Gastric myoelectrical activity and gastric emptying in diabetic patients with dyspeptic symptoms

INTRODUCTION Recently, electrogastrography(EGG) has received more andmore attention.     

Prevalence of Helicobacter pylori infection and atrophic gastritis in patients with dyspeptic symptoms in Myanmar

AIM: To survey the detailed analyses for Helicobacter pylori(H. pylori) infection and gastric mucosal status in Myanmar.METHODS: A total of 252 volunteers with dyspeptic symptoms(155 female and 97 male; mean age of 43.6 ± 14.2 years) was participated in Yangon and Mandalay. The status of H. pylori infection was determined based on 5 different tests including rapid urease test, culture, histology, immunohistochemistry and serology. Histological scores were evaluated according to the update Sydney system and the Operative Link for Gastritis Assessment system. Pepsinogen(PG)Ⅰand PG Ⅱ were measured using enzyme-linked immunosorbent assays.RESULTS: The overall prevalence of H. pylori infectionwas 48.0%. There was no relationship between age and infection rate. Even in young group(less than 29 years old), the H. pylori infection rate was relatively high(41.9%). The prevalence of H. pylori infection was significantly higher in Yangon than that of Mandalay. H. pylori infection was significantly associated with the presence of gastric mucosal atrophy. All 7 subjects with peptic ulcer were infected with H. pylori. Although H. pylori-positive subjects showed stronger gastritis than H. pylori-negative subjects, most cases had mild gastritis.CONCLUSION: We revealed the prevalence of H. pylori infection in patients with dyspeptic symptoms in Myanmar. The H. pylori infection was a risk factor for peptic ulcer and stronger gastritis.     

Prevalence of Helicobacter pylori infection, endoscopic gastric findings and dyspeptic symptoms among a young Japanese population born in the 1970s

BACKGROUND: With the prevalence of Helicobacter pylori (H. pylori) infection rapidly decreasing in Japan, endoscopic findings and dyspeptic symptoms need to be re-evaluated. METHODS: In a health check-up program, endoscopy was performed on 530 young Japanese subjects (371 men and 159 women) born in the 1970s. Helicobacter pylori infection was evaluated using serology and a rapid urease test. Endoscopic gastritis was classified according to the Sydney classification system, in addition to nodular gastritis. Dyspeptic symptoms were also recorded before endoscopy. RESULTS: Of the 530 subjects, 87 (16.4%) were H. pylori positive. Of the 443 H. pylori-negative subjects, 349 (78.8%) were considered to have endoscopically normal gastric mucosa. However, of the 87 H. pylori-positive subjects, only 19 (21.8%) tested normal (P < 0.001). The prevalence of several types of gastritis was significantly higher in H. pylori-positive subjects compared with H. pylori-negative subjects: atrophic gastritis (37.9% vs 1.1%, P < 0.001), flat erosive gastritis (29.9% vs 7.2%, P < 0.001), rugal hyperplastic gastritis (12.6% vs 0.0%, P < 0.001), and nodular gastritis (13.8% vs 0.0%, P < 0.001). Other types of gastritis were not related to H. pylori status. The prevalence of subjects with dyspeptic symptoms was significantly higher in H. pylori-positive subjects compared with H. pylori-negative ones (28.7% vs 6.5%, P < 0.001). CONCLUSION: It is suggested that in consideration of its recent low prevalence and the slow increase in its infection, the prevalence of H. pylori-related gastritis will gradually decrease in Japan. Further studies will be required to ascertain if there is a need for H. pylori eradication in this young population.     

