Dopamine levels in the gastric and duodenal mucosa, blood and urine in patients with duodenal ulcer

A study was made of the dopamine (DA) level in the gastric and duodenal mucosa, blood and urine of 54 patients with duodenal ulcer and 19 healthy persons. An increase in the DA level in the duodenal mucosa, blood and urine during exacerbation of disease was noted. The DA level in the gastric mucosa was normal. Reverse correlation between the DA content in the gastric mucosa and blood, on the one hand, and criteria of acid production, on the other hand, was established. An increase in the activity of chromaffin cells was interpreted as a compensatory reaction ensuring the reduction of catecholamine metabolism, a decrease in gastric secretion, a rise of the rates of reparative regeneration in the duodenal mucosa.     

The influence of antisecretory agents on the antral gastric mucosa in patients with duodenal ulcer

Changes in the antral gastric mucosa of patients with doudenal ulcer after a long-term administration of antisecretory agents were studied. The subjects were five patients with a different duration of the disease. The methods applied included light and electron microscopy of tissue samplings taken from the antral part of the stomach during the periods of exacerbation and remission. In addition to well-known morphological changes, cellular principalis not typical of antral gastric mucosa were found in one patient during exacerbation and remission periods.     

The prognostic value of gastric metaplasia in the duodenal mucosa in patients with Helicobacter pylori positive duodenal bulb ulcer

The predictive value of gastric metaplasia in the duodenal mucosa in patients Helicobacter pylori-positive patients with duodenal bulb ulcer (DBU) was investigated. One hundred and twenty four randomly selected patients with DBU were included in this prospective study. The detection of Helicobacter pylori (HP) in the stomach and duodenum was carried out with Giemsa (using standard visual analogue scale), rapid urease test (standard Jatrox-HP test, Rohm Pharma, Germany), and polymerase chain reaction (PCR) to detect the specific fragment of ureC HP gene (Helicopol II, Lytech, Russia). Regions of gastric metaplasia of the duodenum were confirmed by periodic acid-Schiff and alcian blue (Serva) staining (pH 1.0; 2.5) Duodenal ulcer (DU) complications were registered within 8 to 10 years. Estimation of the predictive factor (gastric metaplasia in the duodenum) was carried out in patients with non-complicated DU (Group 1; n = 73), and with such complications as bleeding, perforation, penetration, pyloroduodenal stenosis (Group 2; n = 51) which were revealed within the 8 to 10 years of observation. Gastric metaplasia in the duodenum was found in 64 or 87.7% of the 73 patients with non-complicated DU and in 5 or 9.8% of the 51 patients with complicated DU within 8 to 10 years of observation. The following facts about the predictive factor for the prognosis of DU complication were found: the sensitivity of 83.6%, the specificity of 92.8%, the predictive accuracy of 88.7%, the relative risk of the predicted outcome of 7.5, the relative risk of a different outcome of 0.11, the odds ration of 65.4. The study revealed a high and significant (p < 0.001) predictive value of gastric metaplasia in the duodenum as a marker of non-complicated clinical course of DU in HP-positive patients within an 8 to 10-year period.     

Low-intensity laser treatment of patients with duodenal ulcer and erosive lesions of gastric and duodenal mucosa

Ninety-eight patients were exposed to low-energy laser irradiation. Of these 52 and 31 had duodenal ulcer in aggravation phase with mucosal erosion and without it, respectively, 15 patients developed isolated erosive lesions of gastroduodenal mucosa. The energy was delivered to the target cites optically using fiber optics endoscope. Microcirculation was studied by bulbar biomicroscopy. Therapeutic response in the laser utilization proved positive being the highest for patients with a short disease history, moderate signs, small-size lesions. Normal microcirculation was not achieved though there was a trend to its improvement.     

Plasma fibronectin in gastric and duodenal ulcer

Solid phase enzyme immunoassay was made to measure fibronectin in blood plasma of 132 patients with ulcer and healthy controls. Exacerbations of ulcer occurred in a significant lowering of fibronectin concentration which tended to an increase with ulcer healing. In the scarring phase fibronectin levels returned to normal. A local stimulating action of a plasma fibronectin preparation on scarring of the ulcer defect is validated.     

Pathogenesis of gastric and duodenal ulcer in the elderly

In the elderly, H. pylori infection and nonsteroidal anti-inflammatory drug(NSAID) use are most important risk factors for peptic ulcer disease. It is now recognized that, in patients with H. pylori infection, nonatrophic antral-predominant gastritis results in increased acid secretion, which is seen in duodenal ulcer patients, whereas corpus-predominant gastritis and pangastritis result in decreased acid secretion, that are seen in patients with proximal gastric ulcer and gastric cancer. These physiological changes are considered to be related to disease outcome. On the other hand, NSAIDs induced gastrointestinal toxicity is primarily due to the inhibition of mucosal prostaglandin synthesis in the gastric mucosa, which subsequently impairs the gastric cytoprotective factors. These two factors may independently, or even synergistically, cause the development of peptic ulcer disease in the elderly.     

Interrelationship between gastric acidity and gastrin concentration in patients with duodenal or gastric ulcer and in healthy subjects

Although increased gastric acidity may be important in the pathogenesis of duodenal ulcer, it has a less well-defined role in the formation of gastric ulcers. The present study was undertaken to determine (1) the 24-hour intragastric pH and serum gastrin profiles of 31 patients with duodenal ulcers, eight patients with gastric ulcers, and seven healthy volunteers and (2) the effect of 600 mg of cimetidine BID on these measurements. There was considerable overlap of basal acid output values in the three groups, and mean values did not differ significantly. In response to pentagastrin, the peak acid output was significantly higher in the duodenal ulcer group than in the gastric ulcer or healthy group. There were no intergroup differences in intragastric hydrogen ion (H+) activity after meals, overnight, and over 24 hours, when all subjects received placebo. However, the pH values remained at or above 4.0 for a longer period during the night in the gastric ulcer patients than in the duodenal ulcer patients or healthy subjects. There were no intergroup differences in basal gastrin concentration, but the postprandial gastrin response after each meal was higher in the gastric ulcer group than in the other two groups. In the gastric ulcer group, cimetidine suppressed H+ activity at all times; in the duodenal ulcer and healthy groups, cimetidine suppressed H+ activity only after breakfast, overnight, and over 24 hours. Cimetidine enhanced the serum gastrin response to food to a greater extent in the ulcer patients than in the healthy subjects. In the healthy subjects, the ratio of H+ to gastrin (H+:G) was higher than in the duodenal or gastric ulcer patients but was suppressed only minimally by cimetidine, whereas cimetidine markedly suppressed the H+:G ratio in both groups of ulcer patients. Patients with a history of duodenal or gastric ulcers differed from healthy volunteers in their food-stimulated gastrin response and in their H+:G ratio when treated with cimetidine. Intergroup differences in gastrin response to food, but not in intragastric pH in response to food, suggests that defective control of or response to gastrin may be important in the pathogenesis of acid-peptic disease. Cimetidine, which was effective in H+ suppression in all subject groups, may alter the sensitivity of the parietal cells to gastrin in patients with duodenal or gastric ulcers.     

Relationship between duodenal ulcer recurrence rate and the degree of gastric mucosa contamination rate with Helicobacter pylori

Recurrence rate of duodenal ulcer (DU) within one and two years after treatment was studied in 42 DU patients with incomplete eradication of Helicobacter pylori (HP) and 16 DU patients with its complete eradication. It is shown that DU recurrence rate after the treatment depends on the degree of gastric mucosa contamination with HP. The risk of the DU recurrence is much higher in moderate and high contamination with HP.