Duodenal contraction wave patterns in patients with and without ulcer.

To determine whether differences in frequency of specific wave sequences and types existed in the four parts of the duodenum in ulcer subjects and controls an analysis of contraction waves in 14 controls and 10 duodenal ulcer patients of similar age was done by a statistical analysis of differences between the two groups. A water-perfused tube system was used. Differences in motor activity, namely, decreased frequency of waves in the proximal duodenum and increased frequency of waves in the distal duodenum in ulcer subjects as compared to controls was demonstrated. This involved a statistically significant decrease in numbers of mixing (or basic rhythm) waves in the proximal duodenum. Increased numbers of isolated waves were found in ulcer patients in the distal duodenum. The predominant types of contraction waves in both ulcer and control subjects were isolated and simultaneous waves, with peristaltic waves were less common in the fasting state. These findings suggest that differences exist in the types of contraction waves in duodenal ulcer subjects compared to controls.     

Gastric acid and pepsin secretion in response to modified sham feeding in active and inactive duodenal ulcer disease

Gastric secretion of acid and pepsin were studied under basal conditions, in response to modified sham feeding (MSF), and in response to pentagastrin in 15 male controls and in 11 and 10 male patients with active and inactive duodenal ulcer disease, respectively. In general, patients with ulcer disease produced more acid and pepsin than controls. No differences between the two ulcer groups were found for basal and pentagastrin-stimulated secretions. The response patterns to MSF, however, were different in the two groups. After an early peak, acid and pepsin responses rapidly decreased, approaching basal level in patients with active duodenal ulcer and in controls. In patients with inactive disease, however, the decrease was less marked, and in some patients the secretion continued to increase for 60 min. When expressed as fractions of the responses to pentagastrin, the acid and pepsin responses during the fourth 15-min period were significantly greater in patients with inactive duodenal ulcer disease than in patients with active disease and in controls. The findings indicate that the gastric response to vagal stimulation is different in patients with active and inactive duodenal ulcer disease.     

慢性浅表性胃炎和消化性溃疡患者人表皮生长因子含量的检测意义初探

目的：了解人类表皮生长因子（ｈＥＧＦ）与胃粘膜完整性的关系。方法：用放免法检测正常人、慢性浅表性胃炎（活动期）、消化性溃疡（愈合期）等四组病人血、尿、胃液中的ｈＥＧＦ含量。结果：慢性浅表性胃炎（活动期）和消化性溃疡（活动期）病人上述三种体液中的ｈＥＧＦ含量明显低于正常人和消化性溃疡（愈合期）病人（Ｐ〈０．０５），而正常人与消化性溃疡（愈合期）病人的ｈＥＧＦ含量无明显差别（Ｐ〉０．０５）。结论：说明     

Comparison of maximal gastric secretion in smokers and non-smokers with and without duodenal ulcer.

Maximal gastric secretion was induced in 122 control subjects (without peptic ulcer) and 201 preoperative duodenal ulcer patients by intravenous histamine acid phosphate (130 nmol/kg/h), and measured as Vg (ml/h) and MAO (mmol/h). In both groups, men secreted more than women, and smokers secreted more than non-smokers. Significant correlations were found between maximal gastric secretion on the one hand, and height, age, and chronic smoking on the other. After standardisation for these factors, including standardisation to zero smoking, the subgroups of the controls no longer differed significantly, as was also the case for the duodenal ulcer patients. Thus, differences in height, age, and smoking habit were sufficient to account for the variation in maximal secretion between individuals in either the control or duodenal ulcer groups. Even after standardisation, however, the duodenal ulcer patients still secreted significantly more than the controls, and therefore, although chronic smoking has been shown to affect maximal gastric secretion, it does not appear to be the sole reason for hypersecretion in duodenal ulcer patients.     

Comparison of 24-hour gastric pH in normal controls and patients with duodenal ulcer or atrophic gastritis

Twenty-four intragastric acidity was measured by continuous recording using intragastric glass electrodes in 16 normal controls, 18 inactive duodenal ulcer patients and 7 patients with atrophic gastritis. Median pH for the 24 h period, for the 8 AM-8 PM period, and for the 8 PM-8 AM period were significantly lower in duodenal ulcer patients than in controls (1.19 vs 1.78; 1.17 vs 2.05; 1.27 vs 1.64). Median pH for these 3 periods were significantly higher in patients with atrophic gastritis than in controls (3.90; 3.72; 3.81). The median pH for the 24 h period was higher than the lower quartile value of the control group in 33 per cent of duodenal ulcer patients. During the night (24 h-3 h), duodenal ulcer patients had significantly lower median pH (1.03) than controls (1.51). Antisecretory treatment should be directed to decrease this period of unbuffered acidity.     