顺铂相关消化不良中胃肌电活动的作用

目的探讨胃肌电活动在顺铂相关消化不良(cisplatin-associated dyspepsia)中的作用。方法于7条比格犬的胃大弯前壁浆膜层植入4对心脏起搏电极。静脉输入顺铂(1mg/kg),1h内匀速输完。根据顺铂呕吐潜伏期,分为20min(基线期),0～1h(给药期间),1～3.5h(呕吐前),3.5～5h(呕吐期间)等4个不同实验时间段。在相应时间段,分别观察出现的消化不良症状并评分,同时记录其间的胃慢波。软件自动分析及肉眼判断呕吐前后胃慢波变化。结果①全部实验犬均出现反复呕吐,平均呕吐次数6·71±2.56,呕吐潜伏期154.71±4.99min,呕吐持续时间80.57±14.79min。②与基线期相比,顺铂输入期间(0～1h)无明显消化不良症状,但在输入后的1～3.5h、3.5～5h逐渐增多。③3.5～5h胃慢波与基线期的胃慢波比较,正常胃慢波百分率明显降低,主功降低,主频无明显变化。而20min、0～1h、1～3.5h之间的正常胃慢波百分率、主频、主功的改变无统计学差异(P>0·05)。④呕吐过程中出现小于1min的呈荆棘样波形的胃电过速,其前后均出现持续时间小于1min的胃电过缓,随之在1min内恢复正常。结论除呕吐具有短暂特征性胃慢波改变之外,顺铂诱发的其余消化不良症状无明显胃肌电改变。胃肌电改变可能不是顺铂相关消化不良的主要发病原因。     

幽门螺杆菌感染与胃黏膜损伤

自从1983年幽门螺杆菌（Hp）被发现，人们对胃黏膜损伤机制的认识发生了彻底的变革。Hp可通过定植、自身致病因子直接造成胃黏膜损伤，也可间接通过增加宿主细胞氧自由基和胃酸的产生，诱发免疫反应而损伤胃黏膜。此文就Hp与胃黏膜损伤关系的研究现状和进展作一综述。     

Correlation between serum pepsinogen levels and gastric mucosal histological findings before and after Helicobacter pylori eradication therapy

Background: Helicobacter pylori causes chronic gastritis and is also associated with many other gastrointestinal diseases. The incidence of gastric cancer is thought to vary according to the degree and topography of chronic gastritis. Histological findings of specimens obtained at endoscopy are therefore important. In the present study, we investigated the correlation between these histological findings and serum pepsinogen (PG) levels. Methods: Helicobacter pylori eradication therapy was conducted in 100 H. pylori‐positive patients. Endoscopies were performed prior to, and 2 months after, eradication therapy; gastric mucosal biopsies were taken from the antrum and corpus. Helicobacter pylori infection was diagnosed using the rapid urease test, culture and histology. Using the Updated Sydney System, histological findings of inflammation, activity, atrophy and intestinal metaplasia were each graded. Blood was taken on the same two occasions for determination of serum levels of PG I and II. Results: Levels of PG I were highest in association with antrum‐predominant gastritis (APG), followed in order by pangastritis (PAN) and corpus‐predominant gastritis (CPG), with a significant difference between APG and CPG. No correlations were seen between PG II levels and gastritis topography. Examination of the relationship between PG levels and histological findings revealed significant correlations between PG I levels after eradication atrophy and intestinal metaplasia in the gastric corpus. No significant correlations were seen between PG II levels and before or after eradication histological findings. Conclusion: Our results indicate that serum PG levels may be a useful indicator of before‐eradication gastritis topography and after‐eradication gastric atrophy in the gastric corpus.     

Prevalence of Helicobacter pylori in patients with gall stones before and after cholecystectomy: a longitudinal study.

Fifty six patients with gall stones were enrolled in this study to assess the presence of Helicobacter pylori in gastric mucosa before and after cholecystectomy. Samples were taken from gastric juice and antral mucosa through endoscopy performed on these patients before and after the operation. Gastric juice was examined for bile salt concentration as an indicator of duodenogastric reflux. Antral mucosa was studied for the presence of H pylori and inflammatory response. Duodenogastric reflux was significantly increased (p < 0.001) and H pylori significantly decreased (p < 0.01) in the postoperative period. Mucosal inflammation and its activity were less in the postoperative period but the differences did not reach statistically significant values.     

