymorphism and chronic gastritis. The study was performed in 179 patients with no evidence of gastric malignancy. The severity of histologic chronic gastritis was classified according to the updated Sydney system. The frequency of miR-27a G allele was 34.6%. Although the frequencies of miR-27a G allele were increased in subjects with peptic ulcer or severe mucosal atrophy, no significant differences were seen. The miR-27a polymorphism showed an interaction with gender in relation to gastric mucosal atrophy (P=.090). In only male subjects, the miR-27a polymorphism was associated with the gastric mucosal atrophy (P=.039) and both atrophy and metaplasia scores in G/G group were significantly higher than those in the other groups. The miR-27a genome region polymorphism may be an important definitive factor to develop the gastric mucosal atrophy in Japanese male subjects.     

一种简便的人正常胃黏膜上皮细胞原代培养方法

背景：原代培养的人正常胃黏膜上皮细胞与体内姊妹细胞相似，是进行胃生理和病理研究的理想工具，但我国尚未见简便、可靠的人正常胃黏膜上皮细胞原代培养方法的报道。目的：探讨简便的人正常胃黏膜上皮细胞原代培养方法。方法：以胶原酶Ⅱ和分散酶磁性搅拌分离人正常胃黏膜上皮细胞。以甲基噻唑基四唑（M1Tr）比色法检测细胞活力，以观察细胞大体生长过程；以溴脱氧尿苷（BrdU）标记法检测S期细胞数量，以观察细胞微观增殖能力。以PAS染色鉴定胃黏膜上皮细胞黏原颗粒；以细胞角蛋白（CK）-18免疫荧光染色鉴定上皮细胞。以光学显微镜和透射电子显微镜观察细胞形态结构。初步观察传代细胞的贴壁生长情况。结果：培养第2～3d．胃黏膜上皮细胞活力增幅最大．第4d达最高点，之后逐渐下降；BrdU孵育18h后，33．3％的细胞处于和曾经处于S期。接种密度高时，细胞PAS染色均呈紫红色，可见细胞核旁黏原颗粒；接种密度低时，仅成团细胞PAS染色呈阳性；培养第3d，绝大部分细胞CK-18阳性。接种第2d，胃黏膜上皮细胞成团簇状生长，增殖迅速，第4d后逐渐停止生长．第5d开始出现漂浮死亡细胞，最终完全被成纤维细胞取代；透射电子显微镜可见微绒毛、分泌颗粒、连接复合体等上皮细胞特征。传代胃黏膜上皮细胞增殖、铺展能力较原代细胞降低。结论：磁性搅拌酶分离培养可得到数量多、纯度高的人正常胃黏膜上皮细胞。     

The Role of Cyclooxygenase in Gastric Mucosal Protection

COX-1 and COX-2 are two cyclooxygenase enzymes responsible for prostanoid production. COX-2 is expressed in inflammatory cells and fibroblasts of the gastric mucosa, and through the production of various growth factors including hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF), plays a key role in the tissue repair process. Aspirin induces and acetylates COX-2 to produce 15-(R)-epi-lipoxinA4, an anti-inflammatory mediator thought to protect the gastric mucosa against aspirin-induced injury. Recently, three different PGE synthases have been identified, that convert COX-2 metabolites into PGE2. mPGE synthase (mPGES)-1 has been shown to be inducible, and to colocalize with COX-2 in fibroblasts and macrophages infiltrating the gastric ulcer bed. cPGES and mPGES-2 have been found expressed in normal gastric mucosa, with no change in expression levels seen in gastritis or gastric ulcer tissue. Finally, this review discusses the role of these enzymes in the pathophysiology of the gastric mucosa, as well as the biologcal significance of their inhibition.     

The pH Measurement of Fasting Gastric Juice in Acute Gastric Mucosal Lesions

Abstract: Fasting gastric juice acidity was assessed to elucidate its role in the cause of acute gastric mucosal lesions (AGML). Gastric juice was aspirated through an auxiliary endoscopic channel during routine endoscopic examinations, and its pH was measured with a glass electrode PH meter. The pH of 100 cases with AGML (acute hemorrhagic erosions (AHE), acute gastric ulcer and acute hemorrhagic gastritis), and 586 cases with other ulcerative or inflammatory lesions were compared with the gastric juice pH in 1775 endoscopically normal subjects. The pH value was classgied into four acid groups: Hyperacidity (pH < 1.4), Normoacidity (1).5 < pH < 2.0), Hypoacidity (2).1 < pH <4.0) and Anacidity (4). 1 < pH). In cases with AHE, a signifcant hyperacidity was recognized both in the periods preceding and just after the onset. This hyperacidity was followed by signgicant anacidity, and thereafter a return to normoacidity. These pH changes coincided well with endoscopic appearances; preceding stage-hypernormacidity, black-slough stage—hyperacidity, white-slough stage-anacidity and scarring stage-;normoacidity. These results suggest that an elevation of gastric acidity etiologically relates with the formation of AGML, especially Shin.     