Incidence of Peptic Ulcer in Men is Inversely Correlated with Blood Pressure: Study in an Apparently Healthy Japanese Population

Objective : To study the role of autonomic nervous innervation in the etiology of peptic ulcer, we investigated the blood pressure in patients with peptic ulcer. Methods : In 100,085 Japanese adults who were undergoing health screening examinations, including barium meal study, there were endoscopic evaluation-confirmed diagnoses of gastric ulcer in 769 cases and of duodenal ulcer in 344 cases. The blood pressure in those patients was compared with that in 57,208 normal Japanese controls with no gastrointestinal abnormalities, as confirmed by barium meal study. Results : The blood pressure of younger and middle-aged men with gastric and duodenal ulcer were lower than those of normal control men. In women, except for the diastolic pressure of those in their 50s, the blood pressure in patients with peptic ulcer and normal controls did not differ significantly. The incidence of duodenal ulcer or of gastric ulcer in men was inversely related to the systolic and diastolic pressure. No definite relationship in this respect was seen in women. Conclusions : An inverse relationship was observed between the occurrence of peptic ulcer and the blood pressure level in Japanese men, but not in women. The relationship may be mediated by an inhibitory effect of the sympathetic nervous system on ulcer formation in hypertensive subjects. The reason for the sex difference in this respect is unknown.     

Procoagulant activity in whole blood from patients with breast and colorectal cancer

Whole blood procoagulant activity was determined by measuring the endotoxin-induced shortening of the celite-activated whole blood recalcification time in patients with breast cancer (n = 29), colorectal cancer (n = 18), benign breast disease (n = 26), benign colorectal disease (n = 10), normal volunteers (n = 17) and surgical in-patients with non-malignant and non-inflammatory conditions (n = 18). Using this method, patients with breast and colorectal cancer produced significantly more procoagulant activity than normal controls (P less than 0.001), surgical in-patients (P less than 0.005) and patients with benign breast (P less than 0.001) and benign colorectal (P = 0.05) disease respectively. The difference between subjects classified as 'cancer' or 'non-cancer' was highly significant (P less than 0.0001). There were no significant differences in total white cell or absolute monocyte counts between subject groups, and in individual patients, there was no correlation between these parameters and the procoagulant activity. It is concluded that the activated whole blood recalcification time is a more reproducible way of measuring whole blood procoagulant activity than the original technique, and that using this method, patients with cancer show higher procoagulant activity than corresponding benign controls.     

Enhanced reactivity of peripheral blood immune cells to HSV-1 in primary achalasia

Abstract

Objective. Achalasia is the best characterized oesophageal motor disorder but the etiology is unknown. The pathology is characterized by a decrease in nitric oxide-producing neurons and the presence of an activated T-cell inflammatory infiltrate in the myenteric plexus that are reactive to HSV-1 viral antigens. These findings are not present in normal controls. The current study compared the reactivity of peripheral blood mononuclear cells (PBMCs) between patients with primary achalasia and normal controls to determine if PBMCs of patients exhibit a similar heightened reactivity to the virus. Material and methods. Whole blood culture experiments were conducted with heparinized peripheral venous blood obtained from 151 patients with primary achalasia and 118 healthy controls. Whole blood was cultured in the presence of ultraviolet inactivated HSV-1 or conditioned cell culture media. Reactivity of mononuclear cells to viral antigens was quantified by measuring expression of the cytokine gene interferon-γ using Taqman^® real-time polymerase chain reaction. Data are expressed as cytokine fold change corresponding to ratio of interferon-γ messenger RNA copies produced in antigen stimulated versus unstimulated cells. Results. The interferon-γ fold change was higher in cases 61.33 (20.54–217.00) than controls 49.67 (10.05–157.05). Mean fold change difference between cases and controls was 1.66 times (95% confidence interval 1.17–2.34, p = 0.004). Conclusions. These results indicate that the PBMCs of patients with primary achalasia show an enhanced immune response to HSV-1 antigens. The data suggest that there is persistent stimulation of immune cells by herpes simplex virus type 1 (HSV-1) or HSV-1 like antigen moieties.     