Prevalence of Helicobacter pylori infection among adult dyspeptic patients in Ethiopia

In developing countries such as Ethiopia, where chronic gastritis and peptic-ulcer disease are the most common endoscopic findings, it is important to study the association between Helicobacter pylori infection and gastroduodenal diseases. Both invasive and non-invasive diagnostic methods were therefore used to investigate 300, consecutive, adult patients with dyspepsia, from the gastrointestinal clinic of Tikur Anbassa University Hospital, Addis Ababa. The apparent overall prevalence of H. pylori infection varied according to the detection method employed. Culture revealed H. pylori in only 69% of the patients but this pathogen appeared more common when rapid urease tests (71%), PCR-denaturating gradient gel electrophoresis (91%), histopathology (81%), silver staining (75%) or stool-antigen tests (81%) were employed. Antibodies to H. pylori were detected, both by enzyme immuno-assay (EIA) and immunoblotting, in approximately 80% of the patients, whether the antigens used were of a reference strain or from a local isolate of H. pylori. When some of the EIA-positive and EIA-negative sera were cross-absorbed with antigens of Campylobacter jejuni and re-tested by EIA, the H. pylori-positive sera remained positive and the negative sera remained negative. Dyspeptic patients in Ethiopia, like most of those previously observed elsewhere in Africa, are often infected with H. pylori. It is important that the management of these patients should not be hampered by the misinterpretation of the African epidemiology of this pathogen.     

Influence of age, sex, and Helicobacter pylori infection before and after eradication on gastric alcohol dehydrogenase activity

BACKGROUND: Gastric alcohol dehydrogenase may contribute to the metabolism of orally ingested ethanol and decrease the bioavailability of the drug. The aims of this study were to assess the impact of Helicobacter pylori infection and its eradication on gastric alcohol dehydrogenase activity and to relate the findings to gastric histology. Furthermore, the role of age- and sex-related differences in gastric alcohol dehydrogenase activity were studied. METHODS: A total of 76 subjects (39 women and 37 men) underwent upper gastrointestinal endoscopy, and biopsies were obtained from the corpus and antrum. The specimens were used for determining gastric alcohol dehydrogenase activity, histological examination, and urease testing. Subjects with H. pylori infection (n = 36) received medication to eradicate the infection, and repeat biopsies were taken 2 and 12 months later. RESULTS: No significant difference in gastric alcohol dehydrogenase activity was found between men and women (p > 0.05). Gastric alcohol dehydrogenase activity did not differ significantly between the subjects older than 50 years (n = 39) and those 50 years or younger (n = 37). In subjects with H. pylori infection, gastric alcohol dehydrogenase activity was significantly reduced in the antrum (p < 0.05). After eradication of H. pylori, alcohol dehydrogenase activity in the antrum increased significantly within 2 months (p < 0.01). Antral biopsies with the most pronounced inflammation and histological changes had significantly decreased alcohol dehydrogenase activity (p < 0.05). In contrast, no significant differences were found in corpus. CONCLUSIONS: H. pylori infection is associated with decreased antral alcohol dehydrogenase activity, which seems to be related to the severity of the inflammatory changes in the mucosa. Eradication of H. pylori normalizes antral alcohol dehydrogenase activity within 2 months.     

Toxigenic Helicobacter pylori induces changes in the gastric mucosal microcirculation in rats