The Correlation of Endoscopic and Histological Diagnosis of Gastric Atrophy

Purpose

Gastric atrophy is a premalignant condition. The aim of this study was to evaluate the correlation between histological and endoscopic findings of atrophy, and to analyze the affecting factors.

Methods

Atrophy was graded by endoscopy, and biopsy was performed in the antrum and body for the diagnosis of atrophy according to the Sydney system in the 1,330 subjects.

Results

Both endoscopic and histological atrophy increased in proportion to age (P < 0.001). The prevalence of endoscopic atrophy was significantly lower than that of histological atrophy especially below 50 years of age. The sensitivity and specificity of endoscopy for the diagnosis of atrophy based on histological diagnosis of atrophy were 61.5 and 57.7% in the antrum, and were 46.8 and 76.4% in the body of the stomach. Multivariate analysis showed that an age <50 (OR 0.38, 95% CI 0.25–0.61) and a PG I/II ratio >3 (OR 0.50, 95% CI 0.35–0.71) in the antrum, and an age < 50 (OR 0.43, 95% CI 0.19–1.00) and a CRP > 5 mg/dl (OR 0.53, 95% CI 0.30–0.94) decreased the sensitivity of the endoscopic diagnosis of atrophy in the body.

Conclusions

A high index of suspicion of gastric atrophy is important in the young age group, and confirmation of the diagnosis by histology is necessary.     

氨水对大白鼠胃粘膜长期作用的影响：胃粘膜屏障功能的变化

本实验使用0.01％及0.02％的氨水,以自由饮水的形式经口长期喂养大白鼠,观察了氨水对胃粘膜血流、胃粘膜电位差及胃粘膜前列腺素E_2的影响。结果表明:由HP分泌的悄素酶所分解产生的氨长期作用于胃粘膜,可以导致大白鼠的胃粘膜血流和前列腺E_2减少,使胃粘膜电信差降低,破坏胃粘膜的防御机能,可能是HP导致慢性胃炎及胃溃疡的一个重要因素。     

Helicobacter pylori and Mucosal Atrophy in Patients with Gastric Cancer (A Special Study Regarding the Methods for Detecting Helicobacter pylori)

We assessed the sensitivities of several methodsfor detecting Helicobacter pylori (culture, histology,rapid urease test, and serology), and evaluated the H.pylori positivity considering the degree of atrophy in the background mucosa in 202 gastriccancer patients and 101 controls. The positivity of H.pylori determined by culture (81%) was significantlyhigher than that determined by serology (62%) in gastric cancer patients (P < 0.001). Thepositivities of H. pylori determined by biopsy and/orserology in intestinal (84%) and diffuse (95%) types ofgastric cancer were higher than that observed in controls (54%) (P < 0.001).Intestinal-type gastric cancer tended to occur in theatrophic mucosa, in which H. pylori positivity was notdifferent from that in controls after adjusting for thedegree of atrophy, whereas diffuse-type gastric cancerwas observed more often in the nonatrophic mucosa, inwhich H. pylori positivity was higher than that incontrols even after adjusting for the degree ofatrophy.     

中药治疗胃癌前期病变的临床观察

对12年来200余例经病理检查证实的慢性萎缩性胃炎（CAG）患者，根据不同临床分型，以温中和胃为基本大法，配合活血化瘀、清热解毒药物治疗，经过3年反复临床验证，取得良好效果。从资料完整的80例病例与治疗前比较，其临床疗效：显效47例，有效24例，无效9例，有效率88．7％。胃镜检查：显效42例，有效24例，无效14例，有效率82．5％。病理组织检查：显效21例．有效34例，无效23例，癌变2例，有效率68．7％。同时可降低血粘稠度，使胃酸分泌增高。     

胃运动功能对乙醇所致大鼠胃黏膜损伤的影响

目的研究普瑞博斯对乙醇所致胃黏膜损伤的影响,以阐明胃运动功能对胃黏膜的保护作用。方法实验包括两部分,实验1：雄性Wistar大鼠24只,随机分为对照组、普瑞博斯小剂量组和大剂量组,分别给予生理盐水、普瑞博斯0．5mg/kg和普瑞博斯1mg／kg灌胃,然后各组均给予无水乙醇灌胃,检测胃黏膜损伤的面积和深度;实验2：大鼠分组同上,实验前所有大鼠均行幽门结扎术,术后给药及胃黏膜损伤的检测方法刚上。结果于末结扎幽门的大鼠中,大剂量普瑞博斯可显著减少无水乙醇所致的胃黏膜损伤深度和面积,小剂量普瑞博斯也可减少胃黏膜损伤的深度。结扎幽门后,普瑞博斯对无水乙醇所致胃黏膜损伤的保护作用消失。结论普瑞博斯对无水乙醇所致的胃黏膜损伤有保护作用,该作用与普瑞博斯促进胃排空有关,提示胃运动功能对胃黏膜的保护作用。     