Increased whole blood viscosity combined with decreased erythrocyte fluidity in untreated patients with essential hypertension

Erythrocyte fluidity and other haemorheological variables were studied in 22 patients with essential hypertension and compared with age- and sex-matched healthy controls. Hypertensive patients displayed a significantly lower erythrocyte fluidity (P less than 0.001). Similarly, significantly elevated values for haematocrit, plasma and whole blood viscosity, as well as aggregation tendency were observed compared to controls. Although differing in these respects from controls, there were no obvious relationships between these rheological variables and either systolic or diastolic blood pressure. The significantly lower erythrocyte fluidity and other changes in haemorheological variables of red blood cells found in hypertensive patients may be explained by an enlarged metabolic pool of free calcium ions in these red blood cells. It is suggested that the molecular mechanisms underlying the evolution of essential hypertension are multifactorial rather than being based on a single molecular derangement. Primary events resulting in altered physicochemical properties of the red blood cells may work in concert in the development of essential hypertension, in addition to the increased availability of calcium ions and their potential role in smooth muscle contraction.     

Effect of heparin on platelet count and platelet aggregation

The in vitro effect of heparin on platelet aggregation was studied in three groups: in 26 subjects recently treated with heparin, in 18 subjects on maintenance hemodialysis, and in 20 normal controls. With the aid of Technicon H6000, platelet counts and platelet aggregations were compared in whole blood samples collected in ethylenediaminetetraacetic acid (EDTA) and in heparinized tubes. Although there was no significant difference between platelet count of heparinized and EDTA blood in the control group, the dialysis group and the group recently treated with heparin showed significantly lower platelet counts and more platelet aggregation in heparinized tubes than in EDTA tubes. We speculate that the majority of subjects exposed to heparin develop an antibody or a proaggregator which can aggregate or agglutinate platelets in the presence of heparin and causes destruction of platelets; but only in a small percentage of subjects receiving heparin is this reaction severe enough to cause thrombocytopenia.     

慢性胃炎及消化性溃疡诱生型一氧化氮合酶表达和Hp感染的意义

目的探讨一氧化氮在慢性胃炎及消化性溃疡发病机制中的作用，以及ＮＯ和Ｈｐ感染的关系．方法用免疫组化法对正常对照者６例，慢性胃炎５６例及消化性溃疡患者１６例的胃粘膜标本进行检测，观察ｉＮＯＳ表达强度．并用改良Ｇｉｅｍｓａ法同步检测Ｈｐ感染状况．结果ｉＮＯＳ染色定位于胞质，在正常人胃及十二指肠粘膜细胞和腺体均有表达．慢性浅表性胃炎组呈过度表达，其平均表达强度明显高于对照组及慢性萎缩性胃炎组（Ｐ＜００１）．慢性萎缩性胃炎组平均表达水平和对照组比较差异无显著性（Ｐ＞００５）．慢性胃炎组ｉＮＯＳ表达强度与其Ｈｐ分级间呈明显正相关（Ｐ＜００５）．消化性溃疡组平均表达水平较对照组增强（Ｐ＜００５），其ｉＮＯＳ表达强度和Ｈｐ分级间相关性不明显（Ｐ＞００５）．结论ｉＮＯＳ活性增强和过度表达可能在慢性胃炎和消化性溃疡的发病机制中发挥一定作用，并可能是Ｈｐ感染导致慢性胃炎的相关发病机制之一．     

Ventilatory function in chronic peptic ulcer. A controlled study of ventilatory function in patients with gastric and duodenal ulcer

The aim of this study was to determine if a defect in ventilatory function is present in patients with chronic peptic ulcer and if so, is it present in both gastric and duodenal ulcer and is it related to smoking. Fifty-six patients with peptic ulceration (27 gastric ulcer, 29 duodenal ulcer), together with 56 healthy controls matched for age, sex, and smoking status, were studied. Ventilatory function was measured and the ABH blood group antigen secretor status was determined. Vital capacity and forced expiratory volume in 1 s were significantly reduced in both smokers and nonsmokers with gastric ulcer when compared with controls; total lung capacity was lower than controls only in smokers with gastric ulcer. In duodenal ulcer patients, a trend similar to that observed in gastric ulcer patients was present. It is concluded that a defect in ventilatory function is present in patients with chronic gastric ulcer; a lesser defect is present in patients with duodenal ulcer.     