BACKGROUND AND AIMS: One of the key components of inflammation is changes in vascular structure and function. This suggests that the microcirculation may be a key target of Helicobacter pylori released factors. It has previously been shown in vivo that pooled H pylori extracts from duodenal ulcer/gastritis patients induce platelet aggregation but no leucocyte activation within rat gastric mucosal microcirculation (GMMC). However, infection with strains associated with ulcer disease as compared with gastritis may exert greater effects on the microcirculation. This study used fluorescent in vivo microscopy to determine the acute effects of extracts of genotypically different H pylori strains on the GMMC. METHODS: Three H pylori extracts, with different cagA and VacA toxigenic status, were individually administered to the gastric mucosa of anaesthetised Wistar rats. The mucosal surface was visualised via an incision made in the exteriorised stomach. Fluoroscein isothiocyanate conjugated to bovine serum albumin (FITC-BSA) or acridine orange was used to quantify macromolecular leak (MML) and leucocyte/platelet activity respectively for 120 minutes. Changes in capillary and post-capillary venule (PCV) diameters were also monitored. RESULTS: The cagA(+) VacA toxigenic strain 60190 induced significant and sustained MML by five minutes (p<0.01). Transient and less leakage was observed with its isogenic VacA(-) mutant and other non-toxigenic strains regardless of cagA status. Significant increases in leucocyte adhesion (p<0.05), platelet aggregation (p<0.05), and PCV vasoconstriction (p<0.05) were only observed with the cag A(+) and toxigenic strain. CONCLUSION: Extracts of H pylori are capable of inducing marked disturbances within the rat GMMC. These disturbances seem to be dependent on the production of an active vacuolating cytotoxin. Varying effects on the GMMC may explain the clinically diverse outcomes associated with genotypically different strains.     

Changes in patients' symptoms and gastric emptying after Helicobacter pylori treatment

AIM: To investigate the changes in clinical symptoms and gastric emptying and their association in functional dyspepsia(FD) patients.METHODS: Seventy FD patients were enrolled and divided into 2 groups Helicobacter pylori(H. pylori)-negative group(28 patients), and H. pylori-positive group(42 patients). Patients in the H. pylori-positive group were further randomly divided into groups: H. pylori-treatment group(21 patients) and conventional treatment group(21 patients). Seventy two healthy subjects were selected as the control group. The proximal and distal stomach area was measured by ultrasound immediately after patients took the test meal, and at 20, 40, 60 and 90 min; then, gastric half-emptying time was calculated. The incidence of symptoms and gastric half-emptying time between the FD and control groups were compared. The H. pylori-negative and conventional treatment groups were givenconventional treatment: domperidone 0.6 mg/(kg/d) for 1 mo. The H. pylori-treatment group was given H. pylori eradication treatment + conventional treatment: lansoprazole 30 mg once daily, clarithromycin 0.5 g twice daily and amoxicillin 1.0 g twice daily for 1 wk, then domperidone 0.6 mg/(kg/d) for 1 mo. The incidence of symptoms and gastric emptying were compared between the FD and control groups. The relationship between dyspeptic symptoms and gastric half-emptying time in the FD and control groups were analyzed. Then total symptom scores before and after treatment and gastric half-emptying time were compared among the 3 groups. RESULTS: The incidence of abdominal pain, epigastric burning sensation, abdominal distension, nausea, belching, and early satiety symptoms in the FD group were significantly higher than in the control group(50.0% vs 20.8%; 37.1% vs 12.5%; 78.6% vs 44.4%; 45.7% vs 22.2%; 52.9% vs 15.3%; 57.1% vs 19.4%; all P 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the FD group were slower than in the control group(93.7 ± 26.2 vs 72.0 ± 14.3; 102.2 ± 26.4 vs 87.5 ± 18.2; 102.1 ± 28.6 vs 78.3 ± 14.1; all P 0.05). Abdominal distension, belching and early satiety had an effect on distal gastric half-emptying time(P 0.05). Abdominal distension and abdominal pain had an effect on the gastric half-emptying time of the whole stomach(P 0.05). All were risk factors(odds ratio 1). The total symptom score of the 3 groups after treatment was lower than before treatment(P 0.05). Total symptom scores after treatment in the H. pylori-treatment group and H. pylori-negative group were lower than in the conventional treatment group(5.15 ± 2.27 vs 7.02 ± 3.04, 4.93 ± 3.22 vs 7.02 ± 3.04, All P 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the H. pylori-negative and H. pylori-treatment groups were shorter than in the conventional treatment group(P 0.05). CONCLUSION: FD patients have delayed gastric emptying. H. pylori infection treatment helps to improve symptoms of dyspepsia and is a reasonable choice for treatment in clinical practice.     