心力衰竭中生化指标检测的临床意义

随着老年化和医学的发展,心力衰竭将成为21世纪心血管两大流行疾病之一。尽管随着β-受体阻滞剂,血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)甚至是基因重组药物等的面世,心力衰竭治疗的目的及方法有了全新的改变,但心力衰竭的诊断、预后判断仍具有相当大的局限性,目前多以临床评估为主。现对心力衰竭中相关生化指标的意义作一简要综述。     

健胃灵合剂防治胃癌癌前病变的临床研究

对经胃镜及病理学确诊的慢性萎缩性胃炎伴肠化和（或）异型增生的患者，随机分为治疗组（健胃灵合剂）61例，对照组（维酶素胶囊）31例。治疗6个月后复查，结果临床总有效率分别为91．8％、54．8％，胃镜疗效分别为86．9％、51．6％，病理疗效分别为77．0％、41．6％，两组比较均提示有非常显著性差异（均P＜0．01）。     

超声内镜对胃黏膜增厚性疾病的诊断价值

目的 探讨超声内镜对胃黏膜增厚性疾病的诊断价值,提高其诊断准确率.方法 对25例胃镜检查发现的胃黏膜增厚的患者行超声内镜检查,分析其内镜表现及超声影像特征.结果 超声内镜可以清楚显示胃壁的厚度及回声变化,对胃黏膜增厚疾病良恶性诊断的符合率为100%,对皮革胃的诊断符合率为94.8%;内镜活榆病理对恶性胃黏膜增厚诊断率为47.6%.超声内镜对恶性胃黏膜增厚疾病的诊断符合率与内镜活检比较有统计学意义(P<0.01).结论 超声内镜对胃黏膜增厚性疾病良恶性的鉴别具有重要的诊断意义,对于皮革胃和淋巴瘤,超声内镜是除手术病理鉴别外最重要鉴别诊断手段.     

Gastric Lymphoma Versus Pseudolymphoma: The Importance of Immunological Differentiation

Two cases are presented demonstrating that the differentiation of gastric pseudolymphoma from lymphoma often cannot be made solely on the basis of the clinical, radiological, endoscopic, or even pathological picture but may be resolved by immunohistological staining for lymphocyte markers.     

Serologically Determined Gastric Mucosal Condition Is a Predictive Factor for Osteoporosis in Japanese Men

Digestive Diseases and Sciences - There are few reports about the influence of Helicobacter pylori infection and/or atrophic gastritis on bone conditions in Japan. To assess whether the combination...     

Comparison of 2 Cricothyrotomy Techniques: Standard Method Versus Rapid 4-Step Technique

Study objective: To compare the success rate, complication rate and time required for the rapid 4-step technique versus the standard technique for cricothyrotomy. Methods: We conducted a prospective, randomized crossover study. Twenty-seven emergency medicine interns, 1 junior medicine resident, and 4 senior medical students, without prior cricothyrotomy experience, were randomly divided into 2 groups. Group 1 was initially instructed in and then performed the standard technique; group 2 was initially instructed in and then performed the rapid 4-step technique. Each group was then instructed in and performed the alternate method. Cricothyrotomies were performed on preserved human cadavers. Results: A surgical airway was established in 28 of 32 attempts with the use of the rapid 4-step technique (88%); the average time elapsed before tube placement was 43 seconds. Thirty of 32 attempts involving the standard technique (94%) were successful; the average time to tube placement was 134 seconds (95% confidence interval for a difference of 91 seconds, 63 to 119; P<.001). Complications were identified in 12 attempts involving the standard technique (38%; 1 considered major) and in 12 involving the rapid four-step technique (38%; 3 considered major). The incidence of major complications was 6% higher for the rapid 4-step technique (95% confidence interval, –9% to 21%). Conclusion: In a group of inexperienced subjects working on a preserved human cadaver model, the rapid 4-step technique for cricothyrotomy was performed in about one third the time required for performance of the standard technique. This finding was both clinically and statistically significant. Although the 2 techniques had similar success and complication rates, we noted a trend toward more severe complications in the rapid 4-step technique.[Holmes JF, Panacek EA, Sakles JC, Brofeldt BT: Comparison of 2 cricothyrotomy techniques: Standard method versus rapid 4-step technique. Ann Emerg Med October 1998;32:442-447.