Indomethacin treatment during initial period of acetic acid-induced rat gastric ulcer healing promotes persistent polymorphonuclear cell-infiltration and increases future ulcer recurrence

The study was performed to examine whether indomethacin administered during the initial period of acetic acid-induced gastric ulcer healing affects future ulcer recurrence. Gastric ulcers were produced in rats by subserosal injection of acetic acid. Indomethacin (1 mg/kg/day, orally) administered either alone or concomitant with ornoprostil (50µg/kg/day, orally) was started on the fourth day and continued for 56 days. In rats whose ulcer healed at the 90th day after production of ulcer, endoscopy was done every 30 days to examine recurrence of ulcer. Gastric specimens were obtained 10, 30, 60, 90, and 240 days after ulcer production for histology, to quantitate the height of regenerated mucosa, thickness of fibrous tissue, degree of polymorphonuclear cell infiltration, and PAS-positive cells. Cumulative ulcer recurrence rate was significantly higher in rats initially treated with indomethacin than in controls. Increased polymorphonuclear cell infiltration was the major histologic abnormality persisting after cessation of indomethacin. Ornoprostil reversed these abnormalities caused by indomethacin. In conclusion, the administration of indomethacin during the initial period of the ulcer healing promoted persistent polymorphonuclear cell infiltration and increased ulcer recurrence rates, possibly via a prostaglandin-dependent mechanism.The work was supported by The Ministry of Education, Science and Culture of Grant-in-Aid for General Scientific Research 02454236 and by the DVA Medical Research Service.     

小儿消化性溃疡遗传性及遗传度的研究

目的研究遗传因素在小儿消化性溃疡（ＰＵ）发病中的作用．方法内镜诊断３～１４岁ＰＵ患儿５２例，抽血测定血型，并随访患儿的遗传度及家族发病情况．同时问卷调查了本市３所小学１１１９位学生家系中一级亲属ＰＵ发病率，按照遗传度计算公式求出小儿ＰＵ的遗传度．结果儿童ＰＵ中多见的是十二指肠溃疡，首次发病年龄＜９岁占４８％，男性患者约为女性２倍，体形多为瘦长形，体块指数＜４５占６７３０％，Ｒｈ＋Ｏ血型人占４６１５％，有ＰＵ家族史为４８０８％，患者一级亲属ＰＵ发病率约为群体的１１倍，其遗传度为１０８６６％．结论小儿ＰＵ与成人不完全相同，遗传因素在本病的发生中起着十分重要的作用．     

Physical activity at work and duodenal ulcer risk

To determine whether the social class differences in duodenal ulcer frequency may be explained by differences in physical activity at work, the energy expenditure during work, smoking habits, and social class were compared in 76 recently diagnosed duodenal ulcer patients and in age and sex matched community controls. As anticipated, the relative risk of duodenal ulcer showed significant associations with smoking and social class. Social class and physical activity at work were associated with one another. After adjusting for age, sex, smoking, and social class, physically active work was still associated with duodenal ulcer, with relative risks for moderate and high activity compared with sedentary work being 1.3 (0.6-3.0) and 3.6 (1.3-7.8) respectively. Within each social class stratum, the relative risk of having a duodenal ulcer was greater in those with a high level of occupational activity than in those undertaking sedentary work.     

Pancreatic polypeptide release in gastric ulcer

The pancreatic polypeptide (PP) response to a protein-rich meal has been studied in similarly aged patients with gastric ulcer, duodenal ulcer, and controls. The response of the gastric ulcer patients was significantly lower at all points than that of the duodenal ulcer patients or controls, which were similar to one another. Vagal stimulation is probably the single most important factor in PP release, and it is possible that diminished PP release in the gastric ulcer patients is a reflection of vagal underactivity.     

Gastric blood flow in patients with gastric ulcer measured by endoscopic laser Doppler flowmetry

Gastric blood flow has been studied endoscopically by laser Doppler flowmetry in 15 patients with chronic gastric ulcer. In all patients the ulcer was located at the lesser curvature of the corpus. The blood flow measured in this area was decreased compared with healthy controls, whereas the flow values in other parts of the stomach were similar to those of controls. In the ulcer bed very low blood flow values were measured. The blood flow of the ulcer margin was similar to that of other parts of the lesser curvature. After 4-6 weeks' treatment with the H2-receptor antagonist cimetidine, the ulcer was healed in about 70% of the patients. The blood flow measured at the lesser curvature and in the ulcer area was still low and of the same magnitude as the corresponding values of the first measurement. After 4 months the ulcer was healed in all but one patient. The blood flow of the lesser curvature had increased significantly, whereas decreased blood flow was measured at the distal part of the greater curvature. In the area where the ulcer was located, very low flow values were still measured. This finding may explain why ulcer recurrence usually occurs at the site of the primary ulcer.     