Association of Helicobacter pylori infection with dyspeptic symptoms in patients undergoing gastroduodenoscopy

PURPOSE: To determine the prevalence of Helicobacter pylori in patients with non-ulcer dyspepsia and ulcer disease as well as in a control population undergoing endoscopic retrograde cholangiopancreatography (ERCP) for suspected pancreatic or biliary disease. PATIENTS AND METHODS: Forty-six eligible patients undergoing upper endoscopy at Massachusetts General Hospital were studied over a period of 18 months, as well as 24 patients undergoing ERCP for presumed pancreatic or biliary disease. Two biopsy specimens from the fundus and two from the antrum were taken for microbiologic and histopathologic analysis. Sera were examined by enzyme-linked immunoabsorbent assay. All specimens were processed in a blind fashion. Chi-square test with Yates' correction was used for statistical analysis. RESULTS: H. pylori was found in 31 of 46 (67%) study patients and in six of 24 (25%) control patients (by microbiologic or histologic techniques) (p less than 0.01). H. pylori was found in all patients with peptic ulcer disease and in 60% of patients without ulcers. No association between H. pylori and any specific gastrointestinal symptom was observed. H. pylori was identified in the fundus as often as in the antrum, although in the antrum the organism was more often associated with histologic gastritis. Compared with histology, serologic assays for IgG and IgA antibodies to H. pylori had sensitivities of 100% and 94%, and specificities of 86% and 76%, respectively. Reexamination of selected specimens without knowledge of their identity revealed that the specificity of serology exceeded 94% while the sensitivity of histologic and microbiologic studies may have been closer to 80%. CONCLUSIONS: H. pylori was more common in dyspeptic patients than in our control subjects undergoing ERCP. Multiple biopsy sites from fundus and antrum are required to exclude infection. Serologies of IgG and IgA were sensitive and specific for H. pylori, suggesting a possible role for non-endoscopic diagnosis of this infection. The frequent association of H. pylori with active inflammation rather than with quiescent gastritis is consistent with a pathologic role of this organism.     

Histological changes in the gastric mucosa after Helicobacter pylori eradication

BACKGROUND AND AIM: Correa described a stepwise model of changes in the gastric mucosa after Helicobacter pylori infection, from the normal gastric epithelium to chronic gastritis, atrophy, intestinal metaplasia, dysplasia and adenocarcinoma. The aim of this study is to assess the reversibility of these mucosal changes after H. pylori eradication. METHODS: The study sample consisted of 89 patients who underwent at least two gastric biopsies from 1990 to 2000, with a positive finding for H. pylori in the first and a negative finding in the second. Specimens were evaluated for acute and chronic inflammation, lymphoid aggregates, proliferation, mucosal atrophy, intestinal metaplasia, dysplasia, and MUC5AC and MUC6 expression using histochemical and immunohistochemical methods. RESULTS: The average time between biopsies was 23.15 +/- 26.30 months. There was a significant decrease in acute and chronic inflammation scores, from 1.48 +/- 1.10 to 0.23 +/- 0.63 and from 2.67 +/- 0.68 to 1.44 +/- 1.04, respectively (P < 0.001), and in a number of lymphoid follicles, from 42.68% to 21.95% of cases (P < 0.008). The number of glands increased from 39.08 +/- 16.67/mm to 48.86 +/- 17.93/mm after eradication (P = 0.062). Intestinal metaplasia was found in 17.07% of the cases, with no change over time. Dysplasia appeared in one case 2 years after eradication. In 27 patients, the Ki67 labeling index decreased significantly after eradication, while MUC5AC and MUC6 expression increased. CONCLUSION: Our findings, although not conclusive for arrest of the malignant potential, support the importance of H. pylori eradication in the prevention of gastric cancer.     

Influence of Helicobacter pylori on the gastric mucosal barrier

AIM: To study the influence of Helicobacter pylori (Hp) on the gastric mucosal barrier (GMB) by the measurement of the potential difference (PD). METHODS: Fifty seven chronic gastritis cases were diagnosed endoscopically and confirmed by forceps mucosal biopsy. PD was measured by the Takeuchi method, and Hp was detected by both culture (modified Skirrow method) and press printing method with the Giemsa stain. Patients were divided randomly into three groups (De-Nol, WeiTong-Ling, and Placebo) for a course of 6 wk therapy. RESULTS: PD across the mucosa of antrum was significantly lower in Hp (+) patients than in Hp (-) patients (16.44 ± 2.36 vs 19.58 ± 2.44, P < 0.0001). In Hp (+) patients, PD in the antrum increased markedly (16.88 ± 2.56 vs 20.03 ± 2.21, P < 0.0001) after Hp was cleared up by the De-Nol treatment. CONCLUSION: Our data strongly indicated that Hp infection might cause a gastric mucosal barrier to be impaired markedly while the clearance of Hp by De-Nol recovered the integrity of the gastric mucosal barrier significantly.     

Relevance of VacA and mucosal pathological changes in Chinese patients with upper gastrointestinal diseases before and after Helicobacter pylori eradication

OBJECTIVE: To investigate the influence of VacA activity on gastric mucosa prior to and after Helicobacter pylori eradication in Chinese patients with peptic ulcers and chronic gastritis. METHODS: Seventy‐four dyspeptic patients with H. pylori infection were enrolled. The status of H. pylori infection was evaluated by culture and histo­pathology before and 4?6 weeks after H. pylori eradication therapy. Histological specimens were examined and graded semiquantitatively according to the updated Sydney classification. RESULTS: Helicobacter pylori with VacA was found in 59 of 74 patients (80%), and its prevalence in patients with peptic ulcers and chronic gastritis was similar. Helicobacter pylori eradication rates in patients with VacA⁺ and VacA^? strains were similar. Before eradication, the degrees of acute or chronic inflammation, epithelial damage, atrophy, intestinal metaplasia (IM) and the number of lymphoid follicles were similar in patients with VacA⁺ and VacA^?H. pylori. Four to 6 weeks after the eradication of H. pylori infection, the degrees of acute and chronic inflammation, and epithelial damage in the antrum decreased significantly, particularly in patients with VacA⁺H. pylori (P < 0.0001). The number of lymphoid follicles in the antrum also decreased more in patients with VacA⁺H. pylori than in those with VacA^?H. pylori (P= 0.051). However, there was no difference in the extent of atrophy and IM between these two groups. CONCLUSIONS: There is no specific correlation between VacA⁺/VacA^?H. pylori strains and mucosal clinicopathological features in Chinese patients with upper gastrointestinal diseases before and after eradication therapy. Successful eradication of H. pylori infection does not improve atrophic and IM lesions of the gastric mucosa.     

胆汁反流性胃炎治疗前后胃电节律的变化

目的探讨胆汁反流性胃炎治疗前后胃电节律的变化。方法胃镜下诊断为胆汁反流性胃炎患者37例,健康志愿者20例被纳入研究。患者给予相同口服药物治疗7 d,并在治疗前1天,治疗后第14天分别行胃电图检查1次,健康志愿者则予胃电图检查1次。治疗前,所有患者按照症状程度差异分为轻、中、重3组,治疗后分为无症状、轻、中、重4组。比较健康志愿者、治疗前及治疗后患者的胃电图参数改变。结果与健康志愿者相比,治疗前、后BRG胃电过速增加、主功率增幅降低。治疗前后的BRG轻、中、重度间比较,其胃电过速、胃电过缓、主功率增幅均无差异。但治疗后无症状者与治疗后轻、中、重组之间比较,胃电过速降低、主功率增幅增加。结论胆汁反流性胃炎存在异常胃电活动。胃电过速减低、主功率增幅增加可能与治疗后症状改善有关。