Glutathione redox cycle enzymes and selenium in severe rheumatoid arthritis: lack of antioxidative response to selenium supplementation in polymorphonuclear leucocytes.

The antioxidant capacity of the glutathione redox cycle and the concentrations of selenium in serum, red blood cells or whole blood, and polymorphonuclear leucocytes was evaluated in nine patients with severe rheumatoid arthritis (RA) and eight healthy controls receiving daily supplementation with 250 micrograms selenomethionine for six months. Serum and whole blood concentrations of selenium and the activity of the selenium dependent enzyme glutathione peroxidase (GSH-Px) were low in the serum, red blood cells, and polymorphonuclear leucocytes of patients with RA before selenium supplementation. During supplementation serum and whole blood concentrations of selenium and the activity of GSH-Px in serum and red blood cells of patients with RA and serum GSH-Px in controls increased. Selenium and GSH-Px in polymorphonuclear leucocytes were unaffected in patients with RA in contrast with the controls where both were augmented. Glutathione reductase activity in the red blood cells and polymorphonuclear leucocytes of patients with RA was low but increased during selenium supplementation. Whole blood concentrations of glutathione were slightly lower in patients with RA than controls and no difference in the content in polymorphonuclear leucocytes was found between the groups. The activity in red blood cells of glucose-6-phosphate dehydrogenase was high in patients with RA, indicating sufficient function of the hexose monophosphate pathway. The reduced antioxidant activity of the glutathione redox cycle in patients with severe RA was mainly due to the low availability of selenium. This was further supported by the response to selenium supplementation in serum and red blood cells. In the polymorphonuclear leucocytes, however, no biochemical effects of selenium supplementation were seen. This lack of antioxidative response could play a pathogenetic part in inflammation in patients with RA.     

Epithelial cell proliferation in human fundic and antral mucosae

Epithelial cell proliferation in the fundic and antral mucosae was studied in 19 duodenal ulcer patients, 11 patients having undergone fundic superselective vagotomy for duodenal ulcer, and 10 controls. This was achieved throughin vitro incorporation of tritriated thymidine in mucosal biopsies and radioautography. Except for increased fundic mucosal height, duodenal ulcer patients did not differ from controls for all parameters studied. In vagotomized patients, as compared to the other two groups, the labeling index was significantly enhanced in the innervated antral mucosa where atrophic gastritis developed, but there was no change in the labeling index and no worsening of mucosal inflammation in the denervated fundic mucosa. The only abnormality in the latter was a striking expansion, towards the surface, of the proliferative area within the fundic pit. The labeling indices and the degree of gastritis in gastric mucosae are significantly correlated in control and duodenal ulcer patients. After superselective vagotomy, this correlation still existed in antral mucosa (r=0.88, P<0.001) but not in fundic mucosa. If findings in antral mucosa, after superselective vagotomy, seemed related to gastritis lesions, those in fundic mucosa were not and may indicate an alteration due to the vagotomyper se.This work was supported by the Institut de la Santé et de la Recherche Médicale (INSERM), France.     

Morphological and Morphometric Assessment of Human Duodenal Biopsies Maintained in Organ Culture

Duodenal biopsy specimens from 51 coeliac patients (children and young adults) and 13 non-coeliac controls were maintained in organ culture for 24 h. Morphometric determinants were compared after culture in the presence of different gluten fractions, after culture on gluten-free medium, and in non-cultured specimens. Biopsies from patients with untreated coeliac disease were susceptible to gluten fractions, which provoked disorganization of crypt architecture, reduced height and irregularities of enterocytes and crypt cells, together with detrition of surface epithelial cells and even tissue necrosis. In latent coeliac disease (silent relapse) biopsies were more resistant to gluten, and higher concentrations were required to induce signs of morphological deterioration. Remission mucosas and biopsies from non-coeliac controls showed no signs of impairment after gluten exposure in vitro.